REPORT FOR THE CAD PROJECT, 2016-2017 1

Bio-Impedance Analysis: assumptions and

techniques review
Francesco Chietera, Giuseppina Monti, and Luciano Tarricone

AbstractBio-Impedance Analysis, or BIA, is a use-

ful system of techniques and medical protocols used to
measure human body composition through some kind
of electrical measurements on the patient body. The
physical foundations of this technique are based on the
different electromagnetic properties of tissues that form
human body. This work is a summerized review of the
state of the art about the BIA and its related topics.
KeywordsBIA, Bioelectric Impedance Analysis, BIA
Vector, Biagram, tetrapolar BIA, Segmental BIA, Local
BIA.

I. Introduction
Bio-Impedance Analysis, from now on BIA, is a very
powerfull method to obtain fast, cheap and non invasive
measurements about the healt of peaple. Bio-impedance or
biological impedance is defined as the ability of biological
tissue to impede electric current [1]. The human body is
formed by a large variety of tissues and materials with very
different electromagnetic properties, so we can derive the
composition of the patient body interpreting the results of
the BIA exam. To understand how we can obtain all this
information from a single measurement, we have to clarify
some basic points.
II. Physical foundaments of BIA
A. Human body composition
The human body is formed by many different type of
tissues, but we can brutally summerize thinking that the
whole body is composed by FM (Fat Mass) and FFM (Fat
Free Mass). The FFM is in turn composed by TBW (Total
Body Water), Bones and Metabolic Tissue (proteins
and minerals). Finally the TBW can be divided again in
ICW (Intra Cellular Water) and ECW (Extra Cellular
Water) and the union betwen Metabolic Tissue and
ICW is commonly called BCM or ABM (Body Cell Mass
or Active Body Mass, because it is the part that provides
active methabolic behavior).
B. Summerized dielectric properties of human body
Each of the previous components has a different behavior
when is crossed by the current. Bones and Fat are very
poor conductors so their impedance contribute is very high.
G. Monti and L. Tarricone are with the EML2 (Electromagnetic
Lab Lecce), Innovation Engineering Department - University of
Salento, Lecce, Le, 73100 Italy, (see http://www.unisalento.it -
http://www.electromagnetics.unisalento.it).
Figure 1. Schematic composition of the human body.
On the countrary the water is a good conductor, so the
contribute of the ICW to the impedance is low. For the
BCM we have to do some different considerations. Infact
its composed by a great part of water and, for this reason,
its impedance has to be less than that of fat or bones, but
it has even a capacitive part. This capacitive part is due to
the cellular membrane. This structure is like a barrier that
shield the interior environment of the cell from the outside.
It is made by a double lipidic layer in which there are many
proteins channels that are responsible for maintaining the
proper concentrations of chemical substances inside the cell.
This channels are drived by the voltage difference between
the inside and the outside of the cell that is mainteined
by the membrane. This voltage is of about 100 mV and
the thickness of the lipidic layers is about 100 A, so the
membrane acts like a real capacitor. For this reason the
BCM provides a complex contribute to the total impedence.
Now its time to spend some words about the electromag-
netic propagation in the human body. From the starting
point, we assumed that the current was able to flow through
the human body, crossing all the different components, like
it was some kind of circuit. This fact is true only under
some conditions about frequency and wavelenght. Infact
the electromagnetic properties of biological tissues are
REPORT FOR THE CAD PROJECT, 2016-2017
Figure 2. Schematic rappresentation of the Cellular Membrane.
strictly frequency dependant and the assumptions that we
make about the dimensions of the electromagnetic problem
depend on wavelenght. For example, for low frequencies,
we can simplify the whole human body with some kind of
cylindrical conductor with a certain value of impedence.
This could be thought like a strong approssimation but it
isnt so rough for wavelenght of about hundreds meters.
On the contrary, the greater is the frequency the smaller
is the difference between wavelenght and the dimension of
biological structures. This assumption let make us possible
to use the simple formula:
h compared with a set of predictive equations to output
R= (1)
A
(with resistivity per meter, A the area and h the height
of the cylinder) to bound the resistence with some shape
parameters like heigh of the subject.
In addition, the penetration depth in the human body
is expressed by the equation:
1 perform measurements is:
= h p i 12 (2)

