Practical but Inaccurate? A-Mode Ultrasound and Bioelectrical Impedance Underestimate Body Fat Percentage Compared to Dual-Energy X-ray Absorptiometry in Male College Students

Abstract

Bioelectrical impedance (BIA) and ultrasound (US) have become popular for estimating body fat percentage (BF%) due to their low cost and clinical convenience. However, the agreement of these devices with the gold-standard method still requires investigation. The aim was to analyze the agreement between a gold-standard %BF assessment method with BIA and US devices. Twenty-three men (aged 30.1 ± 7.7 years, weighing 82.5 ± 14.9 kg, 1.77 ± 0.05 m tall) underwent dual-energy X-ray absorptiometry (DXA), BIA (tetrapolar) and US (three-site method) %BF assessments. Pearson and concordance correlations were analyzed. A T-test was used to compare the means of the methods, and Bland-Altman plots analyzed agreement and proportional bias. Alpha was set at <0.05. The Pearson coefficients of BIA and US with DXA were high (BIA = 0.94; US = 0.89; both p < 0.001). The concordance coefficient was high for BIA (0.80) and moderate for US (0.49). The BF% measured by BIA (24.5 ± 7.5) and US (19.4 ± 7.0) was on average 4.4% and 9.6% lower than DXA (29.0 + 8.5%), respectively (p < 0.001). Lower and upper agreement limits between DXA and BIA were -1.45 and 10.31, while between DXA and US, they were 2.01 and 17.14, respectively. There was a tendency of both BIA (p = 0.09) and US (p = 0.057) to present proportional bias and underestimate BF%. Despite the correlation, the mean differences between the methods were significant, and the agreement limits were very wide. This indicates that BIA and US, as measured in this study, have limited potential to accurately measure %BF compared to DXA, especially in individuals with higher body fat.

Keywords: bioelectrical impedance; body fat; dual-energy X-ray absorptiometry; ultrasound.

Figure 1

Bland–Altman plot. Comparison between BF% derived by DXA and BIA. Green and salmon color areas represent the estimate of the upper and lower limit of agreement (dashed line in the center is the estimate) with lower and upper confidence intervals (dotted lines at the bottom and top of the green and salmon area). Lilac color represents the mean difference between methods (dashed line) with lower and upper confidence intervals (dotted lines at the bottom and top of the lilac color area).

Figure 2

Bland–Altman plot. Comparison between BF% derived by DXA and US. Green and salmon color areas represent the estimate of the upper and lower limit of agreement (dashed line in the center is the estimate) with lower and upper confidence intervals (dotted lines at the bottom and top of the green and salmon area). Lilac color represents the mean difference between methods (dashed line) with lower and upper confidence intervals (dotted lines at the bottom and top of the lilac color area).