WRIST-WEARABLE BIOELECTRICAL

IMPEDANCE ANALYSER

Seminar report

Submitted by

SIMMON MATHEW SHAJI

(B200932EC)

In partial fulfilment for the award of the Degree of

BACHELOR OF TECHNOLOGY
IN
ELECTRONICS AND COMMUNICATION ENGINEERING

DEPARTMENT OF ELECTRONICS AND COMMUNICATION

ENGINEERING
NATIONAL INSTITUTE OF TECHNOLOGY, CALICUT
NIT CAMPUS P.O., CALICUT
KERALA, INDIA 673601.
 NATIONAL INSTITUTE OF TECHNOLOGY, CALICUT
DEPARTMENT OF ELECTRONICS AND COMMUNICATION ENGINEERING

CERTIFICATE

This is to certify that the seminar report entitled "WRIST-WEARABLE BIO-

ELECTRICAL IMPEDANCE ANALYSER" is a bonafide record of the sem-
inar presented by SIMMON MATHEW SHAJI (B200932EC) as part of the
course EC4092D-Seminar at the National Institute of Technology, Calicut towards
partial fulfilment of the requirements for the award of Degree of Bachelor of Technol-
ogy in Electronics and Communication Engineering.

Place: Calicut
Date: 19 - 10 - 2023

Dr. Jailsingh Bhookya

(Seminar Coordinator)

Dr. Jaikumar M.G.

(Head of Department)

i
 ACKNOWLEDGEMENT

I am extremely grateful to Dr. Jailsingh Bhookya, Assistant Professor, Department

of Electronics and Communication Engineering, National Institute of Technology,
Calicut, for all the necessary guidance, help, and advice extended to me. I have
great pleasure in expressing my gratitude and obligations to Mr R. Suresh, Associate
Professor, Department of Electronics and Communication Engineering, National In-
stitute of Technology, Calicut for his valuable guidance, and suggestions to make this
work a success. I express my sincere thanks to my faculty advisor Dr. Chandan
Yadav, Assistant Professor, Department of Electronics and Communication Engi-
neering, National Institute of Technology, Calicut for his valuable support and en-
couragement. I express my gratitude to Dr. Jaikumar M.G, Head of Department,
Department of Electronics and Communication, National Institute of Technology,
Calicut, for his wholehearted cooperation and encouragement. I also acknowledge
my gratitude to other faculty members in the Department of Electronics and Com-
munication Engineering, my family, and my friends for their wholehearted coopera-
tion and encouragement. Above all, I thank God Almighty, without whose help, I
wouldn’t have reached this far.

ii
 ABSTRACT

Bioelectrical Impedance Analysis (BIA), a non-invasive technique for estimating var-

ious health and body composition parameters, such as body fat percentage, muscle
mass, and hydration levels. Traditional BIA devices come with limitations, including
large electrodes that introduce measurement errors due to skin contact resistance and
user cooperation requirements. This presentation introduces an innovative solution,
a wrist-wearable BIA device featuring miniature electrodes that compensate for con-
tact resistance, ensuring precise impedance estimation even with small electrodes.
This user-friendly device allows individuals to measure their body composition ef-
fortlessly by touching a finger to it and can seamlessly integrate with a smartphone
app for health and fitness guidance.

iii
 CONTENTS

List of Figures v

List of Tables vi

1 INTRODUCTION 1

2 Literature Survey 2

3 BACKGROUND 4
3.1 Biology of Body Composition . . . . . . . . . . . . . . . . . . . . . . 4
3.2 BMI and Body Composition . . . . . . . . . . . . . . . . . . . . . . 5
3.2.1 BMI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
3.2.2 Dual-Energy X-Ray Absorptiometry . . . . . . . . . . . . . . 6
3.2.3 BIA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
3.2.4 Omron HBF-306 . . . . . . . . . . . . . . . . . . . . . . . . . 8

4 METHODOLOGY 9
4.1 Wrist-wearable bioelectrical impedance analyzer . . . . . . . . 9
4.2 Contact Resistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
4.3 Contact resistance compensation . . . . . . . . . . . . . . . . . . . . 11

5 EXPERIMENTAL SETUP AND TESTING 17

5.1 Hardware setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
5.2 Clinical test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

