New

from

equations
for estimating
body fat mass
body density
or total body water13

Joop MA van Raazj, PhD, Meta EM Peek, MSc;

Casja M Schonk,
MSc; andJoseph
GAJHautvast,
ABSTRAC1
are

not

appropriate

The equations
for application

in pregnancy

Susan H Vermaat-Miedema,
MD

for estimating

fat mass

in pregnancy,

MSc;

from body density

because

the

body water

or total

underlying

assumptions

with

Clin Nutr l988;48:24-9.

KEY WORDS

Pregnancy,

body fat mass,

body density,

total body water

Introduction

Methods

For an average
well-nourished
woman
who gains 12.5
kg in body weight
over pregnancy,
a net energy
cost of
320
MJ (77 Mcal) was projected
for a full-term
pregnancy (1). In this estimate
ofenergy
cost ofpregnancy,
it
is assumed
that --3.5 kg of fat (133 MJ or 32 Meal) is
deposited
as maternal
fat stores (2). Recommendations
for energy
needs during
pregnancy
are generally
based
on the energy cost ofthis typical pregnancy
(3). It should
be noted that the increase
in maternal
fat stores was ohtamed from an analysis
ofthe total weight gain over pregnancy
and was calculated
as the weight
not accounted
for by tissues directly
concerned
with reproduction
or by
increased
extracellular
water (2). To validate
this estimate ofgain
in fat stores, studies are needed
where body
fat is estimated
more directly.
Most common
methods
for estimating
body fat mass
such as the densitometric
and total-body-water
methods
are based on the concept
that the human
body can be
divided
into a fat and a fat-free component
and that the
composition
and density
of these two components
are
constant
and known
(4). However,
in pregnancy
a relative excess of body water can be observed
and consequently
the usual assumptions
made for the fat-free mass
do not hold. We report here new equations
for estimating
body fat in pregnancy
from body-density
and total-bodywater measurements.
These new equations
take into account the alterations
in density
and composition
of the

Usualequationsfor

maternal
24

fat-free

mass

throughout

bodyfat

mass

Density

and water

Hytten
ofthe

content

and Leitch

literature

offat-free

mass

in pregnancy

made an extraordinarily

on weight gain over pregnancy

thorough

review

and its composi-

I From
the Department
of Human
Nutrition,
Agricultural
University, De Dreijen
12, 6703 BC Wageningen,
The Netherlands.
2 Supported
by a research grant from the Nestl#{233}
Foundation,
Lau-

sanne,

pregnancy.
Am J Clin Nuir

estimating

The human body can be divided

into a fat and a fat-free
component.
The density (D) of the fat mass is quite. constant
and easily measured and at body temperature
human fat has a
density of 0.900 x l0 kg/m3 (5). The density of the fat-free
mass cannot be measured
accurately
but will depend on the
relative contributions
of bone mineral (D = 3.00), protein (D
1.34), and water (D
0.993) (5). Ifit is assumed that the fatfree mass is composed
of protein
(20.5%),
water
(72.4%),
and
bone mineral (7.1%), the density of the fat-free mass can be
calculated
as 1.10 X l0 kg/m3 (5). Sins equation
(4) for estimating fat mass from body density and body weight can be
derived by using these values for the density of fat mass (0.9)
and fat-free mass(l
10)(Table
1).
On the basis ofchemical
analysis ofadult human bodies, the
fat-free mass is assumed to contain
on average
72.4%
water.
This finding is the basis for using total body water and body
weight to estimate body fat mass (5)(Table
2).

l988;48:24-29.

Switzerland.
Addressreprint
requeststo
JMA van Raaij, Department
of Human
Nutrition,
Dc Dreijen
12, 6703 BC Wageningen,
The Netherlands.
Received
February
25, 1987.
Accepted
for publication
September
9, 1987.
3

Printed

in USA.

