Development and validation of BIA prediction equations of upper and lower limb lean soft tissue in athletes
Abstract
Background/objective Knowing the distribution of lean soft tissue (LST) among the body segments is of relevance for optimizing athletic performance, monitoring response to training, and for evaluating injury risk. Bioelectrical impedance (BIA) is a portable, low cost, and easy technique to assess body composition. However, most equations used by BIA to predict LST are not specific for the athlete population. The aim of this investigation was to develop and validate equations to estimate dual-energy X-ray absorptiometry (DXA) appendicular LST of the arms and legs based on whole-body BIA in athletes.Methods Arms and legs LST were assessed by DXA and whole-body reactance (Xc) and resistance (R) were measured by BIA in athletes from various sports. Using measures of height, the resistance index (RI) (RI = height 2/R) was calculated. Prediction equations were established using a cross-validation method where 177 athletes (2/3 of sample) were used for equation development and the remaining 88 athletes (1/3 of sample) were used for equation validation.Results The developed prediction equations were as follows: arm LST = 0.940 × sex (0 = male; 1 = female) + 0.042 × total body weight (kg) + 0.080 × RI + 0.024 × Xc - 3.927; leg LST = 1.983 × sex (0 = male; 1 = female) + 0.154 × total body weight (kg) + 0.127 × RI - 1.147. Both equations validated well for the arms (mean difference = 0.11 kg, R 2 = 0.89, pure error (PE) = 0.61) and for the legs (mean difference = 0.05 kg, R 2 = 0.81, PE = 1.93 kg). There were no differences (p > 0.05) in the mean observed and predicted LST for the arms and legs.Conclusion The developed BIA-based prediction equations provide a valid estimation of upper and lower body LST in athletes.
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To date, only BIA-based predictive equations that include athletes of different sports are available in the literature.
“To date, only BIA-based predictive equations developed that include athletes of different sports are available in literature [32, 33]”
The generalized equations [32,33] explained 88-91% of the variance in the reference data.
“Similarly, the generalized equations [32, 33] explained from 88 to 91% of the variance observed in the reference data.”
In the validation group, routinely used generic athletic BIA equations underestimated FFM and ALST (P < 0.01).
“Train-test validation, performed on the validation group, revealed that generalized formulas for athletes underestimated all the predicted FFM components (p < 0.01)”
The athletes included in the development of previous predictive models were actively involved in many different sport disciplines.
“The athletes included in the development of the previous predictive models were actively involved in different sport disciplines such as basketball, handball, swimming, triathlon, judo, pentathlon, athletics, tennis, rowing, sailing, karate/taekwondo, boxing, hokey, climbing, rugby, soccer, fencing, motorsports, power lifting, padel, futsal, trail running, korfball, surfing, and gymnastics.”
Inclusion of athletes from different sports in previous development studies can result in a loss of accuracy when athletes of specific sports are evaluated.
“Similarly, the inclusion of athletes from different sports in the previous development studies [32, 33], even though they may have satisfied an initial request for predictive equations to be applied in the context of sport [20], can result in a loss of accuracy when athletes of specific sports are evaluated.”
These groups of athletes presented average values of 47.7 kg for FFM and 29.4 kg for ALST.
“These groups of athletes presented average values of 47.7 kg and 29.4 kg for FFM [33] and ALST [32], respectively.”
A trend was verified between the mean and the difference of methods with large limits of agreement for all selected athletic equations [32,33].
“Concerning agreement analysis, a trend was verified between the mean and the difference of methods with large limits of agreement for all the selected athletic equations [32, 33].”
Of the five LSM equations for athletes, three are suitable for both sexes.
“Moreover, we retrieved one equation for estimating TBW [39], one for estimating ECW [39] and five for estimating LSM [31, 87], where three of them are suitable for both sexes [39, 87], and two in male only [31].”
From High-standard predictive equations for estimating body composition using bioelectrical impedance analysis: a systematic review (2024) · cites this paper as [87]
Five equations for athletes are for estimating LSM.
“Moreover, we retrieved one equation for estimating TBW [39], one for estimating ECW [39] and five for estimating LSM [31, 87], where three of them are suitable for both sexes [39, 87], and two in male only [31].”
