Standardization of measurement conditions is essential for obtaining accurate, precise, and reproducible bioelectrical impedance analysis (BIA) data. Errors due to lack of measurement control are propagated in subsequent calculations of body composition and contribute to differences in predictive equations among investigators. Various individual and environmental factors have been shown to influence BIA. We review the factors that have been identified from the literature as being conditions requiring standardization both for healthy subjects and for those in a medical setting.
The 1994 National Institutes of Health Technology Conference on bioelectrical impedance analysis (BIA) did not support the use of BIA under conditions that alter the normal relationship between the extracellular (ECW) and intracellular water (ICW) compartments. To extend applications of BIA to these populations, we investigated the accuracy and precision of seven previously published BIA models for the measurement of change in body water compartmentalization among individuals infused with lactated Ringer solution or administered a diuretic agent. Results were compared with dilution by using deuterium oxide and bromide combined with short-term changes of body weight. BIA, with use of proximal, tetrapolar electrodes, was measured from 5 to 500 kHz, including 50 kHz. Single-frequency, 50-kHz models did not accurately predict change in total body water, but the 50-kHz parallel model did accurately measure changes in ICW. The only model that accurately predicted change in ECW, ICW, and total body water was the 0/infinity-kHz parallel (Cole-Cole) multifrequency model. Use of the Hanai correction for mixing was less accurate. We conclude that the multifrequency Cole-Cole model is superior under conditions in which body water compartmentalization is altered from the normal state.
This study assessed the effects of changes in skin temperature on multifrequency bioimpedance analysis (MF-BIA) and on the prediction of body water compartments. Skin temperature (baseline 29.3 +/- 2.1 degrees C) of six healthy adults was raised over 50 min to 35.8 +/- 0.6 degrees C, followed by cooling for 20 min to 26.9 +/- 1.3 degrees C, by using an external heating and cooling blanket. MF-BIA was measured at both distal (conventional) and proximal electrode placements. Both distal and proximal impedance varied inversely with a change in skin temperature across all frequencies (5-500 kHz). The change in proximal impedance per degree centigrade change in skin surface temperature was approximately 60% of distal impedance. The change in measured impedance at 50 kHz erroneously increased predicted total body water (TBW) by 2.6 +/- 0.9 liters (P < 0.001) and underpredicted fat mass by 3.3 +/- 1.3 kg (P < 0.0001). Computer modeling of the MF-BIA data indicated changes in predicted water compartments with temperature modifications; however, the ratio of extracellular water (ECW) to TBW did not significantly change (P < 0.4). This change in impedance was not due to a change in the movement of water of the ECW compartment and thus probably represents a change in cutaneous impedance of the skin. Controlled ambient and skin temperatures should be included in the standardization of BIA measurements. The error in predicted TBW is < 1% within an ambient temperature range of 22.3 to 27.7 degrees C (72.1-81.9 degrees F).
The use of bioelectrical impedance analysis (BIA) in patients with end-stage renal disease who are receiving dialysis provides researchers with two important applications: 1) a biological model in which the underlying assumptions of BIA can be tested, and 2) if valid, a tool that can be used to improve the clinical management of patients receiving dialysis. We review the rationale of and purpose for using BIA in the dialysis population, the physiologic changes that occur during dialysis that influence BIA measurements, and last, conclusions reached from the current scientific literature.
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