Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 44447

AbstractMaterial and MethodsResultsDiscussionAcknowledgementReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Year : 2021 | Month : July | Volume : 15 | Issue : 7 | Page : KE01 - KE06 Full Version

Applications of Bioelectrical Impedance Analysis in Diagnosis of Diseases: A Systematic Review

Published: July 1, 2021 | DOI:
Mahmood Aldobali, Shabana Urooj, Harvinder Singh Chhabra, Kirti Pal

1. PhD Scholar, Department of Electrical Engineering, Gautam Buddha University, Gautam Buddha Nagar, Uttar Pradesh, India. 2. Assistant Professor, Department of Electrical Engineering, Gautam Buddha University, Gautam Buddha Nagar, Uttar Pradesh, India. 3. Chief of Spine Service and Medical Director, Indian Spinal Injuries Centre, New Delhi, India. 4. Associate Professor, Department of Electrical Engineering, Gautam Buddha University, Uttar Pradesh, India.

Correspondence Address :
Mr. Mahmood Aldobali,
Room No. 09, MRS Hostel, Gautam Buddha University,
Greater Noida, Uttar Pradesh, India.


Introduction: Bioelectrical Impedance Analysis (BIA) is a safe, non-invasive, painless, portable, and inexpensive technology that has the prospect to provide information related to the dynamic performance of the human body. Body Composition (BC) assessment is widely accepted as a clinical method to diagnose and evaluate disease status.

Aim: To predict and validate the applicability of BIA in diagnosis of diseases such as Chronic Kidney Disease (CKD), Chronic Obstructive Pulmonary Disease (COPD), Heart Failure (HF), Pregnancy and Spinal Cord Injury (SCI).

Materials and Methods: A systematic clinical review was conducted following the PRISMA guidelines {PubMed, The Cochrane Archive, Web of Research, Medline, and SPORTDiscus with complete text (EBSCO)}. A literature review was carried out randomly, from 2000 to 2018, published in English; the keyword combinations were evaluated using Boolean operators “OR” and “AND” for BIA, CKD, COPD, HF, Pregnancy, SCI.

Results: A total of 1156 search terms, 1139 citations were excluded, and 17 potentially qualifying articles were shortlisted. Hence, as per the inclusion criteria, three articles on COPD, three articles on CKD, three articles on pregnancy, four articles on HF, and four SCI articles were shortlisted.

Conclusion: The calculated BIA parameters showed that the patient’s actual health could be analysed quickly to monitor the disease progression and provide significant advances in developing therapies for the diseases. However, this paper recommends further study on BIA to improve a clinical assessment of BC.


Chronic kidney disease, Chronic obstructive pulmonary disease, Heart failure, Pregnancy, Spinal cord injury

The BIA was first applied in 1962. BIA remained an experiment until the first device was in use in the mid-1980s (1),(2),(3),(4). In 1871, the tissue’s electrical characteristics were described only as depicting specific properties to a broad range of frequencies on the highest tissue concentration (5). The primary practice of BIA is in accordance with Ohm’s law (6). Regarding the impedance measurement, a safe range of constant current is applied at a defined frequency to a particular region of the body, and the potential is specified (7),(8). BIA is a technique that is to used to estimate BC concerning a biological predicate. Therefore, BIA measures the bioimpedance of tissue in the natural segment if alternating current flows through it (2),(9),(10),(11). The resistive component explains the disruption of a current ionic solution and Intracellular Water Interaction (ICW) and Extracellular Water Interaction (ECW). The capacitive reactance element (Xc) is the added obstruction because of the capacitive reactance concerning tissues’ cells. BIA signifies a more considerable measure of the lean mass and the body cell mass (12),(13).

BIA is an approach in which the BC of biological tissues is studied from their bioelectrical impedance. BIA is used to calculate and estimate BC to predict various clinical diseases, such as CKD, COPD, HF, etc. The BIA system can be conducted using a couple or four electrodes method to measure module resistance (R) and Xc; both manners of measurement are the same, as shown in (Table/Fig 1) (8). The surface electrodes implanted into the human body uses two frequencies, single or multi-frequency, to change the properties of a portion of tissue (2),(8),(14),(15),(16). BIA can designate as a highly impending technique for medical predictions related to BC analysis because of its non-invasiveness, low cost, portable, and easy use (15),(16),(17),(18),(19).

