title: Bioimpedance at the bedside: current applications, limitations, and opportunities.
abstract: The loss of muscle mass is a defining characteristic of malnutrition, and there is ongoing interest in the assessment of lean tissue at the bedside. Globally, bioimpedance techniques have been widely appreciated for their noninvasiveness, safety, ease of use, portability, and relatively low cost compared with other clinically available methods. In this brief update, we review the 3 primary types of commercially available bioimpedance devices (single- and multiple-frequency and spectroscopy) and differentiate the underlying theory and current applications of each. We also address limitations and potential opportunities for using these devices at the bedside for clinical assessment. Mixed reports in the validation literature for all bioimpedance approaches have raised questions about absolute accuracy to estimate whole body composition in clinical populations, particularly those with abnormal fluid status and/or body geometry in whom underlying method assumptions may be violated. Careful selection of equations can improve whole body estimates by single- and multiple-frequency techniques; however, not all devices will allow for this approach. Research is increasing on the use of bioimpedance variables including phase angle and impedance ratio as potential markers of nutrition status and/or clinical outcomes; consensus on reference cut-points for interpreting these markers has yet to be established. Novel developments in the bioimpedance spectroscopy approach are allowing for improved fluid management in individuals receiving dialysis; these developments have implications for the clinical management of other conditions associated with fluid overload and may also provide enhanced whole body estimates of lean tissue through new modeling procedures.
authors.affiliation: Department of Food Science and Nutrition, University of Minnesota-Twin Cities, Saint Paul, Minnesota.
authors.forename: Urvashi
authors.initials: U
authors.lastname: Mulasi
authors.affiliation: Department of Food Science and Nutrition, University of Minnesota-Twin Cities, Saint Paul, Minnesota.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Kuchnia
authors.affiliation: Department of Food Science and Nutrition, University of Minnesota-Twin Cities, Saint Paul, Minnesota.
authors.forename: Abigail J
authors.initials: AJ
authors.lastname: Cole
authors.affiliation: Department of Food Science and Nutrition, University of Minnesota-Twin Cities, Saint Paul, Minnesota cearthma@umn.edu.
authors.forename: Carrie P
authors.initials: CP
authors.lastname: Earthman
mesh_terms: D001823:Body Composition; D017097:Electric Impedance; D004566:Electrodes; D045604:Extracellular Fluid / Q000502:physiology; D006801:Humans; D008209:Lymphedema / Q000175:diagnosis; D015596:Nutrition Assessment; D009752:Nutritional Status; D010992:Plethysmography, Impedance / Q000295:instrumentation / Q000379:methods*; D006435:Renal Dialysis; D012815:Signal Processing, Computer-Assisted / Q000295:instrumentation*; D013057:Spectrum Analysis / Q000295:instrumentation / Q000379:methods*
keywords: body cell mass; body composition; electrical impedance; fat-free mass; lean body mass; nutrition assessment; spectroscopy; total body water