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Development of bioelectrical impedance analysis prediction equations for body composition with the use of a multicomponent model for use in epidemiologic surveys.
Open accessAbstract
Background Previous studies to develop and validate bioelectrical impedance analysis (BIA) equations to predict body composition were limited by small sample sizes, sex specificity, and reliance on reference methods that use a 2-component model. Objective This study was designed to develop sex-specific BIA equations to predict total body water (TBW) and fat-free mass (FFM) with the use of a multicomponent model for children and adults. Design Data from 5 centers were pooled to create a sample of 1474 whites and 355 blacks aged 12-94 y. TBW was measured by dilution, and FFM was estimated with a multicomponent model based on densitometry, isotope dilution, and dual-energy X-ray absorptiometry. Results The final race-combined TBW prediction equations included stature(2)/resistance and body weight (R(2) = 0.84 and 0.79 and root mean square errors of 3.8 and 2.6 L for males and females, respectively; CV: 8%) and tended to underpredict TBW in black males (2.0 L) and females (1.4 L) and to overpredict TBW in white males (0.5 L) and females (0.3 L). The race-combined FFM prediction equations contained the same independent variables (R(2) = 0.90 and 0.83 and root mean square errors of 3.9 and 2.9 kg for males and females, respectively; CV: approximately 6%) and tended to underpredict FFM in black males (2.1 kg) and females (1.6 kg) and to overpredict FFM in white males (0.4 kg) and females (0.3 kg). Conclusion These equations have excellent precision and are recommended for use in epidemiologic studies to describe normal levels of body composition.
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In the citing paper
“Although DXA cannot be considered the gold standard for the determination of FFM at the molecular level, and the four-compartment model (4C) is the most suitable reference method to assess FM and FFM at the molecular level (12), due to the complexity of the technique (13), the use of DXA to derive BIA equations has been widely accepted (14, 15).”
From Development and Cross-Validation of a Predictive Equation for Fat-Free Mass in Brazilian Adolescents by Bioelectrical Impedance (2022) · cites this paper as [15]
In the citing paper
“When comparing the predicted mean FFM values with those obtained by the reference technique, only two equations showed no significant difference (15, 42).”
From Development and Cross-Validation of a Predictive Equation for Fat-Free Mass in Brazilian Adolescents by Bioelectrical Impedance (2022) · cites this paper as [15]
In the citing paper
“However, all equations, including these two (15, 42), showed high limits of agreement, limiting their use at the individual level, for the subjects of this study.”
From Development and Cross-Validation of a Predictive Equation for Fat-Free Mass in Brazilian Adolescents by Bioelectrical Impedance (2022) · cites this paper as [15]
In the citing paper
“The same was verified in the other studies that proposed predictive equations of FFM by BIA in adolescents, which we tested for validity in the sample of this study (15, 23, 24, 40–44).”
From Development and Cross-Validation of a Predictive Equation for Fat-Free Mass in Brazilian Adolescents by Bioelectrical Impedance (2022) · cites this paper as [15]
In the citing paper
“and all parameters used for the proposition and cross-validation of the model confirmed their validity for the studied population (15, 37–39, 57)”
From Development and Cross-Validation of a Predictive Equation for Fat-Free Mass in Brazilian Adolescents by Bioelectrical Impedance (2022) · cites this paper as [15]
In the citing paper
“Although the use of predictive equations in subjects with different characteristics from those presented by the group of origin of the equations is questionable (15)”
From Development and Cross-Validation of a Predictive Equation for Fat-Free Mass in Brazilian Adolescents by Bioelectrical Impedance (2022) · cites this paper as [15]
In the citing paper
“However, due to the complexity of the technique (13), the use of DXA to derive BIA equations has been widely accepted (14, 15).”
From Development and Cross-Validation of a Predictive Equation for Fat-Free Mass in Brazilian Adolescents by Bioelectrical Impedance (2022) · cites this paper as [15]
In the citing paper
“In addition, the Sun (7), Ainsworth (8), and Wang (9) equations included individuals from all weight ranges, whereas Jakicic's (4) sample was exclusively obese, and Hortobagyi (10) included college athletes.”
