Accepted Manuscript

Reliability and Agreement of Various InBody Body Composition

Analyzers as Compared to Dual-energy X-ray Absorptiometry in
Healthy Men and Women

Cherilyn N. McLester , Brett S. Nickerson , Brian M. Kliszczewicz ,

John R. McLester

PII: S1094-6950(18)30221-X
DOI: https://doi.org/10.1016/j.jocd.2018.10.008
Reference: JOCD 1091

To appear in: Journal of Clinical Densitometry

Please cite this article as: Cherilyn N. McLester , Brett S. Nickerson , Brian M. Kliszczewicz ,
John R. McLester , Reliability and Agreement of Various InBody Body Composition Analyzers as
Compared to Dual-energy X-ray Absorptiometry in Healthy Men and Women, Journal of Clinical Den-
sitometry (2018), doi: https://doi.org/10.1016/j.jocd.2018.10.008

This is a PDF file of an unedited manuscript that has been accepted for publication. As a service
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1 Reliability and Agreement of Various InBody Body Composition Analyzers as Compared

2 to Dual-energy X-ray Absorptiometry in Healthy Men and Women

3 Running Title: Reliability and Agreement of InBody Analyzers

4 Cherilyn N. McLestera, Brett S. Nickersonb, Brian M. Kliszczewicza, John R. McLestera

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5 Kennesaw State University, Department of Exercise Science and Sport Management,

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6 520 Parliament Garden Way, MD 4104, Kennesaw, GA, USA 30144

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7 Texas A&M International University, Department of Curriculum and Pedagogy, 5201

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8 University Blvd. Laredo, TX, USA 78041

10 Corresponding author: US
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11 Cherilyn McLester

12 cmclest1@kennesaw.edu
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24 ABSTRACT

25 Background: Bioelectrical impedance analysis (BIA) has evolved over the years to

26 include the use of multiple frequencies and impedance measurements to improve the

27 accuracy and reliability of body composition estimates. The purpose of this investigation

28 was to evaluate the reliability of the InBody230, InBody720, and InBody770 to measure

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29 body fat percent (BF%), fat mass (FM), and fat-free mass (FFM) in the general

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30 population and to compare results to dual-energy x-ray absorptiometry (DXA). Methods:

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31 A total of 31 males and 36 females participated in two days of testing separated by 24

32 to 72 hours. Each visit consisted of a DXA scan, and analysis with the InBody230,

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InBody720, and InBody770. Results: All three bioelectrical impedance devices (InBody230,
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34 InBody720, and InBody770) were reliable in men and women as indicated by high

35 intraclass correlation coefficients for BF% (≥0.98), FM (≥0.98), and FFM (≥0.99) and low
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36 standard error of measurement for BF% (0.77-0.99%), FM (0.54-0.87kg), and FFM

37 (0.58-0.84kg) and minimum difference for BF% (2.12-2.73%), FM (1.49-2.39kg), and

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38 FFM (1.60-2.32kg), respectively. When examining the agreement between the three

39 InBody analyzers with DXA, systematic bias (underestimation of BF% and FM and
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40 overestimation of FFM) was present for all comparisons (p < 0.05) while proportional
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41 bias was present for FM in women and FFM in men. However, there was small

42 individual error for all comparisons as indicated by the standard error of estimate and
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43 95% limits of agreement. Conclusion: The InBody analyzers produce small individual

44 error, which suggest these methods can be used as a surrogate when DXA is not

45 available, however practitioners should be aware of the systematic bias for all

46 comparisons and proportional bias for FM in women and FFM in men. Furthermore,
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47 findings revealed that the research grade models, InBody720 and InBody770, added

48 minimal benefit over the portable InBody230 when assessing BF%, FM, and FFM.

49 Key words: Body fat percent, fat mass, fat free mass, bioimpedance

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70 Introduction

71 Body composition estimates are important in a variety of professional and

72 medical settings when seeking to assess conditions such as obesity, sarcopenia,

73 osteoporosis, and hydration status (1-4). The ability to reliably track body fat percent

74 (BF%), fat mass (FM), and fat-free mass (FFM) allows practitioners to properly inform

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75 patients and clients about current health status or risks. Currently there are numerous

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76 devices available with varying technology across a spectrum of cost such as dual-

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77 energy x-ray absorptiometry (DXA) and the most recent iteration of bioelectrical

78 impedance analysis (BIA).

