Use of bioelectrical impedance analysis to monitor changes in fat-free mass during recovery from colorectal cancer– a validation study

Abstract

Background & aims: Although previous research show high correlation between fat-free mass (FFM) measured by bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA), the validity of BIA to track longitudinal changes in FFM is uncertain. Thus, the aim of this study was to validate the ability of BIA to assess changes in FFM during 6 months of recovery from non-metastatic colorectal cancer (CRC). Methods: A total of 136 women and men (50e80 years) with stage I-III CRC and a wide range of baseline FFM (35.7e73.5 kg) were included in the study. Body composition was measured at study baseline within 2e9 months of surgery and again 6 months later. Whole-body BIA FFM estimates (FFM BIA) were calculated using three different equations (manufacturer's, Schols' and Gray's) before comparison to FFM estimates obtained by DXA (FFM DXA). Results: Correlation between changes in FFM BIA and FFM DXA was intermediate regardless of equation (r z 0.6). The difference in change of FFM BIA was significant compared to FFM DXA , using all three equations and BIA overestimated both loss and gain. However, BIA showed 100% sensitivity and about 90% specificity to identify individuals with !5% loss in FFM, using all three equations. Sensitivity of FFM BIA to detect a smaller loss of FFM (60e76%) or a gain in FFM of !5% (33e62%) was poor. Conclusion: In a well-nourished population of non-metastatic CRC patients, a single-frequency wholebody BIA device yielded imprecise data on changes in FFM, regardless of equation. BIA is thus not a valid option for quantifying changes in FFM in individuals. However, BIA could be used to identify patients with loss in FFM !5% in this population. The validity of BIA to monitor changes in FFM warrants further investigation before implementation in clinical praxis.

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

“…The authors reported that more studies are needed to validate BIA in tracking changes in lean body mass. 31 In a study that validated BIA in the evaluation of body composition of patients with colorectal cancer, it was reported that BIA is a valuable tool for identifying low fat-free body mass as part of the diagnosis of malnutrition of BIA. 32 One validation study was conducted in a small sample (n = 17) of patients with chronic obstructive pulmonary disease.…”

“…In a study that monitored longitudinal change in FFM in patients with colorectal cancer and validated BIA, it was reported that when compared with DXA, BIA overcalculated FFM for both loss and gain but showed 100% sensitivity and 90% specificity in FFM losses which were >5%. The authors reported that more studies are needed to validate BIA in tracking changes in lean body mass 31 . In a study that validated BIA in the evaluation of body composition of patients with colorectal cancer, it was reported that BIA is a valuable tool for identifying low fat‐free body mass as part of the diagnosis of malnutrition of BIA 32 .…”

Bioelectrical Impedance Analysis (BIA) for the Assessment of Body Composition in Oncology: A Scoping Review

“…Their study concluded that FFM estimated from both BIA devices exhibited good agreement with DXA, as long as the appropriate equation was used [40]. However, Bärebring et al [71] reached contrasting conclusions in their study, which aimed to validate the ability of BIA, compared to DXA, to assess changes in FFM in non-metastatic CRC patients. BIA yielded imprecise data on changes in FFM, regardless of the equation used, and was therefore not deemed a valid option for quantifying changes in FFM in patients with CRC.…”

“…Gupta et al conducted two separate studies investigating the prognostic role of PhA in advanced CRC [23] and the association between BIA-derived PhA and Subjective Global Assessment (SGA) [72]. The findings from both studies recognized BIA-derived PhA as a prognostic and potential nutritional indicator in advanced CRC patients [23,31,[34][35][36][37]40,41,71,72].…”