Measuring and Managing Healthy Living
Bioelectric Impedance Analysis
Administrator Edition
PLEASE NOTE
The content of this slide deck is for informational purposes only.
BIA technology is not intended to prevent, cure, diagnose, or treat
any particular disease state.
BIA technology does not replace the educated judgment of a
licensed health care professional.
Measuring and Managing Healthy Living
The US spends more on healthcare per
capita ($8668) and more on healthcare as a
percentage of GDP (17.2%) than any other
nation. From 2011 data
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Meta-analysis of almost 15,000 patients in multidisciplinary hospital and geriatric
settings
145 cited references
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Evidence-based
medicine
requires evidence
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Scale Weight
Putting a patient on the scale
only to confirm a
total weight is like…
drawing a blood sample
only to confirm that
the patient has blood
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Which components are changing fat, lean dry mass, fat free mass,
intracellular water, extracellular water…?
Measuring and Managing Healthy Living
Skin Fold Caliper
•
•
•
•
•
•
Typically 3-7 sites on the body
Variable inter-rater reliability
Calipers only measure subcutaneous fat
No TBW, ICE, ECW, or Phase Angle data
Staff training & time-intensive
Many patients report finding the procedure
socially uncomfortable
Courtesy Defender Body Fat Calipers
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Water and/or Air Displacement
Courtesy Seattle pacific University
• Lung air volume can compromise the accuracy of data
• Many patients report being fearful of immersion,
claustrophobic, or being too self-conscious to be tested
Photo Courtesy ADP Technology
• No TBW, ICW, ECW
• No Phase Angle data.
Measuring and Managing Healthy Living
Dual Energy X-ray Absorptiometry
•
Two radiation sources scan the body, some of
which is absorbed by the bone & soft tissue.
•
Most commonly used to determine bone
mineral/skeletal health, and also measures fat and
muscle.
•
Height must be under 6’6”
•
Weight must be under 350 pounds.
•
There is still no TBW, ICW,
ECW or Phase Angle data.
Measuring and Managing Healthy Living
Bioelectrical Impedance Analysis
Measuring and Managing Healthy Living
“Biological material is conductive and
constantly changing. BIA can measure the
electrical conductive properties of living things,
and illustrate their changes over time.”
- Rudolph J. Liedtke
Measuring and Managing Healthy Living
In 1981, the US Navy ordered 4 BIA devices to be
customized by RJL Systems, for use in the extreme
conditions on Mt. McKinley. Studying naval soldiers in
high altitude, correlating body composition fluids,
correlating their results with blood and urine analysis.
Measuring and Managing Healthy Living
Limitations of other BIA methods
(standing & hand-held)
Standing body composition devices are less accurate
than RJL BIA, due to:
•
central venous pressure unstabilized
•
callouses on hands & feet
•
temperature variables on palms & feet
•
moisture variations on palms & feet
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Limitations of other BIA methods
Signal path differences
• Handheld models: hands, arms, upper chest
• Standing models: heels, legs, pelvis
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Limitations of other BIA methods: Hand-held
Hand Held
Skin temperature dropping just 8.4’C causes an 8% error
in Reactance, and an increase in Impedance (Z), due to changes in
cutaneous blood flow and muscle.
Gudivaka, 1996
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Limitations of other BIA methods: Standing
Foot to Foot Correlation, R = .71,
vs.
Hand to Foot Correlation, R=.96
Jebb, 2000
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Limitations of other BIA methods:
Consumer-grade devices
Consumer grade BIA devices have
been found to be even less accurate
than skin fold thickness methods
Peterson, 2011
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Quantum BIA
• Cleared by the FDA as a Class II
Medical Device, to
assess body composition
& fluid distribution
• 510 (K) Clearance for BC Software
(available on MAC, PC, iPad)
• For use on healthy
humans, ages 3-94 years.
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Quantum BIA
Actual
• Body Mass Index
• Impedance
• Phase Angle
Research Equation
• Body Fat
• Fat Free Mass
• Total Body Water
• Intra-Cellular Water
• Extra-Cellular Water
• Basal Metabolic Rate
• Daily Energy Expenditure
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Proper BIA Protocol
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Proper BIA protocol
• Remove sock, stocking, jewelry, and any other metal objects
from the electrode sites and the side of the body being tested.
• Remove cellphone or other electronic device from body
• Supine position on a flat surface
• Arms out 30’ from waist, and palms down
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Proper BIA protocol
• Clean the 4 electrode sites with alcohol pad, and allow
to dry (about 30 seconds)
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Proper BIA protocol
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Where you’ll see RJL BIA:
•Integrated and Functional Medicine
•Preventive and Lifestyle Medicine
•Hospitals and Private Practice
•University and Military Research
•NASA, NOAA
•NIH
•CTCA
•Mayo Clinic, Cleveland Clinic, Harvard, Yale…
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• BIA technology has been utilized
in over 2000 research studies and
scientific articles
to date.
