Validation of a bioelectrical impedance analysis system for body composition assessment in patients with COPD

Different frequencies to estimate bone mineral content from raw bioelectrical impedance data in adolescent soccer players: a critical analysis

Introduction

Skeletal muscle mass, body cell mass, total body water (TBW), and bone mineral mass (BMC) are components of fat-free mass (FFM), which conducts electrical energy due to its high water and electrolyte content. Multifrequency bioelectrical impedance analysis (MF-BIA) has been used to predict FFM, and studies have explored its application for quantifying BMC, a subset of FFM. However, the accuracy of the BMC predicted using MF-BIA depends on the methodological rigor of the frequency selection. This study examined the relationships between BMC and raw MF-BIA data at different frequencies.

Methods

The MF-BIA (SECA 515®) device obtained raw bioelectrical data at 5, 50, and 500 kHz. BMC was quantified using dual-energy X-ray absorptiometry (DXA). Multiple linear regression models and bioelectrical impedance vector analysis (BIVA) were applied to evaluate whole-body and segmental BMC relationships.

Results

Male adolescent soccer players (n = 149; 15.6 ± 0.6 years) participated in this study. Whole-body BMC (R2 = 0.522), and upper and lower limb BMC (R2 = 0.349) were best predicted at 5 kHz, while trunk BMC (R2 = 0.301) was best predicted at 50 kHz. BIVA revealed a leftward vector shift in participants with higher BMC quartiles. The calculated phase angle (PhA) was significantly higher in the highest BMC quartile for 5, 50, and 500 kHz in both upper and lower limbs (p < 0.05).

Conclusion

These findings indicate that MF-BIA could be a supplementary tool for studying BMC in adolescent athletes. However, its utility is constrained by prediction and interpretation errors, emphasizing the importance of careful frequency selection.

Effects of 12 weeks of inspiratory muscle training and whole body vibration on the inflammatory profile, BDNF and muscular system in pre-frail elderly women: A randomized controlled trial

AIM

to investigate the effects of the whole body vibration (WBV) and inspiratory muscle training (IMT) on the inflammatory profile and in muscle mass and strength in pre-frail older women.

METHODS

this study was a randomized double-blind trial. Forty two older women aged 60-80 years were randomly allocated to IMT + WBV (G1), IMTsham + WBV (G2) or Sham groups (G3). During 12 weeks G1 received both trainings, whereas G2 received WBV alone and G3 received IMT with a low fixed load and were positioned at the vibratory platform without therapeutic effect. Participants were evaluated before and after the intervention for the following outcomes: Brain-derived neurotrophic factor (BDNF) and inflammatory biomarkers (IB), respiratory (RT) and quadriceps thickness (QT) and diaphragmatic mobility (DM) using muscle ultrasound, body composition (BC) using a bioelectrical impedance scale and inspiratory muscle strength (IMS).

RESULTS

after the training, G1 (114.93 ± 21.29) improved IMS (p<0.005) compared with G2 (91.29 ± 23.10) and G3 (85.21 ± 27.02). There was also a significant improve on time of the DM (p<0.001) and RT (p=0.006) for G1 (8.59 ± 3.55 and 11.11 ± 12.66) compared with G2 (1.05 ± 3.09 and 1.10 ± 10.60) and G3 (0.40 ± 2.29 and -1.85 ± 7.45). BDNF, IB, QT and BC were similar between groups.

CONCLUSIONS

IMT associated with WBV is effective to improve in increasing IMS, RT and DM in pre-frail older women. However, these interventions do not modify BDNF, IB, QT or BC in this population.

Functional and Combined Training Promote Body Recomposition and Lower Limb Strength in Postmenopausal Women: A Randomized Clinical Trial and a Time Course Analysis

Encouraging healthy aging in postmenopausal women involves advocating for lifestyle modifications, including regular physical exercise like combined training (CT) and functional training (FT). Regarding this population, age-related alterations in body composition, such as decreased muscle mass and heightened adipose tissue, impact health. The aim of this study was to analyze the effects of FT and CT on body recomposition in postmenopausal women. About the methods, we randomly allocated 96 post-menopausal women to the FT, CT, or control group (CG). We measured body composition by bioimpedance and lower limb muscle strength by sit-to-stand test in five repetitions, respectively. The training protocol lasted 16 weeks, and we measured body composition and lower limb muscle strength every 4 weeks, totaling five assessments. Regarding results, we notice that both training groups increased lean mass from the 8th week of training. In addition, a reduction was observed in total fat percentage and an increase in appendicular lean mass from the 12th week of intervention. No differences were found for body mass. Furthermore, only the experimental groups increase muscle strength, starting from the 4th week of training. The conclusion was that FT and CT promote similar adaptations in body recomposition without affecting body mass in postmenopausal women.

