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PubMed1999

Assessing body composition of adults with diabetes.

Overweight and obesity are associated with the development of type 2 diabetes. Thus, it is important for clinicians to accurately measure and monitor the body composition of at-risk individuals and patients with diabetes. This article reviews valid and reliable field methods and prediction equations for assessing the body composition of obese individuals, as well as persons with type 2 diabetes. We also reviewed research that assessed the validity of practical methods in estimating the body composition of individuals with either type 1 or type 2 diabetes.

Absorptiometry, Photon↗

PubMed1999

Unfavourable impact of growth hormone (GH) discontinuation on body composition and cholesterol profiles after the completion of height growth in GH-deficient young adults.

AIM: Growth hormone (GH) plays an important role in the regulation of body composition and metabolism. GH deficiency is associated with obesity and hypercholesterolemia, which respond to GH treatment. In this study we evaluated changes in body composition and cholesterol profiles after discontinuation of GH therapy to assess atherogenic risk factors in GH-deficient patients. METHODS: We studied 18 male patients with GH deficiency 17-20 years of age at the time of discontinuing GH therapy. Body composition and cholesterol were measured 6 months before discontinuation of GH therapy with a weekly dose of 0.5 IU/kg (approximately 0.19 mg/kg), and immediately, 2 months, and 6 months after the end of GH therapy. RESULTS: Two months after termination of GH therapy the percentage of body fat and fat mass increased from 7.4% to 9.4% and from 3.8 kg to 5.0 kg, respectively, and remained high thereafter. Lean body mass decreased gradually, but the change was not significant. Lean body mass: fat mass ratio decreased from 14.7 at termination of GH therapy to 10.9 at the end of study. Total cholesterol (TC) showed a significant linear increase from 156 mg/dl immediately after discontinuation to 169 mg/dl 6 months after discontinuation of GH, whereas high-density lipoprotein cholesterol (HDLC) showed no change during the study. The TC to HDLC ratio showed a slight but insignificant trend toward an increase. There were no significant changes in any variables during the last 6 months of GH therapy. CONCLUSION: GH therapy in patients with GH deficiency can reduce risk factors for obesity-related diseases and atherosclerosis. These beneficial effects are reversed after discontinuation of GH therapy. Further long-term studies of the effects of the GH withdrawal on lipid profiles, adiposity and life expectancy must be performed.

Adolescent↗

PubMed1992

Impact of dialysis modality on body composition in patients with end-stage renal disease.

Loss of muscle mass and altered body fat distribution (i.e. increased central fat stores in the presence of normal peripheral fat stores) have been reported in patients on hemodialysis (HD), when compared to normal volunteers. Whether treatment of end-stage renal disease (ESRD) with continuous ambulatory peritoneal dialysis (CAPD) would alter body composition in a different manner than HD is unknown. To answer this question, two groups (n = 11 each) of male patients with ESRD (matched for age, residual renal function, body weight and body height as well as physical activity) were studied. Muscle mass and body fat distribution were assessed using computed tomography. Mid-thigh muscle area, peripheral and central fat stores were similar between the two groups of dialysis patients. In both patient groups muscle mass and fat stores were independent of duration of dialysis, age, daily protein intake and residual renal function. In CAPD-patients mid-thigh muscle area was correlated with plasma albumin (r = 0.56, p < 0.05), while serum cholesterol level was correlated with mediastinal fat area (r = 0.81, p < 0.01). The present results indicate that both treatment modalities of ESRD (HD vs CAPD) result in similar changes of body composition. Despite continuous glucose loading in CAPD-patients, neither central nor peripheral fat stores are increased in these subjects compared with HD treated patients.

Adipose Tissue↗

PubMed2003

Effects of tibolone and conjugated equine estrogens with or without medroxyprogesterone acetate on body composition and fasting carbohydrate measures in surgically postmenopausal monkeys.

