1000

Volume 5, Number 2, Section 3

I. Ethnicity and body composition, plenary lectures (continued)

Body mass index as predictor for body fat: comparison between Chinese and Dutch Adult subjects

Deurenberg P, Ge K, Hautvast JGAJ, Wang J

Asia Pacific Journal of Clinical Nutrition (1996) Volume 5, Number 2: 119

The relation between body mass index (kg/m²) and body fat from body density (determined by the underwater weighing technique)was compared in a group of Chinese and Dutch healthy subjects in relation to sex and age. The Dutch group was selected in relation to the Chinese group in that age, weight, height and body mass index did not exceed the maximal observed values of the Chinese subjects. Mean weight, height and body mass index was higher in the Dutch group, but body fat from density did not differ between the groups. Body fat predicted from body mass index, age and sex did not differ from the value obtained by densitometry in both countries. The correlation between measured body fat and predicted body fat was 0.84 (p < 0.001) in the Chinese and 0.90 (p < 0.001) in the Dutch. The difference between measured and predicted body fat was related to the level of body fatness (r = 0.55, p < 0.001), but did not differ between the countries. In different age groups there were slight differences in the measured minus predicted values of the countries, but these differences lessened after correcting for differences in the level of body fatness in each age group. It is concluded that the relation between body fatness and body mass index is not different between the two studied populations.

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Body fatness in Chinese in Southern China and Melbourne

Mai J, Hsu-Hage BH-H, Rao X, Wahlqvist ML, Li Y, Liu X, Zhang K

Asia Pacific Journal of Clinical Nutrition (1996) Volume 5, Number 2: 119

Epidemiological studies have shown consistently that body fatness is positively related to the occurrence of CVD disease, CVD and total mortality, particularly in the affluent populations. Body fatness has emerged as important predictors for most of the CVD risk factors in a study of Melbourne Chinese. We present here the body fatness distribution and its socio-demographic determinants in four Chinese populations, of which the relative affluent Melbourne Chinese will be compared.

We examined 1474 adult Chinese (835 men and 638 women) representatively sampled from Melbourne, Australia (271 men and 269 women), and three counties in Guangdong Province of the People's Republic of China (Chauzhou-202 men and 111 women; Meixian-169 men and 140 women; Xinhui-192 men and 118 women). A standard protocol was used to measure body weight and height, the waist circumference at the level of umbilicus and the maximal hip diameter. Body mass index (BMI) was calculated and t 1000 he Bray's classification for underweight, acceptable weight, overweight or obese was used to describe total body fatness. Waist-to-hip ratio (WHR) was used to asses abdominal body fatness. The questionnaire was adopted from the NHF national survey. Subjects also received a standard CVD risk factor assessment.

In all four populations, BMI is highly and positively associated with WHR. Melbourne Chinese men had a mean WHR higher than that of all three populations in China; no significant differences were found among the three male populations in China. For women, Melbourne Chinese had a higher mean WHR than the Chauzhou in China; again no significant differences were found among the three female populations in China. There was no significant difference in BMI among the four male populations. Melbourne Chinese women, however, had a mean BMI higher than that of their Chauzhou and Meixian counterparts; no significant differences were found among the three female populations in China. These results were age, education level and occupational status adjusted.

Our data indicate that Chinese women living in Melbourne had a relatively higher body fatness compared to their counterparts in China and that overweight, an indicator of increased total body fatness (BMI), is more prevalent in a population living in a relatively affluent society. In Chinese populations where the prevalence of obesity is almost zero, individual differences in abdominal fatness, attributable to age, education level or occupational status, appear to have a greater importance than differences in the population mean. Affluence, insofar as the non-obese Chinese population is concerned, probably has as much, if not more impact on body fat distribution as on total body fatness.

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Total body protein change in growth hormone deficient (GHD) adults on recombinant human growth hormone

Xiong DW, Borovnicar DJ, Stroud DB, Strauss BJG, Wahlqvist ML

Asia Pacific Journal of Clinical Nutrition (1996) Volume 5, Number 2: 120

Objectives. The study aim was to assess whether total body protein is reduced in adults with growth hormone deficiency (GHD) and to study the effect of growth hormone (GH) therapy using a recombinant product known as genotropin on total body protein (TBP) in GHD adults.

