1. Measuring and Managing Healthy Living
Bioelectric Impedance Analysis
Advanced Edition

2. 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

3. Objectives Brief history of body composition assessment
Bioelectrical Impedance Analysis
Scientific foundations
Types of BIA
Utilization of RJL BIA
RJL BIA Report highlights
Summary and Q&A
Measuring and Managing Healthy Living

4. Measuring and Managing Healthy Living
Rudolph J. Liedtke Founder & CEO
Paul Maletz Production Manager
Jeff Polly Office Manager
Kerrie Saunders
Director of Education
Michael Liedtke Director of Business Development
Joshua Myers Engineering Technician
Barry Callahan Chief Technology Officer
William J. Pauly Director of Sales
Measuring and Managing Healthy Living

5. INDICATIONS OF USE   The following outlines RJL Systems Indications of Use approved by the FDA.   Calculation and Historical Tracking of:   ■ Actual Impedance ■ Actual Phase Angle PA) ■ Estimated Body Fat (FAT) ■ Estimated Fat Free Mass (FFM) ■ Lean Dry Mass (LDM) ■ Estimated Total Body Water (TBW) ■ Estimated Intra-Cellular Water (ICW) ■ Estimated Extra-Cellular Water (ECW) ■ Estimated Basal Metabolic Rate (BMR) ■ Estimated Daily Energy Expenditure ■ Actual Body Mass Index (BMI)  
Measuring and Managing Healthy Living

6. INDICATIONS OF USE   Intended Population: BC is intended only for use on normally healthy adults and adolescents age The prediction equations used by the BC software assume that the person being tested has not had either arm or leg amputated. It is not intended to be used to diagnose, treat, or cure any disease or medical condition.   Contraindications: No known contraindications exist.   Warnings: The BC software provides body composition estimates based on the electrical characteristics measured by a Bioelectrical Impedance Analyzer (BIA). BIA works by introducing an alternating current (AC) signal into the body and then measuring how that signal is affected by the body. This device should not be used on subjects with any implanted electronic devices such as pacemakers or implantable cardioverter-defibrillators (ICD)’s.
Measuring and Managing Healthy Living

7. Evidence-based medicine requires evidence
Measuring and Managing Healthy Living

8. Which components are changing - fat, lean dry mass, fat free mass, intracellular water, extracellular water…?
Measuring and Managing Healthy Living

9. 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, ,
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
Measuring and Managing Healthy Living

10. Bioelectrical Impedance Analysis
Measuring and Managing Healthy Living

11. RJL Sciences Quantum Bioelectrical Impedance Analyzers have received FDA clearance to measure:
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
Measuring and Managing Healthy Living

12. Proper BIA Protocol
Measuring and Managing Healthy Living

13. 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
Measuring and Managing Healthy Living

14. Proper BIA protocol
Measuring and Managing Healthy Living

15. Proper BIA protocol
Clean the 4 electrode sites with alcohol pad, and allow to dry (about 30 seconds)
Measuring and Managing Healthy Living

16. Proper BIA protocol Supine position on a flat surface – AMA definition
Knees separated, with arms out 30 degrees from waist, palms down
Measuring and Managing Healthy Living

17. BIA technology has been utilized in over 2000 research studies and scientific articles to date.
Measuring and Managing Healthy Living

18. 10/2013 AMA Annual Meeting
CPT 0358T formally defines BIA Whole Body Composition, supine position, with interpretation and report effective July 1, 2014
Measuring and Managing Healthy Living

19. Measuring and Managing Healthy Living

20. BIA measures whole body reactance (Xc) and resistance (R), the two components of impedance.
Measuring and Managing Healthy Living

21. Evidence-based medicine requires evidence
Measuring and Managing Healthy Living

22. TOTAL BODY WEIGHT
Fat
Fat Free Mass (aka Lean Body Mass = skeletal muscle, nerves, organs, water, smooth muscle)
LDM
(Lean Dry Mass)
Total Body Water
Extra- Cellular Water
Intra- Cellular Water
Measuring and Managing Healthy Living

23. Measuring and Managing Healthy Living

24. Awareness
The body normally varies +/- 3% total weight within 24 hours, due to food in stomach, bladder and bowel contents, etc.
Measuring and Managing Healthy Living

25. Measuring and Managing Healthy Living
Watch percent comparison to outside reference and then pounds for change over time.
Measuring and Managing Healthy Living

26. 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

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28. Measuring and Managing Healthy Living

29. Fat Pounds & Fat Percent
Practitioners discuss:
Dietary fats (dairy, oils, meat, chicken, fish, nuts, seeds, avocado, coconut, olives)
Omega 3:6 balance
Higher fiber (plant) foods, to 40+ grams per day for average adult
Activity level (strength, stamina, stretching)
Proper sleep cycle
Rule out endocrine hormone imbalance
Rule out reproductive hormone imbalance
Rule out liver dysfunction
Rule out food relationship issues
Measuring and Managing Healthy Living