79 US
The accuracy and reliability of BIA devices in the past have come under scrutiny
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80 when utilizing a single-frequency of 50 kHz to assess BF%, FM, FFM, and total body

81 water (TBW) (5). In recent years, BIA devices have made great strides in their
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82 measurement capabilities (6, 7), due to the introduction of multiple device contact

83 points, increased number of frequencies used and increased number of impedance

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84 measurements obtained. Hand-to-foot bioelectrical impedance analysis sends varying

85 frequencies of alternating current through the body where each current passes through
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86 resistors and capacitors, which alters the resulting voltage. The resistors are the
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87 intracellular and extracellular fluids and the capacitors are the cell membranes. These

88 impedance values are then used to predict several variables including BF%, FM, FFM,
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89 and TBW.

90 A previous literature review suggested that multi-frequency BIA devices lead to

91 better precision than single-frequency BIA devices when estimating body composition

92 (8). This statement is further supported by research that has shown multi-frequency BIA
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93 devices have better agreement with reference techniques such as DXA than single-

94 frequency devices. For instance, single-frequency BIA has shown larger bias for FM in

95 obese individuals (8.8%) and wider limits of agreement than multi-frequency BIA when

96 compared to DXA (9, 10). In contrary, Nickerson et al. (11) found that single-frequency

97 BIA produces slightly smaller individual error (i.e., 95% limits of agreement) than multi-

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98 frequency BIA devices when compared to a reference of underwater weighing.

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99 Conflicting findings from previous research raise questions as to whether more

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100 frequencies in BIA measurement add any additional benefit over less sophisticated BIA

101 devices with fewer frequencies for assessing BF%, FM, and FFM.

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Due to improved accuracy and cost effectiveness, BIA devices have become
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103 increasingly more popular in research and clinical settings, driving the development of

104 several commercially available devices. The InBody230 takes 10 impedance

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105 measurements with two frequencies (20 kHz and 100 kHz) whereas the InBody720 and

106 InBody770 both take 30 impedance measurements with six frequencies (1 kHz, 5 kHz,
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107 50 kHz, 250 kHz, 500 kHz, and 1000 kHz). The InBody720 and InBody770 also estimate

108 extracellular water (ECW), and intracellular water (ICW) based on the six frequencies.
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109 Although the InBody720 and InBody770 provide more information and may be more
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110 appropriate for assessing and monitoring certain clinical populations, these devices are

111 not designed to leave the laboratory for off-site testing. While the InBody230 provides
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112 less data, it is more cost effective and designed for portability, making it a possible

113 option when providing services to underserved and rural populations or to individuals

114 who cannot travel to a testing site.

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115 Research thus far has examined the accuracy of InBody230 and InBody720

116 separately (12-16) whereas little to no information is currently available on InBody770. As

117 a result, research has yet to analyze these three InBody body composition analyzers at

118 the same time in a single study. Therefore, the purpose of this study was to evaluate the

119 reliability of the InBody230, InBody720, and InBody770 to measure FFM, FM, and BF% in

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120 the general population and to compare results to the reference method of DXA. Due to

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121 discrepancies from previous research, it was hypothesized that all three InBody body

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122 composition analyzers would produce similar group and individual error when compared

123 to DXA.

124 Materials and Methods US

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125 The university’s Institutional Review Board reviewed and approved this study

126 prior to any testing. All assessments were completed within the university’s exercise
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127 physiology laboratory. Participants had body composition assessed with DXA and three

128 InBody BIA devices, the InBody230, InBody720, and InBody770 during two trials with 24-72
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129 hours separating each visit. Inclusion criteria consisted of being over the age of 18

130 years, free of pacemaker implants, not pregnant, and having all limbs intact.
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131 Additionally, in agreement with the pre-testing procedures per the manufacturer of the
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132 InBody devices, participants had to abstain from exercise and alcohol or excessive

133 caffeine consumption for at least 24 hours and food and drink for four hours prior to
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134 testing, with the exception of water which could be consumed up to 45 minutes before

135 testing. Finally, both visits occurred at the same time of day for each participant.

136 Upon arrival on the first day of testing, participants completed a written consent

137 form. Before any measurements were taken participants were asked to void their
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138 bladders, change into loose fitting athletic attire that was free from any metal and

139 remove any jewelry. Height and body mass were measured with a Tanita WB-3000

140 (Tanita, Arlington Heights, IL) digital physician’s scale. Participant characteristics are

141 depicted in table 1. The order of testing was always DXA, InBody770, InBody720, and

142 InBody230.

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144 Dual-energy X-ray absorptiometry (DXA)

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145 Dual-energy x-ray absorptiometry was assessed with the Lunar iDXA with

146 enCore™ 2011 version 13.60 software (General Electric, Madison, WI), which has

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shown to be reliable (17). This method consists of a full body scan utilizing two x-ray
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148 beams to distinguish between fat mass and lean mass. Daily quality assurance was

149 conducted per manufacturer’s specifications. Participants were instructed to lay supine
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150 on the scanning table and were then assisted by a researcher to assure proper

151 centering. The scan duration was seven to fourteen minutes during which time there
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152 was no talking or movement. Regions of interest were corrected when necessary by a

153 researcher per manufacturer instruction.

