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Cross-validation of bioelectrical impedance analysis for the assessment of body composition in a representative sample of 6- to 13-year-old children

European Journal of Clinical Nutrition volume 63, pages 619–626 (2009)Cite this article

Abstract

Background/Objectives: (1) To cross-validate tetra- (4-BIA) and octopolar (8-BIA) bioelectrical impedance analysis vs dual-energy X-ray absorptiometry (DXA) for the assessment of total and appendicular body composition and (2) to evaluate the accuracy of external 4-BIA algorithms for the prediction of total body composition, in a representative sample of Swiss children.

Subjects/Methods: A representative sample of 333 Swiss children aged 6–13 years from the Kinder-Sportstudie (KISS) (ISRCTN15360785). Whole-body fat-free mass (FFM) and appendicular lean tissue mass were measured with DXA. Body resistance (R) was measured at 50 kHz with 4-BIA and segmental body resistance at 5, 50, 250 and 500 kHz with 8-BIA. The resistance index (RI) was calculated as height2/R. Selection of predictors (gender, age, weight, RI4 and RI8) for BIA algorithms was performed using bootstrapped stepwise linear regression on 1000 samples. We calculated 95% confidence intervals (CI) of regression coefficients and measures of model fit using bootstrap analysis. Limits of agreement were used as measures of interchangeability of BIA with DXA.

Results: 8-BIA was more accurate than 4-BIA for the assessment of FFM (root mean square error (RMSE)=0.90 (95% CI 0.82–0.98) vs 1.12 kg (1.01–1.24); limits of agreement 1.80 to -1.80 kg vs 2.24 to -2.24 kg). 8-BIA also gave accurate estimates of appendicular body composition, with RMSE ⩽0.10 kg for arms and ⩽0.24 kg for legs. All external 4-BIA algorithms performed poorly with substantial negative proportional bias (r⩾0.48, P<0.001).

Conclusions: In a representative sample of young Swiss children (1) 8-BIA was superior to 4-BIA for the prediction of FFM, (2) external 4-BIA algorithms gave biased predictions of FFM and (3) 8-BIA was an accurate predictor of segmental body composition.

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References

  • Bedogni G, Iughetti L, Ferrari M, Malavolti M, Poli M, Bernasconi S et al. (2003a). Sensitivity and specificity of body mass index and skinfold thicknesses in detecting excess adiposity in children aged 8–12 years. Ann Hum Biol 30, 132–139.

    Article  CAS  PubMed  Google Scholar 

  • Bedogni G, Malavolti M, Severi S, Poli M, Mussi C, Fantuzzi AL et al. (2002). Accuracy of an eight-point tactile-electrode impedance method in the assessment of total body water. Eur J Clin Nutr 56, 1143–1148.

    Article  CAS  PubMed  Google Scholar 

  • Bedogni G, Marra M, Bianchi L, Malavolti M, Nicolai E, De Filippo E et al. (2003b). Comparison of bioelectrical impedance analysis and dual-energy X-ray absorptiometry for the assessment of appendicular body composition in anorexic women. Eur J Clin Nutr 57, 1068–1072.

    Article  CAS  PubMed  Google Scholar 

  • Bertoli S, Battezzati A, Testolin G, Bedogni G (2007). Evaluation of air-displacement plethysmography and bioelectrical impedance analysis vs dual-energy X-ray absorptiometry for the assessment of fat-free mass in elderly subjects. Eur J Clin Nutr; e-pub ahead of print 25 July 2007.

  • Chomtho S, Fewtrell MS, Jaffe A, Williams JE, Wells JC (2006). Evaluation of arm anthropometry for assessing pediatric body composition: evidence from healthy and sick children. Pediatr Res 59, 860–865.

    Article  PubMed  Google Scholar 

  • Chumlea WC, Schubert CM, Sun SS, Demerath E, Towne B, Siervogel RM (2007). A review of body water status and the effects of age and body fatness in children and adults. J Nutr Health Aging 11, 111–118.

    PubMed  Google Scholar 

  • de Lorenzo A, Sorge SP, Iacopino L, Andreoli A, de Luca PP, Sasso GF (1998). Fat-free mass by bioelectrical impedance vs dual-energy X-ray absorptiometry (DXA). Appl Radiat Isot 49, 739–741.

