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01-03-2022 | Invited Review

Bioelectrical impedance analysis versus reference methods in the assessment of body composition in athletes

Authors: Francesco Campa, Luis Alberto Gobbo, Silvia Stagi, Leticia Trindade Cyrino, Stefania Toselli, Elisabetta Marini, Giuseppe Coratella

Published in: European Journal of Applied Physiology | Issue 3/2022

Abstract

The present systematic review aimed to compare the accuracy of Bioelectrical Impedance Analysis (BIA) and Bioelectrical Impedance Vector Analysis (BIVA) vs. reference methods for the assessment of body composition in athletes. Studies were identified based on a systematic search of internationally electronic databases (PubMed and Scopus) and hand searching of the reference lists of the included studies. In total, 42 studies published between 1988 and 2021 were included. The methodological quality was assessed using the Quality Assessment Tool for Observational Cohort and Cross-sectional Studies as recommended by the National Institute of Health. Twenty-three studies had an overall good rating in terms of quality, while 13 were rated as fair and 6 as poor, resulting in a low to moderate risk of bias. Fat mass was inconsistently determined using BIA vs. the reference methods, regardless of the BIA-technology. When using the foot to hand technology with predictive equations for athletes, a good agreement between BIA and the reference methods was observed for fat-free mass, total body, intra and extra cellular water. However, an underestimation in fat-free mass and body fluids was found when using generalized predictive equations. Classic and Specific BIVA represented a valid approach for assessing body fluids (Classic BIVA) and percentage of fat mass (Specific BIVA). The present systematic review suggests that BIA and BIVA can be used for assessing body composition in athletes, provided that foot-to-hand technology, predictive equations, and BIVA references for athletes are used.

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Andreoli A, Melchiorri G, Volpe SL et al (2004) Multicompartment model to assess body composition in professional water polo players. J Sports Med Phys Fit 44:38–43

Téllez MJA, Carrasco F, Romero VE et al (2019) A comparison of body composition assessment methods in climbers: which is better? PLoS ONE 14:e0224291. https://doi.org/10.1371/journal.pone.0224291CrossRef

Birzniece V, Khaw C-H, Nelson AE et al (2015) A critical evaluation of bioimpedance spectroscopy analysis in estimating body composition during GH treatment: comparison with bromide dilution and dual X-ray absorptiometry. Eur J Endocrinol 172:21–28. https://doi.org/10.1530/EJE-14-0660CrossRefPubMed

Boileau RA, Horswill CA (2000) Body composition in sports: measurement and applications for weight gain and loss. In: Garret WE Jr, Kinkendall DT (eds) Exercise and sport science. Lippincott Williams & Wilkins, Philadelphia, pp 319–338

Bongiovanni T, Mascherini G, Genovesi F et al (2020) Bioimpedance vector references need to be period-specific for assessing body composition and cellular health in elite soccer players: a brief report. J Funct Morphol Kinesiol. https://doi.org/10.3390/jfmk5040073CrossRefPubMedPubMedCentral

Brewer GJ, Blue MNM, Hirsch KR et al (2019) Appendicular body composition analysis: validity of bioelectrical impedance analysis compared with dual-energy X-ray absorptiometry in Division I College Athletes. J Strength Cond Res 33:2920–2925. https://doi.org/10.1519/JSC.0000000000003374CrossRefPubMed

Buffa R, Saragat B, Cabras S et al (2013) Accuracy of specific BIVA for the assessment of body composition in the United States population. PLoS ONE 8:e58533. https://doi.org/10.1371/journal.pone.0058533CrossRefPubMedPubMedCentral

Campa F, Matias C, Gatterer H et al (2019) Classic bioelectrical impedance vector reference values for assessing body composition in male and female athletes. Int J Environ Res Public Health. https://doi.org/10.3390/ijerph16245066CrossRefPubMedPubMedCentral

Campa F, Matias CN, Marini E et al (2020) Identifying athlete body fluid changes during a competitive season with bioelectrical impedance vector analysis. Int J Sports Physiol Perform 15:361–367. https://doi.org/10.1123/ijspp.2019-0285CrossRef