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10/2013
AMA Annual Meeting
• CPT 0358T formally defines
BIA Whole Body Composition, supine position,
with interpretation and report
effective July 1, 2014
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Measuring and Managing Healthy Living
Rudolph J. Liedtke
Founder & CEO
Joshua Myers
Engineering Technician
Paul Maletz
Production Manager
Barry Callahan
Chief Technology
Officer
Jeff Polly
Office Manager
Kerrie Saunders
Director of Education
William J. Pauly
Director of Sales
Michael Liedtke
Director of
Business Development
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• BIA measures whole body reactance
(Xc) and resistance (R), the two
components of impedance.
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TOTAL BODY WEIGHT
Fat Free Mass
Fat
(aka Lean Body Mass =
skeletal muscle, nerves, organs,
water, smooth muscle)
Total Body Water
ExtraCellular
Water
LDM
(Lean Dry Mass)
IntraCellular
Water
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Measuring and Managing Healthy Living
Measuring and Managing Healthy Living
FAT STORAGE
•
Visceral
around the organs, aka:
central, abdominal
(generally include hepatic fat)
•
Subcutaneous
just beneath the skin, and in limbs
So…..
Measuring and Managing Healthy Living
Measuring and Managing Healthy Living
Contribution of body composition to nutritional
assessment at hospital admission in 995 patients: a
controlled population study U. Kyle, A. Morabia, et al, BJN (2001), 86, 725-731,
• Degree of malnutrition was significantly
underestimated by BMI and serum albumin
• BIA-FFM identified patients with low FFM,
and low or high Fat
• DXA-BIA correlate r=0.986 FFM
• FFM should therefore be included in optimal
objective nutritional assessment
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Practitioners can customize
strategies for
optimal therapeutic outcomes
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Hydrated cells vs. Dehydrated cells
Photo Credit http://prakashthanwani.com/wp-content/uploads/2012/03/normal-dehydrated-cell1.jpg
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Phase Angle
Humans typically range between 3-9
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Can phase angle determined by BIA assess nutritional risk? A
comparison between healthy and hospitalized subjects
U. Kyle, E. Soundar, et. al. Clin Nutr (2012), 875-881
•
Low PA associated with low serum albumin and
moderate-to-severe risk by NRS2000 and SGA.
•
PA is a useful screening tool at hospital admission
without constraints of measuring body weight or
body height
.
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Phase Angle
• See the specified reference range on each individual report, based upon
unique client factors
• Many practitioners report making a referral for further assessment and
diagnosis for Phase Angle under 4
• Phase angle is calculated by finding the ratio of reactance divided by
resistance, and taking the arctangent of that ratio.
• Phase angle is normally expressed in degrees
• Increased hydration is usually associated with higher phase angle
• Practitioners typically say “higher is better”
Measuring and Managing Healthy Living
Phase Angle
• PA is derived directly from the relation between reactance and
resistance, and therefore is an indicator of water distribution
• Phase angle reflects the relative contributions of fluid (resistance)
and cellular membranes (capacitance) of the human body.
• By definition, phase angle is positively associated with capacitance
and negatively associated with resistance
• Phase Angle sometimes shows a temporary drop during fat loss
• Most useful when analyzed and interpreted as a trend.
Measuring and Managing Healthy Living
Many practitioners tell us they monitor for
change…
Reactance
Phase Angle
Capacitance
Fat Free Mass
Lean Dry Mass
Intracellular Water
Resistance
Impedance
Fat
Extracellular Water
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Practitioners specifically target FAT
loss to help achieve…
Cardiovascular risk
Blood sugar & insulin
Total cholesterol
Blood pressure
LDL cholesterol
Triglycerides
Medication reduction/elimination when possible
Gynecological conditions
Symptoms of arthritis
Cardiovascular function
Improved quality of life
Healthy sexual function
HDL cholesterol
Better fitness & lifestyle compliance
Hormone balance
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BC 3.0 Software for MAC & PC
(included in device kit)
Report Options
• Ideal Weight
• Notations (recent exercise, surgery, etc.)
• Lab biomarkers: measurements, HgBA1C, Lipids,
BP, etc.
• Store, email, print
• Tables, graphs, F&F, size of report
• Equation Sets
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Population Equation Options
•NHANES-III (General Population)
This equation set is appropriate for general populations, and the
Fat, FFM, and TBW formulas have been validated with NHANES-III
•New Pediatric (Ages 4 – 19; also validated for obese children)
•Mexican Adults (Male & Female )
•Native Americans
•Obese (BMI > 30 )
•African American (Obese )
•Athletic
•HIV
•All Body Types (BMI adjustable)
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Lifestyle Factor
Upgrades:
Food & Fitness
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Designed to allow patients to see and
navigate CHOICES, helping to make food
fun again.
