Clinical Nutrition (2003) 22(6): 537–543

r 2003 Elsevier Ltd. All rights reserved.

doi:10.1016/S0261-5614(03)00048-7

ORIGINAL ARTICLE

Validation of a bioelectrical impedance analysis equation

to predict appendicular skeletal muscle mass (ASMM)
U. G. KYLE,1 L. GENTON,1 D. HANS,2 C. PICHARD1
1
Clinical Nutrition, Geneva University Hospital, Geneva, Switzerland, 2 Nuclear Medicine, Geneva University Hospital, Geneva,
Switzerland (*Correspondence to: CP, Clinical Nutrition ,Geneva University Hospital, Geneva1211, Switzerland)

Abstract" Rationale: Appendicular skeletal muscle mass (ASMM) is useful in the evaluation of nutritional status be-
cause it re£ects the body muscle protein mass. The purpose of this study was to validate, against dual-energy X-ray
absorptiometry (DEXA), a BIA equation to predict ASMM to be used in volunteers and patients. Method: Healthy men
(n = 246 men, BMI 25.372.9 kg/m2) and women (n =198, 24.173.6 kg/m2), and heart, lung and liver transplant patients
(213 men, BMI of 24.674.4 kg/m2; 113 women, BMI 23.075.2 kg/m2) were measured by BIA (XitronTechnologies) and
DEXA (Hologic QDR 4500). A BIA equation to predict ASMM (kg) that included height2/resistance, weight, gender, age
and reactance, was developed by means of multiple regressions.
Results: Men Women
ASMM (kg) DEXA BIA DEXA BIA
Volunteers 25.873.6 25.773.4 17.372.5 17.272.4
Patients 22.172.8 22.673.5* 15.272.8 15.273.0
Mean7SD, paired t-test between BIA and DXA * Po0.01
Mean di¡erence (Bland-Altman) for volunteers was 0.171.1kg, r =0.95, SEE1.12 kg and for patients
0.471.5 kg, r =0.91,
SEE 1.5 kg.Best ¢tted multiple regression equation was
4.211 + (0.267  height2 / resistance) + (0.095  weight)
+(1.909  sex (men = 1, women = 0)) + (
0.012  age) + (0.058  reactance).
Conclusions: BIA permits the prediction of ASMM in healthy volunteers and patients between 22 and 94 years of age.
A slightly larger, though clinically not significant, error was noted in patients.
r 2003 Elsevier Ltd. All rights reserved.

Key words: appendicular skeletal muscle mass; valida-
tion; bioelectrical impedance analysis; dual X-ray
absorptiometry
Introduction
Aging is associated with a gradual loss of skeletal muscle
mass or sarcopenia. Wasting diseases and many
health related conditions also result in decreases in
skeletal muscle mass (1). Appendicular (or limb)
skeletal muscle mass (ASMM) accounts for475% of
total skeletal muscle (2) and is the primary portion
of skeletal muscle involved in ambulation and physical
activity. In the elderly, skeletal muscle mass loss
may be masked by weight stability resulting from a
corresponding increase in total body fat mass (1). Cross-
sectional data suggest that the loss of ASMM is greater
with aging than the loss on non-skeletal muscle mass
(3). Thus, the evaluation of ASMM can contribute
important information to the assessment of nutritional
status because it reflects the body protein mass. A major
impediment to determining ASMM is the lack of
suitable, easy and non-invasive methods for estimating
ASMM.
Earlier studies support the validity of DXA estimates
of ASMM (4, 5). However, DXA is not a ‘portable’
method and measurement cost and technician skill
limit its use in field studies. Bioelectrical impedance
analysis (BIA) has been used to determine the fat-free
mass (6). Recent studies indicate good correlation
between limb electrical resistance, measured at 50 kHz,
and ASMM by DXA (7, 8). This observation suggests
that limb skeletal muscle can be estimated from
BIA-measured resistance.
Janssen et al. (9) recently developed a BIA equation,
validated against magnetic resonance imaging (MRI)
that provides valid estimates of total skeletal mass in
healthy adults varying in age and adiposity. Lee et al.
(10) developed anthropometric prediction models to
estimate total body skeletal muscle mass, using skin-
fold and limb circumferences. Baumgartner et al. (11)
estimated ASMM from anthropometric parameters,
including hip circumference and grip strength in elderly