Campa F, Matias CN, Nunes CL et al (2021a) Specific bioelectrical impedance vector analysis identifies body fat reduction after a lifestyle intervention in former elite athletes. Biology (basel). https://doi.org/10.3390/biology10060524CrossRef

Campa F, Toselli S (2018) Bioimpedance vector analysis of elite, sub-elite and low-level male volleyball players. Int J Sports Physiol Perform. https://doi.org/10.1123/ijspp.2018-0039CrossRefPubMed

Campa F, Toselli S, Mazzilli M et al (2021b) Assessment of body composition in athletes: a narrative review of available methods with special reference to quantitative and qualitative bioimpedance analysis. Nutrients. https://doi.org/10.3390/nu13051620CrossRefPubMedPubMedCentral

Castizo-Olier J, Irurtia A, Jemni M et al (2018) Bioelectrical impedance vector analysis (BIVA) in sport and exercise: systematic review and future perspectives. PLoS ONE 13:e0197957. https://doi.org/10.1371/journal.pone.0197957CrossRefPubMedPubMedCentral

Civar S, Aktop A, Tercan E et al (2006) Validity of leg-to-leg bioelectrical impedance measurement in highly active women. J Strength Cond Res 20:359–365. https://doi.org/10.1519/R-15884.1CrossRefPubMed

Civar S, Ozer M, Aktop A, et al (2003) Validity of leg-to-leg bioelectrical impedance measurement in higly active males. Biol Sport 20(3):209–219

Colville B, Heyward V, Sandoval W (1989) Comparison of two methods for estimating body composition of bodybuilders. J Strength Cond Res 3:5W_61

Company J, Ball S (2010) Body composition comparison: bioelectric impedance analysis with dual-energy X-ray absorptiometry in adult athletes. Meas Phys Educ Exerc Sci 14:186–201. https://doi.org/10.1080/1091367X.2010.497449CrossRef

Coratella G, Campa F, Matias CN et al (2021) Generalized bioelectric impedance-based equations underestimate body fluids in athletes. Scand J Med Sci Sports. https://doi.org/10.1111/sms.14033CrossRefPubMed

De Lorenzo A, Andreoli A, Matthie J, Withers P (1997) Predicting body cell mass with bioimpedance by using theoretical methods: a technological review. J Appl Physiol 82:1542–1558. https://doi.org/10.1152/jappl.1997.82.5.1542CrossRefPubMed

De Lorenzo A, Bertini I, Iacopino L et al (2000) Body composition measurement in highly trained male athletes. A comparison of three methods. J Sports Med Phys Fit 40:178–183

Dellinger JR, Johnson BA, Benavides ML et al (2021) Agreement of bioelectrical resistance, reactance, and phase angle values from supine and standing bioimpedance analyzers. Physiol Meas. https://doi.org/10.1088/1361-6579/abe6faCrossRefPubMed

Deminice R, Rosa FT, Pfrimer K et al (2016) Creatine supplementation increases total body water in soccer players: a deuterium oxide dilution study. Int J Sports Med 37:149–153. https://doi.org/10.1055/s-0035-1559690CrossRefPubMed

Deurenberg P, Kusters CS, Smit HE (1990) Assessment of body composition by bioelectrical impedance in children and young adults is strongly age-dependent. Eur J Clin Nutr 44:261–268PubMed

Deurenberg P, van der Kooy K, Leenen R et al (1991) Sex and age specific prediction formulas for estimating body composition from bioelectrical impedance: a cross-validation study. Int J Obes 15:17–25PubMed

Dixon CB, Deitrick RW, Pierce JR et al (2005) Evaluation of the BOD POD and leg-to-leg bioelectrical impedance analysis for estimating percent body fat in National Collegiate Athletic Association Division III collegiate wrestlers. J Strength Cond Res 19:85–91. https://doi.org/10.1519/14053.1CrossRefPubMed

Domingos C, Matias CN, Cyrino ES et al (2019) The usefulness of Tanita TBF-310 for body composition assessment in Judo athletes using a four-compartment molecular model as the reference method. Rev Assoc Med Bras 65:1283–1289. https://doi.org/10.1590/1806-9282.65.10.1283CrossRefPubMed

