Mid-upper-arm muscle area is a two-dimensional measure of muscle mass and provides more accurate information than the mid-upper-arm muscle circumference. It is also calculated from the mid-upper arm circumference and triceps skinfold thickness. The measure is based on the assumption that the mid-upper-arm cross- section is circular.

Laboratory Measures

Hydrostatic Weighing

Hydrostatic weighing has been the traditional gold standard for assessing body fat. This method determines body volume, which can be used in turn to calculate total body density. The method is based on the principle that the volume of an object is equal to the volume of water it displaces when submerged in water. The volume of water displaced is equal to the difference in weight of the object in air and in water. Body volume is obtained by weighing an individual as normal, and then weighing the person under water. The calculation must take into account any residual air trapped in the lungs and intestines, and must consider temperature-related changes in the density of the water; the individual must expel as much air as possible while being weighed under water, to measure the residual lung volume. Once the total body volume has been measured, one can calculate a patient's percentage of body fat.

Isotope Dilution

Total body water can be measured by isotope dilution. The size of fat-free mass can be estimated from the proportion of water in fat-free mass. A dose of isotope (deuterium or tritium) labeled water is administered; then the technician measures the concentration of the isotope in the body after equilibrium. Malnourished individuals have more water per unit of fat-free mass. It should be noted that the measurement of total body water tends to overestimate the size of the fat-free mass and underestimate the amount of body fat.

Dual-Energy X-Ray Absorptiometry

Dual-energy x-ray absorptiometry (DEXA) is a technique designed to measure bone density. The patient lies down on the DEXA device and an X-ray apparatus passes over the person, emitting X-rays through the body, measuring the composition of bone and soft tissue. The resultant data includes, specifically, measurements of bone mineral, fat mass, lean soft tissue mass, and percentage of body fat.

Bioelectrical Impedance

Bioelectrical impedance is a measurement based on the electrical conductivity of fat and fat-free mass. The impedance instrument measures the impedance of an electrical current passed through the body when electrodes are placed on the wrist and ankle. This allows for the calculation of body volume. Combining this measurement with body weight, a patient's density and percentage of body fat can be determined. Note that the technique is sensitive to the position of the electrodes on the body, hydration status, and consumption of certain food and drink.