Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Bioelectric impedance spectroscopy underestimates fat-free mass compared to dual energy X-ray absorptiometry in incurable cancer patients

European Journal of Clinical Nutrition volume 63, pages 794–801 (2009)Cite this article

Abstract

Background/Objectives:

Weight loss is frequently seen in advanced cancer. Bioelectrical impedance spectroscopy (BIS) is a convenient method for estimating body composition. We examined in a prospective, comparative study if BIS could accurately estimate fat-free mass (FFM) in cancer patients compared to dual-energy X-ray absorptiometry (DXA).

Subjects/Methods:

The study was based on 132 consecutive incurable cancer patients with solid tumours in a University hospital outpatient clinic. Comparison of FFM from DXA and BIS with standard and revised equations. Bland–Altman plots, t-tests and linear regression analysis were used to evaluate agreement and differences between methods.

Results:

BIS significantly underestimated mean FFM with 7.6±4.7 kg compared to DXA (P<0.001). Bias was significantly correlated to % weight loss (r=0.32), systemic inflammation as measured by C-reactive protein (r=0.29), malnutrition as assessed by low insulin-like growth factor-1 (r=−0.23) and inversely to the per cent body fat estimated by DXA (P=−0.61) and body mass index (BMI; r=−0.30). Revised BIS equations taking BMI into account reduced bias significantly but still with great individual variation.

Conclusions:

BIS by standard equations grossly underestimates FFM compared to DXA in cancer patients. This bias is related to weight loss, malnutrition and systemic inflammation. Revised equations improved FFM estimates, but with large individual variation. Thus, BIS with standard equations is not suitable to estimate FFM in patients with cachexia, inflammation and malnutrition.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  • Altman D (1991). Practical Statistics for Medical Research. Chapman & Hall: London, UK.

    Google Scholar 

  • Baarends EM, van Marken Lichtenbelt WD, Wouters EF, Schols AM (1998). Body-water compartments measured by bio-electrical impedance spectroscopy in patients with chronic obstructive pulmonary disease. Clin Nutr 17, 15–22.

    Article  CAS  Google Scholar 

  • Barber MD, Ross JA, Fearon KC (1999). Cancer cachexia. Surg Oncol 8, 133–141.

    Article  CAS  Google Scholar 

  • Bosaeus I, Daneryd P, Svanberg E, Lundholm K (2001). Dietary intake and resting energy expenditure in relation to weight loss in unselected cancer patients. Int J Cancer 93, 380–383.

    Article  CAS  Google Scholar 

  • Carlsson E, Bosaeus I, Nordgren S (2002). Body composition in patients with an ileostomy and inflammatory bowel disease: validation of bio-electric impedance spectroscopy (BIS). Eur J Clin Nutr 56, 680–686.

    Article  CAS  Google Scholar 

  • Carlsson E, Bosaeus I, Nordgren S (2004). Body composition in patients with short bowel syndrome: an assessment by bioelectric impedance spectroscopy (BIS) and dual-energy absorptiometry (DXA). Eur J Clin Nutr 58, 853–859.

    Article  CAS  Google Scholar 

  • Corcoran C, Anderson EJ, Burrows B, Stanley T, Walsh M, Poulos AM et al. (2000). Comparison of total body potassium with other techniques for measuring lean body mass in men and women with AIDS wasting. Am J Clin Nutr 72, 1053–1058.

    CAS  PubMed  Google Scholar 

  • Cox-Reijven PL, Kooman JP, Soeters PB, van der Sande FM, Leunissen KM (2001). Role of bioimpedance spectroscopy in assessment of body water compartments in hemodialysis patients. Am J Kidney Dis 38, 832–838.

    Article  CAS  Google Scholar 

  • Cox-Reijven PL, van Kreel B, Soeters PB (2003). Bioelectrical impedance measurements in patients with gastrointestinal disease: validation of the spectrum approach and a comparison of different methods for screening for nutritional depletion. Am J Clin Nutr 78, 1111–1119.

    Article  CAS  Google Scholar 

  • De Lorenzo A, Andreoli A, Matthie J, Withers P (1997). Predicting body cell mass with bioimpedance by using theoretical methods: a technological review. J Appl Physiol 82, 1542–1558.

    Article  CAS  Google Scholar 

  • Ellis KJ (2000). Human body composition: in vivo methods. Physiol Rev 80, 649–680.

    Article  CAS  Google Scholar 

  • Fordy C, Glover C, Henderson DC, Summerbell C, Wharton R, Allen-Mersh TG (1999). Contribution of diet, tumour volume and patient-related factors to weight loss in patients with colorectal liver metastases. Br J Surg 86, 639–644.

    Article  CAS  Google Scholar 

  • Gudivaka R, Schoeller DA, Kushner RF, Bolt MJ (1999). Single- and multifrequency models for bioelectrical impedance analysis of body water compartments. J Appl Physiol 87, 1087–1096.

    Article  CAS  Google Scholar 

  • Haderslev KV, Staun M (2000). Comparison of dual-energy X-ray absorptiometry to four other methods to determine body composition in underweight patients with chronic gastrointestinal disease. Metabolism 49, 360–366.

