Body fat measurement in adolescent athletes: multicompartment molecular model comparison

Rapid Four-Compartment Models in Athletes Using Alternative Solutions for Body Volume and Water

The criterion four-compartment (4C) model combines dual-energy x-ray absorptiometry (DXA), deuterium dilution, and air displacement plethysmography (ADP), but its complexity limits practicality. This study aimed to externally validate a DXA-derived body volume (BV) equation (DXA-BVSilva) and assess the accuracy of a rapid 4C model replacing deuterium dilution total body water (TBW) with bioelectrical impedance spectroscopy (BIS) alongside DXA-derived BV in athletes. A total of 143 athletes (27.3% females) validated DXA-BV, with 115 (33.9% females) assessed for FM. Criterion 4C used DXA for bone mineral content, ADP for BV, and deuterium dilution for TBW. Several rapid 4C models were tested. DXA-BVSilva and DXA-BVHeymsfield reliably estimated BV, showing minimal mean differences and narrow 95% limits of agreement (LOA) compared to ADP. Among rapid 4C models, 4CTBWBIS, 4C BVSilvaTBWBIS, and 4C BVHeymsfieldTBWBIS provided the most accurate FM estimates with small, nonsignificant differences to the criterion (MD [SD]: -0.18 [1.25] kg; -0.23 [1.82] kg; 0.18 [1.87] kg, respectively) and narrow 95% LOA (-2.62 to 2.27, -3.79 to 3.33 and - 3.48 to 3.83 kg, respectively) with no proportional bias. This research supports the implementation of rapid 4C models in settings where the criterion 4C model is impractical. By improving accuracy in body composition assessment, our findings have implications for sports nutrition, sports science, and academic research, offering a viable alternative to traditional 2C and 3C models (DXA).

Development and cross-validation of predictive equations for fat-free mass estimation by bioelectrical impedance analysis in Brazilian subjects with overweight and obesity

Introduction

Obesity is a public health problem worldwide, and body composition assessment is a very important diagnostic tool. Bioelectrical Impedance Analysis (BIA) is a fast, non-invasive, relatively low-cost, and user-friendly technique; however, to obtain greater validity of the estimates, the predictive equations used must be population specific. Thus, the objectives of this study were: (1) to test the validity of four BIA equations used for fat-free mass (FFM) estimation and one model for fat mass (FM) estimation in adults with overweight or obesity; (2) develop and cross-validate new equations to estimate FFM to adults with overweight or obesity, and specific for those with obesity.

Methods

The non-probabilistic sample included 269 individuals, 53.2% with overweight and 46.8% with obesity, aged 18-79 years, randomly divided into two groups: development (n = 178) and cross-validation (n = 91), stratified by sex and classification as overweight or obese. The criterion technique was dual-energy-x-ray absorptiometry (DXA), whereas a tetrapolar single-frequency BIA equipment was used as the alternative method. Paired t-test, multiple regression, concordance correlation coefficient, and Bland-Altman analysis were used.

Results

Most existing equations were not valid and new equations were derived: (1) for individuals with overweight or obesity: CCC = 0.982; r2 = 0.95; standard error of estimate (SEE) = 2.50 kg; limits of agreement (LOA) = -5.0 to 4.8; and (2) specific for individuals with obesity: CCC = 0.968; r2 = 0.94; SEE = 2.53 kg; LOA = -5.3 to 5.2. No FFM differences were observed between the new models and the reference method (p > 0.05).

Conclusion

The new proposed models provide valid options to estimate FFM in an adult population with overweight/obesity.

The usefulness of total body protein mass models for adolescent athletes

The present study aimed to assess the utility of a less laborious technique for estimating total body protein (TBPro) in young athletes, using a multicomponent model as the criterion method. A total of 88 (49 boys and 39 girls) adolescent athletes (age: 15.2 ± 1.5 years; body mass index: 21.2 ± 2.7 kg/m2) participated. A 6-compartment model was used as the reference method (TBProReference) involving air displacement plethysmography for body volume, dual-energy X-ray absorptiometry (DXA) for bone mineral content, and deuterium dilution for total body water (TBW). Alternatively, DXA TBPro models were used as TBPro = lean-soft mass (LSM) - HFFFM × fat-free mass (FFM) - Ms. - G, where LSM and FFM were assessed using DXA, HFFFM is the hydration fraction of the FFM using measured TBW or assumed TBW (adult fraction of 0.732; Lohman's constants or mean observed HFFFM), Ms. is soft tissue minerals (Ms = 0.0129 × HFFFM × FFM), and G is glycogen calculated as 0.044 × (LSM - HFFFM × FFM - Ms). The maturation level was determined by self-assessment. TBPro obtained from DXA using the assumed HFFFM explained 73% to 77% of the variance compared to TBProReference. Meanwhile, using the mean values of measured HFFFM, the DXA model explained 53 and 36% for boys and girls, respectively. Larger bias (8.6% for boys and 25.8% for girls) and limits of agreement were found for the DXA model using measured HFFFM (boys for 66.9% and girls for 70%) compared to an assumed HFFFM (bias ranged from 1.5% to 22.5% and limits of agreement ranged from 31.3% to 35.3%). Less complex and demanding TBPro DXA models with the assumed HFFFM are valid alternatives for assessing this relevant FFM component in groups of adolescent athletes but are less accurate for individual results. Though future studies should be conducted to test the usefulness of these models in longitudinal and experimental designs, their potential to provide an estimation of protein mass after exercise and diet interventions in young athletes is anticipated.

Accuracy and precision of multiple body composition methods and associations with muscle strength in athletes of varying hydration: The Da Kine Study

BACKGROUND

Athletes vary in hydration status due to ongoing training regimes, diet demands, and extreme exertion. With water being one of the largest body composition compartments, its variation can cause misinterpretation of body composition assessments meant to monitor strength and training progress. In this study, we asked what accessible body composition approach could best quantify body composition in athletes with a variety of hydration levels.

