International Journal of Clinical Nutrition
ISSN (Print): 2376-1385 ISSN (Online): 2376-1393 Website: http://www.sciepub.com/journal/ijcn Editor-in-chief: Apply for this position
Open Access
Journal Browser
Go
International Journal of Clinical Nutrition. 2014, 2(1), 1-10
DOI: 10.12691/ijcn-2-1-1
Open AccessReview Article

Analysis of Body Composition: A Critical Review of the Use of Bioelectrical Impedance Analysis

Mirele Savegnago Mialich1, , Juliana Maria Faccioli Sicchieri2 and Alceu Afonso Jordao Junior2

1Laboratory of Nutrition and Metabolism, Faculty of Medicine of Ribeirao Preto – USP, Av. Bandeirantes, Ribeirao Preto / SP, Brazil

2Faculty of Medicine of Ribeirão Preto, University of Sao Paulo. Ribeirão Preto, SP, Brazil

Pub. Date: January 08, 2014

Cite this paper:
Mirele Savegnago Mialich, Juliana Maria Faccioli Sicchieri and Alceu Afonso Jordao Junior. Analysis of Body Composition: A Critical Review of the Use of Bioelectrical Impedance Analysis. International Journal of Clinical Nutrition. 2014; 2(1):1-10. doi: 10.12691/ijcn-2-1-1

Abstract

Bioelectrical impedance analysis (BIA) is a method extensively used in studies assessing body composition, especially in view of the high speed of information processing, as a noninvasive method for generating information through portable, easy to use and relatively inexpensive equipment that estimates the distribution of body fluids in the intra- and intercellular spaces in addition to the body components. This technique consists of the passage of a painless low amplitude electrical current applied through cables connected to electrodes or to conducting surfaces placed in contact with the skin, permitting the measurement of resistance (R) and reactance (Xc). These R and Xc values applied to mathematical equations permit the estimate of the following body compartments: fat mass (FM), fat-free mass (FFM) and total body water (TBW). In this respect, the objective of the present report is to review the main concepts involved in the BIA technique, to describe the types of BIA available, their limitations and applications to clinical practice, especially the monitoring of chronic diseases. After this review, we conclude that BIA is an important instrument for health professionals and that its use can provide safe data about body composition, in addition to complementary data about the clinical course of patients followed up on a medium- and long-term basis.

Keywords:
body composition bioelectrical impedance resistance reactance fat mass fat-free mass body water

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]  Rezende F, Rosado L, Franceschinni S, Rosado G, Ribeiro R, Marins JCB. Revisão crítica dos métodos disponíveis para avaliar a composição corporal em grandes estudos populacionais e clínicos. Archivos Latinoamericyears de Nutricion 2007; 57 (4): 327-34.
 
[2]  Mialich MS, Martinez EZ, Jordao Jr AA. Comparative study of instruments for the analysis of body composition in a sample of the Brazilian population. International Journal of Body Composition 2011; 9 (1): 19-24.
 
[3]  Kyle U, Bosaeus I, Lorenzo A, et al. Bioeletrical impedance analisys-part I: review of principles and methods. Clin Nutr 2004; 23: 1226-43.
 
[4]  Lukaski HC, Johnson PE, Bolonchuk WW, Lykken GI. Assessment of fat-free mass using bioelectrical impedance measurements of the human body. Am J Clin Nutr 1985; 4: 810-7.
 
[5]  Heyward VH. ASEP Methods recommendation: body composition assessment. Journal of Exercise Physiology 2011; 4 (4): 1-12.
 
[6]  Kushner RF, Gudivaka R, Schoeller DA. Clinical characteristics influencing bioelectrical impedance analysis measurements. Am J Clin Nutr 1996; 64: (Suppl): S423-7.
 
[7]  Chumlea WC, Sun SS. Bioelectrical Impedance Analysis. In: Heymsfield SB, Lohman TG, Wang ZM, Going SB. Human Body Composition. 2nd ed. Champaign, IL: Human Kinetics; 2005. p. 79-87.
 
[8]  Kyle U, Genton L, Pichard C. Low phase angle determined by bioelectrical impedance analysis is associated with malnutrition and nutritional risk at hospital admission. Clinical Nutrition 2012; 1-6.
 
[9]  Norman K, Stobäus N, Pirlich M, Bosy-Westphal A. Bioelectrical phase angle and impedance vector analysis e Clinical relevance and applicability of impedance parameters. Clinical Nutrition 2012; 1-8.
 
