Determination of Cole parameters in multiple frequency bioelectrical impedance analysis using only the measurement of impedances

Conventional bioimpedance spectrometers measure resistance and reactance over a range of frequencies and, by application of a mathematical model for an equivalent circuit (the Cole model), estimate resistance at zero and infinite frequencies. Fitting of the experimental data to the model is accomplished by iterative, nonlinear curve fitting. An alternative fitting method is described that uses only the magnitude of the measured impedances at four selected frequencies. The two methods showed excellent agreement when compared using data obtained both from measurements of equivalent circuits and of humans. These results suggest that operational equivalence to a technically complex, frequency-scanning, phase-sensitive BIS analyser could be achieved from a simple four-frequency, impedance-only analyser.

A comparison of the whole-body and segmental methodologies of bioimpedance analysis

Theory supports the use of a segmental methodology (SM) for bioimpedance analysis (BIA) of body water (BW). However, previous studies have generally failed to show a significant improvement when the SM is used in place of a whole-body methodology. A pilot study was conducted to compare the two methodologies in control and overweight subjects. BW of each subject was measured by D(2)O dilution and also estimated from BIA measurements. Bland and Altman analysis was used to compare the two values of BW. The SM resulted in a small but not significantly improved "limits of agreement" of measured and BIA estimated BW (approximately 0.3). This and the results of previous studies suggest that improvements in prediction of BW obtained from application of the SM may be intrinsically small and may not justify the additional effort in application.

A new technique for the quantification of peripheral edema with application in both unilateral and bilateral cases

Current noninvasive techniques for the routine and frequent quantification of peripheral lymphedema in patients are total limb volume measurement (by water immersion or by circumferential measurements) and bioelectrical impedance analysis (BIA). However both of these techniques require standardizing the measurement using a contralateral measurement from the unaffected limb. Hence these techniques are essentially restricted to unilateral lymphedema. This paper describes the results from a preliminary study to investigate an alternative approach to the analysis of the data from multiple frequency BIA to produce an index of lymphedema without the need for normalization to another body segment. Twenty patients receiving surgical treatment for breast cancer were monitored prior to surgery and again after diagnosis with unilateral lymphedema. The data recorded were total limb volume, by circumferential measurements; and BIA measurements of both limbs. From these measurements total limb volumes and extracellular fluid volumes were calculated and expressed as ratios of the affected limb to that of the unaffected limb. An index of the ratio of the extracellular fluid volume to the intracellular fluid volume was determined. This ECW/ICW index was calculated for both the affected and unaffected limbs at both measurement times. Results confirmed that the established techniques of total limb volume and extracellular fluid volume normalized to the unaffected contralateral limb were accurate in the detection of lymphedema (p < 10(-6)). Comparison of the ECW/ICW index from the affected limb after diagnosis with that from the pre-surgery measurement revealed a significant (p < 10(-6)) and considerable (75%) increase. The results of this pilot study suggest that by using multiple frequency bioelectrical impedance analysis, an index of the ECW/ICW ratio can be obtained and this index appears to have an equal, or better, sensitivity than the other techniques in detecting lymphedema. More importantly, this index does not require normalization to another body segment and can be used to detect all types of peripheral edema including both unilateral and bilateral lymphedema.

Early diagnosis of lymphedema using multiple frequency bioimpedance

Multiple frequency bioelectrical impedance analysis (MFBIA) has previously been shown to provide accurate relative measures of lymphedema in the upper limb of patients (1). This paper reports the results of a three year prospective study to evaluate the efficacy of MFBIA to predict the early onset of lymphedema in patients following treatment for breast cancer. Bioelectrical impedance measurements and circumferential measurements of each upper limb were recorded in healthy control subjects (n = 60) to determine the normal range of the ratio (dominant/non-dominant) of extracellular and total limb volumes respectively. Patients undergoing surgery for the treatment of breast cancer were recruited as the study group; MFBIA and circumferential measurements were recorded pre-surgery, one month post-surgery and then at two month intervals for 24 months. One hundred and two patients were recruited into the study. Twenty patients developed lymphedema in the 24 months follow up period of this study. In each of these 20 cases MFBIA predicted the onset of the condition up to 10 months before the condition could be clinically diagnosed. Estimates of the sensitivity and specificity were both approximately 100%. At the time of detection by MFBIA, only one of the patients returned a positive test result from the total limb volumes determined from the circumferential measures. These results confirmed the suitability of the MFBIA technique as a reliable diagnostic procedure for the early detection of lymphedema.