Furthermore, the BIA considers the human body as a cylinder, similar to a conductor in some studies (2),(20). Model based approaches are also reported in the literature for the implementation of BIA. Many researchers have studied BIA for examination and medication in many diseases (21),(22),(23). The purpose of this review was to emphasise the significance of the applicability of BIA to clinical and significant diseases.

Material and Methods

The present study was a systematic review in which systematic literature analysis was randomly carried out: {PubMed, The Cochrane Library, Web of Science, Medline, and SPORTDiscus with complete text (EBSCO)”}. The following phrases with Boolean operators “OR” and “AND” were used: BIA, CKD, COPD, HF, Pregnancy; SCI. Of the 1156 records, 460 were duplicates. Based on title, abstract, and full text, 370, 196, and 113 were excluded excluded respectively. After the qualitative synthesis, 17 papers were shortlisted. There were three articles on COPD, three articles on CKD, three articles on pregnancy, four articles on HF, and four articles on SCI.


A total of 17 were included in the present review as shown in the PRISMA (Table/Fig 2) for five diseases (24),(25). Bioimpedance analysis contributes to measuring BC to assess the periodic change in patients’ nutritional situation and observe nutritional risks in the outpatient setting. Moreover, BIA indicated that various diseases’ information measurement should be continuous in diagnosis (26). Accordingly, BIA was utilised in many diseases, and the feedback was reasonable compared to other devices such as Dual-Energy X-Ray Absorptiometry (DEXA), Magnetic Resonance Imaging (MRI), and skinfold measurements, body density (27). BIA is a practical tool in clinical health intended to enhance BC prediction. The five diseases are illustrated with several examples in more detail, explaining how these diseases are influenced by bio-impedance measurement.

1. BIA in COPD

The BIA is reasonably simple and non-invasive method; it may be a valuable tool for calculating BC in COPD. Three COPD papers are covered in this section, shown in (Table/Fig 3) (28),(29),(30).

I. Faisy C and Rabbat A found that BIA estimates the nutritional impact. They included 51 Intensive Care Unit (ICU) COPD patients, their testing showed inconsistent findings in the study of bio-impedance and anthropometric measurements. They concluded that BIA contributes to imprecise anthropometric findings for invasively ventilated patients. BIA is a valuable measure of malnourishment (28).
II. De Blasio F et al., study included 237 COPD patients (161 males and 76 females). Their study showed different diagnostic criteria. They determined that BIA helped to distinguish nutritional phenotypes such as wasting or loss of muscle in COPD patients. They concluded that BIA could be suitable for diagnosing nutritious phenotypes, for example cachexia or sarcopenia in COPD patients (29).
III. Rutten EP et al., showed that BIA could be used to diagnose muscle deterioration in COPD. They studied Fat Free Mass (FFM) BIA along with FFM DEXA in 1087 COPD participants. BIA is the first postulate to detect muscle homicide in COPD patients (30).

The BIA was considered for determining nutritional phenotypes such as deterioration or muscle loss in COPD patients (31),(32),(33). These studies’ outcomes indicated that BIA using the two-electrode and the two-frequency approach is suitable for evaluating the nutritional status and COPD patients’ prediction. Thus, BC estimated by BIA and FFM proved to be a liberated predictor of mortality in COPD.

2. BIA in CKD

Extensive research has been conducted on the containment of hydration status and fluid compartments, particularly in patients with dialysis. Consequently, different models of biofluids have been proposed to characterise the whole body or the corresponding organs. In practice, the bioimpedance technique is used to assess the BC of CKD. Three CKD papers will be covered in this section, shown in (Table/Fig 4) (34),(35),(36).
I. Saxena A and Sharma R (2005) discussed BIA as a screening tool for CKD. They mentioned BIA could estimate clearance and Glomerular Filtration Rate (GFR) and creatinine release in CKD. BIA can be carefully cast off for prediction (34).
II. Satirapoj B et al., (2006) examined GFR in 79 non-diabetic Asian patients with CKD. They proposed that BIA-GFR in non-diabetic CKD patients was similar to creatinine clearance and urea clearance (Ccr-Cu-GFR), particularly in phase three CKD patients. Hence, BIA can be considered an assessment tool for the same (35).
III. Thanakitcharu P and Jirajan B suggested the early discovery of sub-clinical oedema in CKD through BIA. They enrolled CKD patients for 12 months. A 69 CKD patients were compared with 48 healthful volunteers. The current study established that the calculation of body fluid supply by multifrequency-BIA was a substantial measure. Sub-clinical oedema primarily ensued in CKD’s early stages before detecting visible oedema by physical examination (36).

