Using DXA, weight change consisted of a loss ( 47.4%),
and a gain in FM
(þ63.0%). When using MRI, weight change
consisted of a loss ( 66.0%) and a gain in AT
These results suggest that there may be a regional redistribution
of fat and lean mass with weight loss and weight regain. However,
future research needs to be done using an intra-individual study
design. Because AT does not resemble FM and LST is higher than
SM (due to connective tissue and organ mass) absolute
differences in the composition of weight loss and weight gain
between both methods are obvious. However, this does not
explain the differences in fat and lean redistribution with weight
loss and weight gain that may partly be due to inherent
assumptions of DXA software. Taken together, data on DXA- and
MRI-derived changes in regional body composition cannot be
directly compared with each other. The limitations of the DXA
approach (and presumably the 2 component models) has to be
taken into account.
Study strengths and limitations
Some limitations to the present study should be discussed. The
number of men was small (n¼24), therefore sex differences
cannot be addressed with conﬁdence. In addition, physical activity
and ﬁtness have not been addressed which are known to have an
impact on the composition of weight change.
Since in this study
we did not assess intra-individual weight cycles, we cannot
directly compare the composition of weight loss and weight gain.
The strengths of this study is the concomitant use of a variety of
highly standardized body composition techniques including a
4C-model as a gold standard that avoids the assumptions of
different 2C-methods that may be violated during unstable
conditions of weight loss and weight gain. It should be
mentioned that 4C is balancing of the three measurements,
with amended measurement errors from all of them. In addition,
imaging technology allowed the evaluation of regional changes in
body composition with weight loss and weight gain.
When compared with the 4C model ( ¼gold standard), mean bias of
O and densitometry methods is explained by the erroneous
assumption of a constant hydration of FFM. This assumption leads to
an underestimation of FM change measured by D
overestimation of FM change measured by densitometry. Because
hydration does not normalize after weight loss we can deduce that
all 2C-models that are based on the assumption of a constant
hydration of FFM have a systematic error in weight reduced subjects.
The bias between 4C-model and DXA was mainly explained by FM%
at baseline whereas the change in FFM hydration only contributed to
additional 5% of the bias. As to the regional changes in body
composition, MRI data cannot be replaced by DXA measurements.
CONFLICT OF INTEREST
The authors declare no conﬂict of interest.
The authors wish to thank Britta Jux, Klinik fu¨ r Radiologische Diagnostik, UKSH Kiel,
for their help in MRI scanning. The study was funded by Deutsche Forschungsge-
meinschaft (DFG Mu¨ 714/ 8-3) BMBF Kompetenznetz Adipositas, Core domain ‘‘Body
¨rperzusammensetzung; FKZ 01GI1125)
The sponsor of the study (DFG, BMBF) had no role in study design, the collection,
analysis and the interpretation of the data, writing the text or in the decision to
submit the manuscript.
ABW and MJM designed and supervised the study, ABW, MP and MJM wrote the
ﬁnal version of the manuscript, MJM and ABW had primary responsibility for the
ﬁnal content of the manuscript. ABW and WL performed all the investigations. BS,
WL, MP organized the study, collected the data, did the segmentations of whole
body MRI data and performed the statistical analyses. C-CG was responsible for
DXA and MRI examinations.
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