From Comparison of Body Composition Methods in Obese African‐American Women (2006) · cites this paper as [7]
In the citing paper
“Furthermore, Sun (7) noted that their generalized equation (developed on a sample across a wide range of body weights) better estimated body composition in the white sample and that the equation would likely underestimate percentage BF (%BF) in African Americans.”
From Comparison of Body Composition Methods in Obese African‐American Women (2006) · cites this paper as [7]
In the citing paper
“Sun (7) developed one equation that could be used across ethnic groups, whereas the other equations are separate based on ethnicity.”
From Comparison of Body Composition Methods in Obese African‐American Women (2006) · cites this paper as [7]
In the citing paper
“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).”
From Prediction of fat-free mass using bioelectrical impedance analysis in young adults from five populations of African origin (2013) · cites this paper as [31]
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“[59] with data from the National Health and Nutrition Examination Survey (NHANES) III for weight, stature, and BIA, estimated TBW, FFM, FM, and percent body fat for 12- to 19.”
MethodMatias, C. N., Santos, D. A., Júdice, P. B., Magalhães, J. P., Minderico, C. S., Fields, D. A., Lukaski, H. C., Sardinha, L. B., & Silva, A. M. (2016) · Clinical Nutrition · doi:10.1016/j.clnu.2015.03.013 · Cited by 111
Self-citationSaadi, H., Nagelkerke, N. J. D., Benedict, S., Qazaq, H. S., Zilahi, E., Mohamadiyeh, M. K., & Al-Suhaili, A. I. (2006) · Bone · doi:10.1016/j.bone.2006.05.010 · Cited by 107
“Body fat content was estimated by bioelectric impedance (BIA-101A, RJL Systems; USA) using published equations [20].”
MethodWehmeyer, M. H., Zyriax, B., Jagemann, B., Roth, E., Windler, E. E. T., Wiesch, J. S. Z., Lohse, A. W., & Kluwe, J. (2016) · Medicine · doi:10.1097/md.0000000000003887 · Cited by 107
Body fatness and sex steroid hormone concentrations in US men: results from NHANES III
Rohrmann, S., Shiels, M. S., López, D. S., Rifai, N., Nelson, W. G., Kanarek, N., Güallar, E., Menke, A., Joshu, C. E., Feinleib, M., et al. (2011) · Cancer Causes & Control · doi:10.1007/s10552-011-9790-z · Cited by 105
“Validated prediction equations using height and weight were used to convert whole body electrical resistance at 50 kHz to percent body fat [13].”
Diagnosing Obesity by Body Mass Index in Chronic Kidney Disease
Agarwal, R., Bills, J. E., & Light, R. P. (2010) · Hypertension · doi:10.1161/hypertensionaha.110.160747 · Cited by 106
Lustgarten, M. S., & Fielding, R. A. (2011) · The journal of nutrition health & aging · doi:10.1007/s12603-011-0049-x · Cited by 104
“, the reduction of fat-free mass and total body water that occurs with age (85).”
BackgroundRocha, J. C., van Spronsen, F. J., Almeida, M., Soares, G. M., Quelhas, D., Ramos, E., Guimarães, J. T., & Borges, N. (2012) · Molecular Genetics and Metabolism · doi:10.1016/j.ymgme.2012.10.006 · Cited by 100
Prevalence of anxiety and depression in patients with overweight and obesity.
Sharafi, S. E., Garmaroudi, G., Ghafouri, M., Bafghi, S. A., Ghafouri, M., Tabesh, M. R., & Alizadeh, Z. (2020) · Obesity Medicine · doi:10.1016/j.obmed.2019.100169 · Cited by 98
Brunani, A., Perna, S., Soranna, D., Rondanelli, M., Zambon, A., Bertoli, S., Vinci, C., Capodaglio, P., Lukaski, H. C., & Cancello, R. (2021) · Clinical Nutrition · doi:10.1016/j.clnu.2021.04.033 · Cited by 107
Self-citationIron supplementation improves energetic efficiency in iron-depleted female rowers
DELLAVALLE, D. M., & HAAS, J. D. (2014) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000000208 · Cited by 93
Effects of concurrent aerobic and strength training on breast cancer survivors: a pilot study
Luca, V. D., Minganti, C., Borrione, P., Grazioli, E., Cerulli, C., Guerra, E., Bonifacino, A., & Parisi, A. (2016) · Public Health · doi:10.1016/j.puhe.2016.03.028 · Cited by 94
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
“Concomitantly, a prediction equation for body composition that relied on H(2)/R, R, and weight (11) did not show an age-related increase but rather a slight decrease in percentage fat mass in these women (Figure 4B).”