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154 Bioelectrical Impedance Analysis (BIA)

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155 The InBody230, InBody720, and InBody770 (InBodyUSA, Cerritos, CA) are

156 produced from the same manufacturer. Each device utilizes hand-to-foot bioelectrical
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157 impedance analysis that sends varying frequencies of alternating current through the

158 body. These impedance values are then used to predict several variables including

159 BF%, FM, FFM, and TBW. All InBody analyzers utilize a tetrapolar 8-point tactile

160 electrode system. The InBody230 takes 10 impedance measurements with two
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161 frequencies (20 kHz and 100 kHz) with a test duration of approximately 30 seconds.

162 The InBody720 and InBody770 both take 30 impedance measurements with six

163 frequencies (1 kHz, 5 kHz, 50 kHz, 250 kHz, 500 kHz, and 1000 kHz) with a test

164 duration of approximately 60 seconds. Before testing on each device the following

165 protocols were employed: age, sex, and height were entered for each participant.

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166 Before contact with the electrodes participants cleansed their hands and feet with

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167 antibacterial tissue from the manufacturer. Standing in an upright position, the feet were

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168 then centered on the electrodes and the hand electrodes were grasped with arms being

169 held wide enough so that there was no contact between the arms and torso. This

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position was held for the duration of the test. Once the assessment was completed
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171 participants were prompted to return the hand electrodes and step off the device.

172 Statistical Analysis

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173 The agreement of InBody230, InBody720, and InBody770 with DXA were

174 determined by calculating the constant error (e.g., CE = InBody230 – DXA), r value,
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175 standard error of estimate (SEE), total error (TE), and proportional bias. The differences

176 in mean BF%, FM, and FFM among the BIA devices and DXA were analyzed using
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177 dependent t-tests (SPSS version 24, Armonk, NY) with the Bonferroni-adjusted alpha
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178 level (p ≤ 0.00454). The magnitude of the effect size (ES) was determined by Hopkins’

179 scale (18) as follows: 0-0.20 = trivial, 0.30-0.60 = small, 0.70-1.20 = moderate, 1.30-
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180 2.00 = large, >2.0 = very large. The following thresholds were used to describe the r

181 values: 0 to 0.30 small, 0.31 to 0.49 moderate, 0.50 to 0.69 large, 0.70 to 0.89 very

182 large, and 0.90 to 1.00 near perfect (18). The method of Bland-Altman (19) was used to

183 identify the 95% limits of agreement for BF%, FM, and FFM when comparing each BIA
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184 device to DXA. Linear regression was utilized to evaluate proportional bias of the BIA

185 devices. A statistically significant model coefficient indicated the presence of

186 proportional bias between methods. BF%, FM, and FFM values obtained from visits 1

187 and 2 were averaged for each subject and used for comparisons.

188 Test-retest reliability for the BIA devices and DXA were evaluated across two

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189 days using model “2,1” from Shrout and Fleiss (20) to determine the intraclass

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190 correlation coefficient (ICC), standard error of measurement (SEM), and minimum

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191 difference (MD) values to be considered real (21). All reliability data (ICC, SEM, and

192 MD) were analyzed using Microsoft Excel (v. 14.6.7).

193 Results US
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194 Body Fat Percentage

195 The reliability of the BIA devices (InBody230, InBody720, and InBody770) and DXA
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196 for BF%, FM, and FFM are displayed in Table 2. When evaluating BF% in men and

197 women, all ICC were ≥ 0.98 whereas the SEM and MD were all less than ≤ 0.99% and
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198 2.73%, respectively. The agreement between the BIA devices and DXA when

199 comparing BF% are displayed in Table 3. The mean BF% values for InBody230,
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200 InBody720, and InBody770 were significantly underestimated when compared to DXA in
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201 men and women (all p < 0.001). The r values were very large (InBody230, InBody720 in

202 men) to near perfect (InBody770 for men and InBody230, InBody720, and InBody770 for
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203 women) whereas the SEE were all ≤ 3.30% (InBody230) and ≤ 2.63% (InBody230) in men

204 and women, respectively. The 95% limits of agreement ranged from ±5.83% (InBody770)

205 to 6.38% (InBody230) in men and ±5.83% (InBody770) to 5.10% (InBody230) in women. No
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206 proportional bias was found for any of the InBody body composition analyzers when

207 estimating BF% in men or women.

