Whole Body Dual X-Ray Absorptiometry (DXA) and Bioelectrical Impedance Analysis (BIA) to Determine Body Composition

 

Medical Policy: 06.01.31 

Original Effective Date: September 2013 

Reviewed: April 2021 

Revised: April 2020 

 

Notice:

This policy contains information which is clinical in nature. The policy is not medical advice. The information in this policy is used by Wellmark to make determinations whether medical treatment is covered under the terms of a Wellmark member's health benefit plan. Physicians and other health care providers are responsible for medical advice and treatment. If you have specific health care needs, you should consult an appropriate health care professional. If you would like to request an accessible version of this document, please contact customer service at 800-524-9242.

 

Benefit Application:

Benefit determinations are based on the applicable contract language in effect at the time the services were rendered. Exclusions, limitations or exceptions may apply. Benefits may vary based on contract, and individual member benefits must be verified. Wellmark determines medical necessity only if the benefit exists and no contract exclusions are applicable. This medical policy may not apply to FEP. Benefits are determined by the Federal Employee Program.

 

This Medical Policy document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy will be reviewed regularly and be updated as scientific and medical literature becomes available.

 

Description:

There has been an interest in using whole body dual x-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA) in the clinical care setting rather than a research setting.

 

Body composition measurements can be used to quantify and assess the relative proportions of specific body compartments such as fat and lean mass (e.g., bones, tissues, organs, muscles). These measurements may be more useful in informing diagnosis, prognosis, or therapy than standard assessments (e.g., body weight, body mass index) that do not identify the contributions of individual body compartments or their particular relationships with health and disease. While these body composition measurements have been most frequently utilized for research purposes, they may be useful in clinical settings to:

  • Evaluate the health status of undernourished patients, those impacted by certain disease states (e.g., anorexia nervosa, cachexia), or those undergoing certain treatments (e.g., antiretroviral therapy, bariatric surgery).
  • Evaluate the risk of heart disease or diabetes by measuring visceral fat versus total body fat.
  • Assess body composition changes related to growth and development (e.g., infancy, childhood), aging (e.g., sarcopenia), and in certain disease states (e.g., HIV, diabetes).
  • Evaluate patients in situations where body mass index is suspected to be discordant with total fat mass (e.g., body building, edema).

 

A variety of techniques has been researched, including most commonly, anthropomorphic measures, bioelectrical impedance analysis (BIA), and dual-energy x-ray absorptiometry (DXA). All of these techniques are based in part on assumptions about the distribution of different body compartments and their density, and all rely on formulas to convert the measured parameter into an estimate of body composition. Therefore, all techniques will introduce variation based on how the underlying assumptions and formulas apply to different populations of subjects (i.e., different age groups, ethnicities, or underlying conditions).

 

Body Composition Measurement Methods

Clinical Practice

Anthropomorphic Techniques

Routinely, anthropomorphic measures are sufficient to estimate adiposity in a clinical setting. Anthropometric measurements include the following:

  • Height and Weight: Height and weight are the most commonly measured and can be determined with great accuracy. They are important in making clinical decisions regarding treatment of obesity. Weight can be related to height by several methods, but the most widely used is the BMI (body mass index), which is weight in kilograms divided by the height in meters squared. Height and weight should be measured by a provider in the office. BMI is used routinely in the clinical setting to diagnose obesity. Although it correlates with body fat, it does not directly measure body fat.
  • Waist Circumference: Waist circumference is another essential anthropometric measurement. It is measured with flexible tape placed on horizontal plane at the level of iliac crest. Increasing central adiposity, as measured by waist circumference, is associated with an increased risk of morbidity and mortality.
  • Multisite Testing of Skinfold Thickness: Multisite testing of skinfold thickness is one of the oldest and still most common methods of determining a person’s body composition and body fat percentage. This test estimates the percentage of body fat by measuring skinfold thickness at specific locations on the body. The thickness of these folds is a measure of fat under the skin, also called subcutaneous adipose tissue. Skinfold thickness results rely on formulas that convert these numbers into an estimate of a person’s percentage of body fat according to a person’s age and gender. Skinfold measurements are generally taken at specific sites on the right side of the body. The tester pinches the skin at the location site and pulls the fold of skin away from the underlying muscle so only the skin and fat tissue are held. Special skinfold calipers are then used to measure the skinfold thickness in millimeters. 

