Fluid Imbalance Clarifies Differences in Fat Estimated with Bio-Electrical Impedance Analysis Compared to Dual-Energy X-ray Absorptiometry and Single Lateral Standing Digital Image Analy-Sis

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Abstract
Limitations of body mass index (BMI) as a measure of body fat and the need for practical methods to estimate body fat reinforce interest in smartphone two-dimensional digital imaging and bioe-lectrical impedance analysis (BIA). Compared to dual x-ray absorptiometry (DXA), we determined differences in body fat mass (FM) estimated with smartphone single lateral standing digital image (SLSDI) and bioimpedance analysis (BIA) in 188 healthy adults (69 females and 119 males). SLSDI FM estimates were similar to DXA values but BIA underestimated (p25 kg/m2, 54 male rugby players, compared to 40 male non-rugby players, had greater (p<0.001) BMI and fat-free mass but less (p<0.001) FM and ECW/ICW. SLSDI and DXA FM estimates were not different in both groups; BIA underestimated (p<0.001) FM in the non-rugby men. This finding is consistent with expansion of ECW in individuals with excess body fat due to increased adipose tissue mass and its water content. Unlike SLSDI, BIA predictions of FM are affected by altered fluid distribution associated with increased adipose tissue. These findings establish the validity, practicality, and convenience of smartphone SLSDI to estimate FM for healthcare providers in clinical and field settings.

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