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Body Composition
Health and Performance
in Exercise and Sport
Body Composition
Health and Performance
in Exercise and Sport

Edited by
Henry C. Lukaski
CRC Press
Taylor & Francis Group
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Boca Raton, FL 33487-2742

© 2017 by Taylor & Francis Group, LLC

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Library of Congress Cataloging-in-Publication Data

Names: Lukaski, Henry Charles, editor.

Title: Body composition: health and performance in exercise and sport/
[edited by] Henry Lukaski.
Other titles: Body composition (Lukaski)
Description: Boca Raton : Taylor & Francis, 2017. | Includes bibliographical
references and index.
Identifiers: LCCN 2016054140 | ISBN 9781498731676 (hardback : alk. paper)
Subjects: | MESH: Body Composition | Exercise | Sports
Classification: LCC RA781 | NLM QU 100 | DDC 613.7--dc23
LC record available at https://lccn.loc.gov/2016054140

Visit the Taylor & Francis Web site at

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Contents
Editor................................................................................................................................................vii
Contributors.......................................................................................................................................ix

Section I  Body Composition Assessment

Chapter 1 Body Composition in Perspective.................................................................................3

Henry C. Lukaski

Chapter 2 Assessment of Human Body Composition: Methods and Limitations....................... 13

Hannes Gatterer, Kai Schenk, and Martin Burtscher

Chapter 3 Assessment of Muscle Mass........................................................................................ 27

Donald R. Dengel, Christiana J. Raymond, and Tyler A. Bosch

Chapter 4 Hydrometry, Hydration Status, and Performance....................................................... 49

Ronald J. Maughan and Susan M. Shirreffs

Section II  Physical Activity and Body Composition

Chapter 5 Physical Activity, Growth, and Maturation of Youth.................................................. 69

Robert M. Malina and Manuel J. Coelho e Silva

Chapter 6 Anthropometry in Physical Performance and Health................................................. 89

Arthur Stewart and Tim Ackland

Chapter 7 Exercise and Adipose Tissue Redistribution in Overweight and Obese Adults....... 109
Brittany P. Hammond, Andrea M. Brennan, and Robert Ross

Chapter 8 Changes in Body Composition with Exercise in Overweight and

Obese Children...................................................................................................... 129
Scott Going, Joshua Farr, and Jennifer Bea

Section III  Body Composition in Sports and Occupations

Chapter 9 Body Composition Changes with Training: Methodological Implications............... 149

Luís B. Sardinha and Diana A. Santos

v
vi Contents

Chapter 10 Endurance Athletes................................................................................................... 171

Jordan R. Moon and Kristina L. Kendall

Chapter 11 Strength and Speed/Power Athletes.......................................................................... 211

David H. Fukuda, Jay R. Hoffman, and Jeffrey R. Stout

Chapter 12 Weight-Sensitive Sports............................................................................................ 233

Analiza M. Silva, Diana A. Santos, and Catarina N. Matias

Chapter 13 Mathematical Modeling of Anthropometrically Based Body Fat

for Military Health and Performance Applications.................................................. 285
Col. Karl E. Friedl

Chapter 14 Body Composition and Public Safety: The Industrial Athlete..................................307

Paul O. Davis and Mark G. Abel

Section IV Moderating Factors

Chapter 15 Dietary Protein and Physical Training Effects on Body

Composition and Performance.................................................................................. 323
Michaela C. Devries, Sara Y. Oikawa, and Stuart M. Phillips

Chapter 16 Influence of Dietary Supplements on Body Composition......................................... 343

Col. Karl E. Friedl

Chapter 17 Diet and Exercise Approaches for Reversal of Exercise-Associated

Menstrual Dysfunction.............................................................................................. 357
Lynn Cialdella-Kam and Melinda M. Manore

Index............................................................................................................................................... 375
Editor
Henry C. Lukaski, PhD, is an adjunct professor in the Department of Kinesiology and Public
Health Education, University of North Dakota. He earned his undergraduate education at the
University of Michigan and Eastern Michigan University, and earned his master of science and
doctoral degrees in physiology with a minor in nutrition from The Pennsylvania State University
where he was a National Institutes of Health (NIH) pre-doctoral trainee in human biology and a
research ­collaborator at Brookhaven National Laboratory. He was a postdoctoral research associ-
ate at the U.S. Department of Agriculture, Agricultural Research Service, Grand Forks Human
Nutrition Research Center then served as supervisory research physiologist, research leader, and
­assistant ­center director. He is and has been a member of numerous editorial boards of peer-
reviewed ­scientific journals in the fields of human nutrition, exercise science, sports nutrition, and
applied ­physiology, has served as a member of NIH, Department of Defense, National Aeronautics
and Space Administration, U.S. Public Health Service program and grant review boards and advi-
sor to the Food and Drug Administration, Institute of Medicine (Food and Nutrition Board Military
Nutrition Committee), World Health Organization, Pan American Health Organization, National
Collegiate Athletic Association, U.S. and International Olympic Medical Committees, interna-
tional scientific organizations, sports nutrition community, and the biomedical industry. He has
authored more than 145 peer-reviewed research publications, 45 book chapters, 160 abstracts and
short ­communications, coedited special issues of professional p­ ublications on body composition
and sports nutrition, and made more than 240 invited ­presentations in the United States, Europe,
and Central and South America. He is an international authority in the field of interactions among
diet and p­ hysical activity on body structure, function, and health, and is recognized internationally
as a leader in development and validation of methods for the assessment of human body composi-
tion. Dr. Lukaski was elected to Fellowship in the American College of Sports Medicine, Human
Biology Council, and the Society of Nutrition for Latin America.