6 Results 22

7 CONCLUSION 25
BIBLIOGRAPHY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

iv
 List of Figures

3.1 Visceral Fat and Subcutaneous Fat[website] . . . . . . . . . . . . . . 5

3.2 2kg of fat and muscle [website] . . . . . . . . . . . . . . . . . . . . . . 6
3.3 DEXA Apparatus[website] . . . . . . . . . . . . . . . . . . . . . . . . 7
3.4 Picture of Omron HBF-306[website] . . . . . . . . . . . . . . . . . . . 8

4.1 Watch-type BIA device ( There are four electrodes i.e., two wrist and
finger electrodes).[1] . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
4.2 Bioelectrical impedance measurement using single-finger [1] . . . . . 10
4.3 . Contact resistance vs. electrode area and state of skin–electrode
contact interface (CG conductive gel, w/o without, w/ with).[1] . . . 12
4.4 Contact resistance compensation method. (a) 4-point measurement
mode, (b) 2-point measurement mode .[1] . . . . . . . . . . . . . . . . 13
4.5 contact resistance compensation effect. (|Zbody |=1 kΩ, |Zi |=2 MΩ,
Rs=50 kΩ). The max measurement error for contact resistance
compensation 0.5%, for traditional 4-point measurement 11.2%[1] . . 16

5.1 Hardware Setup[1] . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

5.2 Measurement procedure and corresponding graphical user interface of
the wrist-wearable bioelectrical impedance analyser[1] . . . . . . . . 19

6.1 Calculated contact resistance distribution among participants in the

clinical test.[1] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
6.2 Results and Comparisons [1] . . . . . . . . . . . . . . . . . . . . . . . 23

v
 List of Tables

5.1 Physical characteristics of the subjects[1]. . . . . . . . . . . . . . . . . 20

5.2 Bioelectrical impedance analysis client pretesting guidelines[1]˙ . . . . 20

6.1 Comparison of correlation coefficient and standard errors of esti-

mate (SEE) of percentage body fat (%BF) among different body
composition analyzers[1]. . . . . . . . . . . . . . . . . . . . . . . . . . 24

vi
 List of Abbreviations

ADC Analog to Digital Converter

AFE Analog Front End

BI Bioelectric Impedance

BIA Bioelectric Impedance Analysis

BMI Body Mass Index

CG Conductive Gel

DEXA Dual-Energy X-Ray Absorptiometry

SEE Standard Error Estimate

SW Switch

vii
 CHAPTER 1

INTRODUCTION

Amidst a global surge in health consciousness and a growing battle against obe-
sity, there arises a need for innovative tools that seamlessly integrate with modern
lifestyles. Introducing a revolutionary wrist-wearable bioelectrical impedance ana-
lyzer—crafted to meet the evolving health requirements of individuals by offering a
convenient method for monitoring body composition.
In contrast to the widely used Body Mass Index (BMI), The emphasis is on
Bioelectrical Impedance Analysis (BIA), providing a more nuanced understanding
of body composition. BIA distinguishes between fat and muscle mass, offering a
sophisticated perspective on an individual’s fitness journey. However, the challenge
lies in the bulky size and electrode configuration of current BIA devices. This paper
not only delves into the intricacies but proposes a transformative solution. The
objective is to minimize electrode size, enhance device portability, and introduce
user-friendly interfaces. The journey involves an exploration of BIA intricacies, a
critical examination of existing devices, and the unveiling of a paradigm shift in
health monitoring. In a world where every step towards well-being is crucial, this
wrist-wearable bioelectrical impedance analyzer aims to make those steps count.

1
 CHAPTER 2

Literature Survey

The field of bioelectrical impedance measurement faces a persistent challenge in

ensuring accurate readings due to contact resistance, a phenomenon influenced by
electrode characteristics [2]. Introduced in 1963, Thomasset’s two-electrode method
provided simplicity in circuitry but suffered from low accuracy attributed to con-
tact resistance. In response, Hoffer et al. and Nyboer developed the four-electrode
method in the 1960s, aiming to minimize errors arising from contact resistance and
enhance measurement precision [3] [4].
Studies emphasize the critical relationship between electrode size and contact
resistance, with smaller electrodes, essential for certain applications, contributing
to increased contact resistance and potentially affecting impedance measurement
accuracy. Additionally, investigations into the impact of skin conditions on contact
resistance highlight the need for mitigating factors, such as the use of conductive gel
to address skin dryness.
The compromise between electrode size and contact resistance has led to a prefer-
ence for larger electrodes in commercial devices, limiting the feasibility of small-sized
electrodes crucial for wearable applications. Existing literature explores compensa-
tion methods, employing mathematical models and analog front-end (AFE) solutions,
emphasizing the necessity for accurate measurements with smaller electrodes [4].
Experimental validations using electrical circuits and resistors provide insights
into the practical viability of proposed compensation methods. These experiments
assess measurement errors and the effectiveness of compensation methods in con-
trolled settings, contributing to the understanding of the potential applications of
these approaches [3].
Recent technological advances in bioimpedance technology showcase the integra-

