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Cited by 29Body Composition Measurement TechniquesElectrical and Bioimpedance TomographyObesity, Physical Activity, Diet

Prediction of fat-free mass using bioelectrical impedance analysis in young adults from five populations of African origin

Open access
Luke, A, Bovet, P, Forrester, T E, Lambert, E V, Plange-Rhule, J, Dugas, L R, Durazo-Arvizu, R A, Kroff, J +2 more·2013·European Journal of Clinical Nutrition
DOI 10.1038/ejcn.2013.123PMC PMC3766444
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Abstract

Background/objectives Bioelectrical impedance analysis (BIA) is used in population and clinical studies as a technique for estimating body composition. Because of significant under-representation in existing literature, we sought to develop and validate predictive equation(s) for BIA for studies in populations of African origin. Subjects/methods Among five cohorts of the Modeling the Epidemiologic Transition Study, height, weight, waist circumference and body composition, using isotope dilution, were measured in 362 adults, ages 25-45 with mean body mass indexes ranging from 24 to 32. BIA measures of resistance and reactance were measured using tetrapolar placement of electrodes and the same model of analyzer across sites (BIA 101Q, RJL Systems). Multiple linear regression analysis was used to develop equations for predicting fat-free mass (FFM), as measured by isotope dilution; covariates included sex, age, waist, reactance and height(2)/resistance, along with dummy variables for each site. Developed equations were then tested in a validation sample; FFM predicted by previously published equations were tested in the total sample. Results A site-combined equation and site-specific equations were developed. The mean differences between FFM (reference) and FFM predicted by the study-derived equations were between 0.4 and 0.6 kg (that is, 1% difference between the actual and predicted FFM), and the measured and predicted values were highly correlated. The site-combined equation performed slightly better than the site-specific equations and the previously published equations. Conclusions Relatively small differences exist between BIA equations to estimate FFM, whether study-derived or published equations, although the site-combined equation performed slightly better than others. The study-derived equations provide an important tool for research in these understudied populations.

AI snapshot

Written from the paper’s full text.

TL;DR

This study developed and validated bioelectrical impedance analysis (BIA) equations to predict fat-free mass (FFM) in 362 young adults of African origin from five METS cohorts, using isotope dilution as the reference method. A site-combined equation performed slightly better than site-specific or previously published equations, with small mean differences of 0.4–0.6 kg.

Key findings

  • Among 362 adults aged 25–45 with mean BMIs ranging from 24 to 32 across sites, the study-derived equations predicted FFM with mean differences of 0.4–0.6 kg, or about 1% difference from isotope-dilution FFM; validation-sample mean reference FFM was 48.8 kg.
  • The site-combined equation explained 89% of FFM variance (R² = 89%); adding site dummy variables improved R² modestly to 91%, while site-specific equations had R² from 86% to 95%.
  • Study-derived equations showed high agreement with the reference method (concordance correlation = 0.93–0.94); in the combined sample, the new equation had the largest concordance correlation (0.94) versus previously published equations (range 0.86–0.92), and the smallest average bias and error (average bias = −0.1, error = 3.4, pure error = 3.4).
  • Previously published equations yielded mean FFM differences of 0.6–0.9 kg compared with reference values, and the site-combined equation performed slightly better than the site-specific equations.

Methods

  • Data came from the Modeling the Epidemiologic Transition Study (METS): 362 adults of predominantly African descent from rural Ghana, urban South Africa, urban Jamaica, Seychelles, and suburban United States; participants were randomly divided into an equation development sample (n = 244) and validation sample (n = 118).
  • FFM was measured by isotope dilution using total body water from deuterium and 18oxygen dilution with a hydration constant of 0.73; BIA resistance and reactance were measured with a single-frequency 50 kHz analyzer (BIA 101Q, RJL Systems) using tetrapolar electrode placement.
  • Multiple linear regression developed FFM prediction equations using sex, age, waist circumference, reactance, height²/resistance, and site dummy variables; age, waist, reactance, and site-by-weight interactions were not significant and were omitted from final models. Developed equations were tested in the validation sample and compared with previously published equations using R², mean squared error, concordance correlation, bias, total error, pure error, and Bland-Altman plots.