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210 Fat Mass

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211 When evaluating FM in men and women, all ICC were ≥ 0.98 whereas the SEM

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212 and MD were all less than ≤ 0.87 kg and 2.39 kg, respectively. The agreement between

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213 the BIA devices and DXA when comparing FM are displayed in Table 4. The mean FM

214 values for InBody230, InBody720, and InBody770 were significantly underestimated when

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compared to DXA in men and women (all p < 0.001). The r values were near perfect for
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216 all comparisons whereas the SEE were ≤ 2.69 kg (InBody230) and 1.83 kg (InBody230) in

217 men and women, respectively. The 95% limits of agreement ranged from ±4.76 kg
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218 (InBody770) to 5.28 kg (InBody230) in men and ±3.35 kg (InBody770) to 3.62 kg

219 (InBody230) in women. No proportional bias was found in men. However, the
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220 proportional bias in women for InBody230 was not significant (p = 0.051) whereas

221 InBody770 was statistically significant (p = 0.049).

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222 ---Insert Table 4 About Here---

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223 Fat-Free Mass

224 When evaluating FFM in men and women, all ICC were ≥ 0.99 whereas the SEM
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225 and MD were all less than ≤ 0.84 kg and 2.32 kg, respectively. The agreement between

226 the BIA devices and DXA when comparing FFM are displayed in Table 5. The mean

227 FFM values for InBody230, InBody720, and InBody770 were significantly overestimated

228 when compared to DXA in men and women (all p < 0.001). The r values were near
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229 perfect for all comparisons whereas the SEE were ≤ 2.72 kg (InBody230) and 1.93 kg

230 (InBody230) in men and women, respectively. The 95% limits of agreement ranged from

231 ±5.06 kg (InBody770) to 5.58 kg (InBody230) in men and ±3.57 kg (InBody770) to 3.73 kg

232 (InBody230) in women. No proportional bias was found in women. However, proportional

233 bias for all three InBody body composition analyzers revealed statistical significance in

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234 men (all p < 0.05).

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236 Discussion

237 The purpose of this study was to evaluate the reliability of the InBody230,

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InBody720, and InBody770 to measure FFM, FM, and BF% in the general population and
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239 against the reference method of DXA. One of the main findings of the current

240 investigation were that all three body composition methods (InBody230, InBody720, and
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241 InBody770) were deemed reliable. When examining the agreement between InBody230,

242 InBody720, and InBody770 with DXA, the results of each device were similar and
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243 indicated systematic biases, which is the second main finding of the current

244 investigation. For instance, InBody230, InBody720, InBody770 each significantly

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245 underestimated BF% and FM and overestimated FFM in the group of men and women
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246 when compared to DXA. The third main finding was that the individual error was fairly

247 small for all bioimpedance comparisons despite the tendency to yield systematic bias.
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248 For example, the SEE for men and women when estimating BF%, FM, and FFM were

249 all ≤ 3.30%, 2.69 kg, and 2.72 kg, respectively, while the 95% limits of agreement were

250 ≤ ±6.38%, 5.28 kg, and 5.68 kg. These findings suggest that all three bioimpedance

251 methods can be used for individual estimates of body composition (i.e., BF%, FM, and
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252 FFM) when DXA is not available. It is important to note that in addition to the systematic

253 bias, there was proportional bias present for some comparisons (e.g., FM in women and

254 FFM in men). The positive regression coefficient for FM and FFM in women and men,

255 respectively, indicate these metrics are overestimated relative to DXA to a greater

256 extent as the quantity for each increases (i.e., FM in women and FFM in men). Further,

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257 with the mean differences lower for the DXA, it is unknown what magnitude of changes

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258 would need to occur to be confident that a composition change has been observed with

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259 the BIA devices. Collectively, the analysis of the current investigation supports the

260 original hypothesis and reveals the more advanced InBody720 and InBody770 models

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produced nearly identical results as the InBody230 when compared to DXA.
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262 Previous research has reported similar results as that of the current study when

263 comparing InBody body composition analyzers to DXA. For instance, Esco et al. (14)
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264 found that BF% and FFM were significantly underestimated and overestimated,

265 respectively, in a group of female athletes when comparing InBody720 to DXA. Although
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266 there was systematic bias for group comparisons, Esco et al. (14) conveyed there was

267 small individual error for InBody720 (SEE = 2.88% and 1.80 kg, respectively). Similarly,
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268 in a group of collegiate football players, the InBody720 significantly overestimated FFM
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269 and underestimated FM and BF%, all of which are similar to the current study findings

270 when using InBody720 (16). Previous research utilizing InBody230 has also shown a
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271 statistically significant underestimation of BF% in a group of adults with body fat

272 classifications ranging from “ultra lean” to “risky excess fat” (12) as well as a statistically

273 significant overestimation of FFM in a group of men (13) when compared to DXA. The

274 aforementioned findings are similar to that of the current investigation and demonstrate
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275 that InBody body composition analyzers, regardless of model (e.g., InBody230 and

276 InBody720) have small individual error, but a tendency to produce large systematic bias

277 (i.e., CE).

