Bioimpedance Measurement as a Research Tool

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Introduction

Research, whether academic or private, has the primary objective of answering scientific questions using standardized protocols that involve a number of measurement tools. Their role is to generate objective data that are then used to address the scientific hypotheses posed upstream of the protocol. Therefore, it is necessary to know 1) the parameters measured by these tools, 2) with what precision, and 3) if these measurements are repeatable over time. Moreover, it is also possible for research work to demonstrate and develop alternative uses of these tools for measuring parameters other than those initially planned.

In this context, the use of bioimpedance analysis (BIA) in research has gradually increased in recent years, and in this dossier, we will present its current uses as well as future usage perspectives.

Bioimpedance Analysis in Body Evaluation

Research is not a closed-off field and is therefore part of a disciplinary field, where it is in constant relation with everyday field practice, both to retrieve information and to confirm scientific responses obtained. This premise also holds true for BIA, which is mainly used for body composition assessment in a clinical1 context or in a sports2 context for:

  • Determining the body composition of a particular population such as athletes according to their sport3 or patients with a chronic disease4, 5.
  • Determining the effects of an intervention on body composition such as a surgical operation6-8, a physical activity program9-12 or those induced by a sports competition13.
  • Determining the influence of changes in body composition on the physiopathology of certain chronic diseases14, 15.

BIA has a variety of potential uses in a research context, which explains its increasing employment compared to other techniques for evaluating body composition. Indeed, there are numerous techniques, differing in various parameters including the number of body compartments evaluated, the duration of assessment, and subject convenience. For instance, total water estimation through deuterium dilution is highly precise, however, it requires a measurement time of several hours, whereas the same assessment through BIA will be much quicker but with lower precision. Therefore, researchers aiming for the most precise measurement, conducted in a laboratory under controlled conditions with a small number of individuals, will choose deuterium dilution. Whereas for a field study involving rapid measurements and/or a large number of individuals, where having a very precise measurement is less crucial, BIA will be used.

In 2009, in this chapter16, Deurenberg and Roubenoff summarized the principle, advantages, and disadvantages of each of these techniques, which they compiled in the table below:

DXA: Dual-energy X-ray absorptiometry; MRI: Magnetic resonance imaging; TOBEC: Total body electrical conductivity.

If we look at the data in this table, we can observe that BIA has lower precision than reference techniques like DXA or MRI, but it is one of the least expensive, fastest, and most comfortable techniques for the subject, making it relevant for field studies. Thus, it allows for measurements under special conditions or in large populations, as demonstrated by these two studies conducted with the Biody XpertZMII.

The first is a study conducted by Wekre and colleagues17 which focused on the hydration of divers during a saturation intervention, where divers are placed in a closed hyperbaric environment, i.e., with a pressure 2 or 3 times higher than atmospheric pressure, leading them to significant dehydration. Therefore, it is necessary to monitor their hydration to maintain their physical and psychological capacity, and the goal of this study was to verify if the strategies implemented during the intervention maintained good hydration in these divers. Two evaluation methods were used to answer this question: BIA and urinary density, and both confirmed that divers maintained their hydration level throughout the intervention. Additionally, the results show that both techniques have similar performances in determining this level.

The second study was conducted by Martinez-Rodriguez and colleagues18 and focused on the effects of a nutritional intervention program on 196 first-year students at the University of Alicante. This study was based on the observation that the start of a university course was responsible for many changes in the eating habits of the students, whose causes are a lack of information on nutrition, a limited budget, and/or a lack of time and skills for cooking. These changes can cause a significant weight gain and also persist over time, leading to

the possible appearance of lifestyle-related pathologies, such as obesity, diabetes, or cardiovascular diseases. Moreover, the students included in this study were enrolled in a nutrition course and it was shown that they were at higher risk of developing eating disorders. Indeed, they receive a significant amount of information about nutrition, which can create pressure on their own eating behavior. Given this different information, it is necessary that training on these issues be offered through tailored programs, and the goal of this study was to provide a nutritional education program to these students and measure its effects on body composition.

