Lean body mass
Lean body mass (LBM), sometimes conflated with fat-free mass, is a component of body composition. Fat free mass (FFM) is calculated by subtracting body fat weight from total body weight: total body weight is lean plus fat. In equations:
- LBM = BW − BF
- Lean body mass equals body weight minus body fat
- LBM + BF = BW
- Lean body mass plus body fat equals body weight
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LBM differs from FFM in that cellular membranes are included in LBM although this is only a small percent difference in the body's mass (up to 3% in men and 5% in women)[1]
The percentage of total body mass that is lean is usually not quoted – it would typically be 60–90%. Instead, the body fat percentage, which is the complement, is computed, and is typically 10–40%. The lean body mass (LBM) has been described as an index superior to total body weight for prescribing proper levels of medications and for assessing metabolic disorders, as body fat is less relevant for metabolism. LBW is used by anesthesiologists to dose certain medications. For example, due to the concern of postoperative opioid-induced ventilatory depression in the obese patient, opioids are best based on lean body weight. The induction dose of propofol should also be based on LBW.[2]
Estimation
LBM is usually estimated using mathematical formulas. Several formulas exist, having different utility for different purposes. For example, the Boer formula is method of choice for LBM estimation to calculate the dose given in contrast CT in obese individuals with BMI between 35 and 40.[3]
A nomogram based on height, weight and arm circumference may be used.[4]
Boer
The Boer formula is:[3]
For men: LBM = (0.407 × W) + (0.267 × H) − 19.2
For women: LBM = (0.252 × W) + (0.473 × H) − 48.3
where W is body weight in kilograms and H is body height in centimeters.
Hume
The following formula by Hume may be used:[5]
For men: LBM = (0.32810 × W) + (0.33929 × H) − 29.5336
For women: LBM = (0.29569 × W) + (0.41813 × H) − 43.2933
where W is body weight in kilograms and H is body height in centimeters.
Actual measurement
Instead of mathematical estimation the actual value of LBM may be calculated using various technologies such as Dual-energy X-ray absorptiometry (DEXA).
References
- Yu, S; Visvanathan, T; Field, J; Ward, LC; Chapman, I; Adams, R; Wittert, G; Visvanathan, R (14 October 2013). "Lean body mass: the development and validation of prediction equations in healthy adults". BMC Pharmacology & Toxicology. 14: 53. doi:10.1186/2050-6511-14-53. PMC 3833312. PMID 24499708.
LBM differs from FFM in that lipid in cellular membranes are included in LBM but this accounts for only a small fraction of total body weight (up to 3% in men and 5% in women)
- Stoelting's Anesthesia and Co-Existing Disease, 6th Edition. Pages 329-330.
- Caruso, Damiano; De Santis, Domenico; Rivosecchi, Flaminia; Zerunian, Marta; Panvini, Nicola; Montesano, Marta; Biondi, Tommaso; Bellini, Davide; Rengo, Marco; Laghi, Andrea (13 August 2018). "Lean Body Weight-Tailored Iodinated Contrast Injection in Obese Patient: Boer versus James Formula". BioMed Research International. 2018: 8521893. doi:10.1155/2018/8521893. ISSN 2314-6133. PMC 6110034. PMID 30186869.
- Fuchs, RJ; Theis, CF; Lancaster, MC (1 April 1978). "A nomogram to predict lean body mass in men". The American Journal of Clinical Nutrition. 31 (4): 673–8. doi:10.1093/ajcn/31.4.673. PMID 637039.
- Hume, R (Jul 1966). "Prediction of lean body mass from height and weight". Journal of Clinical Pathology. 19 (4): 389–91. doi:10.1136/jcp.19.4.389. PMC 473290. PMID 5929341.