Abstract
Background/Objectives:
Obesity, pregnancy and lactation all affect body composition. Simple methods to estimate body composition are useful in clinical practice and to evaluate interventions. In overweight and obese lactating women, such methods are not fully validated. The objective of this study was to validate the accuracy and precision of bioimpedance spectroscopy (BIS) by Xitron 4200 and 8-electrode multifrequency impedance (multifrequency bioimpedance analysis, MFBIA) by Tanita MC180MA with the reference methods dual energy X-ray absorptiometry (DXA) and doubly labeled water (DLW) for the assessment of body composition in 70 overweight and obese women postpartum.
Subjects/Methods:
The LEVA-study (Lifestyle for Effective Weight loss during lactation) consisted of an intervention and follow-up with three assessments at 3, 6 and 15 months postpartum, which made possible the validation of both accuracy and precision. Mean differences between methods were tested by a paired t-test and Bland–Altman plots for systematic bias.
Results:
At baseline, BIS and MFBIA underestimated fat mass (FM) by 2.6±2.8 and 8.0±4.2 kg compared with DXA (P<0.001) but without systematic bias. BIS and MFBIA overestimated total body water (TBW) by 2.4±2.2 and 4.4±3.2 kg (P<0.001) compared with DLW, with slight systematic bias by BIS. BIS correctly estimated muscle mass without systematic bias (P>0.05). BIS overestimated changes in TBW (P=0.01) without systematic bias, whereas MFBIA varied greatly and with systematic bias.
Conclusions:
BIS underestimates mean FM compared with DXA but can detect mean changes in body composition, although with large limits of agreement. BIS both accurately and precisely estimates muscle mass in overweight and obese women postpartum. MFBIA underestimates FM and overestimates TBW by proprietary equations compared with DXA and DLW.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Gunderson EP . Childbearing and obesity in women: weight before, during, and after pregnancy. Obstet Gynecol Clin North Am 2009; 36: 317–32 ix.
Winkvist A, Rasmussen KM . Impact of lactation on maternal body weight and body composition. J Mammary Gland Biol Neoplasia 1999; 4: 309–318.
Sadurskis A, Kabir N, Wager J, Forsum E . Energy metabolism, body composition, and milk production in healthy Swedish women during lactation. Am J Clin Nutr 1988; 48: 44–49.
Amorim AR, Linne YM, Lourenco PM . Diet or exercise, or both, for weight reduction in women after childbirth. Cochrane Database Syst Rev 2007; CD005627.
Lof M, Forsum E . Evaluation of bioimpedance spectroscopy for measurements of body water distribution in healthy women before, during, and after pregnancy. J Appl Physiol 2004; 96: 967–973.
Ware LJ, Hurling R, Bataveljic O, Fairley BW, Hurst TL, Murray P et al. Rates and determinants of uptake and use of an internet physical activity and weight management program in office and manufacturing work sites in England: cohort study. J Med Internet Res 2008; 10: e56.
Bertz F, Brekke HK, Ellegård L, Rasmussen KM, Wennergren M, Winkvist A . Diet and exercise weight-loss trial in lactating overweight and obese women. Am J Clin Nutr 2012; 96: 698–705.
Jebb S . Measurement of soft tissue composition by dual energy X-ray absorptiometry. Br J Nutr 1997; 77: 151–163.
Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Manuel Gómez J et al. Bioelectrical impedance analysis-part II: utilization in clinical practice. Clin Nutr 2004; 23: 1430–1453.
Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Gómez JM et al. Bioelectrical impedance analysis—part I: review of principles and methods. Clin Nutr 2004; 23: 1226–1243.
Xitron Operating Manual Revision 1.01 San Diego, USA, Xitron Technologies, Inc 1997.
Tengvall M, Ellegård L, Malmros V, Bosaeus N, Lissner L, Bosaeus I . Body composition in the elderly: reference values and bioelectrical impedance spectroscopy to predict total body skeletal muscle mass. Clin Nutr 2009; 28: 52–58.
Ellegård LH, Ahlén M, Körner U, Lundholm KG, Plank LD, Bosaeus IG . Bioelectric impedance spectroscopy underestimates fat-free mass compared to dual energy X-ray absorptiometry in incurable cancer patients. Eur J Clin Nutr 2009; 63: 794–801.
Papathakis PC, Rollins NC, Brown KH, Bennish ML, Van Loan MD . 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 2005; 82: 538–546.