METHODS

The Da Kine Study recruited collegiate and intramural athletes to undergo a variety of body composition assessments including air-displacement plethysmography (ADP), deuterium-oxide dilution (D2O), dual-energy X-ray absorptiometry (DXA), underwater-weighing (UWW), 3D-optical (3DO) imaging, and bioelectrical impedance (BIA). Each of these methods generated 2- or 3-compartment body composition estimates of fat mass (FM) and fat-free mass (FFM) and was compared to equivalent measures of the criterion 6-compartment model (6CM) that accounts for variance in hydration. Body composition by each method was used to predict abdominal and thigh strength, assessed by isokinetic/isometric dynamometry.

RESULTS

In total, 70 (35 female) athletes with a mean age of 21.8 ± 4.2 years were recruited. Percent hydration (Body Water6CM/FFM6CM) had substantial variation in both males (63-73 %) and females (58-78 %). ADP and DXA FM and FF M had moderate to substantial agreement with the 6C model (Lin's Concordance Coefficient [CCC] = 0.90-0.95) whereas the other measures had lesser agreement (CCC <0.90) with one exception of 3DO FFM in females (CCC = 0.91). All measures of FFM produced excellent precision with %CV < 1.0 %. However, FM measures in general had worse precision (% CV < 2.0 %). Increasing quartiles (significant p < 0.001 trend) of 6CM FFM resulted in increasing strength measures in males and females. Moreover, the stronger the agreement between the alternative methods to the 6CM, the more robust their correlation with strength, irrespective of hydration status.

CONCLUSION

The criterion 6CM showed the best association to strength regardless of the hydration status of the athletes for both males and females. Simpler methods showed high precision for both FM and FFM and those with the strongest agreement to the 6CM had the highest strength associations.

SUMMARY BOX

This study compared various body composition analysis methods in 70 athletes with varying states of hydration to the criterion 6-compartment model and assessed their relationship to muscle strength. The results showed that accurate and precise estimates of body composition can be determined in athletes, and a more accurate body composition measurement produces better strength estimates. The best laboratory-based techniques were air displacement plethysmography and dual-energy x-ray absorptiometry, while the commercial methods had moderate-poor agreement. Prioritizing accurate body composition assessment ensures better strength estimates in athletes.

Athletes with different habitual fluid intakes differ in hydration status but not in body water compartments

Physiological differences have been reported between individuals who have habitual low (LOW) and high (HIGH) water intake (WI). The aims of this study were to explore body water compartments, hydration status, and fat-free mass (FFM) hydration of elite athletes exposed to different habitual WI. A total of 68 athletes (20.6 ± 5.3 years, 23 females) participated in this observational cross-sectional study. Total WI was assessed by seven-day food diaries and through WI, athletes were categorized as HIGH (n = 28, WI≥40.0 mL/kg/d) and LOW (n = 40, WI≤35.0 mL/kg/d). Total body water (TBW) and extracellular water (ECW) were determined by dilution techniques and intracellular water (ICW) as TBW-ECW. Hydration status was assessed by urine-specific gravity (USG) using a refractometer. Fat (FM) and FFM were assessed by dual-energy X-ray absorptiometry (DXA). The FFM hydration was calculated by TBW/FFM. The USG was statistically different between groups for females (LOW: 1.024 ± 0.003; HIGH: 1.015 ± 0.006; p = 0.005) and males (LOW: 1.024 ± 0.002; HIGH: 1.018 ± 0.005; p < 0.001). No differences between groups were detected in body water compartments and FFM hydration in both sexes (p > 0.05). Multiple regression showed that WI remains a predictor of USG regardless of FFM, age, and sex (β = -0.0004, p < 0.01). We concluded that LOW athletes were classified as dehydrated through USG although their water compartments were not different from HIGH athletes. These results suggest that LOW athletes may expectedly maintain the body water compartments' homeostasis through endocrine mechanisms. Interventions should be taken to encourage athletes to have sufficient WI to maintain optimal hydration.

The Body Adiposity Index is not applicable to the Brazilian adult population

Background

Obesity is a serious disease that burdens public health systems around the world. It is a risk factor for the development of several non-communicable chronic diseases that are related to the amount and distribution of body fat. Body composition assessment using simple and low-cost techniques can help in the early detection of excess fat, allowing for the prevention and treatment of both obesity and associated diseases. Thus, identifying and proposing valid anthropometric indices for this purpose can be a great ally of health programs.

Objective

To verify the validity of the Body Adiposity Index (BAI) in relation to Dual Energy X-Ray Absorptiometry (DXA) for estimating body fat percentage in Brazilian adults, as well as to propose a new mathematical model to estimate the fat-free mass of this population.

Methods

In a cross-sectional study, 424 subjects (of which 220 were women), aged between 20 and 59 years, were evaluated by BAI and DXA, then randomly divided into two groups stratified by sex: the development group (n = 283) and the cross-validation group (n = 141). Statistical analyses to test the validity of BAI as a predictor of fat mass, in addition to proposing a new mathematical model for estimating fat-free mass, using DXA as a reference method. The analysis included paired t-test, stepwise multiple regression, coefficient of concordance correlation, and Bland-Altman plots.

Results

The BAI validity analysis showed a low correlation coefficient of agreement [CCC = 0.626; ρ (precision) = 0.795; C_b(accuracy) = 0.787]; in addition, the mean difference in the Bland-Altman plot was different from zero in the cross-validation group (p < 0.01) and limits of agreement (LOA) ranged between−8.0 and 14.4 kg, indicating a poor agreement between the BAI and the reference method. The new mathematical model for estimating FFM showed a high correlation coefficient of agreement (CCC = 0.952; ρ = 0.953; C_b = 0.999), in addition to acceptable LOA in the Bland-Altman plot (-6.7 and 6.7).

Conclusion

In the studied sample, the BAI showed low validity for estimating body fat, while the new proposed model was found to be a good option to assess the body composition of Brazilian adults.