    Article  CAS  PubMed  Google Scholar 

  • Deurenberg P, Smit HE, Kusters CS (1989). Is the bioelectrical impedance method suitable for epidemiological field studies? Eur J Clin Nutr 43, 647–654.

    CAS  PubMed  Google Scholar 

  • Efron B, Tibshirani R (1993). An Introduction to the Bootstrap. Chapman & Hall: New York.

    Book  Google Scholar 

  • Fuller NJ, Elia M (1989). Potential use of bioelectrical impedance of the ‘whole body’ and of body segments for the assessment of body composition: comparison with densitometry and anthropometry. Eur J Clin Nutr 43, 779–791.

    CAS  PubMed  Google Scholar 

  • Fuller NJ, Fewtrell MS, Dewit O, Elia M, Wells JC (2002). Segmental bioelectrical impedance analysis in children aged 8–12 y: 2. The assessment of regional body composition and muscle mass. Int J Obes Relat Metab Disord 26, 692–700.

    Article  CAS  PubMed  Google Scholar 

  • Gallagher D, Visser M, De Meersman RE, Sepúlveda D, Baumgartner RN, Pierson RN et al. (1997). Appendicular skeletal muscle mass: effects of age, gender, and ethnicity. J Appl Physiol 83, 229–239.

    Article  CAS  PubMed  Google Scholar 

  • Guo SS, Chumlea WC, Cockram DB (1996). Use of statistical methods to estimate body composition. Am J Clin Nutr 64, 428S–435S.

    Article  CAS  PubMed  Google Scholar 

  • Harrell FE (2001). Regression Modeling Strategies: With Applications to Linear Models, Logistic Regression, and Survival Analysis. Springer: New York.

    Book  Google Scholar 

  • Kim J, Shen W, Gallagher D, Jones A, Wang Z, Wang J et al. (2006). Total-body skeletal muscle mass: estimation by dual-energy X-ray absorptiometry in children and adolescents. Am J Clin Nutr 84, 1014–1020.

    Article  CAS  PubMed  Google Scholar 

  • Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS, Wei R et al. (2000). CDC growth charts: United States. Adv Data 8, 1–27.

    Google Scholar 

  • Kushner RF (1992). Bioelectrical impedance analysis: a review of principles and applications. J Am Coll Nutr 11, 199–209.

    CAS  PubMed  Google Scholar 

  • Kushner RF, Gudivaka R, Schoeller DA (1996). Clinical characteristics influencing bioelectrical impedance analysis measurements. Am J Clin Nutr 64 (3 Suppl), 423S–427S.

    Article  CAS  PubMed  Google Scholar 

  • Lohman TG, Going SB (2006). Body composition assessment for development of an international growth standard for preadolescent and adolescent children. Food Nutr Bull 27, S314–S325.

    Article  PubMed  Google Scholar 

  • Lohman TG, Roche AF, Martorell R (1988). Anthropometric Standardization Reference Manual. Human Kinetics Books: Champaign, IL.

    Google Scholar 

  • Ludbrook J (2002). Statistical techniques for comparing measurers and methods of measurement: a critical review. Clin Exp Pharmacol Physiol 29, 527–536.

    Article  CAS  PubMed  Google Scholar 

  • Malavolti M, Mussi C, Poli M, Fantuzzi AL, Salvioli G, Battistini N et al. (2003). Cross-calibration of eight-polar bioelectrical impedance analysis versus dual-energy X-ray absorptiometry for the assessment of total and appendicular body composition in healthy subjects aged 21–82 years. Ann Hum Biol 30, 380–391.

    Article  CAS  PubMed  Google Scholar 

  • Maynard LM, Wisemandle W, Roche AF, Chumlea WC, Guo SS, Siervogel RM (2001). Childhood body composition in relation to body mass index. Pediatrics 107, 344–350.

    Article  CAS  PubMed  Google Scholar 

  • Medici G, Mussi C, Fantuzzi AL, Malavolti M, Albertazzi A, Bedogni G (2005). Accuracy of eight-polar bioelectrical impedance analysis for the assessment of total and appendicular body composition in peritoneal dialysis patients. Eur J Clin Nutr 59, 932–937.

    Article  CAS  PubMed  Google Scholar 

  • Nielsen BM, Dencker M, Ward L, Linden C, Thorsson O, Karlsson MK et al. (2007). Prediction of fat-free body mass from bioelectrical impedance among 9- to 11-year-old Swedish children. Diabetes Obes Metab 9, 521–539.