Limitations

  • Stated in the paper: BIA is “fraught with imprecision” relative to gold-standard methods such as isotope dilution or DXA, and the METS samples are not meant to be representative of their countries as a whole.
  • Evident from the text: the analysis is limited to healthy young adults aged 25–45, excluding individuals with infectious diseases including HIV, pregnant or lactating women, and persons with conditions preventing normal physical activity, so findings may not generalize to children, older adults, pregnant/lactating women, or disease populations.
  • Evident from the text: the validation sample was modest (n = 118), and the equations were developed and tested only in five African-origin populations, so broader applicability to other African-origin or non-African groups is not established.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1038/ejcn.2013.123

Cites

38 of 38 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

4 of 26 cited sources checked · 2 supported · 0 flagged · accuracy not yet measured

  • Findingown data

    In the validation sample, the study-derived BIA equations overestimated fat-free mass by 0.4-0.6 kg, about 1% of the reference value.

    “The mean differences between FFM (reference) and FFM predicted by the study-derived equations were between 0.4–0.6 kg (i.e. 1% difference between actual and predicted FFM)”
    • Also stated in: § Results · plain
      “Mean FFM (reference method) in the validation samples was 48.8 kg, whereas the mean FFM estimated by the METS equations were larger by 1%, i.e. mean differences of only 0.4–0.6 kg (Table 2).”
    Quote in the paperSubstantial claim
  • Findingown data

    The measured and predicted fat-free mass values were highly correlated.

    “the measured and predicted values were highly correlated.”
    Quote in the paperSubstantial claim
  • Findingown data

    The equation combining all sites performed marginally better than both the site-specific equations and the previously published equations.

    “The site-combined equation performed slightly better than the site-specific equations and the previously published equations.”
    • Also stated in: § Discussion · plain
      “the equation developed using the data from all sites combined yielded the smallest bias as well as the highest concordance correlation with the reference values, although the differences resulting from the different equations were minor.”
    Quote in the paperSubstantial claim
  • Findingown data

    Each of the three study-derived equations agreed closely with isotope dilution reference values (concordance correlation=0.93-0.94).

    “Overall, all three study-derived equations exhibited high agreement with the reference values determined by isotope dilution (concordance correlation=0.93–0.94).”
    Quote in the paperSubstantial claim
  • Findingown data

    For the combined sample, earlier published equations differed from reference fat-free mass by 0.6-0.9 kg.

    “In the combined sample (Table 3), previously published equations yielded differences in mean FFM of 0.6–0.9 kg compared to the reference values.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 16
  • May combine two claims. 16
  • The quote only partly states this claim. 1

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    METS procedures used protocols standardized across sites, and centralized training was finished before recruitment began.

    “All procedures conducted in METS followed protocols standardized across all sites with centralized training completed prior to the start of participant recruitment (18).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [18] Luke A, Bovet P, Forrester TE, Lambert EV, Plange-Rhule J, Schoeller DA et al. Protocol for the modeling the epidemiologic transition study: a longitudinal observational study of energy balance and change in body weight, diabetes and cardiovascular disease risk. BMC Public Health 2012; 11: 927. source

      Methods and Design > Measurements describes common measurements across the METS sites and says dietary-recall interviewers at each site were centrally trained. It does not establish that all procedures followed standardized protocols across sites or that centralized training was completed before participant recruitment began; the stated pre-initiation timing concerns preparation of local-food photographs and portions. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    All participating institutions' ethics committees or review boards approved the METS protocol, and every participant gave written informed consent.

    “The protocol for METS was approved by the institutional review boards or ethics committees of all participating institutions and written, informed consent was obtained from all participants by local investigators in the local language or dialect (18)”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [18] Luke A, Bovet P, Forrester TE, Lambert EV, Plange-Rhule J, Schoeller DA et al. Protocol for the modeling the epidemiologic transition study: a longitudinal observational study of energy balance and change in body weight, diabetes and cardiovascular disease risk. BMC Public Health 2012; 11: 927. source

  • Classified as probably not a substantial claim.

    Premisecitation

    Dioum et al. found little accuracy difference among existing equations based on the ethnic makeup of their development samples.

