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Campa F, Coratella G, Cerullo G, Stagi S, Paoli S, Marini S, Grigoletto A, Moroni A, Petri C, Andreoli A, Ceolin C, Degan R, Izzicupo P, Sergi G, Mascherini G, Micheletti Cremasco M, Marini E, Toselli S, Moro T, Paoli A. New bioelectrical impedance vector references and phase angle centile curves in 4,367 adults: The need for an urgent update after 30 years. Clin Nutr 2023; 42:1749-1758. [PMID: 37544246 DOI: 10.1016/j.clnu.2023.07.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND & AIMS The bioelectrical impedance vector analysis (BIVA) represents a qualitative analysis of body composition. The vector, defined by resistance (R) and reactance (Xc) standardized by stature, can be evaluated compared to the 50%,75%, and 95% tolerance ellipses representative of the reference populations. The tolerance ellipses for healthy adults have been provided in 1995 and were developed by mixing underage, adult, and elderly subjects, possibly misrepresenting the actual adult population. The current multicentric, cross-sectional study aimed to provide new tolerance ellipses specific for the general adult population and as a secondary aim to present centile curves for the bioelectrical phase angle. METHODS R, Xc, and phase angle were measured in 2137 and 2230 males and females using phase-sensitive foot-to-hand analyzers at 50 kHz. A minimum of 35 subjects were included for each sex and age category from 18 to 65 years. RESULTS The new mean vectors showed a leftward shift on the R-Xc graph with respect to the former reference values (males: F = 75.3; p < 0.001; females: F = 36.6, p < 0.001). The results provided new 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, and 97th percentile curves for phase angle, identifying time point phases of decrement (males: -0.03° per year at 33.0-51.0 years and -0.05° per year after 51 years; females: -0.03° per year from 37.2 to 57.9 years). CONCLUSIONS Compared to the original references, the new data are characterized by a different distribution within the R-Xc graph with a higher phase angle. Thirty years after the BIVA invention, the current study presents new tolerance ellipses and phase angle reference values for the adult population.
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Affiliation(s)
- Francesco Campa
- Department of Biomedical Sciences, University of Padua, Padua, Italy
| | - Giuseppe Coratella
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milano, Italy.
| | - Giuseppe Cerullo
- Department of Biomedical Sciences, University of Padua, Padua, Italy
| | - Silvia Stagi
- Department of Life and Environmental Sciences, University of Cagliari, Cittadella Universitaria, Monserrato, Cagliari, Italy
| | - Samuele Paoli
- Department of Statistical Sciences, University of Padua, Padua, Italy
| | - Sofia Marini
- Department for Life Quality Studies, University of Bologna, Rimini, Italy
| | - Alessia Grigoletto
- Department for Life Quality Studies, University of Bologna, Rimini, Italy
| | - Alessia Moroni
- Department of Life Sciences and Systems Biology, University of Torino, Torino, Italy
| | - Cristian Petri
- Department of Sports and Computer Science, Section of Physical Education and Sports, Universidad Pablo de Olavide, Seville, Spain
| | - Angela Andreoli
- Department of Systems Medicine, University of Tor Vergata, Rome, Italy
| | - Chiara Ceolin
- Department of Medicine, Geriatrics Division, University of Padua, Padua, Italy
| | - Raffaella Degan
- Department of Life Sciences and Systems Biology, University of Torino, Torino, Italy
| | - Pascal Izzicupo
- Department of Medicine and Aging Sciences, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Giuseppe Sergi
- Department of Medicine, Geriatrics Division, University of Padua, Padua, Italy
| | - Gabriele Mascherini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Elisabetta Marini
- Department of Life and Environmental Sciences, University of Cagliari, Cittadella Universitaria, Monserrato, Cagliari, Italy
| | - Stefania Toselli
- Department for Life Quality Studies, University of Bologna, Rimini, Italy
| | - Tatiana Moro
- Department of Biomedical Sciences, University of Padua, Padua, Italy
| | - Antonio Paoli
- Department of Biomedical Sciences, University of Padua, Padua, Italy
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Sardinha LB, Rosa GB, Hetherington-Rauth M, Correia IR, Magalhães JP, Silva AM, Lukaski H. Development and validation of bioelectrical impedance prediction equations estimating regional lean soft tissue mass in middle-aged adults. Eur J Clin Nutr 2023; 77:202-211. [PMID: 36253539 DOI: 10.1038/s41430-022-01224-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022]
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.