Association of Bioelectrical Impedance Phase Angle with Physical Performance and Nutrient Intake of Older Adults

In recent years, the phase angle (PhA) as a raw bioelectrical impedance analysis variable has gained attention to assess cell integrity and its association to physical performance in either sports-related or clinical settings. However, data on healthy older adults are scarce. Therefore, data on body composition, physical performance and macronutrient intake from older adults (n = 326, 59.2% women, 75.2 ± 7.2 years) were retrospectively analyzed. Physical performance was evaluated by the Senior Fitness Test battery, gait speed, timed up and go and handgrip strength. Body composition was determined by the BIA and dual-energy X-ray absorptiometry (from a subgroup of n = 51). The PhA was negatively associated with the timed up and go test and age (r = -0.312 and -0.537, p < 0.001), and positively associated with the 6 min walk test, 30 s chair stand, handgrip strength, gait speed and physical performance score (r = 0.170-0.554, p < 0.05), but not protein intake (r = 0.050, p = 0.386). Hierarchical multiple regression analysis showed that especially age, sex, BMI, but also the PhA predicted the performance test outcomes. In conclusion, the PhA seems to be an interesting contributor to physical performance, but sex- and age-specific norm values still need to be determined.

Validation of bioelectrical impedance analysis in the evaluation of body composition in patients with breast cancer

BACKGROUND

The evaluation of body composition is an essential parameter for preventing obesity and sarcopenic obesity, which are prognostic factors in breast cancer. This study aims to validate the bioelectrical impedance analysis (BIA) of women who are breast cancer survivors by using the dual-energy x-ray absorptiometry (DXA) measurement method.

METHODS

This validation study included 104 women without metastasis between 32 and 72 years old (mean 47.03 ± 8.59) whose treatment was completed 6 months prior. Body composition analysis was performed sequentially using both measurements and when participants were hungry.

RESULTS

Meaningful differences were found in fat-free mass (FFM) (BIA: 46.57 ± 5.54 kg; DXA: 41.06 ± 5.11 kg), body fat percentage (%BF) (BIA: 34.28% ± 6.24%; DXA: 43.91% ± 5.58%), body fat mass (FM) (BIA: 25.37 ± 8.84 kg; DXA: 31.24 ± 9.09 kg), and lean soft tissue mass (LSTM) (BIA: 4.42 ± 5.66 kg; DXA: 38.75 ± 4.98 kg) (P < 0.001). Powerful associations for body FM and strong associations for other parameters were seen. A constant and/or proportional error was found between the two devices within the direction of strong and solid components. Compared with DXA, the BIA measurement gives a lower estimate of %BF and FM and a higher estimate of LSTM and FFM.

CONCLUSIONS

By the mathematical relationship between the two measurement methods, it seems possible to adapt the body composition parameters obtained from BIA of patients with breast cancer to DXA results. In the future, there will be a need to evaluate these two devices with more extensive studies.

The Association between Fat-Free Mass and Exercise Test Outcomes in People with Chronic Obstructive Pulmonary Disease: A Systematic Review

People with chronic obstructive pulmonary disease (COPD) tend to have abnormally low levels of fat-free mass (FFM), which includes skeletal muscle mass as a central component. The purpose of this systematic review was to synthesise available evidence on the association between FFM and exercise test outcomes in COPD. MEDLINE, Cochrane Library, EMBASE, Web of Science, and Scopus were searched. Studies that evaluated exercise-related outcomes in relation to measures of FFM in COPD were included. Eighty-three studies, containing 18,770 (39% female) COPD participants, were included. Considerable heterogeneity was identified in the ways that FFM and exercise test outcomes were assessed; however, higher levels of FFM were generally associated with greater peak exercise capacity. This association was stronger for some exercise test outcomes (e.g. peak rate of oxygen consumption during incremental cycle exercise testing) than others (e.g. six-minute walking distance). This review identified heterogeneity in the methods used for measuring FFM and exercise capacity. There was, in general, a positive association between FFM and exercise capacity in COPD. There was also an identified lack of studies investigating associations between FFM and temporal physiological and perceptual responses to exercise. This review highlights the significance of FFM as a determinant of exercise capacity in COPD.