    “The authors concluded that there was little difference in the accuracy of existing equations based on the ethnic origins of the development sample i.e., equations developed from wholly or largely African-origin or black participants did not predict total body water better than those from non-African participants (33).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [33] Dioum A, Gartner A, Cisse AS, Delpeuch F, Maire B, Wade S et al. Validity of impedance-based equations for the prediction of total body water as measured by deuterium dilution in African women. Am J Clin Nutr 2005; 81: 597–604. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Dioum et al. (2005) reviewed the validity of many published BIA equations for total body water prediction in Senegalese women.

    “A 2005 review by Dioum et al. examined the validity of a wide variety of published BIA equations for the prediction of total body water in Senegalese women, some derived from all white or all black samples, some from ethnically mixed samples and some from samples of unknown ethnic composition (33).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [33] Dioum A, Gartner A, Cisse AS, Delpeuch F, Maire B, Wade S et al. Validity of impedance-based equations for the prediction of total body water as measured by deuterium dilution in African women. Am J Clin Nutr 2005; 81: 597–604. source

      The Discussion says the authors tested the validity of 23 published BIA equations for predicting total body water in African women; the Subjects section identifies the participants as women recruited in Dakar, Senegal. The section on published prediction equations describes source samples with differing or unreported ethnic composition. Calling the paper a “review” is inaccurate: it reports an empirical cross-validation study. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    The study developed and validated BIA equations for predicting fat-free mass in adults of African descent from the five METS cohorts.

    “we sought to develop and validate predictive equation(s) for BIA for studies in populations of African origin.”
    • Also stated in: § Discussion · plain
      “Three sets of equations were developed to estimate FFM from resistance as measured by BIA and validated for use among young adults from five populations of African origin.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Other anthropometric measures matched the BMI pattern; Ghanaians, for instance, were roughly 8 cm shorter than US participants and had lower weight and smaller waist circumferences.

    “Other anthropometric measures were consistent with the trends in BMI, e.g., the Ghanaians were about 8 cm shorter than the United States groups and had much lower body weight as well as smaller abdominal circumferences.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The study's equation had the highest concordance correlation (0.94), while other reported equations ranged from 0.86 to 0.92.

    “The concordance correlation coefficient was largest for our equation (0.94) compared to any of the other equations previously reported (range 0.86–0.92).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Site-specific equations showed R2 values between 86% and 95%, with varying mean square errors.

    “Each equation in the third set, 3a – 3e, was developed using only those data generated in each site; (R2 varied from 86% to 95%, with a range of associated mean square errors).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The Bland-Altman plot indicated strong agreement and little bias for the new equation.

    “The Bland-Altman plot (Figure 1) confirms the high level of concordance and small bias associated with the new equation.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Adding site dummy variables gave a modest improvement in R2 and mean squared error, reaching R2=91%.

    “The second set of equations, 2a – 2e, included all data plus dummy variables for site, resulting in site-specific equations; inclusion of the dummy site variables improved the R2 and MSE modestly (R2: 91%).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationnone given

    The METS samples were not designed to represent entire countries; they reflect broad lifestyle patterns typical of each site.

    “The samples are not meant to be representative of the countries as a whole but are, however, characteristic of broad lifestyle patterns common to each site.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    BIA serves as a technique for estimating body composition in population and clinical research.

    “Bio-electrical impedance analysis (BIA) is used in population and clinical studies as a technique for estimating body composition.”
    • Also stated in: § Introduction · plain
      “Bioelectrical impedance analysis (BIA) has been used as a less expensive alternative for estimating body composition in both adults and children (3).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] Lukaski HC, Bolonchuk WW, Hall CB, Siders WA . Validation of tetrapolar bioelectrical impedance method to assess human body composition. J Appl Physiol 1986; 60: 1327–1332. source

  • May combine two claims.

    Premisecitation

    The reference method measured total body water by stable-isotope dilution with deuterium and 18O; fat-free mass was then derived from total body water with a hydration factor of 0.73.

    “Total body water was measured as a constituent of the measurement of total energy expenditure by doubly labeled water, using dilution with stable isotopes, i.e., the average of total body water spaces as measured by deuterium and 18oxygen was used as the reference method (21). Fat-free mass was calculated from total body water using a hydration constant (0.73) (22).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [21] Schoeller DA, van Santen E, Peterson DW, Dietz W, Jaspan J, Klein PD . Total body water measurement in humans with 18O and 2H labeled water. Am J Clin Nutr 1980; 33: 2686–2693. source
    • cites [22] Wang Z, Deurenberg P, Wang W, Pietrobelli A, Baumgartner RN, Heymsfield SB . Hydration of fat-free body mass: new physiological modeling approach. Am J Physiol 1999; 276 (6 Pt 1), E995–E1003. source

  • Classified as probably not a substantial claim.

