Comparison of proximal and distal placements of electrodes to assess body composition by bioelectrical impedance in obese adults

The purpose of this study was to compare the variability and accuracy of proximal and traditional distal electrode placement to estimate body composition in obese adults. Fifty-two obese men and women had a mean age of 37 years and an average body mass index (BMI) of 30.6 kg.m(-2). Body composition was measured using DEXA and an RJL bioelectric impedance analysis 101A bioelectric impedance analyzer. Impedance was measured using the traditional distal electrode placement (hand and foot) and a proximal electrode placement where the current detecting electrodes were placed in the antecubital and popliteal fossae. The distal resistance was 482.4 +/- 79 Omega, which was more than double the mean proximal values of 193.2 +/- 27 Omega. Multiple regression analysis derived the best-fitting equation to predict DEXA-derived fat-free mass. The combination of Ht(2)/R (height(2)/resistance) and mass were the only significant predictors for both the proximal and distal electrode placements. The resulting R(2) values were 0.86 and 0.88, whereas standard errors of the estimate (SEEs) were 4.0 and 3.6 kg for the distal and proximal placements, respectively. An independent sample of 40 obese women was used to cross-validate this new equation. Mean impedance predictions using the distal and proximal electrode placements (45.78 +/- 1.07 and 45.29 +/- 0.97 Omega, respectively) were similar to the reference values (45.29 +/- 0.64 Omega) determined by DEXA. Fat-free mass predicted with the distal and proximal electrode placements correlated significantly (p < 0.001) with the reference fat-free mass value (r = 0.72 and 0.75, respectively). These data suggest that using a proximal electrode placement and a fatness-specific equation helps to reduce the variability of the bioelectric impedance analysis technique in obese adults.