vii
Contributors
Mark G. Abel Manuel J. Coelho e Silva
Department of Kinesiology and Health Faculty of Sport Science and Physical
Promotion Education
University of Kentucky University of Coimbra
Lexington, Kentucky Coimbra, Portugal

Tim Ackland Paul O. Davis

School of Sport Science
Exercise & Health, University of Western
Australia
Perth, Australia
Jennifer Bea
Department of Medicine & Nutritional
Sciences
The University of Arizona
Tucson, Arizona
Tyler A. Bosch
Educational Technology Innovations
College of Education and Human
Development
University of Minnesota
Minneapolis, Minnesota
Andrea M. Brennan
School of Kinesiology and Health Studies
Queen’s University
Kingston, Ontario, Canada
and
School of Physical Education
University of Guelph
Guelph, Ontario, Canada
First Responder Institute
Washington, DC
and
Emergency Responders, Inc.
Silver Spring, Maryland
Donald R. Dengel
School of Kinesiology
University of Minnesota
Minneapolis, Minnesota
and
Department of Pediatrics
University of Minnesota Medical School
Minneapolis, Minnesota
Michaela C. Devries
Department of Kinesiology
University of Waterloo
Waterloo, Ontario, Canada
Joshua Farr
Division of Endocrinology
Mayo Clinic
College of Medicine
Rochester, Minnesota

Martin Burtscher Col. Karl E. Friedl

Department of Sport Science U.S. Army Research Institute of
University of Innsbruck Environmental Medicine
Innsbruck, Austria Natick, Massachusetts

Lynn Cialdella-Kam David H. Fukuda

Department of Nutrition Sport and Exercise Science
School of Medicine Institute of Exercise Physiology and Wellness
Case Western Reserve University University of Central Florida
Cleveland, Ohio Orlando, Florida

ix
x Contributors

Hannes Gatterer Melinda M. Manore

Department of Sport Science Nutrition and Exercise Sciences
University of Innsbruck School of Biological and Population
Innsbruck, Austria Sciences
Oregon State University
Scott Going Corvallis, Oregon
Department of Nutritional Sciences
The University of Arizona
Catarina N. Matias
Tucson, Arizona
Exercise and Health Laboratory
Brittany P. Hammond CIPER, Faculty of Human Kinetics
School of Kinesiology and Health Studies University of Lisbon
Queen’s University Lisbon, Portugal
Kingston, Ontario, Canada
Ronald J. Maughan
and
School of Medicine
School of Physical Education University of St Andrews
University of Guelph Fife, United Kingdom
Guelph, Ontario, Canada
Jordan R. Moon
Jay R. Hoffman
Clinical Department
Sport and Exercise Science
ImpediMed, Inc.
Institute of Exercise Physiology and Wellness
Carlsbad, California
University of Central Florida
Orlando, Florida
Sara Y. Oikawa
Kristina L. Kendall Department of Kinesiology
Department of Digital Publishing McMaster University
Bodybuilding.com Hamilton, Ontario, Canada
Boise, Idaho
Stuart M. Phillips
Henry C. Lukaski Department of Kinesiology
Department of Kinesiology and Public Health McMaster University
Education Hamilton, Ontario, Canada
University of North Dakota
Grand Forks, North Dakota
Christiana J. Raymond
Robert M. Malina School of Kinesiology
Department of Kinesiology and Health Education University of Minnesota
University of Texas at Austin Minneapolis, Minnesota
Austin, Texas
Robert Ross
and
School of Kinesiology and Health Studies
School of Public Health and Information and
Sciences School of Medicine
University of Louisville Queen’s University
Louisville, Kentucky Kingston, Ontario, Canada
and and
Department of Kinesiology School of Physical Education
Tarleton State University University of Guelph
Stephenville, Texas Guelph, Ontario, Canada
Contributors
Diana A. Santos
Exercise and Health Laboratory, CIPER
Faculty of Human Kinetics
University of Lisbon
Lisbon, Portugal
Luis B. Sardinha
Exercise and Health Laboratory, CIPER
Faculty of Human Kinetics
University of Lisbon
Lisbon, Portugal
Kai Schenk
Department of Sport Science
University of Innsbruck
Innsbruck, Austria
Susan M. Shirreffs
School of Medicine
University of St Andrews
Fife, United Kingdom
xi
Analiza M. Silva
Exercise and Health Laboratory,
CIPER
Faculty of Human Kinetics
University of Lisbon
Lisbon, Portugal
Arthur Stewart
School of Health Sciences
Centre for Obesity Research &
Epidemiology
Robert Gordon University
Aberdeen, United Kingdom
Jeffrey R. Stout
Sport and Exercise Science
Institute of Exercise Physiology
and Wellness
University of Central Florida
Orlando, Florida
Section I
Body Composition Assessment
 1 Body Composition
in Perspective
Henry C. Lukaski

CONTENTS
1.1 Introduction...............................................................................................................................3
1.2 Body Composition of Athletes..................................................................................................4
1.3 Body Structure and Function.....................................................................................................4
1.3.1 Body Fat.........................................................................................................................5
1.3.2 Fat-Free Mass................................................................................................................5
1.4 Body Composition, Performance, and Health...........................................................................6
1.4.1 Public Safety Employment............................................................................................6
1.4.2 Extreme Leanness..........................................................................................................6
1.4.3 Hydration.......................................................................................................................7
1.4.4 Injury Risk.....................................................................................................................7
1.4.5 Health Risk....................................................................................................................7
1.5 Empirical Model of Body Composition, Function, and Health.................................................8
References...........................................................................................................................................9