    Premisecitation

    The study tested its equations against earlier published BIA equations whose development samples Dioum et al. assumed included at least some black participants.

    “Performance of developed equations for the prediction of FFM was also tested using all available data (n=362) against previously published equations derived using participant samples which were assumed by Dioum et al. to consist of at least some ethnically black participants (5, 24–32).”
    Quote in the paperSubstantial claim0 of 10 sources checked
    • cites [5] Leman CR, Adeyemo AA, Schoeller DA, Cooper RS, Luke A . Body composition of children in south-western Nigeria: validation of bio-electrical impedance analysis. Ann Trop Paediatr 2003; 23: 61–67. source
    • cites [24] Kushner RF, Schoeller DA, Fjeld CR, Danford L . Is the impedance index (ht2/R) significant in predicting total body water? Am J Clin Nutr 1992; 56: 835–839. source
    • cites [25] Kushner RF, Schoeller DA . Estimation of total body water by bioelectrical impedance analysis. Am J Clin Nutr 1986; 44: 417–424. source
    • cites [26] Luke A, Durazo-Arvizu R, Rotimi C, Prewitt TE, Forrester T, Wilks R et al. Relation between body mass index and body fat in black population samples from Nigeria, Jamaica, and the United States. Am J Epidemiol 1997; 145: 620–628. source
    • cites [27] Wang J, Thornton JC, Burastero S, Heymsfield SB, Pierson RN Jr . Bio-Impendance analysis for estimation of total body potassium, total body water, and fat-free mass in white, black and asian adults. Am J Hum Biol 1995; 7: 33–40. source
    • cites [28] Zillikens MC, Conway JM . Estimation of total body water by biolectrical impedance analysis in blacks. Am J Hum Biol 1991; 3: 25–32. source
    • cites [29] Lukaski HC, Johnson PE, Bolonchuk WW, Lykken GI . Assessment of fat-free mass using bioelectrical impedance measurements of the human body. Am J Clin Nutr 1985; 41: 810–817. source
    • cites [30] Segal KR, Burastero S, Chun A, Coronel P, Pierson RN Jr ., Wang J . Estimation of extracellular and total body water by multiple-frequency bioelectrical-impedance measurement. Am J Clin Nutr 1991; 54: 26–29. source
    • cites [31] Sun SS, Chumlea WC, Heymsfield SB, Lukaski HC, Schoeller D, Friedl K et al. Development of bioelectrical impedance analysis prediction equations for body composition with the use of a multicomponent model for use in epidemiologic surveys. Am J Clin Nutr 2003; 77: 331–340. source
    • cites [32] Van Loan MD, Mayclin P . Bioelectrical impedance analysis: is it a reliable estimator of lean body mass and total body water? Hum Biol 1987; 1987: 299–309.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • The authors state this as an assumption: The previously published BIA equations used for comparison were derived from samples that contained at least some ethnically black participants.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Body mass index is easy to measure and shows a reasonably good correlation with adiposity.

    “It correlates fairly well with adiposity and is simple to perform (1)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] NHLBI Obesity Education Initiative. Practical Guide to the Identification, Evaluation and Treatment of Overweight and Obesity in Adults. National Heart, Lung and Blood Institute. U.S. Department of Health and Human Services., NIH Publication Number: Washington, DC, USA, 2000, NIH Publication no. 02–4084.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Premisereasoning

    Because physiological variables may differ across populations, investigators have proposed that population-specific equations be developed when using BIA to estimate body composition.

    “The potential for these physiologic variables to differ across populations has led investigators to propose that population-specific equations be developed when using BIA to estimate body composition.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    A random sample generator split participants into a development group (two-thirds) and a validation group (one-third).

    “The participants were randomly divided into an equation development sample (66.7% of total) and a validation sample (remaining 33.3% of total) using a random sample generator (StataSE, version 12; College Station, TX).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The number of participants for these analyses came from the sample required to compare total energy expenditure across METS cohorts using doubly labeled water.