Fluid shifts resulting from exercise in rats as detected by bioelectrical impedance

PURPOSE

This study was designed to investigate the immediate effect of exercise intensity and duration on body fluid volumes in rats throughout a 3-wk exercise program.

METHODS

Changes in the extracellular water (ECW) and total body water (TBW) volumes of rats were measured preexercise and postexercise using multiple frequency bioelectrical impedance analysis. Groups of rats were exercised at two intensities (6 m.min(-1) and 12 m.min(-1)) for two exercise times (60 min and 90 min) 5 d.wk(-1) during a 3-wk period. Changes in plasma electrolytes, glucose, and lactate resulting from the exercise were also measured on 3 d of each week.

RESULTS

Each group of animals showed significant losses in ECW and TBW as a direct result of daily exercise. The magnitude of fluid loss was directly related to the intensity of the exercise, but not to exercise duration; although the magnitude of daily fluid loss at the higher intensity exercise (12 m.min(-1)) decreased as the study progressed, possibly indicating a training effect.

CONCLUSION

At low-intensity exercise, there is a small but significant loss in both TBW and ECW fluids, and the magnitude of these losses does not change throughout a 3-wk exercise program. At moderate levels of exercise intensity, there is a greater loss of both TBW and ECW fluids. However, the magnitudes of these losses decrease significantly during the 3-wk exercise program, thus demonstrating a training effect.

Estimation of body water compartments in cirrhosis by multiple-frequency bioelectrical-impedance analysis

Estimation of total body water by measuring bioelectrical impedance at a fixed frequency of 50 kHz is useful in assessing body composition in healthy populations. However, in cirrhosis, the distribution of total body water between the extracellular and intracellular compartments is of greater clinical importance. We report an evaluation of a new multiple-frequency bioelectrical-impedance analysis technique (MFBIA) that may quantify the distribution of total body water in cirrhosis. In 21 cirrhotic patients and 21 healthy control subjects, impedance to the flow of current was measured at frequencies ranging from 4 to 1012 kHz. These measurements were used to estimate body water compartments and then compared with total body water and extracellular water determined by isotope methodology. In cirrhotic patients, extracellular water and total body water (as determined by isotope methods) were well predicted by MFBIA (r = 0.73 and 0.89, respectively). However, the 95% confidence intervals of the limits of agreement between MFBIA and the isotope methods were +/-14% and +/-9% for cirrhotics (extracellular water and total body water, respectively) and +/-9% and +/-9% for cirrhotics without ascites. The 95% confidence intervals estimated from the control group were +/-10% and +/-5% for extracellular water and total body water, respectively. Thus, despite strong correlations between MFBIA and isotope measurements, the relatively large limits of agreement with accepted techniques suggest that the MFBIA technique requires further refinement before it can be routinely used to determine the nutritional assessment of individual cirrhotic patients.

Early diagnosis of lymphedema in postsurgery breast cancer patients

Lymphedema is an accumulation of lymph fluid in the limb resulting from an insufficiency of the lymphatic system. It is commonly associated with surgical or radiotherapy treatment for breast cancer. As with many progressively debilitating disorders, the effectiveness of treatment is significantly improved by earlier intervention. Multiple frequency bioelectrical impedance analysis (MFBIA) previously was shown to provide accurate relative measures of lymphedema in the upper limb in patients after treatment for breast cancer. This presentation reports progress to date on a three-year prospective study to evaluate the efficacy of MFBIA to predict the early onset of lymphedema in breast cancer patients following treatment. Bioelectrical impedance measurements of each upper limb were recorded in a group of healthy control subjects (n = 50) to determine the ratio of extracellular limb-fluid volumes. From this population, the expected normal range of asymmetry (99.7% confidence) between the limbs was determined. Patients undergoing surgery to treat breast cancer were recruited into the study, and MFBIA measurements were recorded presurgery, at one month and three months after surgery, and then at two-month intervals for up to 24 months postsurgery. When patients had an MFBIA measure outside the 99.7% range of the control group, they were referred to their physician for clinical assessment. Results to date: Over 100 patients were recruited into the study over the past two years; at present, 19 have developed lymphedema and, of these, 12 are receiving treatment. In each of these 19 cases, MFBIA predicted the onset of the condition up to four months before it could be clinically diagnosed. The false-negative rate currently is zero. The study will continue to monitor patients over the remaining year to accurately ascertain estimates of specificity and sensitivity of the procedure.