1988 American

Society

for Cliniod

Nutrition

Downloaded from ajcn.nutrition.org by guest on January 31, 2014

respect to density and composition

offat-free
mass do not hold for pregnancy.
Representative
values have been derived from literature
data for density and water content
of maternal
fatfree mass throughout
pregnancy.
Using these values we developed
a method that provides new
equations
for estimating
fat mass from body density or total body water for any desired stage
ofpregnancy.
The validity
ofthe
new equations
based
on body density is discussed
using data
on body weight and body density obtained from a longitudinal
study on well-nourished
Dutch
pregnant women. Because the new equations
result in more valid estimates of maternal
body
fat mass, we suggest that they be used in studies on energy balance in pregnancy.
Am J

ESTIMATING
TABLE
1
Usual and new equations
density and body weight*

for estimating

BODY

FAT MASS

IN PREGNANCY

fat-free mass was assumed

water content was assumed

body fat mass from body

New equationsfor
/100
General

equationt

Usual

(Sins)

equationj

New pregnancy
equations
No edema or leg edema

450)

only

20 wk gestation

W=X(-.-_-458.0)

30 wk gestation

WFM

40 wk gestation

(-;--

41.6)

467.5)

480.5)

15 10.8
(-;-

---

/522.5

edema

10 wk gestation

WFM

20 wk gestation

WFM

WB

/496.4

/504.7
(:-=;-

mass

in pregnancy

in Dutch pregnant

women

Recently we measured
body weight and body density in 42
healthy
well-nourished
Dutch
women
at 6-wk intervals
throughout
pregnancy
and at 2 mo postpartum.
Prepregnancy
measurements
were also performed
in 19 women. The density
ofthe body was calculated
from the body weight and the body
volume that was obtained
by the underwater
weighing technique (6). Some general characteristics
ofthe women are given
in Table 4. None of the women developed
clinical forms of
generalized
edema but several women did show some evidence
ofleg edema.

/502.2

bodyfat

Body weight and body density

/496.4

estimating

water

content

fut-free

10/
t /0
-

460.8)
I

30 wk gestation

76

75

74

/518.1
(--

body

475.7)

I
I

40 wk gestation

WB

-j

/537#{149}3
---

I
I

497.0)

I
1

VB

: volume

of body,

fat mass,

and

fat-free

mass

(Xl03

m3); WB, W,
W,
: weight of body, fat mass, and fat-free
mass (kg); DB, DFM, DFfl,4: density ofbody, fat mass, and fat-free mass
(X l0 kg/m3).

t Derivation:

V5

density

fat-free

body

(xlO3kg.m

-73

; so

1-1o0
DB

DFFM

DFM

1 \

WB

j: Siris equation

is obtained
from the general equation
by entering
0.900 and D
=
1.10.
New pregnancy
equations
are obtained
from the general equation
by entering
DFM
0.900 and D
values as derived from Figure
1.
D

DFFM

1.095

72

1.090-

tion (2). From their findings

estimates
on density and water
content of the gain in fat-free
mass over pregnancy
can be derived (Table 3).
The overall density and water content of the maternal
fatfree
mass throughout
pregnancy
will depend on the relative
contributions
of the prepregnant
fat-free mass and the gain in
fat-free mass over pregnancy.
For a reference woman with a
prepregnant
fat-free body of 42 kg (3) and with a gain in fatfree mass as given by Hytten
(2) (Table 3), we calculated
the
overall density and water content ofthe maternal fat-free mass
throughout
pregnancy
(Fig 1). The density of the prepregnant

1.0851.080

--

no oedema
generatised

oedemci

I;
io

o
pregnancy

40
(weeks)

FIG 1. Density and watercontent

ofmaternal
fat-free body throughout pregnancy
for a reference
woman with no edema or leg edema only
(continuous
line) and with generalized
edema (broken line).

Downloaded from ajcn.nutrition.org by guest on January 31, 2014

WFM

to be 1. 10 X l0 kg/m3 (5) and the

to be 72.4% (5).