From High-standard predictive equations for estimating body composition using bioelectrical impedance analysis: a systematic review (2024) · cites this paper as [87]
Cites
STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT
Martin Bland, J., & Altman, D. (1986) · The Lancet · doi:10.1016/s0140-6736(86)90837-8 · Cited by 47,965 · see citing works
Beckett, A. H., Rowland, M., & TURNER, P. (1965) · The Lancet · doi:10.1016/s0140-6736(65)91037-8 · Cited by 16,917 · see citing works
A concordance correlation coefficient to evaluate reproducibility.
Lin, L. I.-K. (1989) · Biometrics · doi:10.2307/2532051 · Cited by 8,785 · see citing works
Statistical methods for assessing agreement between two methods of clinical measurement
Bland, J. M., & Altman, D. G. (2010) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2009.10.001 · Cited by 5,220 · see citing works
Bioelectrical impedance analysis?part I: review of principles and methods
KYLE, U. (2004) · Clinical Nutrition · doi:10.1016/j.clnu.2004.06.004 · Cited by 3,200 · see citing works
Anthropometric Standardization Reference Manual
Lohman, T. J., Roache, A. F., & Martorell, R. (1992) · Medicine & Science in Sports & Exercise · doi:10.1249/00005768-199208000-00020 · Cited by 2,764 · cited 1× · see citing works
“Participants' weight and height were measured using an electronic scale with stadiometer (Seca, Hamburg, Germany), according to standardized procedures [13].”
MethodBioelectrical impedance analysis—part II: utilization in clinical practice
Kyle, U. G., Bosaeus, I., De Lorenzo, A. D., Deurenberg, P., Elia, M., Manuel Gómez, J., Lilienthal Heitmann, B., Kent-Smith, L., Melchior, J.-C., Pirlich, M., et al. (2004) · Clinical Nutrition · doi:10.1016/j.clnu.2004.09.012 · Cited by 2,350 · see citing works
Total-body skeletal muscle mass: Estimation by a new dual-energy X-ray absorptiometry method
Kim, J., Wang, Z., Heymsfield, S. B., Baumgartner, R. N., & Gallagher, D. (2002) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/76.2.378 · Cited by 737 · see citing works
Sergi, G., De Rui, M., Stubbs, B., Veronese, N., & Manzato, E. (2017) · Aging Clinical and Experimental Research · doi:10.1007/s40520-016-0622-6 · Cited by 291 · see citing works
Effects of different sports on bone density and muscle mass in highly trained athletes
Andréoli, A., Monteleone, M., Loan, M. V., Promenzio, L., Tarantino, U., & LORENZO, A. D. (2001) · Medicine & Science in Sports & Exercise · doi:10.1097/00005768-200104000-00001 · Cited by 284 · see citing works
Fuller, N. J., Laskey, M. A., & Elia, M. (1992) · Clinical Physiology · doi:10.1111/j.1475-097x.1992.tb00831.x · Cited by 232 · see citing works
The accuracy and precision of DXA for assessing body composition in team sport athletes
Bilsborough, J. C., Greenway, K., Opar, D. A., Livingstone, S. G., Cordy, J. T., & Coutts, A. J. (2014) · Journal of Sports Sciences · doi:10.1080/02640414.2014.926380 · Cited by 171 · see citing works
Bioelectrical impedance analysis in the assessment of sarcopenia
González, M. C., Barbosa-Silva, T. G., & Heymsfield, S. B. (2018) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/mco.0000000000000496 · Cited by 146 · see citing works
Stewart, A. D., & Hannan, W. J. (2000) · Journal of Sports Sciences · doi:10.1080/026404100365009 · Cited by 136 · see citing works
Esco, M. R., Snarr, R. L., Leatherwood, M. D., Chamberlain, N. A., Redding, M. L., Flatt, A. A., Moon, J. R., & Williford, H. N. (2015) · Journal of Strength and Conditioning Research · doi:10.1519/jsc.0000000000000732 · Cited by 122 · see citing works
Reliability and validity of body composition measures in female athletes