Design. The study was divided into two parts: Part I was of double-blind, parallel design with patients randomised to receive either genotropin or placebo for 6 months. Part II was an open treatment with genotropin in all patients for a further 6 months.

Patients GH adults, which were defined as isolated or part-of-hypopituitarism, aged 18-64 years, male (n = 34) and females (n = 23) were included in this study. Seventy-five healthy controls, matched for age, height and weight, were also included in this study.

Method. Total body nitrogen (TBN) was measured by in vivo neutron activation analysis (IVNAA) at baseline, 6 and 12 months. Measurements of TBN were standardised for age, sex and height by calculation of a nitrogen index (NI).

Results. GHD adults and healthy controls, both males and females, did not differ in age (40.2 vs 40.6y), weight (76.8 vs 80.7kg) or height (176.2 vs 172.4mm), but mean body mass index (BMI) of male patients was significantly greater than that of male healthy controls (24.6 vs 27, P < 0.05).

GHD adults did not have a depleted TBP compared to 1000 healthy controls (11.3 vs 12.2 kg in males, 7.5 vs 7.9 kg in females); NI also did not differ between GHD adults and healthy controls (0.98 vs 1.01 in males, 0.93 vs 1.00 in females).

At the end of 6 months, the group receiving GH therapy exhibited a trend towards an increase in TBN [mean SEM: 1.65 0.08 kg (baseline) vs 1.70 0.09 kg (6 months), p = 0.05] and a significant increase in NI [0.94 0.03 (baseline) vs 0.99 0.03 (6 months), P < 0.05]. The placebo group demonstrated no significant change in either TBN or NI.

At the end of 12 months, the group receiving GH therapy for twelve months demonstrated a significant increase in both TBN [1.65 0.08 kg (baseline) vs 1.77 0.09 kg (12 months) p < 0.01] and NI [0.94 0.03 (baseline) vs 1.01 0.03 (12 months), p < 0.05]. The group receiving GH therapy for only 6 months also exhibited a trend towards an increase in TBN [1.46 0.08 kg (baseline) vs 1.52 0.08 kg (12 months), p = 0.05] and a significant increase in NI [0.96 0.03 (baseline) vs 1.01 0.03 (12 months), p < 0.05].

Conclusion. In this study, TBP in GHD adults was comparable to normal values. After GH treatment, TBP increased significantly, suggesting that long-term GH therapy impacts favourably on TBP stores in GHD adults.

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The relation of middle-aged cadres' body fat content to lipidaemia, blood pressure and other disorders

Li Q, Gu J, Yang Z, Li H, Hao F, Zhao J, Wang Y

Asia Pacific Journal of Clinical Nutrition (1996) Volume 5, Number 2: 120

The body fat content (%BF) of middle-aged cadres, obesity prevalence and the relation of %BF with blood lipids and some diseases has been assessed. The BFA-100 body fat analyser was used to measure %BF; the principle of this instrument is bioelectric impedance. Male %BF > 25.0 and female %BF > 30.0 were regarded as obese. Cadres (n = 320) aged 3559 years were measured: males (n = 169) were aged 47.9 7.1, females (n = 151) were aged 50.3 7.7. The %BF of males and females were 23.4 8.7 and 35.0 6.6 respectively, using BF criteria. The obesity prevalences for males and females were 43.8% and 75.5% respectively. Blood lipids and blood pressure (BP) were measured in males and the disorders of hyperlipaemia, hypertension, coronary heart disease, hepar adiposum (fatty liver), diabetes, cholecystitis and cerebral infarction documented. The results showed that % BF was positively correlated with Apo-B (the marker opoprotein of low density lipoprotein and BP, and negatively correlated with Apo-A1 (the marker opoprotein for high density lipoprotein). There were differences in triglycerides, Apo-A1, Apo-B and BP between obese and less fat people, but there was no difference in total cholesterol between the two groups, except with cholecystitis. The rate of all documented disorders was higher in obese people than in those with a lesser %BF. Thus, in Beijing Chinese the measurement of BF has useful predictive value for disorders of increasing prevalence.

