Ultrasound in Body Composition Analysis: Au courant

Dear Editor,

We read with great interest the recently published review entitled “Body composition analysis by radiological imaging – methods, applications, and prospects” by Linder et al. [1]. We would like to congratulate the authors for aiming to provide a narrative review of the current diagnostic imaging in body composition analysis. However, we also want to highlight an imperative (as well as convenient) instrument for body composition analysis, ultrasonography (US), which was absent in their article.

To begin, body composition is a vital indicator for many conditions and diseases. Body mass index and waist circumference are simple/useful measures of body composition. However, they do not differentiate subcutaneous and intra-abdominal visceral adipose tissue (VAT) or skeletal muscle, potentially leading to biased associations between different body composition parameters and adverse metabolic risk profile [1]. On the other hand, like what was summarized in the aforementioned review, magnetic resonance imaging and computed tomography are the gold standard techniques (at organ-tissue level) as regards regional body composition. Due to their disadvantages like high cost, low availability, x-ray exposure; skeletal muscle and subcutaneous/visceral fat thickness measurements using ultrasound (US) can alternatively be performed as they are reliable, valid, cheap, easy, accessible, and do not contain radiation [1] [2] [3] [4].

For the diagnosis of low muscle mass and sarcopenia, which is an important factor for morbidity and mortality, US can quantify the anterior thigh (quadriceps) muscle ([Fig. 1]A) [2] [3] [4]. Additionally, as central/intra-abdominal or visceral obesity is more associated with chronic diseases and mortality, and as VAT is more metabolically active with its loss being greater than subcutaneous and total body fat masses; measuring the intra-abdominal VAT with US is possible for obesity and related disorders ([Fig. 1]B) [4]. Last but not least, the tool to combine the two aforementioned measurements, the intra-abdominal VAT to thigh muscle thickness ratio can also be calculated – as another vital index for assessing the disproportion between visceral fat and thigh muscle mass [5]. In closing, taking into account all the discussion above, it is noteworthy that US appears to be a very useful – but underestimated/forgotten – tool in body composition analysis.

Fig. 1 Ultrasonographic measurements using a 5–12 MHz linear probe for the quadriceps muscle thickness at the anterior mid-thigh level (A) and using a 2–5 MHz curvilinear probe for the abdominal subcutaneous (sc) and visceral adipose tissue (VAT) thicknesses. RF: rectus femoris muscle; VI: vastus intermedius muscle; F: femur; A: abdominal aorta.

Publication History

Received: 29 April 2024

Accepted: 12 May 2024

Article published online:
11 June 2024

• References

• 1 Linder N, Denecke T, Busse H. Body composition analysis by radiological imaging – methods, applications, and prospects. Rofo 2024; DOI: 10.1055/a-2263-1501.
• 2 Bazzocchi A, Filonzi G, Ponti F. et al. Ultrasound: Which role in body composition?. Eur J Radiol 2016; 85: 1469-14 -80 DOI: 10.1016/j.ejrad.2016.04.005. (PMID: 27235340)
• 3 Kara M, Kaymak B, Frontera W. et al. Diagnosing sarcopenia: Functional perspectives and a new algorithm from the ISarcoPRM. J Rehabil Med 2021; 53: jrm00209
• 4 Ponti F, De Cinque A, Fazio N. et al. Ultrasound imaging, a stethoscope for body composition assessment. Quant Imaging Med Surg 2020; 10: 1699-1722 DOI: 10.21037/qims-19-1048. (PMID: 32742962)
• 5 Oh J, Kim SK, Shin DK. et al. A simple ultrasound correlate of visceral fat. Ultrasound Med Biol 2011; 37: 1444-1451 DOI: 10.1016/j.ultrasmedbio.2011.05.844. (PMID: 21775047)