Comparison of whole body and segmental bioimpedance methodologies for estimating total body water

We compared the whole body (WB) and segmental bioelectrical impedance analysis (BIA) methodologies in a group of healthy adults (n = 25). It has been suggested that the segmental methodology may overcome the difficulty in generating a single algorithm to predict total body water (TBW) in all groups whether healthy or not. We measured TBW, using D2O dilution, and WB and segmental BIA parameters. Cole-Cole analysis was used to determine the impedance at the characteristic frequency (Zc). The correlation between TBW (by D2O dilution) and segmental BIA measures (multiple regression, r = 0.90, p < 0.001, SEE = 3.1 L) was not significantly higher than the correlation between TBW (D2O dilution) and WB BIA measures (simple regression, r = 0.85, p < 0.001, SEE = 3.6 L). Others have observed this "lack of improvement" in a group of healthy subjects. The true value of the segmental BIA methodology may lie in applications involving groups with altered distributions of segmental and compartmental fluid.

Multiple frequency bioelectrical impedance analysis: a cross-validation study of the inductor circuit and Cole models

It has been proposed that multiple frequency bioelectrical impedance models of the human body should include an inductive property for the circulatory system, the inductor circuit model (ICM), and that such a model, when coupled with a new method of data analysis, can improve the predictive power of multiple frequency bioelectrical impedance analysis (MFBIA). This hypothesis was tested using MFBIA measurements and gold standard measures of total body and extracellular water volumes in a cross-validation study in two subject groups (viz. controls and HIV). The MFBIA measurements were analysed using the current, widely accepted Cole model and the alternative ICM model which includes an inductive component. Correlations in the range 0.75 to 0.92 (for TBW) and 0.46 to 0.79 (for ECW) for impedance quotients versus gold standard measures within the subject groups were observed. These decreased, to as low as r = 0.50 for TBW and r = 0.29 for ECW, when the derived algorithms were applied to the alternative subject group. These results suggest that lack of portability of MFBIA algorithms between subject groups is not due to an inadequacy of the analogue circuit model per se but is possibly due more to fundamental flaws in the principles associated with its application. These include assuming a constant proportionality of body segment geometries and tissue fluid resistivities. This study has also demonstrated that this inadequacy cannot be overcome by simply introducing an inductive component into the analogue electrical circuit.

Sensitivity of multiple frequency bioelectrical impedance analysis to changes in ion status

Bioelectrical impedance analysis has found extensive application as a simple noninvasive method for the assessment of body fluid volumes. The measured impedance is, however, not only related to the volume of fluid but also to its inherent resistivity. The primary determinant of the resistivities of body fluids is the concentration of ions. The aim of this study was to investigate the sensitivity of bioelectrical impedance analysis to bodily ion status. Whole body impedance over a range of frequencies (4-1012 kHz) of rats was measured during infusion of various concentrations of saline into rats concomitant with measurement of total body and intracellular water by tracer dilution techniques. Extracellular resistance (R0), intracellular resistance (R(i)) and impedance at the characteristic frequency (Z(c)) were calculated. R0 and Z(c) were used to predict extracellular and total body water respectively using previously published formulae. The results showed that whilst R0 and Z(c) decreased proportionately to the amount of NaCl infused, R(i) increased only slightly. Impedances at the end of infusion predicted increases in TBW and ECW of approximately 4-6% despite a volume increase of less than 0.5% in TBW due to the volume of fluid infused. These data are discussed in relation to the assumption of constant resistivity in the prediction of fluid volumes from impedance data.