Students included in the intervention group attended several workshops on diets, lifestyle, and the risk of developing eating disorders, during which a “nutrition myth” was confronted with scientific elements. To control the effects of the intervention, students in the control group attended complementary classes to those they were already taking but whose subject was not specific. The results show that students who participated in the intervention improved their body composition, particularly by reducing their fat mass and increasing their muscle mass, while students in the control group did not show changes in these parameters at the end of the protocol. Therefore, this nutritional education program would have beneficial effects on the students’ eating habits, which translates into an improvement in their body composition.

Use of Bioimpedance: Future Perspectives

As previously explained, BIA is a technique that allows the assessment of body composition using predictive equations that include biophysical data measured by devices using this technique. However, recent research has shown that these biophysical data are also related to other biological parameters, thus BIA can assess events other than body composition.

Currently, the most described parameter in the literature is the phase angle, which corresponds to an angular transformation of resistance and reactance, and whose value at 50 kHz reflects the health status of individuals19, making it particularly interesting. Indeed, several studies have shown that it is associated with nutritional status20, the risks of developing cardiovascular diseases21, and even mortality^22, thus it is a relevant tool for the prevention of the development of chronic pathologies. However, additional research is necessary to determine precise thresholds which, when exceeded, indicate a risk of developing a pathology. Moreover, in many diseases, it has also been shown that the phase angle is associated with the clinical state of the patients23-25 and that its value can be used as a prognostic factor in breast cancer26, upon entry into intensive care27, and in many other pathologies19. Similarly, further research is needed to determine threshold values that can be used to achieve these objectives.

Two other parameters also seem interesting for studying the health state of individuals: the impedance ratio (IR), which is the ratio of impedance measured at 200 kHz to that measured at 5 kHz, and capacitance. IR appears to be a marker of inflammation since it is correlated with CRP, a blood marker of systemic inflammation28, and the phase angle, making it relevant for monitoring nutritional status29. Capacitance, on the other hand, is a raw value obtained only by BIA devices in spectroscopy and thus is a parameter little studied in the literature. However, a recent publication has explored the connections between capacitance and various biological events, showing that capacitance may be representative of the cell membrane exchange capacity^30. Interestingly, it also seems that the value of capacitance could detect insulin resistance. Indeed, individuals with this dysfunction of insulin metabolism have capacitance values higher than 2.67 nF for men and 1.65 nF for women, suggesting that these values could be used as a detection threshold31. However, these results remain to be confirmed by future studies on different populations and on a larger scale.

Finally, an alternative use of BIA that presents interest is the study of skeletal muscle using BIA, also known as impedance myography, based on the sensitivity of BIA to the state of the cell membrane and hydration. Indeed, the physiological events suffered by the skeletal muscle target its membrane, such as damage, and/or the amount of water it contains. From the BIA’s perspective, the measured resistance is directly related to tissue hydration, while reactance depends on the state of the cell membrane32, thus it is virtually possible to characterize skeletal muscle using these parameters. In 2015, Bartels et al.33 showed, in three case studies, that raw BIA data were dependent on the state of skeletal muscle contraction and the presence of an injury. Before this date, Nescolarde et al.34,35 had shown that resistance and reactance measured by BIA were locally altered by a muscle tear, diagnosed by MRI. Specifically, the resistance and reactance of the damaged muscle decreased compared to values measured in its non-injured equivalent, which would be explained by the local increase in water volume and the degradation of the membrane due to the tear, respectively. Although these results show the relationship between BIA values and muscle damage, it is currently not possible to quantify muscle damage solely with BIA, limiting its field use. Finally, in 2021, Cebrian-Ponce et al.36 conducted a systematic review of the literature on this issue to highlight the possible uses of impedance myography in healthy subjects. Besides damage, the selected publications show:

  • That BIA values, particularly the phase angle of skeletal muscles, decrease by 0.3 to 0.6° per year with aging.
  • That resistance and reactance increase during muscle contraction, regardless of the level of force produced.
  • That resistance and reactance decrease with the onset of muscle fatigue.

