Results Interpretation. Results Interpretation

Transcription

1 Results Interpretation Results Interpretation

2 39 Glossary Body Compositon Glossary Bioelectrical Impedance Analysis BIA (Bioelectrical Impedance Analysis) is a technique that measures body impedance, sending a low, safe electrical current through the body. The current only passes through the water fluids inside the body, and based on the impedance values obtained, the body water volume is calculated. As water fluids are usually inside muscle tissues, by using the water volume, the fat free mass (FFM) can be calculated. The best advantage of impedance is its high precision, accuracy and the non-invasive application of its method. However, the volume of body water fluctuates to sustain homeostasis in the body thus, alters each measurement. To minimize measurement errors and ensure its high accuracy, subjects must follow standard pretest guidelines under the same conditions. Impedance Impedance, denoted Z, is an expression of the opposition to alternate and/or direct electric current. This is a vector quantity consisting of a sum of electric resistance (R), inductive reactance (XL) and capacitive reactance (XC). The resistor is a device used to control the current of an electrical circuit by providing resistance. In the human body, the water volume is the resistor. Body water is composed of both intracellular and extracellular water, and both resist the current. The capacitor is an electrical element used to store charge temporarily, generally consisting of two metallic plates separated and insulated from each other by a dielectric. The resistance of a capacitor is called reactance, and in the body, the cell membrane performs this function. Simply, the human body has all the components of an electronic conductor. The impedance is expressed as a sum of the vectors: Impedance 2 = Resistance 2 + Reactance 2 8-point Tactile Electrode Method The 8-point tactile electrodes easily contact the body at 2 points in each hand and foot, 8 points in total. This method divides the body into 5 regions (left and right arm, trunk, left and right leg) with a minimal error rate, enhancing measurement reproducibility. The common method using 4 electrodes divides the body into only 2 regions (the upper and lower body) leading to over-generalized inaccurate results. The 8-point tactile electrode method measures the 5 segments of the body directly, giving pinpoint measurement of each sec-

3 Glossary 40 tion. This method minimizes the error and detects the body water content and the level of muscle development in each segment. This helps patients and athletes that need pinpoint accuracy of their muscle measurements, and is also extremely helpful in rehabilitative medicine and movement cure. There are other methods such as pincers or ECGs, but this method is far easier to use for testing. The natural placement of hands, feet and ankles yields consistent measurements, minimizing error. The 8-point tactile electrode method is classified as a tetra-polar method because it utilizes 4 electrodes at a time selected automatically by an internal microprocessor. Multi-Frequency Analysis Conventional BIA uses a single frequency and estimates the amount of intracellular water from the extracellular impedance values. Low frequency current hardly travels through the intracellular water resulting in inaccurate measurements. The proportion of intra and extracellular water is consistent in a healthy body; however, in children, elderly people, obese people and patients, their amounts may be imbalanced. Generally, extracellular water is measured by low frequency currents (lower than 50kHz), and intracellular water is measured by high frequency currents (higher than 200kHz) and it is important to know both. Multifrequency analysis utilizes a variety of frequencies from 1 khz to 1 MHz, accurately assessing body water content, the principal component in BIA. It also compares the results of the lower currents with the higher currents, and calculates water distribution in the intracellular and extracellular compartments. The body resistance increases with currents below 50 khz, and the current loss is lower with higher frequencies. This technology is utilized with great reliability and precision. Segmental Analysis Segmental measurement involves breaking down the body into 5 segments (right arm, left arm, trunk, right leg and left leg) and measuring the resistance for each segment separately. Thus, the amount of body water and fat free mass in each segment are provided. Furthermore, the analysis is highly accurate because the measured value of each part does not affect the measurements of the others. These results are not from estimation but direct measurement. Other body composition analyzers fail to measure body fat accurately and body shape cannot be determined. They use empirical references and estimated values to correct the inaccurate measurements. The InBody examines segmental development of the subject and gives exact measurements regardless of gender, age, disease and ethnicity. The trunk impedance is the most important segmental measurement of all. The trunk, because of the larger circumference, contributes the least to impedance. Its impedance

4 41 Glossary ranges from 15 to 30 depending on the physical size of the subject. Unlike in the limbs, 2-3 difference in the trunk is considered a significant error, capable of affecting the results. Therefore, the precise measurement of the trunk is the key to accurate whole body analysis. Empirical Data Empirical estimation refers to the application of variables estimated from innumerous personal information inputted, such as gender or age, and from some general assumptions, like that athletes usually have more muscle than general people. For example, body fat mass of females can be estimated based on the empirical fact that women usually have more body fat mass than men. Thus, in order to adjust inaccurate results, empirical estimations refer to those variables that may affect the results of a body composition analysis. Obesity Obesity is defined as an excessively high amount of body fat or adipose tissue in relationship to lean body mass. Until the 90 s, obesity was considered just one factor leading to disease, but the WHO defined obesity as a disease in itself, requiring necessary control and treatment. Now, obesity is one of the world s most common diseases, with several different types and treatments. Framingham s studies show that 20% more weight than the standard level increases the risk of health injury, and 120% more weight is medically termed obese. National Institute of Health (NIH) agreed with this Methods to evaluate obesity are becoming more accurate and researchers have been utilizing many different methods to identify obesity such as body mass index (BMI), subcutaneous skin fold measurement, WHR, waist circumference, underwater weighing densitometry, etc. After 1980, with the improvement in technology, the methods diagnosing obesity improved as well. These improved methods include BIA, CT, DEXA, MRI, infrared therapy, ultrasound, and more. Muscular Obesity Muscular obesity type individuals have a high quantity of muscle compared to weight, but they also have a high quantity of body fat. This frequently appears in overweight athletes who have a lot of muscle as well as fat.

