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Development and validation of skinfold-thickness prediction

equations with a 4-compartment model1–3


Matthew J Peterson, Stefan A Czerwinski, and Roger M Siervogel

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ABSTRACT The Durnin and Wormersley equation and the Jackson and Pollock
Background: Skinfold-thickness measurements are commonly equation were developed and validated by using a 2-compartment
obtained for the indirect assessment of body composition. (2C) model. The 2C model separates the composition of the body
Objective: We developed new skinfold-thickness equations by into fat mass and fat-free mass. Using Siri’s equation (7), the 2C
using a 4-compartment model as the reference. Additionally, we model is written as:
compared our new equations with the Durnin and Womersley and %BF = [(4.95/BD)  4.5]  100 (1)
Jackson and Pollock skinfold-thickness equations to evaluate each
equation’s validity and precision. where BD is whole-body density in g/cc. Use of the 2C-model
Design: Data from 681 healthy, white adults were used. Percentage equation requires the assumptions that body hydration level and
body fat (%BF) values were calculated by using the 4-compartment bone mineral content are both stable. Unfortunately, these assump-
model. The cohort was then divided into validation and cross- tions are often violated because of significant variations in hydra-
validation groups. Equations were developed by using regression tion levels and mineral contents between ages, sexes, and races
analyses and the 4-compartment model. All equations were then (8–10). The inability of the 2C model to detect these differences
tested by using the cross-validation group. Tests for accuracy can lead to potentially large errors in estimates of %BF in persons
included mean differences, R2, and Bland-Altman plots. Precision for whom these assumptions are violated. Thus, use of the 2C
was evaluated by comparing root mean squared errors. model for development and validation of skinfold-thickness pre-
Results: Our new equations’ estimated means for %BF in men diction equations is less than ideal (10–14).
and women (22.7% and 32.6%, respectively) were closest to the Recent advances in in vivo measurement, including 4-compartment
corresponding 4-compartment values (22.8% and 32.8%). The (4C) body composition assessment, have allowed researchers to
Durnin and Womersley equation means in men and women assess variations in hydration levels and bone mineral contents
(20.0% and 31.0%, respectively) and the Jackson and Pollock that hydrodensitometry alone cannot measure (13). The 4 com-
mean in women (26.2%) underestimated %BF. All equations partments of the 4C model are fat, mineral, water, and residual.
showed a tendency toward underestimation in subjects with By adding measurements of total body water (TBW), bone min-
higher %BF. Bland-Altman plots showed limited agreement eral density [via dual-energy X-ray absorptiometry (DXA)], and
between Durnin and Wormersley, Jackson and Pollock, and the BD (via hydrodensitometry), it is possible to measure individ-
4-compartment model. Precision was similar among all the equations. ual variances in mineral and water, thus, in theory, leading to
Conclusions: We developed accurate and precise skinfold-thickness more accurate measurement of %BF. It has been theorized that
equations by using a 4-compartment model as the method of ref- multiple measures could lead to the propagation of additive
erence. Additionally, we found that the skinfold-thickness equa- errors when using the 4C model, however, researchers have
tions frequently used by clinicians and practitioners underestimate shown negligible additive errors with this model (11). In addi-
%BF. Am J Clin Nutr 2003;77:1186–91. tion, the 4C model has been used as the criterion method in stud-
ies with children, younger and middle-aged adults, and the eld-
KEY WORDS Body composition, skinfold thickness, body erly (3, 10, 11, 15–18).
compartments, anthropometry, adipose tissue, nutritional assessment,
body fat, obesity
1
From the VA Medical Center, Geriatric Research, Education and Clinical
Center, Durham, NC (MJP); Wright State University School of Medicine, Life-
INTRODUCTION span Health Research Center, Kettering, OH (SAC and RMS); and the Center
Higher amounts of body fat and obesity are associated with for the Study of Aging and Human Development, Duke University Medical
Center, Durham, NC (MJP).
increased risks of adverse health events and greater mortality 2
Supported by the National Institutes of Health, National Institute of Child
(1, 2). Skinfold thicknesses are commonly measured in clinical
Health and Human Development, grant no. R01HD12252.
and field settings for the assessment of percentage body fat 3
Address reprint requests to MJ Peterson, Durham VAMC (182), Geriatric
(%BF) because this method is simple to perform and low in cost Research, Education and Clinical Center, 508 Fulton Street, Durham, NC
(3). Two of the most widely used skinfold-thickness equations 27705. E-mail: peter076@mc.duke.edu.
are those developed by Durnin and Womersley and Jackson and Received May 7, 2002.
Pollock (4–6). Accepted for publication October 24, 2002.