The effects of tibolone on body weight, body composition, and fasting carbohydrate measures in surgically postmenopausal cynomolgus monkeys were compared to those of conjugated equine estrogens (CEE) with and without medroxyprogesterone acetate (MPA). Monkeys were fed a moderately atherogenic diet with either no hormones (control n = 29), CEE (0.042 mg/kg, n = 27), CEE + MPA (0.167 mg/kg, n = 29), low-dose tibolone (LoTib, 0.05 mg/kg, n = 30), or high-dose tibolone (HiTib, 0.20 mg/kg, n = 31) daily for 2 years. Body weight (BW) was measured throughout the study, and dual-energy x-ray absorptiometry (DEXA) scans of the abdominal region (lumbar vertebrae 1 through 5) were performed at the end of the trial to assess abdominal body composition. Fasting carbohydrate measures (glucose, insulin, C-peptide, and fructosamine) were determined at baseline and after 2 years of treatment. Compared to controls, BW significantly increased and abdominal soft tissue mass was greater (analysis of variance [ANOVA], P <.001, P = 0.003, respectively) in all but the CEE-treated group (P =.78, P =.94, respectively). HiTib-treated monkeys had greater abdominal lean mass compared to controls (P =.008), while there was no significant treatment effect on abdominal fat mass (analysis of covariance [ANCOVA], P =.29). Fasting insulin concentrations and fasting insulin/glucose ratios were greater in CEE + MPA- (P =.002, P =.03, respectively) and HiTib-treated monkeys (P =.03, P =.02, respectively) compared to controls. There was a strong trend for a treatment effect on fasting blood glucose concentration (ANCOVA, P =.06) with CEE + MPA-treated animals having the greatest values, despite no difference in fructosamine concentration (ANCOVA, P =.57). Using these fasting measures, the homeostasis model assessment (HOMA-IR) revealed significant insulin resistance with CEE + MPA treatment compared to controls (P =.008), while the quantitative insulin sensitivity check index (QUICKI) showed significantly impaired insulin sensitivity in all hormone replacement therapy (HRT) groups (all P values <.03), except CEE (P =.12). In conclusion, HRT with CEE + MPA or tibolone results in greater BW, abdominal soft tissue, and insulin resistance (CEE + MPA and HiTib) compared to control-treated monkeys.

Animals↗

PubMed1979

Body composition in hypopituitary dwarfs before and during human growth hormone therapy.

The clinical characteristics and body composition of eight hypopituitary dwarfs (10.2-21.6 yr) were analyzed before and after 6 and 12 mo of growth hormone therapy. 2 IU 3 times/wk. Before treatment, growth rate was 1.8 +/- 0.7 cm/yr, height age was 2.0-12.8 yr less, and bone age 2.0-11.1 yr less than chronologic age. Total body water (TBW), lean body mass (LBM), extracellular water (ECW), and intracellular water (ICW) were below normal for chronologic age, but normal for height. Muscle mass (MM) was below normal for age and height. During HGH therapy, growth rate was 7.1 +/- 1.6 cm/yr in the first 6 mo and 7.8 +/- 1.4 cm/yr during the next 6 mo; the ratio of change in height age to change in chronologic age was greater than or equal to 1.0 in all patients and the ratio of change in bone age to change in height age was 1.2 in one patient and less than or equal to 1.0 in the others. TBW, LBM, ECW, and ICW increased according to height increments; however, MM increased at a faster rate than expected from the height gains. Also, a relative or absolute loss of total body fat was recorded during the first 6 mo of therapy. It is suggested (1) that among the body composition parameters studied, muscle mass is the tissue most closely reflecting the lack of HGH and also its therapeutic benefits and (2) evaluation of body composition in hypopituitary dwarfs in response to HGH therapy shows striking changes not reflected by the determination of stature or weight alone.

Adolescent↗

PubMed1996

Body composition differences between Polynesians and Caucasians assessed by bioelectrical impedance.

OBJECTIVE: To assess differences in body composition between Polynesians and Caucasians subjects. SUBJECTS: 48 male and 80 female Polynesians from a village in Rarotonga, Cook islands (81% response rate) and representative sample of 243 male and 250 female Caucasians from Melbourne, Australia. MEASUREMENTS: Body mass index, resistance from bioelectrical impedance, percent body fat derived from 4 equations using resistance, weight, height, age and sex. RESULTS: Male and female Polynesians were younger (by 7.7 years, P < 0.001 and 4.1 years, P < 0.05) and heavier (by 10.7 kg and 12.5 kg, P < 0.0001) than their Caucasian counterparts. Electrical resistance was significantly lower in Polynesians of both sexes by over 130 omega (P < 0.0001). At every level of weight (adjusted for height and age), resistance was lower in the Polynesians (P < 0.0001) and at every level of body mass index, the predicted body fat from 4 different equations was lower in Polynesians (P < 0.0001). CONCLUSIONS: These results imply that, at any given body size. Polynesians are significantly leaner than Caucasians and that specific Polynesian standards for defining obesity need to be developed. The findings will need to be confirmed by other reference methods for measuring body composition.