278 In addition to the systematic bias, the current study revealed proportional bias

279 between the InBody body composition analyzers and DXA (i.e., FM for women and FFM

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280 for men). Ling et al. (15) reported similar proportional bias for InBody720 and DXA in

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281 women (i.e., underestimation at lower FM and overestimation at higher FM).

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282 Proportional bias for BIA and DXA has also been found in adults after consuming high-

283 and low-carbohydrate diets (22). For example, Tinsley (22) revealed positive regression

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coefficients (i.e., proportional bias) for FFM in a group of men when comparing BIA and
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285 DXA, which is similar to proportional bias of men in the current investigation. However

286 Tinsley reported negative regression coefficients for FM in women when comparing BIA
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287 and DXA (22) while the current investigation found positive regression coefficients for

288 FM. The difference in FM proportional bias for women in the current investigation and
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289 Tinsley (22) could be attributed to the different type of BIA analyzers, reference

290 methods, and samples. The current study used InBody body composition analyzers and
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291 iDXA as a reference in an apparently healthy group of men and women whereas Tinsley
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292 (22) utilized a single-frequency foot-to-foot BIA and a Hologic DXA in active adults. This

293 postulation is supported by Nickerson et al. (23) who also found a negative trend
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294 (proportional bias) between single-frequency hand-to-foot BIA and a criterion four-

295 compartment model in physically active women. Finally, another factor worth

296 highlighting is that proportional bias in the current study was more profound as the

297 quantity of FM and FFM increased. For instance, women had larger absolute quantities
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298 of FM (kg) than men whereas men had larger absolute quantities of FFM (kg) than

299 women. Thus, the current investigation adds to previous research and demonstrates

300 that proportional bias with InBody body composition analyzers and DXA varies among

301 males and females. Proportional bias is an important consideration as it may have

302 implications on whether people with specific characteristics such as larger or smaller

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303 amounts of FM or FFM can be accurately assessed.

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304 Other explanations for the systematic and proportional bias observed in the

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305 current investigation should also be discussed. One factor to consider is that DXA was

306 used as a reference method in the current study. Although commonly utilized in body

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composition research, DXA has been shown to produce large error when compared to
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308 more accepted criterion multi-compartment models. In a group of female athletes, Moon

309 et al. (24) found large systematic (overestimation of BF% by 3.71%) and individual error
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310 (95% limits of agreement ±6.39%) when comparing DXA to a five-compartment (5C)

311 model. Nickerson and Tinsley (25) recently found that systematic and individual error in
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312 physically active men (CE = 3.72%; 95% limits of agreement ±5.92%) and women (CE

313 = 4.09%; 95% limits of agreement ±6.09%) were large when comparing DXA to a 5C
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314 model. As a result, the systematic bias (i.e. tendency to underestimate BF%) and
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315 proportional bias of the InBody body composition analyzers in the current study could

316 be attributed to the use of DXA as a reference method, which tends to systematically
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317 overestimate BF% when compared to multi-compartment models (24, 25). Thus, it is

318 possible that the InBody body composition analyzers of the current study provides lower

319 group and individual error than DXA when compared to more advanced multi-

320 compartment models. This postulation seems plausible since Nickerson and Tinsley
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321 (25) rated bioimpedance spectroscopy as a more accurate method for body composition

322 than DXA when compared to a 5C model. Future research examining the validity of

323 various bioimpedance devices with more advanced multi-compartment models is

324 warranted.

325 While this study was carefully designed and executed, it is not without limitations.

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326 First, the pre-testing parameters were based on the recommendations from the InBody

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327 manufacturer which allow food and drink up to three hours before testing and water up

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328 to 45 minutes before testing. The current investigation set food and drink consumption

329 to not exceed four hours but did not enforce an overnight fast or confirm hydration

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status prior to testing. However, research has shown the absorption rate of water from
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331 the gastrointestinal tract typically occurs within five-minutes (26). Due to the quick

332 absorption rate of water, it is likely that this had little influence on testing results. Also,
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333 the participants of this study represented the general population therefore future

334 investigations should include specific populations such as athletes, obese individuals, or
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335 older adults.