MethodMetabolic Demands of Body Armor on Physical Performance in Simulated Conditions
Ricciardi, R., Deuster, P. A., & Talbot, L. A. (2008) · Military Medicine · doi:10.7205/milmed.173.9.817 · Cited by 91
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
Bosy‐Westphal, A., Plachta‐Danielzik, S., Dörhöfer, R., & Müller, M. J. (2009) · British Journal Of Nutrition · doi:10.1017/s0007114508190304 · Cited by 88
“based on a multicompartment model((40)).”
Prediction of Fatness by Standing 8‐Electrode Bioimpedance: A Multiethnic Adolescent Population
Sluyter, J. D., Schaaf, D., Scragg, R. K. R., & Plank, L. D. (2010) · Obesity · doi:10.1038/oby.2009.166 · Cited by 85
“The four-compartment model (24), as the preferred reference technique, has rarely been applied in children and adolescents for the development of equations based on BIA (25).”
MethodTengvall, M., Ellegård, L., Malmros, V., Bosaeus, N., Lissner, L., & Bosaeus, I. (2009) · Clinical Nutrition · doi:10.1016/j.clnu.2008.10.005 · Cited by 87
Rapid Weight Loss and the Body Fluid Balance and Hemoglobin Mass of Elite Amateur Boxers
Reljic, D., Hässler, E., Jost, J., & Friedmann‐Bette, B. (2013) · Journal of Athletic Training · doi:10.4085/1062-6050-48.1.05 · Cited by 88
A prospective Swedish study on body size, body composition, diabetes, and prostate cancer risk
Wallström, P., Bjartell, A. S., Gullberg, B., Olsson, H. L., & Wirfält, E. (2009) · British Journal of Cancer · doi:10.1038/sj.bjc.6605077 · Cited by 86
“An algorithm (Sun et al, 2003) was used to estimate body fat (BF) from impedance.”
MethodPiccoli, A., Pastori, G., Guizzo, M., Rebeschini, M., Naso, A., & Cascone, C. (2004) · Kidney International · doi:10.1111/j.1523-1755.2005.00083.x · Cited by 85
on behalf of the ProActive study group, Golubić, R., Wijndaele, K., Sharp, S. J., Simmons, R. K., Griffin, S. J., Wareham, N. J., Ekelund, U., & Brage, S. (2014) · International Journal of Obesity · doi:10.1038/ijo.2014.66 · Cited by 90
Gallagher, D., Andres, A., Fields, D. A., Evans, W. J., Kuczmarski, R. J., Lowe, W. L., Lumeng, J. C., Oken, E., Shepherd, J., Sun, S. S., et al. (2020) · Obesity Reviews · doi:10.1111/obr.13033 · Cited by 80
Self-citationHume, D. J., Howells, F. M., Rauch, L., Kroff, J., & Lambert, E. V. (2014) · Appetite · doi:10.1016/j.appet.2014.11.012 · Cited by 93
“Body composition was measured using Bioelectrical Impedance Analysis (BIA) (Quantum II, RJL Systems, Michigan, USA), where body fat percentage was determined using the prediction equation by Sun et al. (2003).”
MethodVicente‐Rodríguez, G., Rey‐López, J. P., Mesana, M. I., Poortvliet, E., Ortega, F. B., Polito, A., Nagy, E., Widhalm, K., Sjöström, M., Moreno, L. A., et al. (2012) · Obesity · doi:10.1038/oby.2011.272 · Cited by 79
“Bioresearch, Pontassieve, Italy) that uses the equations previously published by Sun and colleagues (4).”