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Multi-frequency measurements of bioimpedance are more effective than single-frequency measurements

Stroud DB, Borovnicar DJ, Xiong DW

Asia Pacific Journal of Clinical Nutrition (1996) Volume 5, Number 2: 120-121

Single frequency measurements of bioresistance at 50 kHz, R₅₀, are used extensively for estimating Total Body Water (TBW) in human subjects employing the known correlation between TBW and H²/R5 1000 0, where H is height. Equipment suitable for routine measurements of bioimpedance at multiple-frequencies has not been available until quite recently and it is now possible to easily determine Fc, the characteristic frequency, and Rc, the resistance at Fc.

The Cole-Cole theory makes several predictions. One is that measurements at multiple frequencies will lie on a semi-circle when plotted as reactance versus resistance; this was demonstrated experimentally by Settle^l et al in 1980 and confirmed again in more recent work². The theory defines the quantities R₀ and R, the resistance at zero and at infinite frequency respectively. The theory predicts two correlations, one between Extra-Cellular Water (ECV) and H²/R₀, the other between TBW and H²/R. It is difficult to convincingly demonstrate these correlations in normal subjects, but there are several papers that have now found these correlations³.

A lesser known prediction of the theory⁴ is that the correlation between TBW and H²/Rc is better than the correlation between TBW and H²/R₅₀. This prediction can be explained as follows. The theory predicts that at Fc the measured resistance, Rc = ½ (R₀ + R). Since R₀ and R are proportional to ECV and TBW, the same combination of water volumes is measured for every subject. However, R₅₀ = Rc + , where is a quantity that varies between subjects. Hence, at 50 kHz a different combination of water spaces is measured for each subject. Bioimpedance data from human subjects has been analysed to estimate the standard deviation of . This value implies that the SEE from correlations between TBW and H²/Rc will up to 1% better than the SEE for TBW and H2/R50, which is typically 3 - 6%³. This is consistent with the improvement reported by Cornish et al⁴ who measured bioimpedance and D₂O dilution data in rats.

References

1. RG Settle, KR Foster, BR Epstein & JL Mullen, Nutritional assessment: whole body impedance and body fluid compartments, Nutrition and Cancer, 1980,2,72 - 80.
2. DB Stroud, BH Cornish, BJ Thomas & LC Ward, The use of Cole-Cole plots to compare two multi-frequency bio-impedance instruments, Eur J Clin Nutr (in press).
3. WD van Marken Lichtenbelt, KL Westerterp, L Wouters & SC MLuijendijk, Validation of bioelectrical-impedance measurements as a method to estimate body-water compartments, Am J Clin Nutr, 1994, 60, 159 - 166.
4. BH Cornish, BJ Thomas & LC Ward, Improved prediction of extracellular and total body water using impedance loci generated by multiple frequency bioelectrical impedance analysis, Phys Med Biol, 1993, 38, 337 - 346.

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Multi-frequency bioelectrical impedance for the prediction of total body water and extracellular water: validation in four different (ethnic) groups

Deurenberg P, Tagliabue A, Wang J, Wolde-Gebriel Z

Asia Pacific Journal of Clinical Nutrition (1996) Volume 5, Number 2: 121

Multi-frequency bioelectrical impedance (MFBIA) can be used in the assessment of body water compartments. At low frequency body impedance is related mainly to extracellular water (ECW) and at high frequency body impedance is a measure of total body water (TBW). Body weight and body he 1000 ight were measured in the fasting state in different groups of healthy adult males and females from The Netherlands, Northern Italy, Ethiopia and China. MFBIA was measured at frequencies ranging from 1 kHz to 100 kHz. TBW and ECW were determined by dilution techniques with deuterium oxide and bromide respectively. The relation between TBW and ECW as measured by dilution technique and impedance index (height²/impedance) at low and high frequency was not different between the four populations. When a prediction formula for TBW and ECW from impedance index, developed in another (Dutch) population was applied to the four groups, the differences in predicted and measured TBW and ECW were only small and not significant between the populations.

The residuals (measured minus predicted values) for TBW and ECW were correlated with TBW/height (r = 0.29, p < 0.01) and ECW/height (r = 0.48, p < 0.01) respectively, parameters that can be regarded as crude measures of body build.

It is concluded that MFBIA is an appropriate technique to predict body water compartments. Difference between (ethnic) groups can be partly attributed to differences in body build.