Development and Cross-Validation of a Predictive Equation for Fat-Free Mass in Brazilian Adolescents by Bioelectrical Impedance

The bioelectrical impedance analysis (BIA) is one of the most commonly used techniques for assessing body composition in a clinical setting and in field approaches, as it has the advantages of easy application, fast, and non-invasive, in addition to its relatively low cost. However, the available predictive equations need to be valid for the evaluated subjects. The aim of this study was to verify the validity of several published BIA equations in estimating fat-free mass (FFM) among Brazilian adolescents, in addition to developing and cross-validating a BIA equation to estimate FFM appropriate for Brazilian adolescents. This is a cross-sectional study with 257 adolescents (128 girls) aged 10-19 years, randomly divided into two groups, namely, development (n = 172) and cross-validation (n = 85). The standard technique for assessing FFM was dual X-ray absorptiometry (DXA). The paired t-test, multiple regression, and the Bland-Altman plots were used to test the validity of the proposed models and to perform cross-validation of the model. The equation derived in this study was as follows: FFM = -17.189 + 0.498 (Height2/Resistance) + 0.226 Weight + 0.071 Reactance - 2.378 Sex + 0.097 Height + 0.222 Age; r 2 = 0.92; standard error of the estimate = 2.49 kg; the new equation for FFM showed better agreement when compared with that of the equations developed in other countries. In conclusion, the newly developed equations provide a valid FFM estimation and are recommended for Brazilian adolescents with similar characteristics.

Fat-free mass characteristics vary based on sex, race, and weight status in US adults

Common body composition estimation techniques necessitate assumptions of uniform fat-free mass (FFM) characteristics, although variation due to sex, race, and body characteristics may occur. National Health and Nutrition Examination Survey data from 1999 to 2004, during which paired dual-energy x-ray absorptiometry (DXA) and bioimpedance spectroscopy assessments were performed, were used to estimate FFM characteristics in a sample of 4619 US adults. Calculated FFM characteristics included the density and water, bone mineral, and residual content of FFM. A rapid 4-component model was also produced using DXA and bioimpedance spectroscopy data. Study variables were compared across sex, race/ethnicity, body mass index (BMI), and age categories using multiple pairwise comparisons. A general linear model was used to estimate body composition after controlling for other variables. Statistical analyses accounted for 6-year sampling weights and complex sampling design of the National Health and Nutrition Examination Survey and were based on 5 multiply imputed datasets. Differences in FFM characteristics across sex, race, and BMI were observed, with notable dissimilarities between men and women for all outcome variables. In racial/ethnic comparisons, non-Hispanic blacks most commonly presented distinct FFM characteristics relative to other groups, including greater FFM density and proportion of bone mineral. Body composition errors between DXA and the 4-component model were significantly influenced by sex, age, race, and BMI. In conclusion, FFM characteristics, which are often assumed in body composition estimation methods, vary due to sex, race/ethnicity, and weight status. The variation of FFM characteristics in diverse populations should be considered when body composition is evaluated.

Body Composition and Bone Mineral Density of Division 1 Collegiate Track and Field Athletes, a Consortium of College Athlete Research (C-CAR) Study

The purpose of the present study was to generate normative values for total and regional body composition in male and female Division 1 collegiate track and field athletes using dual X-ray absorptiometry. We also sought to examine body composition by event and sex. Data were used from the Consortium of College Athlete Research group. A total of 590 (male [M]/female [F] = 274/316) athletes had their height, weight, total and regional fat mass (FM), lean mass, and bone mineral density (BMD) measured. Athletes were classified into 1 of 7 categories: Jumps (M/F = 28/30); Long Distance (M/F = 104/110), Middle Distance (M/F = 27/24), Multievent (M/F = 11/9), Pole Vault (M/F = 21/27), Sprints (M/F = 54/96), and Throws (M/F = 29/20). Total and regional differences between events and sex were assessed by analysis of variance. Except for male and female throwers, all other track and field athletes' mean percent body fat (M: 10.3%-12.6%, F: 17.5%-21.6%) and visceral FM (<500 g) was low, but in a healthy range. As expected, throwers had significantly (p < 0.05) higher total and regional FM and lean mass than other events. In addition, male (1.55 ± 0.11 g/cm²) and female (1.40 ± 0.12 g/cm²) throwers had significantly greater BMD than all other events while male (1.25 ± 0.10 g/cm²) and female (1.16 ± 0.09 g/cm²) distance runners had significantly lower BMD than all other events. In conclusion, track athletes' body composition differed across events for both males and females. These measurements provide normative data on NCAA Division 1 male and female track and field athletes.

The usefulness of Tanita TBF-310 for body composition assessment in Judo athletes using a four-compartment molecular model as the reference method

Body composition assessment at the molecular level is relevant for the athletic population and its association with high performance is well recognized. The four-compartment molecular model (4C) is the reference method for fat mass (FM) and fat-free mass (FFM) estimation. However, its implementation in a real context is not feasible. Coaches and athletes need practical body composition methods for body composition assessment, and the bioelectrical impedance analysis method (BIA) is usually seen as a useful alternative. The aim of this study was to test the validity of BIA (Tanita, TBF-310) to determine the FM and FFM of elite judo athletes. A total of 29 males were evaluated in a period of weight stability using the reference method (4C) and the alternative method (Tanita, TBF-310). Regarding the 4C method, total-body water was assessed by deuterium dilution, bone mineral by DXA, and body volume by air displacement plethysmography. The slops and intercepts differed from 1 (0.39 and 1.11) and 0 (4.24 and -6.41) for FM and FFM, respectively. FM from Tanita TBF-310 overestimated the 4C method by 0.2 kg although no differences were found for FFM. Tanita TBF-310 explained 21% and 72% respectively in the estimation of absolute values of FM and FFM from the 4C method. Limits of agreement were significant, varying from -6.7 kg to 7.0 kg for FM and from -8.9 kg to 7.5 kg for FFM. In conclusion, TBF-310 Tanita is not a valid alternative method for estimating body composition in highly trained judo athletes.

