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Lower limit of body fat in healthy active men.

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Lower limit of body fat in healthy active men
KARL E. FRIEDL, ROBERT J. MOORE, LESTER E. MARTINEZ-LOPEZ, JAMES A. VOGEL,
E. WAYNE ASKEW, LOUIS J. MARCHITELLI, REED W. HOYT, AND CLAIRE C. GORDON
US Army Research Institute of Environmental Medicine and US Army Natick Research, Development,
and Engineering Center, Natick, Massachusetts 01760; and Martin Army Community Hospital, Fort
Benning, Georgia 31905

Friedl, Karl E., Robert J. Moore, Lester E. Martinez-
Lopez, James A. Vogel, E. Wayne Askew, Louis J. Mar-
chitelli, Reed W. Hoyt, and Claire C. Gordon. Lower limit
of body fat in healthy active men. J. Appl. Physiol. 77(Z): 933-
940,1994.-We examined body composition changes in 55 nor-
mal young men during an 8-wk Army combat leadership train-
ing course involving strenuous exercise and low energy intake,
with an estimated energy deficit of 5.0 t 2.0 MJ/day and a
resultant 15.7 k 3.1% weight loss. Percent body fat (BF) mea-
sured by dual-energy X-ray absorptiometry (DEXA) averaged
14.3% (range 6-26%) and 5.8 t_ 1.8% (range 4-11%) at the be-
ginning and end of the course, respectively. Men who achieved
a minimum percent BF (4-6%) by 6 wk demonstrated only
small additional total and subcutaneous fat losses in the final 2
wk and sacrificed increasingly larger proportions of fat-free
mass. Percent BF estimated from skinfold thicknesses re-
flected relative changes in fat mass, although actual percent BF
was overestimated. Instead of reaching a plateau after fat
stores were substantially depleted, abdominal, hip, and thigh
girths continued to decline with body weight loss. Final percent
BF for the leanest men was similar to that observed after a 25%
body weight reduction in the 1950 Minnesota study (5.2% by
underwater weighing), and height-corrected final fat mass was
the same (1.0 k 0.2 vs. 0.9 t 0.7 kg fat/m2), suggesting that
these values represent a minimal body fat content in healthy
men and that weight loss subsequent to achieving this level is
contributed from the fat-free mass. Our results suggest that
4-6% BF or ~2.5 kg fat represents the lower limit for healthy
men, as assessed by DEXA or by underwater weighing.
densitometry; anthropometry; weight reduction; body compo-
sition; energy expenditure
ATYPICALFITYOUNGMALE hasbody fat(BF)storesto-
taling 15% body weight or - lo-11 kg. This represents a
compact energy store of - 100,000 kcal, equivalent to
230 kg of glycogen. These energy stores are progressively
diminished during a chronic energy deficit and approach
a minimum level beyond which protein catabolism neces-
sarily increases (4,7,19). In some species where an insu-
lating layer of blubber is essential to survival, such as the
elephant seal and king penguin, significant protein catab-
olism occurs during starvation even when large amounts
of fat are present (27). Humans do not appear to spare
subcutaneous fat at the expense of body protein and, on
the basis of studies of lipodystrophy patients, survive
with only a miniscule amount of fat. This minimal or
“essential” fat that is consistent with life represents the
lipid components of cell membranes, nerve sheaths, and
other cellular constituents, with adipose tissue serving
important mechanical functions in at least a few critical
areas such as within the orbits and on the palms and
soles (9). This condition where minimum fat coexists
with still relatively normal amounts of skeletal muscle is
observed in some body builders and wrestlers as an in-
tended consequence of severe dietary practices, and it is
the accidental status of some displaced and famine-
stricken populations in an early stage of food depriva-
tion.
The quantification of a minimum BF in humans has
been elusive because of deviations from the normal as-
sumptions of various chemical models at this extreme
end of body composition. Thus, in one study of lipodys-
trophy patients, three black women all produced spuri-
ous negative percent BF estimates from hydrodensitome-
try, even though adipose tissue was visualized by mag-
netic resonance imaging (9). Another woman assessedby
body water dilution with H,180 and with the tenuous as-
sumption that 73% of the nonfat body weight is water
yielded 3% BF (21). After 24 wk of semistarvation with a
25% reduction in body weight in the Minnesota study,
underwater weighing of several individuals yielded den-
sity values that equaled or exceeded the density normally
assumed for a fat-free mass (FFM) component (1.100
g/cm3) (19). An attempt to correct the normally assumed
density of the FFM for estimated increases in the frac-
tional contributions of both bone and water approxi-
mately cancelled out each other. Anthropometric assess-
ments of BF that have been established by comparison to
hydrodensitometry consistently overestimated lean indi-
viduals (36).
The more recently developed dual-energy X-ray ab-
sorptiometry (DEXA) technology (24) provides another
opportunity to assess extremes of body composition.
This appears to be a promising approach to defining the
lower limits of BF because bone mineral content is sepa-
rately assessed,eliminating this confounder. Validation
studies have demonstrated high correlations between
dual-photon absorptiometry (closely related to DEXA)
and criterion methods including hydrodensitometry (15),
and mixtures of porcine lard and lean ox thigh produced
a high linear correlation with DEXA across a broad span
of soft tissue composition (1.3~87.6%) (13). In our labora-
tory, DEXA estimates of percent BF are well correlated
with hydrodensitometry for young men [r = 0.90, stan-
dard error of estimate (SEE) = 2.94, n = 551 and women
(r = 0.91, SEE = 3.15, n = 48).
We examined the lower limits of BF measured by
DEXA and anthropometry in a group of healthy young
men who lost >lO% of body weight over 8 wk and re-
mained highly active in the face of a large energy deficit
while participating in an 8-wk Army Ranger course. Food
deprivation is a deliberate stressor in this voluntary
combat leadership course, but recent changes in the
course structure had inadvertently increased the energy
deficit to a level excessive to the objectives of the course.
We report data for a group of men who represent an
extreme level of energy deprivation and weight loss that
933
934 LOWER LIMIT OF BODY FAT