1.1 INTRODUCTION
Estimation of body composition is a cornerstone of human nutrition assessment for health care pro-
viders, clinical researchers, and epidemiologists. Similarly, determination of fat-free mass, muscle
mass, fat mass, and bone quantity and quality is an ongoing topic of interest and practice in the
multidisciplinary area of exercise science (Thomas et al. 2016). Awareness and curiosity about the
use and interpretation of body composition measurements are extensive and persist among coaches,
nutritionists, physical therapists, athletic trainers, and physically active people. Interested persons
include not only competitive and recreational athletes but also individuals engaged in physically
demanding occupations. For an individual, however, discussion of body composition assessment
may elicit concerns related to the rationale and implications of such testing: what is measured (fat,
lean, and muscle) and why (e.g., performance enhancement, eligibility for competition, selection and
retention for employment, or physical appearance)? Measurement of body composition is escalating
into health surveillance with the global assessment of risk for cardiometabolic disease (e.g., obesity
and adipose tissue [AT] distribution), appraisal of the impact of increased physical activity with and
without concurrent restriction of energy intake on the manifestation and consequences of endocrine
dysfunction including bone mass and density or increased jeopardy of musculoskeletal injury, as
well as any benefits or detriments of physical training on wellness, growth, and development of
youth. These expanding emphases on the inclusion of body composition measurements, particularly
in conjunction with physical activity or training and encompassing health-related consequences,
contribute to a rationalized, outcome-based model of body composition assessment. These broad
interests advance body composition assessment from a descriptive tool to an innovative model that
integrates body structure, function, and health (Figure 1.1). This chapter outlines the fundamentals
of this practical construct of body composition.

3
4 Body Composition

Body composition

Injury risk Performance

Physical activity

Health

FIGURE 1.1 General model of interaction of physical activity and body composition on health, injury risk,
and performance.

1.2 BODY COMPOSITION OF ATHLETES

The history of human body composition begins circa 400 BC with Hippocrates, who theorized
health as the balance of the four body fluids, and expands into the early Greek concept that the
components of the immediate environment (earth, water, fire, and air) are the basic constituents of
the human body. Wen et al. (2005) chronicled the contributors and their accomplishments in body
composition science since the 1850s, including the progression of methods, models, and appli-
cations in various fields of inquiry including anthropology, medicine, nutrition, and physiology.
Stewart (2012) augmented this narrative and focused on the history, concepts, and application of
body composition assessment in exercise and work. He highlighted the contribution of the Greek
sculptor, Polykleitos (460–410 BC), who is credited with the first association of the ideal body
shape with physical function in his classic work, Doryphorus, the spear bearer, and acknowledged
this work as the origin of the field of anthropometry. Ancient Greek civilization contributed more
tangibly to the field of body composition research with the discovery by Archimedes (287–212
BC) that the mass of water displaced when an object is submerged can be used to determine the
specific gravity of that object. This crucial observation led to the densitometric method to assess
body fatness.
An initial product of body composition research with physically active individuals was the char-
acterization of body fatness (percent body fat) by sport and gender. These reports emphasized the
percent body fat levels of adult athletes and reported them as sport-specific group averages and
ranges of values for women and men (Buskirk and Taylor 1957; Novak et al. 1968; De Garay et al.
1974; Fleck 1983; Wilmore 1983; Buskirk and Mendez 1984; Lukaski 1997). Overall, body fatness
tended to be greater among female compared to male athletes and this trend continued within a spe-
cific sport. Also, participants in sports that required weight classifications or utilized predominantly
endurance activity tended to have lower average body fatness than participants in other sports.
Wilmore (1983) posited that the range of body fatness by gender for a sport could serve as one com-
ponent of an athlete’s physiological profile, and it could be used by aspirant athletes to compare to
elite performers to individualize training and dietary recommendations.

1.3 BODY STRUCTURE AND FUNCTION

The 1940s and 1950s were the formative years of body composition research as related to physical
activity. A.R. Behnke provided the impetus to advance body composition research by first reporting
that differences in body composition were related to significant differences in physical function.
Weltham and Behnke (1942) observed that male professional athletes, compared to male civilians
and Navy personnel, were classified as overweight (91 vs. 68 kg, respectively) according to standard
weight for height tables and, hence, were designated as “unfit for military service and at an increased
risk for life insurance.” Body densities were greater for the athletes compared to the non-athletes
Body Composition in Perspective 5

(1.080 vs. 1.056 g/cc, respectively) indicating that body fatness was less for the athletes. The male
athletes, however, had very high levels of physical fitness that was incongruous with the classifica-
tion of unfit for military service and denial of life insurance. This crucial finding established that
body composition assessment, and densitometry per se, could distinguish “big and muscular from
big and fat” bodies (Behnke et al. 1942). Dupertuis et al. (1951) and others (Bolonchuk et al. 1989;
Siders et al. 1993) later demonstrated that body build or physique, characterized by the principal
components of somatotype, was directly related to body composition and performance.
Concurrently, Behnke (1942) reported that retention of inhaled nitrogen by experienced undersea
divers depended on body fatness. Because inhaled nitrogen is nearly five times more soluble in fat
than water or blood, this finding provided a physiological explanation for the debilitating condition
of nitrogen narcosis afflicting some Navy divers. This important finding provided the first indica-
tion of an association between body composition (body fatness) and physiological function (excess
nitrogen retention), albeit adverse.

