Correct determination of abdominal fat accumulation.

Body composition determination with single slice computed tomography (CT) image analysis that was used in study by Lee at al. (1) has increasingly been popular. This modality relies on determination of lipid and muscle mass by quantitative analysis of predefined CT slice through attenuation value of tissues. In the current work, image analysis was performed at the level of umbilicus (between the fourth and fifth lumbar disc position). Use of predefined and validated anatomic points to calculate body composition is critical due to the fact that distribution of fat mass is not similar in abdominal regions. However, the validity of the single slice CT image analysis at umbilicus level to determine total abdominal lipid mass was not addressed by Lee at al. (1). The value of single slice CT analysis at umbilicus to accurately predict abdominal lipid mass is not evidence based. Also, attenuation values which were predefined as -190 and -30 Hounsfield unit in the study by Lee at al. seems relatively wide (2). Thus, body components out of lipid mass may easily classified as lipid within this wide range. Moreover, to date, validity of single slice CT analysis to predict body composition has only been tested against a non-gold standard modality, Dual-energy Xray absorptiometry (3,4). Before reaching definitive conclusions from the results presented by the authors, we believe their hypothesis needs to be verified with gold standard body composition analysis techniques. Conflict of Interest: No conflict of interest was declared by the authors.