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Bioelectrical impedance analysis versus dual-energy X-ray absorptiometry for body composition assessment in children
Madhu Sudhan Karri1, Lesa Dawman2, Deepthika Sadasivam1
1Department of Paediatrics, Advanced Paediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
Insights
Bioelectrical impedance analysis (BIA) strongly correlates with dual-energy X-ray absorptiometry (DXA) for assessing body composition in children with chronic kidney disease (CKD). However, BIA shows poor concordance, limiting its use for individual patient assessment.
Area of Science:
- Pediatric Nephrology
- Body Composition Analysis
- Medical Imaging
Background:
- Children with chronic kidney disease (CKD) experience significant body composition changes.
- Dual-energy X-ray absorptiometry (DXA) is the gold standard for assessment but has limitations (cost, radiation, availability).
- Bioelectrical impedance analysis (BIA) is a radiation-free, portable alternative, but its accuracy in pediatric CKD requires further evaluation.
Purpose of the Study:
- To evaluate the agreement between BIA and DXA for body composition and bone mineral assessment in children with CKD stages 3-5.
- To determine if BIA can accurately reflect changes in body composition across different stages of CKD.
Main Methods:
- Cross-sectional study of 102 children (aged 5-14) with CKD stages 3-5.
- Simultaneous BIA and DXA measurements were performed on the same day.
- Agreement was assessed using correlation coefficients (Pearson's, Lin's CCC) and Bland-Altman analysis.
Main Results:
- BIA showed strong correlations with DXA for fat mass (FM), fat-free mass (FFM), and bone mineral content (BMC).
- However, Lin's concordance correlation coefficient (CCC) indicated poor agreement (<0.90) for all parameters, especially body fat percentage (BF%).
- BIA systematically underestimated FM and overestimated FFM compared to DXA, and failed to detect stage-wise body composition changes identified by DXA.
Conclusions:
- Despite strong correlations, BIA demonstrates poor concordance with DXA in pediatric CKD, with clinically unacceptable limits of agreement.
- DXA remains essential for individual-level body composition assessment in pediatric CKD.
- BIA may have a role in population-level nutritional screening in resource-limited settings, but its ability to track changes requires further study.
Introduction:
Children with chronic kidney disease (CKD) exhibit progressive body composition alterations. While dual-energy X-ray absorptiometry (DXA) is the reference standard, its routine use is limited by cost, radiation, and availability. Bioelectrical impedance analysis (BIA) offers a portable, radiation-free alternative, but its accuracy relative to DXA in paediatric CKD remains insufficiently evaluated.
Methods:
This cross-sectional study enrolled 102 children aged 5-14 years with CKD stages 3-5. Same-day BIA and DXA measurements were performed. Agreement between methods was assessed using Pearson's correlation coefficient, Lin's concordance correlation coefficient (CCC), and Bland-Altman analysis. Associations with CKD stage and sex were examined.
Results:
BIA showed strong to very strong correlations with DXA for fat mass (FM; r = 0.93), fat-free mass (FFM; r = 0.91), and total bone mineral content (BMC; r = 0.84). Lin's CCC indicated poor concordance for all parameters (all < 0.90): FFM 0.87, total BMC 0.81, total bone mineral density (BMD) 0.74, FM 0.66 and body fat percentage (BF%) 0.29. BIA systematically underestimated FM and overestimated FFM relative to DXA. DXA detected significant stage-wise reductions in FM, FMI, FFM and FFMI across CKD stages, whereas BIA detected only the decline in FFMI (p = 0.012).
Conclusions:
Despite strong correlations, BIA showed poor concordance with DXA for every parameter assessed, with clinically unacceptable limits of agreement; correlation does not imply interchangeability. BIA may retain a role in population-level nutritional screening in resource-limited settings, although its ability to track change was not tested here; DXA remains necessary for individual-level assessment in paediatric CKD. What is known • Children with CKD experience progressive lean tissue loss, fat redistribution, and impaired bone mineralisation contributing to growth failure. • DXA is the reference standard for body composition assessment, but it is limited by cost, radiation, and availability. What is new • BIA shows a strong to very strong correlation with DXA but poor concordance (Lin's CCC < 0.90) for every body composition and bone parameter in paediatric CKD stages 3-5. • BIA cannot detect stage-wise differences in body composition that DXA identifies, limiting its diagnostic precision in this population.
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