appears to rest on the edge between a minimum achiev- TABLE 1. Initial physical characteristics of a Ranger
able BF and a point beyond which food cravings and un- class and a previously studied group of combat engineers
acceptable losses of muscle mass would have ended vol-
untary participation. Ranger Class

Finishers Nonfinishers Combat Engineers

METHODS
Age, Yr 23.622.8 24.6k3.8 25.2k5.4
This study was conducted in accordance with the principles Height, cm 176.6k6.2 176.0k7.2 175.7k7.4
of the Declaration of Helsinki and the explicit directives of Body weight, kg 75.9k9.0 76.8k9.3 79.8k12.9
Army Regulation 70-25, “Use of Volunteers as Subjects of Re- Fat mass, kg ll.Ok4.0 11.724.6 16.5k7.2
search.” This study was approved by an Institutional Review FFM, kg 65.Ok6.2 65.1k6.2 63.327.9
Board at the US Army Research Institute of Environmental Bone mineral, kg 3.52kO.41 3.54kO.46 3.44kO.54
Medicine, Natick, MA, and by the Human Use Review Office, Body mass index, kg/m2 24.3k2.1 24.8k2.2 25.7k3.0
BF by DEXA, % 14.3k4.0 14.9k4.5 2O.lk6.1
Office of the Army Surgeon General. All study subjects were
volunteers from a single class of the Army Ranger Course, and Values are means + SD; n = 55 finishers, 133 nonfinishers, 73 com-
they understood that they could withdraw from the study with- bat engineers. DEXA, dual-energy X-ray absorptiometry; FFM, fat-
out adverse consequences at any time; all volunteers gave their free mass; BF, body fat. See Ref. 34 for study of combat engineers.
informed written consent before the study began. Soldiers
could also quit the Ranger course and be returned to their regu- ues were averaged. They included the neck (at the level of the
lar military unit at any time. infrathyroid landmark), flexed biceps, shoulders (at the maxi-
Description of course. The concept of Ranger training is to mum protrusion of the deltoids), chest, abdomen (at the om-
develop confidence in soldiers who will have to survive, move, phalion), hips (at the greatest protrusion of the buttocks), and
and fight at extended distances behind enemy lines with mini- upper thigh (at the gluteal furrow) (11). Skinfolds were mea-
mum support. This is done by deliberately imposing several sured at four sites (biceps, triceps, subscapular, and suprailiac)
stressors that would be expected in combat, notably food and as described by Durnin and Womersley (6); this sequence was
sleep deprivation, to uncover strengths and weaknesses of an repeated three times, and the measurements were averaged.
individual and to give the soldier insight into himself and his Percent BF assessed by skinfolds was calculated from the sum
fellow soldiers (5). of the four skinfolds using the Durnin and Womersley equation
The Ranger Training Course is divided into four phases of for men 20-29 yr old (6).
-2 wk each that expose soldiers to different environments: 1) At the beginning, at the end of the third phase (6 wk), and at
“temperate forest phase” at Fort Benning, GA, involving the end of the course (8 wk), bone mass and soft tissue compo-
classroom instruction, combatives, and basic patrolling tech- sition were measured using DEXA (DPX-Plus, Lunar, Madi-
niques; 2) “mountain phase” in northern Georgia, involving son, WI) as described by Mazess et al. (24). The assessment of
mountaineering techniques and patrolling in the Blue Ridge tissue composition is based on the relative attenuation (r value)
mountains; 3) “jungle-swamp phase” along tributaries of the of two different energies (6.4 and 12.5 fJ) that vary linearly
Yellow River near Eglin Air Force Base, FL; and 4) “desert with the proportion of fat. The volunteers were measured in a
phase” in the Chihuahuan Desert near El Paso, TX. Each lo-min (“fast scan”) mode on the same device each time. Radia-