5 Glossary 42 Sarcopenic Obesity Sarcopenic obese people have a standard weight, a low BMI, but a disproportional body fat percentage. It occurs frequently in young Asian women. Despite looking thin, they have a low level of lean body mass and a high percentage of body fat. It is hard to detect this kind of obesity just by BMI or through general observations, so body composition analysis is a helpful tool to detect this state of obesity. The treatment focuses on increasing muscle content and decreasing body fat. Low fat diets and increased protein consumption are recommended in conjunction with weight training and physical activity. Intracellular Water / Extracellular Water Body Water are classified as intracellular and extracellular water. The fluid inside the cell membrane is considered intracellular water (ICW), and the extracellular Water (ECW) is the water in the space between the cells (interstitial fluid) as well as the plasma fluid. The proportion between intracellular and extracellular water balanced in healthy, normal individuals, and any disproportion is most likely caused by edema, due to an increased level of interstitial water. Total Body Water About 99% of all molecules in the body are water, about 70% of total body weight. The body water supply is responsible for and involved in nearly all metabolism, including digestion, absorption, circulation, and excretion. It also helps maintain normal body temperature and is essential for carrying waste products out of the body. Inside muscle, there is protein and water. Through body water composition, the muscle quantity can be measured. The body water is distributed throughout the different compartments in the body. Three-fifth of it is in the intracellular compartment, and another fifth is the extracellular compartment. Body Fat Body fat is the result of excess calorie intake. These calories are deposited as fat to reserve energy. Lipids yield 9 kcal of energy per gram while carbohydrates and proteins yield only 4 kcal of energy per gram. Body fat serves as a protective cushion and provides structural support to prevent injury of vital organs such as heart, liver, kidneys, and spleen. Body fat also insulates the body from heat loss and extreme temperature changes, and these deposits under the skin can be metabolized to generate heat in response to low skin temperatures. Most of the fat in food is in the form of triglyceride. Fatty acids are classified according to their degree of saturation as saturated, monounsaturated and polyunsaturated fatty acids. Because of hydrophobic property of fatty acids, they are transported through blood

6 43 Glossary as a lipoprotein. High-density lipoproteins (HDL), low-density lipoproteins (LDL) and very low-density lipoproteins (VLDL) are used as parameters to determine hyperlipidemia. Underwater weighing is considered one of the gold standards of body composition assessment. In this procedure, body density is calculated through body volume according to the Archimedes principle of displacement, which states that an object submerged in water is buoyed up by the weight of the displaced water. Once body density has been determined, one can then convert this value into a body fat percentage through calculations. In BIA method, the electric current flows through body water but not through body fat. Resistance increases with the level of fat content, and impedance values rise. Fat is the most concentrated source of energy, and excess may be harmful. Excess body fat in relation to weight is considered obesity, and its distribution or accumulation in certain parts of the body plays an important role in increasing the risk of many diseases and health conditions. Subcutaneous Fat The subcutaneous fat layer cushions the dermis from underlying tissues, such as muscle and bone. This tissue is usually composed of fat cells as well as the structures that run through it, like blood vessels, nerves, etc. There are some differences in the quantity of subcutaneous fat by gender and age. Adult females are prone to have more subcutaneous fat than juveniles when men have less than both of these groups. Fat helps maintain body temperature and store excess energy. Visceral fat and subcutaneous fat are both included in body fat, but subcutaneous fat is less of a threat for diseases. Basal Metabolic Rate Basal metabolic rate is the lowest rate of energy expenditure to sustain life. (i.e. neurotransmissions, blood circulation, respiration, digestion, body temperature maintenance, and other cellular functions.) It is measured at rest (but not asleep) for minimum 12 hours within a thermally neutral body. This rate is directly related to lean body mass. Therefore, even with the same weight, individuals with less body fat and more muscle have a higher basal metabolic rate. There are three methods to expend energy: basal metabolism, the thermic effect of food and activity. Energy expenditure by food consumption depends on digestion, distribution after absorption, and storage and this method of expenditure cannot be increased. In order to lose weight, it is necessary to increase basal metabolism or/and activity, and appropriate exercises are recommended to increase muscle quantity and basal metabolism and to avoid the repercussions of extreme dieting.