1186 Am J Clin Nutr 2003;77:1186–91. Printed in USA. © 2003 American Society for Clinical Nutrition
SKINFOLD-THICKNESS PREDICTION EQUATIONS 1187

We developed a new skinfold-thickness equation (%BFnew) to oxide (99.9% purity; Cambridge Isotope Laboratories, Woburn,
predict %BF by using the 4C model as the reference in younger MA) in a solution of 75 mL deionized water. A second saliva sam-
and middle-aged adults (18–55 y). We evaluated the performance ple was collected exactly 2 h later. The 2 samples were centrifuged
of %BFnew compared with %BF estimates derived from 2 com- and the supernate was collected, sealed, frozen, and transported
monly used skinfold-thickness equations, namely those of Durnin to the Kettering-Scott Magnetic Resonance Laboratory (Ketter-
and Wormersley (%BFDW) and Jackson and Pollock (%BF JP). ing, OH) for analysis. Nuclear magnetic resonance spectrometry
Because technology that allows us to use a 4C model for valida- was used to determine the TBW from each sample. These values
tion studies is now accessible, we decided it was important to were then divided by 1.04 to account for the estimated 4% H+ non-
examine the possibility of providing clinicians and practitioners aqueous exchange (21).
with improved skinfold-thickness prediction equations. The hydrodensitometry method was used to measure BD
according to the method described by Siri (7). This method deter-
mines BD by using standardized hydrostatic weighing with cor-
SUBJECTS AND METHODS rection for residual volume. Residual volume was measured twice
on land to the nearest 0.1 L by nitrogen washout, using a com-

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Subjects
puterized spirometer (Solatron, Dayton, OH). Underwater weight
The subjects in the present study are a subset of the participants was determined with the participant sitting in a chair suspended
in the Fels Longitudinal Study. They were enrolled in the Fels from 4 load cells in a tank of water at 35 C. When the partici-
Longitudinal Study between 1929 and the present, typically soon pant was completely submerged and at maximal exhalation,
after their birth. Most of the Fels participants are white, resided underwater weights were recorded to the nearest 0.002 kg from
in southwestern Ohio at the time of their enrollment, and were a digital display. Ten repeated underwater weights were com-
selected for enrollment because their parents were willing to allow pleted, and the average of the highest 3 weights (because these
them to participate in a long-term, serial study. To date, there have are indicative of maximal exhalation) was used to calculate BD
been > 1200 participants in the study; they are examined at regu- corrected for residual volume.
lar intervals throughout their life span. Of these 1200, a total of The methods described above can be combined to estimate
900 are participating in the currently funded National Institutes of %BF by using the equation for the %BF4C model (11):
Health study. All subjects provided written informed consent.
%BF4C = [2.559/BD  0.734 (TBW/weight)
The Fels Longitudinal Study and its participants have been
described in detail previously (19). The standard body-composition + 0.983 (TBBM/weight)  1.841]  100 (2)
exam consists of the anthropometric assessment of weight, where BD is whole-body density in g/cc measured with densito-
stature, and several skinfold thicknesses (chest and abdomen metry, TBW is total body water measured with D2O (in L), TBBM
skinfold thicknesses are not currently measured). Many other is total-body bone mineral content measured with DXA (in kg),
measures of body composition, including DXA, hydrodensitom- and weight is body weight (in kg).
etry, and bioelectrical impedance, are also obtained. The protocol
for this study is reviewed and approved annually by the Wright Development of %BFnew equations
State University Institutional Review Board. The study sample is We identified the set of skinfold-thickness and anthropometric
representative of the national population in terms of its socioe- sites that best predicted %BF from the 4C model, and we devel-
conomic composition, except for a slight underrepresentation of oped prediction equations using %BF obtained from the 4C model
the lowest socioeconomic group in recent decades. After exclud- as the reference value. The equation originally included several
ing participants without all of the data needed to derive a %BF skinfold-thickness and circumferential sites and various combi-
reference from the 4C model (see below), there were a total of nations of skinfold-thickness sites. Circumferential measurements
681 healthy, white male (n = 360) and female (n = 321) partici- were included because these measurements are directly affected
pants available for derivation of the %BF 4C individual values. by increasing and decreasing regional adiposity and thus they may
This larger sample was then randomly divided into a validation aid in developing a more precise estimate of %BF (5, 6). In addi-
sample (274 men and 230 women) to develop the %BFnew equa- tion, several variables known to be associated with body compo-
tions and a cross-validation sample (86 men and 91 women) used sition, including age, height, and weight, were included in the
to compare all the equations. equations. Body mass index (BMI, in kg/m2) was also included
because this is easily measured (using height and weight) and is
Development of %BF4C values
commonly used as an index of obesity. The anthropometric sites
DXA scans were performed with a Lunar DPX (Lunar Co, initially included in the new equations were the triceps, sub-
Madison, WI) with total body scan software version 3.6z. The scapular, biceps, midaxillary, suprailiac, midthigh, and lateral calf
Lunar DPX uses a constant X-ray source and a K-edge filter to skinfold thicknesses and the circumferences of the abdomen, hip,
achieve a congruent beam of dual-energy radiation. Tissue mass thigh, calf, and upper arm. Although it would have been most
and bone mass are calculated, and tissue mass is further divided desirable to also include an abdominal skinfold thickness as a
into fat-free nonskeletal mass and fat mass. Total body bone min- measure of central adiposity in the initial equations, the Fels Lon-
eral content is calculated relative to DXA-determined fat-free mass. gitudinal Study data collection protocol does not currently include
Deuterium oxide dilution methods were used to determine such a measure. However, we thought that the inclusion of a total
TBW according to the procedures described by Schoeller et al of 7 skinfold-thickness sites and 5 circumferences in the original
(20). Briefly, this method involves measuring the degree of dilu- equation would result in a strong prediction equation. Two highly
tion of a known dose of deuterium after it has equilibrated with skilled technicians measured each anthropometric site using the
TBW. Participants emptied their bladders before the collection of techniques described in the Anthropometric Standardization Ref-
a 6-mL baseline saliva sample and then drank 15 mL deuterium erence Manual (22) with Holtain skinfold calipers (Holtain Ltd,
1188 PETERSON ET AL