1.3.1 Body Fat

Body composition generally affects cardiorespiratory performance and function. The classic work
of E.R. Buskirk demonstrated that maximal oxygen consumption was highly dependent on the fat-
free mass of a diverse group of men whose usual physical activity ranged from sedentary to trained
endurance athletes (Buskirk 1954; Buskirk and Taylor 1957). Among sedentary male students, body
fatness did not affect maximal oxygen consumption values when expressed per unit fat-free mass. In
contrast, maximal oxygen uptake was significantly reduced when expressed per unit body weight.
Thus, excess weight (e.g., fat) not related to energy production (e.g., fat-free mass) increased the
energy cost of performing work during exercise on a treadmill.
Body fatness, however, impairs weight-dependent physical performance. The results of fitness
tests of speed and endurance (50-yd sprint and 12-min run, respectively) and power (vertical jump)
of women and men were adversely affected by body fatness (Cureton et al. 1979). The men had less
fat and performed better than the women on each of the physical fitness tests. The rate of decline
in performance as related to body fatness, notably, was similar for the women and the men and
indicated that the negative effect of body fatness on weight-dependent activities was independent
of gender. Excess body fat is detrimental to performance of weight-supported physical activities
regardless of whether the activity is vertical (e.g., jumping) or horizontal (e.g., running) because
body fat does not contribute to the production of force that is needed to move the body (Miller and
Blyth 1955; Boileau and Lohman 1977; Harman and Frykman 1992; Malina 1992).
Increased levels of body fat, however, may be advantageous in certain activities. As noted by
Sinning (1996), contact sports that require the absorption of force or momentum (e.g., American
football or Sumo wrestling) may benefit from strategically distributed AT. Similarly, activities that
require prolonged exposure in cold water gain an advantage from the buoyancy and insulative char-
acteristics of body fat.

1.3.2 Fat-Free Mass

Fat-free mass is beneficial in physical activities that require development and application of force
(Boileau and Lohman 1977; Harman and Frykman 1992). Generalizations regarding fat-free mass
and performance should be tempered with awareness of the needs for muscle mass in sport-spe-
cific functions. Activities that require strength and power (e.g., throwing and pushing) and include
body movement should optimize muscle mass and, hence, fat-free mass (Slater and Phillips 2011;
Stellingwerff et al. 2011). Sports with weight classes, however, should maximize power relative to
body weight or size for performance (e.g., combat sports, rowing) with caution to avoid excessive
minimization of body weight and fatness (e.g., diving, gymnastics, and endurance sports) (Sundgot-
Borgen and Garthe 2011; Sundgot-Borgen et al. 2013).
6 Body Composition

Relationships between body composition and work-specific performance emphasize the benefit
of fat-free mass. Extensive studies of military personnel reveal that fat-free mass is positively cor-
related with military-specific assessments of aerobic capacity and muscular strength (Harman and
Frykman 1992). Body fatness, interestingly, does not predict performance of military tasks unless
extreme values are considered (Friedl 2012). Excess adiposity, however, can limit performance in
the field that requires work in restricted areas or prolonged aerobic activity, largely due to the nega-
tive effects of excess weight (fat) on the energy requirement for movement, and possible limitations
associated with impaired thermoregulatory function (Friedl 2004).

1.4 BODY COMPOSITION, PERFORMANCE, AND HEALTH

The relationships among body size and structure, performance and health are interrelated (Figure 1.1).
Some sports favor individuals with body sizes, shapes, and composition that, when taken to extremes,
can be conducive to health disturbances. Conversely, some individuals with excess adiposity engage
in physical activity to change AT distribution and improve health that can be viewed as a form of per-
formance. Other individuals may be required to maintain standards of body composition and physical
performance for retention in employment.

1.4.1 Public Safety Employment

Public service occupations include law enforcement, firefighting, and emergency services. Women
and men who serve in public safety occupations are required to undertake physically demand-
ing tasks. Thus, physical fitness, which includes work capacity (strength and endurance) and body
composition, is a factor in successful completion of employment-related tasks (Moulson-Litchfield
and Freedson 1986). Decrements in physical fitness predict an increased risk of injury and chronic
disease (Pope et al. 1999; Jahnke et al. 2013).
Consistent with the findings from studies involving athletes, body composition affects the out-
comes of physical performance assessments of public safety personnel. Dawes et al. (2016) found
that skinfold-based estimates of body fat were negatively correlated with performance of weight-sup-
ported activities whereas lean body mass was positively related to strength tests of law enforcement
officers. Similarly, performance of simulated work-specific tasks (e.g., carrying weight comparable
to rescue or protective equipment) was adversely affected by increased body weight (BMI) and body
fat (Michaelides et al. 2011). Increased body size can limit body movement and impair the execu-
tion of emergency procedures that can place an emergency responder at an increased risk of injury.