Esco M, Olson MS, Williford H et al (2011) The accuracy of hand-to-hand bioelectrical impedance analysis in predicting body composition in college-age female athletes. J Strength Cond Res 25:1040–1045CrossRefPubMed

Esco MR, Snarr RL, Leatherwood MD et al (2015) Comparison of total and segmental body composition using DXA and multifrequency bioimpedance in collegiate female athletes. J Strength Cond Res 29:918–925. https://doi.org/10.1519/JSC.0000000000000732CrossRefPubMed

Fornetti WC, Pivarnik JM, Foley JM, Fiechtner JJ (1999) Reliability and validity of body composition measures in female athletes. J Appl Physiol 87:1114–1122. https://doi.org/10.1152/jappl.1999.87.3.1114CrossRefPubMed

Francisco R, Jesus F, Gomes T et al (2021) Validity of water compartments estimated using bioimpedance spectroscopy in athletes differing in hydration status. Scand J Med Sci Sports 31:1612–1620. https://doi.org/10.1111/sms.13966CrossRefPubMed

Giorgi A, Vicini M, Pollastri L et al (2018) Bioimpedance patterns and bioelectrical impedance vector analysis (BIVA) of road cyclists. J Sports Sci. https://doi.org/10.1080/02640414.2018.1470597CrossRefPubMed

Graves JE, Pollock ML, Colvin AB et al (1989) Comparison of different bioelectrical impedance analyzers in the prediction of body composition. Am J Hum Biol 1:603–611. https://doi.org/10.1002/ajhb.1310010511CrossRefPubMed

Graybeal AJ, Moore ML, Cruz MR, Tinsley GM (2020) Body composition assessment in male and female bodybuilders: a 4-compartment model comparison of dual-energy X-ray absorptiometry and impedance-based devices. J Strength Cond Res 34:1676–1689. https://doi.org/10.1519/JSC.0000000000002831CrossRefPubMed

Hannan WJ, Cowen SJ, Freeman CP, Wrate RM (1993) Can bioelectrical impedance improve the prediction of body fat in patients with eating disorders? Eur J Clin Nutr 47:741–746PubMed

Nunes RFH, de Bezerra ES, Orssatto LB et al (2020) Assessing body composition in rugby players: agreement between different methods and association with physical performance. J Sports Med Phys Fit 60:733–742. https://doi.org/10.23736/S0022-4707.20.10487-0CrossRef

Heitmann BL (1990) Evaluation of body fat estimated from body mass index, skinfolds and impedance. A comparative study. Eur J Clin Nutr 44:831–837PubMed

Heymsfield S, Lohman T, Wang Z, Going S (2005) Human body composition, 2nd edn. Human Kinetics, LeedsCrossRef

Hortobágyi T, Israel RG, Houmard JA et al (1992) Comparison of four methods to assess body composition in black and white athletes. Int J Sport Nutr 2:60–74. https://doi.org/10.1123/ijsn.2.1.60CrossRefPubMed

Houtkoopr L, Mullins VA, Going SB et al (2001) Body composition profiles of elite American heptathletes. Int J Sport Nutr Exerc Metab 11:162–173. https://doi.org/10.1123/ijsnem.11.2.162CrossRefPubMed

Kirkendall DT, Grogan JW, Bowers RG (1991) Field comparison of body composition techniques: hydrostatic weighing, skinfold thickness, and bioelectric impedance. J Orthop Sports Phys Ther 13:235–239. https://doi.org/10.2519/jospt.1991.13.5.235CrossRefPubMed

Kotler DP, Burastero S, Wang J, Pierson RN Jr (1996) Prediction of body cell mass, fat-free mass, and total body water with bioelectrical impedance analysis: effects of race, sex, and disease. Am J Clin Nutr 64:489S-497S. https://doi.org/10.1093/ajcn/64.3.489SCrossRefPubMed

Krzykała M, Konarski JM, Malina RM et al (2016) Fatness of female field hockey players: comparison of estimates with different methods. Homo 67:245–257. https://doi.org/10.1016/j.jchb.2016.03.003CrossRefPubMed

Kushner R, Schoeller DA, Fjeld CR, Danford L (1992) Is the Impedance index (ht2/R) significant in predicting total body water? Am J Clin Nutr 56:835–839. https://doi.org/10.1093/ajcn/56.5.835CrossRefPubMed

