Whole body counting of total body potassium

Whole body counting (also called total body counting) measures the amount of naturally radioactive potassium 40 (40K) in the body (total body potassium or TBK). Potassium 40 is a naturally occurring isotope found in a known amount (0.0118%) in intracellular water and is not present in stored triglycerides.

The determination of TBK uses the principle that the proportion of total potassium found in human tissues as 40K is constant at 0.0118% of total potassium. Therefore, by measuring 40K, it is possible to calculate total-body potassium.

As potassium is distributed almost entirely within the intracellular compartment of fat-free mass, it is possible to calculate fat-free mass and fat mass using:

  1. TBK via measurement of 40K
  2. The known ratio of TBK to fat-free mass

TBK is a classical method of quantifying total-body fat. It has mostly been replaced by newer more accurate techniques. However, as part of a multi-component body composition model, TBK provides a precise and accurate assessment of nutritional status at all stages of life, from loss of vital tissue with age or during disease to growth studies in infants and children.

The participant is in a supine position on a bed between two arrays of sodium iodide detectors that are inside a room with shielding using concrete, lead or steel, such as 20 cm thick steel walls surrounded by one -metre-thick concrete. This shielding is necessary in order to filter naturally occurring radiation in the environment.

Once the external radiation is minimized, the participant’s natural radiation as 40K is measured through the use of scintillation counters (an instrument for detecting and measuring ionizing radiation). As the participant is measured by the counter, the gamma rays emitted by the potassium at 1.46 MeV are detected by sodium iodide crystals in either single or multi-detector configurations (Figure 1). Depending on the scanning system, measurements are taken over a few minutes to an hour.

Figure 1 Example of a multi-detector whole body counter designed to monitor body potassium in infants, children, and adults. Distance between detector arrays can be varied to maximize counting efficiency and precision.
Source: Image and information from the Body Composition Laboratory at Baylor College of Medicine, Houston, TX.

TBK has been used primarily as a marker for body cell mass (BCM), total body protein and can also be used to estimate FFM. In general, the accuracy of the whole body measurement of TBK is 1–5% for adults, decreasing slightly for the preterm infant. This method was originally applied for predicting total body fat in the 1960s. Although the TBK-fat method is no longer in use, studies support the continued use of TBK for total body protein, body cell mass and skeletal muscle in both adults and children.

After measurement of 40K radiation from the body (as described above), calculation of total body potassium (K) for the data is required. Fat free mass can be estimated from the total body K based on any one of several conversion factors which may vary in men from 2.46 to 3.41g K per kg of fat free mass and in women from 2.28 to 3.16 grams per kilogram. Total body fat can be calculated by subtracting FFM from body weight. Prediction models can be used to derive BCM, total body protein and total body skeletal muscle mass.

An overview of the characteristics of TBK is outlined in Table 1.

The main strength relates to its accuracy. However, it is costly and requires a specific environment in which it can be used. It is limited too in terms of its availability.

It may provide additional precision over anthropometrics and bioelectrical impedance methods (BIA) as the SEE of skeletal muscle in adult studies (1.5 kg) has been shown to be smaller than for simple anthropometric measures (2.2 kg) and bioelectrical methods (2.7 kg). The new technology with TBK counting, unlike many body composition methods, is safe, accurate and feasible in the first 1000 days of life and in pregnancy.

Table 1 Characteristics of whole body counting of TBK.

Characteristic Comment
Number of participants Small
Relative cost High
Participant burden Low
Researcher burden of data collection Medium
Researcher burden of coding and data analysis Medium
Risk of reactivity bias No
Risk of recall bias No
Risk of social desirability bias No
Risk of observer bias Yes
Space required High
Availability Low
Suitability for field use Not suitable
Participant literacy required No
Cognitively demanding No

Considerations relating to the use of whole body counting of TBK for anthropometry in specific populations are described in Table 2.

Table 2 Anthropometry by whole body counting of TBK in different populations.

Population Comment
Pregnancy Suitable
Infancy and lactation Suitable
Toddlers and young children May not be suitable in children between 18 months to 4 years due to lack of cooperation as it might be difficult to persuade them to stay still during the counting times (5-20 minutes). Children at these ages are often measured while asleep and for clinical applications sedation might be required.
Adolescents Suitable
Adults Suitable
Older Adults Suitable
Ethnic groups Suitable
Athletes Suitable
Other (obesity) Suitable for most clinical populations but not for those that have a condition that affects levels of potassium
  1. Any jewellery should be removed before counting, as possible presence of trace radioactivity in the metal.
  2. No need for fasting before measurement as most food contains about the same amount of potassium concentration as the whole body.
  3. As the presence of radioactive contamination on the participant’s body and clothing from atmospheric radon gas can affect the performance of the counters, it is recommended that participants wear clean clothes before undergoing the measurement.

Refer to section: practical considerations for objective anthropometry

Extremely sensitive equipment, which measures the gamma rays emitted from the naturally occurring radioactive isotope of potassium known as 40K, is required.

A method specific instrument library is being developed for this section. In the meantime, please refer to the overall instrument library page by clicking here to open in a new page.

  1. Ackland TR, Lohman TG, Sundgot-Borgen J, Maughan RJ, Meyer NL, Stewart AD, Muller W: Current Status f Body Composition in Sport – Review and Position Statement on Behalf of the Ad Hoc Research Working Group on Body Composition Health and Performance, Under the Auspices of the I.O.C. Medical Commission Sports Med 2012: 42; 227.
  2. Burmeister W: Potassium-40 Content as a Basis for the Calculation of Body Cell Mass in Man Science 1965: 148; 1336
  3. Butte NF, Hopkinson JM, Wong WW, Smith EO, Ellis KJ: Body composition during the first 2 years of life: an updated reference Pediatr Res 2000: 47; 578
  4. Duren DL, Sherwood RJ, Czerwinski SA, Lee M, Choh AC, Siervogel RM, Chumlea WC: Body Composition Methods: Comparisons and Interpretations J Diab Sci Technol 2008: 2; 1139
  5. Flynn MA, Woodruff C, Clark J, Chase G: Total body potassium in normal children. Pediatr Res 1972: 6; 239
  6. Forbes GB, Gallup J, Hursh JB: Estimation of Total Body Fat from Potassium-40 Content Science 1961: 13; 133
  7. Heymsfield SB, Lohman TG, Wang Z, et al: Human body composition. 2nd ed. Human kinetics; Champaigh, IL: 2005
  8. Lee RC, Heymsfield SB, Shen W, Wang ZM. Total-body and regional skeletal muscle mass measurement methods: an overview. Int J Body Compos Res. 2003;1:93–102.
  9. Murphy AJ, Ellis KJ, Kurpad AV, Preston T, Slater C: Total body potassium revisited Eur J Clin Nutr 2014: 68; m153
  10. Wang Z, Heshka S, Wang J, Heymsfield SB: Total body protein mass: validation of total body potassium prediction model in children and adolescents. J Nutr 2006; 136: 1032
  11. Wang Z, Heshka S, Pietrobelli A, Chen Z, Silva AM, Sardinha LB, Wang J, Gallager D, Heymsfield SB: A new total body Potassium method to estimate total body skeletal muscle mass in children J Nutr 2007: 137; 1988
  12. Wells JCK, Fewtrell MS; Measuring body composition Arch Dis Child 2006: 91; 612
  13. Widen EM, Gallagher D: Body composition changes in pregnancy: measurement, predictors and outcomes Eur J Clin Nutr 2014: 68; 643
  14. Yeong Lee S, Gallagher D: Assessment methods in human body composition Curr Opin Clin Nutr Metab Care 2008: 11; 566