BackgroundYoshida, D., Shimada, H., Park, H., Anan, Y., Ito, T., Harada, A., & Suzuki, T. (2014) · Geriatrics & Gerontology International · doi:10.1111/ggi.12177 · Cited by 76
Orsso, C. E., Montes‐Ibarra, M., Findlay, M., van der Meij, B. S., de van der Schueren, M. A. E., Landi, F., Laviano, A., & Prado, C. M. (2022) · Journal of Cachexia, Sarcopenia and Muscle · doi:10.1002/jcsm.12954 · Cited by 73
“cle mass; notably, they provide double indirect and indirect measures of body composition, respectively.(83,84) Handgrip strength is being assessed in most trials; however, it may”
BackgroundMainenti, M. R. M., Rodrigues, É. C., de Oliveira, J. F., Ferreira, A. D. S., Dias, C. M., & Silva, A. L. D. S. (2011) · Clinics · doi:10.1590/s1807-59322011000900001 · Cited by 73
Carter, R. C., Jacobson, J. L., Molteno, C. D., Jiang, H., Meintjes, E. M., Jacobson, S. W., & Duggan, C. (2012) · Alcoholism Clinical and Experimental Research · doi:10.1111/j.1530-0277.2012.01810.x · Cited by 70
“N IH -PA Author M anuscript N IH -PA Author M anuscript N IH -PA Author M anuscript comparisons within an ethnically homogeneous population such as the cohort in this study (Sun et al., 2003).”
BackgroundMethodA New BIA Equation Estimating the Body Composition of Young Children
Clasey, J. L., Bradley, K. D., Bradley, J. W., Long, D. E., & Griffith, J. R. (2011) · Obesity · doi:10.1038/oby.2011.158 · Cited by 73
“Previous reports have indicated that race or ethnicity may be a factor that significantly impacts or influences resulting BIA equations (29,30) while others have found that ethnicity was not a significant predictive factor in resulting BIA prediction equations (31).”
BackgroundGruber, M., Mares, J. A., Chappell, R. J., Millen, A. E., LaRowe, T. L., Moeller, S. M., Iannaccone, A., & Kritchevsky, S. B. (2004) · Journal of Nutrition · doi:10.1093/jn/134.9.2387 · Cited by 70
Development and Validation of a Predictive Equation for Lean Body Mass in Children and Adolescents
Foster, B. J., Platt, R. W., & Zemel, B. S. (2012) · Annals of Human Biology · doi:10.3109/03014460.2012.681800 · Cited by 68
“Although other methods of estimating adiposity, such as skinfolds and bioimpedance, are available, they were judged to be impractical due to problems with availability, imprecision and reproducibility in the clinical setting (Roche 1996; Ellis et al. 1999; Schaefer et al. 2000; Sun et al. 2003).”
MethodBioimpedância elétrica e sua aplicação em avaliação nutricional
Eickemberg, M., de Oliveira, C. C., Roriz, A. K. C., & Sampaio, L. R. (2011) · Revista de Nutrição · doi:10.1590/s1415-52732011000600009 · Cited by 66
Rush, E. C., Chandu, V, & Plank, L. D. (2006) · International Journal of Obesity · doi:10.1038/sj.ijo.0803230 · Cited by 64
Metadata
- Authors
- Sun, S. S., Chumlea, W. C., Heymsfield, S. B., Lukaski, H. C., Schoeller, D., Friedl, K., Kuczmarski, R. J., Flegal, K. M., Johnson, C. L., & Hubbard, V. S.
- Affiliations
- Centers for Disease Control and Prevention (US)
- Corresponding author
- Sun, Shumei S
- ORCID
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2003-02
- Volume
- 77
- Issue
- 2
- Pages
- 331-340
- ISSN
- 0002-9165 (ISSN-L)
- OpenAlex
- W2127226434
- Cited by
- 692
- References
- 44
- Citations by year
- 2026: 21 · 2025: 23 · 2024: 34 · 2023: 34 · 2022: 41 · 2021: 31 · 2020: 37 · 2019: 20 · 2018: 29 · 2017: 23 · 2016: 36 · 2015: 38 · 2014: 42 · 2013: 29 · 2012: 55
- FWCI
- 10.44
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD012252, HD-27063, HD 13404)
- Topics
- Health Sciences › Medicine › Physiology (medical) › 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, body composition, prediction equations, multicomponent model, total body water, fat-free mass, racial differences, children and adults, reference values, epidemiological survey
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Aging, Body Composition, Body Water, Child, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Reference Values, Sensitivity and Specificity, Sex Characteristics, Reproducibility of Results, Body Mass Index, Epidemiologic Studies, Electric Impedance, Black People, White People
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