Research Article

Influence of elbow angle on the reliability and validity of bioelectrical impedance analysis

Robert W Pettitt, Jacob B Mehrhoff, David S Mandeville, Cherie D Pettitt and Steven Ross Murray

Published: 23 November, 2017 | Volume 2 - Issue 4 | Pages: 138-144

Hand-to-hand bioelectrical impedance (HH BIA) is a low-cost method to estimate percent body fat (%BF). The BIA method is consistently reliable, but questions on validity remain. We have observed anecdotally that elbow position can render consistently different measures of %BF while using HH BIA, thus leading to the question: Does elbow angle influence the validity of measures derived using HH BIA? The purpose of this study was to assess the effect of elbow position (i.e., IN=flexed to 90° versus OUT=fully extended) on the reliability of HH BIA on 44 male and 24 female healthy adults (age=21±2 yrs, BMI=23±3). An additional aim was to assess the validity of the HH BIA %BF on a subset of subjects (n=12) using air displacement plethysmography (BOD POD®) as the criterion measure. The IN position was ~4%BF lower than the OUT position for HH BIA (p=0.05, effect size=0.67). Measures of %BF for both trials for the IN [intraclass correlation coefficient (ICC)=0.99, coefficient of variation (CV)=2.99%] and OUT (ICC=0.99, CV=1.48%) conditions were highly reliable. On the subsample, the OUT (18.3±6.7 %BF) position exceeded both the IN (14.5±7.4 %BF) and the BOD POD® (16.1±7.8 %BF) measures (p<0.05); however, IN and BOD POD® measures of %BF did not differ (p=0.21). These findings support that HH BIA is a reliable measure at both elbow positions; however, %BF estimations vary considerably (~4%) with respect to the criterion measure depending on elbow position. The OUT position was found to overestimate criteria %BF. Further research may reveal an optimum elbow angle position for HH BIA estimates of %BF.

Read Full Article HTML DOI: 10.29328/journal.jsmt.1001019 Cite this Article Read Full Article PDF


Air displacement plethysmography; Anthropometrics; BIA; Body composition; Bodyfat


