1 European Journal of Clinical Nutrition 2004 Vol: 58(11):1525-1531. DOI: 10.1038/sj.ejcn.1602003

Comparison of anthropometry to DXA: a new prediction equation for men

Objective: This study compared three professionally recommended anthropometric body composition prediction equations for men to dual energy X-ray absorptiometry (DXA), and then developed an updated equation, DXA Criterion (DC) from DXA.

Mentions
Figures
Figure 1: Values are the difference between measured %BF (DXA) and predicted %BF by the Jackson and Pollock 7-site equation (JP7) (1978). Positive values represent an underestimation by the prediction equation. Figure 2: Values are the difference between measured %BF (DXA) and predicted %BF by the new DC equation.
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References
  1. ACSM's Guidelines for Exercise Testing and Prescription (6th edition) (2000): Baltimore, MD Lippincott Williams & Wilkins , .
    • . . . In fact, the equation that is most often used in exercise science and is professionally recommended by the American College of Sports Medicine (ACSM's Guidelines for Exercise Testing and Prescription, 2000) (ie, the Jackson, Pollock, and Ward 7-site equation) underestimated %BF in 148 of 150 subjects and 23 of the 25 subjects, respectively . . .
    • . . . According to the American College of Sports Medicine (ACSM's Guidelines for Exercise Testing and Prescription, 2000), practitioners should use one of the three generalizable equations for men (Table 1) to predict body density . . .
  2. Bakker HK & Struikenkamp RS. (1977): Biological variability and lean body mass estimates. Hum. Biol. 49 (2), 187-202 , .
    • . . . Differences of 3–4 %BF, attributed mostly to variations in body water, adipose tissue, and bone density have been observed (Bakker & Struikenkamp, 1977) . . .
  3. Ball S, Swan P & Desimone R: Comparison of anthropometry compared to dual energy X-ray absorptiometry: A new generalizable equation for women. Res. Q. Exerc. Sport. in press , .
    • . . . For example, in a recent study (Ball et al, in press), a systematic underestimation of %BF was observed when using the most commonly employed anthropometric equations in two samples of women (n=150 and 25) when compared to DXA . . .
    • . . . Similar results were found in a previous study using two different DXA machines (Ball et al, in press) that support our contention that this particular DXA machine was not overestimating. . . .
    • . . . In an earlier study on women (Ball et al, in press), we adopted predictors from the Jackson et al (1980) study with great success and were able to create a new and improved equation . . .
  4. Bland JM & Altman DG (1986): Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1 (8476), 307-310 , .
    • . . . The underestimation of the 7-site equation by Jackson and Pollock (JP7) compared to DXA is depicted in a Bland Altman plot (Bland & Altman, 1986) (Figure 1) . . .
  5. Bottaro M, Heyward V, Bezerra R & Wagner DR (2002): Skinfold method vs dual energy X-ray absorptiometry to assess body composition in normal and obese women. JEP-online 5 (2), 11-18 , .
    • . . . Similarly, Hart et al (1993) and Bottaro et al (2002) found other skinfold equations to underestimate %BF compared to DXA in a group of adults and Hispanic women, respectively . . .
  6. Brozek J, Grande F, Anderson A & Keys A (1963): Densitometric analysis of body composition: revision of some quantitative assumptions. Ann. N Y Acad. Sci. 110, 113-140 , .
    • . . . Being that HW is only a 2C model it must assume that the fat-free mass (FFM) has a constant density of 1.1000 g/cm3 despite age, gender, fatness, or activity status (Brozek et al, 1963) . . .
  7. Callaway C, Chumlea WC, Bouchard C, Himes JH, Lohman T, Martin A, Mitchell C, Meuller W, Roche AF & Martorell R (1988): Circumferences. In Anthropometric Standardization Reference Manual ed. Roche AF, pp. 39-54. Champaign, IL: Human Kinetics , .
    • . . . Duplicate circumferences of the hip (largest extension of the buttock) and waist (narrowest point between the umbilicus and rib cage) were measured to the nearest 0.5 cm using a Gulick tension retractable tape (Callaway et al, 1988) . . .
  8. Clark RR, Kuta JM & Sullivan JC (1993): Prediction of percent body fat in adult males using dual energy x-ray absorptiometry, skinfolds, and hydrostatic weighing. Med. Sci. Sports Exerc. 25 (4), 528-535 , .
    • . . . Since DXA %BF values tend to be higher compared to HW (Clark et al, 1993; Withers et al, 1998), all anthropometric equations developed from HW, an older standard, should at least be checked and re-evaluated with DXA, an updated standard, to determine if differences exist . . .