TABLE 1 TABLE 2
Descriptive characteristics of the validation and cross-validation groups1 Regression coefficients, partial explanation of variance (partial R2), and
significance of independent variables in the new percentage body fat
Value
(%BFnew) equations (validation group)
Validation group
Variable Coefficient Partial R2 P
Men (n = 274)
Age (y) 36.2 ± 11.0 (18.0–55.4) Men (n = 273)
Height (cm) 179.3 ± 6.6 (158.5–193.6) Intercept 20.94878 0.0091
Weight (kg) 79.0 ± 11.6 (45.2–109.0) Age 0.1166 0.5609 < 0.0001
BMI (kg/m2) 24.5 ± 3.2 (15.6–34.6) Stature 0.1166 0.0277 0.0082
Women (n = 230) Sum4 0.42696 0.0192 < 0.0001
Age (y) 35.1 ± 10.3 (18.0–55.6) Sum42 0.00159 0.0101 0.0002
Height (cm) 166.0 ± 5.6 (154.3–187.0) Model R2 0.6122 < 0.0001
Weight (kg) 63.5 ± 11.6 (43.3–108.6) Women (n = 229)
BMI (kg/m2) 23.0 ± 3.7 (16.5–40.6) Intercept 22.18945 0.0063

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Cross-validation group Age 0.06368 0.6420 0.0128
Men (n = 86) BMI 0.60404 0.0244 < 0.0001
Age (y) 35.2 ± 14.6 (18.0–55.6) Stature 0.14520 0.0157 0.0016
Height (cm) 178.0 ± 7.9 (163.8–192.8) Sum4 0.30919 0.0150 < 0.0001
Weight (kg) 75.8 ± 13.5 (44.7–106.4)2 Sum42 0.00099562 0.0083 0.0025
BMI (kg/m2) 24.0 ± 4.5 (16.3–35.0) Model R2 0.6988 < 0.0001
Women (n = 91)
Age (y) 34.8 ± 12.9 (18.0–54.6)
Height (cm) 166.1 ± 7.0 (153.5–184.3)
Weight (kg) 63.0 ± 10.2 (45.9–101.4) and P < 0.0167 for women. All analyses were performed with SAS
BMI (kg/m2) 22.8 ± 3.0 (18.0–32.5)
version 8e (SAS Institute Inc, Cary, NC).
1–
x ± SD; range in parentheses.
2
Significantly different from men in the validation group, P < 0.05
(unpaired t test). RESULTS

