Skip to main content
SpringerLink
Log in

Agreement Between Body Composition Assessed by Bioelectrical Impedance Analysis and Doubly Labeled Water in Obese Women Submitted to Bariatric Surgery

Body Composition, BIA, and DLW

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

A Correction to this article was published on 03 October 2018

This article has been updated

Abstract

Introduction

Bariatric surgery has a significant influence on body composition (BC), which should be monitored. However, there is a need to recommend low-cost practical methods, with good estimation of BC for class III obese and/or bariatric patients.

Objective

The aim of this study was to determine accuracy and agreement between BC assessed by direct segmental multifrequency bioelectrical impedance analysis (DSM-BIA) and doubly labeled water (DLW) as reference method.

Material and Methods

Twenty class III obese women (age 29.3 ± 5.1 years; body mass index 44.8 ± 2.4 kg/m2) underwent Roux-en-Y gastric bypass surgery. BC (fat mass [FM], fat-free mass [FFM], and total body water [TBW]) was assessed by InBody 230 and DLW in the following periods: before and 6 and 12 months after surgery. Accuracy between the methods was evaluated by the bias and root mean square error. Pearson’s correlation, concordance correlation coefficient (CCC), and Bland-Altman method were used to evaluate agreement between the methods.

Results

Correlations were significant (p < 0.001) and CCC was good/excellent between both methods for the evaluation of FM (r = 0.84–0.92, CCC = 0.84–0.95), FFM (r = 0.73–0.90, CCC = 0.68–0.80), and TBW (r = 0.76–0.91, CCC = 0.72–0.81) before and after bariatric surgery. In addition, no significant bias was observed between DSM-BIA and DLW for FM (mean error [ME] = − 1.40 to 0.06 kg), FFM (ME = 0.91–1.86 kg), and TBW (ME = 0.71–1.24 kg) measurements.

Conclusion

The DSM-BIA was able to estimate the BC of class III obese women submitted to bariatric surgery with values consistent with those of the DLW method.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Change history

  • 03 October 2018

    The name of author Michele Novaes Ravelli was misspelled in the original article – it is correct here.

References

  1. Palazuelos-Genis T, Mosti M, Sánchez-Leenheer S, et al. Weight loss and body composition during the first postoperative year of a laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2008;18(1):1–4.

    Article  Google Scholar 

  2. Graziany R, De Souza M, Gomes AC, et al. Methods for body composition analysis in obese adults. Rev Nutr. 2014;27(5):569–83. https://doi.org/10.1590/1415-52732014000500006.

    Article  Google Scholar 

  3. Carey DG, Pliego GJ, Raymond RL. Body composition and metabolic changes following bariatric surgery: effects on fat mass, lean mass and basal metabolic rate: six months to one-year follow-up. Obes Surg. 2006;16(12):1602–8.

    Article  Google Scholar 

  4. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37. https://doi.org/10.1001/jama.292.14.1724.

    Article  CAS  PubMed  Google Scholar 

  5. Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes—3-year outcomes. N Engl J Med. 2014;370(21):2002–13. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5451259/

    Article  Google Scholar 

  6. Buchowski MS. Doubly labeled water is a validated and verified reference standard in nutrition research. J Nutr. 2014;144(5):573–4.

    Article  CAS  Google Scholar 

  7. Bluck L, Forsum E, Hills A, et al. Assessment of body composition and total energy expenditure in humans using stable isotope technique. IAEA Hum Heal Ser. 2009;3(3):133.

    Google Scholar 

  8. Kyle UG, Bosaeus I, De Lorenzo AD, et al. Bioelectrical impedance analysis—part I: review of principles and methods. Clin Nutr. 2004;23(5):1226–43.

    Article  Google Scholar 

  9. Andreoli A, Garaci F, Cafarelli FP, et al. Body composition in clinical practice. Eur J Radiol. 2016;85(8):1461–8. https://doi.org/10.1016/j.ejrad.2016.02.005.

    Article  PubMed  Google Scholar 

  10. Mialich MS, Maria J, Sicchieri F, et al. Analysis of body composition: a critical review of the use of bioelectrical impedance analysis. Int J Clin Nutr. 2014;2(1):1–10.

    Google Scholar 

  11. de Cleva R. Body composition evaluation in severe obesity: a critical review. Adv Obesity, Weight Manag Control [Internet]. 2016;4(6). Available from: http://medcraveonline.com/AOWMC/AOWMC-04-00113.php

  12. Stoklossa CAJ, Forhan M, Padwal RS, et al. Practical considerations for body composition assessment of adults with class II/III obesity using bioelectrical impedance analysis or dual-energy X-ray absorptiometry. Curr Obes Rep. 2016;5(4):389–96. Available from: http://link.springer.com/10.1007/s13679-016-0228-5

    Article  Google Scholar 

  13. Nicoletti CF, Camelo JS, Dos Santos JE, et al. Bioelectrical impedance vector analysis in obese women before and after bariatric surgery: changes in body composition. Nutrition. 2014;30(5):569–74.