Adipose Tissue↗

PubMed2003

Body composition assessment: an indispensable tool for disease management.

Recent conceptual and technology advancements fostered a rapid development in the field of body composition assessment and provided new and powerful investigative tools. Densitometry, isotopic dilution, bioelectrical impedance, whole-body counting, neutron activation, X-ray absorptiometry, computed tomography, magnetic resonance imaging, and spectroscopy have been the most widely employed methods. The result of this effort is the discovery that body composition at both molecular and cellular or tissue levels is affected by virtually all the pathologic conditions found in medical textbooks. The field is now mature for the clinical translation of this research. Some applications rely on a very solid base and their clinical use has been fully codified. Others still need reference values diversified on a regional and ethnic scale, consensus for interpretation of values, and guidelines for clinical indications. Only after these requirements are satisfied will it be possible to adopt specific practical guidelines, the most reasonable basis for acceptance and accreditation by care providers. Some applications are already being used in several settings. Therefore, establishing the guidelines for clinical application of body composition assessment methods is not only important for physicians and their patients, but is also urgent so as to prevent misuse and to ensure correct communication with the media in this field.

Body Composition↗

PubMed1986

Growth, development and body composition in three genetic stocks of swine.

Differences in growth, chemical body composition and visceral organ development were evaluated in three genetic stocks: Beltsville Highfat (HF) and Lowfat (LF) Duroc-Yorkshire composites and a Hampshire X Large White cross (CX). Ten sets of littermate barrows were used from each stock. One pig from each set was slaughtered at 10, 17 and 24 wk of age. After slaughter, each pig was dissected into three fractions: carcass, head and feet, viscera and blood. Backfat was measured at three locations and visceral organs were weighed separately. Each fraction was frozen, ground, sampled and analyzed in duplicate for protein, fat, water and ash. The CX pigs were heaviest at all ages and contained the most fat-free mass (FFM). The HF pigs were smallest and contained the most fat, while LF pigs tended to be intermediate. The LF pigs deposited a greater proportion of weight in head and feet and a greater proportion of total FFM in the carcass than HF and CX pigs. Estimated allometric growth coefficients for non-fat chemical components relative to empty body weight (EBWT) were lower for HF than LF and CX, which were similar. Coefficients for fat were similar among stocks yet intercepts differed widely. Relative to total FFM, water increased at a faster rate and ash a slower rate in CX pigs compared to HF and LF. Growth coefficients were calculated for internal organs relative to EBWT. Coefficients for organs of the digestive tract were not different among stocks. However, significant differences among stocks were found for heart, lung, spleen and liver that were not explained by differences in body composition.

Animals↗

PubMed2000

Comparison of air-displacement plethysmography, hydrodensitometry, and dual X-ray absorptiometry for assessing body composition of children 10 to 18 years of age.

Body density (Db) of 54 boys and girls 10-18 years of age (13.9 +/- 2.4 years) was measured in an air-displacement plethysmograph, the BOD POD, and compared to Db determined by hydrodensitometry (HW). Both Db values were converted to percent body fat (%BF) using a two-component model conversion formula and compared to %BF determined by dual energy X-ray absorptiometry (DXA). Body density estimated from the BOD POD (1.04657 +/- 0.01825 g/cc) was significantly higher than that estimated from HW (1.04032 +/- 0.01872 g/cc). The relative body fat calculated from the BOD POD (23.12 +/- 8.39 %BF) was highly correlated but, on average, 2.9% BF lower than %BF DXA. Average %BF estimates from HW and DXA were not significantly different. Despite consistently underestimating the %BF of children, the strong relationship between DXA and the BOD POD suggests that further investigation may improve the accuracy of the BOD POD for assessing body composition in children.

Absorptiometry, Photon↗

PubMed2005

Body composition assessment in adults with cystic fibrosis: comparison of dual-energy X-ray absorptiometry with skinfolds and bioelectrical impedance analysis.

