Skip to main content
Log in

Body composition, energy expenditure and physical activity

Body weight difference between dual-energy X-ray absorptiometry and multi-frequency bioelectrical impedance analysis attenuates the equivalence of body-composition assessment

  • Article
  • Published:
European Journal of Clinical Nutrition Submit manuscript



Low agreement of body-composition analysis (BCA) using dual-energy X-ray absorptiometry (DXA) and multi-frequency bioelectrical impedance analysis (MF-BIA) has been reported. We examined whether this discrepancy is influenced by the precision of body weight (BW) measurement using DXA.


This cross-sectional study enrolled 1353 participants aged 53–83 years. A whole-body DXA scan and an eight-polar tactile-electrode impedance-meter using four electronic frequencies of 5, 50, 250, and 500 kHz were employed for BCA. The level of agreement between BW estimated using DXA and actual BW (WgtA) was calculated. The agreement of BCA parameters using DXA and MF-BIA across WgtA groups was also assessed.


DXA incorrectly estimated BW, especially in men. In total, 13.5%, 5.1%, and 5.6% of the participants had BW bias levels of 2%, 3%, and ≥4%, respectively. Correlations of BCA parameters measured using DXA and MF-BIA, including body fat mass, percent body fat, and lean body mass (LBM), were gradually reduced, whereas the root mean square error was increased in accordance with the reduction in WgtA. DXA provided a lower LBM amount compared to MF-BIA and this difference increased significantly across groups with poor WgtA.


Lower WgtA greatly contributed to the difference in BCA measured using DXA and MF-BIA.

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

Access this article

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

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others


  1. Dulloo AG, Jacquet J, Solinas G, Montani JP, Schutz Y. Body composition phenotypes in pathways to obesity and the metabolic syndrome. Int J Obes. 2010;34(Suppl 2):S4–17.

    Article  Google Scholar 

  2. Lukaski HC. Evolution of bioimpedance: a circuitous journey from estimation of physiological function to assessment of body composition and a return to clinical research. Eur J Clin Nutr. 2013;67(Suppl 1):S2–9.

    Article  Google Scholar 

  3. Lloyd LJ, Langley-Evans SC, McMullen S. Childhood obesity and risk of the adult metabolic syndrome: a systematic review. Int J Obes. 2012;36:1–11.

    Article  CAS  Google Scholar 

  4. Manolopoulos KN, Karpe F, Frayn KN. Gluteofemoral body fat as a determinant of metabolic health. Int J Obes. 2010;34:949–59.

    Article  CAS  Google Scholar 

  5. Muller MJ, Lagerpusch M, Enderle J, Schautz B, Heller M, Bosy-Westphal A. Beyond the body mass index: tracking body composition in the pathogenesis of obesity and the metabolic syndrome. Obes Rev. 2012;13(Suppl 2):6–13.

    Article  Google Scholar 

  6. Phillips CM, Tierney AC, Perez-Martinez P, Defoort C, Blaak EE, Gjelstad IM, et al. Obesity and body fat classification in the metabolic syndrome: impact on cardiometabolic risk metabotype. Obesity. 2013;21:E154–61.

    Article  CAS  Google Scholar 

  7. Toombs RJ, Ducher G, Shepherd JA, De Souza MJ. The impact of recent technological advances on the trueness and precision of DXA to assess body composition. Obesity. 2012;20:30–9.

    Article  Google Scholar 

  8. Plank LD. Dual-energy X-ray absorptiometry and body composition. Curr Opin Clin Nutr Metab Care. 2005;8:305–9.

    Article  Google Scholar 

  9. Ward LC. Segmental bioelectrical impedance analysis: an update. Curr Opin Clin Nutr Metab Care. 2012;15:424–9.

    Article  Google Scholar 

  10. Kim H, Kim CH, Kim DW, Park M, Park HS, Min SS, et al. External cross-validation of bioelectrical impedance analysis for the assessment of body composition in Korean adults. Nutr Res Pract. 2011;5:246–52.

    Article  Google Scholar 

  11. Ling CH, de Craen AJ, Slagboom PE, Gunn DA, Stokkel MP, Westendorp RG, et al. Accuracy of direct segmental multi-frequency bioimpedance analysis in the assessment of total body and segmental body composition in middle-aged adult population. Clin Nutr. 2011;30:610–5.

    Article  Google Scholar 

  12. Demura S, Sato S, Kitabayashi T. Percentage of total body fat as estimated by three automatic bioelectrical impedance analyzers. J Physiol Anthropol Appl Human Sci. 2004;23:93–9.

    Article  Google Scholar 

  13. Sun G, French CR, Martin GR, Younghusband B, Green RC, Xie YG, et al. Comparison of multifrequency bioelectrical impedance analysis with dual-energy X-ray absorptiometry for assessment of percentage body fat in a large, healthy population. Am J Clin Nutr. 2005;81:74–8.