2
tion of compensation methods into wearable devices, marking an evolving landscape
in addressing contact resistance. These advancements demonstrate a shift towards
practical applications and the incorporation of compensation methods into real-world
scenarios [1].
In this context, the main paper contributes to the existing body of knowledge by
narrowing its focus on a specific compensation method designed for accurate body
impedance measurement, particularly when utilizing small electrodes. Through a
systematic evaluation, the main paper addresses the specific challenges posed by
contact resistance, providing a novel compensation method [1]. This research aims to
fill existing gaps and further advance the understanding and practical implementation
of compensation methods in bioelectrical impedance measurement[1].

3
 CHAPTER 3

BACKGROUND

3.1 Biology of Body Composition

Understanding the intricacies of body composition involves recognizing the diverse
nature of adipose tissue and its impact on overall health. Adipose tissue, otherwise
known as body fat, is a connective tissue that extends throughout your body. Body
fat is primarily known for storing and releasing energy and providing insulation. it’s
also an active organ in the endocrine system. Adipose tissue contains nerve cells
and blood vessels and communicates through hormone signals with other organs
throughout your body. It has several important functions in regulating whole-body
health. But these can malfunction if you have too much or too little of it.[website]
There are two types of body fat based on their distribution around the body they
are:
Visceral fat: That is fat that’s stored in the abdomen and around all the major
organs, such as the liver, kidneys, pancreas, intestines, and heart. High visceral fat
levels can increase your risk for diabetes, heart disease, stroke, artery disease, and
some cancers.[website]
Subcutaneous Fat: Subcutaneous fat refers to the fat stored under the skin.
It’s the fat that you can squeeze or pinch on your arms, belly, thighs, and buttocks.
A certain amount of subcutaneous fat is normal and healthy, but too much can lead
to imbalanced hormone levels and sensitivity[website]

4
 Figure 3.1: Visceral Fat and Subcutaneous Fat[website]

3.2 BMI and Body Composition

3.2.1 BMI

BMI stands for Body Mass Index, which is a measure of body fat based on height and
weight that applies to adult men and women. It is widely used as a general indicator
of whether a person has a healthy body weight for their height. To calculate your
BMI, you need to divide your weight in kilograms by the square of your height in
meters. The formula is:
weight(kg)
BM I = (3.1)
height(m)2

Limitations of BMI :

While BMI is convenient it has several limitations one major one being it overlooks
the difference between muscle and fat mass leading to inaccuracies in assessing an
individual’s health. Muscle tissues are typically much denser than that of fat as
shown in the image below. This means that a muscular individual can be classified
as obese based on their BMI value while in fact, the individual would be healthy in
reality.

5
 Figure 3.2: 2kg of fat and muscle [website]

3.2.2 Dual-Energy X-Ray Absorptiometry

This above limitation shows us a need for a more sophisticated approach to measuring
a person’s health status based on their muscle and fat mass one such method is dual-
energy X-ray absorptiometry (DEXA).
In DEXA the whole body is scanned using two X-rays of different energies and
based on the absorption rate the body composition is estimated. it’s one of the most
accurate measurements of body composition. However it has limitations like a lack
of portability and the need for sophisticated equipment that requires an expert to
operate, and also it takes time in the range of 30 min.[website]

3.2.3 BIA

Because of the above-mentioned problems with the DEXA, we go for BIA (Bioelec-
trical Impedance Analysis). It works by running a weak electric current through the
body and measuring the voltage to calculate the impedance (resistance and reac-
tance) of the body. Since most body water is stored in muscle, a person with more
muscle will have lower impedance. This value is then used to estimate the body com-
position ie fat mass, muscle mass, and total body water by considering additional
information like age, gender, height and weight.