    Article  Google Scholar 

  14. Dixon JB, Bhasker AG, Lambert GW, et al. Leg to leg bioelectrical impedance analysis of percentage fat mass in obese patients. Can it tell us more than we already know? Surg Obes Relat Dis. 2016;12(7):1397–402. https://doi.org/10.1016/j.soard.2016.01.027.

    Article  PubMed  Google Scholar 

  15. Ramírez E, Valencia M, Bourges H, et al. Body composition prediction equations based on deuterium oxide dilution method in Mexican children: a national study. Eur J Clin Nutr. 2012;66(February):1–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22805494

    Google Scholar 

  16. Lara J, Johnstone AM, Wells J, et al. Accuracy of aggregate 2- and 3-component models of body composition relative to 4-component for the measurement of changes in fat mass during weight loss in overweight and obese subjects. Appl Physiol Nutr Metab. 2014;39(8):871–9. Available from: http://search.ebscohost.com/login.aspx?direct=true&db=sph&AN=97252146&site=ehost-live&scope=cite

    Article  Google Scholar 

  17. Strain GW, Wang J, Gagner M, et al. Bioimpedance for severe obesity: comparing research methods for total body water and resting energy expenditure. Obesity (Silver Spring). 2008;16(8):1953–6.

    Article  Google Scholar 

  18. Widen EM, Strain G, King WC, et al. Validity of bioelectrical impedance analysis for measuring changes in body water and percent fat after bariatric surgery. Obes Surg. 2014;24(6):847–54.

    Article  Google Scholar 

  19. Savastano S, Belfiore A, Di Somma C, et al. Validity of bioelectrical impedance analysis to estimate body composition changes after bariatric surgery in premenopausal morbidly women. Obes Surg. 2010;20(3):332–9.

    Article  Google Scholar 

  20. Vassilev G, Hasenberg T, Krammer J, et al. The phase angle of the bioelectrical impedance analysis as predictor of post-bariatric weight loss outcome. Obes Surg. 2017;27(3):665–9.

    Article  Google Scholar 

  21. Strain GW, Ebel F, Honohan J, et al. Fat-free mass is not lower 24 months postbariatric surgery than nonoperated matched controls. Surg Obes Relat Dis. 2017;13(1):65–9. https://doi.org/10.1016/j.soard.2016.03.003.

    Article  PubMed  Google Scholar 

  22. O’Neill D. Measuring obesity in the absence of a gold standard. Econ Hum Biol. 2015;17(June 2013):116–28. https://doi.org/10.1016/j.ehb.2015.02.002.

    Article  PubMed  Google Scholar 

  23. Schoeller DA. Measurement of energy expenditure in free-living humans by using doubly labeled water. J Nutr. 1988;118(11):1278–89. Available from: http://jn.nutrition.org/content/118/11/1278.short

    Article  CAS  Google Scholar 

  24. Lin LI. A concordance correlation coefficient to evaluate reproducibility. Biometrics. 1989;45(1):255–68.

    Article  CAS  Google Scholar 

  25. Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res. 1999;8(2):135–60. Available from: http://smm.sagepub.com/cgi/doi/10.1191/096228099673819272

    Article  CAS  Google Scholar 

  26. Sheiner LB, Beal SL. Some suggestions for measuring predictive performance. J Pharmacokinet Biopharm. 1981 Aug;9(4):503–12.

    Article  CAS  Google Scholar 

  27. Carvajal C, Savino P, Ramirez A, et al. Anthropometric assessment for bariatric procedures in the private practice of a registered dietitian in Colombia. Obes Surg. 2017;27(6):1612–21.

    Article  Google Scholar 

  28. Dagan SS, Goldenshluger A, Globus I, et al. Nutritional recommendations for adult bariatric surgery patients: clinical practice. Adv Nutr An Int Rev J. 2017;8(2):382–94.

    Article  CAS  Google Scholar 

  29. Kaido T, Uemoto S. Direct segmental multi-frequency bioelectrical impedance analysis is useful to evaluate sarcopenia. Am J Transplant. 2013;13(9):2506–7.

