Elsevier

Clinical Nutrition

Volume 23, Issue 6, December 2004, Pages 1430-1453
Clinical Nutrition

ESPEN GUIDELINES
Bioelectrical impedance analysis—part II: utilization in clinical practice

https://doi.org/10.1016/j.clnu.2004.09.012Get rights and content

Summary

BIA is easy, non-invasive, relatively inexpensive and can be performed in almost any subject because it is portable. Part II of these ESPEN guidelines reports results for fat-free mass (FFM), body fat (BF), body cell mass (BCM), total body water (TBW), extracellular water (ECW) and intracellular water (ICW) from various studies in healthy and ill subjects. The data suggests that BIA works well in healthy subjects and in patients with stable water and electrolytes balance with a validated BIA equation that is appropriate with regard to age, sex and race. Clinical use of BIA in subjects at extremes of BMI ranges or with abnormal hydration cannot be recommended for routine assessment of patients until further validation has proven for BIA algorithm to be accurate in such conditions. Multi-frequency- and segmental-BIA may have advantages over single-frequency BIA in these conditions, but further validation is necessary. Longitudinal follow-up of body composition by BIA is possible in subjects with BMI 16–34 kg/m2 without abnormal hydration, but must be interpreted with caution. Further validation of BIA is necessary to understand the mechanisms for the changes observed in acute illness, altered fat/lean mass ratios, extreme heights and body shape abnormalities.

Section snippets

Background

Nearly 1600 papers about BIA are found in English medical literature between 1990 and 2003, with 450 being published in the last 3 years. This vast body of literature makes it difficult to understand when and how BIA should be used. Part I of these ESPEN 2-part guidelines on BIA discussed the principles, methods and BIA equations.1

Part II of these guidelines, limited to adults, reviews the current applications and limitations and presents the ESPEN recommendations for BIA in clinical practice

BIA measurement conditions

The factors/conditions that affect BIA are shown in Table 1. Subjects must be measured (recall values are not acceptable) for height and weight at the time of the BIA measurement. Standardized conditions with regard to body position, previous exercise, dietary intake and skin temperature must be respected.2, 3, 4 Consumption of food and beverage may decrease impedance by 4–15 Ω over a 2–4 h period after meals, representing an error smaller than 3%.2, 4 Measurements on two consecutive days at the

Healthy subjects, ethnic groups and body shape abnormalities

It is essential that appropriate BIA equations are chosen for the population studies. Published equations and criteria of selection are presented in part 1. Longitudinal changes in FFM and BF can be assessed with BIA, but are controversial when significant weight loss occurs because of physiological changes.8, 9, 10, 11, 12, 13 Assessment of changes in FFM, BF or TBW of less than 1.5–2 kg is limited, because of limitations in BIA precision.14 Reproducibility over a 7-week period was excellent in

Conditions in specific groups with an emphasis on those at risk for malnutrition and weight loss

Table 2 shows that variable and contradictory results are obtained by BIA for FFM, BF and BCM in various pathologies15, 16, 17, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33 by a number of different BIA equations22, 27, 29, 30, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49 with comments or evaluation shown in the last two column of the table. These discrepancies stem not only from the BIA method limitations but also from limitations in reference methods (see part I).1

Conditions of overweight and obesity

The studies69, 70, 71, 72, 73, 74 that have evaluated BIA in overweight and obese subjects are shown in Table 5, with comments or evaluation shown in the last column of the table. Currently, it appears that BIA equations can estimate body composition in overweight patients. BIA has been shown to be valid with BMIs to 34 kg/m2.24, 43 In morbid obesity, most predictive equations are unable to predict static body composition and are not reproducible for individuals over time.69 The disproportion

Conditions with a potential for altered hydration

Table 6 shows various studies81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118 in subjects with altered hydration, which determine TBW, ECW and BCM based on a number of body composition models or equations,22, 35, 38, 40, 45, 119, 120, 121, 122, 123, 124, 125 with comments or evaluation shown in the last two columns of the table. These discrepancies stem not only from the BIA

Conclusion

BIA is non-invasive, relatively inexpensive, does not expose to ionizing radiation, has very limited between observer variations and can be performed in almost any subject because it is portable. BIA works well in healthy subjects and chronic diseases with a validated BIA equation that is appropriate with regard to age, sex and race. However, clinical use of BIA in subjects at extremes of BMI ranges and in subjects with abnormal hydration cannot be recommended for routine assessment of patients

Acknowledgements

The support by Public Foundation Nutrition 2000Plus for Ursula G. Kyle is acknowledged.

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