6
 Figure 3.3: DEXA Apparatus[website]

Advantages of Bioelectrical Impedance Analysis (BIA) Over DEXA:

• Portability:

BIA: Portable devices, like the one discussed, allow for convenient daily use,
integrating body composition monitoring into routines.

DEXA: Bulky machines in clinical settings limit accessibility and regular monitor-
ing.

• Speed of Measurement:

BIA: Rapid assessment (approximately 7 seconds) suits busy lifestyles, facili-

tating effective tracking of body composition changes.

DEXA: Longer scan durations are less suitable for frequent measurements, poten-
tially hindering regular use

• User-Friendly Approach:

BIA: Wrist-wearable device with a user-friendly graphical interface simplifies

the measurement process, promoting adherence.

DEXA: Involves a more complex process, including lying on a specialized scan-

ning table, potentially affecting user-friendliness and frequency of mea-
surements.

7
 Figure 3.4: Picture of Omron HBF-306[website]

3.2.4 Omron HBF-306

The Omron HBF-306 stands as a commercial device utilizing Bioelectrical Impedance

Analysis (BIA) for assessing body composition. However, its accuracy is compro-
mised by the inherent challenge of contact resistance between the skin and elec-
trodes. Despite efforts to use larger electrodes, the Omron HBF-306 continues to
face challenges in providing highly accurate results.[website]

8
 CHAPTER 4

METHODOLOGY

The focal challenge addressed in this study revolves around the conundrum of contact
resistance in bioelectrical impedance analysis. The overarching objective is to dimin-
ish contact resistance without resorting to the conventional approach of increasing
electrode area.
Given the critical need for small electrodes in wearable devices, the study aims
to pioneer more effective solutions. By navigating the intricate interplay between
electrode size and skin conditions, the methodology charts a course toward a break-
through in accurately measuring body impedance.

4.1 Wrist-wearable bioelectrical impedance analyzer

In the paper the researchers developed a wristwatch-style bioelectrical impedance
analyzer for easy single-finger measurements, specifically using the index finger. The
device features two pairs of electrodes: one set (current electrode: 64 mm²; voltage
electrode: 64 mm²) for wrist contact, and another (current electrode: 34 mm²; volt-
age electrode: 64 mm²) for the index finger, as illustrated in Fig. 3.1. This device
boasts smaller electrodes (196 mm²) compared to traditional counterparts like the
Omron HBF-306 (5600 mm²). However, the reduction in electrode size introduces
increased contact resistance, a challenge we address in our design.

4.2 Contact Resistance

Contact resistance is a big problem in bioelectrical research. It refers to electrical
impedance and depends on the electrode area and the resistivity at the electrode-

9
Figure 4.1: Watch-type BIA device ( There are four electrodes i.e., two wrist and finger
electrodes).[1]

Figure 4.2: Bioelectrical impedance measurement using single-finger [1]

10
to-skin interface. There are two configurations of electrodes for measuring bio-
impedance: the two-electrode method and the four-electrode method. The two-
electrode method uses a single pair of electrodes to apply a current and measure
the voltage drop along them. This method has the advantage of a simple circuit
and system structure due to the small number of electrodes involved, but it suffers
from low accuracy due to contact resistance. The four-electrode method uses two
pairs of electrodes and separates current-applying electrodes from voltage-measuring
electrodes.
To study the impact of electrode size and state of the skin and electrode, contact
resistance and body impedance were measured with several electrode sizes (10×8
mm2 , 8×5 mm2 , and 5×4 mm2 ) and for two skin surface states (without conductive
gel and with conductive gel). The conductive gel fills the gaps between the skin and
the electrode, thus reducing skin contact resistance effectively. The measurement
was conducted using a prototype BI measurement system with the four-electrode
method.
As shown in figure 4.3 contact resistance increases as electrode size decreases and
skin dryness increases. As a result, the measured impedance has a different value
from the actual one and propagates into the estimated percentage of body fat value.
To solve this problem, most commercial devices adopt large electrodes. However, for
a wearable device, the small size of electrodes is essential, so more effective solutions
for accurately measuring body impedance with small electrodes are required[1].

