Reliability and Precision of the Nana Protocol to Assess Body Composition Using Dual Energy X-Ray Absorptiometry

in International Journal of Sport Nutrition and Exercise Metabolism
Restricted access

Purchase article

USD  $24.95

Student 1 year subscription

USD  $87.00

1 year subscription

USD  $116.00

Student 2 year subscription

USD  $165.00

2 year subscription

USD  $215.00

The Nana positioning protocol is widely used to position participants to minimize technical error when undertaking body composition scanning and analysis with a Dual energy X-Ray absorptiometry (DXA) machine. Once biological and technical errors are accounted for, the only variation in test–retest results is from statistical fluctuation or machine error. Therefore, the aim of this study is to assess the test–retest reliability of the Nana positioning protocol and establish the smallest real difference percentage (SRD%). A gender-balanced group of 30 participants (15 males, 15 females) underwent two scans in succession using the Nana positioning protocol, with repositioning between scans. Percentage change in mean with typical error, Intraclass Correlation Coefficients (ICC), and standard error measurement percentage (SEM%) were used to identify the test–retest reliability and error rate of these protocols. Additionally, SRD% was calculated to assess the point at which clinically important changes occurred in a participant. The reliabilities of the whole body and regional scans were excellent. Percentage change in mean ranged between 0.00% and 0.23%. High reproducibility of the Nana positioning protocol was evident through an ICC ranging between 0.966–1.000. Additionally, typical error, SEM%, and SRD% were all low. Interestingly, fat mass was associated with the largest fluctuations observed to be associated with any of the parameters assessed. When all sources of biological and technical errors have been accounted for, the Nana positioning protocol has excellent test–retest reliability and produces low SEM% and SRD%.

Shiel, Persson, Furness, and Schram are with the Physiotherapy Program, Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia. Simas, Furness, Climstein, and Schram are with Water Based Research Unit, Faculty of Health Science and Medicine, Bond University, Robina, Queensland, Australia. Climstein is also with Exercise Health & Performance Faculty Research Group, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia. Pope is with the Physiotherapy Program, School of Community Health, Charles Sturt University, Albury, New South Wales, Australia.

Address author correspondence to James Furness at jfurness@bond.edu.au.
  • Australian Radiation Protection and Nuclear Safety Agency (ARPANSA). (2005). Exposure of humans to ionizing radiation for research purposes. Yallambie, Australia: ARPANSA.

    • Search Google Scholar
    • Export Citation
  • Bazzocchi, A., Ponti, F., Albisinni, U., Battista, G., & Guglielmi, G. (2016). DXA: Technical aspects and application. European Journal of Radiology, 85(8), 14811492. PubMed doi:10.1016/j.ejrad.2016.04.004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Beckerman, H., Roebroeck, M.E., Lankhorst, G.J., Becher, J.G., Bezemer, P.D., & Verbeek, A.L. (2001). Smallest real difference, a link between reproducibility and responsiveness. Quality of Life Research, 10(7), 571578. PubMed doi:10.1023/A:1013138911638

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bilsborough, J.C., Greenway, K., Opar, D., Livingstone, S., Cordy, J., & Coutts, A.J. (2014). The accuracy and precision of DXA for assessing body composition in team sport athletes. Journal of Sports Sciences, 32(19), 18211828. PubMed doi:10.1080/02640414.2014.926380

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Chen, H.M., Chen, C.C., Hsueh, I.P., Huang, S.L., & Hsieh, C.L. (2009). Test-retest reproducibility and smallest real difference of 5 hand function tests in patients with stroke. Neurorehabilitation and Neural Repair, 23(5), 435440. PubMed doi:10.1177/1545968308331146

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Colyer, S.L., Roberts, S.P., Robinson, J.B., Thompson, D., Stokes, K.A., Bilzon, J.L., & Salo, A.I. (2016). Detecting meaningful body composition changes in athletes using dual-energy X-ray absorptiometry. Physiological Measurement, 37(4), 596609. PubMed doi:10.1088/0967-3334/37/4/596

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Covey, M.K., Berry, J.K., & Hacker, E.D. (2010). Regional body composition: Cross-calibration of DXA scanners QDR4500W and Discovery Wi. Obesity, 18(3), 632637. PubMed doi:10.1038/oby.2009.420

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Covey, M.K., Smith, D.L., Berry, J.K., & Hacker, E.D. (2008). Importance of cross-calibration when replacing DXA scanners: QDR4500W and Discovery Wi. Journal of Nursing Measurement, 16(3), 155170. PubMed doi:10.1891/1061-3749.16.3.155

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ferreira, M.L., Herbert, R.D., Ferreira, P.H., Latimer, J., Ostelo, R.W., Grotle, M., & Barrett, B. (2013). The smallest worthwhile effect of nonsteroidal anti-inflammatory drugs and physiotherapy for chronic low back pain: A benefit-harm trade-off study. Journal of Clinical Epidemiology, 66(12), 13971404. PubMed doi:10.1016/j.jclinepi.2013.02.018

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ferreira, M.L., Herbert, R.D., Ferreira, P.H., Latimer, J., Ostelo, R.W., Nascimento, D.P., & Smeets, R.J. (2012). A critical review of methods used to determine the smallest worthwhile effect of interventions for low back pain. Journal of Clinical Epidemiology, 65(3), 253261. PubMed doi:10.1016/j.jclinepi.2011.06.018