  9. Clasey JL, Kanaley JA, Wideman L, Heymsfield SB, Teates CD, Gutgesell ME, Thorner MO, Hartman ML & Weltman A (1999): Validity of methods of body composition assessment in young and older men and women. J. Appl. Physiol. 86 (5), 1728-1738 , .
    • . . . Thus, researchers have been forced to develop field methods (ie, anthropometric equations) mostly from the 2C model despite significant differences in %BF values between it and the 4C model (Withers et al, 1998; Clasey et al, 1999) . . .
    • . . . The mean difference was 4.6 %BF. Clasey et al (1999) also found the same equation to significantly underestimate %BF in younger (mean difference=2.4%) and older women (mean difference=7.9%) compared to a 4C model . . .
  10. Durnin JVGA & Womersley J (1974): Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16-72 years. Br. J. Nutr. 32, 77-97 , .
    • . . . Considering that PRESS generally generates less confident estimates of an equation's potential (Holiday et al, 1995), our PRESS values are quite remarkable compared to other equation performance values reported in the literature (Wilmore & Behnke, 1970; Durnin & Womersley, 1974; Pollock et al, 1976) . . .
  11. Going SB, Massett MP, Hall MC, Bare LA, Root PA, Williams DP & Lohman TG. (1993): Detection of small changes in body composition by dual-energy X-ray absorptiometry. Am. J. Clin. Nutr. 57 (6), 845-850 , .
    • . . . DXA is able to directly and accurately measure bone (Going et al, 1993), something that traditional 2C models like HW must estimate . . .
  12. Hart PD, Wilkie ME, Edwards A & Cunningham J (1993): Dual energy X-ray absorptiometry versus skinfold measurements in the assessment of total body fat in renal transplant recipients. Eur. J. Clin. Nutr. 47 (5), 347-352 , .
    • . . . Clasey et al (1999) also found the same equation to significantly underestimate %BF in younger (mean difference=2.4%) and older women (mean difference=7.9%) compared to a 4C model. Similarly, Hart et al (1993) and Bottaro et al (2002) found other skinfold equations to underestimate %BF compared to DXA in a group of adults and Hispanic women, respectively . . .
  13. Holiday DB, Ballard JE & McKeown BC (1995): PRESS-related statistics: regression tools for cross-validation and case diagnostics. Med. Sci. Sports Exerc. 27 (4), 612-620 , .
    • . . . This statistic uses all of the data and thus avoids many of the problems associated with data splitting while still providing estimates of prediction accuracy (Holiday et al, 1995). . . .
    • . . . Considering that PRESS generally generates less confident estimates of an equation's potential (Holiday et al, 1995), our PRESS values are quite remarkable compared to other equation performance values reported in the literature (Wilmore & Behnke, 1970; Durnin & Womersley, 1974; Pollock et al, 1976) . . .
  14. Horber FF, Thomi F, Casez JP, Fonteille J & Jaeger P (1992): Impact of hydration status on body composition as measured by dual energy X-ray absorptiometry in normal volunteers and patients on haemodialysis. Br. J. Radiol. 65 (778), 895-900 , .
    • . . . Despite this limitation, the error in %BF associated with hydration seems to be small (Horber et al, 1992) . . .
  15. Jackson A & Pollock ML (1985): Practical assessment of body composition. Physician Sportsmed. 13, 76-90 , .
    • . . . These site locations and fold directions were those recommended by Jackson and Pollock (1985) . . .
  16. Jackson AS & Pollock ML (1976): Factor analysis and multivariate scaling of anthropometric variables for the assessment of body composition. Med. Sci. Sports Exerc. 8 (3), 196-203 , .
    • . . . The specific combinations of sites were those that Jackson and Pollock (1976) had already found to be the most highly correlated with %BF . . .
    • . . . Since body fatness and skinfolds are typically curvilinear in relationship to one another (Jackson & Pollock, 1976), the squares of these sums were used as separate independent variables . . .
  17. Jackson AS & Pollock ML (1978): Generalized equations for predicting body density of men. Br. J. Nutr. 40 (3), 497-504 , .
    • . . . The recommendations of Jackson and Pollock (1978) were used to determine which variables should be entered into the DC equation . . .
    • . . . Our sample was very similar to that of Jackson and Pollock (1978) from which the professionally recommended JP7 equation was developed . . .
    • . . . In addition, the 7 skinfolds and the 3 skinfolds from the current study are 114.051.9 and 45.320.1 mm, respectively, compared to 122.652.0 and 59.424.3 mm in the Jackson and Pollock (1978) study . . .