1.4.2 Extreme Leanness
Body weight and composition can be important performance-moderating variables in certain sports
(Ackland et al. 2012). Participants in weight-sensitive sports may be at risk for extreme food restric-
tion and clinical disordered eating behaviors (ED) to achieve specific low body weights deemed
appropriate for competition (Manore et al. 2007; Sundgot-Borgen et al. 2013). Consequences of
restricted food intake that result in low energy availability (LEA) may include nutritional deficien-
cies (macro- and micronutrient), increased risk of infections, endocrine disturbances leading to
amenorrhea in women (Sundgot-Borgen and Garthe 2011; Sundgot-Borgen et al. 2013), impaired
bone health (quantity and quality of bone) as well as adverse disruptions of other physiological sys-
tems in women and men (Joy et al. 2016; Tenforde et al. 2016).
The performance consequences of ED and LEA depend on the age of initiation of these factors,
rate of weight reduction, duration of the LEA, use of additive means for weight loss, and the pathol-
ogy of ED. Functional impairments include a decrease in aerobic capacity and muscular strength
due to altered cardiovascular function and concurrent loss of muscle mass, dehydration, and elec-
trolyte imbalance. Descriptions of performance decrements attributed to body composition change
Body Composition in Perspective 7

may be confounded by dubious estimates of body composition. This limitation contributes to con-
cerns related to proposals for minimally acceptable levels of body fatness that impact measures of
performance and health (Sundgot-Borgen and Garthe 2011; Ackland et al. 2012; Sundgot-Borgen
et al. 2013).

1.4.3 Hydration
Hydration is a complex physiological condition that includes total body water, its distribution, and
the concentration of the major electrolytes (osmolality). It may be classified as under- or hypohydra-
tion, normal or euhydration, and over- or hyperhydration. The simplicity of these designations belies
the controversy in establishing the criterion biological indicators and threshold values to classify
the hydration status of an individual (Maughan 2012). There is no universally accepted standard for
classification of hypohydration or dehydration (Cheuvront et al. 2010). Reduction in body weight
is a noninvasive, commonly used indicator whereas plasma or serum osmolality, saliva osmolality,
and various urine parameters are more invasive and should be obtained under controlled condi-
tions (Cheuvront and Kenefick 2014). Weight loss exceeding 2.5% is one indicator of hypohydration
because it reflects a 3% deficit in body water that equates to significant reductions in plasma volume
and increases in plasma osmolality levels (Sawka et al. 2015). Such water deficits and alterations in
electrolyte concentrations are associated with impaired aerobic, strength, and power performances
that are exacerbated in a hot environment (Cheuvront and Kenefick 2014).
Emerging, but not definitive, evidence suggests that hypohydration, may also adversely affect
cognition and other mental functions. Adan (2012) noted that hypohydration, characterized by body
weight loss exceeding 2%, impairs performance of tasks that require attention, psychomotor skills,
and immediate memory skills whereas the performance of long-term, working memory tasks and
executive functions are better preserved, especially if moderate exercise is the cause of dehydra-
tion. Benton and Young (2015) concluded that dehydration, indicated by a 2% or greater decrease
in body mass, impairs mood, decreases perception of alertness and promotes self-reported fatigue.
Muñoz et al. (2015) observed that total daily water intake was a significant predictor of mood in a
large sample of healthy young women. The magnitude of the variance in predicting altered mood
states associated with total daily water intake, however, was modest (<11%) after controlling for
known factors that affect mood (e.g., exercise, caffeine, and macronutrient intakes). Benton et al.
(2016) reported that mild dehydration, described as a 1% decrease in body weight, has functional
consequences including significant reductions in attention and memory and increases in anxiety
among adults.

1.4.4 Injury Risk
Individuals who engage in physical training are likely to incur musculoskeletal injury. Two factors
contribute to an increased relative risk of injury. Extremes of body weight, assessed with BMI, and
body fatness predict increased risk of injury among military recruits and law enforcement officers
(Jones et al. 1992; Jahnke et al. 2013). Aerobic fitness or endurance also predicts risk of injury with
less fit women and men at greater risk of injury (Jones et al. 1992; Pope et al. 1999).

1.4.5 Health Risk

Epidemiological surveys reveal, and clinical research confirms, that body composition is related
to risk of cardiometabolic (obesity, insulin insensitivity, and type 2 diabetes) and cardiovascular
diseases. Excess accumulation of fat or AT in adults, evidenced with BMI values exceeding 30 kg/
m2, is a risk factor positively associated with morbidity and mortality for cardiovascular and other
chronic diseases independent of gender and age (Poirier et al. 2006). However, increased BMI only
partially explains some of this increased risk. Accretion of AT in the abdomen, specifically in the
8 Body Composition

visceral (VAT) as compared to subcutaneous region (SAT), is a unique phenotype associated with
the greatest health risk (Després 2012; Bastien et al. 2014). Whereas magnetic resonance imaging is
the reference method to determine estimated VAT and SAT in clinical research, abdominal circum-
ference is a valid surrogate for practical assessment of VAT (Kuk et al. 2005). Caloric restriction
and exercise, independently and in combination, reduce the volume of VAT and SAT in obese adults
(Ross et al. 2000).
Because the origin of cardiovascular disease can begin early in life, there is a growing interest
in determining the effects of increased physical activity on amelioration of obesity and risk-related
AT distribution of children. Whereas energy restriction can be used to attenuate obesity in adults,
it poses a potential problem in children because excessive dieting may adversely affect growth and
development. Thus, exercise is an attractive modality because it also is critical for growth and devel-
opment of children (Malina et al. 2004).
Aerobic exercise decreases total body fat and facilitates a favorable distribution of abdominal
AT in children (Atlantis et al. 2006; Kelley and Kelley 2013). Interestingly, aerobic and resistance
exercise independently enable loss of body fat and abdominal AT in obese adolescents (Monteiro
et al. 2015). Resistance exercise may be additionally important because it specifically stimulates
musculoskeletal development in adolescents. Noteworthy is the direct benefit of resistance, as com-
pared to aerobic, exercise on bone in youth with evidence that gains in bone quality and quantity
may persist during adulthood (Tan et al. 2014).