Kushner RF, Schoeller DA (1986) Estimation of total body water by bioelectrical impedance analysis. Am J Clin Nutr 44:417–424. https://doi.org/10.1093/ajcn/44.3.417CrossRefPubMed

Kyle UG, Bosaeus I, De Lorenzo AD et al (2004a) Bioelectrical impedance analysis–part I: review of principles and methods. Clin Nutr 23:1226–1243. https://doi.org/10.1016/j.clnu.2004.06.004CrossRefPubMed

Kyle UG, Bosaeus I, De Lorenzo AD et al (2004b) Bioelectrical impedance analysis-part II: utilization in clinical practice. Clin Nutr 23:1430–1453. https://doi.org/10.1016/j.clnu.2004.09.012CrossRefPubMed

Lee L-C, Hsu P-S, Hsieh K-C et al (2021) Standing 8-electrode bioelectrical impedance analysis as an alternative method to estimate visceral fat area and body fat mass in athletes. Int J Gen Med 14:539–548. https://doi.org/10.2147/IJGM.S281418CrossRefPubMedPubMedCentral

Loenneke JP, Wilson JM, Wray ME et al (2012) The estimation of the fat free mass index in athletes. Asian J Sports Med 3:200–203. https://doi.org/10.5812/asjsm.34691CrossRefPubMedPubMedCentral

Loenneke JP, Wray ME, Wilson JM et al (2013) Accuracy of field methods in assessing body fat in collegiate baseball players. Res Sports Med 21:286–291. https://doi.org/10.1080/15438627.2013.792087CrossRefPubMed

Lohman TG (1992) Advances in body composition assessment. Cad Saude Publica 9:S116–S117

Lukaski H, Bolonchuk W (1987) Theory and validation of the tetrapolar bioelectrical impedance method to assess human body composition. In vivo body composition studies; proceedings of an international symposium held at Brookhaven National Laboratory, New York on September 28-October 1, 1986, and sponsored by: United States Department Energy, Brookhaven National Laboratory, Associated Universities, Inc. / edited by K.J. Ellis, S. Yasumura and W.D. Morgan. The Institute of Physical Sciences in Medicine, London

Lukaski H, Raymond-Pope CJ (2021) New frontiers of body composition in sport. Int J Sports Med. https://doi.org/10.1055/a-1373-5881CrossRefPubMedPubMedCentral

Lukaski HC, Bolonchuk WW (1988) Estimation of body fluid volumes using tetrapolar bioelectrical impedance measurements. Aviat Space Environ Med 59:1163–1169PubMed

Lukaski HC, Bolonchuk WW, Hall CB, Siders WA (1986) Validation of tetrapolar bioelectrical impedance method to assess human body composition. J Appl Physiol 60:1327–1332. https://doi.org/10.1152/jappl.1986.60.4.1327CrossRefPubMed

Lukaski HC, Bolonchuk WW, Siders WA, Hall CB (1990) Body composition assessment of athletes using bioelectrical impedance measurements. J Sports Med Phys Fit 30:434–440

Lukaski HC, Johnson PE, Bolonchuk WW, Lykken GI (1985) Assessment of fat-free mass using bioelectrical impedance measurements of the human body. Am J Clin Nutr 41:810–817. https://doi.org/10.1093/ajcn/41.4.810CrossRefPubMed

Lukaski HC, Piccoli A (2012) Bioelectrical impedance vector analysis for assessment of hydration in physiological states and clinical conditions. In: Preedy V (ed) Handbook of anthropometry. Springer, London, pp 287–305CrossRef

Marini E, Campa F, Buffa R et al (2020) Phase angle and bioelectrical impedance vector analysis in the evaluation of body composition in athletes. Clin Nutr 39:447–454. https://doi.org/10.1016/j.clnu.2019.02.016CrossRefPubMed

Matias CN, Campa F, Santos DA et al (2021) Fat-free mass bioelectrical impedance analysis predictive equation for athletes using a 4-compartment model. Int J Sports Med 42:27–32. https://doi.org/10.1055/a-1179-6236CrossRefPubMed