2 1 + p 21
with
p= .
 use the assumption that, in a good hydrated body,
This equation depends on frequency directly, but even
undirectly. Infact the average dielectric constant  in the
human body is in the order of the thousands for low
frequencies, but rapidly drop down in the order of tens
for higher frequencies. For this reason the frequency of the
current used in BIA is not so high, otherwise the current
wave would not be able to penetrate the entire stack of
body components but would flow only through a superficial
path on the skin of the patient (In the single frequency
approach it is about 50 KHz).
2
A
Figure 3. Cylindrical model for human body.
III. BIA techniques
A. Standard BIA
The standard BIA was developed since the early 80s and
consists in the measure of the human impedence that is
the results in term of body components percentage. These
equations rappresent a statistical sample and are specific
for gender, age, race and usually referred to in healt peaple.
They were made in the course of the years through more
or less accurate measurements campaigns. The more the
subject under test differs from the standard model of the
equation used for him, the more those equations lose their
validity. The algorithm used from the standard BIA to
find the TBW using the impedance measurment
(there are some different equations to achive this
goal and usually are based on the determination of
the volume of the human body, that can be realted
2
with resistance and height like V hR )
the TBW rappresent about the 73% of the FFM
find the FM subtracting the FFM from the whole
body weight
use the predictive aquations to obtain the other body
components
B. BIA Vector and Biagram
As we have just seen, standard BIA is strongly dependant
on empirical considerations on the hydratation and on
statistical equations. For this reason it can obtain good
REPORT FOR THE CAD PROJECT, 2016-2017
results only when all the previous assumptions are verified.
However in many cases we would like to use this technique
to obtain information right in non conventional cases like
those of sick subjects that, obviously, do not match those
assumptions. Trying to resolve these defects, the BIA
Vector technique was developed. It consists in the graphical
rappresentation of the impedance vector (composed of real
and immaginary part) that is indipendent from the weight
and height of the subjects. This vector identify a point in the
plane that rappresents the location of the subject under
test. This location is compared with three concentrical
ellipses that contain, respectively, the 50%, the 75% and
the 95% of the population to which the subject belongs.
Figure 4. BIA Vector rappresentation.
As we can see in Fig. 5, the BIA Vector give as an
immediate information on the state of healt of the subject.
Infact we can see if there are some kind of nutrition
problems and how serious they are comparing that with
the reference ellipses. In addition, this test provides a
good marker for the measure of the state of hydratation
of the subject. An other graphical rappresentation of
the BIA measurement is the so called Biagram. It is a
rappresentation of the measured point in a plane in which
there are the phase angle on the x-axis and the reactance
in the y-axis. There are even two line thet identify a sort of
safe hydrated zone, so the opertor can immedatly know
if the patient fall in that zone or not.
C. Measurement procedures
The BIA measurements are very simple and not invasive
for the patient that, however, has to respect four simple
roules for a good realization of the test.
Not eating for 1h before the test.
Not consuming caffeine or alcohol for 12h before the
test.
Not doing extreame exercise for at least 24h before
the test.
Mantain a good hydratation.
The measurement is performed with the patient lying
supine, connected with the instrument usually with four
3
Figure 5. Biagram rappresentation. The point 1 rappresent the
ideal patient and it is the dual of the center of the ellipses in BIA
Vector graphic. The point 5 is the real patient condition.
electrodes. In the tetrapolar method, the two signal elec-
trodes are placed on the dorsal surfaces of the hand and
foot close to the metacarpal-phalangeal and metatarsal-
phalangeal joints, respectively. The two voltage sensing
electrodes are applied at the pisiform prominence of the
wrist and between the medial and lateral maleoli of the
ankle [4] (see Fig. 6). The arms must form with the trunk
a 30 angle.
Its important to note that the tetrapolar approach is
preferred instead of the simple two electrode method (that
even can provide an impedance measurement) because it
guarantees a more accurate result. Infact the two signal
electrodes are used to closed the circuit and make the
current flow, but the other two sensing electrodes are useful
to obtain reference values, a few centimiters after the start
and before the end of the circuit. The tipical value for the
current injected in the body is about from 0.1 to 0.4 mA
at a frequency of 50 KHz.
D. Results interpretation
Now lets see how can we interpret the results of the BIA
test.
1) Phase angle: The first thing we should focus on is
the phase angle. It rappresents one of the most importat
indicator of a good (or poor) state of health. A good value
REPORT FOR THE CAD PROJECT, 2016-2017 4

