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Outcomes · Body composition · continued

DXA precision and the least significant change for lean mass — the long version posts 31–60

This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.

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IsaksenTL3Regular12 May 2025#31

Post #29 describes the usual case. This is about the unusual one.

Air displacement plethysmography and hydrostatic weighing have their own precision limits and their own protocol sensitivities. None of these are exact.

Genuinely open to being wrong about this one.

30 likes 15mo
SV
s.vogelTL212 May 2025#32
f.haddad, post #24: On post #22 — agreed on the reasoning, with one qualification. Precision versus accuracy: the precision you need depends on what question you are answering. "Am I losing fat?" requires less precision than "Is my lean mass preservation within the expected range?" Go to post

Adding the measurement that post #29 says would settle it.

If someone has run DXA precision properly I would rather read that than my own reconstruction of it. Posting mine only because the thread has gone quiet.

15 likes in reply to #24 15mo
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KStephanopoulosTL3Regular12 May 2025#33

Neither method is capable of detecting the month-to-month changes that people report detecting month to month.

The number is defensible. The precision I gave it is not.

6 likes 15mo
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h.castellanosTL212 May 2025#34

DXA (dual-energy X-ray absorptiometry): the standard for body composition in research. Precision is roughly ±1 kg for lean mass. Two scans six months apart on the same machine with the same technician give you useful information. Two scans six weeks apart on different machines tell you about the machines.

The strength of my opinion here exceeds the strength of my evidence.

1 like 15mo
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footnote_entryTL313 May 2025#35
MO
m.oyelaranTL213 May 2025#36
Isaksen, post #31: Post #29 describes the usual case. This is about the unusual one. Air displacement plethysmography and hydrostatic weighing have their own precision limits and their own protocol sensitivities. None of these are exact. Genuinely open to being wrong about this one. Go to post

The version of DXA precision that circulates here is a simplification of a simplification. It is not wrong, but it has lost the conditions under which it holds, and those conditions are where the interesting cases live.

10 likes in reply to #31 15mo
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n.rowntreeTL3Regular13 May 2025 · edited#37

Nothing to add, except that this is the answer I would give if asked.

3 likes 15mo
PF
p.fontaineTL213 May 2025#38

Post #36 is right about the mechanism and I think understates the practical bit.

Where a scan disagrees with the mirror over a short period, the scan's precision limits are usually the explanation.

The part I am sure of is shorter than the part I have written.

0 likes 15mo
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BirkelandTL3Regular14 May 2025#39
g.radich, post #8: Answering the question post #5 raises rather than the one it answers. Filing a mild objection to the consensus on DXA precision. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit. Go to post

My experience of DXA precision contradicts the reply above. I am posting it as a data point rather than as a refutation, because one person's experience is exactly that.

0 likes in reply to #8 14mo
DB
da.bakkerTL214 May 2025#40

Comparison to published data: the trials reported mean fat and lean mass changes. Individual results vary around that mean. Being above or below average is not a sign of something wrong.

Nothing above should be read as advice about what anyone else should do.

29 likes 14mo
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t.tullochTL214 May 2025#41

Post #38 answers the question as asked. The question underneath it is different.

Resting metabolic rate: body composition affects metabolic rate. As fat mass decreases and lean mass is maintained, metabolic rate is usually maintained better than with simple weight loss alone.

If it helps: the failure mode here is usually boring rather than dramatic.

21 likes 14mo
VD
vial_deskTL3Regular14 May 2025#42
f.petrov, post #13: Circumference measurements at marked sites, taken consistently, track composition change better than most people expect for the cost. Go to post

Maintenance phase: tracking body composition during maintenance (weight stable) is different from tracking during active loss. Changes are smaller and precision becomes more important.

0 likes in reply to #13 14mo
GE
g.ekstromTL214 May 2025 · edited#43

Following this. I have the same question and no better information than the first post.

2 likes 14mo
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BBramleyTL3Regular15 May 2025#44

Visceral fat: DXA does not distinguish visceral (organ-associated) fat from subcutaneous fat. That distinction might matter but requires different imaging to measure.

I have changed my mind on this once already, so take it as current rather than settled.

9 likes 14mo
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i.amankwahTL215 May 2025#45

Post #42 is right about the mechanism and I think understates the practical bit.

Precision versus accuracy: the precision you need depends on what question you are answering. "Am I losing fat?" requires less precision than "Is my lean mass preservation within the expected range?"

A weak preference rather than a position.

