Development and validation of bioelectrical impedance prediction equations estimating regional lean soft tissue mass in middle-aged adults
Abstract
Background/objectives Bioelectrical impedance (BIA) whole-body and regional raw parameters have been used to develop prediction models to estimate whole-body lean soft tissue (LSTM), with less attention being given to the development of models for regional LSTM. Therefore, we aimed to develop and validate BIA-derived equations predicting regional LSTM against dual x-ray absorptiometry (DXA) in healthy adults.Subjects/methods 149 adults were included in this cross-sectional investigation. Whole-body and regional LSTM were assessed by DXA, and raw bioelectrical parameters of distinct body regions were measured using a 50 kHz phase sensitive BIA analyzer. BIA-derived equations were developed using a stepwise multiple linear regression approach in 2/3 of the sample and cross-validated in the remaining sample.Results Slopes and intercepts of predicted LSTM and DXA measured LSTM did not differ from 1 and 0, respectively, for each region (p ≥ 0.05), with the exception for the trunk (p < 0.05). The BIA-derived equations exhibited a strong relationship (p < 0.001) between the predicted and measured LSTM for each of the following body regions: right and left arms (R = 0.94; R = 0.96), right and left legs (R = 0.88; R = 0.88), upper body (R = 0.96), lower body (R = 0.89), right and left sides of the body (R = 0.94; R = 0.94), and trunk (R = 0.90). Agreement analyses revealed no associations between the differences and the means of the predicted and DXA-derived LSTM.Conclusion The developed BIA-derived equations provide a valid estimate of regional LSTM in middle-aged healthy adults, representing a cost-effective and time-efficient alternative to DXA for the assessment and identification of LSTM imbalances in both clinical and sport-specific contexts.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
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 [61]
The equations predicting LSM in adults were developed for the appendicular and trunk body segments.
“Particularly, the equations predicting LSM were developed for the appendicular [61, 77] and trunk [61] body segments.”
From High-standard predictive equations for estimating body composition using bioelectrical impedance analysis: a systematic review (2024) · cites this paper as [61]
Ten equations for adults are suitable for estimating LSM in both sexes.
“Two equations are suitable for estimating TBW [42, 54], ten for estimating LSM [61, 77], and one for estimating SMM [82] in both sexes.”
From High-standard predictive equations for estimating body composition using bioelectrical impedance analysis: a systematic review (2024) · cites this paper as [61]
Cites
STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT
Martin Bland, J., & Altman, D. (1986) · The Lancet · doi:10.1016/s0140-6736(86)90837-8 · Cited by 47,965 · see citing works
Statistical methods for assessing agreement between two methods of clinical measurement
Bland, J. M., & Altman, D. G. (2010) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2009.10.001 · Cited by 5,220 · see citing works
Bioelectrical impedance analysis?part I: review of principles and methods
KYLE, U. (2004) · Clinical Nutrition · doi:10.1016/j.clnu.2004.06.004 · Cited by 3,200 · see citing works
Skeletal muscle mass and distribution in 468 men and women aged 18–88 yr
Janssen, I., Heymsfield, S. B., Wang, Z., & Ross, R. (2000) · Journal of Applied Physiology · doi:10.1152/jappl.2000.89.1.81 · Cited by 3,087 · see citing works
Bioelectrical impedance analysis—part II: utilization in clinical practice
Kyle, U. G., Bosaeus, I., De Lorenzo, A. D., Deurenberg, P., Elia, M., Manuel Gómez, J., Lilienthal Heitmann, B., Kent-Smith, L., Melchior, J.-C., Pirlich, M., et al. (2004) · Clinical Nutrition · doi:10.1016/j.clnu.2004.09.012 · Cited by 2,350 · see citing works
The number of subjects per variable required in linear regression analyses
Austin, P. C., & Steyerberg, E. W. (2015) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2014.12.014 · Cited by 1,067 · see citing works
Lee, R. C., Wang, Z., Heo, M., Ross, R., Janssen, I., & Heymsfield, S. B. (2000) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/72.3.796 · Cited by 854 · see citing works
The five-level model: a new approach to organizing body-composition research
