Chapter 25 Instruments
25.1 Overview - Instruments
The following instruments were used for physical measurements performed:
25.2 Automatic Blood Pressure Monitor
Blood pressure was taken on the arm - resulting in two numbers, one high (systolic pressure (in mm Hg), and one low, diastolic pressure (in mm Hg)). Systolic is the first vessel constriction then Diastolic is the second stage of vessel constriction. The upper limit of normal blood pressure is 120/80.
Normal Ranges/Interpretation
| Rating | Systolic | and/or | Diastolic |
|---|---|---|---|
| Normal | <120 | and | <80 |
| Prehypertension | 120-139 | or | 80-89 |
| Stage 1 Hypertension | 140-159 | or | 90-99 |
| Stage 2 Hypertension | >=160 | or | >=100 |
Heart Rate was also measured and reported (in beats per minute, bpm).
- Normal range: 60-100 bpm
- Bradycardia: <=60 bpm
- Tachycardia: >=100 bpm
25.3 Body Composition - overview
Body composition and bone density were measured. They measured the distribution of the participant’s body tissue (fat and muscle) and how strong their bones were. Using these data, BMI, waist-hip ratio, total percent body fat, lean tissue mass and total fat mass were then reported back to each participant.
25.4 Tanita Body Composition Analyzer
BIA (Bioelectrical Impedance Analysis technique which is based on the fact that lean tissues have a high water and electrolyte content, and thus provide a good electrical pathway. Fat mass contains a lower percentage of body water, and thus is a poor conductor of the electrical signal. By inducing a low energy, high frequency, electrical signal (50kHz, 500 microamp), a measurement of the baseline resistance to the flow of electrical current can be made. This current is passed through the anterior electrode on the scale platform, and the voltage drop is then measured on the posterior electrode. The resistance measurement relates directly to the volume of the conductor which is used to determine total body water, lean body mass, and finally, fat mass. Percent body fat, as calculated by Tanita, is highly researched proprietary formula combining impedance and weight measurements with height, gender, and age information. It is looked upon a chart of percentages among age groups and gender.
Measurements include:
- Weight- total body weight which includes muscle, bone, fat, water, etc.
- BMI- Correlates physical stature and body weight with mortality ratios like diabetes, cardio-pulmonary disease, cancer, etc. BMI is recognized as a valid assessment tool in identifying obese individuals. Body composition analysis may provide more information regarding actual changes in composition over an extended period of time.
- BMR- Basal metabolic rate measures the energy expended by the body to maintain normal body functions such as respiration and circulation.
- Impedance – measured in Ohms, the impedance value reflects how hard a mild electrical signal has to work to travel through the body. Lean mass (containing water and electrolytes) conducts the current, while fat mass acts as a resistor to the current. A standard range for impedance is 200-650. Do not compare impedance values among different people.
- Fat mass - Actual fat mass (in pounds, kilos, k or st. pounds) in the body.
- Fat Percent
- FFM (fat free mass)- Fat free mass (in pounds, kilos, or st. pounds) is comprised of muscle, bone, tissue, water, and all other fat free mass in the body. A healthy ratio for fat free mass to fat mass is approximately 5:1 for females, and 7:1 for males. Males carry more muscle than females therefore have a higher FFM.
- TBW (total body water) – (in pounds, kilos, or st. pounds) reflects the amount of water in the body. This monitors the hydration level. TBW/weight X 100= % hydration. According to dialysis standards, women should be approximately 50-60% hydrated, and males should be 60-70% hydrated.
- Body Type
- Age
- Gender
Normal Ranges/Interpretation
| Gender | Age | Underfat | Healthy | Overfat | Obese |
|---|---|---|---|---|---|
| Female | 20-39 | 0-20% | 21-32% | 33-37% | 38-50% |
| 40-59 | 0-23% | 24-33% | 34-39% | 40-50% | |
| 60-79 | 0-24% | 25-36% | 37-43% | 44-50% | |
| Male | 20-39 | 0-7% | 8-20% | 21-25% | 26-50% |
| 40-59 | 0-11% | 12-23% | 24-28% | 29-50% | |
| 60-79 | 0-13% | 14-25% | 26-30% | 31-50% |
25.5 Lunar iDXA Bone Density and Body Composition
Name of Equipment: Lunar iDXA, GE Medical Systems, ME+200156
Bone density is a measurement of how well the body captures calcium while building bones. Calcium is not static in the system, this mineral can move in and out of bones depending on a person’s nutrition, stress levels, and general health.