28 likes 14mo
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LeitermanTL3Regular15 May 2025#46
gradient_review, post #9: Visceral fat: DXA does not distinguish visceral (organ-associated) fat from subcutaneous fat. That distinction might matter but requires different imaging to measure. Written in the hope of being told what I have missed. Go to post

Coming back to post #44, because the follow-up matters more than the original answer.

Bone mineral density changes with substantial weight loss are measurable and slow, and are one of the better reasons to have a baseline scan.

Filing this under things that are true until someone shows me otherwise.

0 likes in reply to #9 14mo
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a.lindqvistTL215 May 2025#47

Lean mass loss during rapid weight reduction: depends on protein intake, resistance training volume, and total energy deficit. Adequate protein and maintaining training intensity both help preserve lean mass.

5 likes 14mo
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j.vandermolenTL3Regular16 May 2025#48

DXA on the same machine with the same technician has a least significant change for lean mass of roughly a kilogram, sometimes more. Below that, two scans are the same scan.

14 likes 14mo
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a.hartmannTL216 May 2025#49

The strongest argument against my own position on DXA precision, stated as well as I can state it, since nobody else has yet.

0 likes 14mo
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buffer_marginTL3Regular16 May 2025#50

That reframing is the whole thing. The facts I already had.

0 likes 14mo
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p.marchettiTL216 May 2025#51

Where a facility reports a precision figure for its own machine, that number is more useful than any published average.

Adding a source would improve this post and I do not have one to hand.

7 likes 14mo
DB
d.bakkerTL216 May 2025#52

The arithmetic in post #51 is right; the assumption feeding it is the part to check.

Bioelectric impedance analysis: less precise than DXA and strongly affected by hydration state. Not reliable for detecting month-to-month changes. Useful for trend over years if done consistently.

Not disagreeing with anyone above, just adding the bit I keep having to look up.

1 like 14mo
EV
e.verhoevenTL217 May 2025#53
unit_conversion, post #21: Comparison to published data: the trials reported mean fat and lean mass changes. Individual results vary around that mean. Being above or below average is not a sign of something wrong. Go to post

Noted, and thank you for writing it out rather than summarising it.

33 likes in reply to #21 14mo
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l.solbergTL217 May 2025#54
br.wikstrom, post #10: On post #8 — agreed on the reasoning, with one qualification. Resting metabolic rate: body composition affects metabolic rate. As fat mass decreases and lean mass is maintained, metabolic rate is usually maintained better than with simple weight loss alone. Go to post

Comparing a body composition result against a population reference is a different exercise from tracking your own change, and the second is what most people want.

Not the answer, but possibly the question that gets there.

17 likes in reply to #10 14mo
MP
mira.patelTL4 Admin17 May 2025#55

Everything in post #51 holds. The case it does not cover is the one I have.

Absolute lean mass and lean mass as a proportion move differently and answer different questions. Report both or say which.

It is one reading of the data and not the only reasonable one.

3 likes 14mo
RL
r.laurentTL217 May 2025 · edited#56

Narrowing post #55, because the general version has more than one answer.

Photographs under fixed lighting and posture are a genuine record and are the hardest of these to standardise.

That is a description of practice, not a recommendation of it.

0 likes 14mo
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owen.bradyTL4 Moderator18 May 2025#57

Lean mass in these measurements includes water, so a change in hydration appears as a change in lean mass.

24 likes 14mo
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c.boatengTL218 May 2025#58
vial_table, post #16: Adding the measurement that post #15 says would settle it. The most useful protocol is the one you will actually repeat identically. An imperfect measurement repeated consistently beats a better one repeated carelessly. A qualification I should have led with rather than closed on. Go to post

Preserving lean tissue during a substantial deficit depends on protein intake and a resistance stimulus, and the evidence for both is reasonably strong.

11 likes in reply to #16 14mo
HN
h.nwosuTL218 May 2025#59

Percentage body fat is a ratio, so it changes when either component changes. A rising percentage during weight loss is arithmetic before it is physiology.

Written from notes rather than memory, which is why the numbers are specific.

1 like 14mo
TS
taper_shiftTL3Regular18 May 2025#60
r.laurent, post #56: Narrowing post #55, because the general version has more than one answer. Photographs under fixed lighting and posture are a genuine record and are the hardest of these to standardise. That is a description of practice, not a recommendation of it. Go to post

Circumference measurements at marked sites, taken consistently, track composition change better than most people expect for the cost.

0 likes in reply to #56 14mo