7 Glossary 44 Balance between the Upper and Lower Body The InBody measures Impedance Index in four limbs and a trunk separately. Healthy individuals who exercise regularly have a well-balanced upper and lower body. Bodies that are imbalanced are correlated with disease and lack of exercise. Many middle-aged men have a weak and unbalanced lower body. On the other hands, young women and children show an insufficiency of muscle in their arms. A lack of exercise utilizing certain parts of the body causes imbalances in the muscle development. Physical activity Weight training increases both muscle content and strength. This type of exercise is called anaerobic exercise and does not utilize oxygen for energy. Muscle stimulation facilitates blood circulation and increase muscle fibers. Activities must start with the bigger muscles and then utilize the smaller ones. For beginners, three sets of each exercise are recommended. One set of exercise is times of repeated movement. Breathing is very important when doing physical activities; inhale with muscle tension, and exhale with muscle relaxation. Always breathe! In order to decrease injury and muscle fatigue by lactate accumulation, each exercise session should begin with a warm-up of aerobic exercise. Examples of weight-training exercises include dumbbells, push-ups, curl-ups or use of equipment such as shoulder press and the leg curl machine. Importance of physical activity 1. 90% of the body s energy is consumed by muscle, making muscle the principal fat burner. Therefore, development of muscle and bone by physical activity increases the body s caloric consumption. 2. Steady physical activity maintains skin elasticity and balances body shape. 3. Stimulation of bone is necessary to prevent osteoporosis by increasing bone density. 4. Muscle has more density than fat so people with more muscle will look thinner regardless of weight. Aerobic Exercise The American College of Sports Medicine defines aerobic exercise as any activity that uses large muscle groups, can be maintained continuously, and is rhythmic in nature. After 5 minutes of exercise, the volume of oxygen intake and expenditure producing energy becomes equal. There are many aerobic exercises like jogging, running, swimming, bicycling, etc. The benefits include an efficient heart, weight loss, improved mental health, improved immune system, improved stamina, disease reduction, increased life span, improved

8 45 Glossary muscle health and others. For more improvements, the heart rate is kept at the lower end of the target heart rate zone, or in other words, at 40-50% of maximum exercise capacity. The Institute of Medicine (IOM) issued a report recommending that adults should spend at least 60 minutes doing moderately intense physical activity every day of the week. Generally, normal adults should exercise 3 times a week to improve cardio respiratory resistance and frequency should eventually increase to 5 times a week in order to continue improvement. Beginners should start with 5 minutes of exercise 3-4 times a week. People who exercise more than 5 times a week should alternate body endurance exercises and other activities, like swimming or bicycling to utilize different muscle groups and give others some rest. Obese people need to do more aerobic exercise. After 30 minutes of exercise, the source of energy shifts from carbohydrates to fat, helping burn fat reserves and decrease body fat. For example, bicyclists use their legs, but the fat utilized is not only the fat concentrated in legs, but rather all throughout their body. The fat is broken down and used as energy. So, running or jogging is better for weight loss than sit-ups.

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10 INTRODUCTION This manual provides a detailed explanation of the InBody520 Body Composition Analyzer and its functions. This manual makes use of actual examinees results to explain the following:the meaning of various analyses, constituents of the standard range for a particular test, required health management measures, and how to properly use this piece of equipment. Please read this manual carefully before using our InBody520 Body Composition Analyzer in your everyday life.

11 1 Body Composition Analysis BODY COMPOSITION ANALYSIS Things to keep in mind for accurate measurement using the InBody520 The accuracy of a body composition analysis test depends on the examinee and on the environment in which the test is conducted. As such, certain precautionary steps should be taken in order to assure accurate test results. Before conducting the test, please read the following rules carefully and make sure that the examinees have taken all the factors capable of affecting its test results and accuracy into account. Precautionary steps to be taken before conducting a test BODY COMPOSITION ANALYSIS 1. Assure the test is conducted before a meal. In cases where the examinee has already eaten, the test should be put off at least for two hours after the meal. This is because the food mass is included in the subject s weight and thus, may result in measurement errors. 2. Make sure to use the bathroom. Waste is not included in the body s compositional elements, but the volume of urine and excrement is included in the weight measurement. This can result in biological errors. 3. Do not exercise right before conducting the test. Strenuous exercise or sharp movements can cause temporary changes in body composition. 4. Stand still for about 5 minutes. Conducting the test immediately after lying in bed or sitting for a long period of time might result in a slight change in the test results. This is because the body water tends to move to the lower extremities of the body as soon as the person stands or gets up. 5. Do not conduct the test right after shower or sauna. Sweating causes a temporary change in a person s body composition.

12 Body Composition Analysis 2 6. Do not take measurements during the menstrual cycle. Females experience increases in body water during their menstrual cycle. 7. Conduct the test at normal temperatures (68 ~77 ). While the human body is stable at normal temperatures, body composition is susceptible to change in hot or cold weather. 8. If a retest is carried out, make sure to conduct the test under consistent conditions. Identical conditions (i.e. wearing the same clothes, testing before eating or exercising etc.) should be maintained in order to assure the accuracy of the test results. Posture guide for body composition analysis A proper posture increases the accuracy of the test results. Weight measurement and how to step on the footpads Please remember to remove your socks or stockings before stepping onto the footpad. If at all possible wear light clothing to ensure the accuracy of the test. Be sure to remove everything from your pockets and all accessories. When ready, place your feet on the footpad electrodes as the shapes guide you to do. A reading of your weight will be conducted first. Do not hold on to the handgrips while the body weight is being registered. Moreover, do not make any sudden movements during the weighing process. It is important to properly place your feet on the footpads. Please do not move during weighing Input of personal data and how to hold the hand grips Please enter your exact height. If the height is incorrect, test results will be inaccurate. The gender of the examinee should also be entered. Once you have entered the personal data, take hold of the handgrips. Put your thumb on the top of the handgrip, while holding the bottom of the handgrip with your other four fingers. Straighten out your elbows and leave some space between your armpits and body. This will ensure proper posture and alignment. If the handgrips are not properly held during the test, an incorrect estimation of the examinee s body composition may occur. Please assure that proper testing methods are maintained until the test is complete.

