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1

Assessing Body Composition and Bone Density

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Body weight and height were measured to the nearest 0.1 kg and 0.1 cm, respectively, while the subjects were wearing light indoor clothes without shoes. BMI was calculated by dividing the weight (kg) by the square of the height (m2), and obesity was defined as BMI ≥25 kg/m2. Dual-energy X-ray absorptiometry (Discovery-W; Hologic Inc., Waltham, MA, USA) was used to measure whole and regional body compositions. Appendicular skeletal muscle mass (ASM) was calculated as the sum of the mass of skeletal muscle in the arms and legs, assuming that all non-fat and non-bone tissues were skeletal muscles. Sarcopenia was defined as the value of the ASM divided by height squared that was <2 standard deviation (SD)s below the sex-specific mean of a young reference group [12 (link),13 (link)]; the cutoff value was 5.45 kg/m2 in women. Bone mineral density (BMD) values were converted into T-scores. The T-score was calculated using the following equation: Tscore=(BMD of the participant−mean BMD of the reference population)/SD of the BMD of the reference population. The reference population comprised Asian, young, healthy female and male subjects, who underwent bone densitometry measurements (Discovery-W, Hologic Inc.) [14 ]. Osteoporosis was defined as a T-score of ≤−2.5 SD of the BMD based on the World Health Organization criteria [15 ].
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2

DXA Assessment of Body Composition

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Total and regional (trunk, leg) fat mass and fat‐free mass were assessed at baseline by dual‐energy x‐ray absorptiometry (DXA, Hologic Discovery W, software version 11.2; Hologic, Inc., Marlborough, MA) as previously described 17.
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3

Comparative Analysis of DXA and BIA

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DXA and BIA measurements were obtained on the same day. Subjects, after overnight fasting, underwent BIA first followed by DXA evaluation with a two-hour gap.
Body FM and FFM (lean mass and bone mineral content) were measured with a DXA scanner (Hologic Discovery W, Hologic Inc., MA, USA, Version 4.6.0.2 application software) adhering to the manufacturer's recommendations. Measurement were taken in light clothing without any metal items in their clothing or elsewhere while the study subjects were lying in a supine position. Scans were analyzed by inbuilt software (for obese subjects) provided by the manufacturers. In vitro precision of the machine was checked on each scanning day with whole body phantom provided by the manufacturer.
A whole body impedance was measured by a foot to foot BIA analyzer (Tanita SC-240A, Tanita Corporation, Tokyo, Japan). Subjects were asked to stand on the metal sole plates on the machine, and gender and height details were entered to the system. The body FM and lean mass were calculated using the built-in prediction software.
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4

Comprehensive Body Composition Analysis via DXA

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Body composition was estimated using DXA by the method described previously [7 (link)]. A Hologic Discovery W dual-energy X-ray absorptiometer (Hologic, Waltham, MA, USA) was used with switching peak energies of 140/100 kV. Quality assurance and calibration were performed daily using the manufacturer’s anthropomorphic spine phantom and quality control software. The repeatability of DXA measurements in dogs has been reported [29 (link)]. Briefly, dogs were placed in lateral recumbency, and the scan field collimated to the size of the dog. Whole body analysis was performed using proprietary purpose-designed computer software and calibrated to body mass. The following variables were estimated: total surface area (cm2), bone mineral content (BMC)(g), bone mineral density (g/cm2), fat (g), lean tissue mass (g), total body weight (g) and the total body fat percentage.
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5