BIA is considered to detect a vital chronic modification in BC altered by adjusted hydration of lean mass, confined fluid amassing or loss, and the capacity to accurately evaluate water allocation between ICW and ECW compartments of CKD patients. Hence, BIA can critically predict creatinine performance as an instrument for diagnosing CKD (29).

3. BIA in Pregnancy

Differences in BC during pregnancy and their influence on pregnancy results indicate great importance in perinatal medicine. The measurement that uses BIA during pregnancy is an easy, quick, and non-invasive way to assess the water distribution in cells (Table/Fig 5) (37),(38),(39) shows three BIA studies.

I. Berlit S et al., (2013) enrolled 90 German healthy pregnant women to investigate the reference values of BIA. The results show that this method indicates a more accurate evaluation of BIA indices in pregnant women compared to natural stratification by General Technology (GT) (37).
II. Valensise H et al., (2000) examined 173 healthy pregnant women in three trimesters. They suggested that MF-BIA can be used to observe an alteration in pregnant women’s body fluid segments (38).
III. da Silva EG et al., (2010) examined 51 healthy pregnant and 65 pre-eclamptic in the third trimester. They found that BIA can help differentiate among pre-eclamptic and healthy pregnant women, and also the pre-eclampsia can change the body parts (39).

MF-BIA is a considerable technique to check longitudinal alteration in pregnant women’s fluid body compartments. An increase in total body water is accountable for a significant weight gain ratio during pregnancy (39).


BIA is found beneficial to check the pathophysiology of Acutely Decompensated Heart Failure (ADHF). Earlier Bioelectrical Vectorial Impedance Analysis (BIVA) and the Phase Angle (PA) were able to discern significant differences in hydration during ADHF. However, several experiments have shown that combined serial BIVA measurements help achieve a sufficient fluid balance in ADHF patients and can be used in medical treatment. (Table/Fig 6) (40),(41),(42),(43),(44) shows four such articles.
I. Sakaguchi T et al., (2015) studied multi-frequency BIA in 130 patients with ADHF. They suggested that the analysis of BIA provides valuable information for the review of the pathophysiology of ADHF also it is one of the best and cheapest devices (40).
II. Rabelo-silva SER et al., (2014) studied 57 patients of ADHF. A 61% of the patients with high congestion by BIVA had lost more weight and progressed to dyspnoea. They concluded that BIVA and PA could detect weight and hydration adjustments during ADHF (41).
III. Edwardson M et al., (2000) studied BIA to improve congestive HF management. Fifty patients were tested and found that the fat-free (FFM) extracellular water ratio (ECS) derived from BIA is more objective than traditional techniques to measure fluid overload. In modern management programs, the BIA telemedicine equipment can be integrated (42).
IV. Castillo Martínez L et al., (2007) assessed MF-BIA in 243 cases. Their outcome was equally HF categories, reactance, and PA was meaningfully lesser. They concluded that the BIA permits ease of BC, which helps stratify HF’s severity (43).

BIA provides valuable information for the analysis of the pathophysiology of ADHF and is one of the cheapest devices. The BIA device applied to a PA can sense significant hydration status variations throughout ADHF (41). Hence, BIA is a valuable clinical health device shown to improve BC prediction (42). Consequently, BIA enables a clear BC and is most valuable to stratify HF’s severity (43).

5. BIA in SCI

The BC of people with SCI was different from persons without SCI due to the injury itself, an inoperative lifestyle, and a diet difference. Furthermore, the BIA technique appears to be a viable approach for evaluating the BC of SCI. Thus, BMI, TBW, FFM, FM, and ECW can be predicted reasonably through SF or MF. (Table/Fig 7) (44),(45),(46),(47),(48) shows four articles.

