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Phenotyping in clinical nutrition

Comparison of body composition assessment across body mass index categories by two multifrequency bioelectrical impedance analysis devices and dual-energy X-ray absorptiometry in clinical settings



InBody-770 and SECA mBCA 515 are multifrequency bioelectrical impedance analysis (BIA) devices, which are commonly used in the clinic to assess fat-free mass (FFM) and body fat (BF). However, the accuracy between devices in clinical settings, across different body mass index (BMI) groups remains unclear.


Body composition for 226 participants (51% men, aged 18–80 years, BMI 18–56 kg/m²) was assessed by two commercial multifrequency BIA devices requiring standing position and using eight-contact electrodes, InBody 770 and SECA mBCA 515, and compared to results from dual-energy X-ray absorptiometry (DXA). Measurements were performed in a random order, after a 3 h fast and no prior exercise. Lin’s-concordance correlation and Bland–Altman analyses were used to compare between devices, and linear regression to assess accuracy in BF% across BMI groups.


We found strong correlation between DXA results for study population BF% and those obtained by InBody (ρc = 0.922, 95% confidence interval (CI) 0.902, 0.938) and DXA and SECA (ρc = 0.940, CI 0.923, 0.935), with 95% limits of agreements between 2.6 and −8.9, and 7.1 and −7.6, respectively. BF% assessment by SECA was similar to DXA (−0.3%, p = 0.267), and underestimated by InBody (−3.1%, p < 0.0001). InBody deviations were largest among normal weight people and decreased with increasing BMI group, while SECA measurements remained unaffected.


Both BIA devices agreed well with BF% assessment obtained by DXA. Unlike SECA, InBody underestimated BF% in both genders and was influenced by BMI categories. Therefore, in clinical settings, individual assessment of BF% should be taken with caution.

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Fig. 1: Comparison of body fat between multifrequency bioelectrical impedance analysis (BIA) devices with DXA.
Fig. 2: Blant–Altman analysis for BF% differences from DXA, for both InBody and SECA.
Fig. 3: Distribution of absolute differences of BF% obtained by InBody () and SECA () from DXA.
Fig. 4: Comparison of the absolute difference of BF% obtained by InBody (gray circles) and SECA (gray balls) from DXA, within different clinically used BMI categories.


  1. 1.

    Richard AJ, Biomedical P, Rouge B. Adipose tissue: physiology to metabolic dysfunction;, Inc., 2020:1–53.

  2. 2.

    Ward ZJ, Bleich SN, Cradock AL, Barrett JL, Giles CM, Flax C, et al. Projected U.S. state-level prevalence of adult obesity and severe obesity. N Engl J Med. 2019;381:2440–50.

    Article  Google Scholar 

  3. 3.

    Warkentin TE. HIT as a preventable disease? Blood. 2005;106:2600.

    Article  Google Scholar 

  4. 4.

    Cornier MA, Després JP, Davis N, Grossniklaus DA, Klein S, Lamarche B, et al. Assessing adiposity: a scientific statement from the american heart association. Circulation. 2011;124:1996–2019.

    Article  PubMed  Google Scholar 

  5. 5.

    Bea JW, Thomson CA, Wertheim BC, Nicholas JS, Ernst KC, Hu C, et al. Risk of mortality according to body mass index and body composition among postmenopausal women. Am J Epidemiol. 2015;182:585–96.

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Liberman K, Forti LN, Beyer I, Bautmans I. The effects of exercise on muscle strength, body composition, physical functioning and the inflammatory profile of older adults: a systematic review. Curr Opin Clin Nutr Metab Care. 2017;20:30–53.

    Article  PubMed  Google Scholar 

  7. 7.

    Deutz NEP, Ashurst I, Ballesteros MD, Bear DE, Cruz-Jentoft AJ, Genton L, et al. The underappreciated role of low muscle mass in the management of malnutrition. J Am Med Dir Assoc. 2019;20:22–7.

    Article  PubMed  Google Scholar 

  8. 8.

    Garlini LM, Alves FD, Ceretta LB, Perry IS, Souza GC, Clausell NO. Phase angle and mortality: a systematic review. Eur J Clin Nutr. 2019;73:495–508.

    Article  PubMed  Google Scholar 

  9. 9.

    Sergi G, De Rui M, Stubbs B, Veronese N, Manzato E. Measurement of lean body mass using bioelectrical impedance analysis: a consideration of the pros and cons. Aging Clin Exp Res. 2017;29:591–7.

    Article  PubMed  Google Scholar 

  10. 10.

    Day K, Kwok A, Evans A, Mata F, Verdejo-Garcia A, Hart K, et al. Comparison of a bioelectrical impedance device against the reference method dual energy X-ray absorptiometry and anthropometry for the evaluation of body composition in adults. Nutrients. 2018;10:1469.

  11. 11.

    Albanese CV, Diessel E, Genant HK. Clinical applications of body composition measurements using DXA. J Clin Densitom. 2003;6:75–85.

    Article  PubMed  Google Scholar 

  12. 12.

    Beaudart C, Bruyère O, Geerinck A, Hajaoui M, Scafoglieri A, Perkisas S, et al. Equation models developed with bioelectric impedance analysis tools to assess muscle mass: a systematic review. Clin Nutr Espen. 2020;35:47–62.

    Article  PubMed  Google Scholar 

  13. 13.