1.5 EMPIRICAL MODEL OF BODY COMPOSITION, FUNCTION, AND HEALTH

Burgeoning information links body composition, a component of physique, as a shared factor
influencing performance, health, and injury risk (Figure 1.2). Increased body size and shape, as
evidenced with an increased BMI and enlarged waist circumference, are risk factors for cardiometa-
bolic disease, and can adversely affect weight-supported performance. Similarly, increased body
fat is adversely related to endurance performance whereas increased fat-free mass and muscle mass
are associated with increased power and strength particularly in weight classification activities.
Emerging evidence identifies differences in muscle quality and function (e.g., distribution of mass
and strength) in the upper versus the lower body, ipsilateral versus contralateral regions and oppos-
ing areas (e.g., anterior and posterior) of major muscle groups (e.g., shoulder, trunk, upper and lower

BodyBmass
Injury risk Health
BMI
>30 kg · m–2
Size and
shape
Imbalanced muscle
mass (strength) WC
>89 cm (F)
>101 cm (M)
Fat-free mass
Water Fat mass or adipose
ICW tissue
ECW VAT
Muscle SAT
Bone

Performance

FIGURE 1.2 Integrated model of body composition variables affecting health, injury risk, and performance.
Solid lines designate beneficial effects and interrupted lines indicate adverse effects. BMI = body mass index;
WC = waist circumference; F = female; M = male; VAT = visceral adipose tissue; SAT = subcutaneous adipose
tissue; ICW = intracellular water; ECW = extracellular water.
Body Composition in Perspective 9

leg) as indicators of an elevated risk of injury and probable constraints to optimal performance and
health.
Environmental and behavioral factors can impact body size and composition, health, injury haz-
ard, and performance. Unwarranted physical activity and dietary restriction to achieve excessive
and unnecessary weight loss among female and male athletes can impair health, bone quality, and
performance. Similarly, failure to adequately maintain fluid intake and balance during periods of
physical training or occupational demands can markedly decrease physical and probably cognitive
functions. Beneficial effects of physical activity to reduce total fat and localized AT of adults and
youth result in improvements in cardiorespiratory function, muscle strength and endurance, and, in
certain situations, bone mass and quality.
Body composition, as a component of physique, is one factor in the physiological profile of an
individual. Reliance on body composition alone to predict performance is inappropriate because of
the fundamental contributions of mediating influences including metabolic capacity, skill, psycho-
logical attributes, and genetics, which influence some of these factors. Proper understanding of the
possible limitations of assessments of fat-free mass, muscle mass, and percent body fat is needed
for interpretation of test results. Specifically, interindividual variability and errors of the method
(technical and biological) impact the validity of any body composition measurement. These factors
need to be considered in relation to proposed changes in compositional variables for anticipated
improvements in performance and health. Thus, body composition assessments broadly describe
characteristics and highlight physical areas to emphasize in development of individualized training
and dietary intervention. Importantly, body composition per se does not predict performance for an
individual but only identifies traits related to the performance of others; it can be a useful guide to
monitor effectiveness of preparation to improve performance and health.

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 2 Assessment of Human
Body Composition
Methods and Limitations
Hannes Gatterer, Kai Schenk, and Martin Burtscher

CONTENTS
2.1 Introduction............................................................................................................................. 13
2.2 Validity and Applicability....................................................................................................... 14
2.3 Techniques for the Assessment of Body Composition............................................................ 15
2.3.1 Two-Component Methods........................................................................................... 15
2.3.1.1 Anthropometry............................................................................................. 15
2.3.1.2 Bioelectrical Impedance Analyses and Bioimpedance Spectroscopy.......... 17
2.3.1.3 Hydrodensitometry and Air Displacement Plethysmography...................... 19
2.3.1.4 Dilution with Isotopes...................................................................................20
2.3.2 Three-Component Method..........................................................................................20
2.3.2.1 Dual X-Ray Absorptiometry.........................................................................20
2.3.3 Four-Component Methods........................................................................................... 21
2.3.3.1 Computed Tomography and Magnetic Resonance Imaging......................... 21
2.3.4 Multicomponent Models.............................................................................................. 23
2.4 Conclusion............................................................................................................................... 23
References......................................................................................................................................... 23

2.1 INTRODUCTION
The assessment of the human body composition is a useful practice in various fields, including
medicine, nutrition, and sports sciences (Ackland et al. 2012; Fosbøl and Zerahn 2015). Individuals
participating in regular and/or intense physical activity (recreation, competition, and occupation)
have an interest in body composition as it relates to key components, such as lean or fat-free mass,
muscle mass, and fatness, that can be associated with function, performance, and health (Ackland
et al. 2012). Measurement of human body composition requires an understanding of the basic prin-
ciples and limitations of the wide variety of methods and techniques available. This information
enables a realistic assessment of body components that allows for characterization and identification
of changes in response to training and other interventions (van Marken Lichtenbelt et al. 2004).
Assessment of human body composition utilizes different models that rely on specific chemical
components and distinctive physical characteristics of the healthy body (Lukaski 1987). The most
commonly applied model in sports is the two-component model that consists of fat mass (FM) and
fat-free mass (FFM) (van Marken Lichtenbelt et al. 2004; Ackland et al. 2012; Fosbøl and Zerahn
2015). It relies on certain assumptions, including a constant hydration of the fat-free body and a
constant bone-to-muscle ratio that have been questioned (Womersley et al. 1976). Awareness of
interindividual differences in bone mineral density and hydration associated with growth, physi-
cal training, and aging led to the development of the three-component (fat, lean content, and bone,
or fat, water, and non-fat solids) and four-component (water, protein, lipids, others) models that