Upper and lower thresholds of fat-free mass index in a large cohort of female collegiate athletes

Fat-free mass index (FFMI) is a height-adjusted metric of fat-free mass which has been suggested as a useful method of body composition assessment in athletic populations. The purpose of this study was to determine sport-specific FFMI values and the natural upper threshold of FFMI in female athletes. 372 female collegiate athletes (Mean±SD; 20.03±1.55 years, 167.55±7.50 cm, 69.46±13.04 kg, 24.18±5.48% bodyfat) underwent body composition assessment via dual-energy x-ray absorptiometry. FFMI was adjusted to height via linear regression and sport-specific reference values were determined. Between-sport differences were identified using one-way ANOVA with Tukey post-hoc tests. Average FFMI was 18.82±2.08 kg/m²; height-adjusted values were not significantly different (p<0.05) than unadjusted values. FFMI in rugby athletes (20.09±2.23 kg/m²) was found to be significantly higher (p<0.05) than in gymnastics (18.62±1.12 kg/m²), ice hockey (17.96±1.04 kg/m²), lacrosse (18.58±1.84 kg/m²), swim & dive (18.16±1.67 kg/m²), and volleyball (18.04±1.13 kg/m²). FFMI in cross country (16.56±1.14 kg/m²) and synchronized swimming (17.27±1.47 kg/m²) was significantly lower (p<0.05) than in Olympic weightlifting (19.69±1.98 kg/m²), wrestling (19.15±2.47 kg/m²), and rugby. The upper threshold for FFMI in female athletes (97.5^th percentile) was 23.90 kg/m². These results can be used to guide personnel decisions and assist with long-term body composition, training, and nutritional goals.

Agreement between dual x-ray absorptiometers using pencil beam and fan beam: indicators of bone health and whole-body plus appendicular tissue composition in adult athletes

OBJECTIVE

The current study was aimed to examine intra-individual variation on indicators of bone health in addition to whole-body plus appendicular tissue measurements using two concurrent assessments based on pencil beam and fan beam dual energy X-ray absorptiometry (DXA) systems in adult athletes from several sports.

METHOD

Thirty-two male participants (27.6±10.1 years) were measured on anthropometry including multifrequency bioelectric impedance and air-displacement plethysmography. Bone mineral content (BMC), bone area, fat and lean soft tissue were derived using pencil beam (Lunar DPX-MD+) and fan beam (Lunar iDXA) absorptiometry. Bone mineral density (BMD) was obtained for the femoral neck, trochanter and triangle of ward. Finally, the right thigh was defined as a region of interest (ROI). Analyses comprised intra-class correlation (ICC), Effect size (d) from mean differences of repeated measurements, coefficient of variation (CV).

RESULTS

ICC were >0.900 for all measurements. Intra-individual differences were large for BMC (d=1,312; CV=2,7%), bone area (d=1,761; CV=2,7%), fat tissue (d=1,612; CV=11%) and all indicators of appendicular lean soft tissue (d=1,237-1687; CV=2,0-4,1%). A very large difference (d=4,014; CV=8.4%) was diagnosed for lean soft tissue of the ROI.

CONCLUSION

Although differences among concurrent instruments for BMC and bone area, the effect size of mean differences was negligible for BMD. Fat and lean soft tissue derived from DXA should be interpreted as reference values (not criterion) due to equipment-related variation, more apparently in the ROI values.

Fatness of female field hockey players: Comparison of estimates with different methods

The aim of the study was to compare relative body fat (% fat) in female field hockey players using several methods with dual-energy X-ray absorptiometry (DXA) as the reference. Participants were 31 Polish hockey players 16-30 years of age, 17 national and 14 youth level. Percent body fat was estimated by DXA (reference method), conventional and segmental bioelectrical impedance analysis (BIA), and predicted from skinfolds (SKF). National and youth team members did not differ in estimated body fat. Correlations between BIA and skinfold estimates of % fat and DXA % fat though significant, were moderate. Both % fat SKF and % fat SBIA differed significantly from % fat DXA, while estimated % fat BIA and % fat DXA did not differ. Limits of agreement were narrow for conventional BIA (-1.20 to 1.71% fat), followed by segmental BIA (3.72-6.09% fat) and broadest for SKF (5.97-9.28% fat). Differences between DXA % fat and estimated % fat with SKF and SBIA increased from the leanest to fattest athletes, whereas conventional BIA overestimated % fat relative to DXA in the small sample of individuals with low relative fatness and underestimated % fat in individuals with elevated relative fatness. Estimated % fat from conventional BIA most closely approximated DXA % fat in this sample of female field hockey players suggesting that the method may be suitable for field surveys to monitor body composition during the season.

Validity of Bioelectrical Impedance Analysis to Estimation Fat-Free Mass in the Army Cadets

Background: Bioelectrical Impedance Analysis (BIA) is a fast, practical, non-invasive, and frequently used method for fat-free mass (FFM) estimation. The aims of this study were to validate predictive equations of BIA to FFM estimation in Army cadets and to develop and validate a specific BIA equation for this population. Methods: A total of 396 males, Brazilian Army cadets, aged 17–24 years were included. The study used eight published predictive BIA equations, a specific equation in FFM estimation, and dual-energy X-ray absorptiometry (DXA) as a reference method. Student’s t-test (for paired sample), linear regression analysis, and Bland–Altman method were used to test the validity of the BIA equations. Results: Predictive BIA equations showed significant differences in FFM compared to DXA (p < 0.05) and large limits of agreement by Bland–Altman. Predictive BIA equations explained 68% to 88% of FFM variance. Specific BIA equations showed no significant differences in FFM, compared to DXA values. Conclusion: Published BIA predictive equations showed poor accuracy in this sample. The specific BIA equations, developed in this study, demonstrated validity for this sample, although should be used with caution in samples with a large range of FFM.

