Obesity Surgery

, Volume 29, Issue 1, pp 183–189 | Cite as

Agreement Between Body Composition Assessed by Bioelectrical Impedance Analysis and Doubly Labeled Water in Obese Women Submitted to Bariatric Surgery

Body Composition, BIA, and DLW
  • Gabriel Cunha BeatoEmail author
  • Michele Novais Ravelli
  • Alex Harley Crisp
  • Maria Rita Marques de Oliveira
Original Contributions



Bariatric surgery has a significant influence on body composition (BC), which should be monitored. However, there is a need to recommend low-cost practical methods, with good estimation of BC for class III obese and/or bariatric patients.


The aim of this study was to determine accuracy and agreement between BC assessed by direct segmental multifrequency bioelectrical impedance analysis (DSM-BIA) and doubly labeled water (DLW) as reference method.

Material and Methods

Twenty class III obese women (age 29.3 ± 5.1 years; body mass index 44.8 ± 2.4 kg/m2) underwent Roux-en-Y gastric bypass surgery. BC (fat mass [FM], fat-free mass [FFM], and total body water [TBW]) was assessed by InBody 230 and DLW in the following periods: before and 6 and 12 months after surgery. Accuracy between the methods was evaluated by the bias and root mean square error. Pearson’s correlation, concordance correlation coefficient (CCC), and Bland-Altman method were used to evaluate agreement between the methods.


Correlations were significant (p < 0.001) and CCC was good/excellent between both methods for the evaluation of FM (r = 0.84–0.92, CCC = 0.84–0.95), FFM (r = 0.73–0.90, CCC = 0.68–0.80), and TBW (r = 0.76–0.91, CCC = 0.72–0.81) before and after bariatric surgery. In addition, no significant bias was observed between DSM-BIA and DLW for FM (mean error [ME] = − 1.40 to 0.06 kg), FFM (ME = 0.91–1.86 kg), and TBW (ME = 0.71–1.24 kg) measurements.


The DSM-BIA was able to estimate the BC of class III obese women submitted to bariatric surgery with values consistent with those of the DLW method.


Body composition Bariatric surgery Bioimpedance analysis Total body water Fat mass Fat-free mass DSM-BIA 