Optimizing electrode sites for segmental bioimpedance measurements

Recent advances in the application of bioelectrical impedance analysis (BIA) have indicated that a more accurate approach to the estimation of total body water is to consider the impedance of the various body segments rather than simply that of the whole body. The segmental approach necessitates defining and locating the physical demarcation between both the trunk and leg and the trunk and arm. Despite the use of anatomical markers, these points of demarcation are difficult to locate with precision between subjects. There are also technical problems associated with the regional dispersion of the current distribution from one segment (cylinder) to another of different cross-sectional area. The concept of equipotentials in line with the proximal aspects of the upper (and lower) limbs along the contralateral limbs was investigated and, in particular, the utility of this concept in the measurement of segmental bioimpedance. The variation of measured segmental impedance using electrode sites along these equipotentials was less than 2.0% for all of the commonly used impedance parameters. This variation is approximately equal to that expected from biological variation over the measurement time. It is recommended that the electrode sites, for the measurement of segmental bioelectrical impedance in humans, described herein are adopted in accordance with the proposals of the NIH Technology Assessment Conference Statement.

Bioimpedance: is it a predictor of true water volume?

Bioelectrical impedance analysis (BIA) has been reported to be insensitive to changes in water volumes in individual subjects. This study was designed to investigate the effect on the intra- and extracellular resistances (Ri and Re) of the segments of subjects for whom body water was changed without significant change to the total amount of electrolyte in the respective fluids. Twelve healthy adult subjects were recruited. Ri and Re of the leg, trunk, and arm of the subjects were determined from BIA measures prior to commencement of two separate studies that involved intervention, resulting in a loss/gain of body water effected either by a sauna followed by water intake (study 1) or by ingestion (study 2). Ri and Re of the segments were also determined at a number of times following these interventions. The mean change in body water, expressed as a percentage of body weight, was 0.9% in study 1 and 1.25% in study 2. For each study, the results for each subject were normalized for each limb to the initial (prestudy) value and then the normalized results for each segment were pooled for all subjects. ANOVA of these pooled results failed to demonstrate any significant differences between the normalized mean values of Ri or Re of the segments measured through the course of each study. The failure to detect a change in Ri or Re is explained in terms of the basic theory of BIA.

Bioimpedance spectrometry in the determination of body water compartments: accuracy and clinical significance

Bioelectrical impedance analysis (BIA) offers the potential for a simple, portable and relatively inexpensive technique for the in vivo measurement of total body water (TBW). The potential of BIA as a technique of body composition analysis is even greater when one considers that body water can be used as a surrogate measure of lean body mass. However, BIA has not found universal acceptance even with the introduction of multi-frequency BIA (MFBIA) which, potentially, may improve the predictive accuracy of the measurement. There are a number of reasons for this lack of acceptance, although perhaps the major reason is that no single algorithm has been developed which can be applied to all subject groups. This may be due, in part, to the commonly used wrist-to-ankle protocol which is not indicated by the basic theory of bioimpedance, where the body is considered as five interconnecting cylinders. Several workers have suggested the use of segmental BIA measurements to provide a protocol more in keeping with basic theory. However, there are other difficulties associated with the application of BIA, such as effects of hydration and ion status, posture and fluid distribution. A further putative advantage of MFBIA is the independent assessment not only of TBW but also of the extracellular fluid volume (ECW), hence heralding the possibility of being able to assess the fluid distribution between these compartments. Results of studies in this area have been, to date, mixed. Whereas strong relationships of impedance values at low frequencies with ECW, and at high frequencies with TBW, have been reported, changes in impedance are not always well correlated with changes in the size of the fluid compartments (assessed by alternative and more direct means) in pathological conditions. Furthermore, the theoretical advantages of Cole-Cole modelling over selected frequency prediction have not always been apparent. This review will consider the principles, methodology and applications of BIA. The principles and methodology will be considered in relation to the basic theory of BIA and difficulties experienced in its application. The relative merits of single and multiple frequency BIA will be addressed, with particular attention to the latter's role in the assessment of compartmental fluid volumes.