 

The measurement sites vary depending on the specific skinfold testing protocol being used, but typically include the following seven locations on the body:

  • Triceps – the back of the upper arm
  • Pectoral – the mid-chest just forward of the armpit
  • Subscapular – beneath the edge of the shoulder blade
  • Mid-axilla – midline of the side of the torso
  • Abdomen – next to the belly button
  • Suprailiac – just above the iliac crest of the hip bone
  • Quadriceps – middle of the upper thigh  

 

According to the American College of Sports Medicine, when performed by a trained, skilled tester, skinfold measurements of body fat are up to 98% accurate. However, due to new technologies available such as electrical impedance methods and scales that measure body composition instead of directly measuring skinfolds, skinfold testing may not be utilized like it once was in clinical practice setting.

 

Research Methods

Underwater Weighing

Underwater weighing requires the use of a specially constructed tank in which the subject is seated on a suspended chair. The subject is then submerged in the water while exhaling. While valued as a research tool, weighing people underwater is obviously not suitable for routine clinical use. This technique is based on the assumption that the body can be divided into 2 compartments with constant densities: adipose tissue, with a density of 0.9 g/cm3, and lean body mass (ie, muscle and bone), with a density of 1.1 g/cm3. One limitation of the underlying assumption is the variability in density between muscle and bone; for example, bone has a higher density than muscle, and bone mineral density varies with age and other conditions. In addition, the density of body fat may vary, depending on the relative components of its constituents (eg, glycerides, sterols, glycolipids).

 

Imaging

Magnetic resonance imaging (MRI) or computed tomography (CT) can be used to measure visceral adipose tissue. The technique usually quantifies adipose tissue in a single slice cross section at the level of the L4/L5 lumbar disc. The subcutaneous fat (outside the abdominal musculature) may be measured in the same image. These measures of visceral adiposity correlate with insulin resistance, triglycerides, hepatic steatosis, and other components of the metabolic syndrome. This technique is used for research in obesity and metabolic disease and does not contribute to clinical care.

 

Bioelectrical Impedance

Bioelectrical impedance is based on the relationship between the volume of the conductor (i.e. human body), the conductor’s length (i.e. height), the components of the conductor (i.e. fat and fat-free mass), and its impedance. Estimates of body composition are based on the assumption that the overall conductivity of the human body is closely related to lean tissue. The impedance value is then combined with anthropomorphic data to give body compartment measures. The technique involves attaching surface electrodes to various locations on the arm and foot. Alternatively, the patient can stand on pad electrodes.

 

Whole Body Dual X-Ray Absorptiometry (DXA)

Using low dose x-rays different energy levels, whole body dual x-ray absorptiometry (DXA) measure lean tissue mass, total and regional body fat, as well as bone density. DXA scans have become a tool for research body composition, but there has been an interest in using DXA in the clinical care setting rather than a research setting.

 

While the cited techniques above assume 2 body compartments, DXA can estimate 3 body compartments consisting of fat mass, lean body mass, and bone mass. DXA systems use a source that generates x-rays at 2 energies. The differential attenuation of the 2 energies is used to estimate bone mineral content and the soft tissue composition. When 2 x-ray energies are used, only 2 tissue compartments can be measured; therefore, soft tissue measurements (i.e. fat and lean body mass) can only be measured in areas in which no bone is present. DXA also has the ability to determine body composition in defined regions (i.e. the arms, legs, and trunk). DXA measurements are based in part on the assumption that the hydration of fat-free mass remains constant at 73%. Hydration, however, can vary from 67% to 85% and can be variable in certain disease states. Other assumptions used to derive body composition estimates are considered proprietary by DXA manufacturers.

 

Dual X-RAY Absorptiometry as a Test to Detect Abnormal Body Composition

Clinical Context and Test Purpose

The purpose of whole body dual x-ray absorptiometry (DXA) body composition studies is to improve the diagnosis and management of patients who have clinical condition associated with abnormal body composition.

 

Patients

The relevant population of interest are individuals with clinical conditions associated with abnormal body composition.

 

Interventions

The test being considered is DXA body composition studies administered in an outpatient setting.

 

Comparators

The following practices are currently being used to make decisions in this patient group: standard of care without DXA or an alternative method of body composition analysis.

 

Outcomes

The general outcomes of interest include symptom management and change in disease status. For patients at risk of osteoporosis outcomes of interest would include fracture incidence. For patients with HIV who are treated with antiretroviral therapy, outcomes of interest would include lipodystrophy.