Performance of bioelectrical impedance analysis compared to dual X-ray absorptiometry (DXA) in Veterans with COPD

We examined the performance of a commercially-available handheld bioimpedance (BIA) device relative to dual X-ray absorptiometry (DXA) to assess body composition differences among Veterans with chronic obstructive pulmonary disease (COPD). Body composition was measured using DXA and BIA (Omron HBF-306C) at a single time point. Correlations between BIA- and DXA-assessed percent fat, fat mass, and fat-free mass were analyzed using Spearman (ρ) and Lin Concordance Correlation Coefficients (ρ_c). Mean differences in fat mass were visualized using Bland–Altman plots. Subgroup analyses by obesity status (BMI < 30 versus ≥ 30) were performed. Among 50 participants (96% male; mean age: 69.5 ± 6.0 years), BIA-assessed fat mass was strongly correlated (ρ = 0.94) and demonstrate excellent concordance (ρ_c = 0.95, [95%CI: 0.93–0.98]) with DXA, with a mean difference of 2.7 ± 3.2 kg between BIA and DXA. Although Spearman correlations between BIA- and DXA-assessed percent fat and fat-free mass were strong (ρ = 0.8 and 0.91, respectively), concordance values were only moderate (ρ_c = 0.67 and 0.74, respectively). Significantly stronger correlations were observed for obese relative to non-obese subjects for total percent fat (ρ_obese = 0.85 versus ρ_non-obese = 0.5) and fat mass (ρ_obese = 0.96 versus ρ_non-obese = 0.84). A handheld BIA device demonstrated high concordance with DXA for fat mass and moderate concordance for total percent fat and fat-free mass.

ClinicalTrials.gov: NCT02099799.

Enhance Access to Pulmonary Rehabilitation with a Structured and Personalized Home-Based Program-reabilitAR: Protocol for Real-World Setting

Home-based models represent one of the solutions to respond to the poor accessibility of pulmonary rehabilitation (PR) services in patients with chronic respiratory disease (CRD). The main goal of this protocol is to present the implementation of the first nationwide home-based PR program—reabilitAR—in Portugal and the strategies to assess its benefits in patients with CRD. The program consists of 2 phases: a 12-week intensive phase and a 40-week maintenance phase (total: 52 weeks, 1 year). The intervention in both phases is composed of presential home visits and phone-call follow ups, including exercise training and the self-management educational program Living Well with COPD. Dyspnea, impact of the disease, emotional status, and level of dyspnea during activities of daily living are used as patient-reported outcomes measures. A one-minute sit-to-stand test is used as a functional outcome, and the number of steps as a measure of physical activity. To ensure safety, fall risk and the cognitive function are assessed. Data are collected at baseline, at 12 weeks, at 26 weeks and at 52 weeks. This is the first nationwide protocol on enhancing access to PR, providing appropriate responses to CRD patients’ needs through a structured and personalized home-based program in Portugal.

Comparison of body composition assessment across body mass index categories by two multifrequency bioelectrical impedance analysis devices and dual-energy X-ray absorptiometry in clinical settings

BACKGROUND

InBody-770 and SECA mBCA 515 are multifrequency bioelectrical impedance analysis (BIA) devices, which are commonly used in the clinic to assess fat-free mass (FFM) and body fat (BF). However, the accuracy between devices in clinical settings, across different body mass index (BMI) groups remains unclear.

METHODS

Body composition for 226 participants (51% men, aged 18-80 years, BMI 18-56 kg/m²) was assessed by two commercial multifrequency BIA devices requiring standing position and using eight-contact electrodes, InBody 770 and SECA mBCA 515, and compared to results from dual-energy X-ray absorptiometry (DXA). Measurements were performed in a random order, after a 3 h fast and no prior exercise. Lin's-concordance correlation and Bland-Altman analyses were used to compare between devices, and linear regression to assess accuracy in BF% across BMI groups.

RESULTS

We found strong correlation between DXA results for study population BF% and those obtained by InBody (ρ_c = 0.922, 95% confidence interval (CI) 0.902, 0.938) and DXA and SECA (ρ_c = 0.940, CI 0.923, 0.935), with 95% limits of agreements between 2.6 and -8.9, and 7.1 and -7.6, respectively. BF% assessment by SECA was similar to DXA (-0.3%, p = 0.267), and underestimated by InBody (-3.1%, p < 0.0001). InBody deviations were largest among normal weight people and decreased with increasing BMI group, while SECA measurements remained unaffected.

