Think Globally, Act Locally: The Importance of Population‐Specific Bioelectrical Impedance Analysis Prediction Equations for Muscle Mass Assessment
Abstract
Background: Bioelectrical impedance analysis (BIA) is a convenient muscle assessment method, but its accuracy highly depends on population‐specific aspects of the adopted equation. We aimed to develop appendicular lean mass (ALM) prediction models for older South Americans and to compare their performances to those of reference equations in the same sample. Methods: Cross‐sectional evaluation of 192 community‐dwelling Brazilian subjects ≥60 years old from the COMO VAI? study. Using measurements from single‐frequency and multifrequency devices (BIASF and BIAMF, respectively), new ALM prediction equations were developed (reference method: dual‐energy x‐ray absorptiometry [DXA]). Validity was assessed by bootstrapping. Four previously established equations were also tested, and the performances were compared using Bland–Altman analysis. Results: Stepwise variable selection produced the following equations: ALM SF‐BIA = (2.08 × sex) + (0.04 × weight) + (0.24 × RI 50) + (0.07 × Xc 50) − 0.16; ALM MF‐BIA = (1.85 × sex) + (0.03 × weight) + (0.31 × RI 50) + (0.04 × Xc 50) + (0.01 × Z 5) − 8.16, where ALM is estimated in kg; female sex = 0 and male sex = 1; weight is measured in kg; RI 50 is the resistance index at 50 kHz measured in cm 2/Ω); Xc 50 is the reactance at 50 kHz measured in Ω; and Z 5 is impedance at 5 kHz measured in Ω. The equations explained, respectively, 89% and 90% of the variability of ALM DXA in our sample, and their estimates were not significantly different from DXA measurements. Bland–Altman analysis revealed accurate and unbiased performances for both models, with similar limits of agreement (BIA SF: ±2.58 kg; BIA MF: ±2.48 kg), and their validity was considered adequate by the bootstrap method. The reference equations, however, systematically overestimated ALM in our sample. Conclusion: The proposed equations might represent practical options to estimate ALM in older noninstitutionalized South Americans. Further external validation, though, is required to verify the reproducibility of our findings.
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Concerns with applicability were unclear in 12 studies.
“Concerns with applicability were high in 19 studies [37, 42–59] and unclear [41, 50, 60–69] in 12 studies due to the restricted sample size.”
From High-standard predictive equations for estimating body composition using bioelectrical impedance analysis: a systematic review (2024) · cites this paper as [67]
Four equations for elderly are for assessing appendicular LSM.
“There is one equation for estimating BCM [63], four equations for assessing appendicular LSM [46, 67, 92, 93], and one equation for assessing SMM [95] suitable for males and females.”
From High-standard predictive equations for estimating body composition using bioelectrical impedance analysis: a systematic review (2024) · cites this paper as [67]
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“Out of the 26 available equations, 23 were developed with foot to hand technology [36, 38, 46, 49, 53, 63, 67, 89–93, 95, 97], while three equations were developed using segmental technology [68, 94].”
BackgroundMethodInfluential
- Authors
- Barbosa‐Silva, T. G., Gonzalez, M. C., Bielemann, R. M., Santos, L. P., Menezes, A. M. B., & the COCONUT Study Group, B.
- Affiliations
- Postgraduate Program in Epidemiology Federal University of Pelotas Pelotas Brazil
- Postgraduate Program in Health and Behavior Catholic University of Pelotas Pelotas Brazil
- Universidade Federal de Pelotas (BR)
- Universidade Federal do Pampa (BR)
- Venue
- Journal of Parenteral and Enteral Nutrition
- Publisher
- Wiley
- Published
- 2019-11-20
- Volume
- 44
- Issue
- 7
- Pages
- 1338-1346
- ISSN
- 0148-6071 (ISSN-L)
- 1941-2444
- OpenAlex
- W2989589069
- Cited by
- 14
- References
- 25
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 4 · 2022: 1 · 2021: 2 · 2020: 1
- FWCI
- 0.69
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Parenteral and Enteral Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
- Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul
- Topics
- Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Physical Sciences › Engineering › Electrical and Electronic Engineering › Electrical and Bioimpedance Tomography
- Keywords
- bioelectrical impedance analysis, appendicular lean mass, muscle mass assessment, prediction equations, older adults, community-dwelling older adults
- MeSH terms
- Aged, Body Composition, Brazil, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Muscles, Reproducibility of Results, Absorptiometry, Photon, Electric Impedance
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