I. Azevedo E, et al., (2016) BC composition calculation by BIA and Body Mass Index (BMI) in people with chronic SCI in 39 patients. Patients were segregated into paraplegia or tetraplegia as per injury level. Their investigation discovers conflicting outcomes in the SCI populace. BMI does not gain enough refinement stoutness, being a progressively reliable physiological estimation. BIA’s existence is a more reliable physical measurement (44).
II. Panisset MG et al., (2017) studied quantification of FFM in acute SCI using BIA on 20 patients. They found that bioimpedance created estimations for assessing FFM in acute SCI for group comparisons (45).
III. Buchholz AC et al., (2003) used BIA to estimate fluid sections in cases with chronic paraplegia. Their examination included a total of 94 patients where 32 patients were with paraplegia and 62 were healthy subjects. They connected single recurrence and various frequencies. The results of TBW, FFM, FM, and ECW can be considered as anticipated by utilising SF (46).
IV Yoshida D et al., (2014) studied appendicular SMM’s growth in 250 Japanese adults. Individuals’ different results offer a good choice for assessing attached skeletal bulk in Japanese grown-ups (47).

Through SF’s application in SCI patients, TBW, FFM, FM, and ECW, ICW, BMI, PA could correctly predict BC (47). BIA parameters reflect disease cruelty and afford the best analysis for patients’ existence (48).


The BIA has some limitations that apply to accepting and classifications of restrictions. The first relates to the anatomy of the human body: the human body is not a cylinder. Instead, five cylinders joined in a better sequence may be defined as (legs and trunk, arms, except for the head) (49). We still need to remember that electrophysical patterns are developing and that biological transmitters are not stable. It can differ based on the exact composition of the muscles, the hydration state, and the distribution of the electrolytic atoms (50). Moreover, BIA’s main limitation of utilising TBW evaluation is that this approach implies that the hydration condition is set. Unfortunately, pregnancy, disease cases, obesity, cancer, malnutrition, and race may interfere with the water situation (51). Hence, various body build distribution (mainly in those who are obese in the abdomen) will occur in estimating body fat percentage (52),(53),(54).


BIA practice is utilised as non-invasive health monitoring for BC. The systematic review has discussed the technical characteristics of some significant diseases diagnosed randomly, such as SCI, CKD, COPD, HF, and pregnancy. A new equation may be required. Nevertheless, results were produced from <1% to approximately 20%, and the matched impedance meter cables can offer additional capacitance depending upon the condition of the device. It is found that BIA has been practised by several researchers and physicians for diagnosis and therapy as well. Most of the significant research proved that BIA is a practical, non-invasive, and inexpensive method. Moreover, BIA parameters estimated that disease prognosis analysis was beneficial reasonably predictable to both patient’s status and healthcare. Nevertheless, this paper recommends using further research on BIA to improvise a medical equation in BC assessment. Also, BIA is a simple method. It gives accurate results, portable, quick, easy, and low cost.


Authors greatest appreciation goes to the Senior Research Associate Dr. Rajesh Sharawat at Indian Spinal Injuries Center for their valuable support.