    Article  CAS  Google Scholar 

  14. Talma H, Chinapaw MJ, Bakker B, HiraSing RA, Terwee CB, Altenburg TM. Bioelectrical impedance analysis to estimate body composition in children and adolescents: a systematic review and evidence appraisal of validity, responsiveness, reliability and measurement error. Obes Rev. 2013;14:895–905.

    Article  CAS  Google Scholar 

  15. Arngrimsson S, Evans EM, Saunders MJ, Ogburn CL 3rd, Lewis RD, Cureton KJ. Validation of body composition estimates in male and female distance runners using estimates from a four-component model. Am J Hum Biol. 2000;12:301–14.

    Article  Google Scholar 

  16. Deurenberg-Yap M, Schmidt G, van Staveren WA, Hautvast JG, Deurenberg P. Body fat measurement among Singaporean Chinese, Malays and Indians: a comparative study using a four-compartment model and different two-compartment models. Br J Nutr. 2001;85:491–8.

    Article  CAS  Google Scholar 

  17. Schoeller DA, Tylavsky FA, Baer DJ, Chumlea WC, Earthman CP, Fuerst T, et al. QDR 4500A dual-energy X-ray absorptiometer underestimates fat mass in comparison with criterion methods in adults. Am J Clin Nutr. 2005;81:1018–25.

    Article  CAS  Google Scholar 

  18. Goran MI, Driscoll P, Johnson R, Nagy TR, Hunter G. Cross-calibration of body-composition techniques against dual-energy X-ray absorptiometry in young children. Am J Clin Nutr. 1996;63:299–305.

    Article  CAS  Google Scholar 

  19. Kim Y, Han BG, KoGES group. Cohort profile: The Korean Genome and Epidemiology Study (KoGES) Consortium. Int J Epidemiol. 2016;46:e20.

  20. Fisher RA. On the probable error of a coefficient of correlation deduced from a small sample. Metron. 1921;1:3–32.

  21. Sillanpaa E, Cheng S, Hakkinen K, Finni T, Walker S, Pesola A, et al. Body composition in 18- to 88-year-old adults--comparison of multifrequency bioimpedance and dual-energy X-ray absorptiometry. Obesity. 2014;22:101–9.

    Article  Google Scholar 

  22. Blaak E. Gender differences in fat metabolism. Curr Opin Clin Nutr Metab Care. 2001;4:499–502.

    Article  CAS  Google Scholar 

  23. Leahy S, O’Neill C, Sohun R, Jakeman P. A comparison of dual energy X-ray absorptiometry and bioelectrical impedance analysis to measure total and segmental body composition in healthy young adults. Eur J Appl Physiol. 2012;112:589–95.

    Article  Google Scholar 

  24. Van Der Ploeg GE, Withers RT, Laforgia J. Percent body fat via DEXA: comparison with a four-compartment model. J Appl Physiol. 2003;94:499–506.

    Article  Google Scholar 

  25. Krueger D, Vallarta-Ast N, Checovich M, Gemar D, Binkley N. BMD measurement and precision: a comparison of GE Lunar Prodigy and iDXA densitometers. J Clin Densitom. 2012;15:21–5.

    Article  Google Scholar 

  26. Malouf J, DiGregorio S, Del Rio L, Torres F, Marin AM, Farrerons J, et al. Fat tissue measurements by dual-energy x-ray absorptiometry: cross-calibration of 3 different fan-beam instruments. J Clin Densitom. 2013;16:212–22.

    Article  Google Scholar 

  27. Anderson LJ, Erceg DN, Schroeder ET. Utility of multifrequency bioelectrical impedance compared with dual-energy x-ray absorptiometry for assessment of total and regional body composition varies between men and women. Nutr Res. 2012;32:479–85.

    Article  CAS  Google Scholar 

Download references


This research was supported by a fund (2014-E71003-00) from the research of Korea Centers for Disease Control and Prevention and the Bio & Medical Technology Development Program of the National Research Foundation (NRF) funded by the Ministry of Science, ICT & Future Planning (Nos. 10068076, 2014M3A9D7034366, 2015M3A9B6028310).

Author contributions

CS, SKL, and NHK designed and supervised the Korean Genome and Epidemiology Study (KoGES), defined the research theme and edited the manuscript. DDP and CHL designed the methods, analyzed the data, interpreted the results, and wrote the manuscript. All authors read and approved the final manuscript.

Author information

Authors and Affiliations


Corresponding authors

Correspondence to Chol Shin or Chae Hun Leem.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Electronic supplementary material

Table 1S. Correlation between the difference in body weight measured by DXA and MF-BIA and anthropometric indices


Table 1S. Comparison of difference in body composition analysis (BCA) by DXA versus MF-BIA of Shillanpaa et al and of the BW matched group in the current study

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pham, D.D., Lee, S.K., Shin, C. et al. Body weight difference between dual-energy X-ray absorptiometry and multi-frequency bioelectrical impedance analysis attenuates the equivalence of body-composition assessment. Eur J Clin Nutr 73, 387–394 (2019).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:

  • Springer Nature Limited

This article is cited by