phase begins with 3-5 days of adequate feeding while soldiers tion exposure from this procedure has been measured at 0.05
are being taught new skills. This is then followed by 7-10 days pGy/scan. Precision of the measurements is better than *0.5%
with one meal per day (5.4 MJ) during realistic small-unit tacti- BF and to.04 kg bone mineral content (8). Each device was
cal operations typically involving 8 to 12-km patrols with calibrated at least daily against a manufacturer-supplied cali-
loaded rucksacks in hostile terrain. bration block to prevent baseline drift. Scans were analyzed
Description of subject populatiorz. Of 261 members in a July using the version 3.6 software (Lunar, Madison, WI).
training class, 190 volunteers were recruited for the study; 55 of Gravimetrically determined body weight was identical to
these soldiers were still present for complete measurements at DEXA assessments at the start of the course; however, after
the end of the study (“finishers”). The primary cause of attri- semistarvation and weight loss, tissue mass was substantially
tion (64% of all attrition) was from unsatisfactory ratings of an overestimated by DEXA (Fig. 1). At the end of 6 and 8 wk,
individual’s ability to lead his patrol unit and accomplish simu- DEXA significantly overestimated gravimetrically determined
lated combat missions; medical problems contributed to course body weight by 2.29 t 1.03 and 2.80 * 1.26 kg, respectively. The
attrition to a lesser degree (25%) (23). effect did not occur in weight-stable subjects not participating
Physical characteristics, including initial percent BF, body in the course and it has been confirmed in a second study of
mass index, height, weight, and amount of weight loss and skin- Rangers involving different DEXA machines (unpublished ob-
fold thicknesses at the end of each training phase, of the fin- servations), thus ruling out the likelihood of a procedural error.
ishers (n = 55) did not differ from the nonfinishing volunteers. For purposes of this report, fat mass and FFM were calculated
However, this self-selected group of volunteers for Ranger from the gravimetrically assessed body weight using only the
school was leaner and more muscular than a group of combat qualitative DEXA-derived percent BF. This approach was
engineers in a previous study who were more representative of taken because the DEXA mass estimates were clearly incor-
typical US soldiers (34; Table 1). rect. The soft tissue mass estimate is based on the attenuation
Body composition. Stature was measured at the start of the of the X ray in the pixels that are presumed to contain only soft
course (GPM anthropometer, Seritex, Carlstadt, NJ). After tissue; measurement artifacts could conceivably be created
precourse baseline measurements, nude body weights, circum- with extreme weight loss either by an alteration in soft tissue
ferences, and skinfolds were obtained at the end of each of the characteristics relative to the assumed soft tissue attenuation
four training phases before any refeeding occurred. Weights coefficients or by violation of the assumptions of the algo-
were obtained to the nearest 0.1 kg using a calibrated electronic rithms that interpolate the soft tissue mass in bone-containing
balance (model 708, SECA Instrument, Columbia, MD). Seven pixels. The r value of the two X-ray energies, from which the
circumferences were measured with a flexible steel tape over relative fat is predicted, is not directly related to the absolute
bare skin by an experienced anthropometrist and a spotter; attenuation from which the tissue mass is estimated; however,
these measurements were repeated at least twice, and the val- without further explanation for the mass error, we cannot dis-
 LOWER LIMIT OF BODY FAT 935