4.3 Contact resistance compensation

For the contact compensation function, we first consider the two modes for measuring
body impedance they are the 4-electrode and the 2-electrode method figure 4.3 a
and b show the block diagram of analog front-end (AFE) with contact resistance
compensation function

11
Figure 4.3: . Contact resistance vs. electrode area and state of skin–electrode contact
interface (CG conductive gel, w/o without, w/ with).[1]

12
Figure 4.4: Contact resistance compensation method. (a) 4-point measurement mode, (b)
2-point measurement mode .[1]

13
 In the 4-point measurement mode, the voltage drop on the two voltage electrodes
was measured while applying an electrical current through the two current electrodes.
Assuming the size ratio of voltage to the current electrode as , and the size ratio of
finger to wrist electrode as , in Fig. 3a, the load impedance detected by the current
source can be expressed by Eq. (4.1)[1]

1
RL = α(β + 1)Rc + 1 1
+
|Zbody | (β+1)Rc +|Zi |

(4.1)

|Zbody | is the measured impedance; |Zi | is the input impedance of the voltmeter,
and Rc is the contact resistance.
The electric current of the current source (Is ) is divided into two parallel branches,
namely the internal resistance (I1 ) loop and the external loop (I2 ). The current
through the external current loop is calculated as Eq. (4.2)[1]:

Rs Rs
I2 = Is × = Is × 1 (4.2)
Rs + RL Rs + α(β + 1)Rc + 1
+ 1
|Zbody | (β+1)Rc +|Zi |

For a finite |Zi ,|, this current (I2 ) is also divided into |Zb ody| and |Zi |. The voltage
meter measures the voltage drop of |Zi |, which can be expressed as Eq. (4.3)[1]:

 
|Zbody |
VM = |Zi | × I2 ×
(β + 1) Rc + |Zi | + |Zbody |
|Zbody | Rs
= Is × |Zi | × × 1
(β + 1) Rc + |Zi | + |Zbody | Rs + α (β + 1) Rc + 1
+ 1
|Zbody | (β+1)Rc +|Zi |

(4.3)
Since the measured voltage (Vm ) and source current (Is ) are known, impedance in

14
the 4-point measurement mode can be represented as Eq. (4.4)[1]:

   
VM 1 Rs
|Z4p | = = |Zbody |× × 
|Zbody |+(β+1)Rc 1
Is Rs + α(β + 1)Rc +
 
1 1
1+ +
|Zi | |Zbody | (β+1)Rc +|Zi |

(4.4)
where |Z4 p| is the measured 4-point impedance, |Zb ody| is the body impedance
to be determined, |Zi | is the input impedance of the voltmeter, Rs is the output
impedance of the current source, and Rc is the contact resistance, also to be de-
termined. |Zi | and Rs are known values from instrument providers. The first
square bracket in Eq. (4.4) shows the effect of contact resistance at the voltage
electrodes. When the voltmeter has a finite input impedance (|Zi |), the measured
4-point impedance decreases with an increase in contact resistance due to the voltage
drop at the voltage electrodes. The second square bracket in Eq. (4.4) shows the
effect of contact resistance at the current electrodes. When the current source has a
finite output impedance (Rs ), the measured 4-point impedance also decreases with
the increase in contact resistance due to the decrease in current flow into the human
body[1].
In the 2-point measurement mode, voltage and current electrodes on the same
side are electrically connected with internal analog switches, so that four electrodes
can be operated as two electrodes. The measured 2-point impedance (|Z2 |) can be
expressed by Eq. (4.5)[1]:

1
|Z2p | = 1 1 1 (4.5)
+ +
|Zbody |+ α(β+1)
α+1
Rc |Zi | Rs

Because there are two equations (Eq. (4.4) and (4.5)) and two unknown quan-
tities (|Zbody | and Rc ), body impedance can be determined independent of contact
resistance as Eq. (4.6):

α+1
θ + |Zi | α+1



2α 2
θ + Rs
|Zbody | = |Z4p |  
(α+1)2 Rs
|Z4p | θ + α |Zi | + + |Zi | Rs
2α α
(4.6)
2
θ= 1 1 1
|Z2p |
− |Zi |
− Rs

The researchers performed an experiment to verify the proposed method by using

15
Figure 4.5: contact resistance compensation effect. (|Zbody |=1 kΩ, |Zi |=2 MΩ, Rs=50
kΩ). The max measurement error for contact resistance compensation 0.5%, for tradi-
tional 4-point measurement 11.2%[1]

a simple electrical circuit. Discrete resistors were used to model body impedance and
contact resistance. The resistance value of the model for body impedance (|Zbody |) was
fixed at 1000 Ω. Figure 4.4 shows the variation of measured impedance values before
and after contact resistance compensation when the contact resistance varied from
0 to 3 k . The maximum measurement error after contact resistance compensation
was reduced to about 0.5%, whereas the conventional 4-point measurement had an
error as large as 11.2%[1].