336 Conclusion
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337 The results of the present study revealed that all InBody body composition
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338 analyzers are reliable. When comparing the agreement of InBody230, InBody720, and

339 InBody770 with DXA, results were similar for all bioimpedance devices. However, the
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340 more advanced InBody body composition models (InBody720, and InBody770) added

341 minimal benefit over the InBody230 for BF%, FM, or FFM. Thus, the InBody body

342 composition analyzers appear to be a reasonable surrogate in the absence of DXA for

343 the estimation of BF%, FM, and FFM. Nonetheless, while the BIA analyzers were
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344 deemed reliable, practitioners and clinicians should be aware of the systematic bias of

345 the bioimpedance devices as well as the proportional bias observed when estimating

346 FM in women and FFM in men.

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348 References

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349 1. Ackland, T.R., T.G. Lohman, J. Sundgot-Borgen, et al., 2012 Current status of

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350 body composition assessment in sport: review and position statement on behalf

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354 2. Chumlea, W.C., S.S. Guo, R.J. Kuczmarski, et al., 2002 Body composition

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356 Disord.26(12):1596-609.
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357 3. Gatterer, H., K. Schenk, L. Laninschegg, P. Schlemmer, H. Lukaski, and M.

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360 4. Nickerson, B.S., M.R. Esco, P.A. Bishop, et al., 2017 Effects of Heat Exposure

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365 return to clinical research. Eur J Clin Nutr.67(S1):S2-S9.

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366 6. Anderson, L.J., D.N. Erceg, and E.T. Schroeder, 2012 Utility of multifrequency

367 bioelectrical impedance compared with dual-energy x-ray absorptiometry for

368 assessment of total and regional body composition varies between men and

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370 7. Dolezal, B.A., M.J. Lau, M. Abrazado, T.W. Storer, and C.B. Cooper, 2013

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371 Validity of two commercial grade bioelectrical impedance analyzers for

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372 measurement of body fat percentage. J Exerc Physiol Online.16(4):74-83.

373 8. Moon, J.R., 2013 Body composition in athletes and sports nutrition: an

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375 9. Gába, A., O. Kapuš, R. Cuberek, and M. Botek, 2015 Comparison of multi- and

376 single-frequency bioelectrical impedance analysis with dual-energy X-ray

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377 absorptiometry for assessment of body composition in post-menopausal women:

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379 Hum Nutr Diet.28(4):390-400.

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380 10. Lee, L.W., Y.S. Liao, H.K. Lu, et al., 2017 Validation of two portable bioelectrical

381 impedance analyses for the assessment of body composition in school age
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387 12. Hurst, P.R., D.C. Walsh, C.A. Conlon, M. Ingram, R. Kruger, and W. Stonehouse,

388 2016 Validity and reliability of bioelectrical impedance analysis to estimate body

389 fat percentage against air displacement plethysmography and dual‐energy X‐

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398 15. Ling, C.H., A.J. de Craen, P.E. Slagboom, et al., 2011 Accuracy of direct
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402 16. Raymond, C.J., D.R. Dengel, and T.A. Bosch, 2018 Total and Segmental Body

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406 17. Hind, K., B. Oldroyd, and J.G. Truscott, 2011 In vivo precision of the GE Lunar

407 iDXA densitometer for the measurement of total body composition and fat

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409 18. Hopkins, W.G., S.W. Marshall, A.M. Batterham, and J. Hanin, 2009 Progressive

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412 19. Bland, J.M. and D.G. Altman, 1986 Statistical methods for assessing agreement

413 between two methods of clinical measurement. Lancet.1(8476):307-10.

414 20.
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Shrout, P.E. and J.L. Fleiss, 1979 Intraclass correlations: uses in assessing rater
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415 reliability. Psychol Bull.86(2):420-8.

416 21. Weir, J.P., 2005 Quantifying test-retest reliability using the intraclass correlation
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417 coefficient and the SEM. J Strength Cond Res.19(1):231-40.

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and bioelectrical impedance analysis varies based on sex in active adults

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420 consuming high- and low-carbohydrate diets. Nutr Res.42:85-100.

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421 23. Nickerson, B.S., M.R. Esco, P.A. Bishop, et al., 2017 Validity Of Selected
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425 24. Moon, J.R., J.M. Eckerson, S.E. Tobkin, et al., 2009 Estimating body fat in NCAA

426 Division I female athletes: a five-compartment model validation of laboratory

427 methods. Eur J Appl Physiol.105(1):119-30.