[10]  Bellizzi V, Scalfi L, Terracciano V, De Nicola L, Minutolo R, Marra M, et al. Early changes in bioelectrical estimates of body composition in chronic kidney disease. J Am Soc Nephrol 2006; 17: 1481-7.
 
[11]  Gupta D, Lis CG, Dahlk SL, King J, Vashi PG, Grutsch JF, et al. The relationship between bioelectrical impedance phase angle and subjective global assessment in advanced colorectal cancer. Nutr J 2008; 7: 19.
 
[12]  de Luis DA, Aller R, Bachiller P, Gonzalez SM, Martin J, Izaola O. Influence of hormonal status and oral intake on phase angle in HIV-infected men. Nutrition 2004; 20: 731-4.
 
[13]  Selberg O, Selberg D. Norms and correlates of bioimpedance phase angle in healthy human subjects, hospitalized patients, and patients with liver cirrhosis. Eur J Appl Physiol 2002; 86: 509-16.
 
[14]  Wirth R, Volkert D, Rosler A, Sieber CC, Bauer JM. Bioelectric impedance phase angle is associated with hospital mortality of geriatric patients. Arch Gerontol Geriatr 2010; 51: 290-4.
 
[15]  Mally, K, Dittmar M. Comparison of three segmental multifrequency bioelectrical impedance techniques in healthy adults. Annals of Human Biology 2012; Early Online: 1-11.
 
[16]  Hsieh K, Kao M, Jang T et al. Estimation of segmental fat free mass in Taiwanese elderly females by bioelectrical impedance analysis with new mathematical model. African Journal of Biotechnology 2011; 10 (75): 17339-46.
 
[17]  Leahy S, O’Neill C, Sohun R, Jakeman P. A comparison of dual energy X-ray absorptiometry and bioelectrical impedance analysis to measure total and segmental body composition in healthy young adults. Eur J Appl Physiol 2012; 112: 589-95.
 
[18]  Kyle UG, Genton L, Karsegard L, Slosman DO, Pichard C. Single prediction equation for bioelectrical impedance analysis in adults aged 20-94 years. Nutrition 2001; 17: 248-53.
 
[19]  Lohman TG. Advances in body composition assessment. Champaign, IL: Human Kinetics Publishers; 1992.
 
[20]  Kotler DP, Burastero S, Wang J, Pierson Jr RN. Prediction of body cell mass, fat-free mass, and total body water with bioelectrical impedance analysis: effects of race, sex, and disease. Am J Clin Nutr 1996; 64: 489S-97S.
 
[21]  Deurenberg P, van der Kooy K, Leenen R, Westrate JA, Seidell JC. Sex and age specific prediction formulas for estimating body composition from bioelectrical impedance: a cross-validation study. Int J Obesity 1991; 15: 17-25.
 
[22]  Boulier A, Fricker J, Thomasset A-L, Apfelbaum M. Fat-free mass estimation by the two-electrode impedance method. Am J Clin Nutr 1990; 52: 581-5.
 
[23]  Stolarczyk LM, Heyward VH, Hicks VL, Baumgartner RN. Predictive accuracy of bioelectrical impedance in estimating body composition of Native American women. Am J Clin Nutr 1994; 59: 964-70.
 
[24]  Sun SS, Chumlea WC, Heymsfield SB, et al. Development of bioelectrical impedance analysis prediction equations for body composition with the use of a multicomponent model for use in epidemiologic surveys. Am J Clin Nutr 2003; 77: 331-40.
 
[25]  Heitmann BL. Prediction of body water and fat in adult Danes from measurement of electrical impedance. A validation study. Int J Obesity 1990; 14: 417-24.
 
[26]  Jakicic JM, Wing RR, Lang W. Bioelectrical impedance analysis to assess body composition in obese adult women: the effect of ethnicity. Int J Obesity 1998; 22: 243-9.
 
[27]  Haapala I, Hirvonen A, Niskanen L, et al. Anthropometry, bioelectrical impedance and dual-energy X-ray absorptiometry in the assessment of body composition in elderly Finnish women. Clin Phys Physiol Meas 2002; 22: 383-91.
 
[28]  Roubenoff R, Baumgartner RN, Harris TB, et al. Application of bioelectrical impedance analysis to elderly population. J Gerontol 1997; 52A: M129-36.
 
[29]  Baumgartner RN, Heymsfield SB, Lichtman S, Wang J, Pierson RNJ. Body composition in elderly people: effect of criterion estimates on predictive equations. Am J Clin Nutr 1991; 53: 1345-53.
 
[30]  Dey DK, Bosaeus I, Lissner L, Steen B. Body composition estimated by bioelectrical impedance in the Swedish elderly. Development of population-based prediction equation and reference values of fat-free mass and body fat for 70- and 75-y olds. Eur J Clin Nutr 2003; 57: 909-16.
 