Wang, Z., Pierson, R., & Heymsfield, S. (1992) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/56.1.19 · Cited by 729 · see citing works
Dual-energy X-ray absorptiometry body composition model: review of physical concepts
Pietrobelli, A., Formica, C., Wang, Z., & Heymsfield, S. B. (1996) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.1996.271.6.e941 · Cited by 594 · see citing works
Lexell, J., Henriksson‐Larsén, K., Winblad, B., & Sjöström, M. (1983) · Muscle & Nerve · doi:10.1002/mus.880060809 · Cited by 582 · see citing works
Muscle tissue changes with aging
Volpi, E., Nazemi, R., & Fujita, S. (2004) · Current Opinion in Clinical Nutrition and Metabolic Care · doi:10.1097/01.mco.0000134362.76653.b2 · Cited by 569 · see citing works
Lean Tissue Imaging: A New Era for Nutritional Assessment and Intervention
Prado, C. M. M., & Heymsfield, S. B. (2014) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607114550189 · Cited by 550 · see citing works
New bioimpedance analysis system: improved phenotyping with whole-body analysis
Pietrobelli, A., Rubiano, F., St‐Onge, M., & Heymsfield, S. B. (2004) · European Journal of Clinical Nutrition · doi:10.1038/sj.ejcn.1601993 · Cited by 378 · see citing works
In vivo validation of whole body composition estimates from dual-energy X-ray absorptiometry
Prior, B. M., Cureton, K. J., Modlesky, C. M., Evans, E. M., Sloniger, M. A., Saunders, M., & Lewis, R. D. (1997) · Journal of Applied Physiology · doi:10.1152/jappl.1997.83.2.623 · Cited by 317 · see citing works
Bosy-Westphal, A., Schautz, B., Later, W., Kehayias, J. J., Gallagher, D., & Müller, M. J. (2013) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2012.160 · Cited by 297 · see citing works
Sergi, G., De Rui, M., Stubbs, B., Veronese, N., & Manzato, E. (2017) · Aging Clinical and Experimental Research · doi:10.1007/s40520-016-0622-6 · Cited by 291 · see citing works
Fuller, N. J., Laskey, M. A., & Elia, M. (1992) · Clinical Physiology · doi:10.1111/j.1475-097x.1992.tb00831.x · Cited by 232 · see citing works
Bosy-Westphal, A., Jensen, B., Braun, W., Pourhassan, M., Gallagher, D., & Müller, M. J. (2017) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2017.27 · Cited by 231 · see citing works
The Validity of Bioelectrical Impedance Models in Clinical Populations
Buchholz, A. C., Bartok, C., & Schoeller, D. A. (2004) · Nutrition in Clinical Practice · doi:10.1177/0115426504019005433 · Cited by 228 · see citing works
Birth size, adult body composition and muscle strength in later life
Ylihärsilä, H., Kajantie, E., Osmond, C., Forsén, T., Barker, D. J. P., & Eriksson, J. G. (2007) · International Journal of Obesity · doi:10.1038/sj.ijo.0803612 · Cited by 226 · see citing works
Shafer, K. J., Siders, W. A., Johnson, L. K., & Lukaski, H. C. (2008) · Nutrition · doi:10.1016/j.nut.2008.07.004 · Cited by 223 · see citing works
Self-citationBuckinx, F., Reginster, J., Dardenne, N., Croisiser, J.-L., Kaux, J., Beaudart, C., Slomian, J., & Bruyère, O. (2015) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-015-0510-9 · Cited by 208 · see citing works
Bredella, M. A., Ghomi, R. H., Thomas, B. J., Torriani, M., Brick, D. J., Gerweck, A. V., Misra, M., Klibanski, A., & Miller, K. K. (2010) · Obesity · doi:10.1038/oby.2010.5 · Cited by 201 · see citing works
Lee, S. Y., Ahn, S., Kim, Y. J., Ji, M. J., Kim, K. M., Choi, S. H., Jang, H. C., & Lim, S. K. (2018) · Nutrients · doi:10.3390/nu10060738 · Cited by 175 · see citing works
Bosy-Westphal, A., & Müller, M. J. (2015) · International Journal of Obesity · doi:10.1038/ijo.2014.161 · Cited by 133 · see citing works
Kim, M., & Kim, H. (2013) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2013.9 · Cited by 132 · see citing works
Bioelectrical Impedance Analysis
Chumlea, W. C., & Sun, S. S. (2005) · doi:10.5040/9781492596950.ch-006 · Cited by 130 · see citing works
Esco, M. R., Snarr, R. L., Leatherwood, M. D., Chamberlain, N. A., Redding, M. L., Flatt, A. A., Moon, J. R., & Williford, H. N. (2015) · Journal of Strength and Conditioning Research · doi:10.1519/jsc.0000000000000732 · Cited by 122 · see citing works
Beaudart, C., Bruyère, O., Geerinck, A., Hajaoui, M., Scafoglieri, A., Perkisas, S., Bautmans, I., Gielen, E., Reginster, J.-Y., & Buckinx, F. (2020) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2019.09.012 · Cited by 113 · see citing works