13
14 Body Composition

FM FM FM

Bone mineral
Protein

FFM Lean soft Water

tissue

Other

Two-component Three-component Four-component

FIGURE 2.1 Main body component models. FM, fat mass; FFM, fat-free mass.

differentiated body fractions to account for interindividual differences in the components of the
fat-free body (Figure 2.1) (Ellis 2000; Ackland et al. 2012; Fosbøl and Zerahn 2015; Heymsfield
et al. 2015).
Numerous methods are available for the assessment of human body composition. They include
simple techniques applicable for use in the field or non-laboratory settings such as weight, standing
height, anthropometry (skinfold thicknesses and body circumferences), and bioelectrical impedance
analysis (BIA). In contrast, more complex methods are limited to the controlled environment of a
laboratory and require sophisticated equipment and trained technical support personnel and range
from isotope dilution, densitometry, whole-body plethysmography, and radiological methods with
increased risk due to exposure to ionizing radiation (Heymsfield et al. 1997). Despite the plethora of
available methods and techniques, there is consensus that an absolute standard or reference method
for human body composition is lacking. Whereas there is growing support for some radiological
methods for use in validation studies of new and indirect methods because of their high preci-
sion and acceptable accuracy, their general availability is very restricted (Earthman 2015). Thus,
all individual methods follow an indirect approach and are not entirely free from error (Withers
et al. 1999; Earthman 2015). Comparisons among newly proposed methods rely on validation with
multicomponent model assessments (Nana et al. 2015). Whereas the validity of body composition
assessment can be ascertained with group comparisons to an accepted reference method, the practi-
cal question remains the precision of an estimate for an individual.
The main aim of this chapter is to describe the physical bases of the methods for the assessment
of body composition and outline the characteristics of each technique focusing on validity, applica-
bility, and precision of estimation of a body component for an individual.

2.2 VALIDITY AND APPLICABILITY

Validity and applicability are critical issues when describing measurement methods. In most body
composition studies, validity encompasses the concepts of accuracy and precision besides others
(Earthman 2015). Precision refers to the degree of agreement among repeated measurements for
a specific method, that is, how variable are repeated measurements. The magnitude of precision
is generally reported as the coefficient of variation (CV), given as percent value and calculated as
standard deviation (SD) expressed as a percent of the mean of repeated measurements (CV = [SD/
mean] × 100%) (Earthman 2015). Another expression of precision is the intraclass (ICC) or simple
Assessment of Human Body Composition 15

correlation coefficient. The ICC measures the relative homogeneity within groups in ratio to the
total variation and is calculated as between subject variability/(between subject variability + error)
(Weir 2005; Currell and Jeukendrup 2008).
Accuracy differs from precision because it indicates the closeness of agreement between two
assessment methods, that is, how close a measured value is to the “true” value. Accuracy is deter-
mined with different statistical approaches. One method uses linear regression analysis between
paired measurements in a group of individuals. It reports the correlation coefficient and standard
error of the estimate (SEE) that indicates the variability of the data distributed around the line repre-
senting the data. Linear regression analysis is a basic approach that provides some insight to validity
when a significant correlation coefficient and a small SEE are found. It also provides the total error
(TE) calculated as the sum of squared differences between the practical estimate of reference and
candidate methods, which is a similar indicator as SEE. Researchers use inferential statistics to
secure a greater degree of examination of validity within a broad sample by using a paired t-test and
can ascertain validity within subgroups (e.g., female and male, lean and obese) of the larger sample
with analysis of variance (ANOVA) and appropriate post hoc test when a significant main effect
is found. The most rigorous test of validity is the Bland–Altman analysis that generally follows
an ANOVA. It is a graphical representation of the mean difference or bias between measured and
predicted values that are shown as a function of the average value ([measured + predicted]/s) and
includes the 95% confidence interval (CI) for the mean difference. Importantly, the Bland–Altman
analysis shows the trend for bias with increasing body composition values expressed as the cor-
relation coefficient and limits of agreement (LOA; e.g., 95% CI) that indicates the precision of an
estimate for an individual (Earthman 2015; Fosbøl and Zerahn 2015). It is important to note that
the true accuracy of any body composition method can be considered problematic, as no “gold stan-
dard” or “true” value is available. Thus, accuracy of an individual method can be established solely
by comparing the results to the best-available reference method (Earthman 2015).
Applicability is a fundamental issue to consider when performing body composition analysis.
Methods like anthropometry, skinfold thicknesses, and BIA are safe, simple, “portable,” noninva-
sive, easy-to-perform, and relatively inexpensive methods that are popular in sports, but might lack
accuracy under some circumstances (Prado and Heymsfield 2014). Conversely, complex methods
(for example, hydrodensitometry, air displacement plethysmography [ADP], dual x-ray absorptiom-
etry [DXA]) require very controlled and standardized conditions, specialized operator technical
skills, high level of patient cooperation, and possible exposure to ionizing radiation, and are costly
to operate but may be considered more accurate (Prado and Heymsfield 2014). Therefore, the choice
of the body composition technique depends on the intended purpose, required accuracy and preci-
sion, and availability of the technique.