%BFnew equations
Croswell, Crymych, United Kingdom) and a metal or cloth (for The physical characteristics of subjects in the validation
upper arm only) tape measure. and cross-validation groups are shown in Table 1. In both
groups, men and women differed significantly in height,
Statistical analyses weight, and BMI, but age was not significantly different
The physical characteristics of the validation and cross-validation between the sexes. Men in the validation group were heavier
groups are presented as means with SDs and ranges. Unpaired t tests than were men in the cross-validation group. Physical char-
were used to determine significant differences between mean val- acteristics did not differ significantly between women in the
ues within each sex between groups (validation and cross-validation validation and cross-validation groups.
groups) and between the sexes within groups. Sex-specific step- Regression analyses in the validation group (Table 2) revealed
wise regression analyses were used to develop the %BFnew equa- that the sum of the triceps, subscapular, suprailiac, and midthigh
tions in the validation group. Variables included in the initial skinfold thicknesses (sum4) explained 56% (partial R2 = 0.56)
analyses included age; height (cm); weight (kg); BMI; the sum of of the variance of %BF in men and 65% (partial R2 = 0.64) of
the triceps, suprailiac, and midthigh skinfold thicknesses (sum3); the variance of %BF in women. In men, age, height, and sum42
and the sum of the triceps, subscapular, suprailiac, and midthigh were also significant contributors to the model, but to a lesser
skinfold thicknesses (sum4). Squares of sum3 (sum32) and sum4 degree, with no remaining variable’s partial R2 being > 0.027. In
(sum42) were also included to test for a curvilinear association women, in addition to the same set of variables that were significant
between skinfold thicknesses and %BF. in the model for men, BMI was also a significant predictor of %BF,
In the cross-validation group, the accuracy of the %BF new, although its effect size was relatively small (partial R2 = 0.024).
%BFDW, and %BFJP equations was tested by calculating correla- Interestingly, sum3, sum32, circumferential measures, and weight
tion coefficients. In addition, Bland-Altman plots (23) were used were not significant predictors of %BF in either model. The final
to determine bias and limits of agreement between equations. Bias equations, which were used in subsequent analyses, are as follows
was defined as (predicted %BF  %BF4C) plotted on the y axis for men and women:
and the mean of %BF4C and predicted %BF plotted on the x axis.
Limits of agreement were defined as upper and lower 95% CIs and For men: %BFnew = 20.94878 + (age  0.1166)
were determined by the mean differences ± 2 SD. To determine  (height  0.11666) + (sum4  0.42696)
each equation’s precision, root mean square error (RMSE) values  (sum42  0.00159) (3)
were obtained by using univariate analysis. In all the analyses,
For women: %BFnew = 22.18945 + (age  0.06368)
%BF4C was used as the method of reference. As described previ-
ously, chest skinfold data were not available for men, so analyses + (BMI  0.60404) (height  0.14520)
with Jackson and Pollock equations are for women only. Alpha + (sum4  0.30919)  (sum42  0.00099562) (4)
was set at P ≤ 0.05. We used a Bonferroni adjustment for multi- where height is in cm and sum4 is the sum of the triceps, sub-
ple comparisons of %BF methods and set  at P < 0.025 for men scapular, suprailiac, and midthigh skinfold thicknesses.
SKINFOLD-THICKNESS PREDICTION EQUATIONS 1189

TABLE 3
Percentage body fat (%BF) estimates and measurements in the
cross-validation group1
Value
Men (n = 86)
%BFnew 22.7 ± 7.1 (11.1–36.6)
%BF4C 22.8 ± 9.5 (4.6–44.3)
%BFJP —
%BFDW 20.0 ± 7.02 (7.6–34.8)
Women (n = 91)
%BFnew 32.6 ± 5.2 (21.7–43.2)
%BF4C 32.8 ± 7.2 (14.1–46.2)
%BFJP 26.2 ± 5.92 (13.6–39.8)
%BFDW 31.0 ± 5.52 (20.4–43.9)

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1–
x ± SD; range in parentheses. 4C, 4-compartment; JP, Jackson and
Pollock; DW, Durnin and Wormersley.
2
Significantly different from %BF4C within the same sex, P < 0.05
(Bonferroni-adjusted P; unpaired t test). FIGURE 2. Bland-Altman plot showing the limits of agreement between
percentage body fat calculated with the 4-compartment-model equation
(%BF4C; the reference equation) and percentage body fat calculated with the
Comparison of all equations new equation developed in the current study (%BFnew) in women.