Fornetti, W. C., Pivarnik, J. M., Foley, J. M., & Fiechtner, J. J. (1999) · Journal of Applied Physiology · doi:10.1152/jappl.1999.87.3.1114 · Cited by 120 · see citing works
Association of Lean Tissue and Fat Mass with Bone Mineral Content in Children and Adolescents
Pietrobelli, A., Faith, M. S., Wang, J., Brambilla, P., Chiumello, G., & Heymsfield, S. B. (2002) · Obesity Research · doi:10.1038/oby.2002.8 · Cited by 113 · see citing works
Beaudart, C., Bruyère, O., Geerinck, A., Hajaoui, M., Scafoglieri, A., Perkisas, S., Bautmans, I., Gielen, E., Reginster, J.-Y., & Buckinx, F. (2020) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2019.09.012 · Cited by 113 · see citing works
Muscularity and the density of the fat-free mass in athletes
Prior, B. M., Modlesky, C. M., Evans, E. M., Sloniger, M. A., Saunders, M. J., Lewis, R. D., & Cureton, K. J. (2001) · Journal of Applied Physiology · doi:10.1152/jappl.2001.90.4.1523 · Cited by 93 · see citing works
Body composition in dancers: the bioelectrical impedance method
YANNAKOULIA, M., KERAMOPOULOS, A., TSAKALAKOS, N., & MATALAS, A.-L. (2000) · Medicine & Science in Sports & Exercise · doi:10.1097/00005768-200001000-00034 · Cited by 67 · see citing works
Body Composition Variables by Sport and Sport-Position in Elite Collegiate Athletes
Fields, J. B., Merrigan, J. J., White, J. B., & Jones, M. T. (2018) · The Journal of Strength and Conditioning Research · doi:10.1519/jsc.0000000000002865 · Cited by 59 · see citing works
Silva, A. M., Santos, D. A., Matias, C. N., Rocha, P. M., Petróski, E. L., Minderico, C. S., & Sardinha, L. B. (2011) · European Journal of Applied Physiology · doi:10.1007/s00421-011-2221-8 · Cited by 46 · see citing works
Self-citationBody composition by x-ray absorptiometry and bioelectrical impedance in female runners
Pichard, C., Kyle, U. G., Gremion, G., Gerbase, M. W., & Slosman, D. O. (1997) · Medicine & Science in Sports & Exercise · doi:10.1097/00005768-199711000-00021 · Cited by 44 · see citing works
Raymond‐Pope, C. J., Dengel, D. R., & Bosch, T. A. (2017) · The Journal of Strength and Conditioning Research · doi:10.1519/jsc.0000000000002320 · Cited by 43 · see citing works
Matias, C. N., Júdice, P. B., Santos, D. A., Magalhães, J. P., Minderico, C. S., Fields, D. A., Sardinha, L. B., & Silva, A. M. (2016) · Journal of the American College of Nutrition · doi:10.1080/07315724.2015.1058198 · Cited by 34 · see citing works
Self-citationDe Rui, M., Veronese, N., Bolzetta, F., Berton, L., Carraro, S., Bano, G., Trevisan, C., Pizzato, S., Coin, A., Perissinotto, E., et al. (2017) · Clinical Nutrition · doi:10.1016/j.clnu.2016.04.011 · Cited by 26 · see citing works
Sun, S. S., & Chumlea, W. C. (2005) · doi:10.5040/9781492596950.ch-011 · Cited by 10 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Campa, F., Toselli, S., Mazzilli, M., Gobbo, L. A., & Coratella, G. (2021) · Nutrients · doi:10.3390/nu13051620 · Cited by 315 · see citing works
Campa, F., Gobbo, L. A., Stagi, S., Cyrino, L. T., Toselli, S., Marini, E., & Coratella, G. (2022) · European Journal of Applied Physiology · doi:10.1007/s00421-021-04879-y · Cited by 115 · see citing works
Rossi, A., Pappalardo, L., & Cintia, P. (2021) · Sports · doi:10.3390/sports10010005 · Cited by 85 · see citing works
Campa, F., Coratella, G., Cerullo, G., Noriega, Z., Francisco, R., Charrier, D., Irurtia, A., Lukaski, H., Silva, A. M., & Paoli, A. (2024) · Journal of Translational Medicine · doi:10.1186/s12967-024-05272-x · Cited by 80 · see citing works
“Four studies involved Portuguese male and female participants from different sport disciplines [39, 69, 84, 87], while two studies recruited male Brazilian army cadets [85] considered as very active individuals [103] and adolescents from various sport disciplines [104].”