Bioimpedance spectrometry in the determination of body water compartments: accuracy and clinical significance

Bioelectrical impedance analysis (BIA) offers the potential for a simple, portable and relatively inexpensive technique for the in vivo measurement of total body water (TBW). The potential of BIA as a technique of body composition analysis is even greater when one considers that body water can be used as a surrogate measure of lean body mass. However, BIA has not found universal acceptance even with the introduction of multi-frequency BIA (MFBIA) which, potentially, may improve the predictive accuracy of the measurement. There are a number of reasons for this lack of acceptance, although perhaps the major reason is that no single algorithm has been developed which can be applied to all subject groups. This may be due, in part, to the commonly used wrist-to-ankle protocol which is not indicated by the basic theory of bioimpedance, where the body is considered as five interconnecting cylinders. Several workers have suggested the use of segmental BIA measurements to provide a protocol more in keeping with basic theory. However, there are other difficulties associated with the application of BIA, such as effects of hydration and ion status, posture and fluid distribution. A further putative advantage of MFBIA is the independent assessment not only of TBW but also of the extracellular fluid volume (ECW), hence heralding the possibility of being able to assess the fluid distribution between these compartments. Results of studies in this area have been, to date, mixed. Whereas strong relationships of impedance values at low frequencies with ECW, and at high frequencies with TBW, have been reported, changes in impedance are not always well correlated with changes in the size of the fluid compartments (assessed by alternative and more direct means) in pathological conditions. Furthermore, the theoretical advantages of Cole-Cole modelling over selected frequency prediction have not always been apparent. This review will consider the principles, methodology and applications of BIA. The principles and methodology will be considered in relation to the basic theory of BIA and difficulties experienced in its application. The relative merits of single and multiple frequency BIA will be addressed, with particular attention to the latter's role in the assessment of compartmental fluid volumes.

A comparison of segmental and wrist-to-ankle methodologies of bioimpedance analysis

The common approach of bioelectrical impedance analysis to estimate body water uses a wrist-to-ankle methodology which, although not indicated by theory, has the advantage of ease of application particularly for clinical studies involving patients with debilitating diseases. A number of authors have suggested the use of a segmental protocol in which the impedances of the trunk and limbs are measured separately to provide a methodology more in keeping with basic theory. The segmental protocol has not, however, been generally adopted, partly because of the increased complexity involved in its application, and partly because studies comparing the two methodologies have not clearly demonstrated a significant improvement from the segmental methodology. We have conducted a small pilot study involving ten subjects to investigate the efficacy of the two methodologies in a group of normal subjects. The study did not require the independent measure of body water, by for example isotope dilution, as the subjects were maintained in a state of constant hydration with only the distribution between limbs and trunk changing as a result of change in posture. The results demonstrate a significant difference between the two methodologies in predicting the expected constancy of body water in this study, with the segmental methodology indicating a mean percentage change in extracellular water of -2.2%, which was not significantly different from the expected null result, whereas the wrist-to-ankle methodology indicated a mean percentage change in extracellular water of -6.6%. This is significantly different from the null result, and from the value obtained from the segmental methodology (p = 0.006). Similar results were obtained using estimates of total body water from the two methodologies.

Data analysis in multiple-frequency bioelectrical impedance analysis

The performance of three analytical methods for multiple-frequency bioelectrical impedance analysis (MFBIA) data was assessed. The methods were the established method of Cole and Cole, the newly proposed method of Siconolfi and co-workers and a modification of this procedure. Method performance was assessed from the adequacy of the curve fitting techniques, as judged by the correlation coefficient and standard error of the estimate, and the accuracy of the different methods in determining the theoretical values of impedance parameters describing a set of model electrical circuits. The experimental data were well fitted by all curve-fitting procedures (r = 0.9 with SEE 0.3 to 3.5% or better for most circuit-procedure combinations). Cole-Cole modelling provided the most accurate estimates of circuit impedance values, generally within 1-2% of the theoretical values, followed by the Siconolfi procedure using a sixth-order polynomial regression (1-6% variation). None of the methods, however, accurately estimated circuit parameters when the measured impedances were low (< 20 omega) reflecting the electronic limits of the impedance meter used. These data suggest that Cole-Cole modelling remains the preferred method for the analysis of MFBIA data.