[31]  Deurenberg P, van der Kooij K, Evers P, Hulshof T. Assessment of body composition by bioelectrical impedance in a population aged greater than 60 y. Am J Clin Nutr 1990; 51: 3-6.
 
[32]  Zhu F, Leonard EF, Levin NW. Extracellular fluid redistribution during hemodialysis: bioimpedance measurement and model. Physiol Meas 2008; 29 (6): 491-501.
 
[33]  Park J, Yang WS, Kim SB, et al. Usefulness of segmental bioimpedance ratio to determine dry body weight in new hemodialysis patients: a pilot study. Am J Nephrol 2009; 29 (1): 25-30.
 
[34]  Fiedler R, Jehle PM, Osten B, Dorligschaw O,Girndt G. Clinical nutrition scores are superior for the prognosis of haemodialysis patients compared to lab markers and bioelectrical impedance. Nephrol Dial Transplant 2009; 24: 3812-17.
 
[35]  De Lorenzo A, Deurenberg P, Andreoli A, Sasso GF, Palestini M, Docimo R. Multifrequency impedance in the assessment of body water losses during dialysis. Ren Physiol Biochem 1994; 17: 326-32.
 
[36]  Kushner R, Gudivaka R, Shoeller DA. Clinical Chracteristics influencing bioeletrical impedance analysis measurements. Am J Clin Nutr 1996; 64 (suppl) 423s-7s.
 
[37]  Ellis KJ, Bell SJ, Chertow GM, et al. Bioelectrical impedance methods in clinical research: a follow-up to the NIH Technology Assessment Conference. Nutrition 1999; 15: 874-80.
 
[38]  Mialich MS, Martinez EZ, Diez-Garcia RW, Jordão AA. New body mass index adjusted for fat mass (BMIfat) by the use of electrical impedance. International Journal of Body Composition Research 2011; 9 (2): 65-72.
 
[39]  Hannan WJ, Cowen SJ, Fearson KCH, Plester CE, Falconer JS, Richardson RA. Evaluation of multi-frequency bioimpedance analysis for the assessment of extracellular and total body water in surgical patients. Clin Sci 1994; 86: 479-85.
 
[40]  Donadio C, Halim AB, Caprio F, Grassi G, Khedr B, Mazzantini M. Single- and multi-frequency bioelectrical impedance analyses to analyse body composition in maintenance haemodialysis patients: comparison with dual-energy x-ray absorptiometry. Physiol Meas 2008; 29: S517-S524.
 
[41]  Mialich MS, Penaforte FRO, Rabito EI, Jordão Junior A A, Chiarello PG. Body composition by segmental bioeletric impedance technique: considerations and practical application. Revista Chilena de Nutrición 2010; 37: 262-69.
 
[42]  Chumlea WC, Baumgartner RN, Roche AF. Specific resistivity to estimate fat-free mass from segmental body measures of bioelectric impedance. Am J Clin Nutr 1988; 48: 7-15.
 
[43]  Baumgartner RN, Chumlea WC, Roche AF. Estimation of body composition from bioelectric impedance of body segments. Am J Clin Nutr 1989; 50: 221-6.
 
[44]  Settle RG, Foster KR, Epstein BR, Muller JL. Nutritional assessment: whole body impedance and body fluid compartments. Nutr Cancer 1988; 2: 72-80.
 
[45]  Tanaka NI, Miyatani M, Masuo Y, Fukunaga T, Kanehisa H. Applicability of a segmental bioelectrical impedance analysis for predicting the whole body skeletal muscle volume. J Appl Physiol 2007; 103 (5): 1688-95.
 
[46]  Shafer KJ, Siders WA, Johnson LK, Lukaski HC. Validity of segmental multiple-frequency bioelectrical impedance analysis to estimate body composition of adults across a range of body mass indexes. Nutrition 2009; 25 (1): 25-32.
 
[47]  Organ LW, Bradham GB, Gore DT, Lozier SL. Segmental bioelectrical impedance analysis: theory and application of a new technique. J Appl Physiol 1994; 77 (1): 98-112.
 
[48]  Ward LC. Segmental bioelectrical impedance analysis:an update. Curr Opin Clin Nutr Metab Care 2012; 15 (5):424-9.
 
[49]  Kyle U, Bosaeus I, Lorenzo A, et al. Bioeletrical impedance analisys – part II: utilization in clinical pratice. Clin Nutr 2004; 23: 1430-53.
 