Prevalence of metabolic syndrome among college football linemen

OBJECTIVE

To determine the prevalence of metabolic syndrome among Canadian amateur football players.

METHODS

University football players from Saskatchewan were invited to participate in this study. Each subject underwent screening for blood pressure using a BpTRU monitor, and serum cholesterol and fasting blood glucose using a Cholestech LDX analyzer. Waist circumference was recorded and body composition was measured by dual-energy x-ray absorptiometry. RESULTS were compared between linemen and non-linemen using independent sample t-tests for continuous data and chi-square for dichotomous variables.

RESULTS

Out of 39 players who consented to participate, 14% of linemen (3/21) and no non-linemen satisfied metabolic syndrome criteria. Compared to non-linemen, linemen had a higher waist circumference (108.0 vs. 82.9 cm; p<0.001), higher total body fat composition (26.4% vs. 11.2%; p<0.001), lower mean high-density lipoprotein cholesterol (0.93, vs. 1.12 mmol/L; p=0.021) and higher fasting blood glucose (5.22 vs. 4.77 mmol/L; p<0.001).

CONCLUSION

Despite their young age and participation in an elite-level athletic program, many collegiate-level football linemen had features of metabolic syndrome. Although our study focused on a single team, we suspect these trends may be consistent across the country.

Reference values for body composition and anthropometric measurements in athletes

BACKGROUND

Despite the importance of body composition in athletes, reference sex- and sport-specific body composition data are lacking. We aim to develop reference values for body composition and anthropometric measurements in athletes.

METHODS

Body weight and height were measured in 898 athletes (264 female, 634 male), anthropometric variables were assessed in 798 athletes (240 female and 558 male), and in 481 athletes (142 female and 339 male) with dual-energy X-ray absorptiometry (DXA). A total of 21 different sports were represented. Reference percentiles (5th, 25th, 50th, 75th, and 95th) were calculated for each measured value, stratified by sex and sport. Because sample sizes within a sport were often very low for some outcomes, the percentiles were estimated using a parametric, empirical Bayesian framework that allowed sharing information across sports.

RESULTS

We derived sex- and sport-specific reference percentiles for the following DXA outcomes: total (whole body scan) and regional (subtotal, trunk, and appendicular) bone mineral content, bone mineral density, absolute and percentage fat mass, fat-free mass, and lean soft tissue. Additionally, we derived reference percentiles for height-normalized indexes by dividing fat mass, fat-free mass, and appendicular lean soft tissue by height squared. We also derived sex- and sport-specific reference percentiles for the following anthropometry outcomes: weight, height, body mass index, sum of skinfold thicknesses (7 skinfolds, appendicular skinfolds, trunk skinfolds, arm skinfolds, and leg skinfolds), circumferences (hip, arm, midthigh, calf, and abdominal circumferences), and muscle circumferences (arm, thigh, and calf muscle circumferences).

CONCLUSIONS

These reference percentiles will be a helpful tool for sports professionals, in both clinical and field settings, for body composition assessment in athletes.

Assessing body composition in taller or broader individuals using dual-energy X-ray absorptiometry: a systematic review

BACKGROUND/OBJECTIVES

Dual-energy X-ray absorptiometry (DXA) is an accurate and reliable method for determining body composition, but a limiting feature is the restricted scanning areas (∼190 × 60 cm(2)). This shortcoming is relevant not only to athletes involved in sports where height is a major performance determinant but also to obese individuals with a large trunk mass and breadth in whom body dimensions frequently exceed the scan area. This study reviews solutions for DXA length and/or width limitations and its accuracy for body composition assessment using the PRISMA statement guidelines.

SUBJECTS/METHODS

Reviewed studies included English language articles from MEDLINE and Thomson Reuters Web of Knowledge platform (1990-2013), and were selected if procedures to overcome the scan area limitations and its validity in assessing the body composition of healthy participants were addressed. Search terms included: DXA, scan, height, width, length, wide, large, tall and obese.

RESULTS

A total of seven studies met the criteria and were selected. The sum of two DXA scans and adopting a knee-bent position are alternative procedures proposed for evaluating individuals using pencil and fan-beam Hologic instruments, who are taller than the scan area, whereas a half-body scan is recommended for overcoming the limitations of whole-body measurements in subjects who are wider than the scan area width of Lunar densitometers.

CONCLUSIONS

Overall, the proposed procedures are useful and valid, in particular the half-body scan alternative, which avoids unnecessary radiation exposure and scanning time. However, these alternatives were developed for specific densitometers, models and scan mode, and applicability to other instruments requires further research.

Total energy expenditure assessment in elite junior basketball players: a validation study using doubly labeled water

An accurate assessment of total energy expenditure (TEE) during a competitive season is required. We aimed to validate TEE estimated by self-reported energy intake (EI) and the dietary reference intake (DRI) method in 19 elite basketball players (aged 16-18 years) using doubly labeled water (DLW) as the reference method. The DRI models and EI from dietary records over a 7-day period were simultaneously assessed for TEE estimation. Resting energy expenditure was assessed by indirect calorimetry. Fat and fat-free mass (FFM) were determined by a 4-compartment model (body volume by air displacement plethysmography, bone mineral by DXA, and water by deuterium dilution). Fat and FFM ranged from 4 to 19 kg and from 47 to 81 kg, respectively. The physical activity level ranged from 2.2 to 3.7 with a mean value of 2.8 ± 0.4. Total energy expenditure from DLW (17,598 ± 3,298 kJ·d) was significantly underestimated by EI (11,274 ± 2,567 kJ·d), whereas no differences were found using DRI (17,008 ± 3,206 kJ·d). The EI and DRI methods explained TEE from DLW by 34% (p = 0.057) and 44% (p = 0.002), respectively, and wide limits of agreement were observed. Our findings suggested that EI is not a valid tool for TEE assessment. The DRI method may be valid at a group level but inaccurate for estimating individual TEE in young players during a demanding competitive season period.

