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Body composition in sport: interobserver reliability of a novel ultrasound measure of subcutaneous fat tissue
  1. Wolfram Müller1,
  2. Martin Horn1,
  3. Alfred Fürhapter-Rieger1,
  4. Philipp Kainz1,
  5. Julia M Kröpfl1,
  6. Timothy R Ackland2,
  7. Timothy G Lohman3,
  8. Ronald J Maughan4,
  9. Nanna L Meyer5,
  10. Jorunn Sundgot-Borgen6,
  11. Arthur D Stewart7,
  12. Helmut Ahammer1
  1. 1Medical University of Graz, Institute of Biophysics, Graz, Austria
  2. 2University of Western Australia, Perth, Australia
  3. 3University of Arizona, Tucson, USA
  4. 4Loughborough University, School of Sport and Exercise Sciences, Loughborough, UK
  5. 5University of Colorado and United States Olympic Committee, Colorado Springs, USA
  6. 6NIH, The Norwegian School of Sport Sciences, Oslo, Norway
  7. 7Robert Gordon University, Aberdeen, UK
  1. Correspondence to Professor Wolfram Müller, Medical University of Graz, Institute of Biophysics, Harrachgasse 21/4, Graz 8010, Austria; wolfram.mueller{at}


Background Very low body mass, extreme mass changes, and extremely low per cent body fat are becoming increasingly common in many sports, but sufficiently reliable and accurate field methods for body composition assessment in athletes are missing.

Methods Nineteen female athletes were investigated (mean (SD) age: 19.5 (±3.3) years; body mass: 59.6 (±7.6) kg; height: 1.674 (±0.056) m; BMI: 21.3 (±2.3) kg/m2). Three observers applied diagnostic B-mode-ultrasound (US) combined with the evaluation software for subcutaneous adipose tissue measurements at eight ISAK sites (International Society for the Advancement of Kinanthrometry). Regression and reliability analyses are presented.

Results US measurements and evaluation of subcutaneous adipose tissue (SAT) thicknesses (including fibrous structures: Dincluded; n=378) resulted in an SE of estimate SEE=0.60 mm, R2=0.98 (p<0.001), limit of agreement LOA=1.18, ICC=0.968 (0.957–0.977). Similar values were found for Dexcluded: SEE=0.68 mm, R2=0.97 (p<0.001). Dincluded at individual ISAK sites: at biceps, R2=0.87 and intraclass-correlation coefficient ICC=0.811 were lowest and SEE=0.79 mm was highest. Values at all other sites ranged from R2: 0.94–0.99, SEE: 0.42–0.65 mm, and ICC: 0.917–0.985. Interobserver coefficients ranged from 0.92 to 0.99, except for biceps (0.74, 0.83 and 0.87). Evaluations of 20 randomly selected US images by three observers (Dincluded) resulted in: SEE=0.15 mm, R2=0.998(p<0.001), ICC=0.997 (0.993, 0999).

Conclusions Subject to optimal choice of sites and certain standardisations, US can offer a highly reliable field method for measurement of uncompressed thickness of the SAT. High accuracy and high reliability of measurement, as obtained with this US approach, are essential for protection of the athlete’s health and also for optimising performance.

  • Body composition methodology
  • Weight loss
  • Assessing validity and reliability of test of physiological parameters
  • Elite performance
  • Ultrasound

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