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Comparison of Bioelectrical Impedance Analysis and Computed Tomography on Body Composition Changes Including Visceral Fat After Bariatric Surgery in Asian Patients with Obesity

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Abstract

Purpose

The accuracy of bioelectrical impedance analysis (BIA) in patients with obesity has been controversial. This study aimed to validate the use of BIA in detecting body composition changes, especially for visceral fat, before and after bariatric surgery using computed tomography (CT) as a reference method.

Materials and Methods

This retrospective study included Korean patients with a BMI of ≥ 35, or ≥ 30 with metabolic comorbidities. All patients underwent bariatric surgery, and underwent BIA and CT evaluation before and 6 months after the operation. The skeletal muscle index (SMI) and visceral fat index (VFI), variables corrected for height, were compared between BIA and CT.

Results

Forty-eight patients (18 men, 30 women) demonstrated a mean weight loss of 27.5 kg. Significant decreases in both VFI and SMI were observed in both BIA and CT (all p<0.001), with greater VFI change compared to SMI (48.2% vs. 10.4% in CT, respectively). Both pre- and post-operative measurements of VFI and SMI were significantly correlated between BIA and CT (all p<0.05). However, the percent decrease was significantly correlated only with VFI (ρ=0.71, p<0.001). The Bland-Altman analysis showed that BIA underestimated VFI, with a greater degree of underestimation in subjects with higher VFI.

Conclusion

Despite the underestimation of BIA in measuring visceral fat, BIA VFI was associated with CT VFI. The SMI values showed significant correlations before and after surgery, but not with the percent decrease. Our results suggest that BIA can be a reliable tool for measuring body composition, especially for visceral fat, after bariatric surgery.

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References

  1. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894:i–xii. 1-253

    Google Scholar 

  2. Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2014;63(25 Pt B):2985–3023.

    Article  Google Scholar 

  3. Maïmoun L, Lefebvre P, Aouinti S, et al. Acute and longer-term body composition changes after bariatric surgery. Surg Obes Relat Dis. 2019;15(11):1965–73.

    Article  Google Scholar 

  4. Després JP, Lemieux I, Bergeron J, et al. Abdominal obesity and the metabolic syndrome: contribution to global cardiometabolic risk. Arterioscler Thromb Vasc Biol. 2008;28(6):1039–49.

    Article  Google Scholar 

  5. Fang H, Berg E, Cheng X, et al. How to best assess abdominal obesity. Curr Opin Clin Nutr Metab Care. 2018;21(5):360–5.

    Article  Google Scholar 

  6. Sizoo D, de Heide LJM, Emous M, et al. Measuring muscle mass and strength in obesity: a review of various methods. Obes Surg. 2021;31(1):384–93.

    Article  Google Scholar 

  7. Leone PA, Gallagher D, Wang JHS. Relative overhydration of fat-free mass in postobese versus never-obese subjects. Ann N Y Acad Sci. 2000;904:514–9.

    Article  CAS  Google Scholar 

  8. Kyle UG, Bosaeus I, De Lorenzo AD, et al. Bioelectrical impedance analysis - Part i: review of principles and methods. Clin Nutr. 2004;23(5):1226–43.

    Article  Google Scholar 

  9. Frisard MI, Greenway FL, DeLany JP. Comparison of methods to assess body composition changes during a period of weight loss. Obes Res. 2005;13(5):845–54.

    Article  Google Scholar 

  10. Evans EM, Saunders MJ, Spano MA, et al. Body-composition changes with diet and exercise in obese women: a comparison of estimates from clinical methods and a 4-component model. Am J Clin Nutr. 1999;70(1):5–12.

    Article  CAS  Google Scholar 

  11. Kushner RF, Kunigk A, Alspaugh M, et al. Validation of bioelectrical-impedance analysis as a measurement of change in body composition in obesity. Am J Clin Nutr. 1990;52(2):219–23.

    Article  CAS  Google Scholar 

  12. Weyers AM, Mazzetti SA, Love DM, et al. Comparison of methods for assessing body composition changes during weight loss. Med Sci Sports Exerc. 2002;34(3):497–502.

    Article  Google Scholar 

  13. Neovius M, Uddén J, Hemmingsson E. Assessment of change in body fat percentage with DXA and eight-electrode BIA in centrally obese women. Med Sci Sports Exerc. 2007;39(12):2199–203.

    Article  Google Scholar 

  14. Ritz P, Sallé A, Audran M, et al. Comparison of different methods to assess body composition of weight loss in obese and diabetic patients. Diabetes Res Clin Pract. 2007;77(3):405–11.

    Article  CAS  Google Scholar 

  15. Savastano S, Belfiore A, Di Somma C, et al. Validity of bioelectrical impedance analysis to estimate body composition changes after bariatric surgery in premenopausal morbidly women. Obes Surg. 2010;20(3):332–9.

    Article  Google Scholar 

  16. Widen EM, Strain G, King WC, et al. Validity of bioelectrical impedance analysis for measuring changes in body water and percent fat after bariatric surgery. Obes Surg. 2014;24(6):847–54.

    Article  Google Scholar 

  17. Otto M, Färber J, Haneder S, et al. Postoperative changes in body composition—comparison of bioelectrical impedance analysis and magnetic resonance imaging in bariatric patients. Obes Surg. 2015;25(2):302–9.