Effect of temperature and sweating on bioimpedance measurements

The effect of skin temperature and hydration status has been suggested by some researchers as a common cause of variation in bioimpedance measurements of the body. This paper details a simple method of measuring the transverse impedance of the skin. The measured resistance and reactance was found to decrease by 35% and 18% for an increase of 20 degrees C. Similarly a decrease in resistance and reactance of 20% and 25% respectively was detected after hydration of the skin. However, the changes in skin temperature and hydration were found to have no significant effect on the whole body bioimpedance measurements using the standard tetra-polar electrode technique.

Potential errors in the application of mixture theory to multifrequency bioelectrical impedance analysis

Potential errors in the application of mixture theory to the analysis of multiple-frequency bioelectrical impedance data for the determination of body fluid volumes are assessed. Potential sources of error include: conductive length; tissue fluid resistivity; body density; weight and technical errors of measurement. Inclusion of inaccurate estimates of body density and weight introduce errors of typically < +/- 3% but incorrect assumptions regarding conductive length or fluid resistivities may each incur errors of up to 20%.

Bioelectrical impedance analysis for the estimation of body composition in rats

Bioelectrical impedance analysis (BIA) was used to assess body composition in rats fed on either standard laboratory diet or on high-fat diet designed to induce obesity. Bioelectrical impedance analysis predictions of total body water and thus fat-free mass (FFM) for the group mean values were generally within 5% of the measured values by tritiated water (3H2O) dilution. The limits of agreement for the procedure were, however, large, approximately +/- 25%, limiting the applicability of the technique for measurement of body composition in individual animals.

Extraction of electrical characteristics from pixels of multifrequency EIT images

Computer modelling has shown that electrical characteristics of individual pixels may be extracted from within multiple-frequency electrical impedance tomography (MFEIT) images formed using a reference data set obtained from a purely resistive, homogeneous medium. In some applications it is desirable to extract the electrical characteristics of individual pixels from images where a purely resistive, homogeneous reference data set is not available. One such application of the technique of MFEIT is to allow the acquisition of in vivo images using reference data sets obtained from a non-homogeneous medium with a reactive component. However, the reactive component of the reference data set introduces difficulties with the extraction of the true electrical characteristics from the image pixels. This study was a preliminary investigation of a technique to extract electrical parameters from multifrequency images when the reference data set has a reactive component. Unlike the situation in which a homogeneous, resistive data set is available, it is not possible to obtain the impedance and phase information directly from the image pixel values of the MFEIT images data set, as the phase of the reactive reference is not known. The method reported here to extract the electrical characteristics (the Cole-Cole plot) initially assumes that this phase angle is zero. With this assumption, an impedance spectrum can be directly extracted from the image set. To obtain the true Cole-Cole plot a correction must be applied to account for the inherent rotation of the extracted impedance spectrum about the origin, which is a result of the assumption. This work shows that the angle of rotation associated with the reactive component of the reference data set may be determined using a priori knowledge of the distribution of frequencies of the Cole-Cole plot. Using this angle of rotation, the true Cole-Cole plot can be obtained from the impedance spectrum extracted from the MFEIT image data set. The method was investigated using simulated data, both with and without noise, and also for image data obtained in vitro. The in vitro studies involved 32 logarithmically spaced frequencies from 4 kHz up to 1 MHz and demonstrated that differences between the true characteristics and those of the impedance spectrum were reduced significantly after application of the correction technique. The differences between the extracted parameters and the true values prior to correction were in the range from 16% to 70%. Following application of the correction technique the differences were reduced to less than 5%. The parameters obtained from the Cole-Cole plot may be useful as a characterization of the nature and health of the imaged tissues.