Compliance with Ethical Standards

The study protocol was approved by the Ethical Committee of the Medical School of Botucatu of the State University of São Paulo, UNESP. Informed consent was obtained from all participants included in the study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Palazuelos-Genis T, Mosti M, Sánchez-Leenheer S, et al. Weight loss and body composition during the first postoperative year of a laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2008;18(1):1–4.CrossRefGoogle Scholar
  2. 2.
    Graziany R, De Souza M, Gomes AC, et al. Methods for body composition analysis in obese adults. Rev Nutr. 2014;27(5):569–83. Scholar
  3. 3.
    Carey DG, Pliego GJ, Raymond RL. Body composition and metabolic changes following bariatric surgery: effects on fat mass, lean mass and basal metabolic rate: six months to one-year follow-up. Obes Surg. 2006;16(12):1602–8.CrossRefGoogle Scholar
  4. 4.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37. Scholar
  5. 5.
    Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes—3-year outcomes. N Engl J Med. 2014;370(21):2002–13. Available from: CrossRefGoogle Scholar
  6. 6.
    Buchowski MS. Doubly labeled water is a validated and verified reference standard in nutrition research. J Nutr. 2014;144(5):573–4.CrossRefGoogle Scholar
  7. 7.
    Bluck L, Forsum E, Hills A, et al. Assessment of body composition and total energy expenditure in humans using stable isotope technique. IAEA Hum Heal Ser. 2009;3(3):133.Google Scholar
  8. 8.
    Kyle UG, Bosaeus I, De Lorenzo AD, et al. Bioelectrical impedance analysis—part I: review of principles and methods. Clin Nutr. 2004;23(5):1226–43.CrossRefGoogle Scholar
  9. 9.
    Andreoli A, Garaci F, Cafarelli FP, et al. Body composition in clinical practice. Eur J Radiol. 2016;85(8):1461–8. Scholar
  10. 10.
    Mialich MS, Maria J, Sicchieri F, et al. Analysis of body composition: a critical review of the use of bioelectrical impedance analysis. Int J Clin Nutr. 2014;2(1):1–10.Google Scholar
  11. 11.
    de Cleva R. Body composition evaluation in severe obesity: a critical review. Adv Obesity, Weight Manag Control [Internet]. 2016;4(6). Available from:
  12. 12.
    Stoklossa CAJ, Forhan M, Padwal RS, et al. Practical considerations for body composition assessment of adults with class II/III obesity using bioelectrical impedance analysis or dual-energy X-ray absorptiometry. Curr Obes Rep. 2016;5(4):389–96. Available from: CrossRefGoogle Scholar
  13. 13.
    Nicoletti CF, Camelo JS, Dos Santos JE, et al. Bioelectrical impedance vector analysis in obese women before and after bariatric surgery: changes in body composition. Nutrition. 2014;30(5):569–74.CrossRefGoogle Scholar
  14. 14.
    Dixon JB, Bhasker AG, Lambert GW, et al. Leg to leg bioelectrical impedance analysis of percentage fat mass in obese patients. Can it tell us more than we already know? Surg Obes Relat Dis. 2016;12(7):1397–402. Scholar
  15. 15.
    Ramírez E, Valencia M, Bourges H, et al. Body composition prediction equations based on deuterium oxide dilution method in Mexican children: a national study. Eur J Clin Nutr. 2012;66(February):1–5. Available from: Google Scholar
  16. 16.
    Lara J, Johnstone AM, Wells J, et al. Accuracy of aggregate 2- and 3-component models of body composition relative to 4-component for the measurement of changes in fat mass during weight loss in overweight and obese subjects. Appl Physiol Nutr Metab. 2014;39(8):871–9. Available from: CrossRefGoogle Scholar
  17. 17.
    Strain GW, Wang J, Gagner M, et al. Bioimpedance for severe obesity: comparing research methods for total body water and resting energy expenditure. Obesity (Silver Spring). 2008;16(8):1953–6.CrossRefGoogle Scholar
  18. 18.
    Widen EM, Strain G, King WC, et al. Validity of bioelectrical impedance analysis for measuring changes in body water and percent fat after bariatric surgery. Obes Surg. 2014;24(6):847–54.CrossRefGoogle Scholar
  19. 19.
    Savastano S, Belfiore A, Di Somma C, et al. Validity of bioelectrical impedance analysis to estimate body composition changes after bariatric surgery in premenopausal morbidly women. Obes Surg. 2010;20(3):332–9.CrossRefGoogle Scholar
  20. 20.
    Vassilev G, Hasenberg T, Krammer J, et al. The phase angle of the bioelectrical impedance analysis as predictor of post-bariatric weight loss outcome. Obes Surg. 2017;27(3):665–9.CrossRefGoogle Scholar
  21. 21.