 

Summary of Evidence

For individuals who have a clinical condition associated with abnormal body composition who receive whole body dual x-ray absorptiometry (DXA) body composition studies, the evidence includes systematic reviews and several cross-sectional studies comparing DXA with other techniques. The available studies were primarily conducted in research settings and often used DXA body composition studies as a reference standard; these studies do not permit conclusions about the accuracy of DXA for measuring body composition. A systematic review exploring the clinical validity of DXA measurements against reference methods for the quantification of intra-abdominal adipose tissue raised concerns for precision and reliability. More importantly, no studies were identified in which DXA body composition measurements were actively used in patient management. The evidence is insufficient to determine the effects of the technology on net health outcomes.

 

Dual X-RAY Absorptiometry as a Test to Monitor Changes in Body Composition

Clinical Context and Test Purpose

The purpose of the serial whole body dual x-ray absorptiometry (DXA) body composition studies in patients who have a clinical condition managed by monitoring body composition changes over time is to improve disease management.

 

Patients

The relevant patient population of interest are individuals with clinical conditions managed by monitoring body composition changes over time.

 

Interventions

The test being considered is serial DXA body composition studies.

 

Comparators

he following practices are currently being used to make decisions in this patient group: standard of care without DXA or an alternative method of body composition analysis.

 

Outcomes

The general outcomes of interest include symptom management and change in disease status. For patients with anorexia nervosa, outcomes of interest would include disease -related mortality and rate of remission.

 

Summary of Evidence

For individuals who have a clinical condition managed by monitoring changes in body composition over time who receive whole body dual x-ray absorptiometry (DXA) composition studies, the evidence includes several prospective studies monitoring patients over time. The studies used DXA as a tool to measure body composition and were not designed to assess the accuracy of DXA. None of the studies used DXA findings to make patient management decisions or addressed how serial body composition assessment might improve health outcomes. The evidence is insufficient to determine the effects of the technology on net health outcomes.

 

Bioelectrical Impedance Analysis (BIA) to Detect Whole Body Composition

During bioelectrical impedance analysis (BIA) electrodes are attached to the hands and feet of the individual being evaluated. Certain electrodes apply the electrical current while other select and measure the output without the current being felt by the individual. Muscle, having higher water content than adipose tissue (fat), should have lower impedance. BIA has been proposed as a method for whole body composition or body fat composition assessment in conjunction with annual wellness examinations or weight management evaluations with an individual’s health care provider. Variables such as testing methods, types of equipment as well has health factors of the individual being tested are known to affect results.

 

Clinical Context and Test Purpose

The purpose of serial bioelectrical impedance analysis (BIA) studies in patients who have a clinical condition managed by monitoring body composition changes over time is to improve disease management.

 

Patients

The relevant patient population of interest are individuals with clinical conditions managed by monitoring body composition changes over time.

 

Interventions

The test being considered is serial bioelectrical impedance analysis (BIA) studies.

 

Comparators

The following practices are currently being used to make decisions in this patient group: standard of care without bioelectrical impedance analysis (BIA) or an alternative method of body composition analysis.

 

Outcomes

The general outcomes of interest include symptom management and change in disease status.

 

Summary of Evidence

Based on review of the peer reviewed medical literature, there is currently no established role for whole body bioelectrical impedance analysis (BIA) for individuals who have a clinical condition associated with abnormal body composition or who have a clinical condition managed by monitoring changes in body composition over time. Currently no studies have been identified in the literature in which BIA measurements were actively used in patient management, and studies have not reported data demonstrating the impact of body composition assessment on net health outcomes. Further studies are needed to assess the clinical value of this testing. The evidence is insufficient to determine the effects of the technology on net health outcomes.

 

Practice Guideline and Position Statements

International Society for Clinical Densitometry (ISCD)

In 2015, The International Society for Clinical Densitometry (ISCD) updated their adult position statement which included a statement on the use of DXA body composition. The statement included the following ISCD position regarding the use of DXA total body composition with regional analysis in the following conditions:

  • In patients living with HIV to assess fat distribution in those using antiretroviral agents associated with risk of lipoatrophy.
  • In obese patients undergoing bariatric surgery (or medical, diet, or weight loss regimens with anticipated large weight loss) to assess fat and lean mass changes when weight loss exceeds approximately 10%. The statement noted that the impact of DXA studies on clinical outcomes in these patients is uncertain.
  • In patients with muscle weakness or poor physical functioning, to assess fat and lean mass. The impact on clinical outcomes is uncertain. 