Ranges and Interpretation
Total Densitometry Range from 0-1.3
| Gender | Normal | Osteopenia | Osteoporosis |
|---|---|---|---|
| Women | 1.181-1.282 | 0.777-0.979 | 0.575-0.777 |
| Men | 1.100-1.402 | 0.998-1.099 | <0.998 |
iDXA Data Fields include:
- T-score
- Z-score
- Total Body Right Trunk Composition Fat
- Total Body Right Trunk Composition Lean
- Total Body Right Trunk Composition Region Fat
- Total Body Right Trunk Composition BMC
- Total Body Right Trunk BMD
- Total Body Right Arm Composition Total Mass
- Total Body Right Trunk Area
- Total Body Right Trunk BMC
- Total Body Right Trunk Composition Tissue
- Total Body Right Trunk Composition Tissue Fat
- Total Body Right Leg Composition Fat
- Total Body Right Leg Composition Lean
- Total Body Right Leg Composition Region Fat
- Total Body Right Leg Composition BMC
- Total Body Right Leg BMD
- Total Body Right Trunk Composition Total Mass
- Total Body Right Leg Area
- Total Body Right Leg BMC
- Total Body Right Arm Composition Tissue Fat
- Total Body Right Arm Composition Tissue
- Total Body Legs Area
- Total Body Legs BMC
- Total Body Legs BMD
- Total Body Legs Composition Total Mass
- Total Body Left Total Composition Total Mass
- Total Body Left Total Composition Region Fat
- Total Body Left Total Composition Tissue
- Total Body Left Total Composition Tissue Fat
- Total Body Pelvis Area
- Total Body Pelvis BMC
- Total Body Right Arm Composition Fat
- Total Body Right Arm Composition Lean
- Total Body Right Arm Composition Region Fat
- Total Body Right Arm Composition BMC
- Total Body Right Arm BMD
- Total Body Pelvis BMD
- Total Body Right Arm Area
- Total Body Right Arm BMC
- Total Body Right Leg Composition Tissue
- Total Body Right Leg Composition Tissue Fat
- Total Body Total %AM
- Total Body Total Z-score
- Total Body Total Area
- Total Body Total Composition Total Mass
- Total Body Total Composition Tissue Fat
- Total Body Total Composition Lean
- Total Body Total Composition Region Fat
- Total Body Total Composition Tissue
- Total Body Total BMC
- Total Body Total BMD
- Recall
- Recommendation
- Total Body Trunk BMD
- Total Body Trunk BMC
- Total Body Total %YA
- Total Body Total T-score
- Total Body Trunk Area
- Total Body Total Composition Fat
- Total Body Total Composition Centile
- Total Body Right Total Composition Fat
- Total Body Right Total Composition Lean
- Total Body Right Total Composition Region Fat
- Total Body Right Total Composition BMC
- Total Body Right Total BMD
- Total Body Right Leg Composition Total Mass
- Total Body Right Total Area
- Total Body Right Total BMC
- Total Body Right Total Composition Tissue
- Total Body Right Total Composition Tissue Fat
- Total Body Spine BMC
- Total Body Spine BMD
- Total Body Total Composition BMC
- Total Body Spine Area
- Total Body Ribs BMD
- Total Body Right Total Composition Total Mass
- Total Body Ribs Area
- Total Body Ribs BMC
- Total Body Left Total Composition Lean
- Total Body Left Total Composition Fat
- Total Body Gynoid Composition Tissue Fat
- Total Body Gynoid Composition Total Mass
- Total Body Head Area
- Total Body Gynoid Composition Tissue
- Total Body Gynoid Composition Region Fat
- Total Body Gynoid Composition BMC
- Total Body Gynoid Composition Fat
- Total Body Gynoid Composition Lean
- Total Body Head BMC
- Total Body Head BMD
- Total Body Trunk Composition Tissue Fat
- Total Body Trunk Composition Total Mass
