Dual-Frequency Bioelectrical Impedance Analysis is Accurate and Reliable to Determine Lean Muscle Mass in The Elderly

Sarcopenia is a skeletal muscle disorder characterized by a generalized and progressive decrease in skeletal muscle mass and muscle strength, and it is common in the elderly population.1 The disease is associated with an increased risk of undesired outcomes, such as falls, fractures, disability, and mortality.2, 3, 4, 5 Regarding financial aspects, sarcopenia is costly for healthcare systems, leading to financial burdens when left untreated.6 Using affordable, accessible, and reliable diagnostic devices can improve physician awareness of sarcopenia and promote optimal care.

According to the European Working Group on Sarcopenia in Older People and Asian Working Group on Sarcopenia, the parameters for diagnosing sarcopenia are muscle strength, skeletal muscle mass, and physical performance7,8. Skeletal muscle mass or quantity can be measured using magnetic resonance imaging, dual-energy X-ray absorptiometry (DXA), and bioelectrical impedance analysis (BIA). DXA is most widely used for standard reference measurements of lean muscle mass9. The advantages of DXA are that it is noninvasive, delivers highly reliable results, and provides reproducible estimates of skeletal muscle mass. However, the main disadvantage of DXA is that it lacks portability (due to the size of the device), making it inconvenient to use in daycare orthopedic clinics. Moreover, the device is costly and needs ongoing maintenance, restricting its availability at hospitals. The use of DXA also involves radiation exposure and requires highly trained personnel.

Another device commonly used is BIA, which can measure lean muscle mass indirectly using the electrical conductivity principle. BIA devices are inexpensive, portable, and easy to perform.9 Due to these advantages, these devices may be interchangeable with DXA.8 On the other hand, different brands of BIA may give inconsistent results because of differences in the equations used to estimate muscle mass.10 The results of BIA are also related to age and race or ethnicity.11 Consequently, it is essential to compare the accuracy of specific brands of BIA with the corresponding DXA values for each population.

The accuracy of multifrequency bioelectrical impedance analysis (MF-BIA) in measuring lean muscle mass has been demonstrated in several populations.12,13 Dual-frequency bioelectrical impedance analysis (DF-BIA) devices are more accessible, affordable, easier to perform, and able to provide comprehensive measurements of body composition in less than a minute. Due to these advantages, dual-frequency BIA can be used in the outpatient clinics of resource-limited local hospitals, during home visits, or as part of national surveys. Although there was only one study that explored the accuracy of DF-BIA for body composition measurement compared to DXA,14 no study reports the accuracy and reliability of DF-BIA in the elderly Asian population. The current investigation focused on 2 objectives. First, it compared the accuracies of lean muscle mass measurements of Thai elderly individuals obtained with a DF-BIA device and DXA (as the standard reference). Second, it evaluated the reliability of the DF-BIA device.

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