Hu HY, Kato Y. Body composition assessed by Bioelectrical Impedance Analysis (BIA) in patients with graves' disease before and after treatment. Endocrine Journal. 2008;42:545-50. [crossref] [PubMed]
Bera TK. Bioelectrical Impedance Methods for Noninvasive Health Monitoring: A Review. Journal of Medical Engineering and Technology. 2014;381251:28. [crossref] [PubMed]
Mulasi U, Kuchnia AJ, Cole AJ, Earthman CP. Bioimpedance at the bedside: Current applications, limitations, and opportunities principles of bioimpedance. Nutrition in Clinical Practice. 2015;30(2):180-93. Epub ahead of print 2015. Doi: 10.1177/0884533614568155. [crossref] [PubMed]
Formenti P, Bolgiaghi L, Chiumello D. Bioelectrical impedance analysis in critical care. Annual Update in Intensive Care and Emergency Medicine. 2018;275-90. [crossref]
Bai X, Hou J, Wang L, Wang M, Wang X, Wu C, et al. Electrical impedance analysis of pork tissues during storage. Journal of Food Measurement and Characterization. 2018;12:164-72. [crossref]
Kao MF, Lu HK, Jang TR, Yang WC. Comparison of different measurement equations for body composition estimation in male athletes. Int J Sport and Exercise Sci. 2010;3:11-16.
Marini E, Buffa R, Saragat B, Coin A, Toffanello ED, Berton L, et al. The potential of classic and specific bioelectrical impedance vector analysis for the assessment of sarcopenia and sarcopenic obesity. Clinical Interventions in Aging. 2012;7:585-91. [crossref] [PubMed]
Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Gómez JM, et al. Bioelectrical impedance analysis- Part I: Review of principles and methods. Clinical Nutrition. 2004;23:1226-43. [crossref] [PubMed]
Guha S, Harikrishnan S, Ray S, Sethi R, Ramakrishnan S, Banerjee S, et al. CSI position statement on management of heart failure in India. Indian Heart Journal. 2018;70 Suppl 1(Suppl 1):S01-72. Epub ahead of print 2018. Doi: 10.1016/j.ihj.2018.05.003. [crossref] [PubMed]
Khalil SF, Mohktar MS, Ibrahim F. The theory and fundamentals of bioimpedance analysis in clinical status monitoring and diagnosis of diseases. Sensors (Switzerland). 2014;14:10895-928. [crossref] [PubMed]
R Joshi MS, Bagal PUR. Development of Bioelectrical impedance analyser for Body composition analysis. IOSR Journal of Electrical and Electronics Engineering. 2014;9:53-62. [crossref]
Singh G, Anand S, Lall B, Srivastava A, Singh V. A technical review of various bioelectric impedance methods for health monitoring. In: 2018 IEEE Long Island Systems, Applications and Technology Conference, LISAT 2018. IEEE, 2018, pp. 1-6. [crossref]
da Silva AT, Hauschild DB, de Almeida Oliveira LD, de Fragas Hinnig P, Franco Moreno YM, Wazlawik E. Association of hyperhydration evaluated by bioelectrical impedance analysis and mortality in patients with different medical conditions: Systematic review and meta-analyses. Clinical Nutrition ESPEN. 2018;28:12-20. [crossref] [PubMed]
Bera TK, Nagaraju J, Lubineau G. A Labview-based electrical bioimpedance spectroscopic data interpreter (LEBISDI) for biological tissue impedance analysis and equivalent circuit modelling. J Electr Bioimp. 2016;7:35. [crossref]
Andronesi A, Robe C, Berbecar V, Andronesi D, Gamala A, Obrisca B, et al. Assessment of body composition in patients with chronic kidney disease using multiple-frequency bioelectrical impedance analysis. Nephrology Dialysis Transplantation. 2018;131-32. [crossref]
Caicedo-Eraso JC, González-Correa CAH, González-Correa CAH. Use of electrocardiogram (ECG) electrodes for Bioelectrical Impedance Analysis (BIA). J Phys. 2012. Conf. Ser. 407 012008. [crossref]
Caicedo-Eraso JC, Gonzalez-Correa CA, Gonzalez-Correa CH. Bioelectrical impedance analysis (BIA) equations validation against hydrodensitometry in a Colombian population. J. Phys. 2013:Conf. Ser. 434 012065. [crossref]
Gonzalez-Correa CH, Caicedo-Eraso JC. Looking for optimum ECG electrodes for Bioelectrical Impedance Analysis (BIA). The need for validation. Nutrición Hospitalaria. Epub ahead of print 2018. Doi: 10.20960/nh.1126. [crossref] [PubMed]
Kotler DP, Burastero S, Wang J, Pierson RN Jr. Prediction of body cell mass, fat-free mass, and total body water with bioelectrical impedance analysis: Effects of race, sex, and disease. Am J Clin Nutr. 1996;64:489S-97S. [crossref] [PubMed]
