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Cited by 37Body Composition Measurement TechniquesReliability and Agreement in MeasurementSports Performance and Training

Relative body weight and standardised brightness-mode ultrasound measurement of subcutaneous fat in athletes: an international multicentre reliability study, under the auspices of the IOC Medical Commission

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Müller, Wolfram, Fürhapter-Rieger, Alfred, Ahammer, Helmut, Lohman, Timothy G., Meyer, Nanna L., Sardinha, Luis B., Stewart, Arthur D., Maughan, Ronald J. +10 more·2020·Sports Medicine
DOI 10.1007/s40279-019-01192-9PMC PMC7018793
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Abstract

Introduction: Fat is a metabolic fuel, but excess body fat is ballast mass, and therefore, many elite athletes reduce body fat to dangerously low levels. Uncompressed subcutaneous adipose tissue (SAT) thickness measured by brightness-mode ultrasound (US) provides an estimate of body fat content. Methods: The accuracy for determining tissue borders is about 0.1–0.2 mm and reliability (experienced measurers) was within ± 1.4 mm (95% limit of agreement, LOA). We present here inter- and intra-measurer scores of three experienced US measurers from each of the centres C1 and C2, and of three novice measurers from each of the centres C3–C5. Each of the five centres measured 16 competitive adult athletes of national or international level, except for one centre where the number was 12. The following sports were included: artistic gymnastics, judo, pentathlon, power lifting, rowing, kayak, soccer, tennis, rugby, basketball, field hockey, water polo, volleyball, American football, triathlon, swimming, cycling, long-distance running, mid-distance running, hurdles, cross-country skiing, snowboarding, and ice hockey. SAT contour was detected semi-automatically: typically, 100 thicknesses of SAT at a given site (i.e., in a given image), with and without fibrous structures, were measured. Results: At SAT thickness sums D I(of eight standardised sites) between 6.0 and 70.0 mm, the LOA of experienced measurers was 1.2 mm, and the intra-class correlation coefficient ICC was 0.998; novice measurers: 3.1 mm and 0.988. Intra-measurer differences were similar. The median D I value of all 39 female participants was 51 mm (11% fibrous structures) compared to 17 mm (18%) in the 37 male participants. Discussion: D I measurement accuracy and precision enables detection of fat mass changes of approximately 0.2 kg. Such reliability has not been reached with any other method. Although females’ median body mass index and mass index were lower than those of males, females’ median D I was three times higher, and their percentage of fibrous structures was lower. The standardised US method provides a highly accurate and reliable tool for measuring SAT and thus changes in body fat, but training of measurers is important.

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  • With operator training and sampling several sites, reliable assessments of subcutaneous adipose tissue thicknesses can be obtained via skinfolds and B-mode ultrasound, demonstrating good accuracy and sensitivity, especially for lean individuals.

    “Conversely, with operator training and sampling several sites, reliable assessments of subcutaneous adipose tissue thicknesses can be obtained via skinfolds (compressed and skin included) and brightness-mode (B-mode) ultrasound (uncompressed) method demonstrating good accuracy and sensitivity, especially for lean individuals.137”

    From 2023 international olympic committee's (IOC) consensus statement on relative energy deficiency in sport (REDs) (2023) · cites this paper as [137]

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Authors
Müller, W., Fürhapter-Rieger, A., Ahammer, H., Lohman, T. G., Meyer, N. L., Sardinha, L. B., Stewart, A. D., Maughan, R. J., Sundgot-Borgen, J., Müller, T., Harris, M., Kirihennedige, N., Magalhaes, J. P., Melo, X., Pirstinger, W., Reguant-Closa, A., Risoul-Salas, V., & Ackland, T. R.
Affiliations
  • Medical University of Graz (AT)
  • University of Arizona (US)
  • University of Colorado Colorado Springs (US)
  • Robert Gordon University (GB)
  • University of St Andrews (GB)
  • University of Lisbon (PT)
Corresponding author
Müller, Wolfram
ORCID
Venue
Sports Medicine
Publisher
Springer Science and Business Media LLC
Published
2019-09-30
Volume
50
Issue
3
Pages
597-614
ISSN
  • 0112-1642 (ISSN-L)
  • 1179-2035
DOI
10.1007/s40279-019-01192-9
PMC
PMC7018793
OpenAlex
W2978240592
Cited by
37
References
2
Citations by year
2026: 3 · 2025: 6 · 2024: 2 · 2023: 6 · 2022: 4 · 2021: 8 · 2020: 7 · 2019: 1
FWCI
3.43
Type
journal article
Language
en
Open access
Licence
Locations
  • Sports Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • UWA Profiles and Research Repository (UWA) (submittedVersion, cc-by)
  • NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
  • St Andrews Research Repository (St Andrews Research Repository) (submittedVersion, cc-by)
  • Open Access Institutional Repository at Robert Gordon University (Robert Gordon University) (submittedVersion, cc-by)
Funders
International Olympic Committee
Topics
  • Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
  • Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Reliability and Agreement in Measurement
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
Keywords
subcutaneous fat thickness, body fat measurement, athletes, measurement reliability, interobserver agreement, intraobserver agreement, fibrous structure, body composition, sex differences, body mass index, mass index, limits of agreement, intraclass correlation coefficient
MeSH terms
Adult, Body Composition, Body Weight, Female, Humans, Male, Reproducibility of Results, Subcutaneous Fat, Athletes

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