    Strain GW, Ebel F, Honohan J, et al. Fat-free mass is not lower 24 months postbariatric surgery than nonoperated matched controls. Surg Obes Relat Dis. 2017;13(1):65–9. Scholar
  22. 22.
    O’Neill D. Measuring obesity in the absence of a gold standard. Econ Hum Biol. 2015;17(June 2013):116–28. Scholar
  23. 23.
    Schoeller DA. Measurement of energy expenditure in free-living humans by using doubly labeled water. J Nutr. 1988;118(11):1278–89. Available from: CrossRefGoogle Scholar
  24. 24.
    Lin LI. A concordance correlation coefficient to evaluate reproducibility. Biometrics. 1989;45(1):255–68.CrossRefGoogle Scholar
  25. 25.
    Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res. 1999;8(2):135–60. Available from: CrossRefGoogle Scholar
  26. 26.
    Sheiner LB, Beal SL. Some suggestions for measuring predictive performance. J Pharmacokinet Biopharm. 1981 Aug;9(4):503–12.CrossRefGoogle Scholar
  27. 27.
    Carvajal C, Savino P, Ramirez A, et al. Anthropometric assessment for bariatric procedures in the private practice of a registered dietitian in Colombia. Obes Surg. 2017;27(6):1612–21.CrossRefGoogle Scholar
  28. 28.
    Dagan SS, Goldenshluger A, Globus I, et al. Nutritional recommendations for adult bariatric surgery patients: clinical practice. Adv Nutr An Int Rev J. 2017;8(2):382–94.CrossRefGoogle Scholar
  29. 29.
    Kaido T, Uemoto S. Direct segmental multi-frequency bioelectrical impedance analysis is useful to evaluate sarcopenia. Am J Transplant. 2013;13(9):2506–7.CrossRefGoogle Scholar
  30. 30.
    Karelis AD, Chamberland G, Aubertin-Leheudre M, et al. Validation of a portable bioelectrical impedance analyzer for the assessment of body composition. Appl Physiol Nutr Metab. 2013;38(1):27–32. Available from: CrossRefGoogle Scholar
  31. 31.
    Faria SL, Faria OP, Cardeal MDA, et al. Validation study of multi-frequency bioelectrical impedance with dual-energy X-ray absorptiometry among obese patients. Obes Surg. 2014;24(9):1476–80.CrossRefGoogle Scholar
  32. 32.
    Verney J, Metz L, Chaplais E, et al. Bioelectrical impedance is an accurate method to assess body composition in obese but not severely obese adolescents. Nutr Res. 2016;36(7):663–70. Scholar
  33. 33.
    de Faria ER, de Faria FR, Gonçalves VSS, et al. Prediction of body fat in adolescents: comparison of two electric bioimpedance devices with dual-energy X-ray absorptiometry. Nutr Hosp. 2014;30(6):1270–8.PubMedGoogle Scholar
  34. 34.
    Snijder MB, van Dam RM, Visser M, et al. What aspects of body fat are particularly hazardous and how do we measure them? Int J Epidemiol. 2006;35(1):83–92.CrossRefGoogle Scholar
  35. 35.
    Ward LCC. Bioelectrical impedance validation studies: alternative approaches to their interpretation. Eur J Clin Nutr. 2013;67(S1):S10–3. Scholar
  36. 36.
    Kutac P, Kopecky M. Comparison of body fat using various bioelectrical impedance analyzers in university students. Acta Gymnica. 2015;45(4):177–86. Available from: CrossRefGoogle Scholar
  37. 37.
    Park KS, Lee DH, Lee J, et al. Comparison between two methods of bioelectrical impedance analyses for accuracy in measuring abdominal visceral fat area. J Diabetes Complicat. 2016;30(2):343–9. Scholar
  38. 38.
    LaForgia J, Dollman J, Dale MJ, et al. Validation of DXA body composition estimates in obese men and women. Obesity. 2012;17(4):821–6. Scholar
  39. 39.
    Das SK, Roberts SB, Kehayias JJ, et al. Body composition assessment in extreme obesity and after massive weight loss induced by gastric bypass surgery. Am J Physiol - Endocrinol Metab. 2003;284(6):E1080–8.CrossRefGoogle Scholar
  40. 40.
    Levitt DG, Beckman LM, Mager JR, et al. Comparison of DXA and water measurements of body fat following gastric bypass surgery and a physiological model of body water, fat, and muscle composition. J Appl Physiol. 2010;109(3):786–95. Available from: CrossRefGoogle Scholar
  41. 41.
    Ravelli MN, Schoeller DA, Crisp AH, et al. Accuracy of total energy expenditure predictive equations after a massive weight loss induced by bariatric surgery. Clin Nutr ESPEN. 2018;26:57–65. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of Pharmaceutical SciencesSão Paulo State University (UNESP)AraraquaraBrazil
  2. 2.Institute of BiosciencesSão Paulo State University (UNESP)BotucatuBrazil
  3. 3.Methodist University of PiracicabaPiracicabaBrazil
  4. 4.Department of Education, Institute of BiosciencesSão Paulo State University (UNESP)BotucatuBrazil

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