Chitturi V, Farrukh N. Spatial resolution in electrical impedance tomography: A topical review. J Electr Bioimp. 2017;8:66-78. [crossref]
Paterna S, Di Pasquale P, Parrinello G, Changes in brain natriuretic peptide levels and bioelectrical impedance measurements after treatment with high-dose furosemide and hypertonic saline solution versus high-dose furosemide alone in refractory congestive heart failure: A double-blind study. Journal of the American College of Cardiology. 2005;45:1997-2003. [crossref] [PubMed]
Hollander FM, Roelofs J, van der Boom ST, Burghard M. Bio-electrical impedance analysis and relationship with pulmonary function in cystic fibrosis patients. Journal of Cystic Fibrosis. 2018;17:S112. [crossref]
Janssen YJH, Deurenberg P, Roelfsema F. Using dilution techniques and multi-frequency bioelectrical impedance to assess both total body water and extracellular water at baseline and during recombinant human growth hormone (GH) treatment in GH-deficient adults. Journal of Clinical Endocrinology and Metabolism. 1997;82:3349-3355. [crossref] [PubMed]
Blasio F De, Gregorio A Di, de Blasio FF, Systematic review on the use of bioelectrical impedance analysis in chronic obstructive pulmonary disease. European Respiratory Journal. 2017, pp. 8-10.
Lardiés-Sánchez B, Sanz-Paris A, Boj-Carceller D, Systematic review: Prevalence of sarcopenia in ageing people using bioelectrical impedance analysis to assess muscle mass. European Geriatric Medicine. Epub ahead of print 2016. Doi: 10.1016/j.eurger.2016.01.014. [crossref]
Pegram GC, Rollins N, Espey Q. Estimating the costs of diarrhoea and epidemic dysentery in KwaZulu-Natal and South Africa. Water. 1998;24:11-20.
Pineda-Juárez JA, Lozada-Mellado M, Ogata-Medel M. Body composition evaluated by body mass index and bioelectrical impedance vector analysis in women with rheumatoid arthritis. Nutrition. 2018;53:49-53. [crossref] [PubMed]
Faisy C, Rabbat A. Bioelectrical impedance analysis in estimating nutritional status and outcome of patients with chronic obstructive pulmonary disease and acute respiratory failure. Intensive Care Med. 2000;26(5):518-25. [crossref] [PubMed]
Santaniello MG, De Blasio F, Mazzarella G, Bianco A, Lionetti L, Franssen FME, et al. Raw BIA variables are predictors of muscle strength in patients with chronic obstructive pulmonary disease. European Journal of Clinical Nutrition. 2017;71:1336-40. [crossref] [PubMed]
Rutten EP, Spruit MA, Wouters EF. Critical view on diagnosing muscle wasting by single-frequency bio-electrical impedance in COPD. Respir Med. 2010;104(1):91-98. [crossref] [PubMed]
Faisy C, Rabbat A, Kouchakji B, Laaban JP. Bioelectrical impedance analysis in estimating nutritional status and outcome of patients with chronic obstructive pulmonary disease and acute respiratory failure. Intensive Care Med. 2000;26(5):518-25. [crossref] [PubMed]
Rutten EPA, Spruit MA, Wouters EFM. Critical view on diagnosing muscle wasting by single-frequency bio-electrical impedance in COPD. Respiratory Medicine. 2010;104:91-98. [crossref] [PubMed]
Monies D, Abouelhoda M, AlSayed M, The landscape of genetic diseases in Saudi Arabia based on the first 1000 diagnostic panels and exomes. Human Genetics. 2017;136:921-39.
Saxena A, Sharma R. Role of Bioelectrical Impedance Analysis (BIA) in Renal Diseases. Indian Journal of Nephrology. 2005;15:194-197.
Satirapoj B, Supasyndh O, Patumanond J, Choovichian P. Estimating glomerular filtration rate in asian patients with chronic kidney diseases from bioelectrical impedance analysis. J Med Assoc Thai. 2006 Oct;89(10):1584-91.
Thanakitcharu P, Jirajan B. Early detection of subclinical edema in chronic kidney disease patients by bioelectrical impedance analysis. J Med Assoc Thai. 2014;97 Suppl 11:S01-10.
Berlit S, Tuschy B, Stojakowits M, Weiss C, Leweling H, Sütterlin M, et al. Bioelectrical impedance analysis in pregnancy: Reference ranges. In Vivo. 2013;27(6):851-54.
Valensise H, Andreoli A, Lello S, Magnani F, Romanini S, De Lorenzo A. Multifrequency bioelectrical impedance analysis in women with a normal and hypertensive pregnancy. Am J Clin Nutr. 2000;72(3):780-83. [crossref] [PubMed]