	Ethiopia	China	Italy	Netherlands
Age (years)	34.2 (6.3)	31.5 (6.4)	22.0 (2.0)	31.4 (4.5)
Weight (kg)	56.4 (10.1)	58.3 (10.2)	64.6 (11.1)	74.4 (13.5)
Height (cm)	163 (9)	165 (7)	170 (10)	176 (10)
BMI(kg/m2)	21.3 (3.4)	21.3 (2.6)	22.2 (2.5)	24.1 (4.8)
TBW (kg)	26.9 (5.2)	34.7 (5.9)	35.6 (7.4)	39.7 (7.0)
ECW (kg)	11.7 (1.6)	13.9 (2.3)	14.1 (2.5)	16.2 (2.4)
TBW (kg)	0.5 (1.7)	0.3 (2.0)	0.1 (2.2)	0.6 (2.2)
ECW (kg)	1.0 (1.0)	0.9 (1.3	1.1 (0.9)	0.3 (0.9)

BMI: body mass index; TBW: measured minus predicted TBW; ECW: measure 1000 d minus predicted ECW.

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An improved water displacement method (IWDM) for body measurement and its application

Yang Q-H, Zhang H-Z

Asia Pacific Journal of Clinical Nutrition (1996) Volume 5, Number 2: 121

In order to solve the problem of estimating body fat content of obese people and increase the measurement accuracy for body fat, an improved water displacement method (IWDM) was established. A highly sensitive human body volumeter added to a breath oxygen procedure, are the main features of the IWDM. The standard deviation of a single observation of body fat by IWDM is 0.1 kg, which is lower than the 0.36 kg for the ordinary water displacement method. The body fat content of 20 children aged nine, 73 obese outpatients and 51 controls were estimated by IWDM successfully. The body fat content of the male and female obese groups was 27.7 5.0 (19.7 40.0)% and 38.7 5.9 (27.5 49.2)%, respectively. The body fat contents of a male non-obese employee group, a male weight lifter group and a female swimming group were 16.4 3.8%, 10.8 4.8% and 17.2 2.7%, respectively. IWDM should reduce the measurement error of body fat and expand the applicable range of the "Density Method".

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Body composition and physical activity of institutionalised elderly Indonesians with chronic energy deficiency

Iswarawanti DW, Schultink JW, Rumawas JSP, Lukito W

Asia Pacific Journal of Clinical Nutrition (1996) Volume 5, Number 2: 122

The body composition and physical activity of elderly individuals were studied. Forty elderly subjects were divided into two groups according to their body mass indices (BMI). One group (n = 20) had BMI < 17 kg/m² (low BMI) and regarded as in a chronic energy deficiency (CED) state (Grade II CED by WHO criteria, above 17 to 18.5 is Grade I), and the other group (n = 20) had BMI values between 22 to 25 kg/m². Body composition was measured using skinfold thickness and bioelectrical impedance analysis (BIA). The Durnin and Womersley table was used to estimate fat mass (FM) from the sum of four skinfold thicknesses, namely biceps, triceps, subscapular and suprailiac. For BIA, two formulae were adopted to calculate fat free mass (FFM); they were the Lukaski and Deurenberg equations. Results obtained from these three formulae were compared. Physical activity level (PAL) was estimated on the basis of recorded daily physical activity patterns, and calculation of energy expenditure was based on values reported by FAO/WHO/UNU.

The Durnin and Womersley formula provided the highest value for FM. In elderly subjects with CED, FM calculated by the Lukaski equation was 4.2 1.2 kg (when height was used as denominator) and 3.7 2.9 kg (when armspan was used as denominator), higher than that by the Deurenberg equation. This was not so in the elderly subjects with a normal BMI. FM values derived from the Lukaski equation approximated those derived from the Durnin and Womersley equation. The discrepancy between the Lukaski and Deurenberg equations was less with an increase in FM.

Both groups had a similar PAL [1.3 x basal metabolic rate (BMR)]. Elderly subjects with CED had the same level of activity of daily living (ADL) as those with normal BMI. Although appropriate formulae to calculate FM in elderly Indonesians are not available, these findings suggest that the Lukaski equation is an acceptable formula to do this. The cut-off point to define CED pro 1000 posed by James and colleague is not sensitive enough to detect perturbations in ADL of elderly Indonesians.