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Affiliation(s)
- Luís B Sardinha
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz-Quebrada, Portugal.
| | - Gil B Rosa
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz-Quebrada, Portugal
| | - Megan Hetherington-Rauth
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz-Quebrada, Portugal
| | - Inês R Correia
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz-Quebrada, Portugal
| | - João P Magalhães
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz-Quebrada, Portugal
| | - Analiza M Silva
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz-Quebrada, Portugal
| | - Henry Lukaski
- Department of Kinesiology and Public Health Education, Hyslop Sports Center, University of North Dakota, Grand Forks, ND, USA
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Cáñez-Ríos M, Esparza-Romero J, González-Arellanes R, Ramírez-Torres M, Figueroa-Pesqueira G, Urquidez-Romero R, Rangel-Peniche DB, Alemán-Mateo H. External validation of BIA equations to estimate appendicular skeletal muscle mass in older adults: Importance of the bias analysis and derivation of correction factors to achieve agreement. Front Nutr 2022; 9:951346. [PMID: 36091228 PMCID: PMC9454307 DOI: 10.3389/fnut.2022.951346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/25/2022] [Indexed: 12/02/2022] Open
Abstract
There are several equations based on bioelectrical impedance analysis (BIA) to estimate with high precision appendicular skeletal muscle mass (ASM). However, most of the external validation studies have reported that these equations are inaccurate or biased when applied to different populations. Furthermore, none of the published studies has derived correction factors (CFs) in samples of community-dwelling older adults, and none of the published studies have assessed the influence of the dual-energy X-ray absorptiometry (DXA) model on the validation process. This study assessed the agreement between six BIA equations and DXA to estimate ASM in non-Caucasian older adults considering the DXA model and proposed a CF for three of them. This analysis included 547 non-institutionalized subjects over 60 years old from the northwest of Mexico who were physically independent and without cognitive impairment: 192 subjects were measured using DXA Hologic, while 355 were measured by DXA Lunar. The agreement between each of the equations and DXA was tested considering the DXA model used as a reference method for the design of each equation, using the Bland and Altman procedure, a paired t test, and simple linear regression as objective tests. This process was supported by the differences reported in the literature and confirmed in a subsample of 70 subjects measured with both models. Only six published BIA equations were included. The results showed that four equations overestimated ASMDXA, and two underestimated it (p < 0.001, 95% CI for Kim's equation:−5.86-−5.45, Toselli's:−0.51-−0.15, Kyle's: 1.43–1.84, Rangel-Peniche's: 0.32–0.74, Sergi's: 0.83–1.23, and Yoshida's: 4.16–4.63 kg). However, Toselli's, Kyle's and Rangel-Peniche's equations were the only ones that complied with having a homogeneous bias. This finding allowed the derivation of CFs, which consisted of subtracting or adding the mean of the differences from the original equation. After estimating ASM applying the respective CF, the new ASM estimations showed no significant bias and its distribution remained homogeneously distributed. Therefore, agreement with DXA in the sample of non-Caucasian was achieved. Adding valid CFs to some BIA equations allowed to reduce the bias of some equations, making them valid to estimate the mean values of ASM at group level.
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Affiliation(s)
- María Cáñez-Ríos
- Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo (CIAD), A.C., Hermosillo, Mexico
| | - Julián Esparza-Romero
- Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo (CIAD), A.C., Hermosillo, Mexico
| | - Rogelio González-Arellanes
- Departamento de Ciencias de la Salud, Instituto de Ciencias Biomédicas, Universidad Autónoma de Ciudad Juárez, Ciudad Juárez, Mexico
| | - Maribel Ramírez-Torres
- Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo (CIAD), A.C., Hermosillo, Mexico
- Coordinación de Nutrición, Universidad Estatal de Sonora, Hermosillo, Mexico
| | - Guadalupe Figueroa-Pesqueira
- Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo (CIAD), A.C., Hermosillo, Mexico
| | - René Urquidez-Romero
- Departamento de Ciencias de la Salud, Instituto de Ciencias Biomédicas, Universidad Autónoma de Ciudad Juárez, Ciudad Juárez, Mexico
| | - Diana Beatriz Rangel-Peniche
- Facultad de Ciencias Naturales, Licenciatura y Maestría en Nutrición, Campus Juriquilla, Universidad Autónoma de Querétaro, Querétaro, Mexico