    Article  CAS  PubMed  Google Scholar 

  • NIH (1996). Bioelectrical impedance analysis in body composition measurement: National Institutes of Health Technology Assessment Conference Statement. Am J Clin Nutr 64, 524S–532S.

    Article  Google Scholar 

  • Pietrobelli A (2004). Outcome measurements in paediatric obesity prevention trials. Int J Obes Relat Metab Disord 28 (Suppl 3), S86–S89.

    Article  PubMed  Google Scholar 

  • Pietrobelli A, Andreoli A, Cervelli V, Carbonelli MG, Peroni DG, De Lorenzo A (2003). Predicting fat-free mass in children using bioimpedance analysis. Acta Diabetol 40 (Suppl 1), S212–S215.

    Article  PubMed  Google Scholar 

  • Pietrobelli A, Formica C, Wang Z, Heymsfield SB (1996). Dual-energy X-ray absorptiometry body composition model: review of physical concepts. Am J Physiol 271, E941–E951.

    CAS  PubMed  Google Scholar 

  • Pietrobelli A, Rubiano F, St-Onge MP, Heymsfield SB (2004). New bioimpedance analysis system: improved phenotyping with whole-body analysis. Eur J Clin Nutr 58, 1479–1484.

    Article  CAS  PubMed  Google Scholar 

  • Plank LD (2005). Dual-energy X-ray absorptiometry and body composition. Curr Opin Clin Nutr Metab Care 8, 305–309.

    Article  PubMed  Google Scholar 

  • Sartorio A, Malavolti M, Agosti F, Marinone PG, Caiti O, Battistini N et al. (2005). Body water distribution in severe obesity and its assessment from eight-polar bioelectrical impedance analysis. Eur J Clin Nutr 59, 155–160.

    Article  CAS  PubMed  Google Scholar 

  • Tanner JM (1962). Growth at adolescence 2nd edn. Blackwell Scientific Publications: Oxford, England.

    Google Scholar 

  • Wang ZM, Visser M, Ma R, Baumgartner RN, Kotler D, Gallagher D et al. (1996). Skeletal muscle mass: evaluation of neutron activation and dual-energy X-ray absorptiometry methods. J Appl Physiol 80, 824–831.

    Article  CAS  PubMed  Google Scholar 

  • Wells JC (2003). Body composition in childhood: effects of normal growth and disease. Proc Nutr Soc 62, 521–528.

    Article  CAS  PubMed  Google Scholar 

  • Wells JC, Fewtrell MS (2006). Measuring body composition. Arch Dis Child 91, 612–617.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Zahner L, Puder JJ, Roth R, Schmid M, Guldimann R, Pühse U et al. (2006). A school-based physical activity program to improve health and fitness in children aged 6–13 years (‘Kinder-Sportstudie KISS’): study design of a randomized controlled trial [ISRCTN15360785]. BMC Public Health 6, 147.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

KISS is supported by research grants from the Swiss Federal Office of Sports and the Swiss National Foundation.

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Authors and Affiliations

  1. Institute of Exercise and Health Sciences, University of Basel, Basel, Switzerland

    S Kriemler, L Zahner & R Roth

  2. Division of Endocrinology, Diabetes and Metabolism, University Hospital of Lausanne, Lausanne, Switzerland

    J Puder

  3. Institute of Social and Preventive Medicine, University of Basel, Basel, Switzerland

    C Braun-Fahrländer

  4. Clinical Epidemiology Unit, Liver Research Center, Trieste, Italy

    G Bedogni

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  1. S Kriemler
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  2. J Puder
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  3. L Zahner
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  4. R Roth
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  6. G Bedogni
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Correspondence to S Kriemler.

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Guarantors: S Kriemler and G Bedogni.

Contributors: SK and LZ coordinated the study and contributed to the final version of the manuscript; JP and RR were main investigators of the study and contributed to the final version of the manuscript; CB-F supervised the study and gave important inputs for the content of the manuscript; GB performed statistical analysis and wrote the first draft of the article.

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Kriemler, S., Puder, J., Zahner, L. et al. Cross-validation of bioelectrical impedance analysis for the assessment of body composition in a representative sample of 6- to 13-year-old children. Eur J Clin Nutr 63, 619–626 (2009). https://doi.org/10.1038/ejcn.2008.19

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