    Marra M, Sammarco R, De Lorenzo A, Iellamo F, Siervo M, Pietrobelli A, et al. Assessment of body composition in health and disease using bioelectrical impedance analysis (bia) and dual energy x-ray absorptiometry (dxa): a critical overview. Contrast Media Mol Imaging. 2019;2019.

  14. 14.

    Gába A, Kapuš O, Cuberek R, Botek M. Comparison of multi- and single-frequency bioelectrical impedance analysis with dual-energy X-ray absorptiometry for assessment of body composition in post-menopausal women: Effects of body mass index and accelerometer-determined physical activity. J Hum Nutr Diet. 2015;28:390–400.

    Article  PubMed  Google Scholar 

  15. 15.

    Haverkort EB, Reijven PLM, Binnekade JM, De Van Der Schueren MAE, Earthman CP, Gouma DJ, et al. Bioelectrical impedance analysis to estimate body composition in surgical and oncological patients: a systematic review. Eur J Clin Nutr. 2015;69:3–13.

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Ramírez-Vélez R, Tordecilla-Sanders A, Correa-Bautista JE, González-Ruíz K, González-Jiménez E, Triana-Reina HR, et al. Validation of multi-frequency bioelectrical impedance analysis versus dual-energy X-ray absorptiometry to measure body fat percentage in overweight/obese Colombian adults. Am J Hum Biol. 2018;30.

  17. 17.

    Lee SY, Ahn S, Kim YJ, Ji MJ, Kim KM, Choi SH, et al. Comparison between dual-energy x-ray absorptiometry and bioelectrical impedance analyses for accuracy in measuring whole body muscle mass and appendicular skeletal muscle mass. Nutrients. 2018,10.

  18. 18.

    Hume PA, Kerr DA, Ackland TR. Best practice protocols for physique assessment in sport. Int J Sport Nutr Exerc Metab. 2016;26:259–67.

  19. 19.

    Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Gómez JM, et al. Bioelectrical impedance analysis—part II: utilization in clinical practice. Clin Nutr. 2004;23:1430–53.

    Article  PubMed  Google Scholar 

  20. 20.

    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.

    Article  PubMed  Google Scholar 

  21. 21.

    Pateyjohns IR, Brinkworth GD, Buckley JD, Noakes M, Clifton PM. Comparison of three bioelectrical impedance methods with DXA in overweight and obese men. Obesity. 2006;14:2064–70.

    Article  PubMed  Google Scholar 

  22. 22.

    Vicente-Rodríguez G, Rey-López JP, Mesana MI, Poortvliet E, Ortega FB, Polito A, et al. Reliability and intermethod agreement for body fat assessment among two field and two laboratory methods in adolescents. Obesity. 2012;20:221–8.

    Article  PubMed  Google Scholar 

  23. 23.

    Lohman T, Milliken L. ACSM’s body composition assessment. Humen Kinetics. 2019. p. 6–34.

  24. 24.

    McLester CN, Nickerson BS, Kliszczewicz BM, McLester JR. Reliability and agreement of various inbody body composition analyzers as compared to dual-energy x-ray absorptiometry in healthy men and women. J Clin Densitom. 2018.

  25. 25.

    Fonseca FR, Karloh M, de Araujo CLP, Dos Reis CM, Mayer AF. Validation of a bioelectrical impedance analysis system for body composition assessment in patients with COPD. J Bras Pneumol. 2018;44:315–20.

    Article  PubMed  PubMed Central  Google Scholar 

  26. 26.

    Fosbøl MO, Zerahn B. Contemporary methods of body composition measurement. Clin Physiol Funct Imaging. 2015;35:81–97.

    Article  PubMed  Google Scholar 

  27. 27.

    Heymsfield SB, Ebbeling CB, Zheng J, Pietrobelli A, Strauss BJ, Silva AM, et al. Multi-component molecular-level body composition reference methods: evolving concepts and future directions. Obes Rev. 2015;16:282–94.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Lukaski HC. Body composition health and performance in exercise and sport. CRC Press. 2017; vol. 1; ISBN. p 13–23.

  29. 29.

    Ward LC. Bioelectrical impedance analysis for body composition assessment: reflections on accuracy, clinical utility, and standardisation. Eur J Clin Nutr. 2019;73:194–9.

    Article  PubMed  Google Scholar 

  30. 30.

    Achamrah N, Colange G, Delay J, Rimbert A, Folope V, Petit A, et al. Comparison of body composition assessment by DXA and BIA according to the body mass index: a retrospective study on 3655 measures. PLoS ONE. 2018;13:1–13.

    CAS  Article  Google Scholar 

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We would like to thank Tal Sigawy, Registered Dietitian (R.D) for his contribution in data collection and measurements coordination.

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Conceptualization, YL, NG, and YG; methodology, YL and YG; formal analysis, NG; investigation, YL and NG; resources, YL and YG; data curation, YL and NG; writing—original draft preparation, YL, NG, and YG; writing—review and editing, YG; visualization, NG; supervision, YG; project administration, YL.

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Correspondence to Yftach Gepner.

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Lahav, Y., Goldstein, N. & Gepner, Y. Comparison of body composition assessment across body mass index categories by two multifrequency bioelectrical impedance analysis devices and dual-energy X-ray absorptiometry in clinical settings. Eur J Clin Nutr (2021).

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