537
538 SKELETAL MUSCLE MASS AND BIOELECTRICAL IMPEDANCE

subjects. Pietrobelli et al. (8) found BIA to be valid Patients

for estimating arm and leg skeletal muscle mass.
Estimation of regional muscle mass by segmental BIA
measurements, compared to MRI (12–14), requires
further validation before it can be applied in clinical
settings.
Currently there are no BIA-determined prediction
equations to estimate ASMM. The purpose of this study
was to validate, against dual-energy X-ray absorptio-
metry (DXA), a BIA equation to predict ASMM to be
used in volunteers and patients.
Subjects and methods
Volunteers
Four hundred and forty-four healthy ambulatory
Caucasians (246 men and 198 women) aged 22 –94
years (Table 1) were included in this study. Subjects
were non-randomly recruited through advertisement in
local newspapers and invitations to participate in the
study sent to members of elderly leisure clubs. Although
subjects were non-randomly selected, statistical analysis
revealed no difference in height, weight and body mass
index (BMI) between subjects in this study and age-
matched healthy men and women (n = 3170) in Geneva.
Exclusion criteria were active medical treatment or
hospitalization within 3 months of measurement or
physical handicap that might interfere with body
composition measurement (amputation, paralysis,
etc.). Three women, aged over 65 years who had BMIs
ofo18.0 kg/m2, but no history of recent weight loss or
illness were considered healthy and therefore not
excluded. Each subject was first measured by BIA, then
by DXA. All subjects signed an informed consent
statement and the study protocol was approved by the
Geneva University Hospital Ethics Committee.
Patients (213 men and 113 women) aged 18–70 years
(Table 1) who were seen as part of the pre-transplant
evaluation or during post-transplant followup examina-
tion were also included in this study. Patients with
clinically detectable ascites or other fluid abnormalities
require therapeutic correction were excluded (15).
Bioelectrical impedance analysis
Body height was measured to the nearest 0.5 cm and
body weight was measured to the nearest 0.1 kg on a
balance beam scale. Height and weight of both groups
were normally distributed. Briefly, an electrical current
of 50 kHz and 0.8 mA was produced by a generator,
Xitron 4000B (Xitron Technologies, Inc, San Diego,
CA, USA), and applied to the skin using adhesive
electrodes (3 M Red Dott, 3 M Health Care, Borken,
Germany) with subject in supine position. The skin was
cleaned with 70% alcohol. Standard whole body
procedure as previously described was used (16) The
resistance and reactance were measured by the BIA
generator and used to mathematically derive ASMM
(16,17) using the formula V ¼ rx height2/resistance in
which conductive volume (V) is assumed to represent
ASMM, r is the specific resistivity of the conductor,
height (ht) is taken as the length of the conductor, and
body resistance (R) is measured with four surface
electrodes placed on the right wrist and ankle. Reac-
tance (the related BIA factor of phase angle) was
included as an additional potential measure of soft
tissue composition (8). Short- and long-term reproduci-
bility of resistance measurements indicate coefficients of
variation of 1.8–2.9% (18,19). In our data, reproduci-
bility was r ¼ 0:999 for measurements taken in the same
subject within one week (n ¼ 29) and 0.977 for repeat
measurements up to 1 month (n ¼ 40) or 2.5% variance.

Table 1 Anthropometric and bioelectrical impedance (BIA) characteristics of volunteers and patients
Men Women
Volunteers 20-94 years o55 years 455 years 20-94 years o55 years 455 years
N 246 144 102 198 85 113
Height Cm 175.177.7 177.976.9 171.176.9 162.176.2 165.375.4 159.775.8
Weight Kg 77.779.9 79.379.7 75.479.8 63.3710.0 62.678.1 63.9711.2
Body mass index Kg/m2 25.372.9 25.072.6 25.873.2 24.173.6 22.972.7 25.173.9
Resistance O 457747 451742 467751 564760 555756 571762
Reactance O 54.679.8 60.077.1 47.177.9 60.4710.7 66.979.2 55.579.1
Height2/resistance Cm2/O 67.979.1 71.078.5 63.578.2 47.376.6 49.876.2 45.376.2
Fat-free mass Kg 60.376.7 63.075.9 56.676.0 42.975.0 44.974.6 41.474.7
Patients
N 213 127 86 113 80 33
Height Cm 172.777.0b 174.276.9b 170.376.5 160.775.2a 161.675.2b 158.674.6
Weight Kg 73.3713.3b 72.9714.9b 73.8710.8 59.4714.5a 59.0712.9a 60.6718.0
Body mass index Kg/m2 24.674.4a 24.175.1 25.472.9 23.075.2a 22.574.5 24.076.6
Resistance O 516791b 522798b 507778b 6207103b 618780b 6257146a
Reactance O 46.3713.9b 49.1714.1b 42.2712.6a 50.1714.2b 51.9714.0b 45.7713.9b
Height2/resistance Cm2/O 59.5710.9b 60.0710.6b 58.9711.3a 42.978.1b 43.076.6b 42.6711.1
Fat-free mass Kg 55.277.6b 55.678.1b 54.776.9a 40.376.4b 40.576.0b 39.977.3