| | - Heliodoro Alemán-Mateo
- Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo (CIAD), A.C., Hermosillo, Mexico
- *Correspondence: Heliodoro Alemán-Mateo
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Dos Santos Quaresma MVL, Maria de Melo C, Lima Ribeiro SM. Effect of proteins, amino acids, and other nitrogenated supplements on the skeletal muscle mass in people living with HIV (PLWH): A systematic review. Clin Nutr ESPEN 2022; 51:160-173. [DOI: 10.1016/j.clnesp.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 03/28/2022] [Accepted: 07/07/2022] [Indexed: 10/17/2022]
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Kim H, Song KH, Ambegaonkar JP, Chung S, Jeon K, Jiang FL, Eom JJ, Kim CH. Two-megahertz impedance index prediction equation for appendicular lean mass in Korean older people. BMC Geriatr 2022; 22:385. [PMID: 35501769 PMCID: PMC9059377 DOI: 10.1186/s12877-022-02997-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 03/29/2022] [Indexed: 01/06/2023] Open
Abstract
Background Whole-body bioelectrical impedance analysis (BIA) has been accepted as an indirect method to estimate appendicular lean mass (ALM) comparable to dual-energy X-ray absorptiometry (DXA). However, single or limited frequencies currently used for these estimates may over or under-estimate ALM. Accordingly, there is a need to measure the impedance parameter with appendicular lean-specific across multiple frequencies to more accurately estimate ALM. We aimed to validate muscle-specific frequency BIA equation for ALM using multifrequency BIA (MF-BIA) with DXA as the reference. Methods 195 community-dwelling Korean older people (94 men and 101 women) aged 70 ~ 92y participated in this study. ALM was measured by DXA and bioimpedance measures at frequencies of 5 kHz ~ 3 MHz were assessed for independent predictive variables. Regression analyses were used to find limb-specific frequencies of bioimpedance, to develop the ALM equations and to conduct the internal cross-validation. The six published equations and the final equation of MF-BIA were externally cross-validated. Results 195 participants completed the measurements of MF-BIA and DXA. Using bivariate regression analysis, the 2 MHz impedance index explained R2 = 91.5% of variability (P < 0.001) in ALM and predictive accuracy of standard error of estimate (SEE) was 1.0822 kg ALM (P < 0.001). Multiple stepwise regression analysis obtained in the development group had an adjusted R2 of 9.28% (P < 0.001) and a SEE of 0.97 kg ALM. The cross-validation group had no significant difference between the measured ALM and the predicted ALM (17.8 ± 3.9 kg vs. 17.7 ± 3.8 kg, P = .486) with 93.1% of R2 (P < 0.001) and 1.00 kg ALM of total error. The final regression equation was as follows: ALM = 0.247ZI@2 MHz + 1.254SEXM1F0 + 0.067Xc@5 kHz + 1.739 with 93% of R2 (P < 0.001), 0.97 kg ALM of SEE (Subjective Rating as “excellent” for men and “very good” for women). In the analysis of the diagnostic level for sarcopenia of the final regression, the overall agreement was 94.9% (k = 0.779, P < 0.001) with 71.4% of sensitivity, 98.8% of specificity, 91.3 of positive prediction value and 95.3% of negative prediction value. Conclusion The newly developed appendicular lean-specific high-frequency BIA prediction equation has a high predictive accuracy, sensitivity, specificity, and agreement for both individual and group measurements. Thus, the high-frequency BIA prediction equation is suitable not only for epidemiological studies, but also for the diagnosis of sarcopenia in clinical settings.
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Affiliation(s)
- Hyeoijin Kim
- Department of Physical Education, Korean National University of Education, Cheongju, Republic of Korea
| | - Keon-Hyoung Song
- Department of Pharmaceutical Engineering, Soonchunhyang University, Asan, Republic of Korea
| | - Jatin P Ambegaonkar
- SMART Laboratory, School of Kinesiology, George Mason University, Manassas, VA, USA
| | - Sochung Chung
- Department of Pediatrics, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Kwonchan Jeon
- School of Health Sciences, Public Health Program, Salisbury University, Salisbury, MD, USA
| | - Fang Lin Jiang
- Department of Sports Medicine, Soonchunhyang University, Asan, Republic of Korea.,National Traditional Sports Teaching and Research Section of Hunan Province, College of Physical Education, Hunan Narmal University, Changsha, China
| | - Jin Jong Eom
- Department of Sport, Leisure & Recreation, Soonchunhyang University, Asan, Republic of Korea
| | - Chul-Hyun Kim
- National Traditional Sports Teaching and Research Section of Hunan Province, College of Physical Education, Hunan Narmal University, Changsha, China.
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