 

The position statement also included that pregnancy is a contraindication to DXA body composition.

 

U.S. Preventative Services Task Force Recommendations (USPSTF)

Weight loss to Prevent Morbid Obesity-Related Morbidity and Mortality in Adults; Behavioral Interventions

In 2018, the USPSTF updated their 2012 recommendation for screening all adults for obesity to the following. Clinicians should offer or refer adults with body mass index (BMI) of 30 kg/m2 or higher to intensive, multicomponent behavioral interventions.

 

Waist circumference may be an acceptable alternative to BMI measurement in some patient populations.

 

The USPSTF commissioned a systematic evidence review to update its 2012 recommendation on screening for obesity in adults. Because screening for obesity is now part of routine clinical practice, it was not a focus of this review.

 

Obesity in Children and Adolescents: Screening

In 2017, the USPSTF recommends that clinicians screen for obesity in children and adolescents 6 years and older and offer or refer them to comprehensive, intensive behavioral interventions to promote improvements in weight status.

 

Body mass index measurement is the recommended screening test for obesity. Body mass index percentile is plotted on growth charts, such as those developed by the CDC, which are based on US-specific, population-based norms for children 2 years and older. Obesity is defined as an age- and sex-specific BMI in the 95th percentile or greater.

 

American College of Cardiology (ACC)/American Heart Association (AHA)/The Obesity Society (TOS)

In 2013, the ACC/AHA/TOS issued a guideline for the management of overweight and obesity in adults and the summary of recommendations for obesity state, “identifying patients who need to lose weight (BMI and waist circumference), measure height and weight and calculate BMI at annual visits or more frequently. Measure weight circumference at annual visits or more frequently in overweight and obese adults.” (E-Expert Opinion)

 

This guideline does not mention the use of whole body dual x-ray absorptiometry (DXA) or bioelectrical impedance analysis (BIA) in the assessment and management of overweight and obese adults.

 

National Institute for Health and Clinical Excellence (NICE)

In 2014, National Institute for Health and Clinical Excellence (NICE) issued a guideline on obesity: identification, assessment and management. The guideline included the following:

  • Use BMI as a practical estimate of adiposity in adults. Think about using waist circumference in addition to BMI in people with a BMI less than 35 kg/m2.
  • Use BMI (adjusted for age and gender) as a practical estimate of adiposity in children and young people. Waist circumference is not recommended as a routine measure.
  • Do not use bioimpedance as a substitute for BMI as a measure of general adiposity in adults and children.

 

Regulatory Status

Body composition software for several bone densitometer systems has been approved by the U.S. Food and Drug Administration through the premarket approval process. They include the Lunar iDXA systems (GE Healthcare), Hologic DXA systems (Hologic), and Norland DXA systems (Swissray).

 

Prior Approval:

Not applicable.

 

Policy:

The use of whole-body dual x-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA) for body composition studies is considered investigational for all indications. There is insufficient evidence to support a conclusion concerning the net health outcomes or benefits associated with this testing.

 

Procedure Codes and Billing Guidelines:

To report provider services, use appropriate CPT* codes, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or diagnosis codes.

  • 76499 Unlisted diagnostic radiographic procedure
  • 0358T Bioelectrical impedance analysis whole body composition assessment, with interpretation and report

 

Selected References:

  • Methods for Body Composition Analysis in Adults, The Open Obesity Journal, 2011, Volume 3, 62-69
  • Centers for Disease Control and Prevention: Healthy Weight: Assessing Your Weight: BMI: About BMI for Adults.
  • U.S. Preventative Services Task Force: Screening for and Management of Obesity in Adults.
  • U.S. Preventative Services Task Force: Screening for Obesity in Children and Adolescents. 
  • American Heart Society Body Composition Tests
  • Kendler DL, Borges JL, Fielding RA, et. al. International Society for Clinical Densitometry: The Official Positions of ISCD: Indications of Use and Reporting of DXA for Adults.
  • International Society for Clinical Densitometry: 2007 Pediatric Official Positions.
  • Agency for Healthcare Research and Quality: Screening and Intervention for Childhood Overweight: Evidence Synthesis. July 2005. Investigators: Evelyn P. Whitlock, M.D., MPH; Selvi B. Williams, M.D.; Rachel Gold, PhD, MPH; Paula Smith, R.N., BSN; Scott Shipman, M.D., MPH
  • Evaluation of Lunar Prodigy dual energy x-ray absorptiometry for assessing body composition in healthy persons and patients by comparison with the criterion 4-component model. American Journal of Clinical Nutrition 2006. Jane E. Williams, Jonathan CK Wells, Catherine M. Wilson, Dalia Haroun, Alan Lucas and Mary S. Fewtrell.
  • American College of Radiology (ACR) and the Society of Skeletal Radiology (SSR) Practice Guideline for the Performance of Dual Energy X-Ray Absorptiometry (DXA). Revised 2008
  • Pediatrics Official Journal of the American Academy of Pediatrics: Prevention of Pediatric Overweight and Obesity Committee on Nutrition, 2003, 112;424
  • ACR SPR-SSR Practice Parameter for the Performance of Dual-Energy X-Ray Asbsorptiometry (DXA), Amended 2014.
  • UpToDate Measurement of Body Composition in Children, Sarah M. Phillips, MS, RD, LD, Robert J. Shulman, M.D., Topic last updated March 31, 2019.
  • UpToDate Determining Body Composition in Adults, Leigh Perrault, M.D., Topic last updated January 10, 2019.
  • Jensen MD, Ryan DH, Apovian CM, et al.; American College of Cardiology/American Heart Association Task Force on Practice Guidelines; Obesity Society. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014;129(25 Suppl 2):S102-S138
  • National Institute for Health and Clinical Excellence (NICE), NICE Guidelines (CG 189), Obesity: Identification, Assessment and Management. Published November 2014.
  • Ritz P, Salle A, Audran M, et. al. Comparison of different methods to assess body composition of weight loss in obese and diabetic patients. Diabetes Res Clin Pract 2007 Sep:77(3):405-11. PMID 17306903
  • Alves FD, Souza GC, Biolo A, et. al. Comparison of two bioelectrical impedance devices and dual-energy x-ray absorptiometry to evaluate body composition in heart failure, J Hum Nutr Diet 2014 Dec: 27(6):632-8. PMID 24684316
  • Ziai S, Coriati A, Chabot K, et. al. Agreement of bioelectric impedance analysis and dual-energy x-ray absorptiometry for body composition evaluation in adults with cystic fibrosis. J Cyst Fibros 2014 Sep:13(5):585-8. PMID 24522087
  • Elkan AC, Engvall IL, Tengstrand B, et. al. Malnutrition in women with rheumatoid arthritis is not revealed by clinical anthropometrical measurements or nutritional evaluation tools. Eur J Clin Nutr 2008 Oct:62(10):1239-47. PMID 17637600
  • Jensky-Squires NE, Dieli-Conwright CM, Rossuello A, et. al. Validity and reliability of body composition analysers in children and adults. BR J Nutr 2008 Oct:100 (4):859-65. PMID 18346304
  • Liem ET, De Lucia Rolfe E, L’Abee C, et. al. Measuring abdominal adiposity in 6 to 7 year old children. Eur J Clin Nutr 2009 Jul:63(7):835-41. PMID 19127281
  • Bedogni G, Agosti F, De Col A, et. al. Comparison of dual energy x-ray absorptiometry, air displacement pleythysmography and bioelectrical impedance analysis for the assessment of body composition in morbidly obese women. Eur J Clin Nutr 2013 Nov:67(11):1129-32. PMID 24022260
  • Tompuri TT, Lakka TA, Hakulinen M, et. al. Assessment of body composition by dual energy x-ray absorptiometry, bioimpedance analysis and anthropometrics in children: the physical activity and nutrition in children study. Clin Physiol Funct Imaging 2015 Jan:35(1):21-33. PMID 24325400