The results of the predicted and measured %BF means, SDs,


and ranges for each equation or method are shown in Table 3 for Differences in %BF4C and %BFnew in men and women were plot-
the cross-validation group. As the reported mean values show, the ted against %BF4C in Figures 1 and 2. The limits of agreement
%BFnew values are closest to the %BF4C values for both men and (mean difference ± 2 SD) were approximately ± 9.5 %BF, with
women, with slight overestimations of %BF (0.1% and 0.2% in the exception of the lower confidence limits (10.1%) for women.
men and women, respectively). Jackson and Pollock underesti- This is interpreted as 95% of individuals’ predicted %BF value
mated %BF in women when compared with the 4C model, with a could be up to 10% above or below their actual value. Mean dif-
mean underestimation of 6.6%. In men and women, Durnin and ferences were close to 0, at 0.18% and 0.25% (P > 0.05) in
Wormersley also underestimated %BF when compared with the men and women, respectively. In Figures 3 and 4, relations
4C model, with mean underestimations of 3.1% and 2.4%, respec- between %BF4C and %BFDW differences and their means in men
tively. When considering differences in means between the pre- and women are shown. Limits of agreement and bias tend to favor
dicted and %BF4C values, the %BFnew equations were the most an underestimation by the Durnin and Wormersley equation, with
accurate in the cross-validation group. upper limits at 7.2% and 8.0% in men and women, respectively
Bland-Altman plots were used to further assess the accuracy of and lower confidence limits at 12.9% and 11.4% in men and
each prediction equation. In Figures 1–5, we have shown the bias women, respectively. There is also an underestimation bias in men
and limits of agreement in each prediction equation by plotting and women when using the Durnin and Wormersley equation, with
the difference between the measured and predicted values (y axis) mean differences at 2.8% and 1.8% (P < 0.05) in men and
against the mean of the measured and predicted values (x axis). women, respectively. Differences between %BFJP and %BF4C and

FIGURE 1. Bland-Altman plot showing the limits of agreement between FIGURE 3. Bland-Altman plot showing the limits of agreement between
percentage body fat calculated with the 4-compartment-model equation percentage body fat calculated with the 4-compartment-model equation
(%BF4C; the reference equation) and percentage body fat calculated with the (%BF4C; the reference equation) and percentage body fat calculated with the
new equation developed in the current study (%BFnew) in men. Durnin and Wormersley equation (%BFDW) in men.
1190 PETERSON ET AL

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FIGURE 4. Bland-Altman plot showing the limits of agreement between FIGURE 5. Bland-Altman plot showing the limits of agreement between
percentage body fat calculated with the 4-compartment-model equation percentage body fat calculated with the 4-compartment-model equation
(%BF4C; the reference equation) and percentage body fat calculated with the (%BF4C; the reference equation) and percentage body fat calculated with the
Durnin and Wormersley equation (%BFDW) in women. Jackson and Pollock equation (%BFJP) in women.