initial body weight, during the course. Body weights at

baseline and the end of each 2-wk phase are shown in
Table 2. With no substantial change in energy deficit, the
rate of loss was halved after the 1st 2 wk from ~2 to 1
kg/wk. Body mass index declined from 24.3 t 2.1 to 20.3
t 1.7 kg/m’ (P < 0.01) during the course. The quartile of
c' 80 men with the greatest relative weight loss was signifi-
.Cn
Q)
cantly leaner at baseline (12.5 t 3.3% BF) than the quar-
3 tile of men with the smallest relative weight loss (17.2 t
ax 70 5.1% BF) (P < 0.01).
Changes in body composition. The percent BF assessed
by DEXA changed from a normal distribution averaging
60 14.3 t 4.0% at the start of the course to a drastically
skewed distribution averaging 5.8 t 1.8% at the end (Ta-
ble 3, Fig. 2). Weight lossesincluded 4.8 t 2.4 kg of lean
tissue (range -0.3 to 13.8 kg) and 7.3 t 3.2 kg of fat
-30 60 70 80
(range 1.5 to 16.4 kg), indicating an estimated energy
Scale weight (kg) deficit of 315 t 124 MJ or 5.0 t 2.0 MJ/day (range 1.4 to
FIG. 1. Correspondence between body weight measured by dual-en-
10.7 MJ/day). Average energy intake was 11.7 MJ/day
ergy X-ray absorptiometry (DEXA) and gravimetrically at beginning based on the content of rations offered (including days
(filled circles) and end (open circles) of Ranger training. Total body with only 5.4 MJ as well as days with adequate feeding).
mass assessed by DEXA [0.992(body wt) + 0.691 was not significantly Thus, the total energy expenditure during the course was
different [0.07 -t 0.57 (SD) kg] for baseline measurements (r = 0.999)
but was significantly overestimated at end of training.
16.7 MJ/day, verified by the double-labeled water tech-
nique in a representative subsample of men (n = 6 men
miss the possibility that the interpretation of the r value is also dosed in each phase, average energy expenditure = 16.7
affected. MJ/day) (16, 25).
Statistics were performed using repeated measures analysis Fat mass declined according to initial fatness (r = 0.93,
of variance in the multiple analysis of variance procedure P < 0.01) but did not decline below -2.5 kg or 4% BF
(SPSSX, Chicago, IL), and Scheffe’s test was applied to vari- (Fig. 3). The men who had declined to this level of fat by 6
ables with significant differences to further define differences wk did not decrease further despite a continued energy
between means. Paired t tests were used for simple pre-post deficit. There was only a moderate relationship between
comparisons.
the change in FFM and initial fatness (r = -0.45, P <
0.01; Fig. 3). The proportion of weight loss contributed
RESULTS
from the FFM was -40% at the end of the course,
Changes in body weight. Body weight loss averaged 12.1 whether estimated by DEXA or skinfolds (Table 3). By 6
-+ 3.4 kg (range 6.5-20.6 kg), or 15.7 t 3.1% (g-23%) of wk, this proportion of weight loss for men in the leanest
. .
TAB,LE 2. Anthropometric measurements during Ranger tratnlng

Baseline 2 wk 4 wk 6 wk 8 wk

Body weight, kg 75.9+9.0* 71.0+8.0-j- 68.9+7.6-f 66.4&7.2t$ 63.8+6.7$

Weight change, kg 5.133.9 2.2kl.O 2.6H.5 2.3d.4
Weight change, % 6.6U.9 2.9k1.2 3.4k2.0 3.Ok1.7
Weight change, kg/day 0.34 0.13 0.16 0.16
Circumference measurements, cm
Neck 38.1+1.6* NM 36.4+1.1-j- 35.5+1.3-F 35.3+1.3-f
Shoulders 115.5+4.7* 113.1+4.5*t 111.3+5.1t$ 111.0+4.0t$ 109.8+4.2$
Chest 100.5+5.0* NM 95.6+4.7? 95.2+4.1t 93.7+4.0t
Flexed biceps 33.7+2.2* 33.0t2.1*t 32.2+1.9t 31.0&1.7$ 30.5*1.9$
Abdomen 82.4k5.9” 78.5+5.9t 76.3+5.1t$ 74.6+4.3$§ 72.4+3.9§
Hips 95.5+4.6* 92.7&4.3? 91.0+4.2t$ 89.1+3.8$§ 87.9&3.4§
Right thigh 58.2+3.9* 55.6+3.7-f’ 54.7+3.3-f 51.7+3.4$ 50.2+3.3$
Skinfold measurements
Biceps, mm 5.Ok1.2” 4.3+0.8t 3.9kO.7~$ 3.5+0.55§ 3.3kO.55
Triceps, mm 10.1+2.5* 7.7+1.6? 7.1+1.4t 5.6+1.2$ 5.2+1.2$
Subscapular, mm 11.8+2.2* 9.6+2.2-j- 8.7+ 1.7t$ 8.0+1.6$ 7.9k1.65
Suprailiac, mm 18.1+6.1* 11.1&4.4-j- 8.3+2.3$ 6.8+1.7$ 6.7+1.7$
Skinfolds, mm 44.9+11.5* 32.7+7.9t 28.025.45 23.9+4.5$§ 23.2&4.4§
BF by skinfold, % 17.2+2.8* 13.4+2.5’f 11.7+2.1$ 9.9+2.1§ 9.4k2.Q
Waist-to-hips ratio 0.86+0.04* 0.85+0.04*-f- 0.84+0.04t$ 0.84kO.O4t$ 0.82+0.03$
Subscapular-to-triceps ratio 1.19+0.25* 1.27+0.26* 1.23+0.20* 1.47+0.27t 1.55kO.28t