Unilateral Resistance Exercise and BCAA

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Participants reported to the laboratory on five separate occasions, including two experimental trials that were separated by approximately three weeks. During the initial visit, body composition was assessed using dual-energy x-ray absorptiometry (DEXA; Hologic Discovery W, Hologic Inc., Bedford, Massachusetts, USA) and one repetition maximum (1RM) was predicted for each leg individually on both leg press and leg extension. Approximately one week later, participants returned to the laboratory to confirm their 1RM for each leg. Three days later, participants performed their first blinded trial in which they consumed either a BCAA containing drink (BCAA; GlaxoSmithKline, Brentford, UK) or placebo (PLA) drink (GlaxoSmithKline, Brentford, UK; Table 1). BCAA contained 5.6 g of BCAAs which is equivalent to the typical BCAA content of 20 g whey protein. Participants performed a unilateral bout of resistance exercise prior to consuming the test drink in each trial. Myofibrillar-MPS was determined by measuring the incorporation of L-[ring-13C6] phenylalanine into myofibrillar protein during a primed continuous infusion. The complete testing procedure was repeated on the contralateral leg approximately three weeks after the first trial. Trial and exercised leg order were counter-balanced and randomized.
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6

Standardized Diets for Exercise Performance

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To control for effects of diet on exercise performance, participants consumed a eucaloric study diet with standardized macronutrient distributions for 3 days prior to exercise testing and fasted for at least 4 h prior to exercise testing.10 (link) Eucaloric diets were developed by registered dieticians based on body composition assessed by Dual-energy X-ray Absorptiometry (DXA scan, Hologic/Discovery W, Hologic Inc, Bedford, Massachusetts, USA). DXA was also used to assess the exercise effort-related covariate of total fat-free mass.
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7

Body Composition Assessment by DXA

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Body composition was assessed by dual x-ray absorptiometry (Hologic Discovery W, Hologic, Marlborough, MA) at the Department of Radiology, University Hospital Basel, within 2 weeks of the respective study visit.
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8

Dual-Energy X-Ray Absorptiometry Measurements

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At baseline and after 36 weeks of training, BMD of the proximal femur (total and neck, trochanter, and subtrochanteric regions) and lumbar spine (L1-4), fat-free mass (FFM), and fat mass were measured by dual-energy x-ray absorptiometry (DXA) using a Hologic Discovery W instrument (version 12.6; Hologic, Inc., Bedford, MA). In our laboratory, the coefficients of variation (CVs) for lumbar spine, total hip, femoral neck, trochanter, and subtrochanter BMD are (mean (SD)) 1.2% (0.8%), 0.8% (0.6%), 1.9% (0.9%), 1.5% (1.0%), and 1.1% (0.6%). CVs for FFM and fat mass are 1.2% (0.8%) and 1.8% (0.9%), respectively. Hip and spine images that included metal implants were excluded from the BMD analyses. DXA scan reports were reviewed by two investigators for quality assurance.
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9

Accurate Body Composition Measurement by DXA

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DXA was the criterion lab assessment for body composition. DXA (Hologic Discovery W, software version 12.1, Hologic Inc.; Bedford, MA, USA) provides accurate and precise measurements of body bone mineral content and total fat mass with precision scores < 2% [33 (link)]. Body composition was divided into bone mass and soft tissue mass. Soft tissue mass was further divided into fat mass and fat-free mass. Percent body fat was calculated by dividing the fat mass by total body mass. DXA procedures were carried out via a trained and certified administrator within a private screening room.
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10

Anthropometric and Body Composition Evaluation

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Height and body weight were measured according to standard procedures using a calibrated electronic scale (Cardinal Detecto Scale Model 8430, Webb City, MO, USA), with a precision of +/-0.02 kg. Waist and hip circumference was measured using a Gulick tensiometer tape measure using standard criteria. 32 Body composition and bone density (excluding the cranium) were evaluated using calibrated Hologic Discovery W (Hologic Inc., Waltham, MA, USA) dual-energy X-ray absorptiometry (DEXA) equipped with APEX Software (APEX Corporation Software, Pittsburg, PA, USA).
Test-retest reliability studies performed with this DEXA machine have previously yielded mean coefficients of variation for total bone mineral content and total fat-free/soft tissue mass of 0.31-0.45% with a mean intra-class correlation of 0.985. 33
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