13 3 Contents RESULTS SHEET p.4 p.25 p.4 p.26 p.9 p.10 p.12 p.27

14 Results interpretation 4 1. Name, Age, Height, Gender and Date Once the body composition analysis of the examinee is completed, the results are automatically printed. Appearing at the top of the results sheet you will see: the name (or ID), age, height and gender of the examinee and the date and time when the test was conducted. Personal data such as gender, age and height of the examinee should be entered on the LCD touch screen. 2. Body Composition Analysis The horizontal bar graphs help UNIT:% you understand your body composition when compared to standard values. The values next to the bars show you the numerical values and the end of bars indicate your position in the range given. If the length of the bars are similar, your body composition is well balanced. If the length of the bars differ, it means your body composition is unbalanced. The InBody technology is able to measure weight, Lean Body Mass (LBM), and Body Fat Mass (BFM). The results sheet shows a comparative chart of the value of these body compositional elements using the bar graphs. Each compositional element has its own absolute value. The lengths of the bar graphs indicate the percentage of the standard value for each compositional element. Therefore, a score of 100% indicates the standard value calculated based on the standard weight for that particular individual. When an individual controls his/her exercise levels and diet as part of a weight management program, the body composition of Body Fat Mass and Lean Body Mass (muscle) change. When a weight management program is followed, the program manager can verify if the body composition of the participants have properly changed by monitoring LBM and BFM. 1) Weight Standard weight indicates the ideal value in accordance with the examinee s height.the InBody520 provides the standard weight range, based on the BMI (Body Mass Index) Standard Weight Index. BMI method Standard Weight(kg)=ideal BMI Height 2 (m 2 )

15 5 Results interpretation The Obesity Index indicates the level of obesity. Generally, a BMI of 18.5~24.9 is used to determine the normal weight range. With the InBody520, the normal weight range is 15% of standard value, very similar to one based on BMI (18.5~25). Standard weight is determined according to a BMI of 22 for males, a BMI of 21.5 for females and a growth chart for those under 18 years of age. 2) Lean Body Mass 100% Lean Body Mass indicates that the examinee being measured has reached his/her standard weight and standard Lean Body Mass. The standard proportion of LBM is 85% of the standard weight for males, and 77% of the standard weight for females. The normal range of LBM is % of the standard LBM. Change in muscle is the most effective indicator of health improvements as a result of exercise. The UCLA definition of obesity is based on the level of muscle development. This definition is based on a proactive approach to obesity, one in which obesity is regarded as a problem involving the proportion of Lean Body Mass to Body Fat Mass. Lean Body Mass refers to the entire body weight with the exception of Body Fat Mass. Athletes have a higher proportion of Lean Body Mass than regular people. As such, it is important for athletes to measure their Lean Body Mass. InBody520 provides comprehensive data which can be used to evaluate the health of an examinee. 3) Body Fat Mass Body Fat Mass indicates the total quantity of lipids that can be extracted from fat and other cells. Body Fat Mass is not directly measured using the BIA method, but calculated by subtracting Lean Body Mass from the body weight. InBody520 uses the following formula to measure Body Fat Mass: Body Fat Mass = Body Weight - Lean Body Mass Body Fat Mass is stored under the skin, in visceral areas and between muscles. When an examinee s fat mass is higher than the standard range, he/she is diagnosed as being obese (excess body fat). The range of diseases that can result from obesity include hypertension, arteriosclerosis, hyperlipemia, fatty liver, cholelithiasis, diabetes,obstetrical diseases, breast cancer, and endometritis

16 Results interpretation 6 The normal range of Body Fat Mass is ascertained by calculating an examinee s body fat mass as compared to the standard weight and standard Body Fat Mass. The InBody520 displays the percentage of the standard value of Body Fat Mass in a bar graph. Table1. Standard body composition ranges Males Females Weight 85 ~115% of standard weight 85 ~115% of standard weight Lean Body Mass 90 ~110% of standard LBM 90 ~110% of standard LBM Body Fat Mass 80 ~160% of standard BFM 80 ~160% of standard BFM Compared with Lean Body Mass, Body Fat Mass is various among people. Therefore, each bar has different scale. HOW TO APPLY THESE RESULTS TO YOUR CLIENTS The test results have been designed so the examinee can easily understand them, and that then facilitates his/her ability to follow the program designated. The test conductor can use alphabetical shapes that are based on the length of the graphs to provide explanations to the examinees regarding their overall health. 1) Relations among Weight, Lean Body Mass and Body Fat Mass A person is identified as having an ideal body composition when the body composition graphs form a D shape. In such cases, the LBM bar graph is longer than the weight and Body Fat Mass bar graphs. On the other hand, if the LBM graph is shorter than the Body Fat Mass graph, the body composition graph forms a C shape. Persons with such results should immediately begin taking weight control measures. Let us now use the following examples to identify ways of using the test results.