BackgroundMethodInfluentialSelf-citationPhase angle, muscle tissue, and resistance training
Sardinha, L. B., & Rosa, G. B. (2023) · Reviews in Endocrine and Metabolic Disorders · doi:10.1007/s11154-023-09791-8 · Cited by 53 · see citing works
Self-citationBennett, J. P., Cataldi, D., Liu, Y. E., Kelly, N. N., Quon, B. K., González, M. C., Heymsfield, S. B., & Shepherd, J. (2024) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2024.07.009 · Cited by 36 · see citing works
Athlete or Non-athlete? This Is the Question in Body Composition
Campa, F., & Coratella, G. (2021) · Frontiers in Physiology · doi:10.3389/fphys.2021.814572 · Cited by 35 · see citing works
Bongiovanni, T., Trecroci, A., Rossi, A., Iaia, F. M., Pasta, G., & Campa, F. (2021) · European Journal of Investigation in Health Psychology and Education · doi:10.3390/ejihpe11030063 · Cited by 25 · see citing works
Bongiovanni, T., Rossi, A., Trecroci, A., Martera, G., Iaia, F. M., Alberti, G., Pasta, G., & Lacome, M. (2022) · Sports · doi:10.3390/sports10050066 · Cited by 22 · see citing works
Paoli, A., & Campa, F. (2024) · Current Obesity Reports · doi:10.1007/s13679-024-00573-0 · Cited by 24 · see citing works
Body Composition and Bioelectrical-Impedance-Analysis-Derived Raw Variables in Pole Dancers
Ballarin, G., Scalfi, L., Monfrecola, F., Alicante, P., Bianco, A., Marra, M., & Sacco, A. M. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182312638 · Cited by 19 · see citing works
Campa, F., Bongiovanni, T., Rossi, A., Cerullo, G., Casolo, A., Martera, G., Trecroci, A., Moro, T., & Paoli, A. (2023) · Journal of Translational Medicine · doi:10.1186/s12967-023-04795-z · Cited by 16 · see citing works
“Similarly, the inclusion of athletes from different sports in the previous development studies [32, 33], even though they may have satisfied an initial request for predictive equations to be applied in the context of sport [20], can result in a loss of accuracy when athletes of specific sports are…”
BackgroundMethodInfluentialBongiovanni, T., Rossi, A., Iaia, F. M., Alberti, G., Pasta, G., & Trecroci, A. (2021) · The Journal of Sports Medicine and Physical Fitness · doi:10.23736/s0022-4707.21.12911-1 · Cited by 14 · see citing works
Prediction of Somatotype from Bioimpedance Analysis in Elite Youth Soccer Players
Campa, F., Matias, C. N., Nikolaidis, P. Τ., Lukaski, H. C., Talluri, J., & Toselli, S. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17218176 · Cited by 14 · see citing works
Bongiovanni, T., Tinsley, G., Martera, G., Orlandi, C., Genovesi, F., Puleo, G., Rossi, A., & Trecroci, A. (2022) · European Journal of Investigation in Health, Psychology and Education · doi:10.3390/ejihpe12080064 · Cited by 11 · see citing works
Sardinha, L. B., Rosa, G. B., Hetherington-Rauth, M., Correia, I. R., Magalhães, J. P., Silva, A. M., & Lukaski, H. (2023) · European Journal of Clinical Nutrition · doi:10.1038/s41430-022-01224-0 · Cited by 10 · see citing works
Self-citationOrtega, D. R., Moya-Amaya, H., Berral-Aguilar, A. J., Baratto, P., Molina-López, A., & de la Rosa, F. J. B. (2024) · Nutrition Research · doi:10.1016/j.nutres.2024.01.002 · Cited by 11 · see citing works
Choi, H.-J., Ko, C.-Y., Chang, Y., Kim, G.-S., Choi, K., & Kim, C.-H. (2021) · PeerJ · doi:10.7717/peerj.10970 · Cited by 10 · see citing works