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The agreement of three different methods in the estimation of percent total body fat

Wattanapenpaiboon N, Lukito W, Strauss BJG, Hsu-Hage BH-H, Wahlqvist ML

Asia Pacific Journal of Clinical Nutrition (1996) Volume 5, Number 2: 122

Percent total body fat (%BF) assessed by three different methods was compared in a representative population of apparently healthy Anglo-Celtic Australians. Four-skinfold thickness measurement (SKF) and single-frequency bioelectrical impedance analysis (BIA) were performed on a total of 477 subjects (211 men and 266 women), aged 26-84 years. %BF estimated by SKF was derived from Durnin and Wormersley's table, and Lukaski's formula was used to calculate %BF estimated by BIA. Dual energy X-ray absorptiometry (DEXA) using Lunar DPX densitometer was performed in a subsample of 68 men and 137 women.

There were significant differences between %BF estimated by BIA and DEXA or SKF. Mean differences between %BF estimated by DEXA and BIA (DEXABIA) were 3.7 5.6% in men and 7.8 6.0% in women, while those between SKF and BIA (SKF-BIA) were 3.9 5.5% in men and 4.3 5.2% in women. A significant difference between %BF estimated by DEXA and SKF (DEXA-SKF, 3.1 5.6%) was also found in women, but not in men. In addition, there was a reduction in the agreement between %BF estimated by DEXA and SKF with increasing %BF averaged of the two methods. Similar observations were also made between BIA and DEXA, and between BIA and SKF only in women, not in men. In contrast, the agreement between BIA and SKF in %BF estimation in men was improved with increasing %BF.

In conclusion, significant differences in %BF estimated by BIA, DEXA and SKF were observed in the present study. Those differences, in most cases, were not independent of body fatness. Gender differences observed in the agreement between methods may be due to differences in body fat distribution between men and women. This may result from the differential capability of methods to estimate body fat at different sites such as subcutaneous and abdominal fat. Results of this study indicate the need to identify a reference method for %BF estimation, which would be required for comparisons between populations.

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Comparison of D₂O with various methods for measuring total body water in growth hormone deficient adults

Xiong DW, Borovnicar DJ, Bainbridge R, Stroud DB, Wahlqvist ML, Strauss BJG

Asia Pacific Journal of Clinical Nutrition (1996) Volume 5, Number 2: 122-123

Objective. The study aim was to compare different methods of assessing TBW in growth hormone deficient (GHD) adults with the reference method of deuterium oxide (D₂O) dilutometry.

Design. TBW in GHD adults was estimated by three different methods and compared with the reference method of D₂O dilutometry.

Patients. GHD adults, males (n = 34) and females (n = 23) with either isolated or partial of hypopituitarism, aged 1864 years, were included in this study.

Measurements. TBW has been determined from:

• Deuterium oxide dilution, the D₂O concentration was measured using a Fourier Transfer Infrared (FTIR) spectrometer.
• Resistance (R) was obtained using a BEI-10lA body composition analyser (RJL-Systems Inc, Detroit, MI, USA). TBW was calculated using the manufacturers software (Bodycomp II, version 1.1; RJL System Inc) and the regression equations of Kushner and Lukaski relating TBW estimated by D₂O dilution and [height(cm)]²/R as estimated by single frequency bioelectrical impedance analysis (BIA) in normal healthy adults.
• The sum of extracellular water (ECW) determined from in vivo neutron activation analysis (IVNAA) and intracellular water (ICW) determined from total body potassium (TBK) as measured by potassium 40 counting.
• Fat free mass (FFM) multiplied by 0.73 where FFM was determined as body weight less fat mass (FM) as estimated from skinfold thickness (SF) measurements.

Results. BIA (RJL, Kushner and Lukaski) estimates of TBW were strongly correlated and in agreement with the dilutometric reference method [RJL: r² = 0.91 (P 0.001); bias -0.8 L with 95% CI of +0.2 to -1.8L; limit of agreement 6L. Kushner: r² = 0.89 (P < 0.001); bias -0.2L with 95% CI of +0.9 to -1.4L; limit of agreement 7L. Lukaski: r² = 0.89 (P < 0.001 ); bias +1.2L with 95% CI of +1.3 to -0.2L; limit of agreement 7.5L].

Estimate of TBW as (ECW + ICW) was correlated and agreed with the D₂O dilution method [r² = 0.84 (p < 0.001 ); bias -1.0L with 95% CI of +0.2 to -2.2L, limit of agreement +7.9 to 9.8L]. SF estimates of TBW were strongly correlated with the D₂O reference method (r² = 0.89, P < 0.001), and were significantly biased (bias -2.3L with 95% CI of -1.2 to -3.3L, limit of agreement +4.6 to -9.1L).