Paired t-Test between volunteers and patients a

P o 0.05, b
P o 0.001.
 CLINICAL NUTRITION 539

Dual energy X-ray absorptiometry The subjects were split into two samples of Odd and
Even on the basis of age (odd youngest, even second
Body composition was determined with DXA, Hologic
youngest). Thus the two groups were evenly matched for
QDR 4500A (Hologic Inc., Waltham, MA, USA),
the age of the subjects. An equation was developed for
Enhanced 8.26 Whole-body software version. In this
each, with the opposite group being used to cross-
scanning technique, an X-ray generator emits switched
validate each equation. If the equations proved to be
pulsed radiation of two energies, 100 and 140 kVp, in a
similar (evaluated by a comparison of multiple r values
fan-beam mode. As they pass through the body, these
and visible inspections of graphs), groups were com-
two X-ray beams are attenuated due to the absorption
bined and a single equation was developed using the
and scattering of the photons. The attenuation is
entire sample. The equation was separately validated
measured for every pixel of the body surface by a linear
ino55 and over 55 year subjects.
array of 216 detectors. A complex development mea-
Simple regressions were calculated to test correlations
surement allows determination of bone mineral and soft
of ASMM between DXA and BIA. T-test was used to
tissue densities. Soft tissue can further be partitioned
test differences between methods. Bland and Altman
into body fat and fat-free mass, since they have different
analysis was calculated according to methods previously
attenuation characteristics. The scanner was calibrated
described (26) to assess the agreement between two
for bone mineral component with a rotating drum and
clinical measurements. The difference between the
for fat with an external lucite-aluminum phantom (20).
values is plotted against their mean, the mean being
The calculation of ASMM has been previously
the best available estimate of the true value. This
described in detail (4). With the use of specific anatomic
analysis allows for the calculation of bias (estimated by
landmarks, the legs and arms are isolated on the skeletal
the mean differences), the 95% confidence interval for
X-ray planogram (anterior view). The arm encompasses
the bias, and the limits of agreement (two standard
all soft tissue extending from the center of the arm
deviations of the difference) (26). The technical error
socket to the phalange tips and contact with the ribs,
was calculated as TE ¼ OSn i ¼ 1 (ASMM1—ASMM2 )2/
pelvis and greater trochanter is avoided. The leg consists
2n (27). It represents the dispersion of the differences
of all soft tissue extending from an angled line drawn
from a normal distribution, 95% of the values for a
through the femoral neck to the phalange tips. The
measurement should be within plus or minus twice the
system software provides the total mass, bone mineral
technical error values of the corresponding true value.
mass, lean and fat mass extremities for each region. The
Ideally, body composition methods should have low
fat and bone mineral-free portion of the extremities were
TE and high correlation coefficients (27). Statistical
assumed to represent ASMM along with a small and
significance was set at P p 0.05 for all tests.
relatively constant amount of skin and underlying
connective tissue (21).
Radiation dose per individual was 2.6 mSv. To our
knowledge, no information on precision of QDR 4500A
Results
for measuring body composition is available, but the
precision of DXA QDR 2000, a former model of
A total of 444 healthy volunteers between ages 22 and 94
Hologic, is 1.0% for FFM and 2.0% for FM (22). The
years and 326 patients were included. Table 1 shows
FM derived from DXA measurements in previous
their anthropometric and bioelectrical impedance ana-
studies correlates well with the FM determined by
lysis characteristics. The weight was significantly higher
hydrodensitometry and total body K40 measurements
in volunteers than patients. The resistance and height2/
(23,24).
resistance were significantly higher and the reactance
significantly lower in patients than volunteers. The
reactance was significantly lower in volunteers and
Statistics
patients455 year than in those o 55 years.
Descriptive statistics were calculated for height, weight, The prediction equations developed in the odd (n =
body mass index and bioelectrical impedance para- 222) and even numbered subjects (n = 222) are shown in
meters, including resistance, reactance and height2/ Table 2. The BIA-predicted ASMM by the odd or even
resistance and are expressed as mean 7 standard equations was not different from the DXA-measured
deviation (x7SD). ASMM. The odd equation resulted in a predicted
ASMM value measured by DXA was used as the ASMM of 22.175.3 kg in the even-numbered subjects
criterion measurement. Stepwise multiple regressions (r = 0.977, SEE = 1.14 kg). The even equation resulted
were used to derive a prediction equation by BIA. in a predicted ASMM of 21.875.1 kg in the odd -
Predictor variables, entered into the BIA model in the numbered subjects (r = 0.976, SEE = 1.11 kg). Thus,
order of highest correlation coefficient and smallest the correlation coefficients (r values) and SEE were
SEE, were height2/resistance, weight, gender, age and similar between the even and odd samples and the cross-
reactance. The prediction equation for BIA was devel- validation showed similar results. The regression lines
oped by using a double cross-validation technique (25). (Odd = 0.95370.01 and Even = 0.95370.01) were
540 SKELETAL MUSCLE MASS AND BIOELECTRICAL IMPEDANCE