Modified
equations
for estimating
fat mass in pregnancy
from body density or total body water are obtained
by reading
the density or water content ofthe fat-free mass from Figure 1
and by entering these values in the general equations
given in
Tables 1 and 2. The density of the fat mass can be considered
constant at 0.900 x iO kg/m3. Equations
can be derived for
any stage ofpregnancy;
equations
for 10, 20, 30, and 40 wk of
gestation are given in Tables 1 and 2.

10 wk gestation

Generalized

lOO\

/1

25

VAN RAAU

26
TABLE2
Usual and new equations
water and body weight*
General

Usual

Discussion
for estimating

equationt

equations

body

fat mass

from total

TBW
WAThR%

WB

WFM

WB

body

The results ofthe calculations

on the reference
women
(Table
5, Figure 2) clearly show that application
in late
pregnancy
ofthe usual (Siris) equation
for body density
may result in an overestimation
ofthe actual fat mass by
1 .5-2.5
kg whereas
application
ofthe usual equation
for
total body water may result in an underestimation
of the
actual
fat mass by 1.0-2.0
kg. Such large systematic
enrors are unacceptable;
therefore,
new equations
are proposed.
The new equations
are based on two assumptions.
The
first assumption
concerns
the validity
of the supposed
composition
of the gain in fat-free
mass. This composition is derived
from Hytten
(2) and is based on a extraordinary
thorough
review of the literature.
We believe

0.724
New pregnancy
equations
No edema or leg edema

only

10 wk gestation

WFM

20 wk gestation

30 wk gestation

FM

TBW

WB

0.732

WB
0.740
=

W8

TABLE
3
Weight gain throughout

edema

lOwkgestation

pregnancyand

its composition

WFM=WBI

Weeks

of

pregnancy

0.725
10

20 wk gestation

w8

0.734
30 wk gestation

W8

0.748
40 wk gestation

W5

0.765
*

W8, W,

TBW: total body

(X l0%).

t Derivation:

: weight

ofbody,

water(kg);

WATER%

WB

Wfl4

t Assumed
water content
Water content offat-free

fat mass
: water

and fat-free
content

mass

(kg);

fat-free

mass

W;
W
=
TBW/WATER%
offat-free
mass 72.4%.
mass derived from Figure 1.

Results
In Table 5 the expected
amount
of total body water
and the expected
density
of the whole body were calculated for a reference
woman
who has a prepregnant
body
weight of6O kg and who shows a weight gain and weight
gain composition
as given in Table 3. It is assumed
that
the prepregnant
body contains
18 kg fat and that the prepregnant
fat-free mass has a water content
of72.4%
and
a density
of 1 10 X i03 kg/rn3. Table 5 also presents
the
estimated
fat mass when the calculated
amount
of total
body water or the calculated
body density
are entered
into the usual prediction
equations.
Figure 2 presents
the
systematic
differences
between
actual fat mass gain over
pregnancy
and predicted
fat mass gain.
The results on body weight and body density
as measured in our Dutch women
before, during,
and after their
pregnancy
are given in Table 4. The results on body fat
mass
as calculated
by the usual
and the modified
equations
are presented
in Figure 3.
.

20

30

40

656
328
328
36
292
0

4000
2064
1936
165
1730
41

8500
3594
498
4294
1 14

12500
3825
8675
925
7613
137

89.0

89.4

87.5

87.8

1.022

1.027

1.032

1.030

4470
2064
2406
2200

9946
3594
6352
5740

15717
3825
11892
10830

91 .4

90.4

91.1

1.023

1.019

No edema or leg edema

Gain in
Weight* (g)
Fatmass*(g)
Fat-freemasst(g)
Protein*(g)
Water(g)
Remainderj
(g)
Derived
Water content
ofgain in
fat-freemass(%)
Density ofgain in fat-free
mass(Xl03kWm3)
Generalized
edema
Gain in
Weightil (g)
Fatmassll(g)
Fatfreemass**(g)
Water(g)
Derived
Water content
ofgain in
fat-free mass(%)
Density ofgain in fat-free
mass(Xl03kg/m3)
*

Data

from

Hytten

656
328
328
292

89.0
1.022

1.020

4906

(2).

t Calculated

as total-weight
gain minus fat-mass
gain.
:t Calculated
as fat-free mass minus protein mass minus water mass.
Assumed
densities
of protein,
water, and remainder
of 1.34 (5),
0.993 (5), and 2.0 (Xl03 kgjm3),
respectively.
The density
of the remainder
component
is based on the assumption
that 75% ofits weight
is minerals
with a density of3.0 (5) and 25% is other materials
with an
average density of 1.0.