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Food Categories
Categories help lifestyle medicine
practitioners target and customize
patient preferences and nutritional
needs and patient preferences.
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Food Category Titles
Higher Protein
Higher Carbohydrate
Higher Fat
Calcium rich
Snacks
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Designed to allow practitioners to more
easily address and customize many
sample food options, including:
wheat-, dairy-, egg-, gluten-,and
cholesterol-free, and high fiber, vegan,
and vegetarian diets
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Health
Enhanced
Options
Hummus
Sprouted bread
Earth Balance™
Yam or sweet potato
Almond milk
Soy milk
Hemp milk
Coconut milk
Rice milk
Green/red/purple grapes
Cherries
Dates/figs
Spinach
Collard greens
Bok choy
Vegetarian chili
Black bean salsa
Garbanzo beans
Blueberries
Strawberries
Raspberries
Non-dairy mayonnaise
Sliced red or green peppers
All fruit jam/conserves
Veggie Burger
Black bean burger
Brown/wild rice
Quinoa
Baked potato
Teff
Millett
Chia seeds
Ground flax seeds
Walnuts
Purslane greens
Romaine or red lettuce
Green beans
Jicama
soy/rice/oat/coconut ice cream
whole grain muffin
Mueslix or granola
3-bean salad
Lentil couscous or bulgur wheat salad
Bean, rice & veggie burrito
Minestrone soup
Vegetable soup
Bean soup
Pea soup
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Menu Options
Note: The Standard Menu Options are listed for
patient familiarity. Specific recommendations are
determined during the patient-practitioner
interaction.
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Measuring and Managing Healthy Living
The many forms of fitness…
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Designed to include a spectrum of
lifestyle activities and exercises, helping
you show your patients they are
already moving, they just might need
to move MORE.
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Measuring and Managing Healthy Living
Note: FFM could also be divided into
Bone Mineral Content (BMC) + Lean Soft Tissue (LST)
BMC is the mineral deposits of the skeleton.
LST includes organs, connective & supportive tissues, & SMM.
Skeletal Muscle Mass (SMM) is required for posture and movement.
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How do we measure health?
Measuring and Managing Healthy Living
Tracking options also include:
HgbA1C
TC
HDL
LDL
Triglycerides
BP
Vitamin D
Neck
Shoulder
Waist
Hip
Wrist
Measuring and Managing Healthy Living
Every combination of these biomarkers
should be considered in true evidencebased
medicine
 Fat Pounds
 Fat Percent
 Fat Free Mass
 Lean Dry Mass
 Total Body Water
 Intracellular Water
 Extracellular Water
 Impedance
 BMI
 Phase Angle
 HgbA1C
 TC
 HDL
 LDL
 Triglycerides
 Vitamin D
 BP
 Neck
 Shoulder
 Waist
 Hip
 Wrist
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There is a direct and causal
relationship between all of
these biomarkers.
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Upcoming this year…
• New measures: Lean Soft Tissue, Skeletal
Muscle Mass, Bone Mineral Content
• Practitioner Report format option
• Segmental BIA
• 35th Anniversary Event October 2014
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Affordability & Quantum ROI
The average BIA technician can analyze 32 individuals
in an average 8 hour day.
$20-$125 nationwide reported range, per test.
Consider adding this additional revenue stream to
your practice.
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Affordability & Quantum ROI
• The opportunity to recommend your
appropriately selected products
• Graphic or tabular images of individual
results & progress
• Repeat analyses to monitor changes
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Affordability & Quantum ROI
Consider offering:
• Health Fair Specials
• Lower cost Analysis fee, with referral to RJL’s Free
Online BIA calculator
• Discount for new patients from Fair
• “BIA Days” at your office
• Free, Half-price, 2 for 1, Bring a Friend, etc.
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Collateral Gains
• Mitigating patient lifestyle reporting errors
• Protocol development
• Ability to strategically shift individual
patient protocols when needed
• Practitioner protocol evaluation
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Quantum IV
(includes BC software for MAC or PC)
$2590
Consider:
You can get started
now, and still
benefit from new
software release
Prices increase in
2015
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Access to RJL BIA
a. Purchase
b. Finance
c. Lease options around $115/month
d. Trade-in $250 credit for old
and non-RJL devices
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TRAINING RESOURCES
YouTube videos
Website resources
USB drive included
Superb customer service
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We invite your Questions!
(feel free to also use the Chatbox option)
William Pauly, Director of Sales
33939 Harper Avenue
Clinton Township, MI 48035
(800) 528-4513
Photo Credits: Sunrise – Santa Banta, Midday – Dreamstime.com, Sunset –David baker
www.RJLSystems.com