    Article  Google Scholar 

  18. Das SK, Roberts SB, Kehayias JJ, et al. Body composition assessment in extreme obesity and after massive weight loss induced by gastric bypass surgery. Am J Physiol Endocrinol Metab. 2003;284(6):1080–8.

    Article  Google Scholar 

  19. Lim CH, Lee PC, Lim E, et al. Resolution of erosive esophagitis after conversion from vertical sleeve gastrectomy to Roux-en-Y gastric bypass. Obes Surg. 2020;30(12):4751–9.

    Article  Google Scholar 

  20. Brethauer SA, Kim J, El Chaar M, et al. Standardized outcomes reporting in metabolic and bariatric surgery. Surg Obes Relat Dis. 2015;11(3):489–506.

    Article  Google Scholar 

  21. Tewari N, Awad S, Macdonald IA, et al. A comparison of three methods to assess body composition. Nutrition. 2018;47:1–5.

    Article  Google Scholar 

  22. Shen W, Punyanitya M, Wang ZM, et al. Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image. J Appl Physiol. 2004;97(6):2333–8.

    Article  Google Scholar 

  23. Mourtzakis M, Prado CMM, Lieffers JR, et al. A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab. 2008;33(5):997–1006.

    Article  Google Scholar 

  24. Shen W, Punyanitya M, Wang Z, et al. Visceral adipose tissue: relations between single-slice areas and total volume. Am J Clin Nutr. 2004;80(2):271–8.

    Article  CAS  Google Scholar 

  25. Mitsiopoulos N, Baumgartner RN, Heymsfield SB, et al. Cadaver validation of skeletal muscle measurement by magnetic resonance imaging and computerized tomography. J Appl Physiol. 1998;85(1):115–22.

    Article  CAS  Google Scholar 

  26. Andreoli A, Garaci F, Cafarelli FP, et al. Body composition in clinical practice. Eur J Radiol. 2016;85(8):1461–8.

    Article  Google Scholar 

  27. Park KS, Lee DH, Lee J, et al. Comparison between two methods of bioelectrical impedance analyses for accuracy in measuring abdominal visceral fat area. J Diabetes Complicat. 2016;30(2):343–9.

    Article  Google Scholar 

  28. Sun G, French CR, Martin GR, et al. Comparison of multifrequency bioelectrical impedance analysis with dual-energy X-ray absorptiometry for assessment of percentage body fat in a large, healthy population. Am J Clin Nutr. 2005;81(1):74–8.

    Article  CAS  Google Scholar 

  29. Deurenberg P. Limitations of the bioelectrical impedance method for the assessment of body fat in severe obesity. Am J Clin Nutr. 1996;64(3 Suppl):449S–52S.

    Article  CAS  Google Scholar 

  30. Waki M, Kral JG, Mazariegos M, et al. Relative expansion of extracellular fluid in obese vs. nonobese women. Am J Phys. 1991;261(2 Pt 1):E199–203.

    CAS  Google Scholar 

  31. Mazariegos M, Kral JG, Wang J, et al. Body composition and surgical treatment of obesity: effects of weight loss on fluid distribution. Ann Surg. 1992;216(1):69–73.

    Article  CAS  Google Scholar 

  32. Lear SA, Humphries KH, Kohli S, et al. Visceral adipose tissue accumulation differs according to ethnic background: results of the Multicultural Community Health Assessment Trial (M-CHAT). Am J Clin Nutr. 2007;86(2):353–9.

    Article  CAS  Google Scholar 

  33. Kreidieh D, Itani L, El Masri D, et al. Association between sarcopenic obesity, type 2 diabetes, and hypertension in overweight and obese treatment-seeking adult women. J Cardiovasc Dev Dis. 2018;5(4):51.

    Article  Google Scholar 

  34. Ishii S, Nagai Y, Sada Y, et al. Liraglutide reduces visceral and intrahepatic fat without significant loss of muscle mass in obese patients with type 2 diabetes: a prospective case series. J Clin Med Res. 2019;11(3):219–24.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea

    Ja Kyung Lee & Young Suk Park

  2. Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea

    Kyuho Kim & Tae Jung Oh

  3. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea

    Tae Jung Oh

  4. Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea

    Won Chang

Authors
  1. Ja Kyung Lee
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  2. Young Suk Park
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  3. Kyuho Kim
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  4. Tae Jung Oh
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  5. Won Chang
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Corresponding author

Correspondence to Young Suk Park.

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Key Points

• Despite the underestimation of BIA in measuring visceral fat, visceral fat measured by BIA was well correlated with CT.

• The skeletal muscle showed significant correlation before and after surgery, but not with the percent decrease.

• BIA can be a reliable tool to measure and track body composition, especially for visceral fat, after bariatric surgery.

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Lee, J.K., Park, Y.S., Kim, K. et al. Comparison of Bioelectrical Impedance Analysis and Computed Tomography on Body Composition Changes Including Visceral Fat After Bariatric Surgery in Asian Patients with Obesity. OBES SURG 31, 4243–4250 (2021). https://doi.org/10.1007/s11695-021-05569-6

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  • DOI: https://doi.org/10.1007/s11695-021-05569-6

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