Lai, Y.-K., Ho, C.-Y., Lai, C.-L., Taun, C., & Hsieh, K.-C. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192315807 · Cited by 9 · see citing works
Lai, C.-L., Lu, H.-K., Huang, A.-C., Chu, L.-P., Chuang, H.-Y., & Hsieh, K.-C. (2022) · Frontiers in Nutrition · doi:10.3389/fnut.2022.952929 · Cited by 6 · see citing works
Campa, F., Mascherini, G., Polara, G., Chiodo, D., & Stefani, L. (2021) · Muscles Ligaments and Tendons Journal · doi:10.32098/mltj.03.2021.09 · Cited by 6 · see citing works
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Silva, T. R., Jesus, F., Poínhos, R., Sardinha, L. B., Teixeira, V. H., Heymsfield, S. B., & Silva, A. M. (2025) · European Journal of Clinical Nutrition · doi:10.1038/s41430-025-01594-1 · Cited by 4 · see citing works
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Choi, H., Ko, C., Chang, Y., Kim, G., & Kim, C. (2022) · Measurement · doi:10.1016/j.measurement.2022.111145 · Cited by 3 · see citing works
Bauermann, A., Silva, A. D. A. C. E., Figueiredo, F. A., & Koury, J. C. (2022) · Frontiers in Nutrition · doi:10.3389/fnut.2022.935128 · Cited by 3 · see citing works
Self-citationLai, Y.-K., Ho, C.-Y., Huang, A.-C., Lu, H.-K., & Hsieh, K.-C. (2024) · PLoS ONE · doi:10.1371/journal.pone.0300911 · Cited by 2 · see citing works
Abdelrahman, A. S., & Saad, M. K. (2025) · Journal of Medical Sciences and Interdisciplinary Research · doi:10.51847/jblojwtyn0 · Cited by 1 · see citing works
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Lai, Y.-K., Ho, C.-Y., Huang, A.-C., & Hsieh, K.-C. (2022) · Research Square · doi:10.21203/rs.3.rs-1849511/v1
de la Rosa, F. J. B., Ortega, D. R., Moya-Amaya, H., Molina-López, A., & Berral-Aguilar, A. J. (2025) · Retos · doi:10.47197/retos.v63.110170
Campa, F., Rossi, A., Martera, G., Trecroci, A., & Bongiovanni, T. (2025) · International Journal of Kinanthropometry · doi:10.34256/ijk2519
Campa, F., Coratella, G., Cerullo, G., Noriega, Z., Francisco, R., Charrier, D., Irurtia, A., Lukaski, H. C., Silva, A. M., & Paoli, A. (2024) · Figshare · doi:10.6084/m9.figshare.26727262
Self-citationCattem, M. V. D. O., Coelho, G. M. O., dos Santos, G. G., & Koury, J. C. (2026) · Nutrition · doi:10.1016/j.nut.2026.113435
- Authors
- Sardinha, L. B., Correia, I. R., Magalhães, J. P., Júdice, P. B., Silva, A. M., & Hetherington-Rauth, M.
- Affiliations
- University of Lisbon (PT)
- Corresponding author
- Sardinha, Luís B.
- Venue
- European Journal of Clinical Nutrition
- Published
- 2020-05-29
- Volume
- 74
- Issue
- 12
- Pages
- 1646-1652
- ISSN
- 0954-3007 (ISSN-L)
- 1476-5640
- OpenAlex
- W3029904966
- Cited by
- 38
- References
- 27
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 7 · 2023: 2 · 2022: 9 · 2021: 12 · 2020: 1
- FWCI
- 3.62
- Type
- journal article
- Language
- en
- Update notices
- correction (2024-08-23)
- Open access
- closed
- Licence
- Locations
- European Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
- Physical Sciences › Engineering › Electrical and Electronic Engineering › Electrical and Bioimpedance Tomography
- Keywords
- bioimpedance, lean tissue, appendicular lean mass, prediction equations, athletes, body composition, resistance index, upper limb, lower extremity
- MeSH terms
- Body Composition, Female, Humans, Leg, Male, Reproducibility of Results, Absorptiometry, Photon, Electric Impedance, Athletes
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