428 25. Nickerson, B. and G. Tinsley Utilization of BIA-derived bone mineral estimates

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429 exerts minimal impact on body fat estimates via multi-compartment models in

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430 physically active adults. J Clin Densitom, 2018. DOI:

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431 10.1016/j.jocd.2018.02.003.

432 26. Péronnet, F., D. Mignault, P. du Souich, et al., 2012 Pharmacokinetic analysis of

433 US
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434 humans. Eur J Appl Physiol.112(6):2213-2222.

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449 Table 1. Subject characteristics (mean and standard deviation (SD) and range)
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Men (n = 31) Women (n = 36)
Mean ± SD Min Max Mean ± SD Min Max
Age (years) 25 ± 6 20 43 26 ± 8 18 51
Height (cm) 172.2 ± 8.0 158.0 189.0 163.4 ± 5.7 150.0 172.0

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Body Mass (kg) 77.7 ± 13.3 56.9 111.3 64.3 ± 11.8 48.9 93.9

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Table 2. Reliability statistics of body composition variables derived from BIA methods and DXA between visits 1 and 2.

Men (n = 31) Women (n = 36)

BF% FM (kg) FFM (kg) BF% FM (kg) FFM (kg)

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Visit 1 16.83 ± 6.81 13.27 ± 6.44 64.97 ± 11.45 28.00 ± 7.51 18.58 ± 8.05 45.82 ± 6.29
Visit 2 16.71 ± 7.02 13.20 ± 6.53 65.04 ± 11.55 27.71 ± 7.46 18.37 ± 8.02 46.05 ± 6.41
InBody 230 ICC 0.99 0.99 1.00 0.98 1.00 0.99
SEM 0.82 0.70 0.74 0.95 0.56 0.67
MD
Visit 1
Visit 2
2.25
16.69 ± 6.84
16.55 ± 6.79
1.94
13.18 ± 6.61
13.08 ± 6.64
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65.03 ± 11.22
65.14 ± 11.20
2.64
27.36 ± 7.49
27.29 ± 7.26
1.56
18.18 ± 7.99
18.12 ± 7.81
1.84
46.18 ± 6.20
46.29 ± 6.34
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InBody 720 ICC 0.98 0.98 0.99 0.99 1.00 0.99
SEM 0.99 0.87 0.84 0.87 0.54 0.61
MD 2.73 2.39 2.32 2.41 1.49 1.70
Visit 1 16.33 ± 6.81 12.92 ± 6.56 65.26 ± 11.19 27.39 ± 7.48 18.21 ± 7.99 46.14 ± 6.08
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Visit 2 16.23 ± 7.00 12.83 ± 6.72 65.37 ± 11.28 27.03 ± 7.53 17.85 ± 8.00 46.39 ± 6.32
InBody 770 ICC 0.98 0.99 1.00 0.99 0.99 0.99
SEM 0.91 0.73 0.82 0.77 0.68 0.58
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MD 2.52 2.01 2.28 2.12 1.88 1.60

Visit 1 19.81 ± 6.23 15.86 ± 6.42 59.38 ± 9.97 30.61 ± 6.69 19.88 ± 7.35 41.41 ± 5.98
Visit 2 19.82 ± 6.31 15.69 ± 6.46 59.34 ± 10.15 30.47 ± 6.77 19.96 ± 7.53 41.51 ± 5.95
DXA ICC 1.00 1.00 1.00 1.00 0.99 0.99
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SEM 0.39 0.24 0.57 0.45 0.69 0.50

MD 1.06 0.66 1.56 1.23 1.92 1.38
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BIA = bioimpedance analysis; DXA = dual energy X-ray absorptiometry; BF% = body fat percentage; FM = fat mass; FFM = fat-free mass; ICC =
intraclass correlation coefficient; SEM = standard error of the measurement; MD = minimum difference
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Table 3. Comparison of BF% values between the BIA methods and DXA

95% Limits of
Linear Regression
Agreement

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Method (Mean ± SD) p-value Cohen’ d r SEE TE CE ± 1.96 SD Upper Lower Coefficient p-value
Men (n = 31) --- --- --- --- --- --- --- --- --- --- ---
DXA 19.81 ± 6.26 --- --- --- --- --- --- --- --- --- ---
InBody230 16.77 ± 6.89 < 0.001 0.46 0.88 3.30 4.42 -3.05 ± 6.38 3.33 -9.42 0.10 0.283
InBody720
InBody770
Women
(n=36)
16.62 ± 6.78
16.28 ± 6.87