Matias CN, Júdice PB, Santos DA et al (2016a) Suitability of bioelectrical based methods to assess water compartments in recreational and elite athletes. J Am Coll Nutr 35:413–421. https://doi.org/10.1080/07315724.2015.1058198CrossRefPubMed

Matias CN, Santos DA, Júdice PB et al (2016b) Estimation of total body water and extracellular water with bioimpedance in athletes: a need for athlete-specific prediction models. Clin Nutr 35:468–474. https://doi.org/10.1016/j.clnu.2015.03.013CrossRefPubMed

Micheli ML, Pagani L, Marella M et al (2014) Bioimpedance and impedance vector patterns as predictors of league level in male soccer players. Int J Sports Physiol Perform 9:532–539. https://doi.org/10.1123/ijspp.2013-0119CrossRefPubMed

Moissl UM, Wabel P, Chamney PW et al (2006) Body fluid volume determination via body composition spectroscopy in health and disease. Physiol Meas 27:921–933. https://doi.org/10.1088/0967-3334/27/9/012CrossRefPubMed

Morgenstern BZ, Mahoney DW, Warady BA (2002) Estimating total body water in children on the basis of height and weight: a reevaluation of the formulas of Mellits and Cheek. J Am Soc Nephrol 13:1884–1888. https://doi.org/10.1097/01.asn.0000019920.30041.95CrossRefPubMed

NIH (2014) Quality assessment tool for observational cohort and cross- sectional studies. National Institution of Health: U. S Department of Health and Human Services

Oppliger RA, Nielsen D, Hoegh J, Vance C (1991) Bioelectrical impedance prediction of fat free mass for high school wrestlers validated. Med Sci Sports Exerc 23:S73CrossRef

Page MJ, McKenzie JE, Bossuyt PM et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71. https://doi.org/10.1136/bmj.n71CrossRefPubMedPubMedCentral

Piccoli A, Rossi B, Pillon L, Bucciante G (1994) A new method for monitoring body fluid variation by bioimpedance analysis: the RXc graph. Kidney Int 46:534–539CrossRefPubMed

Pichard C, Kyle UG, Gremion G et al (1997) Body composition by X-ray absorptiometry and bioelectrical impedance in female runners. Med Sci Sports Exerc 29:1527–1534. https://doi.org/10.1097/00005768-199711000-00021CrossRefPubMed

Raymond CJ, Dengel DR, Bosch TA (2018) Total and segmental body composition examination in collegiate football players using multifrequency bioelectrical impedance analysis and dual X-ray absorptiometry. J Strength Cond Res 32:772–782. https://doi.org/10.1519/JSC.0000000000002320CrossRefPubMed

Santos DA, Silva AM, Matias CN et al (2010) Accuracy of DXA in estimating body composition changes in elite athletes using a four compartment model as the reference method. Nutr Metab (lond) 7:22. https://doi.org/10.1186/1743-7075-7-22CrossRef

Sardinha LB, Correia IR, Magalhães JP et al (2020) Development and validation of BIA prediction equations of upper and lower limb lean soft tissue in athletes. Eur J Clin Nutr 74:1646–1652. https://doi.org/10.1038/s41430-020-0666-8CrossRefPubMed

Schoeller DA, Luke A (2000) Bioelectrical impedance analysis prediction equations differ between African Americans and Caucasians, but it is not clear why. Ann N Y Acad Sci 904:225–226. https://doi.org/10.1111/j.1749-6632.2000.tb06456.xCrossRefPubMed

Segal KR, Van Loan M, Fitzgerald PI et al (1988) Lean body mass estimation by bioelectrical impedance analysis: a four-site cross-validation study. Am J Clin Nutr 47:7–14. https://doi.org/10.1093/ajcn/47.1.7CrossRefPubMed

Sergi G, Bussolotto M, Perini P et al (1994) Accuracy of bioelectrical impedance analysis in estimation of extracellular space in healthy subjects and in fluid retention states. Ann Nutr Metab 38:158–165. https://doi.org/10.1159/000177806CrossRefPubMed