is a chronic status that could take even some weeks to

be resolved. Dehydratation is the most common nutrition
problem and it causes the decrease of brain, organs and
joints functionalities.
5) ECW and ICW: Even if a good hydratation is a key
factor in our health, even a greater importance has the
place where this water is located in our body. We can store
water inside or outside the cells. Normally the greatest
quantity of water should be inside the cells, so an ideal
value shoud be something about 65% for ICW and 35%
for the ECW. If the ECW increases, it means that the
cells arent working fine. This is a sign of toxocity, cellular
membranes breakdown and inflammation.

E. Some technique improvements

Using the combination of the traditional BIA with the
graphical rappresentation of BIA Vector and Biagram,
we can have a pretty clear picture of the patient status.
However the biggest criticism that is moved to the BIA
is about the precision of its results, due to poor heuristic
models and unusual hydratation conditions. These problems
can be attenuated by the application of more accurate
statistical criteria and the use of BIA Vector and Biagram.
Nevertheless some errors remain, due to the not so strict
Figure 6. Configuration of tetrapolar electrodes for BIA mea- assumptions about the modellization of the human body
surement.
like a single cylinder. Trying to mitigate these errors,
some improvements to the measurement technique were
is between 5 and 10 and is directly related with the good introduced.
cellular membrane functionality, hence, with the active
methabolic part of our body. Normally this value drop
down with the age, the stress or the disease. If it fall down
under 5, it means that the cells are dieing much faster than
they rigenerate and this is a very bad indicator (for eample
it is used to predict the dead in AIDS patients).
2) BCM: This is an other important biomarker of our
health status. It consists in the active part of the organism,
which means muscles, organs and nervous system. The
higher the better. If this value increase it means that
the patient is improved his physical and his nutritional
status. If this value decrease it indicates that the patient
is experimenting malnutrition problems and even more
serious desease.
3) FM: A foundamental part of our organism. Contrary
to popular belief, fat is not always an enemy. Normally
we need a percentage of FM between 15% and 25%. An
athletic person can temporary go down that thrashold value,
missing about a couple of percentage points, but must not
be a lasting condition. Infact if FM drop down under 13-
12%, the patient experiments hormonal and immunological
problems. On the other hand, if the FM overcomes the
30%, it becomes very inflammatory, bringing with it all the
pathologies related with obesity.
4) TBW: It indicates the hydratation of the subject.
Normally it is higher than 55% but, ideally, it should be
around 65%. When that value drop down under 50% the Figure 7. Example of 8-electrodes BIA instrument.
patient is dehydrated and, if this condition persists, there
REPORT FOR THE CAD PROJECT, 2016-2017 5

1) 8-electrodes method: This consists in the use of 8

instead of 4 electrodes to measure the impedance. The
increase of the electrodes number is useful to obtain more
accurate measurements and to mitigate the bias between
one side of the body and the other one. The 8-electrodes
measure is also used in new stand-alone instruments that
are similar to balances, that perform measurements with
the patient standing (See Fig. 7) (however the quality of
the measurement is strongly lower than that performed
with the patient lying supine).
2) Segmental/Local BIA: The segmental BIA consists in
the analysis of the human body, not more like a simple
cylinder, but like the composition of five of them: two for
arms, two for legs, and one bigger for the trunk (See Fig.
8).