  1. Bosy-Westphal A, Muller MJ. Identification of skeletal muscle mass depletion across age and BMI groups in health and disease--there is need for a unified definition. Int J Obes (Lond). 2015; 39: 379-386. Ref.: https://goo.gl/Kja6XR
  2. Brooks GC, Blaha MJ, Blumenthal RS. Relation of C-reactive protein to abdominal adiposity. Am J Cardiol. 2010; 106: 56-61. Ref.: https://goo.gl/1BLif2
  3. Pou KM, Massaro JM, Hoffmann U, Vasan RS, Maurovich-Horvat P, et al. Visceral and subcutaneous adipose tissue volumes are cross-sectionally related to markers of inflammation and oxidative stress: the Framingham Heart Study. Circulation. 2007; 116: 1234-1241. Ref.: https://goo.gl/Fw6eMg
  4. Horton ES. Effects of lifestyle changes to reduce risks of diabetes and associated cardiovascular risks: results from large scale efficacy trials. Obesity (Silver Spring). 2009; 17: 43-48. Ref.: https://goo.gl/hfws6F
  5. Ackland TR, Lohman TG, Sundgot-Borgen J, Maughan RJ, Meyer NL, et al. Current status of body composition assessment in sport: review and position statement on behalf of the ad hoc research working group on body composition health and performance, under the auspices of the I.O.C. Medical Commission. Sports Med. 2012; 42: 227-249. Ref.: https://goo.gl/99HjFg
  6. Ballesteros-Pomar MD, Calleja-Fernandez A, Diez-Rodriguez R, Vidal-Casariego A, Blanco-Suarez MD, et al. Comparison of different body composition measurements in severely obese patients in the clinical setting. Nutr Hosp. 2012; 27: 1626-1630. Ref.: https://goo.gl/AaMuud
  7. Brodie DA, Stewart AD. Body composition measurement: a hierarchy of methods. J Pediatr Endocrinol Metab. 1999; 12: 801-816. Ref.: https://goo.gl/s54AgH
  8. Wagner DR, Heyward VH. Techniques of body composition assessment: a review of laboratory and field methods. Res Q Exerc Sport. 1999; 70: 135-149. Ref.: https://goo.gl/YACF4j
  9. Lu HK, Chiang LM, Chen YY, Chuang CL, Chen KT, et al. Hand-to-Hand Model for Bioelectrical Impedance Analysis to Estimate Fat Free Mass in a Healthy Population. Nutrients. 2016; 8. Ref.: https://goo.gl/9kz7F5
  10. Xiao J, Purcell SA, Prado CM, Gonzalez MC. Fat mass to fat-free mass ratio reference values from NHANES III using bioelectrical impedance analysis. Clinical nutrition (Edinburgh, Scotland). 2017. Ref.: https://goo.gl/GNDA9y
  11. Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, et al. Bioelectrical impedance analysis--part I: review of principles and methods. Clin Nutr. 2004; 23: 1226-1243. Ref.: https://goo.gl/HtoUme
  12. Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, et al. Bioelectrical impedance analysis-part II: utilization in clinical practice. Clin Nutr. 2004; 23: 1430-1453.Ref.: https://goo.gl/4rGzKU
  13. Aandstad A, Holtberget K, Hageberg R, Holme I, Anderssen SA. Validity and reliability of bioelectrical impedance analysis and skinfold thickness in predicting body fat in military personnel. Military medicine. 2014; 179: 208-217. Ref.: https://goo.gl/5PpZpm
  14. Stewart SP, Bramley PN, Heighton R, Green JH, Horsman A, et al. Estimation of body composition from bioelectrical impedance of body segments: comparison with dual-energy X-ray absorptiometry. Br J Nutr. 1993; 69: 645-655. Ref.: https://goo.gl/PBxETp
  15. Hsueh-Kuan L, Chiang L, Chen Y, Chuang C, Chen K, et al. Hand-to-hand model bioelectric impedance analysis to estimate fat free mass in a health population. Nutrients. 2016; 8: 654. Ref.: https://goo.gl/oUMAUm
  16. De Lorenzo A, Bertini I, Iacopino L, Pagliato E, Testolin C, et al. Body composition measurement in highly trained male athletes. A comparison of three methods. J Sports Med Phys Fitness. 2000; 40: 178-183. Ref.: https://goo.gl/Ep66Yp
  17. Lazzer S, Bedogni G, Agosti F, De Col A, Mornati D, et al. Comparison of dual-energy X-ray absorptiometry, air displacement plethysmography and bioelectrical impedance analysis for the assessment of body composition in severely obese Caucasian children and adolescents. Br J Nutr. 2008; 100: 918-924. Ref.: https://goo.gl/UTaCaM
  18. Turner AA, Bouffard M, Lukaski HC. Examination of bioelectical impedance errors using generalizability theory. Sports Med, Train Rehab. 1996; 7: 87-103. Ref.: https://goo.gl/tDzhsL
  19. Peeters MW, Claessens AL. Effect of different swim caps on the assessment of body volume and percentage body fat by air displacement plethysmography. J Sports Sci. 2011; 29: 191-196. Ref.: https://goo.gl/shTJVt
  20. Hopkins WG. Measures of reliability in sports medicine and science. Sports Med. 2000; 30: 1-15. Ref.: https://goo.gl/kqafAP
  21. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986; 1: 307-310. Ref.: https://goo.gl/8KF5kh
  22. Lukaski HC, Siders WA. Validity and accuracy of regional bioelectrical impedance devices to determine whole-body fatness. Nutrition. 2003; 19: 851-857. Ref.: https://goo.gl/F22DPn
  23. Vicente-Rodriguez G, Rey-Lopez JP, Mesana MI, Poortvliet E, Ortega FB, et al. Reliability and intermethod agreement for body fat assessment among two field and two laboratory methods in adolescents. Obesity (Silver Spring). 2012; 20: 221-228. Ref.: https://goo.gl/Pz47dw
  24. Fogelholm M, van Marken Lichtenbelt W. Comparison of body composition methods: a literature analysis. Eur J Clin Nutr. 1997; 51: 495-503. Ref.: https://goo.gl/rAJ8aZ
  25. McCullagh WA, Ward LC. Assessing limb movement using real-time bioimpedance recording (abstract). 2003 Australian Conference of Science and Medicine in Sport; Canberra: 2003 Australian Conference of Science and Medicine in Sport. 2003. Ref.: https://goo.gl/xBxFKF
  26. McCullagh WA, Ward LC. Assessing limb movement by electroimpedancemyography. International Conference on Electrical Bioimpedance & Electrical Impedance Tomography; Gdansk, Poland: ICEBI XII - EIT V. 2004; 291-294. Ref.: https://goo.gl/tqzo6v


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