Assessment of body composition in health and disease using bioelectrical impedance analysis (BIA) and dual energy X-ray absorptiometry (DXA): a critical overview.
Open accessAbstract
The measurement of body composition (BC) represents a valuable tool to assess nutritional status in health and disease. The most used methods to evaluate BC in the clinical practice are based on bicompartment models and measure, directly or indirectly, fat mass (FM) and fat-free mass (FFM). Bioelectrical impedance analysis (BIA) and dual energy X-ray absorptiometry (DXA) (nowadays considered as the reference technique in clinical practice) are extensively used in epidemiological (mainly BIA) and clinical (mainly DXA) settings to evaluate BC. DXA is primarily used for the measurements of bone mineral content (BMC) and density to assess bone health and diagnose osteoporosis in defined anatomical regions (femur and spine). However, total body DXA scans are used to derive a three-compartment BC model, including BMC, FM, and FFM. Both these methods feature some limitations: the accuracy of BIA measurements is reduced when specific predictive equations and standardized measurement protocols are not utilized whereas the limitations of DXA are the safety of repeated measurements (no more than two body scans per year are currently advised), cost, and technical expertise. This review aims to provide useful insights mostly into the use of BC methods in prevention and clinical practice (ambulatory or bedridden patients). We believe that it will stimulate a discussion on the topic and reinvigorate the crucial role of BC evaluation in diagnostic and clinical investigation protocols.
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BIA is one of the most convenient techniques for assessing body composition in a clinical setting and in epidemiological approaches, mainly because it is easy to apply, fast, and non-invasive, in addition to having a relatively low cost.
“The BIA is one of the most convenient techniques for assessing body composition in a clinical setting and in epidemiological approaches, mainly, because it is easy to apply, fast, and non-invasive, in addition to having a relatively low cost (5, 45, 46).”
From Development and Cross-Validation of a Predictive Equation for Fat-Free Mass in Brazilian Adolescents by Bioelectrical Impedance (2022) · cites this paper as [5]
The Introduction (page unavailable) describes BIA as widely used for epidemiological and clinical purposes, noninvasive, and low cost. It does not state that BIA is easy to apply or fast; the reference to monitoring over the short and long term in Section 2 concerns follow-up, not the speed of a measurement. (LLM, conf=0.83)
Experimental — accuracy not yet measuredIncorporating DEXA or BIA alongside BMI measurements can provide a more comprehensive assessment of body fat percentage and distribution.
“Incorporating body composition analysis techniques such as dual-energy X-ray absorptiometry (DEXA) or bioelectrical impedance analysis (BIA) alongside BMI measurements can provide a more comprehensive assessment of body fat percentage and distribution.”
From Advantages and Limitations of the Body Mass Index (BMI) to Assess Adult Obesity (2024) · cites this paper as [34]
Section 3 explains that BMI cannot distinguish fat from nonfat mass, while Section 2.4 says DXA estimates whole-body and regional fat mass, supporting a more comprehensive assessment. The BIA sections describe estimates of body composition and fat mass, but do not establish that BIA assesses fat distribution. (LLM, conf=0.83)
Experimental — accuracy not yet measured
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Advantages and Limitations of the Body Mass Index (BMI) to Assess Adult Obesity
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- Authors
- Marra, M., Sammarco, R., De Lorenzo, A., Iellamo, F., Siervo, M., Pietrobelli, A., Donini, L. M., Santarpia, L., Cataldi, M., Pasanisi, F., & Contaldo, F.
- Affiliations
- Federico II University Hospital (IT)
- Department of Biomedicine and Prevention, Division of Clinical Nutrition and Nutrigenomic, University of Rome “Tor Vergata”, Italy
- University of Rome Tor Vergata (IT)
- Newcastle University (GB)
- University of Verona (IT)
- Sapienza University of Rome (IT)
- University of Naples Federico II (IT)
- ORCID
- Venue
- Contrast Media & Molecular Imaging
- Publisher
- Wiley
- Published
- 2019-05-29
- Volume
- 2019
- Pages
- 1-9
- ISSN
- 1555-4309 (ISSN-L)
- 1555-4317
- PMC
- PMC6560329
- OpenAlex
- W2947625911
- Cited by
- 401
- References
- 75
- Citations by year
- 2026: 55 · 2025: 74 · 2024: 75 · 2023: 56 · 2022: 61 · 2021: 49 · 2020: 29 · 2019: 1
- FWCI
- 4.15
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Contrast Media & Molecular Imaging (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion, cc-by)
- Cineca Institutional Research Information System (Tor Vergata University) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity) (cc-by)
- Topics
- Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Keywords
- body composition, bioelectrical impedance analysis, dual-energy X-ray absorptiometry, fat mass, fat-free mass, bone mineral content, nutritional assessment, osteoporosis diagnosis, prediction equations, measurement accuracy, three-compartment model, clinical practice
- MeSH terms
- Adipose Tissue, Body Composition, Humans, Nutritional Status, Osteoporosis, Absorptiometry, Photon, Bone Density, 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 ›
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