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Georgeson, E.C., Weeks, B.K., McLellan, C.P., & Beck, B.R. (2011). Body composition change over a professional rugby league season and relationship to rates and types of injury. Medicine & Science in Sports & Exercise, 43(5 Suppl. 1), 108. doi:10.1249/01.MSS.0000402994.36487.79

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hangartner, T.N., Warner, S., Braillon, P., Jankowski, L., & Shepherd, J. (2013). The official positions of the International Society for Clinical Densitometry: Acquisition of dual-energy X-ray absorptiometry body composition and considerations regarding analysis and repeatability of measures. Journal of Clinical Densitometry, 16(4), 520536. PubMed doi:10.1016/j.jocd.2013.08.007

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Herbert, R.D. (2000). How to estimate treatment effects from reports of clinical trials. I: Continuous outcomes. Australian Journal of Physiotherapy, 46(3), 229235. PubMed doi:10.1016/S0004-9514(14)60334-2

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hopkins, W.G. (2000). Measures of reliability in sports medicine and science. Sports Medicine, 30(1), 115. PubMed doi:10.2165/00007256-200030010-00001

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hopkins, W.G., Marshall, S.W., Batterham, A.M., & Hanin, J. (2009). Progressive statistics for studies in sports medicine and exercise science. Medicine & Science in Sports & Exercise, 41(1), 313. PubMed doi:10.1249/MSS.0b013e31818cb278

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kerr, A., Slater, G.J., Byrne, N., & Nana, A. (2016). Reliability of 2 different positioning protocols for dual-energy X-ray absorptiometry measurement of body composition in healthy adults. Journal of Clinical Densitometry, 19(3), 282289. doi:10.1016/j.jocd.2015.08.002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lee, S.Y., & Gallagher, D. (2008). Assessment methods in human body composition. Current Opinion in Clinical Nutrition and Metabolic Care, 11(5), 566572. PubMed doi:10.1097/MCO.0b013e32830b5f23

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lewiecki, E.M. (2005). Clinical applications of bone density testing for osteoporosis. Minerva Medica, 96(5), 317330. PubMed

  • Lexell, J.E., & Downham, D.Y. (2005). How to assess the reliability of measurements in rehabilitation. American Journal of Physical Medicine & Rehabilation, 84(9), 719723. doi:10.1097/01.phm.0000176452.17771.20

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lohman, M., Tallroth, K., Kettunen, J.A., & Marttinen, M.T. (2009). Reproducibility of dual-energy X-ray absorptiometry total and regional body composition measurements using different scanning positions and definitions of regions. Metabolism, 58(11), 16631668. doi:10.1016/j.metabol.2009.05.023

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Moon, J.R., Stout, J.R., Smith-Ryan, A.E., Kendall, K.L., Fukuda, D.H., Cramer, J.T., & Moon, S.E. (2013). Tracking fat-free mass changes in elderly men and women using single-frequency bioimpedance and dual-energy X-ray absorptiometry: A four-compartment model comparison. European Journal of Clinical Nutrition, 67(Suppl. 1), 4046. doi:10.1038/ejcn.2012.163

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Munro, B., & Visintainer, M. (2005). Statistical methods for health care research (5th ed., Vol. 1). Philadelphia, PA: Lippincott.

  • Nana, A., Slater, G.J., Hopkins, W.G., & Burke, L.M. (2012). Effects of daily activities on dual-energy X-ray absorptiometry measurements of body composition in active people. Medicine & Science in Sports & Exercise, 44(1), 180189. PubMed doi:10.1249/MSS.0b013e318228b60e

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Nana, A., Slater, G.J., Hopkins, W.G., & Burke, L.M. (2013). Effects of exercise sessions on DXA measurements of body composition in active people. Medicine & Science in Sports & Exercise, 45(1), 178185. PubMed doi:10.1249/MSS.0b013e31826c9cfd

    • Crossref
    • Search Google Scholar
    • Export Citation
  • National Health and Nutrition Examination Survery (NHANES). (2013). Body composition procedures manual. Retrieved from https://www.cdc.gov/nchs/data/nhanes/nhanes_13_14/2013_Body_Composition_DXA.pdf

    • Search Google Scholar
    • Export Citation
  • Rothney, M.P., Brychta, R.J., Schaefer, E.V., Chen, K.Y., & Skarulis, M.C. (2009). Body composition measured by dual-energy X-ray absorptiometry half-body scans in obese adults. Obesity, 17(6), 12811286. PubMed doi:10.1038/oby.2009.14

    • Search Google Scholar
    • Export Citation
  • Smith-Ryan, A.E., Mock, M.G., Ryan, E.D., Gerstner, G.R., Trexler, E.T., & Hirsch, K.R. (2017). Validity and reliability of a 4-compartment body composition model using dual energy X-ray absorptiometry-derived body volume. Clinical Nutrition, 36(3):825830. doi:10.1016/j.clnu.2016.05.006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Trevethan, R. (2017). Intraclass correlation coefficients: Clearing the air, extending some cautions, and making some requests. Health Services and Outcomes Research Methodology, 17, 127143. doi:10.1007/s10742-016-0156-6

    • Crossref
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 187 187 10
Full Text Views 9 9 0
PDF Downloads 11 11 0