Sillanpää, E., Cheng, S., Häkkinen, K., Finni, T. J., Walker, S., Pesola, A. J., Ahtiainen, J. P., Stenroth, L., Selänne, H., & Sipilä, S. (2013) · Obesity · doi:10.1002/oby.20583 · Cited by 112 · see citing works
Bosy‐Westphal, A., Danielzik, S., Dörhöfer, R., Piccoli, A., & Müller, M. J. (2005) · American Journal of Clinical Nutrition · doi:10.1093/ajcn.82.1.60 · Cited by 107 · see citing works
Bosy‐Westphal, A., Danielzik, S., Dörhöfer, R., et al. (2005) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/82.1.60 · Cited by 92 · see citing works
Kriemler, S., Puder, J. J., Zahner, L., Roth, R., Braun‐Fahrländer, C., & Bedogni, G. (2008) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2008.19 · Cited by 91 · see citing works
Validity and accuracy of regional bioelectrical impedance devices to determine whole-body fatness
Lukaski, H. C., & Siders, W. A. (2003) · Nutrition · doi:10.1016/s0899-9007(03)00166-7 · Cited by 73 · see citing works
Self-citationScafoglieri, A., Clarys, J. P., Bauer, J. M., Verlaan, S., Van Malderen, L., Vantieghem, S., Cederholm, T., Sieber, C. C., Mets, T., & Bautmans, I. (2017) · Clinical Nutrition · doi:10.1016/j.clnu.2016.04.026 · Cited by 64 · cited 1× · see citing works
“Since the main component of whole-body and appendicular LSTM is SMM, an important health and nutritional indicator particularly during older adulthood [29], most of BIA-derived equations predicting ALSTM have been developed for the older adult population using DXA as the reference method [17, 18].”
MethodWingo, B. C., Barry, V. G., Ellis, A. C., & Gower, B. A. (2018) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2018.08.013 · Cited by 63 · see citing works
Schoenfeld, B. J., Nickerson, B. S., Wilborn, C. D., Urbina, S. L., Hayward, S. B., Krieger, J., Aragon, A. A., & Tinsley, G. M. (2020) · Journal of Strength and Conditioning Research · doi:10.1519/jsc.0000000000002708 · Cited by 59 · see citing works
Silva, A. M., Santos, D. A., Matias, C. N., Rocha, P. M., Petróski, E. L., Minderico, C. S., & Sardinha, L. B. (2011) · European Journal of Applied Physiology · doi:10.1007/s00421-011-2221-8 · Cited by 46 · see citing works
Self-citationRaymond‐Pope, C. J., Dengel, D. R., & Bosch, T. A. (2017) · The Journal of Strength and Conditioning Research · doi:10.1519/jsc.0000000000002320 · Cited by 43 · see citing works
Sardinha, L. B., Correia, I. R., Magalhães, J. P., Júdice, P. B., Silva, A. M., & Hetherington-Rauth, M. (2020) · European Journal of Clinical Nutrition · doi:10.1038/s41430-020-0666-8 · Cited by 38 · see citing works
Self-citationMoore, M. L., Benavides, M. L., Dellinger, J. R., Adamson, B. T., & Tinsley, G. M. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2019.12.009 · Cited by 32 · see citing works
Brewer, G. J., Blue, M. N. M., Hirsch, K. R., Peterjohn, A. M., & Smith‐Ryan, A. E. (2019) · The Journal of Strength and Conditioning Research · doi:10.1519/jsc.0000000000003374 · Cited by 28 · see citing works
De Rui, M., Veronese, N., Bolzetta, F., Berton, L., Carraro, S., Bano, G., Trevisan, C., Pizzato, S., Coin, A., Perissinotto, E., et al. (2017) · Clinical Nutrition · doi:10.1016/j.clnu.2016.04.011 · Cited by 26 · see citing works
Cheng, M., Chen, Y.-Y., Jang, T.-R., Lin, W.-L., Chen, J., & Hsieh, K.-C. (2016) · Biology of Sport · doi:10.5604/20831862.1224097 · Cited by 19 · see citing works
Tinsley, G. M., Moore, M. L., Rafi, Z., Griffiths, N., Harty, P. S., Stratton, M. T., Benavides, M. L., Dellinger, J. R., & Adamson, B. T. (2020) · Journal of Clinical Densitometry · doi:10.1016/j.jocd.2020.05.003 · Cited by 19 · see citing works
Lee, L.-C., Hsieh, K.-C., Wu, C.-S., Chen, Y.-J., Chiang, J., & Chen, Y.-Y. (2014) · International journal of gerontology · doi:10.1016/j.ijge.2013.08.010 · Cited by 14 · see citing works
Toselli, S., Campa, F., Matias, C. N., de Alencar Silva, B. S., dos Santos, V. R., Maietta Latessa, P., & Gobbo, L. A. (2021) · Experimental Gerontology · doi:10.1016/j.exger.2021.111393 · Cited by 12 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Campa, F., Coratella, G., Cerullo, G., Noriega, Z., Francisco, R., Charrier, D., Irurtia, A., Lukaski, H., Silva, A. M., & Paoli, A. (2024) · Journal of Translational Medicine · doi:10.1186/s12967-024-05272-x · Cited by 80 · see citing works
“The remaining studies involved European [50, 52, 71, 77, 101], Eastern Asian [47, 78], and Australian [66] populations with a balanced number of male and female participants.”
