University of Oulu

Näsänen-Gilmore P, Kumwenda C, Nurhonen M, Hallamaa L, Mangani C, Ashorn P, et al. (2023) Body composition among Malawian young adolescents: Cross-validating predictive equations for bioelectric impedance analysis using deuterium dilution method. PLoS ONE 18(4): e0284158.

Body composition among Malawian young adolescents : cross-validating predictive equations for bioelectric impedance analysis using deuterium dilution method

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Author: Näsänen-Gilmore, Pieta1,2; Kumwenda, Chiza3; Nurhonen, Markku2;
Organizations: 1Center for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
2Population Health Unit, Finnish Institute for Health and Welfare, Helsinki and Oulu, Finland
3Department of Food Science and Nutrition, University of Zambia, Lusaka, Zambia
4Department of Public Health, School of Public Health and Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
5Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
6Clinical Medicine Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
7Children’s Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.2 MB)
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Language: English
Published: Public Library of Science, 2023
Publish Date: 2023-09-07


Background: Body composition can be measured by several methods, each with specific benefits and disadvantages. Bioelectric impedance offers a favorable balance between accuracy, cost and ease of measurement in a range of settings. In this method, bioelectric measurements are converted to body composition measurements by prediction equations specific to age, population and bioimpedance device. Few prediction equations exist for populations in low-resource settings. We formed a prediction equation for total body water in Malawian adolescents using deuterium dilution as reference.

Methods: We studied 86 boys and 92 girls participating in the 11-14-year follow-up of the Lungwena Antenatal Intervention Study, a randomized trial of presumptive infection treatment among pregnant women. We measured body composition by Seca m515 bioimpedance analyser. Participants ingested a weight-standardized dose of deuterium oxide, after which we collected saliva at baseline, at 3 and 4 h post-ingestion, measured deuterium concentration using Fourier-transform infrared spectroscopy and calculated total body water. We formed predictive equations for total body water using anthropometrics plus resistance and reactance at a range of frequencies, applying multiple regression and repeated cross-validation in model building and in prediction error estimation.

Results: The best predictive model for percentage total body water (TBW %) was 100*(1.11373 + 0.0037049*height (cm)²/resistance(Ω) at 50 kHz– 0.25778*height(m)– 0.01812*BMI(kg/m²)– 0.02614*female sex). Calculation of absolute TBW (kg) by multiplying TBW (%) with body weight had better predictive power than a model directly constructed to predict absolute total body water (kg). This model explained 96.4% of variance in TBW (kg) and had a mean prediction error of 0.691 kg. Mean bias was 0.01 kg (95% limits of agreement -1.34, 1.36) for boys and -0.01 kg (1.41, 1.38) for girls.

Conclusions: Our equation provides an accurate, cost-effective and participant-friendly body composition prediction method among adolescents in clinic-based field studies in rural Africa, where electricity is available.

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Series: PLoS one
ISSN: 1932-6203
ISSN-E: 1932-6203
ISSN-L: 1932-6203
Volume: 18
Issue: 4
Article number: e0284158
DOI: 10.1371/journal.pone.0284158
Type of Publication: A1 Journal article – refereed
Field of Science: 3142 Public health care science, environmental and occupational health
Funding: The original LAIS study was supported by grants from the Academy of Finland (grants 79787 and 207010 to PA;, the Foundation of Pediatric Research in Finland (; PA), and the Medical Research Fund of Tampere University Hospital (PA). This study was supported by the Academy of Finland (EK;, Finnish Medical Foundation (Finska Läkaresällskapet) (EK), Foundation for Pediatric Research in Finland (EK,, Novo Nordisk Foundation (EK,, Signe and Ane Gyllenberg Foundation (PNG, EK; and Sigrid Juselius Foundation (EK; The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Copyright information: © 2023 Näsänen-Gilmore et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.