British Journal of Nutrition

Research Article

Validation of foot-to-foot bioelectrical impedance analysis with dual-energy X-ray absorptiometry in the assessment of body composition in young children: the EarlyBird cohort

Joanne Hoskinga1a2 c1, Brad S. Metcalfa1, Alison N. Jefferya1, Linda D. Vossa1 and Terence J. Wilkina1

a1 Department of Endocrinology and Metabolism, Peninsula Medical School, Plymouth Campus, Plymouth, UK

a2 University Medicine, Level 7, Derriford Hospital, Plymouth, PL6 8DH, UK


Foot-to-foot bioelectrical impedance analysis (BIA) is simple and non-invasive, making it particularly suitable for use in children. There is insufficient evidence of the validity of foot-to-foot BIA compared with dual-energy X-ray absorptiometry (DEXA) as the criterion method in healthy young children. Our objective was to assess the validity of foot-to-foot BIA against DEXA in a large cohort of healthy young children. Body composition was measured by foot-to-foot BIA and DEXA in 203 children (mean age 8·9 (sd 0·3) years). Bland–Altman and simple linear regression analyses were used to determine agreement between methods. BIA overestimated fat-free mass by a mean of 2·4 % in boys and 5·7 % in girls, while fat mass was underestimated by 6·5 % in boys and 10·3 % in girls. The percentage fat recorded by BIA was, accordingly, also lower than by DEXA (boys 4·8 %; girls 12·8 %). In boys, however, there were correlations between the size of the difference between methods and the size of the measure under consideration such that in smaller boys fat-free mass was underestimated (r − 0·57; P < 0·001) while fat mass and percentage fat were overestimated (r 0·74 for fat mass; r 0·69 for percentage fat; both P < 0·001) with the reverse in bigger boys. Mean differences between techniques were greater in the girls than in the boys but in boys only, the direction of the differences was dependent upon the size of the child. Therefore, BIA may be useful for large-scale studies but is not interchangeable with DEXA and should be interpreted with caution in individuals.

(Accepted August 30 2006)

(Received April 27 2006)

(Revised August 04 2006)


c1 * Corresponding author: Dr Joanne Hosking, fax +44 1752 792471, email


Abbreviations: BIA, bioelectrical impedance analysis; DEXA, dual-energy X-ray absorptiometry