    • . . . The similarities between our sample and that of Jackson and Pollock (1978) likely rule out that the underestimation is due to an increased internal body fatness of the current cohort . . .
    • . . . In fact, the cross-validation correlations for these equations with DXA are actually higher than the validation correlations published in the original paper (Jackson & Pollock, 1978) . . .
    • . . . There are hundreds of anthropometric equations to select from, but the most popular and most recommended equations in exercise medicine for men are those developed by Jackson and Pollock (1978) . . .
  18. Jackson AS, Pollock ML & Ward A (1980): Generalized equations for predicting body density of women. Med. Sci. Sports Exerc. 12 (3), 175-181 , .
    • . . . In an earlier study on women (Ball et al, in press), we adopted predictors from the Jackson et al (1980) study with great success and were able to create a new and improved equation . . .
  19. Jebb SA, Goldberg GR, Jennings G & Elia M (1995): Dual-energy X-ray absorptiometry measurements of body composition: effects of depth and tissue thickness, including comparisons with direct analysis. Clin. Sci. 88 (3), 319-324 , .
    • . . . Research however demonstrates that beam hardening is of minimal concern in DXA's ability to predict %BF (Jebb et al, 1995) . . .
  20. Lohman T (1992): Advances in Body Composition Assessment. Champaign, IL: Human Kinetics , .
    • . . . Compare this to the most accurate model of body composition analysis, the four component model (4C), which estimates fat mass, total body water, bone mineral mass and residual (protein and nonbone mineral) following a combination of methods (Lohman, 1992) . . .
  21. Lohman TG (1981): Skinfolds and body density and their relation to body fatness: a review. Hum. Biol. 53 (2), 181-225 , .
    • . . . Other combinations of the abdominal, triceps, thigh, and subscapular sites were also tested as recommended by Lohman (1981) . . .
    • . . . For example, on average the SEE is approximately 4.4 %BF (range 3.4–4.6 %BF) (Lohman, 1981) whereas the DC equation yielded a SEE of 2.2%. . . .
  22. Lohman TG, Pollock ML, Slaughter MH, Brandon LJ & Boileau RA (1984): Methodological factors and the prediction of body fat in female athletes. Med. Sci. Sports Exerc. 16 (1), 92-96 , .
    • . . . One highly trained technician took all measurements as intertester variability is a major source of error in skinfold measurements (Lohman et al, 1984) . . .
  23. Pietrobelli A, Formica C, Wang Z & Heymsfield SB (1996): Dual-energy X-ray absorptiometry body composition model: review of physical concepts. Am. J. Physiol. 271 (6 Pt 1), E941-E951 , .
    • . . . Dual energy X-ray absorptiometry (DXA) is a technically sophisticated method of body composition that simultaneously measures fat mass, lean mass, and bone (three components) without having to make assumptions about their densities (Pietrobelli et al, 1996) . . .
  24. Pollock ML, Hickman T, Kendrick Z, Jackson A, Linnerud AC & Dawson G (1976): Prediction of body density in young and middle-aged men. J. Appl. Physiol. 40 (3), 300-304 , .
    • . . . Considering that PRESS generally generates less confident estimates of an equation's potential (Holiday et al, 1995), our PRESS values are quite remarkable compared to other equation performance values reported in the literature (Wilmore & Behnke, 1970; Durnin & Womersley, 1974; Pollock et al, 1976) . . .
  25. Prior BM, Cureton KJ, Modlesky CM, Evans EM, Sloniger MA, Saunders M & Lewis RD (1997): In vivo validation of whole body composition estimates from dual-energy X-ray absorptiometry. J. Appl. Physiol. 83 (2), 623-630 , .
    • . . . Although two studies have found DXA to slightly underestimate fatness compared to the 4C model (Tylavsky et al, 2003a; Van Der Ploeg et al, 2003), in general there is a strong agreement between %BF by DXA and the 4C model (Prior et al, 1997; Withers et al, 1998; Salamone et al, 2000) . . .
  26. Salamone LM, Fuerst T, Visser M, Kern M, Lang T, Dockrell M, Cauley JA, Nevitt M, Tylavsky F & Lohman TG (2000): Measurement of fat mass using DEXA: a validation study in elderly adults. J. Appl. Physiol. 89 (1), 345-352 , .
    • . . . Although two studies have found DXA to slightly underestimate fatness compared to the 4C model (Tylavsky et al, 2003a; Van Der Ploeg et al, 2003), in general there is a strong agreement between %BF by DXA and the 4C model (Prior et al, 1997; Withers et al, 1998; Salamone et al, 2000) . . .