Values are means -t SD; n = 55 men. Intervals between testing periods are baseline-2 wk, 15 days; 2-4 wk, 17 days; 4-6 wk, 16 days; 6-8 wk, 14
days. NM, not measured due to time limitations. Different symbols indicate significantly different means (Scheffe’s test; P < 0.05).
936 LOWER LIMIT OF BODY FAT

half of the group was double that of the other half (40 t 10

Baseline
11 vs. 18 t 8%). When subdivided to the leanest quartile
of men, FFM loss accounted for ~50% of the weight loss 8.
achieved by 6 wk and 60% of all weight lost by the end of
the course.
6'
Comparison of gravimetrically based and DEXA-as-
sessedweights. Mean fat mass detected by DEXA was
nearly identical to the mass calculated from body weight 4-

and percent fat assessedby DEXA (11.0 t 4.0 vs. 11.1 t

4.0 kg at baseline, 3.8 t 1.5 vs. 3.9 t 1.6 kg at 8 wk), but
FFM estimated directly by DEXA was substantially
higher at 6 and 8 wk (65.1 t 6.1 vs. 65.0 t 6.2 kg at
baseline, 63.8 t 5.7 vs. 61.7 t 5.8 kg at 6 wk, and 63.0 t
5.6 vs. 60.3 t 5.5 kg at 8 wk). This estimate of FFM Six weeks
produced unlikely estimates of the proportion of weight
loss comprised of lean tissue: 13.7 and 17.4% at 6 and 8
wk, respectively, compared with 30-40% estimated from
skinfolds and the weight-to-DEXA relative fat estimates
shown in Table 3.
Changes in anthropometric measurements. Circumfer-
ences in the lower trunk and upper leg (abdomen, hips,
and thigh) demonstrated the largest and most consistent
declines with weight and fat loss, whereas the neck cir-
cumference had the smallest change (Table 2). Changes
in abdominal, hip, and thigh circumferences were corre-
lated with the reduction in fat mass, and the change in
thigh circumference was also correlated with the change
in FFM (r = 0.40, P < 0.01; Table 4). Only the change in
neck circumference had a similar correlation with the
change in FFM (r = 0.41), but unlike the change in thigh
circumference, it had a nonsignificant correlation with
the change in fat mass. The largest reductions in FFM
were indicated by reductions in neck and thigh circumfer-
ences exceeding 4 and IO cm, respectively.
Relative change was greater in the abdominal measure-
ment than in the hip measurement, and this was also
reflected in the waist-to-hip ratio (Table 2). Abdominal
and thigh girths declined by an average of IO and 8 cm,
respectively, but relative decreases in circular cross-sec- 0 2 4 6 8 10 12 14 16 18 20 22 24 26
tional areas were -23 and -26%, respectively. Percent body fat
In the first half of the course, truncal (subscapular and FIG. 2. Distribution of percent body fat at baseline, 6 wk, and 8 wk
suprailiac) skinfold measurements demonstrated larger (end) of Ranger training (n = 55 men at baseline and 8 wk, 49 men at 6
changes than sites at the biceps or triceps. This early wk).
change in suprailiac fat and delayed change in upper ex-
tremity (triceps) fat were also reflected in the ratio of subscapular-to-triceps measurements in the second half
of the course (Table 2).
TABLE 3. Body composition of soldiers completing As body weight declined, abdominal and hip circumfer-
Ranger training ences continued to decline in a linear relationship even
though skinfold thicknesses, including the suprailiac
Baseline 6 wk 8 wk
skinfold, reached a plateau. This plateau corresponded
BF by DEXA, % 14.3-t4.0* 6.9+2.5-f 5.8+1.&t to the achievement of a minimum percent BF measured
BF by skinfold, % 17.2+2.8* 9.9k2.1 t 9.4*2.lt by DEXA. Thus, the reduction in fat mass predicted
Fat mass, kg 11.0+4.0* 4.6k2.1 t 3.8&1.5t from skinfolds using the equation of Durnin and Wo-
FFM, kg 65.Ok6.2" 61.7*5.8? 60.3k5.5t mersley (6) is reasonably well correlated with reduction
Bone mineral, kg 3.52kO.41 3.49kO.39 3.46kO.39
Wt loss as FFM by DEXA, % 34.2k17.3 39.4+ 16.9 into the lowest portion of the BF range (r = 0.79; SEE =
Wt loss as FFM by skinfold, % 30.1k17.7 40.6klO.l 2.0 kg; Fig. 4). The sum of four skinfolds for the men in
the leanest half of the group (n = 27) dropped from 38.0 t
Values are means 2 SD; n = 55 men at baseline and 8 wk and 50 men
for DEXA data at 6 wk. Fat mass and FFM calculated from percent
6.5 mm to 21.8 t 3.0 and 21.2 t 3.8 mm at 6 and 8 wk,
body fat measured by DEXA and body weight. Different symbols indi- respectively. In the final measurements, seven men
cate significantly different means (Scheffe’s test; P < 0.05). achieved four skinfold totals of 16-17 mm,I the lowest
 LOWER LIMIT OF BODY FAT 937
- .- ..,.II.. ^ .- -...... -. -e-^---w. II - ..-^.-- -.^^ -I-^^^