  • Kullberg J, Brandberg J, Angelhed JE, et. al. Whole body adipose tissue analysis: comparison of MRI, CT and dual energy x-ray absorptiometry. BR J Radiol. Feb 2009;85(974): 123-130. PMID 19168691
  • Monteiro PA, Antunes Bde M, Silveira LS, et. al. Body composition variables as predictors of NAFLD by ultrasound in obese children and adolescents. BMC Pediatr 2014;14:25. PMID 24476029
  • Bazzocchi A, Ponti F, Cariani S, et. al. Visceral fat and body composition changes in a female population after RYGBP: A Two year follow up by DXA. Obes Surg. Sep 14 2014. PMID 25218013 
  • International Society for Clinical Densitometry: 2015 ISCD Official Positions-Adult.
  • UpToDate. Nutritional assessment in chronic liver disease. Puneeta Tandon M.D., FRCP, Leah Gramlich M.D., FRCP. Topic last updated August 17, 2015.
  • UpToDate. Growth failure and poor weight gain in children with inflammatory bowel disease. Jonathan E. Teitelbaum M.D., Topic last updated October 6, 2015.
  • UpToDate. Indications for nutritional assessment in childhood. Sarah M. Phillips MS RD LD, Craig Jensen M.D. Topic last updated November 29, 2017.
  • Franzoni E, Ciccarese F,  Di Piertro E, et. al. Follow-up of bone mineral density and body composition in adolescents with restrictive anorexia nervosa: role of dual-energy X-ray absorptiometry. European Journal of Clinical Nutrition February 2014;68(2):247-252. PMID 24346474
  • Murphy J, Bacon SL, Morais JA et al. Intra-Abdominal Adipose Tissue Quantification by Alternative Versus Reference Methods: A Systematic Review and Meta-Analysis. Obesity (Silver Spring), 2019 Jul;27(7). PMID 31131996
  • Sheean P, Gonzalez MC, Prado CM et al. American Society for Parenteral and Enteral Nutrition Clinical Guidelines: The Validity of Body Composition Assessment in Clinical Populations. JPEN J Parenter Enteral Nutr, 2019 Jun 20. PMID 31216070
  • Calella P, Valerio G, Brodlie M et al. Tools and Methods Used for the Assessment of Body Composition in Patients With Cystic Fibrosis: A Systematic Review. Nutr Clin Pract, 2019 Feb 7. PMID 30729571
  • Calella P, Valerio G, Brodlie M et al. Cystic fibrosis, body composition, and health outcomes: a systematic review. Nutrition, 2018 Nov;55-56:131-139. PMID 29981489
  • Alves Junior CAS, de Lima LRA, de Souza MC et al. Anthropometric measures associated with fat mass estimation in children and adolescents with HIV. Appl Physiol Nutr Metab, 2018 Oct 5;44(5). PMID 30286302
  • Reina D, Gómez-Vaquero C, Díaz-Torné C et al. Assessment of nutritional status by dual X-Ray absorptiometry in women with rheumatoid arthritis: A case-control study. Medicine (Baltimore), 2019 Feb;98(6):e14361. PMID 30732168
  • Sinclair M, Hoermann R, Peterson A et al. Use of Dual X-ray Absorptiometry in men with advanced cirrhosis to predict sarcopenia-associated mortality risk. Liver Int., 2019 Feb 13;39(6). PMID 30746903
  • Lindqvist C, Brismar TB, Majeed A et al. Assessment of muscle mass depletion in chronic liver disease: Dual-energy x-ray absorptiometry compared with computed tomography. Nutrition, 2019 Feb 1;61:93-98. PMID 30703575
  • Dordevic AL, Bonham M, Ghasem-Zadeh A et al. Reliability of Compartmental Body Composition Measures in Weight-Stable Adults Using GE iDXA: Implications for Research and Practice. Nutrients, 2018 Oct 12;10(10). PMID 30321991
  • Bazzocchi A, Ponti F, Cariani S, et al. Visceral fat and body composition changes in a female population after RYGBP: a two-year follow-up by DXA. Obes Surg. Mar 2015;25(3):443-451. PMID 25218013
  • Franzoni E, Ciccarese F, Di Pietro E, et al. Follow-up of bone mineral density and body composition in adolescents with restrictive anorexia nervosa: role of dual-energy X-ray absorptiometry. Eur J Clin Nutr. Feb 2014;68(2):247-252. PMID 24346474
  • Iyengar NM, Arthur R, Manson JE et al. Association of Body Fat and Risk of Breast Cancer in Postmenopausal Women With Normal Body Mass Index: A Secondary Analysis of a Randomized Clinical Trial and Observational Study. JAMA Oncol, 2019 Feb;5(2):155-163. PMID 30520976