17 7 Results interpretation 8 different body types, based on a balanced body composition This body composition graph forms a slightly curved D This is the ideal body composition. Of course, it goes without saying that this healthy state should be continuously maintained. As such, the person conducting the test should mention to the examinee that abdominal fat often increases as a person gets older, and emphasize the necessity for continuously monitoring their body to ensure that the healthy state is maintained. At the opposite end of the health spectrum, we find the C shaped graph. In this case, the examinee s weight is within the normal range. Although the examinee s body weight might not be classified as obese, he/she does not have the ideal body shape.they are experiencing difficulties managing the shape of their bodies through simple weight control measures. People who are in this category usually visit the obesity clinic. If a person who is diagnosed as this type change his/her body composition through exercise, he/she can maintain a satisfactory body shape without actually losing any weight. The conductor of the test can recommend that the examinee can achieve a D shape in his/her body composition graphs,by losing Body Fat Mass while gaining LBM. Many adults who have a high level of Body Fat Mass are included in this category. Abdominal obesity is a factor in the development of cardiovascular diseases for those within the standard weight range, no different than individuals in the overweight range. This type is a typical healthy body with well developed LBM. However people in this category need to be careful not to lose too much Body Fat Mass. This type is exemplified by a person whose weight is within the standard range, but yet cannot be regarded as being in ideal health. For this type, the length of the LBM graph is shorter than the standard range, while the Body Fat Mass is within the standard range. An examinee of this type will also exhibit a C shape on his/her body composition graphs. However, this type should be identified as a weak body type, and not as an obesity type. People who belong to this type have usually lost intestinal and muscular protein; a situation caused by such potential factors as a lack of exercise, lack of proper protein nutrition, or an increased.

18 Results interpretation 8 metabolism as a result of injuries or disease. Symptoms of this include edema, the decomposition of muscle cells, changes in nerve tissues, secondary infections, and stunted growth in children. Obesity causes many diseases. People diagnosed as being obese run a higher risk of myocardial infarction, congestion, cardiac failure, and hypertension. In addition, there exists a correlation between obesity and diabetes(niddm). Moreover, obese people also run a higher risk of contracting large intestine cancer, rectal cancer, and in the case of males, prostatic carcinoma. Furthermore, other potential problems have been identified, such as a decrease in tolerance to exercise, osteoarthritis, as well as a decrease in lung function. Athletes are usually included in the overweight muscle type. Such people can easily be included in the obese category when the BMI method is used. This type is deemed to be overweight because of the weight of their skeletal muscle. This type of person does not need to undertake weight control measures. Most people who fall under the obesity type caused by excess weight are those that have been diagnosed as chronically obese. The LBM is measured to be over the standard range, not developed through exercise, but because the person has excessive bodycomposition mass compared to the standard weight. Those diagnosed as being chronically obese need medical treatment. This type of patient should follow a weight reduction program that is designed to decrease their Body Fat Mass and treat or prevent diseases that may accompany this condition, rather than focusing on improving the shape of their body. Those people who are diagnosed as belonging to theunderweight weak body type, have a lower possibility of developing adult diseases. However, should this poor nutrition continue for a long period of time, many health problems can arise, such as a decrease in the body s ability to absorb nutrition, poor nutrition caused by a loss of appetite, imbalanced nutrition due to a loss of intestinal protein,metabolic disorders, as well as other side effects.

19 9 Results interpretation 3. Body Water Balance UNIT:% The InBody520 Analyzer measures TBW by using a multifrequency technique that separates TBW into ICW and ECW. Intracellular Water(ICW) indicates the quantity of water within the cellular membrane. Extracellular Water(ECW) indicates the total quantity of water in the interstitial fluid and blood. In the case of a healthy body, the proportion of ICW and ECW is maintained at about a 3:2 ratio. Total Body Water (TBW) = Intracellular Water (ICW) + Extracellular Water (ECW) Figure 1. Accuracy of Total Body Water analysis The right graph displays the results of Total Body Water analysis, comparing results from InBody520 with results from deuterium oxide dilution method. The accuracy of Total Body Water analysis was found to be R2adj=0.87. This confirms that InBody is capable of higher accuracy when it comes to the analysis of Total Body Water. Ref 1. G. Bedogni, Accuracy of an eight-point tactile electrode impedance method in the assessment of total body water, Eur. J. Clin. Nutr. 56, 1143~1148, Table2. Standard ranges of body composition Males Females Total Body Water 90 ~110% of standard TBW 90 ~110% of standard TBW Intracellular Water 90 ~110% of standard ICW 90 ~110% of standard ICW Extracellular Water 90 ~110% of standard ECW 90 ~110% of standard ECW FAQ 1 Q1. How do you measure the amount of water in the intestines? Microamperage current is limited in its ability to penetrate the walls of the intestines. It is impossible to measure the amount of water in the intestines using bioelectrical impedance analysis(bia). This is why examinees are recommended to take the test before eating. For example, if an examinee uses InBody520 after having taken in 1L of water, this water can cause an increase in body weight. Recent water addition is mistaken as fat cells, increasing the Fat Mass.