These results suggest that impedance myography could allow local assessment of skeletal muscle at rest, which would be particularly interesting for detecting sarcopenia but also for monitoring neuromuscular pathologies37 where currently used measurement tools remain invasive. Additionally, they also suggest that BIA could be used to assess muscle changes during exercise, however, further research is needed to verify if it could replace existing techniques, such as surface electromyography.

Conclusion

In a research context, the main use of BIA is the study of body composition with the goal of characterizing it in specific populations, studying the effects of an intervention on it, and/or characterizing the mechanisms by which an imbalance of one or more body compartments can participate in the pathophysiology of some chronic diseases. However, other potential uses of BIA are emerging, which involve using the raw data obtained by BIA, including the phase angle, IR, or capacitance, which can be used to characterize the health status of individuals, or impedance myography for the localized study of skeletal muscle.

References

  1. Mulasi U, Kuchnia AJ, Cole AJ, Earthman CP. Bioimpedance at the bedside: current applications, limitations, and opportunities. Nutr Clin Pract Off Publ Am Soc Parenter Enter Nutr. avr 2015;30(2):180‑93.
  2. Campa F, Toselli S, Mazzilli M, Gobbo LA, Coratella G. Assessment of Body Composition in Athletes: A Narrative Review of Available Methods with Special Reference to Quantitative and Qualitative Bioimpedance Analysis. Nutrients. 12 mai 2021;13(5):1620.
  3. Fields JB, Merrigan JJ, White JB, Jones MT. Body Composition Variables by Sport and Sport-Position in Elite Collegiate Athletes. J Strength Cond Res. nov 2018;32(11):3153‑9.
  4. Spanjer MJ, Bultink IEM, de van der Schueren MAE, Voskuyl AE. Prevalence of malnutrition and validation of bioelectrical impedance analysis for the assessment of body composition in patients with systemic sclerosis. Rheumatol Oxf Engl. 1 juin 2017;56(6):1008‑12.
  5. Lee Y, Kwon O, Shin CS, Lee SM. Use of Bioelectrical Impedance Analysis for the Assessment of Nutritional Status in Critically Ill Patients. Clin Nutr Res. janv 2015;4(1):32‑40.
  6. van Venrooij LMW, Verberne HJ, de Vos R, Borgmeijer-Hoelen MMMJ, van Leeuwen PAM, de Mol BAJM. Preoperative and postoperative agreement in fat free mass (FFM) between bioelectrical impedance spectroscopy (BIS) and dual-energy X-ray absorptiometry (DXA) in patients undergoing cardiac surgery. Clin Nutr Edinb Scotl. déc 2010;29(6):789‑94.
  7. Borges LPSL, de Carvalho KMB, da Costa THM. Usual dietary intake, physical activity, weight loss, and body composition after five years of Roux-en-Y gastric bypass. Int J Obes 2005. avr 2023;47(4):263‑72.
  8. Martínez MC, Meli EF, Candia FP, Filippi F, Vilallonga R, Cordero E, et al. The Impact of Bariatric Surgery on the Muscle Mass in Patients with Obesity: 2-Year Follow-up. Obes Surg. mars 2022;32(3):625‑33.
  9. Hayotte M, Iannelli A, Nègre V, Pradier C, Thérouanne P, Fuch A, et al. Effects of technology-based physical activity interventions for women after bariatric surgery: study protocol for a three-arm randomised controlled trial. BMJ Open. 30 juill 2021;11(7):e046184.