Table 2 Contribution and order of entry of independent variables to the BIA model for ASMM
Cumulative Individual
2 2
Prediction variables r SEE P value r SEE P value
BIA
Height2/resistance 0.917 1.53 0.0001 0.917 1.53 0.0001
+ Weight 0.924 1.46 0.0001 0.668 3.05 0.0001
+ Gender 0.933 1.38 0.0001 0.644 3.15 0.0001
+ Age 0.948 1.21 0.0001 0.164 4.84 0.0001
+ Reactance 0.953 1.15 0.0001 0.038 5.19 0.0001
Bmi 0.123 4.95 0.0001
Height 0.688 2.96 0.0001
Height, weight 0.816 2.27 0.0001
Height, weight, age 0.830 2.18 0.0001

n = 444 subjects, r2 value of the validity coefficient, SEE=Standard error of the estimate.

Table 3 Prediction equation for appendicular skeletal muscle mass (ASMM), using all volunteers
ASMM =
4.211 + (0.267*height2 / resistance) + (0.095*weight) + (1.909*sex (men = 1, women = 0))
+ (
0.012*age ) + (0.058*reactance)
DXA-measured ASMM 22.075.3 kg
BIA-predicted ASMM 21.975.2 kg, r = 0.976, SEE = 1.12 kg, TE 0.65 kg

n = 444 subjects, r = validity coefficient, SEE = standard error of the estimate, TE = technical error (see methods)

Table 4 Comparison of appendicular skeletal muscle mass by DXA and BIA as estimated by equation determined in volunteers
Volunteers Patients
Age (years) DXA(kg) BIA(kg) t-test DXA(kg) BIA(kg) t-test
Men
20-94 25.873.6 25.773.3 0.58 22.173.8 22.673.5 0.001
o 55 27.473.0 27.272.7 0.07 22.673.9 23.073.5 0.001
4 55 23.573.0 23.772.9 0.17 21.373.5 22.173.5 0.001

Women
20-94 17.372.5 17.272.4 0.61 15.272.8 15.273.0 0.96
o 55 18.372.5 18.572.0 0.16 15.272.5 15.372.4 0.36
4 55 16.572.3 16.372.3 0.06 15.273.5 14.874.1 0.13