- Total Body Left Arm Area
- Total Body Trunk Composition Tissue
- Total Body Trunk Composition Region Fat
- Total Body Trunk Composition BMC
- Total Body Trunk Composition Fat
- Total Body Trunk Composition Lean
- Total Body Fat Mass Ratio Legs/Total
- Total Body Fat Mass Ratio Trunk/Total
- Total Body Arms Composition Tissue Fat
- Total Body Arms Composition Total Mass
- Total Body Android Composition BMC
- Total Body Arms Composition Tissue
- Total Body Arms Composition Region Fat
- Total Body Arms Composition BMC
- Total Body Arms Composition Fat
- Total Body Arms Composition Lean
- Total Body Android Composition Fat
- Total Body Android Composition Lean
- Total Body Arms BMC
- Total Body Arms BMD
- Total Body Fat Mass Ratio Extremities/Total
- Total Body Arms Area
- Total Body Android Composition Total Mass
- Total Body Android Composition Region Fat
- Total Body Android Composition Tissue
- Total Body Android Composition Tissue Fat
- Total Body Left Arm BMC
- Total Body Left Arm BMD
- Total Body Left Leg BMC
- Total Body Left Leg BMD
- Total Body Left Leg Composition BMC
- Total Body Left Leg Area
- Total Body Left Trunk Composition Total Mass
- Total Body Left Trunk Composition Region Fat
- Total Body Left Trunk Composition Tissue
- Total Body Left Trunk Composition Tissue Fat
- Total Body Left Leg Composition Fat
- Total Body Left Leg Composition Lean
- Total Body Left Total BMC
- Total Body Left Total BMD
- Total Body Left Total Composition BMC
- Total Body Left Total Area
- Total Body Left Leg Composition Total Mass
- Total Body Left Leg Composition Region Fat
- Total Body Left Leg Composition Tissue
- Total Body Left Leg Composition Tissue Fat
- Total Body Left Trunk Composition Lean
- Total Body Left Trunk Composition Fat
- Total Body Left Arm Composition Tissue Fat
- Total Body Left Arm Composition Total Mass
- Total Body Legs Composition BMC
- Total Body Left Arm Composition Tissue
- Total Body Left Arm Composition Region Fat
- Total Body Left Arm Composition BMC
- Total Body Left Arm Composition Fat
- Total Body Left Arm Composition Lean
- Total Body Legs Composition Fat
- Total Body Legs Composition Lean
- Total Body Left Trunk BMC
- Total Body Left Trunk BMD
- Total Body Left Trunk Composition BMC
- Total Body Left Trunk Area
- Total Body Legs Composition Tissue Fat
- Total Body Legs Composition Region Fat
- Total Body Legs Composition Tissue
- Assessment
25.6 Waist-to-Hip Measurement
Description of Equipment: The measurements of the waist and hips were done with measuring tape. Once measured (in cm), the waist and hip circumferences are divided = waist/hip. Example for a man waist is 40” and a 38” (inches) hip would be (40/38) = 1.05 which may indicate that they are at a higher risk for disease. Each measurement was made 3 times and the average computed. The “umbilicus” was also measured which is the waist measurement at the “belly-button”.
The NIH provided a protocol for the measurement of waist circumference for the Multi‐Ethnic Study of Atherosclerosis (MESA) study. This protocol indicates that the waist measurement should be made at the level of the umbilicus or navel. However, published reports indicate that measurements of waist circumference made at the level of the umbilicus may underestimate the true waist circumference (CROFT et al. 1995). Some studies have assessed the waist circumference at the point of the minimal waist (Ross et al. 2008).