20 Results interpretation 10 Examinees are recommended to remove their clothes and accessories, to avoid eating prior to the test, and to dispose of urine and excrement; all of which are not part of the body s composition, but affect body weight. Ref 2. Vivian H. Heyward, Applied Body Composition Assessment, Human Kinetics, p44-55, Obesity Diagnosis InBody520 s obesity diagnosis function makes use of BMI (Body Mass Index) and Percent Body Fat to determine obesity levels. By analyzing the examinee s weight using BMI and Percent Body Fat, InBody520 Analyzer makes it possible to screen for sarcopenic obesity. People included in this sarcopenic obesity type fall within the standard range when it comes to BMI and weight, but are regarded as obese when their percentage of body fat is calculated. Table3. Standard ranges of body composition Standard Range Males Females BMI 22 (Standard range: 18.5 ~24.9) 21.5 (Standard range: 18.5 ~24.9) Percent Body Fat 10 ~20% 18 ~ 28% 1) BMI(Body Mass Index) As we can see from the formula, BMI = Weight(kg) / height 2 (m 2 ), BMI is used to approximate obesity levels. The BMI method has been widely applied in the general medicine, dietary, and sports medicine fields as the main means of diagnosing obesity. However, this method is flawed in that it cannot be applied to adults with high levels of LBM, children, those over the age of 65, or pregnant females. Nevertheless, as the BMI has been the most commonly used index, much research on using the BMI method to prevent adult diseases has been conducted. This is why InBody520 also includes BMI based information. Differences have emerged among researchers as to which standards should be used to determine the BMI of examinees of different age and gender. InBody520 uses the WHO standards as the standard ranges for BMI (1998, Table4). InBody520 identifies the standard BMI as 22 for males, 21.5 for females and the standard BMI ranges as for both males and females.

21 11 Results interpretation Table4. European weight classification based on the BMI method (WHO, 1998) Classification BMI(kg/m 2 ) Danger of onset of accompanying diseases Underweight 18.5 Low Norma 18.5 ~ 24.9 Moderate Overweight 25 Dangerous weight level 25 ~ 29.9 Increased 1st level obesity 30 ~ 34.9 Dangerous 2nd level obesity 35 ~ 39.9 Advanced 3rd level obesity 40 Very advanced With regards to the BMI and Percent Body Fat of children, InBody520 applies children standards, not adult standards. 2) Percent Body Fat Percent Body Fat indicates the percentage of Body Fat to Body Weight. Percent Body Fat = Body Fat Mass / Body Weight 100 The standard Percent Body Fat is 15% for males and 23% for females, while the standard range of Body Fat Mass for males is 10-20% of the standard weight, and 18-28% of the standard weight for females. 3,4 When a person s Percent Body Fat is calculated as being beyond the standard range, he/she is regarded as being obese. When a person s Percent Body Fat falls below the standard range, he/she is regarded as having a low level of body fat. This low level of body fat can be separated into two types: The first is a person whose muscle type is deemed to account for a desirable proportion of the body composition. Such people s weight is regarded as being within the standard range or falling within the overweight range. The second type, the poor nutrition type, is one in which a person s body is deemed to be in an unhealthy state because of a lack of Body Fat Mass and LBM. This type has a higher possibility of contracting clinical diseases. In case of children less than 18 years old, different standards are applied as it is necessary to consider the difference in physical characteristics from adults. Ref 3. Robert D. Lee, David C. Nieman, Nutritional Assessment 2th, McGraw-Hill, 1998 Ref 4. George A. Bray, MD. Contemporary Diagnosis and Management of Obesity, Handbooks in Health Care Co.,1998

22 Results interpretation Segmental Lean Development Under Normal Over UNIT:% With the InBody520, you can measure the soft lean mass of your body parts. It is achieved through the use of one of the InBody520 s measuring principles, bioelectrical impedance measurements of body parts. The measurement of soft lean mass for body parts is based on the following theory. Segmental Soft Lean Mass (Height) /(Segmental Resistance) Ref 5. Henry C Lukaski, Phyllis E Johnson, William W Bolonchuk and Glenn I Lykken, Assessment of fat-free mass using bioelectrical impedance measurements of the human body, The American J. of Clinical Nutrition, Vol. 41, pp , 1985 There are two bar graphs for each body part in the Lean Balance graph. The two graphs have different meanings, respectively. The numbers beside the upper bar graph indicates the actual soft lean mass of a subject. If the upper bar graph reaches 100%, it means that the subject has ideal soft lean mass for his or her ideal weight, which is derived from the subject s height. Therefore, the length of the upper bar graph shows the relative ratio of the ideal soft lean mass for his or her ideal weight. If the lower bar graph reaches 100%, it denotes the ideal soft lean mass for the subject in relation to his or her actual weight. Therefore, the length of the lower bar graph indicates the relative ratio of the ideal soft lean mass for the actual weight, while the number beside the lower bar graph shows that ratio. By displaying these two bar graphs, it makes it more effective to diagnose the actual soft lean mass of the subject. The upper bar graph is based on the soft lean mass of the subject s ideal weight, so that the 100% value will not vary unless there is a change in his or her height. Thus, it is easier to see the increase or decrease of the soft lean mass while providing an enduring goal. Since the lower bar graph is only based on the soft lean mass of the actual weight, the 100% value will alter in accordance with the weight change.