II Calculated
#{182}
Assumed

as fat mass plus fat-free mass.

to be the same as for women with no edema

or leg edema

only.
** Calculated
as sum ofwater,
protein,
and remainder
mass. Protein
and remainder
mass assumed
to be the same as for women
with no
edema or leg edema only.

Downloaded from ajcn.nutrition.org by guest on January 31, 2014

40 wk gestation
Generalized

ET AL

ESTIMATING
TABLE 4
Body weight and body
healthy Dutch women*

density

BODY

and aft er pregnancy

be fore, during,

Body weight

x1kg/m-

19

60.23

1.0367

19
19

60.59
61.51

1.0369
1.0357

42
42
42
42

6 1.70
66.10
70.85
63.30

1.0342
1.0295
1.0298
1.0308

Beforepregnancy

Results

are expressed

t General

in

Body density

kg

Pregnancy
6wk
l2wk
Pregnancyt
1 1 wk
23wk
35wk
Postpartum,9wk

FAT MASS

characteristics:

as mean

values.

age, 28.5 y; height,

(at
kg;
30

that at present
more complete
data sets are not available.
The supposed
composition
of the gain in fat-free
mass
can be considered
as representative
but it should be recognized
that the between-women
variation
in composi-

TABLES
Expected
body
of 18 kg*

density and total body water

throu ghout

pregnancy

27

tion might be quite substantial.

It is also conceivable
that
the composition
may depend
on the absolute
size of the
gain in fat-free
mass, even for women
without
development of edema.
However,
in this respect
literature
data
are scarce.
The second
assumption
concerns
the supposed ratio ofprepregnant
fat-free mass to gain in fat-free
mass. The equations
were derived
for a reference
woman
with a prepregnant
fat-free mass of42 kg and with a gain
in fat-free
mass over pregnancy
of 8.7 kg (no edema
or
leg edema
only) or of 1 1 .9 kg (generalized
edema).
For
this reference
woman
the ratio obtained
is 4.8: 1 (no
edema
or leg edema
only) or 3.5: 1 (generalized
edema).
In Table 6 the density
and water content
of the fat-free
mass at term were calculated
for various
ratios of prepregnant
fat-free mass to gain in fat-free mass. It is quite
remarkable
that even relatively
extreme
ratios give only
relatively
small differences
in estimates
of density
and
water content
of fat-free mass especially
when estimates
are compared
with prepregnant
water content
and density of fat-free
mass. Table 6 also includes
estimates
of
body fat mass at term based on either total body water
or body density.
It is clear that relatively
extreme
ratios
ofprepregnant
fat-free mass to gain in fat-free mass result
in body fat estimates
that differ only slightly (0.3-0.6
kg)
from estimates
based
on the ratios
for the reference

for a referen

with an initial

ce woman

body

weight

Weeks
Before
No edema or leg edema
Given
Weight(kg)
Fatmass(kg)
Fat-free mass(kg)
Expected
Totalbodywatert(kg)
Body densityl
(X l0 kg/m3)
Fat mass(kg)
predicted
by usual
Basedontotalbodywater
Based on body densityll
Generalized
edema
Given
Weight (kg)
Fatmass(kg)
Fat-freemass(kg)
Expected
Total body water (kg)
Bodydensityj(Xl03km3)
Fat mass(kg)
predicted
by usual
Based on total body waters
Weight

t Assumed

content

as given

ofprepregnant

:$:Assumed
density offat mass, 0.900;
Usual equation
given in Table 2.