[50]  Gonzalez MC, Nin LA, Reijven PLM. Bioelectrical impedance analysis. In: Sobotka L, editor-in-chief. Basics in Clinical Nutrition. Semily, Czech Republic: Galen; 2011. p. 13-21.
 
[51]  Codognotto M, Piazza M, Frigatti P, Piccoli A. Influence of localized edema on whole-body and segmental bioelectrical impedance. Nutrition 2008; 24 (4): 569-74.
 
[52]  Pirlich M, Schutz T, Ockenga J, et al. Improved assessment of body cell mass by segmental bioimpedance analysis in malnourished subjects and acromegaly. Clin Nutr 2003; 22: 167-74.
 
[53]  De Lorenzo AD, Andreoli A. Segmental bioelectrical impedance analysis. Curr Opin Clin Nutr Metab Care 2003; 6: 551-5.
 
[54]  Foster KR, Lukaski HC. Whole-body impedance-what does it measure? Am J Clin Nutr 1996; 64: 388S-96S.
 
[55]  Pirlich M, Schutz T, Spachos T, et al. Bioelectrical impedance analysis is a useful bedside technique to assess malnutrition in cirrhotic patients with and without ascites. Hepatology 2000; 32: 1208-15.
 
[56]  Cornish BH, Jacobs A, B J Thomas BJ,Ward LC. Optimizing electrode sites for segmental bioimpedance measurements. Physiol Meas 1999; 20: 241-50.
 
[57]  Pietrobelli A, Rubiano F, St-Onge MP, Heymsfield SB. New bioimpedance analysis system: improved phenotyping with whole-body analysis. European Journal of Clinical Nutrition 2004; 58: 1479-84.
 
[58]  Silva DRP, Ribeiro AS, Pavão FH, Ronquea ERV, Avelar A, Silva AM, Cyrino ES. Validade dos métodos para avaliação da gordura corporal em crianças e adolescentes por meio de modelos multicompartimentais: uma revisão sistemática. Ver Assoc Med Bras 2013; 9(5): 475-486.
 
[59]  Collins CT, Reid J, Makrides M, Lingwood BE, McPhee AJ, Morris SA, Gibson RA, Ward LC. Prediction of body water compartments in preterm infants by bioelectrical impedance spectroscopy. European Journal of Clinical Nutrition 2013; 67: S47-S53.
 
[60]  Lingwood BE. Bioelectrical impedance analysis for assessment of fluid status and body composition in neonates-the good, the bad and the unknown. European Journal of Clinical Nutrition 2013; 67, S28-S33.
 
[61]  T. Sharpe JK, Byrne NM, Terry J,Stedman TJ, Hills AP. Bioelectric impedance is a better indicator of obesity in men with schizophrenia than body mass index Psychiatry Research 2008; 159: 121-126.
 
[62]  Janssen I, Heymsfield S, Baumgartner R, Ross R. Estimation of skeletal muscle mass by bioelectrical impedance analysis. J Appl Physiol 2000; 89: 465-471.
 
[63]  Gonzalez MC, Maslonek J, Uliano GL et al. Illness marker as a prognostic tool in intensive care unit: a prospective study. JPEN J Parenter Enteral Nutr 2009; 33: 219-25.
 
[64]  Suzuki H, Akihiro Asakawa A, Amitani H, Nakamura N, Inui A. Cancer cachexia-pathophysiology and management. J Gastroenterol 2013; 48: 574-594.
 
[65]  Associação Brasileira de Cuidados Paliativos. Consenso Brasileiro de Caquexia e Anorexia em Cuidados Paliativos. Revista Brasileira de Cuidados Paliativos, 2011; (3) suplemento 1.
 
[66]  Mika C, Herpertz-Dahlmann B, Heer M, Holtkamp K. Improvement of nutritional status as assessed by multifrequency BIA during 15 weeks of refeeding in adolescent g irls with Anorexia Nervosa. J Nutr Nov 2004; 134: 3026-30.
 
[67]  Ohashi Y, Otani T, Tai R, Tanaka Y,Sakai K, Atsushi Aikawa A. Assessment of Body Composition using dry mass index and ratio of total body water to estimated volume based on bioelectrical impedance analysis in chronic kidney disease patients. Journal of Renal Nutrition 2013; 23(1): 28-36.
 
[68]  Norman K, Stoba¨us N, Zocher D, Westphal AB, Szramek A, Scheufele R, Smoliner C, Pirlich M. Cutoff percentiles of bioelectrical phase angle predict functionality, quality of life, and mortality in patients with cancer. Am J Clin Nutr 2010; 92: 612-9.