Diagnostic and prognostic relevance of imaging-based body composition analysis in postmenopausal women: a review

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Abstract

The article presents an assessment of body composition markers measured by imaging in clinical practice for postmenopausal and aging women. Body composition changes with aging and is specifically affected by endocrinological changes occurring with menopause. Several imaging markers have been proposed and used in the assessment of body composition status. The associations of different imaging markers with cardiometabolic risk and risks for other diseases, with impact on morbidity/mortality, functional impairment, and frailty, are discussed. The imaging markers confirmed by evidence and are applicable to clinical practice are highlighted. With this purpose, the current level of evidence in the literature on reliability and potential associations of each relevant marker was reviewed.

This review describes what can and should be done with available imaging tools (e.g., dual-energy x-ray absorptiometry, ultrasound, computed tomography, and magnetic resonance imaging) in dedicated and opportunistic settings (i.e., tests for assessing body composition vs those for other clinical reasons but wherein exploitation of imaging data is possible) to improve the management and understanding of lifestyle needs of postmenopausal women and thus to prevent or decrease unhealthy aging and rate of women with aging-related diseases.

About the authors

Maria P. Aparisi Gómez

Te Toka Tumai Auckland (Auckland District Health Board); Waipapa Taumata Rau — University of Auckland

Email: pilar.aparisi@tewhatuora.govt.nz
ORCID iD: 0000-0002-6483-7139
New Zealand, Auckland; Auckland

Miriana R. Petrera

National Institute for Infectious Disease “Lazzaro Spallanzani”

Email: mirianapetrera@gmail.com
ORCID iD: 0000-0002-1275-6265
Italy, Rome

Aurelia Santoro

University of Bologna, Sant'Orsola-Malpighi Hospital

Email: aurelia.santoro@unibo.it
ORCID iD: 0000-0002-7187-1116

MD, PhD, Associate Professor

Italy, Bologna

Maria L. Petroni

University of Bologna, Sant'Orsola-Malpighi Hospital

Email: marialetizia.petroni@unibo.it
ORCID iD: 0000-0002-7040-6466

MD, Associate Professor

Italy, Bologna

Chiara Gasperini

IRCCS Istituto Ortopedico Rizzoli

Email: chiara.gasperini@unibo.it
ORCID iD: 0000-0002-5306-0985
Italy, Bologna

Claudio Franceschi

University of Bologna, Sant'Orsola-Malpighi Hospital

Email: claudio.franceschi@unibo.it
ORCID iD: 0000-0001-9841-6386

MD, Professor

Italy, Bologna

Giulio Marchesini

University of Bologna, Sant'Orsola-Malpighi Hospital

Email: giulio.marchesini@unibo.it
ORCID iD: 0000-0003-2407-9860

MD, Professor

Italy, Bologna

Giuseppe Guglielmi

University of Foggia; “IRCCS Casa Sollievo della Sofferenza” Hospital

Author for correspondence.
Email: giuseppe.guglielmi@unifg.it
ORCID iD: 0000-0002-4325-8330

MD, Professor

Italy, Foggia; San Giovanni Rotondo

Alberto Bazzocchi

IRCCS Istituto Ortopedico Rizzoli

Email: abazzocchi@gmail.com
ORCID iD: 0000-0002-2659-4535
Italy, Bologna

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2. Fig. 1. Analysis of body composition using dual-energy X-ray absorptiometry. The measurements are based on a three-component model, which for simplicity can be represented as fat mass (FM — yellow), lean mass excluding bones (LM — red), and bone mineral content (BMC — white). By examining the whole body and individual areas, it is possible to estimate body mass and bone mineral density.

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3. Fig. 2. Linear measurements of adipose tissue based on ultrasound and computed tomography data: a — minimum abdominal skinfold thickness (MinASFT) is defined as the distance between the anterior surface of the linea alba and the dermo-hypodermal junction (1), measured in a plane passing through the subcostal region. The thickness of preperitoneal fat (2) is measured from the anterior surface of the peritoneum covering the liver to the posterior surface of the linea alba in a plane passing through the subcostal region; b — maximum abdominal skinfold thickness (MaxASFT) is defined as the distance between the anterior surface of the linea alba and the dermo-hypodermal junction (3), measured at the level of the suprapubic region. The thickness of intra-abdominal fat is usually measured as the distance from the posterior wall of the abdominal muscle to the anterior wall of the aorta in the suprapubic region (4).

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4. Fig. 3. Measurement of the area of various fat compartments using magnetic resonance imaging: a — image obtained in T1-weighted Fast Spin Echo mode at the level of the II–III lumbar vertebrae; b — segmentation of subcutaneous adipose tissue (orange), visceral adipose tissue (yellow) and non-adipose tissue (blue). Gas in the intestinal loops is visualised as black areas, and bone tissue as white areas.

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