    Article  CAS  Google Scholar 

  30. Karelis AD, Chamberland G, Aubertin-Leheudre M, et al. Validation of a portable bioelectrical impedance analyzer for the assessment of body composition. Appl Physiol Nutr Metab. 2013;38(1):27–32. Available from: http://www.nrcresearchpress.com/doi/10.1139/apnm-2012-0129

    Article  Google Scholar 

  31. Faria SL, Faria OP, Cardeal MDA, et al. Validation study of multi-frequency bioelectrical impedance with dual-energy X-ray absorptiometry among obese patients. Obes Surg. 2014;24(9):1476–80.

    Article  Google Scholar 

  32. Verney J, Metz L, Chaplais E, et al. Bioelectrical impedance is an accurate method to assess body composition in obese but not severely obese adolescents. Nutr Res. 2016;36(7):663–70. https://doi.org/10.1016/j.nutres.2016.04.003.

    Article  CAS  PubMed  Google Scholar 

  33. de Faria ER, de Faria FR, Gonçalves VSS, et al. Prediction of body fat in adolescents: comparison of two electric bioimpedance devices with dual-energy X-ray absorptiometry. Nutr Hosp. 2014;30(6):1270–8.

    PubMed  Google Scholar 

  34. Snijder MB, van Dam RM, Visser M, et al. What aspects of body fat are particularly hazardous and how do we measure them? Int J Epidemiol. 2006;35(1):83–92.

    Article  CAS  Google Scholar 

  35. Ward LCC. Bioelectrical impedance validation studies: alternative approaches to their interpretation. Eur J Clin Nutr. 2013;67(S1):S10–3. https://doi.org/10.1038/ejcn.2012.159.

    Article  PubMed  Google Scholar 

  36. Kutac P, Kopecky M. Comparison of body fat using various bioelectrical impedance analyzers in university students. Acta Gymnica. 2015;45(4):177–86. Available from: http://gymnica.upol.cz/doi/10.5507/ag.2015.021.html

    Article  Google Scholar 

  37. Park KS, Lee DH, Lee J, et al. Comparison between two methods of bioelectrical impedance analyses for accuracy in measuring abdominal visceral fat area. J Diabetes Complicat. 2016;30(2):343–9. https://doi.org/10.1016/j.jdiacomp.2015.10.014.

    Article  PubMed  Google Scholar 

  38. LaForgia J, Dollman J, Dale MJ, et al. Validation of DXA body composition estimates in obese men and women. Obesity. 2012;17(4):821–6. https://doi.org/10.1038/oby.2008.595.

    Article  Google Scholar 

  39. Das SK, Roberts SB, Kehayias JJ, et al. Body composition assessment in extreme obesity and after massive weight loss induced by gastric bypass surgery. Am J Physiol - Endocrinol Metab. 2003;284(6):E1080–8.

    Article  CAS  Google Scholar 

  40. Levitt DG, Beckman LM, Mager JR, et al. Comparison of DXA and water measurements of body fat following gastric bypass surgery and a physiological model of body water, fat, and muscle composition. J Appl Physiol. 2010;109(3):786–95. Available from: http://jap.physiology.org/cgi/doi/10.1152/japplphysiol.00278.2010

    Article  Google Scholar 

  41. Ravelli MN, Schoeller DA, Crisp AH, et al. Accuracy of total energy expenditure predictive equations after a massive weight loss induced by bariatric surgery. Clin Nutr ESPEN. 2018;26:57–65. https://doi.org/10.1016/j.clnesp.2018.04.013.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara-Jaú Road, km 01, s/n, Araraquara, SP, 14800-903, Brazil

    Gabriel Cunha Beato

  2. Institute of Biosciences, São Paulo State University (UNESP), Antônio Celso Wagner Zanin, 250, Botucatu, SP, 18618-689, Brazil

    Michele Novais Ravelli

  3. Methodist University of Piracicaba, Sugar Road, Km 156, Taquaral, Piracicaba, SP, 13400-911, Brazil

    Alex Harley Crisp

  4. Department of Education, Institute of Biosciences, São Paulo State University (UNESP), Antônio Celso Wagner Zanin, 250, Botucatu, SP, 18618-689, Brazil

    Maria Rita Marques de Oliveira

Authors
  1. Gabriel Cunha Beato
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michele Novais Ravelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alex Harley Crisp
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maria Rita Marques de Oliveira
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gabriel Cunha Beato.

Ethics declarations

The study protocol was approved by the Ethical Committee of the Medical School of Botucatu of the State University of São Paulo, UNESP. Informed consent was obtained from all participants included in the study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of Interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Beato, G.C., Ravelli, M.N., Crisp, A.H. et al. Agreement Between Body Composition Assessed by Bioelectrical Impedance Analysis and Doubly Labeled Water in Obese Women Submitted to Bariatric Surgery. OBES SURG 29, 183–189 (2019). https://doi.org/10.1007/s11695-018-3505-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-018-3505-4

Keywords

Search

Navigation