OBJECTIVE: We compared body composition measurement in adults with cystic fibrosis (CF) by using non-invasive methods (skinfold thicknesses and bioelectrical impedance analysis [BIA]) with dual-energy X-ray absorptiometry (DXA). METHODS: Seventy-six adults with CF (mean age 29.9 +/- 7.9 y, mean body mass index 21.5 +/- 2.5 kg/m(2)) were studied. Body composition was measured to calculate fat-free mass (FFM) using DXA, the sum of four skinfold thicknesses, and BIA (predictive equations of Lukaski and of Segal). RESULTS: Mean FFM values +/- standard deviation measured using DXA were 54.8 +/- 7.3 kg in men and 41.2 +/- 3.9 kg in women. Mean FFM values measured using BIA/Lukaski were 51.5 +/- 7.8 kg in men and 40.4 +/- 4.9 kg in women (P < 0.0005 for men, not significant for women for comparison with DXA). Mean FFM values measured using BIA/Segal were 54.2 +/- 7.5 kg for men and 44.1 +/- 5.9 kg for women (not significant for men, P < 0.0005 for women for comparison with DXA). Mean FFM values measured using skinfolds were significantly higher than those for FFM with DXA (57.2 +/- 7.2 kg in men, 43.3 +/- 4.3 kg in women, P < 0.0005 for comparison with DXA). The 95% limits of agreement with FFM using DXA were, for men and women, respectively, -8.3 to 1.7 kg and -6.4 to 4.8 kg for BIA/Lukaski, -4.8 to 3.6 kg and -3.1 to 8.9 kg for BIA/Segal, and -2.8 to 7.3 kg and -1.5 to 5.7 kg for skinfolds. CONCLUSION: This study suggests that skinfold thickness measurements and BIA will incorrectly estimate FFM in many adults with CF compared with DXA measurements of FFM. These methods have limited application in the assessment of body composition in individual adult patients with CF.

Absorptiometry, Photon↗

PubMedDate not supplied

DXA body composition properties: inherent in the physics or specific to scanner type?

Experimental results with DXA body composition are partly attributable to the DXA technology itself (X-ray physics) and partly to the particular implementation (Lunar DPX, Hologic QDR, etc). This paper identifies a number of advantages and disadvantages of DXA body composition measurement, distinguishing between those which are common to all DXA and those which are specific to particular instruments.

Absorptiometry, Photon↗

PubMed1998

The relationship between R amplitude in lead V5 (RV5) and left ventricular mass in the groups of adolescent subjects classified by body composition.

How the amplitude of the R wave in lead V5 (RV5) of the ECG represents the left ventricular (LV) mass was investigated in 894 students aged 15 (boys: 545, girls: 349). The influence of body composition [ie, percentage of body fat (%fat)] was taken into consideration. A significant correlation was found between RV5 amplitude and LV mass for both genders. However, the relationship was stronger for boys than for girls. The students were then divided into 3 groups; that is, those at either the top or bottom 10th percentile (low or high-fat range) and the rest of the students (middle-fat range), depending on the % fat calculated by the bioelectrical impedance method. The significant correlation between RV5 and LV mass was found only for the 2 groups of boys whose percentage fat was in the low or middle-fat range. The correlation coefficients were 0.40 and 0.34, respectively. Moreover, in the boys' low-fat range, the RV5 of students whose LV mass was large (> or =90th percentile), was significantly higher (p<0.01) than in the other ranges. Setting a particular cutoff point of RV5 in the low-fat range of boys improved sensitivity as well as specificity (20-30% better among all boys) for detecting large LV mass. These observations suggest that classification of subjects by body composition could be improve the reliability of ECG assessment for left ventricular hypertrophy, although the gender and number of subjects in whom improvement is expected are limited.

Adolescent↗

PubMed2006

The effects of growth hormone treatment on bone mineral density and body composition in girls with turner syndrome.