II Usual

equation

given

in Table

of pregnancy

10

20

30

60.00
18.00
42.00

60.66
18.33
42.33

64.00
20.06
43.94

30.41
1 .03 13

30.69
1.0304

32.14
1 .0263

34.70
1.0235

38.02
1.0232

18.00
17.99

18.26
18.44

19.61
20.68

20.57
23.04

19.98
24.49

60.00
18.00
42.00

60.66
18.33
42.33

64.47
20.06
44.41

69.95
21.59
48.35

75.72
21.83
53.89

32.6 1
1.0260

36. 15
1.0228

19.43
20.92

20.02
23.75

68.50
21.59
46.9 1

40

72.50
21.83
50.67

30.41
1.0313

30.69
1.0304

18.00
17.99

18.26
18.44

41.24
1.0218

equations

gain and its composition

water

kg and bod y fat mass

equations

Basedonbodydensityll
*

pregnancy

of6O

in Table

18.76
26.07

3.

fat-free mass,
assumed
density

72.4%; water
ofprepregnant

content
ofpregnant
fat-free mass as given in Figure 1.
fat-free mass, 1.10; density ofpregnant
fat-free mass as given

in Figure

1.

Downloaded from ajcn.nutrition.org by guest on January 31, 2014

168.2 cm; weight

1 1 wk gestation),
61.7 kg; fat-free mass (at 1 1 wk gestation),
44.2
birth weight, 341 1 g; placental
weight, 638 g; at 2 mo postpartum
out ofthe 42 women did lactate.

IN PREGNANCY

28

VAN

fat

gain

8.0

pregnancy

weight

-0-

by usual
densitometric
equations
fat mass by modified
densitometric
equations
fatmo.ss

-.-

(kg)

by usual
densitometric
equation

,,

7.0

ET AL

RAAU

no oedema
generalised

oedema

0-

increase above
prepregnant
level
12 (kg)

6.0

5.0

2.0
by usual total
body water equation

/
/#{149}

6
0.0

io

dta

20

30

pregnancy

40
(weeks)
o_

FIG 2. Fat gain throughout

gain as calculated
by presently
equations.

pregnancy
for reference
woman and fat
used densitometric
and total body water

pregnancy

women.
Therefore
the values on density
and water content of fat-free
mass for the reference
women
(Figure
1)
may be considered
as appropriate
for most pregnant
women.
At 2 mo postpartum
body fat mass in our Dutch
women
was 2. 1 kg above prepregnant
fat mass (Figure
3). Factorial
analysis
oftotal
weight gain over pregnancy
TABLE 6
Water content
and density
FFM to prepregnant
FFM

ofmaternal

fat-free

mass (FFM)

at term

FIG

3. Body

measured

weight

post-partum

and

body

in 42 well-nourished

Dutch

in FFM*

to

Water
ofFFM

FFMt

kgf
No edema
1:4
1:5
1:6
Generalized
1:3
1:3.5
1:4

and estimates

Water

content

content
at term

ofbody

fat mass at term

and density

ofgain

in FFM

Based on total
body water

ratios

Based on
body density

kg

kg

22.1
21.8
21.5

21.3
21.9
22.3

77.1
76.6
76.1

1.0785
1.0810
1.0830

22.2
21.9
21.5

21.2
21.8
22.3

in Table

3.

to be 72.4%

and

1.10 X l0 kgjm3,

respectively

kg; body density,

1 .0232

X l0 kgJm3;

total

body water,

38.02

72.72

kg; body

1 .02 18 X l0 kg/rn3;

total

body

41 .24 kg(see

water,

kg(Table

(5).