  10. Touillaud M, Fournier B, Pérol O, Delrieu L, Maire A, Belladame E, et al. Connected device and therapeutic patient education to promote physical activity among women with localised breast cancer (DISCO trial): protocol for a multicentre 2×2 factorial randomised controlled trial. BMJ Open. 13 sept 2021;11(9):e045448.
  11. Björkman MP, Suominen MH, Kautiainen H, Jyväkorpi SK, Finne-Soveri HU, Strandberg TE, et al. Effect of Protein Supplementation on Physical Performance in Older People With Sarcopenia-A Randomized Controlled Trial. J Am Med Dir Assoc. févr 2020;21(2):226-232.e1.
  12. Gruchała-Niedoszytko M, Niedoszytko P, Kaczkan M, Pieszko M, Gierat-Haponiuk K, Śliwińska A, et al. Cardiopulmonary exercise test and bioimpedance as prediction tools to predict the outcomes of obesity treatment. Pol Arch Intern Med. 30 avr 2019;129(4):225‑33.
  13. Cebrián-Ponce Á, Irurtia A, Castizo-Olier J, Garnacho-Castaño MV, Espasa-Labrador J, Noriega Z, et al. Bioelectrical, Anthropometric, and Hematological Analysis to Assess Body Fluids and Muscle Changes in Elite Cyclists during the Giro d’Italia. Biology. 15 mars 2023;12(3):450.
  14. Björkman MP, Pitkala KH, Jyväkorpi S, Strandberg TE, Tilvis RS. Bioimpedance analysis and physical functioning as mortality indicators among older sarcopenic people. Exp Gerontol. 15 juill 2019;122:42‑6.
  15. Eyre S, Bosaeus I, Jensen G, Saeed A. Using Bioimpedance Spectroscopy for Diagnosis of Malnutrition in Chronic Kidney Disease Stage 5-Is It Useful? J Ren Nutr Off J Counc Ren Nutr Natl Kidney Found. mars 2022;32(2):170‑7.
  16. Deurenberg P, Roubenoff R. Body Composition. Introd Hum Nutr MJ Gibney HH Vorster FJ Kok – Sl Blackwell Publ 2002. 1 janv 2009;
  17. Wekre SL, Landsverk HD, Lautridou J, Hjelde A, Imbert JP, Balestra C, et al. Hydration status during commercial saturation diving measured by bioimpedance and urine specific gravity. Front Physiol [Internet]. 2022 [cité 4 oct 2022];13. Disponible sur: https://www.frontiersin.org/articles/10.3389/fphys.2022.971757
  18. Martínez-Rodríguez A, Vidal-Martínez L, Martínez-Olcina M, Miralles-Amorós L, Sánchez-Sáez JA, Ramos-Campo DJ, et al. Study the Effect of an Innovative Educational Program Promoting Healthy Food Habits on Eating Disorders, Mediterranean Diet Adherence and Body Composition in University Students. Healthcare. janv 2023;11(7):965.
  19. Bellido D, García-García C, Talluri A, Lukaski HC, García-Almeida JM. Future lines of research on phase angle: Strengths and limitations. Rev Endocr Metab Disord. 12 avr 2023;1‑21.
  20. Lukaski HC, Kyle UG, Kondrup J. Assessment of adult malnutrition and prognosis with bioelectrical impedance analysis: phase angle and impedance ratio. Curr Opin Clin Nutr Metab Care. sept 2017;20(5):330‑9.
  21. Langer RD, Larsen SC, Ward LC, Heitmann BL. Phase angle measured by bioelectrical impedance analysis and the risk of cardiovascular disease among adult Danes. Nutrition. 1 sept 2021;89:111280.
  22. Garlini LM, Alves FD, Ceretta LB, Perry IS, Souza GC, Clausell NO. Phase angle and mortality: a systematic review. Eur J Clin Nutr. avr 2019;73(4):495‑508.