2.3 TECHNIQUES FOR THE ASSESSMENT OF BODY COMPOSITION

2.3.1 Two-Component Methods
2.3.1.1 Anthropometry
The most commonly recorded anthropometric data are body mass, standing height, specific body
segment lengths, breadths and circumferences, skinfold thickness, and, currently, the measurement
of subcutaneous fat with ultrasound (Bellisari and Roche 2005; Ackland et al. 2012; Pescatello et al.
2014; Fosbøl and Zerahn 2015; Müller et al. 2016b). Owing to their association with body com-
ponents, all of these values, individually or in various combinations, can be used to estimate FM
and FFM in a two-component model. It should be emphasized that all equations are specific to the
population from whom the equation was derived and thus large estimation errors may occur with
differing populations (e.g., in athletes). Nonetheless, anthropometric data in general can be provided
by simple and feasible measurements outside laboratory conditions. As a consequence, anthro-
pometry may be used on large samples to obtain national estimates of body composition and/or
16 Body Composition

representative samples for investigating changes over time (Bellisari and Roche 2005). However,
performing anthropometric measurements have to be trained in order to achieve high precision and
reduce the intra- and interobserver variability (Fosbøl and Zerahn 2015).

2.3.1.1.1 Body Mass Index

Body mass index (BMI) is calculated from body mass and height (kg/m2). BMI values are moder-
ately correlated to body-fat percentage (%BF, r = 0.6–0.8) and can be used to estimate %BF with an
intraindividual precision (SEE) of approximately ±5% (Gallagher et al. 2000; Bellisari and Roche
2005; Pescatello et al. 2014). To be meaningful for children and adolescents, the BMI must be com-
pared to a reference standard that accounts for age and sex (Must and Anderson 2006).
The use of BMI to estimate changes in %BF after strength training in bodybuilders was associ-
ated with a mean estimated bias of +2.6%BF with LOA of approximately 3.7% compared to a four-
component model, which showed changes of −1.6%BF and a range of −5.0% to 1.2% (van Marken
Lichtenbelt et al. 2004). For FFM changes, mean bias was approximately −2.3 kg with LOA of
approximately 3.8 kg compared to the four-component model with reported changes of +3.7 kg and
a range of −0.6 to 7.7 kg (van Marken Lichtenbelt et al. 2004). Additionally, in judo athletes per-
forming a weight loss program, an SEE for the determination of %BF changes of 1.9% was reported
(compared to a four-component model) (Silva et al. 2009).

2.3.1.1.2 Circumferences
Measurements of body regions provide a general picture of body composition. Abdominal and limb
circumferences show moderate correlation with body density (r = −0.7 and r = −0.4, respectively)
and the accuracy of %BF estimation may be within 2.5%–4.4% if the subjects possess similar
characteristics as the reference population (Tran and Weltman 1988, 1989; Bellisari and Roche
2005; Pescatello et al. 2014). Moreover, when compared to a four-component model, LOA ranging
between +11.4% and −13.2% for %BF estimation were reported for a general healthy population
(Clasey et al. 1999).

2.3.1.1.3 Skinfold Thickness

Assessment of subcutaneous adipose tissue measured by using a calibrated caliper is an accepted
and frequently applied method to predict body density and body FM. There are described more
than 19 sites for measuring skinfold thickness and well over 100 FM prediction equations exist
(Ackland et al. 2012; Fosbøl and Zerahn 2015). The method is based on two basic assumptions:
the amount of subcutaneous fat is proportional to the total amount of FM and the sites selected for
measurement represent the average thickness of the subcutaneous tissue (Lukaski 1987; Pescatello
et al. 2014). Both assumptions are questionable and may give rise to measurement errors. For exam-
ple, sex, age, and race differences may exist in the exact proportion of subcutaneous to total FM
(Pescatello et al. 2014). Additionally, even though the measurement method appears simple, sub-
stantial intra- and interobserver variability may exist (Fosbøl and Zerahn 2015). The reasons for
this variability include variations in the selection/location of the measurement site and/or in the
technique of grasping the skinfold, edema, or difficulties when measuring extremely lean or obese
subjects (Pescatello et al. 2014; Fosbøl and Zerahn 2015). Skinfold thickness shows correlations in
the range of r = 0.7–0.9 with %BF and a precision of within 5% can be attained by properly trained
individuals (Lukaski 1987; Bellisari and Roche 2005). The accuracy of %BF prediction is approxi-
mately ±3.5% provided that appropriate techniques and equations are applied (Evans et al. 2005;
Pescatello et al. 2014), but also SEE of ∼5% and LOA ranging from 13% to 22%FM are reported
when %BF was compared with four-component models (Durnin and Womersley 1974; Clasey et al.
1999; Ackland et al. 2012; Fosbøl and Zerahn 2015). In male and female athletes, SEE for %FM
estimation in the range of 2.38%–3.16% and 3.02%–3.37%, respectively, were reported compared
to underwater weighing (UWW) (Sinning and Wilson 1984; Sinning et al. 1985). When %BF and
FFM changes after strength training were compared to a four-component model, a mean estimation
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