Evaluation of bioelectrical impedance for prospective nutritional assessment in cystic fibrosis

We have compared the use of bioelectrical impedance analysis (BIA) with anthropometry for the prediction of changes in total body potassium (TBK) in a group (n = 31) of children with cystic fibrosis. Linear regression analysis showed that TBK was highly correlated (r > 0.93) with height2/impedance, weight, height, and fat-free mass (FFM) estimated from skin-fold measurements. Changes in TBK were also correlated, but less well, with changes in height2/impedance, weight, height, and FFM (r = 0.69, 0.59, 0.44, and 0.40, respectively). The children were divided into two groups: those who had normal accretion of TBK (> 5%/y) and those who had suboptimal accretion of TBK (< 5%/y). Analysis of variance showed that the significant difference in the change in TBK between the groups was detectable by concomitant changes in impedance and weight but not by changes in height, FFM, or weight and height Z scores. The results of this study suggest that serial BIA measures may be useful as a predictor of progressive undernutrition and poor growth in children with cystic fibrosis.

Bioelectrical impedance for monitoring the efficacy of lymphoedema treatment programmes

The treatment of lymphoedema includes a combination of massage, compression bandaging, and exercise. To date the most common technique of assessing the efficacy of treatment has involved estimating the total limb volume from circumferential measurements at fixed intervals along the limb. This study investigated the application of multiple frequency bioelectrical impedance analysis, MFBIA, to monitor the volume of lymphoedema in the upper limb of patients who developed this disorder following surgery for cancer of the breast. Daily measurements of both circumference and impedance of both the affected and unaffected limbs were recorded for 20 patients throughout their 4 week treatment programmes. Twenty control subjects were also monitored daily over a similar 4 week period. Prior to the commencement of treatment the bioimpedance technique detected a significant (P < 0.01) asymmetry between the two limbs of the control subjects, associated with handedness (P < 0.001). Circumferential estimates of limb volumes in the control group detected no asymmetry. Impedance measures of extracellular fluid showed all of the patients to lie outside the 95% confidence interval determined from the data of the control group. The trends of the impedance measures and the circumferential estimates of volume throughout the 4 week program were found to be significantly different (P < 0.05); MFBIA exhibiting a greater sensitivity in the detection of lymphoedema. The results demonstrate that MFBIA is significantly more sensitive than circumferential measurement both in the early diagnosis of lymphoedema and in monitoring change.

Evaluation of multiple frequency bioelectrical impedance and Cole-Cole analysis for the assessment of body water volumes in healthy humans

OBJECTIVE

To assess the application of a Cole-Cole analysis of multiple frequency bioelectrical impedance analysis (MFBIA) measurements to predict total body water (TBW) and extracellular water (ECW) in humans. This technique has previously been shown to produce accurate and reliable estimates in both normal and abnormal animals.

DESIGN

The whole body impedance of 60 healthy humans was measured at 496 frequencies (ranging from 4 kHz to 1 MHz) and the impedance at zero frequency, Ro, and at the characteristic frequency, Zc, were determined from the impedance spectrum, (Cole-Cole plot). TBW and ECW were independently determined using deuterium and bromide tracer dilution techniques.

SETTING

At the Dunn Clinical Nutrition Centre and The Department of Biochemistry, University of Queensland.

SUBJECTS

60 healthy adult volunteers (27 men and 33 women, aged 18-45 years).

RESULTS

The results presented suggest that the swept frequency bioimpedance technique estimates total body water, (SEE = 5.2%), and extracellular water, (SEE = 10%), only slightly better in normal, healthy subjects than a method based on single frequency bioimpedance or anthropometric estimates based on weight, height and gender.

CONCLUSIONS

This study has undertaken the most extensive analysis to date of relationships between TBW (and ECW) and individual impedances obtained at different frequencies ( > 400 frequencies), and has shown marginal advantages of using one frequency over another, even if values predicted from theoretical bioimpedance models are used in the estimations. However in situations where there are disturbances of fluid distribution, values predicted from the Cole-Cole analysis of swept frequency bioimpedance measurements could prove to be more useful.

Multiple frequency bioelectrical impedance for the prediction of total body potassium in cystic fibrosis

The use of multiple frequency bioelectrical impedance analysis (MFBIA) was compared with single frequency bioelectrical impedance analysis (SFBIA) and anthropometry to estimate the size of the body cell mass (BCM) in a paediatric cystic fibrosis population. BCM was independently determined from the accepted gold standard reference of total body potassium (TBK). MFBIA was used to measure the impedance of the body at 248 frequencies from 4 kHz to 1 MHz. Data were analysed using Cole-Cole plots of reactance versus resistance. The limits of agreement procedure was used to determine the reliability and precision of the different techniques to predict values for TBK, in an individual subject. The results indicate that MFBIA with a precision of 12% offers little improvement over single frequency BIA but is better and more accurate than anthropometry for the prediction of TBK in an individual patient.