Paired t-test: comparison between DXA and BIA, significance level Po 0.05

virtually identical, with deviation from the line of
identities being similar for both samples. Thus a single
equation using all 444 subjects was developed for BIA
prediction of ASMM, shown in Table 2.
The order of entry of predictor variable was height2/
resistance, weight, gender, age and reactance, which
each contributed significantly to the BIA Model (Table
3). Height2/resistance accounted for 91% of the
variability (SEE 1.5 kg) of the equation, whereas weight
alone only accounted for 67% of the variability (SEE
3.0 kg) and height alone accounted of 69% of the
variability (SEE 5.0 kg). Inclusion of height, weight and
age, without BIA parameters, accounted for 83% of the
variability with a SEE of 2.2 kg. BMI was a poor
predictor of ASMM (r2 = 0.12, SEE 4.95 kg). The
prediction equation developed from all subjects is shown
in Table 2. Thus, the inclusion of BIA parameters
clearly improved the prediction power and decreased the
SEE, compared to anthropometric parameters only.
Table 4 shows the mean ASMM and t-test of the
prediction equation in healthy volunteers and patients
agedo55 and 455 years. Non-significant mean differ-
ence in ASMM between DXA and BIA equations in
volunteers ranged from
0.1 to +0.2 kg. Thus the
combined equation is valid to predict FFM in healthy
volunteers aged o55 and 455 years. Mean difference in
ASMM between DXA and BIA equations in patients
ranged from
0.4 to +0.6 kg and t-tests were significant
for male patients. Figure 1 shows the correlation (top)
and mean difference, according to Bland-Altman
(bottom), using the combined equation in healthy
volunteers (left) and patients (right).
Discussion
The aim of the study was to develop and cross-validate a
prediction equation for estimating ASMM from BIA
measurements. Our findings indicate that DXA-mea-
sured ASMM was strongly correlated to the BIA-
derived resistance, normalized for height, (ht2/R) and
that the BIA method is a valid method for estimating
ASMM in healthy volunteers and patients. The error
(SEE) for predicting ASMM was 1.1 kg (5%) in
volunteers and 1.5 kg (7.6%) in patients.
 CLINICAL NUTRITION 541

Y = 1.01 + 0.95 * X, r2 = 0.95 Y = 1.05 + 0.97 * X, r2 = 0.91,

SEE 1.12 kg, TE 0.65 kg SEE 1.50 kg, TE 1.12 kg
40 40
35 35

ASMM (bia) (kg)

30 30
25 25
20 20
15 15
10 10
10 15 20 25 30 35 40 10 15 20 25 30 35 40
ASMM (dxa) (kg) ASMM (dxa) (kg)

6 6
Difference ASMM dxa-bia (kg)

4 4
+ 2 SD 2 + 2 SD
2
0 0
-2 - 2 SD -2
-2 SD
-4 -4
-6 -6
10 15 20 25 30 35 40 10 15 20 25 30 35 40
ASMM (dxa + bia)/2(kg) ASMM (dxa+bia)/2 (kg)

Fig. 1 Correlations (top) and differences (bottom) of appendicular skeletal muscle mass (ASMM) in volunteers (left side) and patients (right side)
estimated by dual-energy X-ray absorptiometry (ASMMDXA) and bioelectrical impedance. The difference of ASMM (calculated as
ASMMDXA
ASMMBIA) per Bland-Altman) is plotted against the mean of the measurements of ASMM by DXA and BIA. SEE = standard
error of the estimate, TE = technical error (see methods). d = men, m = women.