Figure 9. Example of 8-electrodes configuration for the segmental

BIA measurement of the whole right part of the body.

Figure 8. Five cylinders model for human body rappresentation.

This model is much more accurate, not only because it

obviously match better the human shape, but even because
the distribution of the TBW is not uniform in the whole
body. Infact the greater part of that is located in the legs
and the arms, and the trunk only contain about the 10% of
TBW. In Fig. from 9 to 12, we can see how the 8-electrodes
measurement method can be used to obtain a segmental
BIA.
An other face of the segmental BIA is the so called local
BIA. This consists in the measurement of the localized bio-
impedance of only one part of the human body for example
the belly. This could be very useful when we are interested
in a precise knowledge of the composition of a certain
part, instead of a results that evaluate the whole body. For
example H Scharfetter et al. developed a procedure based
on the tetrapolar BIA, with the four electrodes applied
on the abdomen, that turned out to be excellent in the
assessment of the central obesity [5].
3) Multifrequency analysis: As we said before, the fre- Figure 10. Example of 8-electrodes configuration for the segmental
quency used to perform the measurement is usually 50 BIA measurement of the left arm.
KHz. However we can perform BIA even with different
REPORT FOR THE CAD PROJECT, 2016-2017
Figure 11. Example of 8-electrodes configuration for the segmental
BIA measurement of the left leg.
Figure 12. Example of 8-electrodes configuration for the segmental
BIA measurement of the left part of trunk.
6
frequencies, higher or lower, obtaining results that could
improve the accuracy of the test. For example, due to their
reactive bheavior, the cell membranes act like capacitors.
This means that for low frequencies they act like open
circuits, opposing the current flow. This feature could be
used to precisely evaluate the ECW that is the only one
crossed by the current at low frequency. On the other side,
increasing the frequency may lead to a higher detail level,
but we always need to rimember that the higher is the
frequency, the weaker are the assumptions that support
the BIA. The newer BIA instruments usually perform
measurements with variable frequencies between 1 Hz to
hundreds of KHz.
IV. Conclusion
We have made a review on the physical foundamentals
and technical improvemets related with the bio impedance
analysis. As we have seen, this technique is very useful
because its cheap, not invasive and fast. The grater
criticism was about the accuracy and the dependance from
a not so accurate statistical sample. However we have seen
how these problems were, at least in a great part, resolved
with some improvement that we have described. So at the
state of the art, BIA is a very interesting kind of medical
test, which could support different medical branches: from
the nutrition, to the sport medicine, from the prevention
of electrolyte imbalances in sick patients to the monitoring
therapy and so on.
References
[1] Martinsen O.G., Grimnes S. - Bioimpedance and
Bioelectricity Basics. Academic Press; Waltham,
MA, USA: 2011.
[2] Jaakko Malmivuo - Bioelectromagnetism: Princi-
ples and Applications of Bioelectric and Biomag-
netic Fields.
[3] Frank S. Barnes, Ben Greenebaum - Handbook of
biological effects of electromagnetic field 3rd
edition.
[4] Anja Walter-Kroker, Axel Kroker, Muriel
Mattiucci-Guehlke and Thomas Glaab - A practical
guide to bioelectrical impedance analysis using the
example of chronic obstructive pulmonary disease.
[5] H. Scharfetter, T. Schlager, R. Stollberger, R.
Felsberger, H. Hutten, H. Hinghofer-Szalkay - As-
sessing abdominal fatness with local bioimpedance
analysis: basics and experimental findings. Interna-
tional Journal of Obesity: 2001
[6] Khalil SF, Mohktar MS, Ibrahim F. The Theory and
Fundamentals of Bioimpedance Analysis in Clinical
Status Monitoring and Diagnosis of Diseases. Sen-
sors (Basel, Switzerland). 2014;14(6):10895-10928.
doi:10.3390/s140610895.