Bioelectrical impedance analysis

Bioelectrical impedance analysis (BIA) is a commonly used method for estimating body composition, and in particular body fat. Since the advent of the first commercially available devices in the mid-1980s the method has become popular owing to its ease of use, portability of the equipment and its relatively low cost compared to some of the other methods of body composition analysis. It is familiar in the consumer market as a simple instrument for estimating body fat. BIA actually determines the electrical impedance, or opposition to the flow of an electric current through body tissues which can then be used to calculate an estimate of total body water (TBW). TBW can be used to estimate fat-free body mass and, by difference with body weight, body fat.

Accuracy
Many of the  early research studies showed that BIA was quite variable and it was not regarded by many as providing an accurate measure of body composition. In recent years technological improvements have made BIA a more reliable and therefore more acceptable way of measuring body composition. Nevertheless it is not a "gold standard" or reference method. Like all assessment tools, the result is only as good as the test done.

Although the instruments are straightforward to use, careful attention to the method of use (as described by the manufacturer) should be given.

Simple devices to estimate body fat, often using BIA, are available to consumers as body fat meters. These instruments are generally regarded as being less accurate than those used clinically or in nutritional and medical practice. They tend to under-read body fat percentage.

Dehydration is a recognized factor affecting BIA measurements as it causes an increase in the body's electrical resistance, so has been measured to cause a 5 kg underestimation of fat-free mass i.e. an overestimation of body fat.

Body fat measurements are lower when measurements are taken shortly after consumption of a meal, causing a variation between highest and lowest readings of body fat percentage taken throughout the day of up to 9.9%.

Moderate exercise before BIA measurements lead to an overestimation of fat-free mass and an underestimation of body fat percentage due to reduced impedance. For example moderate intensity exercise for 90–120 minutes before BIA measurements causes nearly a 12 kg overestimation of fat-free mass, i.e. body fat is significantly underestimated. Therefore it's recommended not to perform BIA for several hours after moderate or high intensity exercise.

BIA is considered reasonably accurate for measuring groups, or for tracking body composition in an individual over a period of time, but is not considered sufficiently accurate for recording of single measurements of individuals.

The accuracy of consumer grade devices for measuring BIA has not been found to be sufficiently accurate for single measurement use and are better suited for use to measure changes in body composition over time for individuals. Two-electrode foot-to-foot measurement is less accurate than 4-electrode (feet, hands) and eight-electrode measurement. Results for some four- and eight-electrode instruments tested found poor limits of agreement and in some cases systematic bias in estimation of visceral fat percentage, but good accuracy in the prediction of resting energy expenditure (REE) when compared with more accurate whole-body magnetic resonance imaging (MRI) and dual-energy X-ray absorptiometry (DXA).

Historical background
Electrical properties of tissues have been described since 1871. These properties were further described for a wider range of frequencies on larger range of tissues, including those that were damaged or undergoing change after death. Thomasset conducted the original studies using electrical impedance measurements as an index of total body water (TBW), using two subcutaneously inserted needles. Hoffer et al. and Nyboer first introduced the four-surface electrode BIA technique. A disadvantage of surface electrodes is that a high current (800 μA) and high voltage must be utilized to decrease the instability of injected current related to cutaneous impedance (10 000 Ω/cm2). By the 1970s the foundations of BIA were established, including those that underpinned the relationships between the impedance and the body water content of the body. A variety of single frequency BIA analyzers then became commercially available, and by the 1990s, the market included several multi-frequency analyzers. The use of BIA as a bedside method has increased because the equipment is portable and safe, the procedure is simple and noninvasive, and the results are reproducible and rapidly obtained. More recently, segmental BIA has been developed to overcome inconsistencies between resistance (R) and body mass of the trunk.

Measurement configuration
The impedance of cellular tissue can be modeled as a resistor (representing the extracellular path) in parallel with a resistor and capacitor in series (representing the intracellular path). This results in a change in impedance versus the frequency used in the measurement. The impedance measurement is generally measured from the wrist to the contralateral ankle and uses either two or four electrodes. A small current on the order of 1-10 uA is passed between two electrodes, and the voltage is measured between the same (for a two electrode configuration) or between the other two electrodes.