Normal Ranges/Interpretation
| Men | Women | Disease Risk |
|---|---|---|
| < .95 | < .80 | Very Low |
| 0.96-0.99 | 0.81-0.84 | Low |
| > 1.00 | > 0.85 | High |
25.7 Holtain Skin Fold Thickness Calipers
Name of Equipment: Anthropometric Measurement Techniques Holtain Calipers
Description of Equipment: Measurement of body girths at different sites such as: Chest (men), Abdomen (men), Thigh (men and women), Triceps (women), Supraillium (women). The reason being is that most men collect all of their fat in the abdomen and chest. Most women collect fat in the triceps and around the waist and thighs. Calipers are one of the few measurements to take because of cost and time.
Type of Measurement: Measuring the body fat area then calculated the measurements a total of three attempts. The calculation answer will be the BMI which is then categorized along with your height and weight and age. This determines if you are under the underweight, normal, overweight, and obese category. Measurements range from 0-100 mm.
Data fields reported:
- TOTAL_BODYFAT
- SF_TRICEPS3
- SF_TRICEPS2
- SF_TRICEPS1
- SF_THIGH3
- SF_THIGH2
- SF_THIGH1
- SF_SUPRAILIAC3
- SF_SUPRAILIAC2
- SF_SUPRAILIAC1
- SF_SUBSCAPULAR3
- SF_SUBSCAPULAR2
- SF_SUBSCAPULAR1
- SF_MIDAXILLARY3
- SF_MIDAXILLARY2
- SF_MIDAXILLARY1
- SF_CHEST3
- SF_CHEST2
- SF_CHEST1
- SF_ABDOMINAL3
- SF_ABDOMINAL2
- SF_ABDOMINAL1
- NOTES
- MEASUREMENT_TYPE
- INCOMPLETE
25.8 GE T2100 Treadmill Modified Blake Protocol
Name of Equipment: GE Treadmill 2100
Description of Equipment: Our fitness test that was completed on the treadmill is known as the Bruce Protocol. This test measures the participant’s ability to adjust to increasing levels of exercise. Unlike a doctor’s office stress test, we are not pushing people to a level of exercise that they are not comfortable with. Instead, a target heart rate is used that is based on established data for each person’s age and gender.
Type of Measurement: Exercise level by using the participant’s target heart rate which is 220-age. Example 220-25 = 195.
Measurements reported:
| Field Description | Integer | Digits | Units |
|---|---|---|---|
| Target Heart Rate | positive | 0-300 | BPM |
| Grade | positive | 0-30% | percentage |
| Miles Per Hour (mph) | positive | 0-6 | MPH |
| MET | positive | 0-24 | whole number |
| Modified Balke Protocol | pick list (yes or no) | a protocol | a protocol |
| Bruce Protocol | pick list (yes or no) | a protocol | a protocol |
| VO2 Max Estimate | positive | calculated equation | volume of oxygen |
| Heart Rate | positive | 0-200 | BPM |
25.9 Vivid 7 Ultrasound Caroid IMT
Name of Equipment: GE Vivid 7 Ultrasound
Description of Equipment: This is a measure of how thick the wall of the artery in the participant’s neck (carotid artery) is. That is one measure of the status of their blood vessels. In a group of very healthy people age 20-70 years, carotid IMT increased on average with age (see graph). However, some older people had low numbers. We think the low numbers are healthier and we will discover whether that is the case by studying a large number of people over time, including you. For example, the report could say “Your carotid IMT is 0.42 mm and the large star on the graph shows where you fit in the normal population.”
Type of Measurement: Measures thickness of carotid artery.
Normal Ranges/Interpretation: This result indicates that your carotid IMT thickness is less than the average for people your age, possibly indicating better than average vascular health.