  23. Bifolco G, Pinazzi A, Bini V, Stefani L. Side Bioimpedance Analysis in Menopausal Post-Oncological Breast Cancer. Int J Environ Res Public Health. janv 2022;19(18):11329.
  24. Lee GR, Kim EY. Usefulness of phase angle on bioelectrical impedance analysis as a surveillance tool for postoperative infection in critically ill patients. Front Med [Internet]. 2023 [cité 4 oct 2023];10. Disponible sur: https://www.frontiersin.org/articles/10.3389/fmed.2023.1111727
  25. Di Vincenzo O, Marra M, Di Gregorio A, Pasanisi F, Scalfi L. Bioelectrical impedance analysis (BIA) -derived phase angle in sarcopenia: A systematic review. Clin Nutr Edinb Scotl. mai 2021;40(5):3052‑61.
  26. Gupta D, Lammersfeld CA, Vashi PG, King J, Dahlk SL, Grutsch JF, et al. Bioelectrical impedance phase angle as a prognostic indicator in breast cancer. BMC Cancer. 27 août 2008;8(1):249.
  27. Ellegård LH, Petersen P, Öhrn L, Bosaeus I. Longitudinal changes in phase angle by bioimpedance in intensive care patients differ between survivors and non-survivors. Clin Nutr ESPEN. avr 2018;24:170‑2.
  28. Demirci C, Aşcı G, Demirci MS, Özkahya M, Töz H, Duman S, et al. Impedance ratio: a novel marker and a powerful predictor of mortality in hemodialysis patients. Int Urol Nephrol. juill 2016;48(7):1155‑62.
  29. Rinninella E, Cintoni M, Addolorato G, Triarico S, Ruggiero A, Perna A, et al. Phase angle and impedance ratio: Two specular ways to analyze body composition. Ann Clin Nutr. 24 avr 2018;1.
  30. Garr Barry V, Chiang JL, Bowman KG, Johnson KD, Gower BA. Bioimpedance-Derived Membrane Capacitance: Clinically Relevant Sources of Variability, Precision, and Reliability. Int J Environ Res Public Health. 30 déc 2022;20(1):686.
  31. Barry VG, Peterson CM, Gower BA. Membrane Capacitance from A Bioimpedance Approach: Associations with Insulin Resistance in Relatively Healthy Adults. Obes Silver Spring Md. nov 2020;28(11):2184‑91.
  32. Khalil SF, Mohktar MS, Ibrahim F. The Theory and Fundamentals of Bioimpedance Analysis in Clinical Status Monitoring and Diagnosis of Diseases. Sensors. 19 juin 2014;14(6):10895‑928.
  33. Bartels EM, Sørensen ER, Harrison AP. Multi-frequency bioimpedance in human muscle assessment. Physiol Rep. 20 avr 2015;3(4):e12354.
  34. Nescolarde L, Yanguas J, Lukaski H, Alomar X, Rosell-Ferrer J, Rodas G. Localized bioimpedance to assess muscle injury. Physiol Meas. févr 2013;34(2):237‑45.
  35. Nescolarde L, Yanguas J, Medina D, Rodas G, Rosell-Ferrer J. Assessment and follow-up of muscle injuries in athletes by bioimpedance: preliminary results. Annu Int Conf IEEE Eng Med Biol Soc IEEE Eng Med Biol Soc Annu Int Conf. 2011;2011:1137‑40.
  36. Cebrián-Ponce Á, Irurtia A, Carrasco-Marginet M, Saco-Ledo G, Girabent-Farrés M, Castizo-Olier J. Electrical Impedance Myography in Health and Physical Exercise: A Systematic Review and Future Perspectives. Front Physiol [Internet]. 2021 [cité 28 mars 2023];12. Disponible sur: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8476966/
  37. Sanchez B, Rutkove SB. Electrical Impedance Myography and Its Applications in Neuromuscular Disorders. Neurotherapeutics. janv 2017;14(1):107‑18.

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