  • Murphy J, Bacon SL, Morais JA, et al. Intra-Abdominal Adipose Tissue Quantification by Alternative Versus Reference Methods: A Systematic Review and Meta-Analysis. Obesity (Silver Spring). Jul 2019; 27(7): 1115-1122. PMID 31131996
  • Sheean P, Gonzalez MC, Prado CM, et al. American Society for Parenteral and Enteral Nutrition Clinical Guidelines: The Validity of Body Composition Assessment in Clinical Populations. JPEN J Parenter Enteral Nutr. Jan 2020; 44(1): 12-43. PMID 31216070
  • Calella P, Valerio G, Brodlie M, et al. Tools and Methods Used for the Assessment of Body Composition in Patients With Cystic Fibrosis: A Systematic Review. Nutr Clin Pract. Oct 2019; 34(5): 701-714. PMID 30729571
  • Calella P, Valerio G, Brodlie M, et al. Cystic fibrosis, body composition, and health outcomes: a systematic review. Nutrition. Nov 2018; 55-56: 131-139. PMID 29981489
  • Bundred J, Kamarajah SK, Roberts KJ. Body composition assessment and sarcopenia in patients with pancreatic cancer: a systematic review and meta-analysis. HPB (Oxford). Dec 2019; 21(12): 1603-1612. PMID 31266698
  • Alves Junior CAS, de Lima LRA, de Souza MC, et al. Anthropometric measures associated with fat mass estimation in children and adolescents with HIV. Appl Physiol Nutr Metab. May 2019; 44(5): 493-498. PMID 30286302
  • Woolcott OO, Bergman RN. Defining cutoffs to diagnose obesity using the relative fat mass (RFM): Association with mortality in NHANES 1999-2014. Int J Obes (Lond). Jun 2020; 44(6): 1301-1310. PMID 31911664
  • Staunstrup LM, Nielsen HB, Pedersen BK, et al. Cancer risk in relation to body fat distribution, evaluated by DXA-scans, in postmenopausal women - the Prospective Epidemiological Risk Factor (PERF) study. Sci Rep. Mar 29 2019; 9(1): 5379. PMID 30926844
  • Reina D, Gomez-Vaquero C, Diaz-Torne C, et al. Assessment of nutritional status by dual X-Ray absorptiometry in women with rheumatoid arthritis: A case-control study. Medicine (Baltimore). Feb 2019; 98(6): e14361. PMID 30732168
  • Sinclair M, Hoermann R, Peterson A, et al. Use of Dual X-ray Absorptiometry in men with advanced cirrhosis to predict sarcopenia-associated mortality risk. Liver Int. Jun 2019; 39(6): 1089-1097. PMID 30746903
  • Lindqvist C, Brismar TB, Majeed A, et al. Assessment of muscle mass depletion in chronic liver disease: Dual-energy x-ray absorptiometry compared with computed tomography. Nutrition. May 2019; 61: 93-98. PMID 30703575
  • Dordevic AL, Bonham M, Ghasem-Zadeh A, et al. Reliability of Compartmental Body Composition Measures in Weight-Stable Adults Using GE iDXA: Implications for Research and Practice. Nutrients. Oct 12 2018; 10(10). PMID 30321991
  • Iyengar NM, Arthur R, Manson JE, et al. Association of Body Fat and Risk of Breast Cancer in Postmenopausal Women With Normal Body Mass Index: A Secondary Analysis of a Randomized Clinical Trial and Observational Study. JAMA Oncol. Feb 01 2019; 5(2): 155-163. PMID 30520976
  • Arthur RS, Xue X, Kamensky V, et al. The association between DXA-derived body fat measures and breast cancer risk among postmenopausal women in the Women's Health Initiative. Cancer Med. Feb 2020; 9(4): 1581-1599. PMID 31875358

 

Policy History:

  • April 2021 - Annual Review, Policy Renewed
  • April 2020 - Annual Review, Policy Revised
  • April 2019 - Annual Review, Policy Renewed
  • April 2018 - Annual Review, Policy Renewed
  • April 2017 - Annual Review, Policy Renewed
  • April 2016 - Annual Review, Policy Revised
  • July 2015 - Annual Review, Policy Revised
  • August 2014 - Annual Review, Policy Renewed
  • September 2013 - New policy

Wellmark medical policies address the complex issue of technology assessment of new and emerging treatments, devices, drugs, etc.   They are developed to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Wellmark medical policies contain only a partial, general description of plan or program benefits and do not constitute a contract. Wellmark does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Wellmark or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. Our medical policies may be updated and therefore are subject to change without notice.

 

*CPT® is a registered trademark of the American Medical Association.