BACKGROUND: Many girls with Turner syndrome (TS) are treated with GH to increase adult height. In addition to promoting longitudinal bone growth, GH has effects on bone and body composition. OBJECTIVE: The objective was to determine how GH treatment affects bone mineral density (BMD) and body composition in girls with TS. METHOD: In a cross-sectional study, we compared measures of body composition and BMD by dual energy x-ray absorptiometry, and phalangeal cortical thickness by hand radiography in 28 girls with TS who had never received GH and 39 girls who were treated with GH for at least 1 yr. All girls were participants in a National Institutes of Health (NIH) Clinical Research Center (CRC) protocol between 2001 and 2006. RESULTS: The two groups were similar in age (12.3 yr, sd 2.9), bone age (11.5 yr, sd 2.6), and weight (42.8 kg, sd 16.6); but the GH-treated group was taller (134 vs. 137 cm, P = 0.001). The average duration of GH treatment was 4.2 (sd 3.2) yr (range 1-14 yr). After adjustment for size and bone age, there were no significant differences in BMD at L1-L4, 1/3 radius or cortical bone thickness measured at the second metacarpal. However, lean body mass percent was higher (P < 0.001), whereas body fat percent was lower (P < 0.001) in the GH-treated group. These effects were independent of estrogen exposure and were still apparent in girls that had finished GH treatment at least 1 yr previously. CONCLUSIONS: Although GH treatment has little effect on cortical or trabecular BMD in girls with TS, it is associated with increased lean body mass and reduced adiposity.

Adipose Tissue↗

PubMed1996

Autoregulation of body composition during weight recovery in human: the Minnesota Experiment revisited.

OBJECTIVES: To gain insights into the control systems underlying human variability in the regulation of body composition during weight recovery, as well as the disproportionate recovery of fat relative to lean tissue, the classical Minnesota Experiment conducted on 32 men subjected to long-term semi-starvation and refeeding was revisited with the following objectives: (1) to determine whether the control of energy-partitioning between lean and fat tissues during weight loss and weight recovery is an individual characteristic, and if a predictor can be statistically identified, (2) to determine whether the reduction in thermogenesis during weight loss persists during weight recovery, and underlies the disproportionate recovery of fat tissue and (3) to integrate the control of energy-partitioning and that of thermogenesis in order to explain the pattern of lean and fat tissue mobilisation and deposition during weight loss and weight recovery. METHODS: Individual data on body weight, body fat, fat-free-mass (FFM), and basal metabolic rate (BMR), assessed during the control baseline period (i.e. prior to weight loss), at the end of 24 weeks of semi-starvation, and at the end of a 12 week period of restricted refeeding, were used to calculate the following parameters: (i) a quantitative index of energy-partitioning, the P-ratio, defined as the proportion of body energy mobilised as protein during weight loss, or as the proportion of body energy deposited as protein during weight recovery, (ii) a quantitative index of changes in thermogenesis, defined as the change in BMR adjusted for FFM (or for both FFM and fat mass) and (iii) the degree of replenishment of fat and FFM compartments, defined as the recovery of body fat and FFM (during refeeding) as a percentage of that lost during semi-starvation. RESULTS: This re-analysis indicates the following: (i) a large inter-individual variability in P-ratio during both weight loss and weight recovery, but for a given individual, the P-ratio during refeeding is strongly correlated with the P-ratio during semi-starvation, (ii) body composition during the control period is the most important predictor of variability in P-ratio, such that the higher the initial % body fat, the lower the proportion of energy mobilised as protein, and hence the greater the propensity to mobilise fat during semi-starvation and to subsequently deposit fat during refeeding and (iii) at week 12 of refeeding, the change in adjusted BMR is found to be reduced by a magnitude which is inversely proportional to the degree of fat recovery, but is unrelated to the degree of FFM recovery. A quantitative relationship is derived between the P-ratio during refeeding, the % fat recovery, and the P-ratio during semi-starvation. CONCLUSIONS: Evidence is presented here suggesting that (i) human variability in the pattern of lean and fat tissue deposition during weight recovery is to a large extent determined by individual variations in the control of energy-partitioning, for which the initial % body fat is the most important predictor and (ii) the disproportionate gain in fat relative to lean tissue during weight recovery is contributed by a reduction in thermogenesis (i.e. increased efficiency of food utilization) for accelerating specifically the replenishment of the fat stores. These control systems, operating via energy-partitioning and thermogenesis, have been integrated into a compartmental model for the regulation of body composition during underfeeding/refeeding, and can be used to explain the individual pattern of lean and fat tissue deposition during weight recovery in situations ranging from the rehabilitation after malnutrition to the relapse of obesity.

Adipose Tissue↗

PubMedDate not supplied

Assessment of body composition in elderly: accuracy of bioelectrical impedance analysis.

