Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Health issues and nutrition in the elderly

Body size normalization of ultrasound measured anterior upper leg muscle thickness in younger and older males and females

European Journal of Clinical Nutrition volume 76, pages 958–963 (2022)Cite this article

Subjects

Abstract

Background

Ultrasound measurements of the anterior upper leg muscle thickness are often used to quantify muscle mass; however, the ideal normalization approach is unclear. Our primary objective was to examine how the anterior upper leg muscle thickness scales with indices of body size in younger and older adults. Our secondary objectives were to examine how normalization with body size alters the identification of low muscle thickness and associations with strength and physical function.

Methods

Younger (<45 years) males (n = 38) and females (n = 24) and older (≥60 years) males (n = 53) and females (n = 24) were evaluated for anthropometrics and anterior upper leg muscle thickness. Allometric models were used to examine how body size metrics scale with anterior upper leg muscle thickness. A subset of older males was evaluated for strength and function.

Results

Weight and BMI scaled with anterior upper leg muscle thickness with coefficients less than 1 (0.58 to 0.82, r2 = 0.15 to 0.31, p < 0.05) for both younger and older males and females. Compared to absolute anterior upper leg thickness, normalized indices identified a greater proportion of older adults with low muscle thickness (p < 0.05). Absolute muscle thickness provided stronger associations with strength compared to weight normalized indices.

Conclusions

Scaling exponents less than 1 for weight and BMI for the anterior upper leg muscle thickness indicate that allometric normalization is the ideal approach to develop body size independent metrics. However, allometric normalization of muscle thickness increases the proportion of older adults classified as low muscle mass but decreased the associations with strength.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Correlation coefficients for anterior upper leg scaling factors.

Similar content being viewed by others

References

  1. Heymsfield SB, Heo M, Thomas D, Pietrobelli A. Scaling of body composition to height: relevance to height-normalized indexes. Am J Clin Nutr. 2011;93:736–40.

    Article  CAS  Google Scholar 

  2. Heymsfield SB, Peterson CM, Thomas DM, Heo M, Schuna JM, Hong S, et al. Scaling of adult body weight to height across sex and race/ethnic groups: relevance to BMI. Am J Clin Nutr. 2014;100:1455–61.

    Article  CAS  Google Scholar 

  3. Gonzalez MC, Correia MITD, Heymsfield SB. A requiem for BMI in the clinical setting. Curr Opin Clin Nutr Metab Care [Internet]. 2017;20:314–21.

  4. Paris MT, Lafleur B, Dubin JA, Mourtzakis M. Development of a bedside viable ultrasound protocol to quantify appendicular lean tissue mass. J Cachexia Sarcopenia Muscle. 2017;8:713–26.

    Article  Google Scholar 

  5. Sanada K, Kearns CF, Midorikawa T, Abe T. Prediction and validation of total and regional skeletal muscle mass by ultrasound in Japanese adults. Eur J Appl Physiol [Internet]. 2006;96:24–31.

    Article  Google Scholar 

  6. Paris MT, Letofsky N, Mourtzakis M. Site-specific skeletal muscle echo intensity and thickness differences in subcutaneous adipose tissue matched older and younger adults. Clin Physiol Funct Imaging. 2021;41:156–64.

  7. Abe T, Loenneke JP, Thiebaud RS, Fukunaga T. Age-related site-specific muscle wasting of upper and lower extremities and trunk in Japanese men and women. Age (Dordr) [Internet]. 2014;36:813–21.

    Article  Google Scholar 

  8. Kara M, Kaymak B, Ata AM, Özkal Ö, Kara Ö, Baki A, et al. STAR - Sonographic thigh adjustment ratio: a golden formula for the diagnosis of sarcopenia. Am J Phys Med Rehabil. 2020;99:902–8.

    Article  Google Scholar 

  9. Wilson DV, Moorey H, Stringer H, Sahbudin I, Filer A, Lord JM, et al. Bilateral anterior thigh thickness: a new diagnostic tool for the identification of low muscle mass? J Am Med Dir Assoc. 2019;20:1247–.e2.

    Article  Google Scholar 

  10. Nuzzo JL, Mayer JM. Body mass normalisation for ultrasound measurements of lumbar multifidus and abdominal muscle size. Man Ther [Internet]. 2013;18:237–42.

    Article  Google Scholar 

  11. Heymsfield SB, Hwaung P, Ferreyro-Bravo F, Heo M, Thomas DM, Schuna JM. Scaling of adult human bone and skeletal muscle mass to height in the US population. Am J Hum Biol. 2019;31:1–12.

    Google Scholar 

  12. Moore K. The developing human: clinically oriented embryology. Philadelphia: WB Saunderes; 1988.

  13. Paris M, Bell KE, Avrutin E, Mourtzakis M. Ultrasound image resolution influences analysis of skeletal muscle composition. Clin Physiol Funct Imaging. 2020;40:277–83.

    Article  Google Scholar 

  14. Paris MT, Bell KE, Avrutin E, Mourtzakis M. Older males exhibit reduced anterior upper leg and anterior abdominal muscle thickness compared to younger males when matched for relative appendicular lean tissue. Arch Gerontol Geriatr. 2021;96:104483. Sep

    Article  CAS  Google Scholar 

  15. Paris MT, Bell KE, Avrutin E, Mourtzakis M. Associations between skeletal muscle echo intensity and thickness in relation to glucose homeostasis in healthy and glucose impaired older males. Exp Gerontol. 2021;154:111547. June

    Article  CAS  Google Scholar 

  16. Crapo R, Casaburi R, Coates A, Enright P, MacIntrye N, McKay R, et al. American Thoracic Society ATS Statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166:111–7.

    Article  Google Scholar 

  17. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis. Age Ageing. 2018;39:412–23.

    Article  Google Scholar 

  18. Rustani K, Kundisova L, Capecchi PL, Nante N, Bicchi M. Ultrasound measurement of rectus femoris muscle thickness as a quick screening test for sarcopenia assessment. Arch Gerontol Geriatr [Internet]. 2019;83:151–4.

    Article  Google Scholar 

  19. Minetto MA, Caresio C, Menapace T, Hajdarevic A, Marchini A, Molinari F, et al. Ultrasound-based detection of low muscle mass for diagnosis of sarcopenia in older adults. PM R [Internet]. 2016;8:453–62.

    Article  Google Scholar 

  20. Derstine BA, Holcombe SA, Ross BE, Wang NC, Su GL, Wang SC. Optimal body size adjustment of L3 CT skeletal muscle area for sarcopenia assessment. Sci Rep. [Internet]. 2021;11:1–10.

    Google Scholar 

Download references

Funding

This research was funded by the Network for Aging Research at the University of Waterloo. MTP was supported by a CIHR Doctoral research award and KEB was supported by a CIHR Fellowship.

Author information

Authors and Affiliations

  1. Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada

    Michael T. Paris, Kirsten E. Bell, Egor Avrutin & Marina Mourtzakis

Authors
  1. Michael T. Paris
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kirsten E. Bell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Egor Avrutin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marina Mourtzakis
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MTP and MM designed the research; MTP, KEB, and EA conducted all data collections; MTP performed all statistical analysis; MTP drafted the manuscript; all authors have responsibility for the final content and read and approved the final manuscript.

Corresponding author

Correspondence to Marina Mourtzakis.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Paris, M.T., Bell, K.E., Avrutin, E. et al. Body size normalization of ultrasound measured anterior upper leg muscle thickness in younger and older males and females. Eur J Clin Nutr 76, 958–963 (2022). https://doi.org/10.1038/s41430-022-01070-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41430-022-01070-0

Search

Advanced search

Quick links