Resistance index (height2/R) had an r2 value of 0.92 patients , respectively) and the SEE was smaller (1.1 or
and thus accounted for 92% of the variability. Addi- 5.0% and 1.5 kg or 7.6% in volunteers and patients,
tional prediction variables further improved the predic- respectively). The BIA method was within 5% error in
tion equation. In agreement with others (8,9), gender 68% and 52%, and within 10% in 93% and 83% of
and age were significant independent predictors. volunteers and patients, respectively. Because the model
Furthermore, age was reported to be a significant development size is large, the model should be applic-
predictor, even at frequencies 4 50 kHz (8). Our study able to a large proportion of a white adult population.
further indicates that reactance is a significant indepen- Validation in patients also permits the estimation of
dent predictor of ASMM and FFM (28) and was ASMM in patients without altered hydration due to
responsible for a small improvement in the prediction disease or drug treatment. The slightly lower r2 value
equation. Reactance was lower in older than younger and higher SEE noted in patients suggests that patients
subjects and lower in patients than volunteers and are different from healthy subjects. The predicted
would explain about 1.0 kg of the difference in ASMM ASMM was significantly higher in male patients, with
between patients 455 years and volunteerso55 years. the largest difference (0.871.6 kg) noted in male
Reactance reflects the cell membrane capacitance, tissue patients 455 years. We can only speculate on these
interfaces and non-ionic tissues (29), and has been differences. There were no clear trends and differences
suggested to be a function of intracellular water and were inconsistent. Patients were measured when they
thus of body cell mass (30). Thus the findings of lower were seen as part of the pre-transplant evaluation or
reactance, lower body cell mass and lower ASMM during post-liver, lung or heart transplant followup
found in older and ill subjects are consistent. Our data examination. Larger ASMM differences were noted in
contradicts Pietrobelli et al. (8) who found that phase some patients evaluated prior to liver transplantation,
angle (the related BIA factor of reactance) failed to which might suggest the presence of sub-clinical ascites
improve the predicted ASMM. and/or altered hydration. Although there were no clear
In a review of a number of studies, Houtkouper et al. trends, overestimation of ASMM was noted in some
(6) found that the r2 for equations developed for patients at extremes of BMI (low or high) and patients
estimating fat-free mass ranged from 0.73 to 0.98 and with lower than expected FFM (FFM below the 10th
that SEE ranged from 1.7 to 4.1 kg. Janssen et al. (9) percentile).
reported an r2 value of 0.86 and a SEE of 2.7 kg for total Pietrobelli et al. (8) suggest that, although at an
skeletal muscle mass. In our study, the r2 value for empirical level, the development of good skeletal muscle
ASMM was higher (0.95 and 0.91 in volunteers and mass prediction models is possible, additional BIA
542 SKELETAL MUSCLE MASS AND BIOELECTRICAL IMPEDANCE
studies are probably necessary to improve the under-
standing of appendicular conduction pathways.
Our study confirms that men have higher ASMM
than women and younger subjects had higher ASMM
than older subjects. The ASMM in woman was two-
thirds the ASMM of men. Our ASMM results (Table 4)
are similar to the New Mexico Elder Health Survey (11)
(22.5 and 14.5 kg in men and women, respectively) and
to the younger adults in the Rosetta Study (11) (27.3 and
17.7 kg, respectively). We also found that patients had
significantly lower ASMM than volunteers. The ASMM
in our study was 76% of total skeletal muscle mass
reported by Janssen et al. (9) (29.677.2 kg), which is
close to the 75% of the total skeletal muscle being
ASMM, as reported in reference man (2).
Study limitations
DXA was the reference method used in our study. One
limitation of this method is subject thickness, which may
lead to an overestimation of % FFM in large people
(30). However, only one volunteer and eight patients
exceeded a BMI of 35 kg/m2 in our study and therefore
errors due to this limitation should be minimal.
Differences in FFM, and therefore ASMM, have been
reported between dual-energy X-ray absorptiometry
instruments by different manufacturers (Hologic versus
Lunar) (31). We have no information on the compar-
ability of regional estimates across instruments from
different manufacturers. These differences would affect
the final BIA equation.
The second limitation is that the measured ASMM
includes not only appendicular skeletal muscle but also
non-muscle components as skin, neurovascular tissues,
and connective tissue and interstitial fat. Some authors
describe an increase with age of these last three elements,
which may result in an overestimation of ASMM in
elderly compared to other reference methods (21,32).
The ASMM determined by DXA includes estimated
skin, connective tissue and intramuscular fat and thus
would be higher than CT determined ASMM. ASMM
was 2.1 (8.1%) and 0.9 kg (5.2%) lower in men and
women, respectively, when using regression equation to
adjust for differences between CT and DXA (33).
However, in clinical application, comparison of direct
predicted ASMM would be better than using adjusted
ASMM that is based on a number of assumptions which
may vary with age and gender and has not been
validated in women, obese and elderly subjects (33).
ASMM as presented in this study permits comparison of
patients to healthy subjects, and of longitudinal follow-
up in individual subjects and group of subjects.
Furthermore, soft tissue algorithms rely on a fixed
hydration of FFM (0.73 ml/g), which may be question-
able in the elderly. Nevertheless, Visser et al. (34)
validated DXA in the elderly against a four-compart-
ment model. The described limitations apply to all DXA
instruments.
The BIA methods used may be criticized, but have
been optimized for this study, namely: Water and
electrolyte abnormalities are known to influence body
composition measurements, including BIA measure-
ments. To limit the impact of such interference, BIA
measurements were performed before IV fluids for
medications and treatment for dehydration were started,
and patients with edema, and dehydration were
excluded.
Whole body impedance measurements were used in
this study to estimate ASMM. Although segmental
impedance measurements to determine ASMM are an
interesting concept, we found that segmental (limb)
impedance measurements were less accurate in predict-
ing individual limb ASMM than whole body impedance
and were therefore not used in this study. This appears
to be due to the non-uniform conduction of impedance
through various tissues, which distorts the contribution
of different body segments.
Conclusions
The study validated a BIA equation to predict ASMM.
BIA permits the prediction of ASMM in healthy
volunteers between 22 and 94 years and patients
between 18 and 70 years. A slightly larger, though
clinically not significant, error was noted in patients.
Acknowledgements
We thank the Foundation Nutrition 2000Plus for its financial support.
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