BACKGROUND: In the literature there are several body impedance analysis (BIA) prediction equations generally determined in younger populations and their accuracy in the elderly has not been adequately confirmed. OBJECTIVE: We verified the reliability of the BIA method in a body composition study in the elderly. METHODS: To assess the accuracy of bioelectrical impedance analysis we compared this method with dual photon absorptiometry (DPA), assumed as a gold standard; body composition was predicted by seven BIA prediction equations in 24 healthy elderly individuals. RESULTS: The best equation in fat-free mass (FFM) estimation is the RJL System formula (published by Segal in 1988); nevertheless, the wide range of the error in FFM estimating may limit its clinical application. The FFM hydration variability seems to be the principal variable which explains the error in FFM estimation by BIA prediction equations. CONCLUSION: These findings indicate that the use of BIA equations is not interchangeable, when FFM is calculated in an elderly population, and more validation studies are necessary in this age group to evaluate the clinical application of this method.

Absorptiometry, Photon↗

PubMed1995

Prediction of carcass and empty body composition of steers by 40K emission detection.

Although originally used for prediction of whole body composition (WBC), use of 40K emission detection was later suggested for determination of empty body composition (EBC), Therefore, the present study was conducted to validate existing equations developed to predict WBC and to develop more useful equations to predict EBC or carcass composition (CC) of beef steers. Fourteen crossbred steers were detected for 40K emissions and slaughtered and their chemical composition determined from chemical analyses and total body K determined from 40K emissions. the existing equation for percentage whole body lipid had a slope of .93 and an intercept of -1.62%, indicating a close approximation of percentage of whole body lipid. Percentage of whole body protein was poorly estimated by existing equations. Equations developed for prediction of EBC relied on both BW and predicted K. Coefficients of variation for prediction of empty water or protein were within 5% and those for prediction of empty body lipid were approximately 15%. These results demonstrate that use of predicted K from 40K emission detection enhances the determination of EBC and CC.

Animals↗

PubMed2003

Clinical applications of body composition measurements using DXA.

Dual-energy X-ray absorptiometry (DXA) scanning was primarily developed for the diagnosis of osteoporosis and was initially applied to studies of the clinically important sites of the lumbar spine, femoral neck, and forearm. The rapid adoption of DXA has led to the development of different, competing generations of equipment. Improvements have been achieved through advances in X-ray generation and detection technology, modification of data acquisition protocols, and implementation of more sophisticated image analysis algorithms. As a result, DXA has been extended to allow the study of the total skeleton and its regional parts, as well as soft-tissue composition measurement. The three major components of the body: fat mass, lean mass, and bone mineral mass, can now be easily measured using a single whole body DXA scan with high precision and low scanning time. The comprehensive view of body composition provided by DXA makes it an attractive technique for a variety of clinical applications such as the prevention of cardiovascular and metabolic diseases, clinical management of different chronic diseases, and monitoring of the impact of treatment regimens on body tissues. In this article we review the contribution DXA has made to the understanding of body composition in clinical studies in adults.

Absorptiometry, Photon↗

PubMed2003

A new air displacement plethysmograph for the measurement of body composition in infants.

ABSTRACT This article introduces and evaluates the PEA POD Infant Body Composition System, an air displacement plethysmograph designed for the assessment of body composition in infants between birth and 6 mo of age. The performance of the PEA POD was evaluated by repeated testing of National Institute of Standards and Technology-traceable weights and volumes. Mass was measured in a single session. Volume was measured in four sessions during a 2-d period (five times/session for both). The mean values for repeated mass measurements were almost identical to the masses of traceable weights. The SD and CV for repeated volume measurements were 1.1-4.5 mL and 0.02-0.09%, respectively. Both the mean SD and CV were within very narrow ranges (1.4-3.1 mL for SD and 0.03-0.08% for CV) across all volume levels. Furthermore, mean CV values using results from the four sessions indicated excellent within- and between-day reliability. Regression analyses (by session or with all sessions combined) of the measured volume against actual volume gave very low standard error of the estimate (SEE) (0.853-1.957 mL) and very high R(2) (1.000), with the intercept and slope not significantly different from 0 and 1, respectively. The mean percentage error in volume measurements was < or =0.05% at all volume levels. The study findings and the operational and physical characteristics of the system indicate that the PEA POD has the potential to provide clinicians and researchers with a diagnostic and research tool that is accurate, easily used by operators, and comfortable for subjects.

Air↗