I
. - .1.1 ‘>
obtained on any individual was 3.8% BF. By all indica-
2ov
?.??
--CI
Fat loss - six weeks
tions, 2.5 kg of fat mass (or -4% body weight) represents
, Fat loss - last 2 wk
a physiological lower limit in healthy men (Fig. 3). At the
i m Remaining fat
ip ___-... . .---_ end of the Ranger course, skinfold thicknesses had ap-
proached a minimum (total of 4 skinfolds ~20 mm) in the
men who were leanest at the start of the course (~10%
BF). Body fat did not appreciably decline in these men
during the final 2 wk of the course, and their predomi-
nant source of energy from body stores (by weight) came
from components of the FFM. As in the Minnesota study
(3l), this level of food restriction also approached the
voluntarily tolerable limit for even highly motivated
men. Thus, even though all of the soldiers understood
the rules of the course, two of the leanest men from our
original study group were failed because they obtained
unauthorized food in the final week of their evaluation;
unfortunately, final data could not be obtained on
these two.
In contrast to two-compartment evaluations of body
composition that rely on assumptions about the homoge-
neity of the fat-free component, DEXA estimates the fat
and fat-free tissue solely on the basis of the soft tissue
pixels (interpolating the composition and quantity of
soft tissue in bone-containing pixels), eliminating any
bV -16 A.._-_.-_-u-m- _., -.- _____ ._--
error due to differences in the fractional contribution of
6

Individuals, by initial fat weight bone mineral to the FFM. Such an error becomes impor-
tant as lean tissue other than bone is catabolized during a
3. Individual
FIG. fat mass at start, 6 wk, and end of Ranger train- progressive weight loss and the density of the remaining
ing (top). Bottom: change in fat-free mass for same individuals. n = 55.
* Five men who were not measured at 6 wk. FFM increases. Even though DEXA is an improvement
over methods such as underwater weighing because of
value in the original test population of Durnin and Wo- the actual assessment of bone separately from the soft
mersley. tissue, the method is still dependent on assumptions
about the composition of the representative lean tissue
against which the r values are compared. Large weight
DISCUSSION
reductions involving primarily fat mass in massively
After 8 wk of sustained high activity and a substantial obese subjects appear to be properly assessedby the simi-
shortfall in energy intake, the volunteers in our study lar dual-photon absorptiometry devices (22), but an ex-
averaged 5.8% BF by DEXA. The lowest measurement amination of weight loss involving a substantial loss of

TABLE 4. Correlations of key measurements at baseline and changes over 8 wk

Body Weight Fat Wt by DEXA Fat Wt by Skinfold FFM

Initial A Initial A Initial A Initial A

BF by DEXA, % 0.54* 0.57* 0.95” 0.94* 0.78* 0.66* 0.14 -0.44*

Fat mass by DEXA 0.76* 0.73* 0.89" 0.79" 0.41* -0.28
FFM 0.91" 0.45* 0.41* -0.28 0.60* 0.13
Circumferences
Neck 0.66" 0.50* 0.35" 0.22 0.50* 0.32 0.70* 0.41*
Flexed biceps 0.71" 0.47" 0.49* 0.30 0.60* 0.39" 0.68* 0.26
Shoulders 0.76* 0.49* 0.55" 0.30 0.63* 0.48" 0.71* 0.29
Chest 0.83* 0.63" 0.70* 0.46* 0.76* 0.66* 0.70* 0.28
Abdomen 0.88* 0.75* 0.74* 0.60* 0.84* 0.77* 0.75" 0.27
Hips 0.90* 0.77* 0.81* 0.65* 0.86" 0.71* 0.73* 0.23
Right thigh 0.84' 0.79* 0.80* 0.54* 0.83" 0.65* o-66* 0.40*
Skinfolds
Biceps 0.55* 0.49* 0.73" 0.65* 0.77* 0.73" 0.29 -0.17
Triceps 0.57* 0.57* 0.76* 0.67* 0.81* 0.76* 0.30 -0.08
Subscapular 0.49* 0.51* 0.61* 0.55* 0.75* 0.72* 0.18 -0.05
Suprailiac 0.49* 0.51* 0.74* 0.61* 0.85" 0.82" 0.21 -0.08
Sum of skinfolds 0.55* 0.59* 0.80* 0.71* 0.91* 0.91* 0.26 -0.10
* Significant correlation coefficients (P < 0.01).
 LOWER LIMIT OF BODY FAT

