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But is there a \u2018gold\u2019 standard or accepted reference method for quantifying the amount and composition of human SM mass? Exploring that question led us to recognize the existence of a SM measurement paradigm that divides methods into two broad categories, in\u00a0vitro and in\u00a0vivo. In\u00a0vitro methods quantify SM mass, weighing intact muscles as part of whole cadaver evaluations, only 51 of which are reported in medical literature with no recent additions. In\u00a0vivo methods are used to evaluate SM in\u00a0vivo, and two tiers were revealed in our analyses. An upper tier that included three methods considered \u2018reference\u2019 approaches for their accuracy and precision: computed tomography, magnetic resonance imaging and dual\u2010energy X\u2010ray absorptiometry. A lower in\u00a0vivo method tier included bioimpedance analysis, three\u2010dimensional imaging, several approaches involving creatine metabolism, ultrasound and anthropometry. A feature common to all of the lower tier methods is their need for calibration or validation against reference approaches in the upper in\u00a0vivo method tier. A critical review of the three in\u00a0vivo reference methods in the upper tier revealed widely variable SM volume\/mass acquisition protocols, image analysis methods and applied terminology. Some reports espouse an upper tier reference method as the \u2018gold\u2019 standard while providing minimal details of exactly how and what was measured, thus making replication in follow\u2010up studies difficult. Any technical issues related to an in\u00a0vivo reference method are propagated to the in\u00a0vivo methods in the lower tier that are calibrated or validated against them. Our review of in\u00a0vivo reference methods of quantifying SM mass and composition led us to two broad recommendations. First, published reports including these reference methods should provide enough details related to acquisition and analysis protocols so that readers can replicate their findings. Second, an effort should be made to apply precise terminology in published reports in order to avoid confusion on exactly what was measured; suggestions are made on definitions of commonly used terms when referring to body composition compartments. Lastly, because there is no consensus on what constitutes a \u2018gold\u2019 standard for SM measurement, we suggest expert groups convene in the future to recommend optimum approaches and working guidelines for quantifying muscle mass and composition in\u00a0vivo.<\/jats:p>","DOI":"10.1002\/jcsm.70184","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T06:41:44Z","timestamp":1768891304000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Reference Methods for Measuring Skeletal Muscle Mass: A Critical Perspective"],"prefix":"10.1002","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1127-9425","authenticated-orcid":false,"given":"Steven\u00a0B.","family":"Heymsfield","sequence":"first","affiliation":[{"name":"Pennington Biomedical Research Center LSU System  Baton Rouge Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Houchun\u00a0H.","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Radiology Mayo Clinic  Jacksonville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edvin","family":"Johanssen","sequence":"additional","affiliation":[{"name":"Antaros Medical  M\u00f6lndal Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia","family":"Ramirez","sequence":"additional","affiliation":[{"name":"Pennington Biomedical Research Center LSU System  Baton Rouge Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela","family":"de Oliveira\u00a0Lemos","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology University of S\u00e3o Paulo School of Medicine\u2010FMUSP  Sao Paolo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria\u00a0Cristina","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Nutrition and Food Federal University of Pelotas  Pelotas Rio Grande do Sul Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla\u00a0M.","family":"Prado","sequence":"additional","affiliation":[{"name":"Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences University of Alberta  Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan\u00a0P.","family":"Bennett","sequence":"additional","affiliation":[{"name":"Department of Epidemiology University of Hawai\u02bbi Cancer Center  Honolulu Hawaii USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,19]]},"reference":[{"key":"e_1_2_12_2_1","volume-title":"Report on the Task Group on Reference Man: ICRP Publication 23","author":"International Commission on Radiological Protection (ICRP)","year":"1975"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu14071526"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213\u20108587(24)00272\u20109"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afz046"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2023.155533"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2021.11.014"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/56.3.m146"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2023.03.028"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2022.02.001"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcsm.12383"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcsm.13083"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00045.2014"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00260.2004"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/76.2.378"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/61.3.457"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/56.1.19"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/37.3.478"},{"key":"e_1_2_12_19_1","first-page":"185","article-title":"Urinary Creatinine\u2010Skeletal Muscle Mass Method: A Prediction Equation Based on Computerized Axial Tomography","volume":"9","author":"Wang Z. 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