Bioelectric Impedance Analysis

The Breakdown

Of How It Works

And

Why You Need It

Dr. June Riedlinger, R.Ph., Pharm.D., NDCertified First Line Therapy Provider

Clinical Relevance of BIA

“BIA is an important clinical tool for evaluating the metabolic status of patients. It is inexpensive and noninvasive, and it provides useful information concerning altered body composition and membrane potential at the tissue level measured by phase angle.”

Jeff Bland PhD.

Clinical Relevance of BIA

“BIA is a simple in-office test that converts easily obtained electrical measurements into information about the patient’s body composition and fluid distribution ...”

Robert Rakowski DC

Biomarkers 2000

• Portable

• Battery powered

• Highly accurate meter

• Mini-computer

• Inkless printer (thermal paper)

Pre-test Preparation

• No alcohol within 24 hours

• No exercise for 4 hours

• Avoid caffeine or food for 4 hours

• Consume 2-4 glasses of water within 2 hours

Placement of sensor pads

Bioelectric Impedance Analysis (BIA)

“Bioelectric impedance analysis is a simple, noninvasive, rapid, portable, reproducible, and convenient method of measuring body composition; it is sufficiently accurate for clinical use and makes fewer physical demands (than anthropometric techniques).”

JADA 2001;101(10):1209-1212

•Phase Angle, Capacitance,Resistance and ReactanceDo not rely on input of patient’sheight, weight, age or sex.

• Mass Distribution Results are based on findings from largepopulation studies.

• These numbers require accurate input of a patients height, weight, sex and age.

Increasing lean body mass willreduce resistance which is a positive change.

When your lean body mass increasesYou will increase reactance which is positive change.

STEP 1 Total Body Water/Fat

Free Mass = TBW/FFM This marker refers to the

hydration of the patient. Must be higher than 69%

for a test to be valid. If <69%, patient should

be put on hydration protocol and retested in 24-48 hours.

Higher is typically better Accurate even when

subject is significantly overweight

STEP 1 (CONTINUED) TBW/Total Weight

Percentage of total weight that is water

Declines with age Shows dehydration if

person is significantly overweight.

STEP 2 Phase angle

General indicator of cellular health

Provides info on cell membrane potential at the tissue level

Cellular health tends to be correlated to a person’s phase angle

Lance

Armstrong

Suboptimal

STEP 3 Intracellular Water

Healthy cells maintain their integrity and hold their fluid inside

>60% is optimal. Changes with age

Extracellular Water Water volume outside of

the body cell mass Higher values may be

related to fluid retention

STEP 4 Fat Free Mass vs. Fat

Determine the amount of metabolically active tissue in the person.

Optimal range depends on sex and age of person.

BIA can determine both subcutaneous fat (Love Handles) as well as visceral fat found around the organs of the body.

Advantage over calipers to assess true health status.

Do You Believe in Miracles?

•Lance Armstrong is monitored with the BIA during his preparation for the Tourde France.

“. . . we found that fat-free mass was lower and fat mass was higher in acutely ill and chronically ill patients than controls.”

“. . . we found that fat-free mass was lower and fat mass was higher in acutely ill and chronically ill patients than controls.”

J Amer Diet Assoc 2002;102(7):944-955

STEP 5 ECM/BCM

Ratio of extracellular mass (non-metabolically active) to body cell mass (metabolically active)

Low value is desirable Upward shift suggests

imbalanced weight loss. Downward shift suggests

balanced weight loss. Use Body Composition

Protocol to shift.

“Sarcopenia is the backdrop against which the drama of disease is played out: a body already depleted of protein because of aging is less able to with stand the protein catabolism that comes with acute illness or inadequate protein intake.”

“Sarcopenia is the backdrop against which the drama of disease is played out: a body already depleted of protein because of aging is less able to with stand the protein catabolism that comes with acute illness or inadequate protein intake.”

JAMA 286(10) (2001)

Am J Clin Nutrition 1996; 64:472S-477S

BIA may be clinically useful for demonstrating sarcopenic obesity in women at normal body mass indices, with additional studies necessary to determine the metabolic reasons underlying this change in body composition.

BIA may be clinically useful for demonstrating sarcopenic obesity in women at normal body mass indices, with additional studies necessary to determine the metabolic reasons underlying this change in body composition.

STEP 6 Body Mass Index

BMI correlates with a person’s health.

Studies show even moderate BMI shifts mean health consequences.

Lower is better Alter using Body

Composition Program.

Weight Gain and Diabetes Risk

2.11.01.0

5.33.6

2.5

21.1

9.1

6.3

0

5

10

15

20

25

<22 22-23 24+

<5 kg 5-10 kg 11+ kg

Body Mass Index at Age 21

Rela

tive R

isk

Weight Change Since Age 21

Adapted from Chan JM, et al. Diabetes Care 1994;17:960-969.

26 -Year Incidence of Coronary Heart Disease in Men

177

255

350333366

440

0

100

200

300

400

500

600

<25 25-<30 30+

<50 years 50+ years

Incid

en

ce/1

,000

BMI LevelsAdapted from Hubert HB, et al. Circulation 1983;67:968-977. Metropolitan Relative Weight of 110 is a BMI of approximately 25.

Relationship of BMI to Excess Mortality

300Age at Issue

Bray GA. Overweight is risking fate. Definition, classification, prevalence and risks. Ann NY Acad Sci 1987;499:14-28.

20-29250

Mort

alit

y R

ati

o

Body Mass Index (kg/[m2])

200

150

100

50

150

30-39

20 25 30

LowRisk

4035

High

Risk

ModerateRisk

STEP 7 Basal Metabolic Rate

BMR- is the amount of calories a person burns during a 24 hour period while at rest.

More lean body mass will increase the BMR

Higher is typically better. Each person is very unique Essential in establishing a

proper body composition program.

Dr. June RiedlingerR.Ph., Pharm.D., ND

FLT Certified Provider

• FLT is based on National Institutes of Health TLC program recommendations.

• Allows for me to tailor to your needs.

• Delivers a concise and effective report of findings.