Although the need to assess hydration is well recognized, laboratory tests and clinical impressions are impractical and lack sensitivity, respectively, to be clinically meaningful. Different approaches use bioelectrical impedance measurements to overcome some of these limitations and aid in the classification of hydration status. One indirect approach utilizes single or multiple frequency bioimpedance in regression equations and theoretical models, respectively, with anthropometric measurements to predict fluid volumes (bioelectrical impedance spectroscopy—BIS) and estimate fluid overload based on the deviation of calculated to reference extracellular fluid volume. Alternatively, bioimpedance vector analysis (BIVA) uses direct phase-sensitive measurements of resistance and reactance, measured at 50 kHz, normalized for standing height, then plotted on a bivariate graph, resulting in a vector with length related to fluid content, and direction with phase angle that indexes hydration status. Comparison with healthy population norms enables BIVA to classify (normal, under-, and over-) and rank (change relative to pre-treatment) hydration independent of body weight. Each approach has wide-ranging uses in evaluation and management of clinical groups with over-hydration with an evolving emphasis on prognosis. This review discusses the advantages and limitations of BIS and BIVA for hydration assessment with comments on future applications.

The body composition phenotype of an athlete displays the complex interaction among genotype, physiological and metabolic demands of a sport, diet, and physical training. Observational studies dominate the literature and describe the sport-specific physique characteristics (size, shape, and composition) of adult athletes by gender and levels of competition. Limited data reveal how body composition measurements can benefit an athlete. Thus, the objective is to identify purposeful measurements of body composition, notably fat and lean muscle masses, and determine their impact on the health and performance of athletes. Areas of interest include relationships among total and regional body composition measurements, muscle function, sport-specific performance, risk of injury, return to sport after injury, and identification of activity-induced fluid shifts. Discussion includes the application of specific uses of dual X-ray absorptiometry and bioelectrical impedance including an emphasis on the need to minimize measurement errors and standardize protocols, and highlights opportunities for future research. This focus on functional body composition can benefit the health and optimize the performance of an athlete.

The aims of this study were to analyze the usefulness of raw bioelectrical impedance (BI) parameters in assessing water compartments and fluid distribution in athletes. A total of 202 men and 71 female athletes were analyzed. Total body water (TBW) and extracellular water (ECW) were determined by dilution techniques, while intracellular water (ICW) was calculated. Fluid distribution was calculated as the ECW/ICW ratio (E:I). Phase angle (PhA), resistance (R) and reactance (Xc) were obtained through BI spectroscopy using frequency 50kHz. Fat (FM) and fat-free mass (FFM) were assessed by dual-energy X-ray absorptiometry. After adjusting for height, FM, FFM, age and sports category we observed that: PhA predicted ICW (females: β = 1.62, p < 0.01; males: β = 2.70, p < 0.01) and E:I (males and females: β = −0.08; p < 0.01); R explained TBW (females: β = −0.03; p < 0.01; males: β = −0.06; p < 0.01) and ECW (females: β = –0.02, p < 0.01; males: β = −0.03, p < 0.01) and ICW (females: β = –0.01, p < 0.053; males: β = –0.03 p < 0.01); and Xc predicted ECW (females: β = −0.06, p < 0.01; males: β = −0.12, p < 0.01). A higher PhA is a good predictor of a larger ICW pool and a lower E:I, regardless of body composition, age, height, and sports category. Lower R is associated with higher water pools whereas ECW expansion is explained by lower Xc. Raw BI parameters are useful predictors of total and extracellular pools, cellular hydration and fluid distribution in athletes.