23 13 Results interpretation Hence, though it is not possible to check the increase or decrease of the soft lean mass as with the upper graph, it will directly reflect changes in the subject s weight, thereby allowing you to determine whether or not there is actual soft lean mass appropriate to his or her weight. In addition, you can also see if the subject has appropriate ratio between muscles and body fat in his or her body parts. Throughout the lean balance muscle graph for body parts, you can see if upper lower left right muscle developments are balanced and if body parts soft lean mass is appropriate(muscle strength). The normal range of the graph is: for right and left arms, 80~120%; for trunk, right and left legs, 90~110%. FAQ 2 Why are the standard ranges for arms and legs different? The standard range for Soft Lean Mass in the arm is 80 ~ 120%, while that in the trunk and legs is 90 ~ 110%. The difference in these standard ranges is based on the fact that while the upper body tends to vary greatly from individual to individual, very little variations are found in terms of people s legs. As people use their legs, this part of the body tends to be the first to benefit from exercise; as such, the degree of Lean Mass in legs usually ranges somewhere between 90 ~ 110% of the standard. However, one should also take the time to exercise his/her upper body. In this regards, it is difficult to develop Lean Mass of arm when one does not partake in exercises designed to specifically develop muscle in that particular part of the body. This is the main reason why Lean Mass of arm tends to vary greatly from the standard. Therefore, the standard range for Lean Mass of arms is 80 ~ 120%, which is a wider range than that applied to Lean Mass of legs.

24 Results interpretation 14 FAQ 3 How precise is the soft lean mass for the body parts? The precision data of the soft lean mass for the body parts can be obtained from DEXA (Dual Energy X-ray Absorptiometry) and the InBody precision test. The following are the results of a comparative study that shows that the R_ is above This indicates that the precision of body part measurement is high FFM LTMarm FFM LTMleg 8 LTMarm LTMleg 8 (kg) 40 (kg) 40 (kg) (kg) 2 (kg) 2 (kg) RIsum500 RIarm500 RIleg500 RIsum500 RIarm500 RIleg500 (cm (cm / 2 / ) ) (cm (cm / 2 / ) ) (cm (cm / 2 / ) ) aa bb cc Prediction of fat-free mass and appendicular lean tissue mass from eight-polar RMSE Y by DXA Y by BIA DY (BIA-DXA) Y X a0 a1 R 2 adj Kg (%) (kg) (kg) (kg) FFM RIsum (6) LTMarm RIarm (8) LTMleg RIleg (8) Abbreviations : a0, intercept; a1, slope; R 2 adj, adjusted coefficient of determination; RMSE, root mean square error; BIA, bioelectrical impedance analysis: DXA, dual-energy X-ray absorptiometry; FFM, fat-free mass; LTM, lean tissue mass; RIx, resistance index at x khz; sum, sum of segmental resistances (arms, trunk and legs). * Ref 6. G. Bedogni et al, Cross-calibration of eight-polar bioelectrical impedance analysis versus dual-energy X- ray absorptiometry for the assessment of total and appendicular body composition in healthy subjects aged years, Annals of human biology, Vol. 30, No. 4, pp ,

25 15 Results interpretation TIP2 Comprehending two muscle bar graphs in the Segmental Lean Development. 1. Find out more about the lean balance and body strength. A. Compare the length of the soft lean mass graph for body parts to see if muscle distribution is balanced. B. Evaluate the appropriateness of soft lean mass (muscle strength) by the length of the below bar. 2. Find out the relationships among weight, upper and lower bar graphs in the Segmental Lean Development. A. If the actual weight is close to the ideal one. B. If the actual weight is higher than the ideal one. C. If the actual weight is lower than the ideal one. 3. Observe the trend of Segmental Lean Development graph. 1. Find out more about the lean balance and body strength. By comparing the lengths of the body part graphs, see if each body part has proportionally developed. The lean balance of the comprehensive evaluation will be based on the lower bar graph. A. Compare the length of the soft lean mass graph for body parts to see if muscle distribution is balanced. Balanced development of the upper & lower body and of the left & right side of the body The length of the arm, trunk and leg graphs are similar, thus indicating that the upper and Under Normal Over lower parts of the body are well balanced. In addition, the left and right sides of body are also in balance, as exhibited by the fact that the graphs for both arms and legs are of the same length. All the graph bars for the upper and lower body fall within the standard range, indicating a proper muscle balance.

26 Results interpretation 16 Left-right imbalance in the upper body There is about one-cell difference in length between right and left arms in the upper body. This subject does not have proportionallydeveloped arms. He or she must have a habit of using the right arm more or a history of not using his or her left arm due to some reason such as injury. Left-right imbalance in the lower body The bar graph of the right leg is shorter than that of the left. This subject does not have proportionally-developed lower body. He or she must have a habit of using the left leg more or a history of not using his or her right leg due to some reason such as injury. Under Normal Over Under Normal Over Upper & lower body imbalance strong upper body type The length of the arm bar graph is longer than that of the leg and falls above the normal range. In addition, although the bar graph for legs is within the normal range, the difference in length of the upper Under and Normal lower Over body graphs is more than one cell. Therefore, it can be categorized as the strong upper body type, which is marked by the better-developed lower body. Upper & lower body imbalance strong lower body type The length of the leg bar graph is longer than that of the arm and falls above the normal Under Normal Over range. In addition, although the arm s bar graph is in the normal range, the difference in length of the upper and lower body graph is more than one cell. Therefore, it can be categorized as the strong lower body type, which is marked by the better-developed upper body. Under Normal Over Under Normal Over Under Normal Over Under Normal Over Under Normal Over