A PRISMA-driven systematic review of predictive equations for assessing fat and fat-free mass in healthy children and adolescents using multicomponent molecular models as the reference method

Simple methods to assess both fat (FM) and fat-free mass (FFM) are required in paediatric populations. Several bioelectrical impedance instruments (BIAs) and anthropometric equations have been developed using different criterion methods (multicomponent models) for assessing FM and FFM. Through childhood, FFM density increases while FFM hydration decreases until reaching adult values. Therefore, multicomponent models should be used as the gold standard method for developing simple techniques because two-compartment models (2C model) rely on the assumed adult values of FFM density and hydration (1.1 g/cm(3) and 73.2%, respectively). This study will review BIA and/or anthropometric-based equations for assessing body composition in paediatric populations. We reviewed English language articles from MEDLINE (1985-2012) with the selection of predictive equations developed for assessing FM and FFM using three-compartment (3C) and 4C models as criterion. Search terms included children, adolescent, childhood, adolescence, 4C model, 3C model, multicomponent model, equation, prediction, DXA, BIA, resistance, anthropometry, skinfold, FM, and FFM. A total of 14 studies (33 equations) were selected with the majority developed using DXA as the criterion method with a limited number of studies providing cross-validation results. Overall, the selected equations are useful for epidemiological studies, but some concerns still arise on an individual basis.

The multicomponent anthropometric model for assessing body composition in a male pediatric population: a simultaneous prediction of fat mass, bone mineral content, and lean soft tissue

The aim of this study was to propose and cross-validate an anthropometric model for the simultaneous estimation of fat mass (FM), bone mineral content (BMC), and lean soft tissue (LST) using DXA as the reference method. A total of 408 boys (8-18 years) were included in this sample. Whole-body FM, BMC, and LST were measured by DXA and considered as dependent variables. Independent variables included thirty-two anthropometrics measurements and maturity offset determined by the Mirwald equation. From a multivariate regression model ((n)Y(m) = (n)x(r + 1)(r + 1)β(m) + (n)ε(m)), a matrix analysis was performed resulting in a multicomponent anthropometric model. The cross-validation was executed through the sum of squares of residuals (PRESS) method. Five anthropometric variables predicted simultaneously FM, BMC, and LST. Cross-validation parameters indicated that the new model is accurate with high R(PRESS)(2) values ranging from 0.94 to 0.98 and standard error of estimate ranging from 0.01 to 0.09. The newly proposed model represents an alternative to accurately assess the body composition in male pediatric ages.

Validity of extracellular water assessment with saliva samples using plasma as the reference biological fluid

Extracellular water (ECW) assessment is based on dilution techniques, commonly using blood sampling. However, plasma collection is an invasive procedure. We aimed to validate the use of saliva for ECW estimation by the bromide dilution technique using plasma as the reference method, in a sample of elite athletes. A total of 89 elite athletes with a mean age of 20.4 ± 4.4 years were evaluated. Baseline samples were collected before sodium bromide oral dose administration, and enriched samples were collected 3 h post-dose administration. The bromide concentration was assessed by high-performance liquid chromatography. Comparison of means, concordance coefficient correlation (CCC), multiple regression and Bland-Altman analysis were performed. The ECW from saliva explained 91% of the variance in ECW by plasma with a standard error of estimation of 0.91 kg. The CCC between alternative and reference methods was 0.952. No significant trend was observed between the mean and difference of the methods, with limits of agreement ranging between -1.5 and 2.1 kg. These findings reveal that bromide dilution volume calculated from saliva samples is a valid noninvasive method for ECW assessment in elite athletes.

Are under- and overweight female elite athletes thin and fat? A controlled study

PURPOSE

The study's purpose was to relate body mass index (BMI) to body fat percentage as measured by dual-energy x-ray absorptiometry in female elite athletes from different sports and nonathletic controls and to investigate what characterizes the athletes with unhealthy low and high body fat values.

METHODS

This study was conducted in three phases: 1) screening with a detailed questionnaire, 2) body composition measurement (dual-energy x-ray absorptiometry), and 3) clinical interview. All female elite athletes representing national teams at the junior or senior level age 13-39 yr (n = 938) and an age group-matched randomly selected population-based control group (n = 900) were invited to participate. A stratified random sample was invited to participate in parts 2 and 3. A total of 186 athletes (62%) and 145 controls (48%) participated in all three phases.

RESULTS

Of those athletes with normal BMI values (18.5-24.9 kg·m⁻²) (n = 150), 2.0% were classified with low body fat levels (<12%), and 6.7% were classified with obese body fat levels (≥ 33%). The median value for the entire group was 24.3% body fat. For the controls with normal BMI values (n = 96), none was classified with low body fat levels, and 50% were classified with obese body fat levels (median = 33.1%). The correlation between BMI and body fat percentage was 0.671 (P < 0.01) (SEE = 5.3%) for the athletes and 0.813 (P < 0.01) (SEE = 4.1%) for the controls. Both under- and overfat athletes self-reported menstrual dysfunction, stress fractures, history of weight fluctuation, and use of pathogenic weight control methods and were diagnosed with clinical eating disorders and/or low bone density.

CONCLUSIONS

Our data show that BMI is not a valid measure for assessing or monitoring body composition in female elite athletes, and it should be used carefully in female nonathletes.