  27. Tothill P, Avenell A, Love J & Reid DM (1994): Comparisons between Hologic, Lunar and Norland dual-energy X-ray absorptiometers and other techniques used for whole-body soft tissue measurements. Eur. J. Clin. Nutr. 48 (11), 781-794 , .
    • . . . Finally, the difference between DXA models, and between software packages, has been investigated as possible sources of error (Tothill et al, 1994; Tylavsky et al, 2003a, 2003b) . . .
  28. Tylavsky FA, Lohman T, Blunt BA, Schoeller DA, Fuerst T, Cauley JA, Nevitt MC, Visser M & Harris TB (2003a): QDR 4500A DXA overestimates fat-free mass compared with criterion methods. J. Appl. Physiol. 94 (3), 959-965 , .
    • . . . Although two studies have found DXA to slightly underestimate fatness compared to the 4C model (Tylavsky et al, 2003a; Van Der Ploeg et al, 2003), in general there is a strong agreement between %BF by DXA and the 4C model (Prior et al, 1997; Withers et al, 1998; Salamone et al, 2000) . . .
    • . . . Finally, the difference between DXA models, and between software packages, has been investigated as possible sources of error (Tothill et al, 1994; Tylavsky et al, 2003a, 2003b) . . .
  29. Tylavsky FA, Lohman TG, Dockrell M, Lang T, Schoeller DA, Wan JY, Fuerst T, Cauley JA, Nevitt M & Harris TB (2003b): Comparison of the effectiveness of 2 dual-energy X-ray absorptiometers with that of total body water and computed tomography in assessing changes in body composition during weight change. Am. J. Clin. Nutr. 77 (2), 356-363 , .
    • . . . Finally, the difference between DXA models, and between software packages, has been investigated as possible sources of error (Tothill et al, 1994; Tylavsky et al, 2003a, 2003b) . . .
  30. Van Der Ploeg GE, Withers RT & Laforgia J (2003): Percent body fat via DEXA: comparison with a four-compartment model. J. Appl. Physiol. 94 (2), 499-506 , .
    • . . . Although two studies have found DXA to slightly underestimate fatness compared to the 4C model (Tylavsky et al, 2003a; Van Der Ploeg et al, 2003), in general there is a strong agreement between %BF by DXA and the 4C model (Prior et al, 1997; Withers et al, 1998; Salamone et al, 2000) . . .
  31. Wagner DR & Heyward VH (1999): Techniques of body composition assessment: a review of laboratory and field methods. Res. Q. Exerc. Sport. 70 (2), 135-149 , .
    • . . . In fact, with the advent of more modern and advanced technological means of assessing fatness, the 2C model is now considered an obsolete criterion measure by some (Wagner & Heyward, 1999) . . .
  32. Wilmore JH & Behnke AR (1970): An anthropometric estimation of body density and lean body weight in young women. Am. J. Clin. Nutr. 23 (3), 267-274 , .
    • . . . Considering that PRESS generally generates less confident estimates of an equation's potential (Holiday et al, 1995), our PRESS values are quite remarkable compared to other equation performance values reported in the literature (Wilmore & Behnke, 1970; Durnin & Womersley, 1974; Pollock et al, 1976) . . .
  33. Withers RT, LaForgia J, Pillans RK, Shipp NJ, Chatterton BE, Schultz CG & Leaney F (1998): Comparisons of two-, three-, and four-compartment models of body composition analysis in men and women. J. Appl. Physiol. 85 (1), 238-245 , .
    • . . . Thus, researchers have been forced to develop field methods (ie, anthropometric equations) mostly from the 2C model despite significant differences in %BF values between it and the 4C model (Withers et al, 1998; Clasey et al, 1999) . . .
    • . . . Since DXA %BF values tend to be higher compared to HW (Clark et al, 1993; Withers et al, 1998), all anthropometric equations developed from HW, an older standard, should at least be checked and re-evaluated with DXA, an updated standard, to determine if differences exist . . .
    • . . . For example, Withers et al (1998) found the FFM density to be significantly greater (mean 1.10750.0049) than the assumed value of 1.1000 g/cm3 in 48 men and women, which led HW to significantly underestimate %BF by 2.3–2.8% . . .
    • . . . Although two studies have found DXA to slightly underestimate fatness compared to the 4C model (Tylavsky et al, 2003a; Van Der Ploeg et al, 2003), in general there is a strong agreement between %BF by DXA and the 4C model (Prior et al, 1997; Withers et al, 1998; Salamone et al, 2000) . . .
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