Estimation of whole body muscle, adipose/fat mass, validation in health and during weight loss. Development of prediction equations using MRI as reference method

Background: Body composition is affected by diseases, and affects responses to medical treatments, dosage of medicines, etc., while an abnormal body composition contributes to the causation of many chronic diseases. While we have reliable biochemical tests for certain nutritional parameters of body composition, such as iron or iodine status, and we have harnessed nuclear physics to estimate the body’s content of trace elements, the very basic quantification of body fat content and muscle mass remains highly problematic. Both body fat and muscle mass are vitally important, as they have opposing influences on chronic disease, but they have seldom been estimated as part of population health surveillance. Instead, most national surveys have merely reported BMI and waist, or sometimes the waist/hip ratio; these indices are convenient but do not have any specific biological meaning. Anthropometry offers a practical and inexpensive method for muscle and fat estimation in clinical and epidemiological settings; however, its use is imperfect due to many limitations, such as a shortage of reference data, misuse of terminology, unclear assumptions, and the absence of properly validated anthropometric equations. To date, anthropometric methods are not sensitive enough to detect muscle and fat loss. Aims: The aim of this thesis is to estimate Adipose/fat and muscle mass in health disease and during weight loss through; 1. evaluating and critiquing the literature, to identify the best-published prediction equations for adipose/fat and muscle mass estimation; 2. to derive and validate adipose tissue and muscle mass prediction equations; and 3.to evaluate the prediction equations along with anthropometric indices and the best equations retrieved from the literature in health, metabolic illness and during weight loss. Methods: a Systematic review using Cochrane Review method was used for reviewing muscle mass estimation papers that used MRI as the reference method. Fat mass estimation papers were critically reviewed. Mixed ethnic, age and body mass data that underwent whole body magnetic resonance imaging to quantify adipose tissue and muscle mass (dependent variable) and anthropometry (independent variable) were used in the derivation/validation analysis. Multiple regression and Bland-Altman plot were applied to evaluate the prediction equations. To determine how well the equations identify metabolic illness, English and Scottish health surveys were studied. Statistical analysis using multiple regression and binary logistic regression were applied to assess model fit and associations. Also, populations were divided into quintiles and relative risk was analysed. Finally, the prediction equations were evaluated by applying them to a pilot study of 10 subjects who underwent whole-body MRI, anthropometric measurements and muscle strength before and after weight loss to determine how well the equations identify adipose/fat mass and muscle mass change. Results: The estimation of fat mass has serious problems. Despite advances in technology and science, prediction equations for the estimation of fat mass depend on limited historical reference data and remain dependent upon assumptions that have not yet been properly validated for different population groups. Muscle mass does not have the same conceptual problems; however, its measurement is still problematic and reference data are scarce. The derivation and validation analysis in this thesis was satisfactory, compared to prediction equations in the literature they were similar or even better. Applying the prediction equations in metabolic illness and during weight loss presented an understanding on how well the equations identify metabolic illness showing significant associations with diabetes, hypertension, HbA1c and blood pressure. And moderate to high correlations with MRI-measured adipose tissue and muscle mass before and after weight loss. Conclusion: Adipose tissue mass and to an extent muscle mass can now be estimated for many purposes as population or groups means. However, these equations must not be used for assessing fatness and categorising individuals. Further exploration in different populations and health surveys would be valuable.

Interaction techniques with novel multimodal feedback for addressing gesture-sensing systems

Users need to be able to address in-air gesture systems, which means finding where to perform gestures and how to direct them towards the intended system. This is necessary for input to be sensed correctly and without unintentionally affecting other systems. This thesis investigates novel interaction techniques which allow users to address gesture systems properly, helping them find where and how to gesture. It also investigates audio, tactile and interactive light displays for multimodal gesture feedback; these can be used by gesture systems with limited output capabilities (like mobile phones and small household controls), allowing the interaction techniques to be used by a variety of device types. It investigates tactile and interactive light displays in greater detail, as these are not as well understood as audio displays. Experiments 1 and 2 explored tactile feedback for gesture systems, comparing an ultrasound haptic display to wearable tactile displays at different body locations and investigating feedback designs. These experiments found that tactile feedback improves the user experience of gesturing by reassuring users that their movements are being sensed. Experiment 3 investigated interactive light displays for gesture systems, finding this novel display type effective for giving feedback and presenting information. It also found that interactive light feedback is enhanced by audio and tactile feedback. These feedback modalities were then used alongside audio feedback in two interaction techniques for addressing gesture systems: sensor strength feedback and rhythmic gestures. Sensor strength feedback is multimodal feedback that tells users how well they can be sensed, encouraging them to find where to gesture through active exploration. Experiment 4 found that they can do this with 51mm accuracy, with combinations of audio and interactive light feedback leading to the best performance. Rhythmic gestures are continuously repeated gesture movements which can be used to direct input. Experiment 5 investigated the usability of this technique, finding that users can match rhythmic gestures well and with ease. Finally, these interaction techniques were combined, resulting in a new single interaction for addressing gesture systems. Using this interaction, users could direct their input with rhythmic gestures while using the sensor strength feedback to find a good location for addressing the system. Experiment 6 studied the effectiveness and usability of this technique, as well as the design space for combining the two types of feedback. It found that this interaction was successful, with users matching 99.9% of rhythmic gestures, with 80mm accuracy from target points. The findings show that gesture systems could successfully use this interaction technique to allow users to address them. Novel design recommendations for using rhythmic gestures and sensor strength feedback were created, informed by the experiment findings.