Relationship between changes in total-body water and fluid distribution with maximal forearm strength in elite judo athletes

Among judo athletes, strong grip strength is crucial for performing offensive and defensive maneuvers that rely predominantly on forearm maximal strength (FMS). The study aims were to evaluate changes in total-body water (TBW) and its compartments (extracellular water [ECW] and intracellular water [ICW]) and their relationship with loss of FMS in elite judo athletes. At baseline (weight stability), 27 male elite athletes were evaluated (age: 23.2 ± 2.8 years) and again evaluated 1-3 days before competition. Athletes were free to gain or lose weight based upon their specific competition needs. Using dilution techniques (deuterium and bromide), TBW and ECW were estimated, and ICW was calculated (ICW = TBW - ECW). Fat, fat-free mass, and appendicular lean soft tissue (LST) were assessed by dual-energy x-ray absorptiometry. Handgrip was used to assess FMS. Using a reduction of 2% as a representative outcome for decreased FMS, 10 athletes were identified as having lost FMS, whereas 17 changed <2% or gained. Comparison of means and logistic regression analysis were performed. Results from baseline to before competition indicated that those who lost ≥2% of FMS significantly decreased TBW and ICW by -2.7 ± 3.0 and -4.4 ± 4.2%, respectively. The groups differed in ICW changes (-4.4 ± 4.2 vs. 1.9 ± 6.1%), respectively, for those who lost FMS by ≥2%. The ICW changes, but not in TBW or ECW, significantly predicted the risk of losing FMS (β = 0.206; p = 0.027), even adjusting for weight and arm LST changes. These findings indicated that reductions in ICW increased the risk of losing grip strength in elite judo athletes.

Accuracy of DXA in estimating body composition changes in elite athletes using a four compartment model as the reference method

BACKGROUND

Dual-energy x-ray absorptiometry (DXA) provides an affordable and practical assessment of multiple whole body and regional body composition. However, little information is available on the assessment of changes in body composition in top-level athletes using DXA. The present study aimed to assess the accuracy of DXA in tracking body composition changes (relative fat mass [%FM], absolute fat mass [FM], and fat-free mass [FFM]) of elite male judo athletes from a period of weight stability to prior to a competition, compared to a four compartment model (4C model), as the criterion method.

METHODS

A total of 27 elite male judo athletes (age, 22.2 +/- 2.8 yrs) athletes were evaluated. Measures of body volume by air displacement plethysmography, bone mineral content assessed by DXA, and total-body water assessed by deuterium dilution were used in a 4C model. Statistical analyses included examination of the coefficient of determinant (r2), standard error of estimation (SEE), slope, intercept, and agreement between models.

RESULTS

At a group level analysis, changes in %FM, FM, and FFM estimates by DXA were not significantly different from those by the 4C model. Though the regression between DXA and the 4C model did not differ from the line of identity DXA %FM, FM, and FFM changes only explained 29%, 36%, and 38% of the 4C reference values, respectively. Individual results showed that the 95% limits of agreement were -3.7 to 5.3 for %FM, -2.6 to 3.7 for FM, and -3.7 to 2.7 for FFM. The relation between the difference and the mean of the methods indicated a significant trend for %FM and FM changes with DXA overestimating at the lower ends and underestimating at the upper ends of FM changes.

CONCLUSIONS

Our data indicate that both at group and individual levels DXA did not present an expected accuracy in tracking changes in adiposity in elite male judo athletes.

Are skinfold-based models accurate and suitable for assessing changes in body composition in highly trained athletes?

This study was designed to assess the usefulness of skinfold (SKF) equations developed by Jackson and Pollock (JP) and by Evans (Ev) in tracking body composition changes (relative fat mass [%FM], absolute fat mass [FM], and fat-free mass [FFM]) of elite male judo athletes before a competition using a 4-compartment (4C) model as the reference method. A total of 18 male, top-level (age: 22.6 +/- 2.9 yr) athletes were evaluated at baseline (weight: 73.4 +/- 7.9 kg; %FM4C: 7.0 +/- 3.3%; FM4C: 5.1 +/- 2.6 kg; and FFM4C: 68.3 +/- 7.3 kg) and before a competition (weight: 72.7 +/- 7.5 kg; %FM4C: 6.5 +/- 3.4%; FM4C: 4.8 +/- 2.6 kg; and FFM4C: 67.9 +/- 7.1 kg). Measures of body density assessed by air displacement plethysmography, bone mineral content by dual energy X-ray absorptiometry, and total-body water by bioelectrical impedance spectroscopy were used to estimate 4C model %FM, FM, and FFM. Seven SKF site models using both JP and Ev were used to estimate %FM, FM, and FFM along with the simplified Ev3SKF site. Changes in %FM, FM, and FFM were not significantly different from the 4C model. The regression model for the SKF in question and the reference method did not differ from the line of identity in estimating changes in %FM, FM, and FFM. The limits of agreement were similar, ranging from -3.4 to 3.6 for %FM, -2.7 to 2.5 kg for FM, and -2.5 to 2.7 kg for FFM. Considering the similar performance of both 7SKF- and 3SKF-based equations compared with the criterion method, these data indicate that either the 7- or 3-site SFK models are not valid to detect %FM, FM, and FFM changes of highly trained athletes. These results highlighted the inaccuracy of anthropometric models in tracking desired changes in body composition of elite male judo athletes before a competition.

Total body water measurements in adolescent athletes: a comparison of six field methods with deuterium dilution

-Assessing hydration, that is, total body water (TBW) in adolescent athletes should be part of a comprehensive training program. However, there are no specific methods to assess TBW in young athletes. Moreover, the use of traditional techniques developed in healthy youths, based on a 2-compartment model, may yield inaccurate TBW estimates in young athletes. Therefore, the purpose of this study was to assess the accuracy of TBW non-reference field methods with a criterion method (i.e., deuterium dilution) in 118 adolescent athletes. Body volume was assessed by air displacement plethysmography, bone mineral was measured by dual-energy X-ray absorptiometry, and TBW by deuterium dilution. Non-reference TBW methods included 2 bioelectrical impedance analysis techniques (Tanita Body Composition Analyzer, model TBF-310) and bioelectrical impedance spectroscopy (BIS) (model 4000B); the Lohman's hydration constants of fat-free mass (FFM); and 3 derived anthropometric equations developed, respectively, by Kushner et al., Wells et al., and Morgenstern et al. The highest accuracy between TBW estimates and the reference model in both girls and boys was observed using the Lohman's constants (r2= 0.94, SEE = 1.56 kg; r2 = 0.92, SEE = 2.42 kg, respectively; p < 0.001), followed by both foot-to-foot Tanita (r2 = 0.88, SEE = 2.15 kg; r2 = 0.87, SEE = 3.01 kg, respectively; p < 0.001) and BIS (r2 = 0.92, SEE = 1.70 kg; r2 = 0.87, SEE = 3.04 kg, respectively; p < 0.001) with slopes and intercepts not significantly different from the line of identity. The regressions between anthropometric equations and the criterion method deviated from the line of identity (p < 0.05). The practical application of this study is that the specific constants of FFM hydration developed by Lohman seem to accurately estimate TBW in adolescent athletes. Foot-to-foot Tanita and BIS were also found to be valid and non-biased tools for predicting TBW. It would appear that the 3 anthropometric equations used are not appropriate for young athletes.