CONCLUSIONS

Both BIA devices agreed well with BF% assessment obtained by DXA. Unlike SECA, InBody underestimated BF% in both genders and was influenced by BMI categories. Therefore, in clinical settings, individual assessment of BF% should be taken with caution.

Six-minute stepper test in hospitalized elderly patients: Convergent validity, test-retest reliability and safety

OBJECTIVE

To evaluate the convergent validity of the six-minute stepper test (6MST) with the variables used in the diagnosis of sarcopenia (appendicular muscle mass, handgrip strength and six-meter gait speed test), as well as to evaluate test-retest reliability and safety when applied to hospitalized elderly patients. Finally, we aimed to compare the performance in the 6MST between hospitalized elderly patients and healthy elderly from the community.

MATERIALS AND METHODS

Observational and cross-sectional study. Elderly patients admitted to a private hospital and healthy elderly from the community were recruited. On the first day, the patients included underwent the following assessments: anthropometric, handgrip strength (HGS), six-meter gait speed test (6GST) and 6MST. On the second day, before breakfast, patients underwent body composition assessment. The healthy elderly were evaluated on a single day and performed only anthropometric assessment and 6MST.

RESULTS

30 hospitalized patients (age 71.0±7.9 years) and 15 healthy elderly (age 68.1±5.8 years) were included. There was a high correlation of 6MST with 6GST (r = 0.78; p<0.001), moderate correlation with HGS (r = 0.59; p<0.001) and low correlation with appendicular muscle mass (r = 0.45; p = 0.01). There was no statistical difference between the first and second 6MST performed by hospitalized elderly (196.2±91.0 cycles vs. 191.3±103.7 cycles; p = 0.66), in addition to an excellent agreement between these measures (ICC = 0.90; 95% IC 0.78-0.95). Only one adverse event (3.3%) occurred in the sample.

CONCLUSION

6MST showed convergent validity with the functional variables used in the diagnosis of sarcopenia. In addition, excellent test-retest reliability was observed, which indicates the need for a single assessment in hospitalized elderly patients. The prevalence of adverse events during the application of the test is low, without resulting in clinical symptoms; therefore, the test is considered safe for this population. In addition, hospitalized elderly patients perform worse in the 6MST compared to healthy elderly from the community.

Anthropometry, bioimpedance and densitometry: Comparative methods for lean mass body analysis in elderly outpatients from a tertiary hospital

OBJECTIVES

To evaluate lean mass index (LMI) measured by bioimpedance (BIA) and anthropometry compared to densitometry (DXA) in elderly outpatients from a tertiary care hospital.

METHODS

Participants were over 60-year-old men, presenting no dementia or disability, from a tertiary geriatric ambulatory. LMI obtained by BIA, anthropometry and DXA were submitted to Baumgartner, Janssen and Delmonico calculations respectively. Sarcopenia was calculated as LMI by DXA and handgrip strength. Data were analyzed by T student's test, ANOVA for repeated measures and pos hoc Bonferroni test, Pearson's correlation test, regression equation and Bland Altman analysis, ROC curve and contingency table 2 × 2 for sensitivity, specificity and predictive values.

RESULTS

A total of 92 participants completed the study. Most of them were married, aged 72.9 ± 6.6, lived a sedentary lifestyle, presented multiple morbidities, and in use of polypharmacy. Appendicular lean mass was lower in sarcopenic participants when compared to that in nonsarcopenic ones (20.2 kg/m² and 23 kg/m² respectively, p < 0.0001). BIA sensitivity, specificity and correlation to DXA were 37%, 98% and r = 0.81 (p < 0.001), and for anthropometry 67%, 92% and r = 0.77 (p < 0.0001) respectively. Bland Altman's analysis showed congruence between methods and DXA (anthropometry: bias = -0,05 ± 0,66, limits of agreement (LoA) = -1.37 and 1.26; BIA: bias = 2,2; LoA = 0,7 and 3,7).

CONCLUSION

Aging and multiple chronic and degenerative morbidities affect LM in vulnerable elderly patients. Both anthropometry and BIA, are accurate to measure LMI independently in this population but Anthropometry presented better agreement to DXA than Bioimpedance and has the advantage of lower price, easier application and cheaper equipment to be applied.