Accuracy of DXA in estimating body composition changes in elite athletes using a four compartment model as the reference method

Santos et al. Nutrition & Metabolism 2010, 7:22 http://www.nutritionandmetabolism.com/content/7/1/22 RESEARCH Open Access Accuracy of DXA in estimating body composition changes in elite athletes using a four compartment model as the reference method Diana A Santos1, Analiza M Silva1*, Catarina N Matias1, David A Fields2, Steven B Heymsfield3, Luís B Sardinha1 Abstract Background: Dual-energy x-ray absorptiometry (DXA) provides an affordable and practical assessment of multiple whole body and regional body composition. However, little information is available on the assessment of changes in body composition in top-level athletes using DXA. The present study aimed to assess the accuracy of DXA in tracking body composition changes (relative fat mass [%FM], absolute fat mass [FM], and fat-free mass [FFM]) of elite male judo athletes from a period of weight stability to prior to a competition, compared to a four compartment model (4C model), as the criterion method. Methods: A total of 27 elite male judo athletes (age, 22.2 ± 2.8 yrs) athletes were evaluated. Measures of body volume by air displacement plethysmography, bone mineral content assessed by DXA, and total-body water assessed by deuterium dilution were used in a 4C model. Statistical analyses included examination of the coefficient of determinant (r2), standard error of estimation (SEE), slope, intercept, and agreement between models. Results: At a group level analysis, changes in %FM, FM, and FFM estimates by DXA were not significantly different from those by the 4C model. Though the regression between DXA and the 4C model did not differ from the line of identity DXA %FM, FM, and FFM changes only explained 29%, 36%, and 38% of the 4C reference values, respectively. Individual results showed that the 95% limits of agreement were -3.7 to 5.3 for %FM, -2.6 to 3.7 for FM, and -3.7 to 2.7 for FFM. The relation between the difference and the mean of the methods indicated a significant trend for %FM and FM changes with DXA overestimating at the lower ends and underestimating at the upper ends of FM changes. Conclusions: Our data indicate that both at group and individual levels DXA did not present an expected accuracy in tracking changes in adiposity in elite male judo athletes. Background In combat sports, athletes are subdivided into weight divisions. In order to qualify for their respective weight category, many athletes undergo a impressive weight changes preceding the competition [1]. With this drastic weight loss, lean body weight and percentage of fat mass (%FM) decrease [2,3]. Differences related to body mass, stature, and body composition may significantly influence fighting strategies (including technical and tactical skills) and consequently the physiologic profile of these athletes [4,5]. Thus, the ability of researchers and coaches to accurately * Correspondence: 1 Exercise and Health Laboratory, Faculty of Human Movement-Technical University of Lisbon, Portugal estimate minimal changes in fat mass (FM) and fatfree-mass (FFM) is crucial in sports with weight categories (i.e., martial arts, wrestling, weight lifting, and combat sports) [6]. The lack of an easy, valid, and quick body composition method to assess FM and FFM does not allow the estimation of a correct minimal weight for athletes in specific sports, such as wrestling and the martial arts (e. g. judo and karate). At the most basic molecular level the human body is divided into two compartments, FM and FFM. Although FM is a relatively homogenous component of the body, FFM is an heterogeneous mixture of water, mineral, protein, and other minor constituents [7]. Many body composition methods assume that some of these components have a stable proportion © 2010 Santos et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Santos et al. Nutrition & Metabolism 2010, 7:22 http://www.nutritionandmetabolism.com/content/7/1/22 within the FFM, and therefore a constant value of 1.1 g/cc is used for the fat-free mass density (FFMD) [7,8]. However, assuming that FFMD is stable increases the error in fat mass estimation as interindividual differences might not be considered, particularly in specific groups such as athletes [9-11]. This means the accuracy in the estimation of body composition increases when methods rely on fewer assumptions of the components of the FFM [12]. A four-compartment (4C) model using the updated predicted model for soft-tissue minerals developed by Wang and colleagues [13], is an example of a criterion method for assessing FM, as the major FFM molecular components are estimated [total body water (TBW), mineral and protein] and less assumptions are made for determining FM [14]. Despite their advantages, few studies have used 4C models to evaluate changes in body composition in athletes [15]. The elevated costs implicated in assessing all the body components required for the use of this criterion model, and the lack of accessibility may justify the limited number of follow-up body composition studies in the literature, especially in athletes. Thus, other less expensive alternative methods need to be validated for tracking body composition in athletes. Dual-energy X-ray absorptiometry (DXA) seems to present an excellent alternative to 4C models as the systems are affordable, practical, require no subject involvement, and impose minimal risk [16]. DXA permits quantification of multiple whole body and regional components, including bone mineral (Mo), fat, and lean soft tissue (LST) [17,18]. Although DXA has been validated in cross-sectional analysis in athletes [12], it has not been validated for estimating changes in %FM, FM and FFM in combat sports in general and Judo athletes in particular. Thus, the purpose of the present study was to examine the accuracy of DXA in tracking body composition of elite male Portuguese judo athletes from a period of stability to prior to a competition, comparing with a 4C criterion. Page 2 of 9 investigation before giving their written informed consent to participate; all procedures were approved by the Institutional Review Board of the Faculty of Human Movement, Technical University of Lisbon. Experimental Design A convenience sample of national top-level Judo athletes, engaged on this sport for more than 7 years, was used. Data collection was performed between September (1 month after the beginning of the in-season) to December. Body composition assessment was made during a period of weight stability and again prior to competition. A period of about one month was used between the period of stability and prior to competition. The period of weight stability is considered the baseline phase with judo athletes performing their regular regimens of (...truncated)