title: Bio-electrical impedance spectroscopy: alternatives for the conventional hand-to-foot measurements.
abstract: OBJECTIVE
  Bio-impedance spectroscopy (BIS) is a very attractive method for measuring body composition. The standard method measures impedance from hand to foot. However, in patients a hand or foot is not always accessible. In these cases alternative methods would be helpful. The objective of this study was to compare BIS measurements from hand to foot (HF) with foot to foot (FF) and hand to hand (HH) measurements as alternatives. Aims were firstly, to assess the relationship between resistance (R) values measured by the different methods, secondly, to study the influence of body geometry on this relationship and lastly, to assess the predictive capacity of the methods for measuring body fluid volumes.
  
  
  METHODS
  In 53 subjects with different degrees of obesity (mean BMI = 38; SD = 9 kg/m(2)) three BIS measurements were performed from HF, HH and FF with a Xitron 4000B machine. Resistances of extracellular (Recw) and intracellular water (Ricw) were extrapolated by fitting the data to a Cole-Cole plot. Total body water (TBW) and extracellular water (ECW) were measured by deuterium and bromide dilution respectively. Intracellular water (ICW) was calculated as TBW-ECW. Anthropometric measurements, including length and circumference of limbs and trunk, were performed as measures for body geometry.
  
  
  RESULTS
  The Recw, Ricw and R50 values of HF measurements could be accurately described as a function of the Recw, Ricw and R50 values of HH or FF measurements. The relative circumference of arms and legs and the length of the trunk influenced the relationship between R values of the three different measurements. The degree of overweight did not affect this relationship. The precision of the predictions of TBW, ECW and ICW based on R values of the HH measurements were comparable with the traditional HF measurements while the FF measurements gave slightly less accurate results.
  
  
  CONCLUSIONS
  Under circumstances where total body BIS measurements cannot be performed, FF or HH measurements may be used as alternatives. However, for clinical use the effect of changes in fluid distribution on the accuracy of these methods needs to be studied further.
authors.affiliation: Department of Dietetics, University Hospital Maastricht, The Netherlands.
authors.forename: P L M
authors.initials: PL
authors.lastname: Cox-Reijven
authors.forename: B
authors.initials: B
authors.lastname: Van Kreel
authors.forename: P B
authors.initials: PB
authors.lastname: Soeters
mesh_terms: D001823:Body Composition; D015992:Body Mass Index; D001834:Body Water; D001965:Bromides; D003903:Deuterium; D017097:Electric Impedance; D005260:Female; D005528:Foot; D006225:Hand; D006801:Humans; D007201:Indicator Dilution Techniques; D016014:Linear Models; D009765:Obesity / Q000503:physiopathology*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
chemical_list: D001965:Bromides; D003903:Deuterium