Precision and accuracy of bioelectrical impedance analysis devices in supine versus standing position with or without retractable handle in Caucasian subjects

Abstract

Background & aims: Bioelectrical impedance analysis (BIA) could be facilitated in subjects who are able to stand by using scales without (BIA std4 ) or with a retractable handle (BIA std8 ), provided that they are as precise as BIA devices commonly used in the supine position in the hospital setting (BIA sup ). This observational prospective cross-sectional study aimed to compare the precision and accuracy of BIA std4 , BIA std8 and BIA sup in a Caucasian population. Methods: Fat mass percentage (FM%) was measured in 160 healthy Caucasian subjects (80 men/80 women) aged 20e60 years, with a body mass index (BMI) !18.5 and < 30 kg/m 2 , using the HAGRID Body Fat Scales (Huawei Technologies Co., Ltd., China) in BIA std4 or BIA std8 mode, and the Nutriguard-M (Data Input GmbH, Germany) as BIA sup . Intra-unit and inter-unit precisions of each device were evaluated by calculating the coefficients of variation (CV%) of 3 measurements with 3 different units of each device. Inter-device precisions were evaluated with Pearson correlations, BlandeAltman plots, and repeated measures ANOVA followed by post-hoc Bonferroni tests. Accuracy of these BIA devices was estimated in a subgroup of 16 subjects, using comparison with dual-energy X-ray absorptiometry (DXA). Results: The study population was 40 ± 12 years old, with a body height and weight of 171 ± 10 cm and 72.2 ± 11.5 Kg, respectively. All three devices were very precise with intra-unit CV% of 0.5%, 0.9%, and 0.3% and inter-unit CV% of 0.5%, 1.1%, and 0.4% for BIA std4 , BIA std8 and BIA sup , respectively. Inter-device precision was ±2.1% for BIA std4 /BIA sup , ±1.9% for BIA std8 /BIA sup , and ±1.3% for BIA std8 /BIA std4 . Bland eAltman plots showed bias ±1.96 SD of 0.3 ± 5.2% for BIA std4 /BIA sup , À0.4 ± 4.5% for BIA std8 /BIA sup and À0.6 ± 3.1% for BIA std8 /BIA std4 . Compared to DXA, all three devices tended to underestimate FM% in men with low BMI, while only BIA std4 and BIA std8 tended to overestimate FM% in women with high BMI. FM% measurement accuracy was ±2.6% for BIA sup /DXA, ±3.3% for BIA std4 /DXA, and ±3.4% for BIA std8 /DXA. Conclusions: Both BIA std4 and BIA std8 show a good intra-and inter-unit precision close to BIA sup , making them suitable for rapid body composition assessment in non-bedridden subjects. However, all these three devices should not be used interchangeably, because BIA std4 and BIA std8 tend to accentuate FM% changes during body composition monitoring compared to BIA sup and DXA. Trial registration: ClinicalTrial.gov no. NCT04504799.

Impact of Using Population-Specific Cut-Points, Self-Reported Health, and Socio-Economic Parameters to Predict Sarcopenia: A Cross-Sectional Study in Community-Dwelling Kosovans Aged 60 Years and Older

“…Among the several methods available, the usage of BIA in this study instead of DXA, which presents a widely available non-invasive instrument [ 3 , 54 ] and has also been suggested as a reference standard [ 54 ], might have overestimated the muscle mass [ 55 ]. One study has even suggested the possibility of standing multi-frequency BIA (the same as used in this study) overestimating the fat mass percentage in women with higher BMIs in comparison to both the supine BIA and DXA methods [ 56 ]. With respect to the different forms of BIA, good inter-unit precision and no differences between the standing and supine BIA were reported [ 56 , 57 ].…”

“…One study has even suggested the possibility of standing multi-frequency BIA (the same as used in this study) overestimating the fat mass percentage in women with higher BMIs in comparison to both the supine BIA and DXA methods [ 56 ]. With respect to the different forms of BIA, good inter-unit precision and no differences between the standing and supine BIA were reported [ 56 , 57 ]. However, BIA as a technique was shown to have an acceptable accuracy [ 58 , 59 ], was recommended for use in research [ 3 ], presented a high degree of correlation with the DXA approach [ 20 , 60 ] and magnetic resonance imaging (MRI) [ 61 ] in the muscle mass assessment.…”

Body Composition, Somatotype and Raw Bioelectrical Impedance Parameters of Adolescent Elite Tennis Players: Age and Sex Differences

“…Therefore, their transfer to other levels should be made according to individual characteristics and necessities. Lastly, recent studies have observed a lack of agreement in BIA measurements between supine and standing positions, even in raw bioelectrical parameters [ 61 , 62 ]. Therefore, our reference values should not be compared with those obtained with supine bioimpedance analyzers.…”

Does Body Position Influence Bioelectrical Impedance? An Observational Pilot Study

“…The position of the patient’s body during the test is of great importance. Some researchers have emphasized the advantage of lying over standing [ 18 , 19 , 20 ] due to the better equalization of fluid levels, and thus more reliable research results, especially in relation to the hydrated spaces of the body. In addition, using the BIA apparatus adapted to the supine position, we were also able to estimate selected body composition parameters in seriously ill people who are immobilized in bed [ 21 , 22 ].…”

“…However, the main problem is the comparison of the data obtained with a given measuring tool with the results of other researchers who also use the BIA method, but with a different starting position of the patient. There are single research results analyzing different measuring devices in the same study group [ 18 , 23 , 24 ]. An additional problem is the technological differences that have been reported to potentially correspond to the disagreement between devices, where different frequencies are used in different devices [ 25 ].…”