16
 CHAPTER 5

EXPERIMENTAL SETUP AND TESTING

5.1 Hardware setup

Figure 5.1: Hardware Setup[1]

(a) Hardware block diagram of the overall system, (b) current path for 4-point
measurement mode, and (c) current path for 2-point measurement mode. Zbody
measured impedance, Zi input impedance of the voltmeter, Rs output impedance
of the current source, Rc contact resistance, I current, VM measured voltage, SW
switch, the size ratio of voltage to current electrode, the size ratio of finger to
wrist electrode.

The electrode’s part is composed of two current-driving electrodes and two voltage-
sensing electrodes. The total area of finger electrodes (a pair of one current electrode
and one voltage electrode on the top side of the device) was 68 mm2 and that of wrist

17
electrodes (another pair of one current electrode and one voltage electrode on the
bottom side of the device) was 128 mm2. The AFE (S3FBP5A, BioProcessor2, Sam-
sung Electronics) delivers 30 A sinusoidal alternating current with 50 kHz frequency
to the two current electrodes and measures voltage drop between the two voltage
electrodes. Acquired voltage values were converted to a digital signal by analogue-
to-digital converter (ADC), and this digital code was converted to impedance value
with a calibration curve which had been made by the calibration process. The in-
ternal microcontroller unit of BioProcessor2 calculated body fat, lean body mass,
and body water volume using impedance data and user profile information such as
height, age, weight, and gender. The measured data was displayed on a liquid crys-
tal display. Bluetooth was used for data transfer between a body fat analyzer and a
personal computer, and external flash memory was used for user data storage[1].
The contact resistance compensation function was adapted to our bioelectrical
impedance analyzer. The contact resistance compensation circuit included two analog
switches. One analog switch was connected between the current and voltage path of
the finger electrodes, and the other was connected between the current and voltage
path of the wrist electrodes. For the 4-point measurement mode, analog switches
were turned off, and for the 2-point measurement mode, analog switches were turned
on for the electrical connection of each voltage and current electrode pair. This very
simple and small compensation circuit had a flexibility that allowed easy adaptation
to variable AFEs[1].
Figure 5.2 shows the measurement procedure and corresponding graphical user
interface of the wrist-wearable device. On the home screen, a user can register infor-
mation (gender, age, height, and weight) by touching the [CHG INFO] icon. If the
user is already registered on the device, the registration process can be skipped by
touching the [USER] icon. The measurement is initiated by touching the [START]
icon. When the proper posture is maintained, BIA measurement begins automati-
cally. It takes about 7 s to complete the test: 3 s for 4-point measurement, 1 s for
measurement mode change, and 3 s for 2-point measurement. When the measure-
ment is completed, the percentage of body fat, lean mass, and basal metabolic rate
are shown on the screen[1].

18
Figure 5.2: Measurement procedure and corresponding graphical user interface of the
wrist-wearable bioelectrical impedance analyser[1]

5.2 Clinical test

To evaluate the accuracy of the bioelectrical impedance analyzer, a clinical test
was conducted on 203 volunteers who were recruited at Seoul St. Mary’s Hospi-
tal. The study population consisted of 18–68-year-old healthy male (n=101) and
female (n=102) volunteers. Participants were recruited to have as uniform distribu-
tions as possible on the basis of gender, age, and body mass index (BMI). Ages were
divided into 6 groups (18 and 19, 20–29, 30–39, 40–49, 50–59, and 60–69 years), and
weights were divided into 3 ranges, which are underweight (BMI<18.50 kg/m2), nor-
mal (18.50BMI24.99 kg/m2), and overweight (BMI>25.0 kg/m2)19. Participants’
characteristics are shown in Table 1. The BIA pretesting client guidelines in Table 2
were explained to all volunteers before the clinical test[1].