27 17 Results interpretation Upper & lower body imbalance ; weak upper body type Although the bar graph for the legs is beyond the standard range, the bar graph for the arms falls below the standard level. This case can be referred to as a weak upper body type. This type is often exhibited among persons who seldom exercise. Upper & lower body imbalance ; weak lower body type Although the bar graph for the arms is beyond the standard range, the bar graph for the legs falls below the standard level. This case can be referred to as a weak lower body type. As the lower body must support the body weight, proper muscle development is essential. When the lower body muscles are not sufficiently developed, diseases such as arthritis and osteoporosis become more likely. Under Normal Over Under Normal Over B. Evaluate the appropriateness of soft lean mass(body strength) by the length of the lower bar. The upper bar graph presents the ideal weight to which each subject should aspire. As the length of the upper bar graph encompasses the concepts of ideal weight and soft lean mass, it provides the goal to keep the ideal soft lean mass, while considering the ideal and actual weights. Since the lower bar graph compares the soft lean mass in relation to the actual weight, it checks if there is an appropriate, ideal amount of soft lean mass for each body part in relation to the actual weight. At that time, the body strength index item in the comprehensive evaluation is determined according to whether or not the lower bar graph falls in each category: below average, average, or above average. Thus the body strength will differ in accordance with the range to which the length of bar graph belongs. It would be ideal for both the upper and lower bar graphs to be in the normal or above average range, in particular, both to be more than 100%. In addition, depending on whether the lower bar graph is bigger or smaller than 100%, it is possible to determine if soft lean mass and body fat amounts are appropriate. In other words, if one has a soft lean mass ideal for the actual weight, it should be near 100%. It can be seen that the soft lean mass and body fat in body parts are well balanced. On the other hand, if soft lean mass is smaller, it will be

28 Results interpretation 18 short of 100%. The smaller the bar graph is, it can be said that the person is either a weak type with low muscle or a type with more body fat and less lean muscle. Lastly, if there is more muscle, the lower body graph will exceed 100%. The higher the bar graph is raised above 100%, the more muscles the person has developed than body fat. Therefore, the length of the lower body graph allows you to see the ratio between muscles and body fat. Let s look at the following examples. Male, 25 years old, 5ft. 8.9in., 126.5lbs. (Ideal weight:148.8lbs.) Currently, this man has yet to reach his the ideal weight. If you look at the upper bar graphs in the Segmental Lean Development, you can see that they are all below the normal range. The shortness of the graph may be caused by his actual weight falling behind the ideal weight or just by an actual insufficiency of the soft lean mass. If you see the lower bar graph, the arms are within the normal range while legs are above 100%, indicating that he has an appropriate soft lean mass for the actual weight. Female, 68 years old, 5ft. 4.2in., 152.3lbs. (Ideal weight:123.5lbs.) This female s actual weight is higher than the ideal weight. If you look at the upper bar graphs in the Lean Balance, they all fall in the normal range. So it seems that she has an appropriate soft lean mass. However, there are two possible explanations for that. It may be caused by her higher actual weight to the ideal one. Or she may just be well muscled. At that time, if you see the lower bar graph, the arms are about 90% while the legs are within the 79% range, indicating that it is below the normal range. In other words, although she appears to have appropriate muscles due to her higher actual weight than the ideal one, she lacks a certain amount of soft lean mass appropriate to her actual weight. In particular, in case of the legs, the lower bar graph is short of 100% so that she has more body fat and less soft lean mass.

29 19 Results interpretation 2. Find out the relationships among weight, upper and lower bar graphs in the Segmental Lean Development. As the concepts of ideal weight and actual weight are included in the standards of determining the lengths of upper and lower bar graphs in the lean balance, the length type of upper and lower bar graphs will vary depending on the difference between subject s actual and ideal weight. A. If the actual and ideal weights are alike, the upper and lower bar graphs will not be much different. As the discrepancy between the actual and ideal weight is insignificant, the 100% standard value is similar to each other. Therefore the lengths of the graphs are similar. a) If the lower bar graph exceeds 100% It is a desirable health state in terms of both ideal weight and actual weight. Male, 28 years old, 5ft. 8.9in., 150.1lbs. Actual weight (150.3lbs.) ideal weight (148.8lbs) As the discrepancy between the actual and ideal weight is insignificant, the lengths of the two bar graphs are similar. As the lower bar graph of the lower body falls in the normal range, the upper and lower body strength is in the average range. Especially, as it exceeds 100%, the balance between muscles and body fat is met. b) If the lower bar graph does not exceed 100% Based on the actual weight, the subject is weak in health with insufficient soft lean mass. Female, 28 years old, 5ft. 3in., 119.7lbs. Actual weight (119.9lbs.) ideal weight (118.8lbs) Again, the lengths of the two bar graphs are similar. As the lower bar graph is below the normal range, the upper and lower bodies are weak. Especially, as they fail to reach 100%, it can be said that the subject has more body fat and less soft lean mass.