Validity of bioelectrical impedance analysis in estimation of fat-free mass in colorectal cancer patients
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Background & aims Bioelectrical impedance analysis (BIA) is an accessible and cheap method to measure fat-free mass (FFM). However, BIA estimates are subject to uncertainty in patient populations with altered body composition and hydration. The aim of the current study was to validate a whole-body and a segmental BIA device against dual-energy X-ray absorptiometry (DXA) in colorectal cancer (CRC) patients, and to investigate the ability of different empiric equations for BIA to predict DXA FFM (FFM DXA ). Methods Forty-three non-metastatic CRC patients (aged 50–80 years) were enrolled in this study. Whole-body and segmental BIA FFM estimates (FFM whole-bodyBIA , FFM segmentalBIA ) were calculated using 14 empiric equations, including the equations from the manufacturers, before comparison to FFM DXA estimates. Results Strong linear relationships were observed between FFM BIA and FFM DXA estimates for all equations (R 2 = 0.94–0.98 for both devices). However, there were large discrepancies in FFM estimates depending on the equations used with mean differences in the ranges −6.5–6.8 kg and −11.0–3.4 kg for whole-body and segmental BIA, respectively. For whole-body BIA, 77% of BIA derived FFM estimates were significantly different from FFM DXA , whereas for segmental BIA, 85% were significantly different. For whole-body BIA, the Schols* equation gave the highest agreement with FFM DXA with mean difference ±SD of −0.16 ± 1.94 kg ( p = 0.582). The manufacturer's equation gave a small overestimation of FFM with 1.46 ± 2.16 kg ( p < 0.001) with a tendency towards proportional bias ( r = 0.28, p = 0.066). For segmental BIA, the Heitmann* equation gave the highest agreement with FFM DXA (0.17 ± 1.83 kg ( p = 0.546)). Using the manufacturer's equation, no difference in FFM estimates was observed (−0.34 ± 2.06 kg ( p = 0.292)), however, a clear proportional bias was detected ( r = 0.69, p < 0.001). Both devices demonstrated acceptable ability to detect low FFM compared to DXA using the optimal equation. Conclusion In a population of non-metastatic CRC patients, mostly consisting of Caucasian adults and with a wide range of body composition measures, both the whole-body BIA and segmental BIA device provide FFM estimates that are comparable to FFM DXA on a group level when the appropriate equations are applied. At the individual level (i.e. in clinical practice) BIA may be a valuable tool to identify patients with low FFM as part of a malnutrition diagnosis.
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Different bioelectrical impedance analysis devices using the same technology may yield different outcomes due to potential between-device inconsistencies.
“different devices using the same technology may yield different outcomes due to potential between-device inconsistencies [106], even though agreement has been observed [21].”
From High-standard predictive equations for estimating body composition using bioelectrical impedance analysis: a systematic review (2024) · cites this paper as [106]
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- Authors
- Ræder, H., Kværner, A. S., Henriksen, C., Florholmen, G., Henriksen, H. B., Bøhn, S. K., Paur, I., Smeland, S., & Blomhoff, R.
- Affiliations
- Oslo University Hospital (NO)
- University of Oslo (NO)
- Corresponding author
- Blomhoff, Rune
- ORCID
- Venue
- Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2018-02
- Volume
- 37
- Issue
- 1
- Pages
- 292-300
- ISSN
- 0261-5614 (ISSN-L)
- OpenAlex
- W2575449066
- Cited by
- 77
- References
- 30
- Citations by year
- 2026: 3 · 2025: 9 · 2024: 16 · 2023: 3 · 2022: 9 · 2021: 11 · 2020: 9 · 2019: 7 · 2018: 9 · 2017: 1
- FWCI
- 5.26
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Clinical Nutrition (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- NORA - Norwegian Open Research Archives (submittedVersion, cc-by-nc-nd)
- Funders
- Research Council of Norway (190329)
- Norwegian Cancer Society (3924/3927)
- 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, fat-free mass, colorectal cancer, dual-energy X-ray absorptiometry, validation, empirical equations, body composition, hydration, proportional bias, nutritional assessment, cancer cachexia, sarcopenia
- MeSH terms
- Aged, Aged, 80 and over, Anthropometry, Body Composition, Female, Humans, Male, Middle Aged, Colorectal Neoplasms, Reproducibility of Results, Absorptiometry, Photon, Electric Impedance, Diagnostic Techniques and Procedures
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