Abstract Body mass index (BMI) fails to detect altered
nutritional state in the presence of overweight or obesity,
since malnutrition can be present and masked by the abnor-
mal amount of fat mass. Measuring body cell mass (BCM)
contents for the evaluation of muscle mass and protein tis-
sue states is well accepted. The aim of the present study was
to apply body cell mass index (BCMI) to monitor the mus-
cular mass changes of male and female Olympic athletes,
renal dialysis patients, and anorexia nervosa patients in
comparison with healthy subjects. The BCMI values of male
subjects from the healthy group and Olympic athletes
groups, but not the renal dialysis group, were significantly
higher ( p<0.0001) than those of female subjects from the
same groups. In addition, subjects with normal or high BMI
values may be malnourished as highlighted by a low BCMI.
We believe the BCMI is more sensitive than the BMI for
studying the nutritional status of the individual.
Key words Creatinine clearance •Body cell mass •Body
mass index •Athletes •Anorexia nervosaIntroduction
In field studies, measurements of body composition have
traditionally been restricted to simple measures such as
weight adjusted for various height power indices for
assessing adiposity. Body mass index (BMI), which is cal-
culated as weight divided by height squared (kg/m2), has
been shown to be highly correlated with the amount of fat
mass [1]. Thus, measuring BMI is a poor approach for the
measurement of muscle mass, protein status or lean tis-
sues. Moreover, BMI is of little diagnostic value, since
higher BMI values may not necessarily reflect excess adi-
posity. For example, certain athletes, like body builders
and heavy-weight boxers, and pregnant women may have
high BMI values, which may be wrongly interpreted as
overweight or obesity.
The body cell mass (BCM), which is the metabolically
active component of fat-free mass, is the single best predic-
tor of a subject ’s nutritional status [2, 3]. The normal range
of BCM is set at 40% of the ideal healthy body weight [4].
The body cell mass index (BCMI), which is calculated as
BCM divided by height squared (kg/m2) [5], has been
shown to be more sensitive to changes in protein status and
lean tissue compared to BMI. The muscle mass depletion in
certain pathologic conditions can be best described by the
loss of BCM (e.g. sarcopenia [6], anorexia nervosa [7, 8],
and renal dialysis patients [9]). In addition to bioelectric
impedance analysis [5, 8, 9] and total-body potassium-40
counting [6], BCM can be estimated using creatinine clear-
ance (CCr) [9]. Creatinine is produced by muscle cells and
therefore its daily rate of production and of subsequent uri-
nary excretion are strictly related to the amount of body
muscle mass [2]. It has been shown that CCr is significant-
ly correlated with a subject ’s height, but not weight, an
observation which has been translated into sex-specific stan-
dard tables predicting ideal CCr values for a subject on the
basis of his/her height [10]. The objective of the presentActa Diabetol (2003) 40:S286 –S289
DOI 10.1007/s00592-003-0088-9 © Springer-Verlag 2003
A. Talluri •R. Liedtke •E.I. Mohamed •C. Maiolo •R. Martinoli •A. De Lorenzo
The application of body cell mass index for studying muscle mass
changes in health and disease conditions
A. Talluri ( /L53175) •R. Liedtke
Akern Srl, Via Lisbona 32-34, I-50065 Pontassieve, Florence, Italy
E-mail:
E.I. Mohamed •C. Maiolo •R. Martinoli •A. De Lorenzo
Division of Human Nutrition, Faculty of Medicine and Surgery
University of Tor Vergata, Rome, Italy
E.I. Mohamed
Department of Biophysics, Medical Research Institute
University of Alexandria, Egypt
A. De Lorenzo
Casa di Cura Nova Salus Srl, Trasacco, L ’Aquila, Italy
nutritional state in the presence of overweight or obesity,
since malnutrition can be present and masked by the abnor-
mal amount of fat mass. Measuring body cell mass (BCM)
contents for the evaluation of muscle mass and protein tis-
sue states is well accepted. The aim of the present study was
to apply body cell mass index (BCMI) to monitor the mus-
cular mass changes of male and female Olympic athletes,
renal dialysis patients, and anorexia nervosa patients in
comparison with healthy subjects. The BCMI values of male
subjects from the healthy group and Olympic athletes
groups, but not the renal dialysis group, were significantly
higher ( p<0.0001) than those of female subjects from the
same groups. In addition, subjects with normal or high BMI
values may be malnourished as highlighted by a low BCMI.
We believe the BCMI is more sensitive than the BMI for
studying the nutritional status of the individual.
Key words Creatinine clearance •Body cell mass •Body
mass index •Athletes •Anorexia nervosaIntroduction
In field studies, measurements of body composition have
traditionally been restricted to simple measures such as
weight adjusted for various height power indices for
assessing adiposity. Body mass index (BMI), which is cal-
culated as weight divided by height squared (kg/m2), has
been shown to be highly correlated with the amount of fat
mass [1]. Thus, measuring BMI is a poor approach for the
measurement of muscle mass, protein status or lean tis-
sues. Moreover, BMI is of little diagnostic value, since
higher BMI values may not necessarily reflect excess adi-
posity. For example, certain athletes, like body builders
and heavy-weight boxers, and pregnant women may have
high BMI values, which may be wrongly interpreted as
overweight or obesity.
The body cell mass (BCM), which is the metabolically
active component of fat-free mass, is the single best predic-
tor of a subject ’s nutritional status [2, 3]. The normal range
of BCM is set at 40% of the ideal healthy body weight [4].
The body cell mass index (BCMI), which is calculated as
BCM divided by height squared (kg/m2) [5], has been
shown to be more sensitive to changes in protein status and
lean tissue compared to BMI. The muscle mass depletion in
certain pathologic conditions can be best described by the
loss of BCM (e.g. sarcopenia [6], anorexia nervosa [7, 8],
and renal dialysis patients [9]). In addition to bioelectric
impedance analysis [5, 8, 9] and total-body potassium-40
counting [6], BCM can be estimated using creatinine clear-
ance (CCr) [9]. Creatinine is produced by muscle cells and
therefore its daily rate of production and of subsequent uri-
nary excretion are strictly related to the amount of body
muscle mass [2]. It has been shown that CCr is significant-
ly correlated with a subject ’s height, but not weight, an
observation which has been translated into sex-specific stan-
dard tables predicting ideal CCr values for a subject on the
basis of his/her height [10]. The objective of the presentActa Diabetol (2003) 40:S286 –S289
DOI 10.1007/s00592-003-0088-9 © Springer-Verlag 2003
A. Talluri •R. Liedtke •E.I. Mohamed •C. Maiolo •R. Martinoli •A. De Lorenzo
The application of body cell mass index for studying muscle mass
changes in health and disease conditions
A. Talluri ( /L53175) •R. Liedtke
Akern Srl, Via Lisbona 32-34, I-50065 Pontassieve, Florence, Italy
E-mail:
E.I. Mohamed •C. Maiolo •R. Martinoli •A. De Lorenzo
Division of Human Nutrition, Faculty of Medicine and Surgery
University of Tor Vergata, Rome, Italy
E.I. Mohamed
Department of Biophysics, Medical Research Institute
University of Alexandria, Egypt
A. De Lorenzo
Casa di Cura Nova Salus Srl, Trasacco, L ’Aquila, Italy