19
 Table 5.1: Physical characteristics of the subjects[1].

Men (n = 101) Women (n = 102)

Variables
Mean (s.d.) Min–Max Mean (s.d.) Min–Max

Age (years) 38.0 (15.4) 18–66 38.5 (15.9) 18–68

Height (cm) 172.1 (6.0) 155–192 160.4 (5.7) 148–177
BMI (kg/m2 ) 24.0 (3.3) 18–34 22.2 (3.5) 16–31
Weight (kg) 71.3 (11.0) 53–104 57.1 (8.8) 42–83
s.d. standard deviation, BMI body mass index.

Table 5.2: Bioelectrical impedance analysis client pretesting guidelines[1]

# Guidelines

1 No eating or drinking within 4 h of the test

2 No exercise within 12 h of the test
3 Client should urinate within 30 min of the test
4 No alcohol consumption within 48 h of the test
5 No diuretic medications within 7 days of the test
6 No testing of female clients who perceive they are retaining water during that stage of the

Four different devices were used in the clinical test: our wrist-wearable device,
a whole-body composition analyzer (InBody 720), an upper-body portable body fat
analyzer (Omron HBF-306), and a DEXA instrument (GE Lunar Prodigy). The
study was approved by the Institutional Review Board of Seoul St. Mary’s Hospital
(KC15DISI0610), and all experiments were performed in accordance with relevant
guidelines and regulations of the Medical Ethics Committee of Seoul St. Mary’s
Hospital. For the approval of the review board, our bioelectrical impedance analyzer
was registered as a broadcasting and communication equipment (MSIP-REM-SEC-
SAIT-MyLean100) by the Ministry of Science, ICT and Future Planning (MSIP),
Republic of Korea).
Written informed consent was obtained from each volunteer before the clinical
test. To undergo the test, participants changed into a light gown in order to control
the weight of their clothes. All metal items were removed from the participants to
ensure the accuracy of measurement. Then anthropometric measurement was con-
ducted by a skilled nurse. After anthropometric measurement, body impedance and

20
body composition data were measured using the whole-body composition analyzer
and the upper-body portable body fat analyzer. Next, the DEXA instrument was
used to measure the reference body composition. Finally, our wrist-wearable device
was used to measure body impedance.
Statistical analysis was performed after data acquisition. Bioelectrical impedance
equation was derived for our wrist-wearable device: multiple linear regression with
five independent variables (height, age, gender, weight, and height2/impedance) and
one dependent variable (percentage body fat or lean body mass) was conducted using
DEXA as a reference instrument. The accuracy of each device was compared to that
of others[1].

21
 CHAPTER 6

Results

The study explored a novel method that uses considerably small electrodes that can
be adapted into small devices, such as a wristwatch. Figure 6.1 shows the calculated
contact resistance distribution of the study participants. While the average value
was 1808 , it is notable that the maximum value was as high as 6301 [1].

Figure 6.1: Calculated contact resistance distribution among participants in the clinical
test.[1]

Figure 6.2a shows the impedance correlation between this device and the whole-
body composition analyzer. The coefficient of determination (R2) of impedance was
0.7448 (correlation coefficient, R=0.863) for the traditional 4-point measurements
method while R2 after contact resistance compensation was 0.8214 (R=0.906). This

22
result shows that there is a strong correlation for impedance measurements between
the wrist-wearable bioelectrical impedance analyzer and the whole-body bioelectri-
cal impedance analyzer, and the proposed contact resistance compensation method
improves the correlation coefficient effectively.

Figure 6.2: Results and Comparisons [1]

(a) Impedance correlation with contact resistance compensation (blue dots) and
without contact resistance compensation (orange dots). Body fat algorithm
accuracy (n=203) assessment with (b) correlation plot and (c) Bland–Altman plot
between the wrist-wearable bioelectrical impedance analyzer and the reference
instrument (DEXA). DEXA dual-energy X-ray absorptiometry.

Figure 6.2b shows the correlation of percentage body fat measurement between
the wrist-wearable bioelectrical impedance analyzer and the reference instrument
(DEXA), from which it can be seen that R is 0.899 (R2Table 3 shows the com-
parison of accuracy in the measurement of percentage body fat by the whole-body
composition analyzer, the upper-body portable body fat analyzer, and the wrist-

23
wearable bioelectrical impedance analyzer. It is notable that the wrist-wearable
device (R=0.899, SEE=3.8%BF) produced more accurate results than the commer-
cial upper-body portable body fat analyzer (R=0.893, SEE=4.7%BF), more so with
quite a smaller size of electrodes.