their means in women are shown in Figure 5. Bias with the Jack- groups similar to the one presented here. Bland-Altman plots pro-
son and Pollock equation is seen, with a mean difference of vided additional information regarding the underestimation of
6.6% (P < 0.05). Limits of agreement follow the same tendency %BF by the Durnin and Wormersley and Jackson and Pollock
of underestimation, with upper and lower confidence limits at equations. With the Durnin and Wormersley equations, the lower
3.3% and 16.5%, respectively. Relations are evident between the limits of agreement (mean differences  2 SD) were 12.9% and
mean of the measured and predicted values and the individual dif- 11.4% in men and women, respectively. These lower limits of
ferences in %BF in both sexes with all equations. In other words, agreement are considerably larger than the upper limit values, at
the relations seen in all equations are a function of %BF, with all 7.2% and 7.9% in men and women, respectively. On the basis of
equations having a tendency to produce larger underestimations these data, a man or woman is more likely to have their %BF
as %BF increased. underestimated using the Durnin and Wormersley equations. This
To address issues of precision, RMSEs of predicted %BF in the tendency to have the limits of agreement shifted toward underes-
cross-validation groups were investigated. %BFnew had a RMSE timations is even more pronounced in women using the Jackson
for men of 4.6% when predicting %BF, and the corresponding and Pollock equation, with upper and lower limits of agreement
value for %BFDW was 4.9%. In women, %BFnew equations had a of 3.3% and 16.5%, respectively. This indicates that a woman
RMSE of 5.0%. The corresponding values for %BFDW and %BFJP could have her %BF underestimated by as much as 16.5%. These
in women were both 4.9%. Overall, RMSEs were quite similar underestimations are most likely a result of systematic overesti-
among all the prediction equations. mations of BD. For example, the mean BD value with the Durnin
and Wormersley equation was higher, at 1.032 g/mL, than the
value of 1.028 g/mL that was measured by hydrodensitometry.
DISCUSSION Although 0.004 g/mL may initially appear to be a small difference
We developed new skinfold-thickness prediction equations and in BD estimates, when using these 2 values to predict %BF, the
compared them with the equations of Durnin and Wormersley and differences in mean predicted %BF values are almost 2%. A rela-
Jackson and Pollock, and with a 4C model, which we used as the tively small under- or overestimation of BD can result in consid-
reference equation. To our knowledge, no previous study has used erable errors in predicted %BF values.
a 4C model to cross-validate several skinfold-thickness prediction %BFnew, %BFJP, and %BFDW all had similar estimates of preci-
equations. We chose the Durnin and Wormersley and Jackson and sion, as shown by the similar RMSE values. A prediction equa-
Pollock equations because of their popularity in the field and in tion’s RMSE is certainly important, however, it should not be con-
research settings (18, 24–31). Previous studies have explored the sidered the only criterion when choosing a proper equation.
predictive accuracy and precision of the Jackson and Pollock and Although %BF DW and %BF JP values were similar in terms of
Durnin and Wormersley equations in different populations (18, RMSE values and precision, we showed that accuracy was less
24–31). Our study is also unique in that we present data from than desirable in the Durnin and Wormersley and Jackson and Pol-
healthy, white men and women who had characteristics compara- lock equations in a cohort similar in age and physical character-
ble to those of the groups used by Durnin and Wormersley and istics to their derivation samples.
Jackson and Pollock. Providing precise and accurate body-composition information
The skinfold-thickness equations developed in our laboratory is of great importance. The comparisons provided in this paper
had no significant mean differences with the %BF4C model in men should aid in making a more informed decision, considering pre-
or women in the cross-validation group. In this cohort, %BFDW cision and accuracy, when choosing among popular equations for
and %BFJP means were significantly lower than the %BF4C mean, predicting %BF. In summary, we have shown that our newly
which may need to be considered when using the Durnin and developed generalized equations, which use the 4C model as a ref-
Wormersley and Jackson and Pollock equations to predict %BF in erence, can accurately predict %BF in healthy, white adults. Our
SKINFOLD-THICKNESS PREDICTION EQUATIONS 1191

newly developed skinfold-thickness equations are important for 2 fat estimations from a four-compartment model by using density,
reasons. First, the %BFnew equations were validated and cross- water, and bone mineral measurements. Am J Clin Nutr 1992;55:
validated with large samples of men and women spanning a wide 764–70.
age range (18–55 y). The validation sample used by Durnin and 12. Williams DP, Going SB, Lohman TG, Hewitt MJ, Haber AE. Estima-
Wormersley was similar to ours in size, but they did not cross- tion of body fat from skinfold thicknesses in middle-aged and older
validate their equations. Jackson and Pollock did cross-validate, men and women: a multiple component approach. Am J Hum Biol
1992;4:595–605.
but their cross-validation did not provide an analysis of their equa-
tions’ potential to over- or underestimate %BF. Second, the 13. Withers RT, LaForgia J, Pillans RK, et al. Comparisons of two-, three-,
and four-compartment models of body composition analysis in men
%BFnew equations were developed and validated by using a 4C
and women. J Appl Physiol 1998;85:238–45.
model as a reference. The 4C model has been shown to be more
14. Heyward VH, Stolarczyk LM. Applied body composition assessment.
accurate in measuring %BF than the 2C method, which was the Champaign, IL: Human Kinetics, 1996.
criterion method for Durnin and Wormersley and Jackson and Pol-
15. Clasey JL, Kanaley JA, Wideman L, et al. Validity of methods of body
lock. When validated against the 4C model, the Durnin and Worm- composition assessment in young and older men and women. J Appl
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Jackson and Pollock generalized equations underestimated %BF 16. Fields DA, Goran MI. Body composition techniques and the four-
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MJP throughout the writing and revision of this work. bridge University Press, 1992.
MJP, SAC, and RMS were all involved in the study design and writing of the 20. Schoeller DA, Dietz W, Van Santen E, Klein PD. Validation of saliva
manuscript. Data analyses were performed by MJP. The authors had no finan- sampling for total body water determination by H2O18 dilution. Am
cial or personal interests in the sponsoring organization. J Clin Nutr 1982;35:591–4.
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