The use of Cole-Cole plots to compare two multi-frequencybioimpedance instruments

Two commercially available multifrequency bioimpedance spectrometers (Xitron 4000B and SEAC SFB3) were compared by performing measurements on a set of electronic circuits and by studying 14 healthy volunteers. Output data were plotted as reactance versus resistance and fitted with a semi-circle using a least squares fitting program. In tests with six electronic circuits both instruments produced impedance loci that were well described by semicircular Cole-Cole plots, though there were some minor discrepancies using the Xitron instrument at frequencies above 150 kHz. When tested on the volunteers the SEAC instrument gave very good fits (RMSE = 1.5 Omega) to a semi-circle from 5-600 kHz on all volunteers. The Xitron instrument gave excellent fits to the semi-circle between 5 and 55 kHz (RMSE = 0.7 Omega) but above 55 kHz the phase measurements stayed constant or even increased, confirming the anomalous behaviour reported by other authors. The conclusions to be drawn are that the semicircular plots predicted by the Cole-Cole theory give a very good description of multifrequency impedance data recorded by the SEAC SFB3 instrument, on human subjects, for frequencies between 5 and 600 kHz. The Xitron 4000B is not able to reproduce the theoretically expected results in humans above 55 kHz.

Improved prediction of extracellular and total body water using impedance loci generated by multiple frequency bioelectrical impedance analysis

Bioelectrical impedance analysis (BIA) using a frequency of 50 kHz is an established method of predicting total body water (TBW). However, very little research has been performed to determine whether 50 kHz is the optimum frequency for the prediction of TBW from impedance measurements. This paper analyses a mathematical expression describing the equivalent electrical circuit for biological tissue, and derives a graphical representation of the resistive and reactive components. The nature of the resulting impedance locus was used in the analysis of measured whole-body impedance of 42 rats over a range of frequencies to determine the impedance at the characteristic frequency, Zc, and also the impedance at zero frequency, R0. The standard error associated with the prediction of TBW (determined by isotope dilution) using Zc was 5.9% compared with a standard error of prediction of 10.1% using the established BIA method at 50 kHz on the same data. Predictions of extracellular water (ECW) using the impedance at zero frequency, R0, yielded a standard error of 3.2% compared with standard errors of 4.8% and 4.2% using single frequency BIA measurements at 5 kHz and 1 kHz, respectively. These results demonstrate a significant (P < 0.01) improvement in the prediction of TBW and ECW using multiple frequency bioelectrical impedance analysis (MFBIA).

Multi-frequency bioelectrical impedance augments the diagnosis and management of lymphoedema in post-mastectomy patients

The value of multiple frequency bioelectric impedence analysis (MFBIA) in the monitoring and management of post-mastectomy lymphoedema of the arm was evaluated in 15 patients and controls. The technique was found to produce quantitative agreement with a clinical diagnosis of lymphoedema and with the currently-used measure (limb volume calculated from circumferential measurements) of limb size. The significance of this finding lies in MFBIA being diagnostically informative: it indicates when an observed change in limb volume is directly, albeit theoretically, attributable to accumulation of extracellular fluid. MFBIA potentially offers the means for earlier definitive diagnosis and more-accurate monitoring of extracellular fluid changes during and after treatment.

Bioelectrical impedance analysis for measurement of body fluid volumes: a review

The need for a portable, inexpensive, accurate and safe method for measuring body composition is well established. Bioelectrical impedance analysis (BIA) has the potential to partially meet this need by estimating the water component of body composition. There are still a number of unresolved questions and limitations to the applications of BIA, however. This paper briefly reviews the theory of BIA, its application and its limitations. Recent progress in the development and validation of swept or multiple frequency BIA used to determine both extracellular water and total body water is discussed in detail.