Comparison of dual-energy X-ray absorptiometry, air displacement plethysmography and bioelectrical impedance analysis for the assessment of body composition in severely obese Caucasian children and adolescents

The objectives of the present study were to compare body composition assessed by dual-energy X-ray absorptiometry (DXA), air displacement plethysmography (ADP) and bioelectrical impedance analysis (BIA) in severely obese Caucasian children and adolescents and to develop and validate new equations for predicting body composition from BIA using DXA as the reference method. Body composition was assessed in fifty-eight obese children and adolescents (BMI 34·4 (sd 4·9) kg/m2) aged 10–17 years by DXA, ADP and BIA. ADP body fat content was estimated from body density using equations devised by Siri (ADPSiri) and Lohman (ADPLohman). In the whole sample, the Bland–Altman test showed that ADPSiri and ADPLohman underestimated percentage fat mass (%FM) by 2·1 (sd 3·4) and by 3·8 (sd 3·3) percent units (P < 0·001), respectively, compared to DXA. In addition, compared to DXA, BIA underestimated %FM by 5·8 (sd 4·6) percent units in the whole group (P < 0·001). A new prediction equation (FFM (kg) = 0·87 × (stature2/body impedance)+3·1) was developed on the pooled sample and cross-validated on an external group of sixty-one obese children and adolescents. The difference between predicted and measured FFM in the external group was − 1·6 (sd 2·9) kg (P < 0·001) and FFM was predicted accurately (error < 5 %) in 75 % of subjects. In conclusion, DXA, ADP and the BIA are not interchangeable for the assessment of %FM in severely obese children and adolescents. The new prediction equation offers an alternative approach to DXA for the estimation of body composition in severely obese children and adolescents.

Validity of the BOD POD for assessing body composition in athletic high school boys

The purpose of this study was to validate the percentage of body fat (%BF) values estimated from the BOD POD (BP) with those obtained from hydrostatic weighing (HW) in athletic American high school boys. Additionally, the %BF values measured via near-infrared interactance (NIR), bioelectrical impedance (BIA), and skinfold (SF) were compared to HW to determine the validity of these measures. Thirty white boys (mean age +/- SD = 15.8 +/- 1.0 years) who where currently participating in organized sports volunteered to have their %BF estimated. Measurements were obtained from NIR, BP, BIA, and SF in random order and concluded with HW. The findings from the present study indicated that the NIR and BIA instruments produced significant (P < 0.008) constant error (CE) and total error (TE) values that were too large to be of practical value (TE > 4.0%BF). The BP produced a significantly (P < 0.008) higher CE with acceptable TE values compared to HW, but compared to all three SF estimations, the BP TE values were higher. Two of the SF equations were nonsignificant (P > 0.008) and had the lowest TE values compared to HW. These data suggest that the BP can produce acceptable body fat measures for athletic white boys but is not superior to estimates made by the SF equations used in this study.

Changes in thoracic gas volume with air-displacement plethysmography after a weight loss program in overweight and obese women

OBJECTIVE

This study was designed to compare measured and predicted thoracic gas volume (V (TG)) after weight loss and to analyze the effect of body composition confounders such as waist circumference (WC) on measured V (TG) changes.

DESIGN

Prospective intervention study.

SETTING

Outpatient University Laboratory, Lisbon, Portugal.

SUBJECTS

Eighty-five overweight and obese women (body mass index = 30.0+/-3.5 kg/m(2); age = 39.0+/-5.7 years) participating in a 16-month university-based weight control program designed to increase physical activity and improve diet.

METHODS

Body weight (Wb), body volume (Vb), body density (Db), fat mass (FM), percent fat mass (%FM) and fat-free mass (FFM) were assessed by air-displacement plethysmography (ADP) at baseline and at post-intervention (16 months). The ADP assessment included a protocol to measure V (TG) and a software-based predicted V (TG). Dual-energy X-ray absorptiometry (DXA) (Hologic QDR 1500) was also used to estimate FM, %FM and FFM. Maximal oxygen uptake (VO(2) max) was assessed with a modified Balke cardiopulmonary exercise testing protocol with a breath-by-breath gas analysis.

RESULTS

Significant differences between the baseline and post-weight loss intervention were observed for body weight and composition (Vb, Db, %FM, FM and FFM), and measures of V (TG) (measured: Delta=0.2 l, P<0.001; predicted: Delta=0.01 l, P<0.010) variables. Measured V (TG) change was negatively associated with the change in the WC (P=0.008), controlling for VO(2) max and age (P=0.007, P=0.511 and P=0.331). Linear regression analysis results indicated that %FM and FM using the measured and predicted V (TG) explained 72 and 76%, and 86 and 90% respectively, of the variance in %FM and FM changes using dual-energy x-ray absorptiometry.

CONCLUSIONS

After weight loss, measured V (TG) increased significantly, which was partially attributed to changes is an indicator of body fat distribution such as WC. Consequently, measured and predicted V (TG) should not be used interchangeably when tracking changes in body composition. The mechanisms relating the reduction of an upper body fat distribution with an increase measured V (TG) are worthy of future investigation.