Shiose K, Kondo E, Takae R et al (2020) Validity of bioimpedance spectroscopy in the assessment of total body water and body composition in wrestlers and untrained subjects. Int J Environ Res Public Health. https://doi.org/10.3390/ijerph17249433CrossRefPubMedPubMedCentral

Silva AM, Matias CN, Nunes CL et al (2019) Lack of agreement of in vivo raw bioimpedance measurements obtained from two single and multi-frequency bioelectrical impedance devices. Eur J Clin Nutr 73:1077–1083. https://doi.org/10.1038/s41430-018-0355-zCrossRefPubMed

Silva AM, Nunes CL, Matias CN et al (2020) Usefulness of raw bioelectrical impedance parameters in tracking fluid shifts in judo athletes. Eur J Sport Sci 20:734–743. https://doi.org/10.1080/17461391.2019.1668481CrossRefPubMed

Stagi S, Irurtia A, Rafel JR et al (2021) Segmental body composition estimated by specific BIVA and dual-energy X-ray absorptiometry. Clin Nutr 40:1621–1627. https://doi.org/10.1016/j.clnu.2021.02.043CrossRefPubMed

Stahn A, Terblanche E, Gunga H-C (2012) Use of bioelectrical impedance: general principles and overview. In: Preedy VR (ed) Handbook of anthropometry: physical measures of human form in health and disease. Springer, New York, pp 49–90CrossRef

Stolarczyk LM, Heyward VH, Hicks VL, Baumgartner RN (1994) Predictive accuracy of bioelectrical impedance in estimating body composition of Native American women. Am J Clin Nutr 59:964–970. https://doi.org/10.1093/ajcn/59.5.964CrossRefPubMed

Stratton MT, Smith RW, Harty PS et al (2021) Longitudinal agreement of four bioimpedance analyzers for detecting changes in raw bioimpedance during purposeful weight gain with resistance training. Eur J Clin Nutr 75:1060–1068. https://doi.org/10.1038/s41430-020-00811-3CrossRefPubMed

Sun SS, Chumlea WC, Heymsfield SB et al (2003) Development of bioelectrical impedance analysis prediction equations for body composition with the use of a multicomponent model for use in epidemiologic surveys. Am J Clin Nutr 77:331–340. https://doi.org/10.1093/ajcn/77.2.331CrossRefPubMed

Svantesson U, Zander M, Klingberg S, Slinde F (2008) Body composition in male elite athletes, comparison of bioelectrical impedance spectroscopy with dual energy X-ray absorptiometry. J Negat Results Biomed 7:1. https://doi.org/10.1186/1477-5751-7-1CrossRefPubMedPubMedCentral

Syed-Abdul MM, Soni DS, Barnes JT, Wagganer JD (2021) Comparative analysis of BIA, IBC and DXA for determining body fat in American Football players. J Sports Med Phys Fitness 61:687–692. https://doi.org/10.23736/S0022-4707.21.11278-2CrossRefPubMed

Van Loan M, Mayclin P (1987) Bioelectrical impedance analysis: is it a reliable estimator of lean body mass and total body water? Hum Biol 69:299–309

Wang Z, Pi-Sunyer FX, Kotler DP, Wielopolski L, Withers RT, Pierson Jr RN, Heymsfield SB (2002) Multicomponent methods: evaluation of new and traditional soft tissue mineral models by in vivo neutron activation analysis. Am J clin Nutr 76(5):968–974CrossRef

Williams CA, Bale P (1998) Bias and limits of agreement between hydrodensitometry, bioelectrical impedance and skinfold calipers measures of percentage body fat. Eur J Appl Physiol Occup Physiol 77:271–277. https://doi.org/10.1007/s004210050332CrossRefPubMed

Title: Bioelectrical impedance analysis versus reference methods in the assessment of body composition in athletes
Authors: Francesco Campa
Luis Alberto Gobbo
Silvia Stagi
Leticia Trindade Cyrino
Stefania Toselli
Elisabetta Marini
Giuseppe Coratella
Publication date: 01-03-2022
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Applied Physiology / Issue 3/2022
Print ISSN: 1439-6319
Electronic ISSN: 1439-6327
DOI: https://doi.org/10.1007/s00421-021-04879-y

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Bioelectrical impedance analysis versus reference methods in the assessment of body composition in athletes

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