30. Why Correct the Omega-3 deficiency and the Om-6:Om-3 Ratio?
SAD is several times higher in omega 6 than required, competing for omega 3 for absorption
Measuring and Managing Healthy Living

31. Omega 3 Sources (and generally decrease omega 6s)
Purslane
Ground flaxseeds
Hempseeds
English walnuts
Chia seeds
Pumpkin seeds
Greens, soy, pumpkin
Plant-based supplements
Follow cautions on fish oils, and if using salmon or mackerel, it must be oz., ‘open water’
Omega 3 Sources (and generally decrease omega 6s)
Measuring and Managing Healthy Living

32. Lean Mass
Measuring and Managing Healthy Living

33. Measuring and Managing Healthy Living

34. Lean Mass Practitioners discuss:
Activity (especially strength and stretching)
Stamina/ Endurance
VARIETY
NASA Study
Measuring and Managing Healthy Living

35. Lean Mass Practitioners discuss:
Plant proteins (beans, peas, lentils, sprouts, quinoa)
Rule out tobacco, alcohol or other drug use
Rule out cachexia
Proper sleep cycle
Measuring and Managing Healthy Living

36. Awareness
Over-training with too few calories can lead to sarcopenia Cytokines, Growth Mediators and Physical Activity in Children during Puberty,   edited by J. Jürimäe, A.P. Hills, T. Jürimäe, 2010
Measuring and Managing Healthy Living

37. Measuring and Managing Healthy Living
Source credit:
Measuring and Managing Healthy Living

38. Measuring and Managing Healthy Living

39. Hydrated cells vs. Dehydrated cells
Measuring and Managing Healthy Living

40. Intracellular Water Practitioners discuss: Ensure proper water intake
Decrease alcohol and caffeine
Salt balance
Electrolytes
B Vitamins
Omega 3: Omega 6 balance
Rule out toxicity, allergies, kidney issues
Rule out inflammatory processes
Consider chronic stress
Measuring and Managing Healthy Living

41. Measuring and Managing Healthy Living

42. High Electrolyte Foods
Celery
Cucumber
Berries
Grapes
Oranges
Bananas
Measuring and Managing Healthy Living

43. High Electrolyte Foods
Ultima Replenisher
Accelerade
Alacer EmerGenC
VEGA Electrolytes
UNflavored Pedialyte
Measuring and Managing Healthy Living

44. Measuring and Managing Healthy Living

45. Phase Angle (Humans typically range between 3-9)
Optimal Reference Values, decreasing, as Men age from years =
Optimal Reference Values, decreasing, as Women age from years =
Rakowski, 2005
Measuring and Managing Healthy Living

46. Can phase angle determined by BIA assess nutritional risk
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),
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
Measuring and Managing Healthy Living

47. 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

48. 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
Measuring and Managing Healthy Living

49. 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
Measuring and Managing Healthy Living

50. BC 3.0 Software for MAC & PC (included in device kit) Report Options
Target Weight
Notations (recent exercise, surgery, etc.)
Lab biomarkers: measurements, HgBA1C, Lipids, BP, etc.
Store, , print
Tables, graphs, F&F, size of report
Equation Sets
Measuring and Managing Healthy Living

51. 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)
Measuring and Managing Healthy Living

52. Lifestyle Factor Upgrades: Food & Fitness
Measuring and Managing Healthy Living

53. Designed to allow patients to see and navigate CHOICES, helping to make food fun again.
Measuring and Managing Healthy Living

54. Food Categories Categories help lifestyle medicine practitioners target and customize patient preferences and nutritional needs and patient preferences.
Measuring and Managing Healthy Living

55. Food Category Titles. Higher Protein. Higher Carbohydrate. Higher Fat
Food Category Titles Higher Protein Higher Carbohydrate Higher Fat Calcium rich Snacks
Measuring and Managing Healthy Living

56. 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
Measuring and Managing Healthy Living

57. Health Enhanced Options Measuring and Managing Healthy Living
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 
Health
Enhanced
Options
Measuring and Managing Healthy Living

58. Menu Options Note: The Standard Menu Options are listed for patient familiarity. Specific recommendations are determined during the patient-practitioner interaction.
Measuring and Managing Healthy Living

59. Measuring and Managing Healthy Living

60. The many forms of fitness…
Measuring and Managing Healthy Living

61. 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.
Measuring and Managing Healthy Living

62. Measuring and Managing Healthy Living

63. Note: FFM could also be divided into
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.
Measuring and Managing Healthy Living

64. TRAINING RESOURCES YouTube videos Website resources USB drive included Superb customer service
Measuring and Managing Healthy Living

65. We invite your Questions! (feel free to also use the Chatbox option)
William Pauly, Director of Sales
33939 Harper Avenue
Clinton Township, MI
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