Table 1.

Techniques Commonly Used to Estimate Body Composition and Adipose Deposits

Method of Assessment	Brief Description	Advantages	Disadvantages
Anthropometric measures	Various measures including body mass index, skinfold thickness, waist circumference, arm circumference, predicted fat mass	•Low cost •Readily available data in many cases	•Limited accuracy •Unclear if same thresholds apply across different races and ethnicities
Bioelectrical impedance	Weak electric current is used to calculate impedance of the body, with differences in values for total body water and body fat	•Low cost •Relatively accurate estimates	•Limited accuracy
Dual-energy X-ray absorptiometry	X-rays are differentially attenuated with bone mineral content, fat and lean mass	•High accuracy •Low cost •Widely available •Total body assessment possible	•Radiation exposure (low) •Manual measurement required
Ultrasound	Echo reflections of multiple imaging planes are used to assess adipose tissue thickness	•Relatively low cost •High accuracy	•Interscan variability and scans can be user dependent •Lack of volumetric data
Computed tomography	Cross-sectional imaging with volumetric reconstruction to measure abdominal adipose tissue, pericardium, epicardium, pancreas, liver, kidney, and skeletal muscle on the basis of preestablished Hounsfield units	•High accuracy •Clinically available at most sites •Rapid scan time •Total volume datasets •Semiautomatic quantification with commercial software	•Radiation exposure •Higher cost than other modalities
Magnetic resonance imaging	Cross-sectional imaging with volumetric reconstruction on the basis of different magnetic properties of water vs fat focusing on abdominal adipose tissue (subcutaneous separately from visceral adipose tissue), pericardium, epicardium, pancreas, liver, kidney, and skeletal muscle	•Highest accuracy •Total volume datasets •Allows complete separation of adipose and lean tissues into fat-only (adipose) and water-only (lean) images •Whole-body scans possible	•Higher cost than other modalities •Limited access at some locations •Specially trained personnel are required •Longer scan times relative to other modalities

Adapted and modified with permission from Neeland IJ, Yokoo T, Leinhard OD, Lavie CJ. 21st century advances in multimodality imaging of obesity for care of the cardiovascular patient. J Am Coll Cardiol Img. 2021;14(2):482-494.