Smartwatch-based bioimpedance analysis for body composition estimation: precision and agreement with a 4-compartment model

Given that the prevalence of smartwatches has allowed them to become a hallmark in health monitoring, they are primed to provide accessible body composition estimations. The purpose of this study was to evaluate the precision and agreement of smartwatch-based bioimpedance analysis (SW-BIA) and multifrequency bioimpedance analysis (MFBIA) against a 4-compartment (4C) model criterion. A total of 186 participants (114 females) underwent body composition assessments necessary for a 4C model and SW-BIA and MFBIA. Values of total body water (TBW) from each device were compared with those obtained from bioimpedance spectroscopy. Precision was adequate though slightly lower for the smartwatch compared with other methods. No device demonstrated equivalence with the 4C model. Specifically, the SW-BIA overestimated and MFBIA underestimated body fat. MFBIA, but not SW-BIA, demonstrated equivalence for TBW. Overall error was higher for males using the smartwatch compared with females. While these findings do not invalidate the use of smartwatch-based estimates, clinicians should consider that there may be large errors relative to clinical measures. If this wearable device is intended to be used to monitor body composition change over time, these findings demonstrate the need for future research to evaluate its accuracy during follow-up testing.