    “The sample size for these analyses was determined by the requisite sample needed for the comparison of total energy expenditure across the METS cohorts, as assessed by the doubly labeled water method.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    BIA has served as a cheaper option for body composition estimation in adults and children.

    “Bioelectrical impedance analysis (BIA) has been used as a less expensive alternative for estimating body composition in both adults and children (3).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] Lukaski HC, Bolonchuk WW, Hall CB, Siders WA . Validation of tetrapolar bioelectrical impedance method to assess human body composition. J Appl Physiol 1986; 60: 1327–1332. source

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Randomization assigned 244 participants to equation development and 118 to validation.

    “The participants were randomized to either the equation development sample (n=244) or validation sample (n=118).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The study's validated equations outperformed a sample of existing equations and offer a workable BIA option for body composition estimation in African-origin populations.

    “The validated equations presented here performed better than a sampling of existing equations and provide a viable option for the estimation of body composition by BIA among African-origin populations.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The stable isotope protocol was completed by 362 participants, about 72 at each site.

    “A total of 362 participants completed the stable isotope protocol, approximately 72 individuals per site.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Characteristics did not differ significantly between development and validation samples by site or between the total samples (all p>0.10).

    “There were no significant differences in characteristics between the development sample and the validation sample by site or between the total samples (all p>0.10).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisenone given

    Every earlier equation in the comparison used isotope dilution as its reference method; all except one used analyzers from the same manufacturer.

    “Like the current study, all of the previously published equations were developed using isotope dilution as the reference method (either deuterium dilution alone, the average of deuterium and 18O dilution, or tritium dilution) and all but one (Segal; Daninger Medical Technology, Columbus, OH) used bioimpedance analyzers from the same manufacturer (RJL Systems).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Because anthropometric measures differed widely by site and the combined equation captures that variation, the single site-combined equation might apply to other African-origin groups.

    “The single, site-combined equation is thus recommended for use in these five populations and may be relevant for other African-origin groups, as anthropometric measurements varied widely across sites and the site-combined equation captures this variability.”
    Quote in the paperSubstantial claim
25 of 25

  • The authors state this as an assumption.

    The previously published BIA equations used for comparison were derived from samples that contained at least some ethnically black participants.

    “previously published equations derived using participant samples which were assumed by Dioum et al. to consist of at least some ethnically black participants (5, 24–32).”
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Authors
Luke, A., Bovet, P., Forrester, T. E., Lambert, E. V., Plange-Rhule, J., Dugas, L. R., Durazo-Arvizu, R. A., Kroff, J., Richie, W. N., & Schoeller, D. A.
Affiliations
  • Loyola University Chicago (US)
  • Centre Hospitalier Universitaire Vaudois (CH)
  • University of the West Indies System (JM)
  • University of Cape Town (ZA)
  • University of Wisconsin–Madison (US)
Corresponding author
Luke, A
ORCID
Venue
European Journal of Clinical Nutrition
Publisher
Springer Science and Business Media LLC
Published
2013-07-24
Volume
67
Issue
9
Pages
956-960
ISSN
  • 0954-3007 (ISSN-L)
  • 1476-5640
DOI
10.1038/ejcn.2013.123
PMC
PMC3766444
OpenAlex
W2004727742
Cited by
29
References
39
Citations by year
2026: 1 · 2025: 3 · 2024: 4 · 2023: 4 · 2022: 1 · 2020: 2 · 2019: 2 · 2018: 3 · 2017: 4 · 2016: 1 · 2015: 3
FWCI
0.82
Type
journal article
Language
en
Open access
Licence
Locations
  • European Journal of Clinical Nutrition (publishedVersion)
  • PubMed (publishedVersion)
  • SERVAL (Université de Lausanne) (acceptedVersion, other-oa)
  • IRIS (submittedVersion)
  • Europe PMC (PubMed Central) (submittedVersion)
  • PubMed Central (submittedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
  • Physical Sciences › Engineering › Electrical and Electronic Engineering › Electrical and Bioimpedance Tomography
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Keywords
bioelectrical impedance analysis, fat-free mass, body composition, prediction equations, African-origin populations, young adults, isotope dilution, equation validation
MeSH terms
Adult, Black or African American, Body Composition, Body Weight, Female, Ghana, Humans

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

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