Abstract
Objectives: Pediatric obesity represents a significant public health challenge, requiring accurate and accessible tools for assessing body composition in pediatric populations. This systematic review (PROSPERO CRD42024592366) compares the methodological accuracy and clinical utility of bioelectrical impedance analysis (BIA) and dual x-ray absorptiometry (DXA) in evaluating obesity among children and adolescents. Methods: Utilizing a comprehensive search across PubMed, EMBASE, and Web of Science between 1 January 2014 and 31 December 2024, we identified 28 studies meeting our inclusion criteria. The studies included involved participants aged 2-17 years with obesity and compared BIA with DXA as the reference standard. The exclusion criteria were studies focusing on adults, those that assessed BC solely using anthropometry, and those that did not report primary outcomes relevant to the comparison of BIA vs. DXA. Results: The findings reveal that despite recent technological advances improving BIA's precision, it consistently underestimates body fat percentage and fat mass, particularly in overweight and obese pediatric populations. DXA it is often used as a reference method in the evaluation of whole-body composition due to its higher accuracy and reliability. BIA offers significant practical advantages in accessibility, cost-effectiveness, and portability, but enhancements are needed to improve its accuracy for individual-level assessments. Conclusions: While BIA shows promise as a practical tool for body composition assessment in children, its accuracy varies significantly by device type. Multi-frequency segmental analyzers, such as InBody 720, demonstrate better agreement with DXA, whereas simpler models tend to underestimate fat mass. Therefore, conclusions regarding BIA performance should be device-specific and its clinical utility should be carefully weighed based on the technology used.