Feasibility and Accuracy of Body-Fat Assessment Using Standardized Skinfold-Thickness Assessment Versus Dual-Energy X-Ray Absorptiometry in Paralympic Athletes.

DXA was feasible in all Paralympic athletes, while skinfold measurements faced completion challenges depending on the number of sites required.

• Study included 49 male and female Paralympic athletes across Para cycling, Para skiing, Para swimming, wheelchair basketball, and wheelchair tennis.
• DXA was feasible in 100% (all 49) of athletes.
• The sum of 4 skinfolds was obtainable in 88% of athletes.
• The sums of 7 and 8 skinfolds were each obtainable in only 73% of athletes.
• Challenges in skinfold measurement were attributed to disability-related landmarking issues.

Median DXA-derived body-fat percentage differed between male and female Paralympic athletes.

• Median DXA-derived body-fat percentage in males was 16.3% (interquartile range 13.4%–20.5%).
• Median DXA-derived body-fat percentage in females was 27.8% (interquartile range 21.1%–33.4%).
• These values were obtained via whole-body DXA scan.
• Cross-sectional study design was used.

Strong correlations were found between DXA-derived body-fat percentage and skinfold sum scores across all three skinfold protocols.

• Correlation between DXA-derived body-fat percentage and sum of 4 skinfolds was r = .85.
• Correlation between DXA-derived body-fat percentage and sum of 7 skinfolds was r = .83.
• Correlation between DXA-derived body-fat percentage and sum of 8 skinfolds was r = .83.
• Correlation and Bland-Altman analyses were used to compare methods.

Skinfold-based prediction equations for estimating body-fat percentage demonstrated substantial negative bias and large individual error compared with DXA.

• Negative bias ranged from -2.0% to -7.9% across skinfold-based prediction equations.
• Bland-Altman analysis was used to quantify bias and individual error.
• Despite strong correlations, the prediction equations systematically underestimated DXA-derived body-fat percentage.
• Large individual error was noted in addition to the systematic bias.

The authors recommend using a cumulative 'sum of feasible sites' approach rather than enforcing a universal skinfold metric across all Paralympic athletes.

• ISAK standards were used for skinfold-thickness measurements.
• Not all standard ISAK skinfold sites could be reliably obtained in all Paralympic athletes due to disability-related landmarking issues.
• The recommendation is to measure all skinfolds that can be reliably obtained according to ISAK standards.
• These should be interpreted as a cumulative 'sum of feasible sites' rather than as a fixed universal metric.