ments of six men at the start of Ranger training gave

estimates of 6.4 t 2.2% BF (compared with 12.2 t 2.3%
BF measured by DEXA). Because most of the men in this
study had completed at least a l-wk heat acclimatization
period just before the course, an expansion of plasma
volume and a consequent underestimate of BF based on
body water would be expected. However, total body water
measurements in each phase after the start of the course
predicted a greater FFM than the total body weight mea-
sured (i.e., all predictions yielded negative percent BFs),
with estimates of >3 kg of excess water. We could not
account for the change in terms of osmotic or other bio-
chemical parameters, and no individual in this study
demonstrated a decline in serum proteins or albumin be-
low the normal range (25). This is consistent with the
findings of Keys and co-workers (19, 20) of an unex-
plained expansion of the thiocyanate space during semi-
n
"0 5 10 15 20 starvation. They also noted a pattern of fluid accumula-
tion in the knee joints that may be a contributory factor
change in fat weight (sknfld), kg
to the knee problems commonly observed with Ranger
FIG. 4. Comparison of change in fat mass predicted by skinfolds students (23).
(sknfld) (6) and by DEXA. Dashed line, line of identity. The 16% weight loss in this group of men represents
the region of transition between nearly exhausted fat en-
lean tissue has not been previously reported. A linear ergy reserves and the necessary increased catabolism of
relationship has been demonstrated between the DEXA muscle for energy, marking entry to a new phase of star-
soft tissue r value and the proportion of fat in ox thigh vation. This level of energy deprivation appears to have
and lard combinations, with regressions through the ori- been empirically established by what a limited number of
gin (13). However, the mass attenuation coefficient may soldiers could just tolerate. At the end of 24 wk of semi-
be different for lean tissue from semistarved animals. starvation in the Minnesota study, average BF estimated
The computed tomography-determined density of some with the Siri equation from a density value corrected for
lean tissue in obese patients is not the same as in normal changes in bone and water contributions (1.087 g/cm3)
subjects (18), and rapid weight loss with adequate so- was 5.3% BF (19); thus, the fat mass was very similar at
dium intake can produce an increase in extracellular the end of our study and after 24 wk in the Minnesota
fluid, elevating the relative hydration of the FFM (1, 19, study. With fat mass expressed relative to height (35),
20, 33). Nevertheless, small changes in weight (- 1.5 kg) our men also started with a quantity of fat similar to the
induced by dehydration and rehydration appear to be men in the Minnesota study (3.5 t 1.2 vs. 3.1 t 1.2 kg
accurately reflected in DEXA weight estimations, al- fat/m2) and ended the studies with similar amounts (1.2
though some of this weight change may be misassigned t 0.5 vs. 0.9 t 0.7 kg fat/m2) at 8 and 24 wk, respectively.
between the fat and FFM components (10). Instead of a The men in the leanest half of our group clearly estab-
zero-sum weight shift between compartments, our obser- lished a minimum fat mass at 1.0 t 0.2 kg fat/m2. How-
vations suggest a different DEXA problem, with a 3-4% ever, lean mass was substantially lower after the more
overestimate of total weight. Whether this error resides protracted energy deficit in the Minnesota study men
exclusively in the FFM estimate or includes errors of (15.5 t 1.1 vs. 19.3 t 1.4 kg FFM/m2), demonstrating the
-100 g in the final fat mass estimates as well cannot be progression of lean mass catabolism after depletion of
determined from this study. An increase in tissue hydra- available storage fat. Thus, the men in our study were on
tion observed after the start of semistarvation in this the brink of this increased muscle catabolism, but they
study suggests one possible source of body mass overesti- finished the course with a smaller reduction in FFM than
mation. The resultant decrease in FFM density produces observed in the Minnesota study and retained a greater
an underestimation of FFM (and overestimation of fat) proportion of their muscular strength (17).
by two-compartment models such as the Siri equation; The severity of medical consequences from high rates
however, DEXA may overestimate FFM by misinter- of weight loss arising from a simple energy deficit are
preting this more hydrated FFM as a higher density tis- determined primarily by the extent of FFM catabolism;
sue (e.g., normal FFM). this becomes a problem at a point well beyond that at
Although there was no overt evidence of edema in any which fat stores have been depleted (26). At the extremes
of these men at the end of the study, there is evidence of semistarvation observed in wartime studies of the
that body water did not diminish in proportion to their blockades of northern Holland (4) and the Warsaw
weight loss. Total body water measurements are avail- ghetto (7), there is a high death rate among men with
able from 180 dilution performed as part of energy ex- 25-35% weight loss, whereas the women with higher fat
penditure estimations made on a small but representa- reserves do better. Other examples in the literature sup-
tive subset (n = 6 men at each phase) of these men port this difference between the 16% body weight loss
throughout the course (25). With the assumption that that we observed and the effects of 25-35% reported in
73% of the weight of normal lean mass is water, measure- other studies. Clearly, the starting body composition is a
 LOWER LIMIT OF BODY FAT 939

