Evaluation of appendicular lean mass using bio impedance in persons aged 80+: A new equation based on the BUTTERFLY-study

Background: To date, the accuracy of bio-impedance (BIA) to assess body composition & sarcopenia in persons aged 80 and over remains unclear. Objective: We aimed to evaluate the agreement between dual energy X-ray absorptiometry (DXA) and BIA equations to determine lean mass, as well as their suitability to identify sarcopenia. Design: 174 community dwelling well-functioning persons (83 women, 91 men) aged 80 and over were included. Appendicular lean mass (ALM) was predicted using BIA-based equations available in literature, and compared to DXA outcomes. Through cross-validation and stepwise multiple linear regression, a new ALM-formula was generated suitable for this population. Results: Literature-based BIA equations systematically overestimated ALM. The new prediction formula that we propose for the 80+ is: ALM = 0,827+(0,19*Impedance Index)+(2,101*Sex)+(0,079*Weight); R2 = 0,888; SEE = 1,450 kg. Sarcopenia classification based on our new BIA equation for ALM showed better agreement with DXA (k ≥ 0,454) compared to literature-based BIA equations (k < 0,368). Conclusions: Despite the high correlation between both methods, literature-based BIA equations consistently overestimate ALM compared to DXA in persons aged 80 and over. We proposed a new equation for ALM, reaching higher agreement with DXA and thus improving the accuracy of BIA for this specific age group.