Measurements include:
| Field Description | Integer | Digits | Units |
|---|---|---|---|
| RCNW (mm) | positive | 0.001-1.0 | mm |
| RCRW (mm) | positive | 0.001-1.0 | mm |
| Right Mean Carotid IMT (mm) | positive | 0.001-1.0 | mm |
| LCNW (mm) | positive | 0.001-1.0 | mm |
| LCFW (mm) | positive | 0.001-1.0 | mm |
| Left Mean Carotid IMT (mm) | positive | 0.001-1.0 | mm |
| Plaque (yes or no) | yes or no | yes or no | yes or no |
25.10 SphygmoCor Pulse Wave Velocity
Name of Equipment: SphygmoCor Pulse Wave Analysis, SCOR-PX
Description of Equipment: This is a special measure of blood pressure that interprets the pulse wave generated by the beating heart to estimate the pressure in your aorta, the large blood vessel that carries blood from the heart throughout the body. There is some evidence that this measure of blood pressure is a better predictor of how healthy your blood vessels are than blood pressure the usual way it is taken.
Approximate Time to Complete: 15 minutes
Type of Measurement: Average Pulse height, Pulse height variation, Diastolic variation, Shape deviation, and your central blood pressure.
Normal Ranges/Interpretation: Average Pulse height - greater than 80, Pulse height variation- less than 5, Diastolic variation- less than 5, Shape deviation- less than 2.
Measurements include:
| Field Description | Integer | Digits | Units |
|---|---|---|---|
| Central Systolic Pressure | positive | 0-300 | mmHg |
| Central Diastolic Pressure | positive | 0-300 | mmHg |
| Central Pulse Pressure | positive | 0-200 | mm Hg |
| Central Augment Index | positive | 0-100 | percentage |
| Augmentation Pressure | positive | 0-100 | mmHg*ms |
25.11 Itamar Endo-Pat2000
Name of Equipment: Itamar Endo-PAT2000 (EP), Itamar Medical Ltd.
Description of Equipment: The Endo-PAT2000 device is a non-invasive, intended for use as a diagnostic aid in the detection of coronary artery Endothelial Dysfunction (positive or negative) using a reactive hyperemia procedure.
Type of Measurement: Any kind of dysfunction in the Endothelial layer means some of some blockage in the body.
This device aids in the detection of the overall functioning of the arteries in the heart. The results from the Endo-Pat have been shown to be predictive of early heart disease and artery dysfunction but is not intended to be diagnostic. Reactive Hyperemia Index (RHI) and Augmentation Index (AI) are reported.
Normal Ranges/Interpretation for RHI:
- RHI > 1.67-Normal, Above 1.67 means there is no Endothelial Dysfunction.
- RHI < 1.67-Abnormal, Below 1.67 means there is Endothelial dysfunction.
25.12 Flow Mediated Dilation Ultrasound
Data Fields:
- PARTICIPANT_FASTING
- OPERATOR
- NOTES
- INCOMPLETE
- HYPEREMIA_VTI
- HYPEREMIA_QRS3
- HYPEREMIA_QRS2
- HYPEREMIA_QRS1
- HYPEREMIA_PEAKV
- HYPEREMIA_MEAN
- HYPEREMIA_HR
- FMD_PCT
- DATE_PERFORMED
- BASELINE_VTI
- BASELINE_QRS3
- BASELINE_QRS2
- BASELINE_QRS1
- BASELINE_PEAKV
- BASELINE_MEAN
- BASELINE_HR
- AFTER_BLOOD_DRAW
- ABSOLUTE_CHANGE
References
CROFT, JANET B., NORA L. KEENAN, DAVID P. SHERIDAN, FRANCES C. WHEELER, and MARJORIE A. SPEERS. 1995. “Waist-to-Hip Ratio in a Biracial Population.” Journal of the American Dietetic Association 95 (1). Elsevier BV:60–64. https://doi.org/10.1016/s0002-8223(95)00014-3.
Ross, R., T. Berentzen, A. J. Bradshaw, I. Janssen, H. S. Kahn, P. T. Katzmarzyk, J. L. Kuk, et al. 2008. “Does the Relationship Between Waist Circumference, Morbidity and Mortality Depend on Measurement Protocol for Waist Circumference?” Obesity Reviews 9 (4). Wiley:312–25. https://doi.org/10.1111/j.1467-789x.2007.00411.x.