Table 6.1: Comparison of correlation coefficient and standard errors of esti-

mate (SEE) of percentage body fat (%BF) among different body composition
analyzers[1].

InBody 720 Omron HBF-306 Wrist-Wearable BIA

R 0.946 0.893 0.899

SEE (%BF) 3.7 4.7 3.8
Measurement Time (s) 150 7 7
Device Type Stationary Handheld Wrist-Wearable

24
 CHAPTER 7

CONCLUSION

The study delves into the examination of an innovative wrist-wearable bioelectrical

impedance analyzer, specifically designed to overcome the challenges posed by contact
resistance when employing electrodes of reduced dimensions (outer electrodes: 68
mm2 ; inner electrodes: 128 mm2 ). The primary objective is to enable accurate
estimation of bioelectrical impedance, even with significantly smaller electrode sizes.
In terms of performance evaluation, the correlation coefficient and the standard
error of estimation (SEE) of percentage body fat in relation to the Dual-Energy X-
ray Absorptiometry (DEXA) instrument were determined. The results revealed a
correlation coefficient of 0.899 and an SEE of 3.8%BF. These metrics surpass the
performance levels achieved by commercial upper-body portable body fat analyzers
.
One notable advantage highlighted in the analysis is the swift measurement time
of the wrist-wearable Bioelectrical Impedance Analysis (BIA) device, clocking in
at a mere 7 seconds. Furthermore, there exists potential for further reduction in
measurement time. This efficiency in data collection positions the sensor technology
as a promising avenue for the development of a wearable bioelectrical impedance
analyzer tailored for daily obesity management.
The implications of this research suggest a paradigm shift in the realm of BIA,
particularly for applications in obesity management. The utilization of miniature
electrodes, coupled with rapid measurement capabilities, not only enhances accuracy
but also opens up new possibilities for convenient and real-time monitoring in daily
life scenarios. The study lays the foundation for future advancements in wearable
health technologies, offering a potential solution for addressing the limitations posed
by electrode size and contact resistance in bioelectrical impedance measurement[1].

25
 BIBLIOGRAPHY

[1] Kim, J., Lee, J., Kim, S., Lee, J., Kim, J., and Kim, S. (2021). Wrist-wearable bio-
electrical impedance analyzer with miniature electrodes for daily obesity manage-
ment. Scientific Reports, 11(1), 1-12. https://doi.org/10.1038/s41598-020-79667-3

[2] Thomasset, A. Bio-electrical properties of tissue impedance measurements. Lyon

Med. 94, 107–118 (1962).

[3] Hoffer, E. C., Meador, C. K. & Simpson, D. C. Correlation of whole-body

impedance with total body water volume. J. Appl. Physiol. 27, 531–534 (1969).

[4] Nyboer, J. Electrical Impedance Plethysmography. (Springfield, 1970).

[5] Kim, J., Lee, J., Kim, S., Lee, J., Kim, J., and Kim, S. (2016). Wrist-wearable
bioelectrical impedance analyzer with contact resistance compensation function.
In 2016 IEEE Biomedical Circuits and Systems Conference (BioCAS) (pp. 352-
355). IEEE. https://doi.org/10.1109/BioCAS.2016.7833887

[6] Bera, T. K. Bioelectrical impedance and the frequency dependent current con-
duction through biological tissues: a short review. In IOP Conf. Ser. Mater. Sci.
Eng. 331, 012005 (2018)

[7] Bogónez-Franco, P. et al. Effect of electrode contact impedance mismatch on 4-

electrode measurements of small body segments using commercial BIA devices.
20th IMEKO TC4 International Symposium and 18th International Workshop
on ADC Modelling and Testing. 895–899 (2014).

[8] Ramel, A., Geirsdottir, O. G., Arnarson, A. & Thorsdottir, I. Regional and total
body bioelectrical impedance analysis compared with DXA in Icelandic elderly.
Eur. J. Clin. Nutr. 65, 978–983 (2011)

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[9] Aldosky, H. Y. Y., Yildiz, A. & Hussein, H. A. Regional body fat distribution
assessment by bioelectrical impedance analysis and its correlation with anthro-
pometric indices. Phys. Med. 5, 15–19 (2018).

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