    Article  CAS  Google Scholar 

  • Jebb S (1997). Measurement of soft tissue composition by dual energy X-ray absorptiometry. Br J Nutr 77, 151–163.

    Article  CAS  Google Scholar 

  • Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Gómez JM et al. (2004a). Bioelectrical impedance analysis—part I: review of principles and methods. Clin Nutr 23, 1226–1243.

    Article  Google Scholar 

  • Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Manuel Gómez J et al. (2004b). Bioelectrical impedance analysis-part II: utilization in clinical practice. Clin Nutr 23, 1430–1453.

    Article  Google Scholar 

  • Lof M, Forsum E (2004). Evaluation of bioimpedance spectroscopy for measurements of body water distribution in healthy women before, during, and after pregnancy. J Appl Physiol 96, 967–973.

    Article  Google Scholar 

  • Matthie JR (2005). Second generation mixture theory equation for estimating intracellular water using bioimpedance spectroscopy. J Appl Physiol 99, 780–781.

    Article  Google Scholar 

  • Moissl UM, Wabel P, Chamney PW, Bosaeus I, Levin NW, Bosy-Westphal A et al. (2006). Body fluid volume determination via body composition spectroscopy in health and disease. Physiol Meas 27, 921–933.

    Article  Google Scholar 

  • Papathakis PC, Rollins NC, Brown KH, Bennish ML, Van Loan MD (2005). Comparison of isotope dilution with bioimpedance spectroscopy and anthropometry for assessment of body composition in asymptomatic HIV-infected and HIV-uninfected breastfeeding mothers. Am J Clin Nutr 82, 538–546.

    Article  CAS  Google Scholar 

  • Plank L, Hill GH (2001). Body Composition. In: Souba WW, Wilmore DW (eds). Surgical Research. Academic Press: San Diego, USA. pp 797–812.

    Chapter  Google Scholar 

  • Royall D, Greenberg GR, Allard JP, Baker JP, Harrison JE, Jeejeebhoy KN (1994). Critical assessment of body-composition measurements in malnourished subjects with Crohn's disease: the role of bioelectric impedance analysis. Am J Clin Nutr 59, 325–330.

    Article  CAS  Google Scholar 

  • Soldervik J (2005). Determination of Intra- and Extracellular Volume with BIS. Validation Against Total Body Water, Bromide Dilution Technique, Total Body Potassium and Dual Energy X-ray Absorptiometry. Master Thesis in Clinical Nutrition. Department of Clinical Nutrition: Göteborg, Sweden.

  • Van Der Ploeg GE, Withers RT, Laforgia J (2003). Percent body fat via DEXA: comparison with a four-compartment model. J Appl Physiol 94, 499–506.

    Article  Google Scholar 

  • Van Loan MD, Kopp LE, King JC, Wong WW, Mayclin PL (1995). Fluid changes during pregnancy: use of bioimpedance spectroscopy. J Appl Physiol 78, 1037–1042.

    Article  CAS  Google Scholar 

  • Van Loan MD, Withers P, Matthie J, Mayclin PL (1993). Use of bioimpedance spectroscopy to determine extracellular fluid, intracellular fluid, total body water, and fat-free mass. Basic Life Sci 60, 67–70.

    CAS  PubMed  Google Scholar 

  • van Marken Lichtenbelt WD, Snel YE, Brummer RJ, Koppeschaar HP (1997). Deuterium and bromide dilution, and bioimpedance spectrometry independently show that growth hormone-deficient adults have an enlarged extracellular water compartment related to intracellular water. J Clin Endocrinol Metab 82, 907–911.

    Article  CAS  Google Scholar 

  • Ward LC, Dyer JM, Byrne NM, Sharpe KK, Hills AP (2007). Validation of a three-frequency bioimpedance spectroscopic method for body composition analysis. Nutrition 23, 657–664.

    Article  CAS  Google Scholar 

  • Xitron (1997). Xitron Hydra ECF/ICF (Model 4200) Bio-impedance spectrum analyzer. Issue 1.01 6/97. Operating Manual Revision 1.01 Xitron Technologies Inc.: San Diego, USA.

Download references

Acknowledgements

This study was sponsored by Medical Faculty of Göteborg University.

Author information

Authors and Affiliations

  1. Department of Clinical Nutrition, Sahlgrenska University Hospital, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden

    L H Ellegård, M Åhlén & I G Bosaeus

  2. Department of Surgery, Sahlgrenska University Hospital, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden

    U Körner & K G Lundholm

  3. Department of Surgery, University of Auckland, Auckland, New Zealand

    L D Plank

Authors
  1. L H Ellegård
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M Åhlén
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. U Körner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K G Lundholm
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. L D Plank
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. I G Bosaeus
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L H Ellegård.

Additional information

Guarantor: IGBosaeus.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ellegård, L., Åhlén, M., Körner, U. et al. Bioelectric impedance spectroscopy underestimates fat-free mass compared to dual energy X-ray absorptiometry in incurable cancer patients. Eur J Clin Nutr 63, 794–801 (2009). https://doi.org/10.1038/ejcn.2008.35

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2008.35

Keywords

This article is cited by

Search

Advanced search

Quick links