Conclusion. The BIA is the most appropriate clinical method of assessing TBW in GHD adults.

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A simple water displacement method of measuring the change of body fat and water during bed rest

Yang Q-H, Duan B-Z

Asia Pacific Journal of Clinical Nutrition (1996) Volume 5, Number 2: 123

The simple water displacement method (SWDM) of measuring the change of body fat means the F = C₁ (Vt₁ Vt₂) C₂ (M₁ M₂) formula, where F is the change of body fat, Vt₁, Vt₂ and M₁, M₂ represent total human body volume and body weight before and after the experiment respectively. Five male adults were studied in continuous bed rest for 16 days. During bed rest the energy intake of the subjects was 2913 100 (27923014) kcal/d, the increase of body fat estimated by the ordinary water displacement method (OWDM) and SWDM was 1.20 0.92 (0.022.42) kg and 1.28 0.38 (1.011.93) kg respectively. With the "Energy Requirement = Total Metabolic Energy 12875 x Increase of Body Fat + 5650 x Decrease of Body Protein" formula, the range of energy requirement calculated using the data estimated by OWDM and SWDM was 7712788 kcal/d (17.047.9 kcal/d/kgLBM) and 11651992 kcal/d (25.734.2 kcal/d/kgLBM) respectively. Sixteen days of bed rest were divided into 4 per 1000 iods equally. With the "Body Water = Body Weight Body Protein - Body Fat" formula, the body water loss of the successive I, II, III and IV periods calculated by SWDM was 0.62 0.35L, 0.22 0.18L, 0.23 0.16L and 0.06 0.30L respectively.

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The adequacy of predicted body fat percent in Chinese children with Caucasian prediction formulas

Wang J, Deurenberg P

Asia Pacific Journal of Clinical Nutrition (1996) Volume 5, Number 2: 123

Body composition was measured by underwater weighing and by anthropometry and bio-electrical impedance in 165 Chinese boys and 150 Chinese girls, aged 7 to 17 years and living in Beijing. Until age 12 years there were no differences in body weight, body height and body mass index (kg/m²) between boys and girls, but body fat from density was slightly higher in girls. After age 12, boys had higher body weights, body heights and body mass index, but lower body fat as calculated from body density.

Predicted body fat from body mass index, body impedance and skinfold thickness was generally slightly lower compared to body fat from body density, except for body fat from impedance, which was both in boys and in girls slightly higher compared to body fat from body density. However, the mean differences were small and maximally reached 2.7% body fat in boys (impedance) and 1.7% in girls (skinfolds). The standard deviations of the differences were within the estimation error of the used methodology and comparable with values obtained in other studies. The differences between measured and predicted values were slightly higher in the youngest and the oldest children, probably indicating invalid assumptions in the used methodologies at these ages. At the lower level of body fatness all prediction formulas systematically overestimated body fat, and at higher fat levels body fat was systematically underestimated.

It is concluded that prediction formulas developed in Caucasian subjects are generally valid in Chinese children. However, in countries with a high prevalence of low weight (low body fat) children, there may be a need for specific prediction formulas for body composition for the low body weight group.

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Body fat measurement and obesity analysis of old people with different rest style in two places

Li Q, Gu J, Yang Z, Zhao J, Hao F, Liu W, Cao C, Wang Y

Asia Pacific Journal of Clinical Nutrition (1996) Volume 5, Number 2: 123-124

The author observed and compared body fat content, body fat distribution, energy intake and the prevalence of high energy intake and obesity of 83 retired cadres in rest agencies (45 males, aged 67.4 4.2 y; 38 females, aged 64.3 3.8 y), and 47 old people in the old flats (32 males, aged 69.8 9.3 y; 15 females, aged 72.0 11.4 y). Weight, waist-hip circumference, body fat content, energy intake and prevalence of high energy intake and obesity of subjects in rest agencies were higher than those in old flats. The authors considered that a high energy intake was the main cause of the higher body fat content and prevalence of obesity in the retired cadres. The authors advised that a low-calorie diet was an effective method to reduce body fat and obesity prevalence. In this study the significance of circumference measurement in the trunk area to assess body fat content, body fat distribution and changes of body fat content was discussed.

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