BackgroundSelf-citationPhase angle, muscle tissue, and resistance training
Sardinha, L. B., & Rosa, G. B. (2023) · Reviews in Endocrine and Metabolic Disorders · doi:10.1007/s11154-023-09791-8 · Cited by 53 · see citing works
Self-citationPaoli, A., & Campa, F. (2024) · Current Obesity Reports · doi:10.1007/s13679-024-00573-0 · Cited by 24 · see citing works
Rosa, G. B., Hetherington‐Rauth, M., Magalhães, J. P., Correia, I. R., Bernardino, A. V., & Sardinha, L. B. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2023.11.039 · Cited by 6 · see citing works
Self-citationMoya-Amaya, H., Ortega, D. R., Molina-López, A., Berral-Aguilar, A. J., Portolan, A., & de la Rosa, F. J. B. (2025) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2025.06.025 · Cited by 1 · see citing works
Forné, Á. F., Fernández‐Jiménez, R., Toledo, M. D., Jiménez-Rodríguez, H., Muñoz-Lupiáñez, M., Ruiz-López, M. A., García‐Almeida, J. M., la Peña-Fernández, L. D., Queipo‐Ortuño, M. I., & Gómez‐Millán, J. (2025) · Nutrients · doi:10.3390/nu17203301
Campa, F., Coratella, G., Cerullo, G., Noriega, Z., Francisco, R., Charrier, D., Irurtia, A., Lukaski, H. C., Silva, A. M., & Paoli, A. (2024) · Figshare · doi:10.6084/m9.figshare.26727262
Self-citationCairoli, A., Grinzinger, M., Coenegracht, C., Hund-Georgiadis, M., & Maguire, C. (2026) · BMC Neurology · doi:10.1186/s12883-026-04777-w
Rosa, G. B., Francisco, R., Correia, I., Bernardino, A., Magalhães, J., Pires, M., Lukaski, H. C., Silva, A. M., & Sardinha, L. B. (2026) · Research Square · doi:10.21203/rs.3.rs-9224431/v1
Self-citationSilva-Filho, J. Z., Pereira, J. P. D. C., Fortunato, W. S. L., Ramiro, C. P. S. P., & Filho, D. C. S. (2026) · Nutrition · doi:10.1016/j.nut.2026.113328
- Authors
- Sardinha, L. B., Rosa, G. B., Hetherington-Rauth, M., Correia, I. R., Magalhães, J. P., Silva, A. M., & Lukaski, H.
- Affiliations
- University of Lisbon (PT)
- University of North Dakota (US)
- Corresponding author
- Sardinha, Luís B.
- ORCID
- Venue
- European Journal of Clinical Nutrition
- Published
- 2022-10-17
- Volume
- 77
- Issue
- 2
- Pages
- 202-211
- ISSN
- 0954-3007 (ISSN-L)
- 1476-5640
- OpenAlex
- W4306409866
- Cited by
- 10
- References
- 47
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 3 · 2023: 2
- FWCI
- 1.08
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- European Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
- Physical Sciences › Engineering › Electrical and Electronic Engineering › Electrical and Bioimpedance Tomography
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Keywords
- bioimpedance, prediction equations, dual-energy X-ray absorptiometry, middle-aged adults, body composition assessment, trunk lean mass
- MeSH terms
- Adult, Body Composition, Cross-Sectional Studies, Humans, Middle Aged, Reproducibility of Results, Absorptiometry, Photon, Linear Models, Electric Impedance
About these checks
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.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