Da Silva EG, De Barros Leite Carvalhaes MA, Hirakawa HS, da Silva EG, Peraçoli JC. Bioimpedance in pregnant women with pre-eclampsia. Hypertension in Pregnancy. 2010;29:357-65. [crossref] [PubMed]
Sakaguchi T, Yasumura K, Nishida H, Inoue H, Furukawa T, Shinouchi K, et al. Quantitative Assessment of Fluid Accumulation Using Bioelectrical Impedance Analysis in Patients With Acute Decompensated Heart Failure. Circulation Journal. 2015;79(12):2616-22. [crossref] [PubMed]
Rabelo-silva SER, Clausell SN, Biolo A. Dynamic changes in bioelectrical impedance vector analysis and phase angle in acute decompensated heart failure. Nutrition. Epub ahead of print 2014. Doi: 10.1016/j.nut.2014.05.004. [crossref] [PubMed]
Edwardson M, Talaie V, Clark C, Antinoro R, Risse A, Gonazales J, et al. A Bioelectrical impedance analysis device for improved management of congestive heart failure. Computers in Cardiology. 2000; 27(Cat. 00CH37163):09-12. Doi: 10.1109/CIC.2000.898442. [crossref]
Castillo Martínez L, Colín Ramírez E, Orea Tejeda A. Bioelectrical impedance and strength measurements in patients with heart failure: Comparison with functional class. Nutrition. 2007;23:412-18. [crossref] [PubMed]
Azevedo E, Alonso KC, Jr AC. Body composition assessment by bioelectrical impedance analysis and body mass index in individuals with Body composition assessment by bioelectrical impedance analysis and body mass index in individuals with c. Journal of Electrical Bioimpedance. 2016;7:02-05. [crossref]
Panisset MG, Desneves K, Ward LC, Bedside quantification of fat-free mass in acute spinal cord injury using bioelectrical impedance analysis: A psychometric study Bedside quanti fi cation of fat-free mass in acute spinal cord injury using bioelectrical impedance analysis: A psychometric. Spinal Cord. Epub ahead of print 2017. Doi: 10.1038/s41393-017-0035-1. [crossref] [PubMed]
Buchholz AC, Mcgillivray CF, Pencharz PB. The use of bioelectric impedance analysis to measure fluid compartments in subjects with chronic paraplegia. Arch Phys Med Rehabil. 2003;84(6):854-61. [crossref]
Yoshida D, Shimada H, Park H, Development of an equation for estimating appendicular skeletal muscle mass in Japanese older adults using bioelectrical impedance analysis. Geriatrics and Gerontology International. 2014;14:851-57. [crossref] [PubMed]
Krause L, Becker MO, Brueckner CS, Bellinghausen CJ, Becker C, Schneider U, et al. Nutritional status as marker for disease activity and severity predicting mortality in patients with systemic sclerosis. Ann Rheum Dis. 2010;69(11):1951-57. [crossref] [PubMed]
Patterson GR, DeBaryshe BD, Ramsey E. A Developmental Perspective on Antisocial Behavior. American Psychologist. Epub ahead of print 1989. Doi: 10.1037/0003-066X.44.2.329. [crossref]
Meguid MM, Lukaski HC, Tripp MD, Rosenburg JM, Parker Jr. FB. Rapid bedside method to assess changes in postoperative fluid status with bioelectrical impedance analysis. Surgery. Epub ahead of print 1992. Doi: 10.5555/uri:pii:003960609290252U. [crossref]
Coppini LZ, Waitzberg DL, Campos ACL. Limitations and validation of bioelectrical impedance analysis in morbidly obese patients. Current Opinion in Clinical Nutrition and Metabolic Care. Epub ahead of print 2005. Doi: 10.1097/01.mco.0000165013.54696.64. [crossref] [PubMed]
Graves JE, Pollock ML, Colvin AB, Loan MV, Lohman TG. Comparison of different bioelectrical impedance analyzers in the prediction of body composition. Am J Hum Biol. Epub ahead of print 1989. Doi: 10.1002/ajhb.1310010511. [crossref] [PubMed]
Smye SW, Sutcliffe J, Pitt E. A comparison of four commercial systems used to measure whole-body electrical impedance. Physiological Measurement. Epub ahead of print 1993. Doi: 10.1088/0967-3334/14/4/008. [crossref] [PubMed]
Oldham NM. Overview of bioelectrical impedance analysers. In: American Journal of Clinical Nutrition. 1996. Epub ahead of print 1996. Doi: 10.1093/ajcn/64.3.405S. [crossref] [PubMed]

DOI and Others


Date of Submission: Sep 07, 2020
Date of Peer Review: Nov 07, 2020
Date of Acceptance: May 26, 2021
Date of Publishing: Jul 01, 2021

• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Sep 10, 2020
• Manual Googling: May 20, 2021
• iThenticate Software: Jun 14, 2021 (9%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)