---
< 0.001
< 0.001

---
0.49
0.54

---
0.89
0.90

---
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3.16
3.02

---
4.42
4.59

---
-3.19 ± 6.10
-3.53 ± 5.83

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2.91
2.30

---
-9.30
-9.36

---
0.08
0.10

---
0.360
0.258

---
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DXA 30.54 ± 6.72 --- --- --- --- --- --- --- --- --- ---
InBody230 27.85 ± 7.45 < 0.001 0.40 0.94 2.63 3.72 -2.69 ± 5.10 2.42 -7.79 0.11 0.092
InBody720 27.33 ± 7.35 < 0.001 0.46 0.94 2.62 4.10 -3.22 ± 5.07 1.86 -8.29 0.09 0.149
InBody770 27.21 ± 7.49 < 0.001 0.47 0.94 2.58 4.18 -3.33 ± 5.02 1.69 -8.35 0.11 0.073
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BF% = body fat percentage; BIA = bioimpedance analysis; DXA = dual energy X-ray absorptiometry; SEE = standard error of estimate; CE =
constant error; SD = standard deviation, Linear regression = Proportional bias
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Table 4. Comparison of FM (kg) values between the BIA methods and DXA

95% Limits of
Linear Regression
Agreement

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Method (Mean ± SD) p-value Cohen’ d r SEE TE CE ± 1.96 SD Upper Lower Coefficient p-value
Men (n = 31) --- --- --- --- --- --- --- --- --- --- ---
DXA 15.68 ± 6.44 --- --- --- --- --- --- --- --- --- ---
InBody230 13.24 ± 6.47 < 0.001 0.39 0.91 2.69 3.61 -2.45 ± 5.28 2.84 -7.73 0.01 0.955
InBody720
InBody770
Women
(n=36)
13.13 ± 6.59
12.88 ± 6.62

---
< 0.001
< 0.001

---
0.39
0.43

---
0.92
0.93

---
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2.60
2.46

---
3.60
3.69

---
-2.55 ± 5.05
-2.81 ± 4.76

---
2.49
1.96

---
-7.60
-7.57

---
0.03
0.03

---
0.744
0.691

---
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DXA 19.92 ± 7.42 --- --- --- --- --- --- --- --- --- ---
InBody230 18.48 ± 8.02 < 0.001 0.19 0.97 1.83 2.32 -1.44 ± 3.62 2.17 -5.06 0.08 0.051
InBody720 18.15 ± 7.89 < 0.001 0.23 0.97 1.81 2.50 -1.77 ± 3.53 1.76 -5.29 0.06 0.123
InBody770 18.03 ± 7.98 < 0.001 0.25 0.98 1.69 2.53 -1.89 ± 3.35 1.46 -5.23 0.07 0.049
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FM = fat mass; BIA = bioimpedance analysis; DXA = dual energy X-ray absorptiometry; SEE = standard error of estimate; CE = constant error;
SD = standard deviation, Linear regression = Proportional bias
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Table 5. Comparison of FFM (kg) values between the BIA methods and DXA

95% Limits of
Linear Regression
Agreement

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Method (Mean ± SD) p-value Cohen’ d r SEE TE CE ± 1.96 SD Upper Lower Coefficient p-value
Men (n = 31) --- --- --- --- --- --- --- --- --- --- ---
DXA 59.36 ± 10.05 --- --- --- --- --- --- --- --- --- ---
InBody230 65.00 ± 11.49 < 0.001 0.52 0.97 2.72 6.33 5.65 ± 5.68 11.32 0.03 0.14 0.004
InBody720
InBody770
Women
65.09 ± 11.20
65.31 ± 11.22

---
< 0.001
< 0.001

---
0.54
0.56

---
0.97
0.98

---
US
2.66
2.46

---
6.33
6.47

---
5.73 ± 5.38
5.95 ± 5.06

---
11.10
11.02

---
0.35
0.89

---
0.11
0.11

---
0.044
0.010

---
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(n=36)
DXA 41.46 ± 5.96 --- --- --- --- --- --- --- --- --- ---
InBody230 45.93 ± 6.33 < 0.001 0.72 0.95 1.93 4.85 4.47 ± 3.73 8.21 0.74 0.06 0.243
InBody720 46.23 ± 6.25 < 0.001 0.78 0.96 1.87 5.11 4.77 ± 3.61 8.38 1.17 0.05 0.341
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InBody770 46.26 ± 6.19 < 0.001 0.79 0.96 1.85 5.13 4.80 ± 3.57 8.37 1.23 0.04 0.450

FFM = fat-free mass; BIA = bioimpedance analysis; DXA = dual energy X-ray absorptiometry; SEE = standard error of estimate; CE = constant
error; SD = standard deviation, Linear regression = Proportional bias
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