5).
Table

5).

ofgain in

fat mass at term

1.0850
1.0875
1.0895

72.50

density,

ofbody

with various

75.5
75.0
74.6

as given

as

women.

for women

X1Okg/m-

t Water content and density ofprepregnant

FFM assumed
t Example: prepregnant FFM assumed to be 42 kg.
At term: body weight,
II At term: body weight,

Density of
FFM at term

or leg edemas
10.5:42
8.4:42
7.0:42
edemall
14.0:42
12.0:42
10.5:42

pregnancy

and fat mass estimates

from
skinfold
measurements
(Table 7) also revealed
that fat mass throughout
the fIrst
2 mo postpartum
was -2 kg above prepregnant
fat mass

Estimates
Ratio ofgain
prepregnant

mass throughout

fat

Downloaded from ajcn.nutrition.org by guest on January 31, 2014

3.0

1.0

/!

10

reference

4.0

ESTIMATING

BODY

FAT MASS

IN PREGNANCY

29

TABLE 7
Estimates

ofgain

in maternal

fat mass

over pregnancy

in healthy

Dutch

women4

Method

Analysis

oftotal

weight gain

Total weight gain

Weight
Weight
Weight

Skinfold

measurements

Analysis

ofpostpartum

For details

see reference

body

weight

is completely

finding

1.9 kg

1.9 kg

1.9 kg

2.9 kg
0.4 kg
2.5 k4

2.0 kg

strongly

in line
suggests

with
that

the postpartum
the

new

densi-

tometric
equations
are appropriate
for application
in
pregnancy.
As noted before the between-women
variation
in density and composition
of the fat-free mass might be quite
substantial;
therefore,
interpretation
ofindividual
results
for body fat mass with the new equations
is still to be
done with great caution.
However,
because
application
ofthe new pregnancy
equations
will result in more valid
estimates
ofmaternal
body fat mass than the usual equa-

extravascular

fluid assumed

to be 5. 1 kg(2).

tion will, we suggest that they be commonly

ies on energy balance
in pregnancy.

used

in stud-

#{163}3

References
1. Hyuen FE. Nutrition.
In: Hytten FE, Chamberlain
G, eds. Clinical
physiology
in obstetrics.
Part 2: Nutrition
and metabolism.
Oxford: Blackwell
Scientific
Publications,
1980:163-92.
2. Hytten FE. Weight gain in pregnancy.
In: Hyuen FE, Chamberlain
G, eds. Clinical Physiology
in Obstetrics.
Part 2: Nutrition
and metabolism.
Oxford:
Blackwell
Scientific
Publications,
1980:193233.
3. World Health Organization.
Energy and protein requirements.
Geneva: WHO, 1985. (WHO technical
report series #724.)
4. Siri WE. Gross composition
ofthe body. In: Lawrence
JH, Tobias
CA, eds. Advances
in biological
and medical physics. Vol IV. New
York: Academic
Press, 1956:239-80.
5. Garrow
JS. Indices ofadiposity.
Nutr Abstr Rev Clin Nutr Series
A 1983;53:697-708.
6. Raaij JMA van, Vermaat-Miedema
SH, Schonk CM, Peek MEM,
Hautvast
JGAJ. Energy requirements
ofpregnancy
in The Netherlands. Lancet 1987;2:953-5.

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value

kg

2.4

6.

(6). However,
the pregnancy
results
on fat mass when
calculated
with the usual Siris equation
(Figure
3) suggest an increase
in fat mass over pregnancy
of
5 kg.
When fat mass is calculated
with the new equations,
the
total increase
in fat mass over pregnancy
is -2.5 kg. After correcting
for -0.5 kg for fat in fetus and placenta
(2), the increase
in maternal
fat stores can be estimated
as
This

3.46 kg
0.66 kg
5. 1 kgt

Gain in adipose tissue

Fat mass at 1 mo postpartum
above
prepregant
level
Weight at 1 mo postpartum
above
prepregnant
level
Increased
maternal
organs(breasts)
Gain in adipose tissue

ofuterus,
amniotic
fluid, mammary
gland, blood, and extracellular
:$:Fat content ofadipose
tissue assumed
to be 80%.
Increased
weight maternal
organs(mainly
breasts) assumed
to be 0.4 kg.

2 kg. This

1 1.6 kg

fetus
placenta
uterus etc

t Weight

results.

Estimate
of gain
in fat mass

Calculation