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      Validation of two portable bioelectrical impedance analyses for the assessment of body composition in school age children

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          Abstract

          Background

          Bioelectrical impedance analysis (BIA) is a convenient and child-friendly method for longitudinal analysis of changes in body composition. However, most validation studies of BIA have been performed on adult Caucasians. The present cross-sectional study investigated the validity of two portable BIA devices, the Inbody 230 (BIA 8MF) and the Tanita BC-418 (BIA 8SF), in healthy Taiwanese children.

          Methods

          Children aged 7–12 years (72 boys and 78 girls) were recruited. Body composition was measured by the BIA 8SF and the BIA 8MF. Dual X-ray absorptiometry (DXA) was used as the reference method.

          Results

          There were strong linear correlations in body composition measurements between the BIA 8SF and DXA and between the BIA 8MF and DXA. Both BIAs underestimated fat mass (FM) and percentage body fat (%BF) relative to DXA in both genders The degree of agreement in lean body mass (LBM), FM, and %BF estimates was higher between BIA 8MF and DXA than between BIA 8SF and DXA. The Lin’s concordance correlation coefficient (ρ c) for LBM 8MF met the criteria of substantial to perfect agreement whereas the ρ c for FM 8MF met the criteria of fair to substantial agreement. Bland-Altman analysis showed a clinically acceptable agreement between LBM measures by BIA 8MF and DXA. The limit of agreement in %BF estimation by BIA and DXA were wide and the errors were clinically important. For the estimation of ALM, BIA 8SF and BIA 8MF both provided poor accuracy.

          Conclusions

          For all children, LBM measures were precise and accurate using the BIA 8MF whereas clinically significant errors occurred in FM and %BF estimates. Both BIAs underestimated FM and %BF in children. Thus, the body composition results obtained using the inbuilt equations of the BIA 8SF and BIA 8MF should be interpreted with caution, and high quality validation studies for specific subgroups of children are required prior to field research.

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          Most cited references23

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          Statistical methods for assessing agreement between two methods of clinical measurement.

          In clinical measurement comparison of a new measurement technique with an established one is often needed to see whether they agree sufficiently for the new to replace the old. Such investigations are often analysed inappropriately, notably by using correlation coefficients. The use of correlation is misleading. An alternative approach, based on graphical techniques and simple calculations, is described, together with the relation between this analysis and the assessment of repeatability.
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            A concordance correlation coefficient to evaluate reproducibility.

            L Lin (1989)
            A new reproducibility index is developed and studied. This index is the correlation between the two readings that fall on the 45 degree line through the origin. It is simple to use and possesses desirable properties. The statistical properties of this estimate can be satisfactorily evaluated using an inverse hyperbolic tangent transformation. A Monte Carlo experiment with 5,000 runs was performed to confirm the estimate's validity. An application using actual data is given.
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              Is Open Access

              The Theory and Fundamentals of Bioimpedance Analysis in Clinical Status Monitoring and Diagnosis of Diseases

              Bioimpedance analysis is a noninvasive, low cost and a commonly used approach for body composition measurements and assessment of clinical condition. There are a variety of methods applied for interpretation of measured bioimpedance data and a wide range of utilizations of bioimpedance in body composition estimation and evaluation of clinical status. This paper reviews the main concepts of bioimpedance measurement techniques including the frequency based, the allocation based, bioimpedance vector analysis and the real time bioimpedance analysis systems. Commonly used prediction equations for body composition assessment and influence of anthropometric measurements, gender, ethnic groups, postures, measurements protocols and electrode artifacts in estimated values are also discussed. In addition, this paper also contributes to the deliberations of bioimpedance analysis assessment of abnormal loss in lean body mass and unbalanced shift in body fluids and to the summary of diagnostic usage in different kinds of conditions such as cardiac, pulmonary, renal, and neural and infection diseases.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                3 February 2017
                2017
                : 12
                : 2
                : e0171568
                Affiliations
                [1 ]Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
                [2 ]Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan
                [3 ]Sport Science Research Center, National Taiwan University of Sport, Taichung, Taiwan
                [4 ]Department of Physical Education, National Taiwan University of Sport, Taichung, Taiwan
                [5 ]Department of Cosmetic Application and Management, St. Mary's Junior College of Medicine, Nursing and Management, Yilan, Taiwan
                [6 ]Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taiwan
                [7 ]Department of Dermatology, Chang Gung Memorial Hospital, Chiayi, Taiwan
                [8 ]College of Medicine, Chang Gung University, Taoyuan, Taiwan
                [9 ]Office of Physical Education and Sport, National Chung Hsing University, Taichung, Taiwan
                [10 ]Research Center, Charder Electronic Co, Ltd, Taichung, Taiwan
                University of Palermo, ITALY
                Author notes

                Competing Interests: One of the authors (KCH) is employed by Charder Electronic Co, Ltd. This does not alter our adherence to all the PLoS ONE policies on sharing data and materials. There are no patents, products in development nor marketed products to be declared. The other authors declare no conflict of interest.

                • Conceptualization: LWL YSL HKL PLH YYC CCC KCH.

                • Formal analysis: LWL KCH.

                • Funding acquisition: LWL CCC.

                • Investigation: LWL YSL PLH.

                • Methodology: LWL YSL.

                • Project administration: LWL CCC.

                • Resources: LWL YSL HKL PLH YYC CCC KCH.

                • Supervision: CCC KCH.

                • Validation: LWL YSL HKL PLH YYC CCC KCH.

                • Visualization: LWL KCH.

                • Writing – original draft: LWL KCH.

                • Writing – review & editing: LWL YSL HKL PLH YYC CCC KCH.

                Article
                PONE-D-16-35004
                10.1371/journal.pone.0171568
                5291432
                28158304
                e1ae8841-5cfd-43f7-a85d-219d048270a4
                © 2017 Lee et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 31 August 2016
                : 21 January 2017
                Page count
                Figures: 4, Tables: 3, Pages: 14
                Funding
                Funded by: Chang Gung Memorial Hospital
                Award ID: CMRPG6D0353
                Award Recipient :
                Funded by: Chang Gung Memorial Hospital
                Award ID: CMRPG6C0052
                Award Recipient :
                This study was funded by a single institution, the Chang Gung Memorial Hospital (grant number CMRPG6D0353, CCC and CMRPG6C0052, LWL). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. One of the authors (KCH) is an employee of Charder Electronic Co, Ltd. This company did not provide KCH financial support in executing this study. Nor did the company have any additional role in the research funding, study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of the author are articulated in the Author Contributions section.
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