critical consideration, and even for nonobese individuals, provides an accurate reflection of total BF stores even at
differences in nutritional status will have a significant this extreme, even though problems have been encoun-
impact on the final outcome. For example, the weights of tered when using skinfold thicknesses to demonstrate
1,200 semistarved British and Indian soldiers were fol- large fat reductions at the other extreme of fatness in
lowed carefully during the Turkish siege of Kut, where it obese patients (2, 30) and when the change is in the op-
was noted that the men who began with a “superabun- posite direction, during refeeding of malnourished
dance of fat” were able to withstand the loss of lo-14% of men (32).
body weight, whereas other men, primarily the Indian Eight of the men in this study were again tested by
soldiers who began with a smaller fat reserve, readily DEXA 6 mo after the end of their training, and values of
died in the cold temperatures of a southern Mesopota- lean mass and fat mass were nearly identical to their
mian winter (14). The US Army Ranger School has de- starting values. During the course, body weights declined
termined through experience that wintertime Ranger from 76.0 t 11.4 to 63.5 t 8.6 kg and 6 mo later averaged
classes require more food to meet energy demands, and 77.4 t 11.2 kg (25). H owever, soldiers completing this
students typically receive 11.7 MJ/day on the days that training report an interim period of fat mass rebound
summertime students receive restricted rations of 5.4 and intensive refeeding that peaked l-2 mo after the
MJlday. course. This has been measured in a second study and
Extreme differences in the response to energy deficit averages -150% of the fat mass of the original measure,
between individuals were demonstrated by two of the with the largest increase in abdominal circumference
leanest individuals who completed the study. They both (unpublished data).
started at 6-8% BF, 75-77 kg body weight, and a body In summary, 4-6% BF or -2.5 kg of BF appears to be
mass index of 24.5 kg/m2 and completed the course at the minimum BF achievable in healthy men. This corre-
4-5% BF, but one weighed 69 kg (-9.0% of initial body sponds to a sum of four skinfolds <20 mm. In fit and
weight) and the other weighed 59 kg (-23.4% of initial well-nourished young American men averaging 15% BF,
body weight). These two men bracketed the full range of the rapid loss of 16% of body weight leads to a virtual
relative weight loss observed in this study. The young depletion of fat stores, i.e., fat other than “essential fat.”
soldier with the highest weight loss also achieved the Because this is also the point at which the individuals
highest FFM loss (13.8 kg of initial FFM, or -40% of his enter a phase of increased muscle catabolism, this is an
total muscle mass). Thus, relative to the other men, one excessive weight loss for healthy young men. Large
was remarkable for his ability to adapt to the restricted changes in neck and thigh circumference are markers of
energy intake and the other was remarkable for his fail- this increased catabolism, whereas skinfolds are good
ure to adapt. This highlights the difficulty of modeling markers of the reduction in BF, as are waist and hip
weight loss due to restricted energy intake, especially in circumferences.
the absence of direct measurements or better predictors
of individual metabolic responses (12, 28). We are grateful to Robert Petrin, Sgt. Kong Ang, Maj. Barry Fair-
brother (Royal Logistics Corps, UK), S. Sgt. Glenn Thomas, Elaine
The pattern of changes in skinfold thicknesses and Christensen, and Spc. Sherry1 Kubel for dedication and skilled work in
body circumferences supports the notion that truncal fat this study. We thank Dr. John Patton for careful review of earlier
stores are the primary energy supply even for relatively drafts of this manuscript. We are most indebted to the men who agreed
lean young men (3). The abdominal girth decreased more to participate in this study, over and above the extreme demands of
than the girth of the hips, probably reflecting the use of Ranger training. This study was performed at the request of Col. John
Maher III, Commander of the IJS Army Ranger Training Brigade.
intra-abdominal as well as subcutaneous fat. Abdominal The opinions or assertions contained herein are the private views of
girths continued to decline almost in a linear fashion to the authors and are not to be construed as reflecting the official views
the end of the course, clearly reflecting lean tissue as well of the Department of the Army or Department of Defense.
as fat loss from this area in the later stages of the course. This work was presented at American Association for the Advance-
ment of Science Symposium “Humans Under Stress: Will They Sur-
A previous study of Norwegian cadets in a Ranger train-
vive?” at the Institute of Environmental Stress, Santa Barbara, CA, on
ing program with 1 wk of complete food and sleep depri- June 21-25, 1992.
vation demonstrated emptying of abdominal and gluteal Address for reprint requests: K. E. Friedl, SGRD-PLC, HQ, US
adipocytes with little change in femoral fat (29). How- Army Medical Research & Development Command, Fort Detrick, MD
ever, in our protracted period of energy deficit, there was 217025012.
a startling decline in the girth of even the thigh, repre- Received 26 July 1993; accepted in final form 4 April 1994.
senting even a slightly greater proportional reduction in
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