Medoua GN, Nana ES, Essa'a VJ, Ntsama PM, Matchawe C, Rikong HA et al. Body composition of Cameroonian lactating women determined by anthropometry, bioelectrical impedance, and deuterium dilution. Nutrition 2011; 27: 414–419.
Bosaeus M, Karlsson T, Holmäng A, Ellegård L . Accuracy of quantitative magnetic resonance and eight-electrode bioelectrical impedance analysis in normal weight and obese women. Clin Nutr 2014; 33: 471–477.
Anonymous. Multi-frequency body composition analyzer MC-180 MA III instruction manual Tokyo, Japan, Tanita 2008.
Kim J, Heshka S, Gallagher D, Kotler DP, Mayer L, Albu J et al. Intermuscular adipose tissue-free skeletal muscle mass: estimation by dual-energy X-ray absorptiometry in adults. J Appl Physiol 2004; 97: 655–660.
Matthie JR . Second generation mixture theory equation for estimating intracellular water using bioimpedance spectroscopy. J Appl Physiol 2005; 99: 780–781.
Baumgartner RN, Chumlea WC, Roche AF . Bioelectric impedance phase angle and body composition. Am J Clin Nutr 1988; 48: 16–23.
Slinde F, Bertz F, Winkvist A, Ellegård L, Olausson H, Brekke HK . Energy expenditure by multisensor armband in overweight and obese lactating women validated by doubly labeled water. Obesity (Silver Spring) 2013; 21: 2231–2235.
Bland JM, Altman DG . Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307–310.
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: 589–595.
Neovius M, Hemmingsson E, Freyschuss B, Uddén J . Bioelectrical impedance underestimates total and truncal fatness in abdominally obese women. Obesity (Silver Spring) 2006; 14: 1731–1738.
Thomson R, Brinkworth GD, Buckley JD, Noakes M, Clifton PM . Good agreement between bioelectrical impedance and dual-energy X-ray absorptiometry for estimating changes in body composition during weight loss in overweight young women. Clin Nutr 2007; 26: 771–777.
Sartorio A, Malavolti M, Agosti F, Marinone PG, Caiti O, Battistini N et al. Body water distribution in severe obesity and its assessment from eight-polar bioelectrical impedance analysis. Eur J Clin Nutr 2005; 59: 155–160.
Xitron Operating Manual San Diego, USA, Xitron Technologies, Inc 1993.
Van Loan MD, Kopp LE, King JC, Wong WW, Mayclin PL . Fluid changes during pregnancy: use of bioimpedance spectroscopy. J Appl Physiol 1995; 78: 1037–1042.
Ward LC . Segmental bioelectrical impedance analysis: an update. Curr Opin Clin Nutr Metab Care 2012; 15: 424–429.
Slinde F, Bark A, Jansson J, Rossander-Hulthén L . Bioelectrical impedance variation in healthy subjects during 12 h in the supine position. Clin Nutr 2003; 22: 153–157.
Acknowledgements
This work was supported by the Swedish Research Council (Project grant: K2009-21091-01-3. PI Anna Winkvist) and the Swedish Council for Working Life and Social Research (Project grant: 2006-0339, PI Anna Winkvist).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Ellegård, L., Bertz, F., Winkvist, A. et al. Body composition in overweight and obese women postpartum: bioimpedance methods validated by dual energy X-ray absorptiometry and doubly labeled water. Eur J Clin Nutr 70, 1181–1188 (2016). https://doi.org/10.1038/ejcn.2016.50
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/ejcn.2016.50
This article is cited by
-
Associations between Hair Mineral Concentrations and Skeletal Muscle Mass in Korean Adults
The Journal of nutrition, health and aging (2022)
-
Bone metabolism and osteoporosis during pregnancy and lactation
Archives of Osteoporosis (2022)
-
Comparison of bioimpedance spectroscopy and dual energy X-ray absorptiometry for assessing body composition changes in obese children during weight loss
European Journal of Clinical Nutrition (2021)
-
A Randomized, Controlled Trial Comparing the Impact of a Low-Calorie Ketogenic vs a Standard Low-Calorie Diet on Fat-Free Mass in Patients Receiving an Elipse™ Intragastric Balloon Treatment
Obesity Surgery (2021)
-
May Bioelectrical Impedance Analysis Method Be Used in Alternative to the Dual-Energy X-Ray Absorptiometry in the Assessment of Fat Mass and Fat-Free Mass in Patients with Obesity? Pros, Cons, and Perspectives
Obesity Surgery (2020)