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Nutrition and Health (including climate and ecological aspects)

Validity of a 3-compartment body composition model using body volume derived from a novel 2-dimensional image analysis program



The purpose of this study was: (1) to compare body volume (BV) estimated from a 2-dimensional (2D) image analysis program (BVIMAGE), and a dual-energy x-ray absorptiometry (DXA) equation (BVDXA-Smith-Ryan) to an underwater weighing (UWW) criterion (BVUWW); (2) to compare relative adiposity (%Fat) derived from a 3-compartment (3C) model using BVIMAGE (%Fat3C-IMAGE), and a 4-compartment (4C) model using BVDXA-Smith-Ryan (%Fat4C-DXA-Smith-Ryan) to a 4C criterion model using BVUWW (%Fat4C-UWW).


Forty-eight participants were included (60% male, 22.9 ± 5.0 years, 24.2 ± 2.6 kg/m2). BVIMAGE was derived using a single digital image of each participant taken from the rear/posterior view. DXA-derived BV was calculated according to Smith-Ryan et al. Bioimpedance spectroscopy and DXA were used to measure total body water and bone mineral content, respectively, in the 3C and 4C models. A standardized mean effect size (ES) assessed the magnitude of differences between models with values of 0.2, 0.5, and 0.8 for small, moderate, and large differences, respectively. Data are presented as mean ± standard deviation.


Near-perfect correlation (r = 0.998, p < 0.001) and no mean differences (p = 0.267) were observed between BVIMAGE (69.6 ± 11.5 L) and BVUWW (69.5 ± 11.4 L). No mean differences were observed between %Fat4C-DXA-Smith-Ryan and the %Fat4C-UWW criterion (p = 0.988). Small mean differences were observed between %Fat3C-IMAGE and %Fat4C-UWW (ES = 0.2, p < 0.001). %Fat3C-IMAGE exhibited smaller SEE and TE, and tighter limits of agreement than %Fat4C-DXA-Smith-Ryan.


The 2D image analysis program provided an accurate and non-invasive estimate of BV, and subsequently %Fat within a 3C model in generally healthy, young adults.

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Fig. 1: Bland–Altman plot of the difference between relative adiposity (%Fat) measured by the 3-compartment image-based model (%Fat3C-IMAGE) and the 4-compartment underwater weighing criterion method (%Fat4C-UWW).
Fig. 2: Bland–Altman plot of the difference between relative adiposity (%Fat) measured using DXA-derived body volume (%Fat4C-Smith-Ryan) and the 4-compartment underwater weighing criterion method (%Fat4C-UWW).

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Authors and Affiliations



Conception and design: MRE and MVF. Collection and assembly of data: KS, BH, CJH, and MVF. Data analysis and interpretation: KS, MRE, and MVF. Manuscript writing/revisions: KS, BH, CJH, MRE, and MVF. Final approval of manuscript: KS, BH, CJH, MRE, and MVF.

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Correspondence to Michael V. Fedewa.

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Conflict of interest

MRE and MVF are co-inventors of the novel 2-dimensional image analysis system (US Utility Patent 16/841,944) which was developed as part of their ongoing research at the University of Alabama. Funding for the development of the 2-Dimensional Image Analysis Program, as well as for other laboratory equipment used in this study was provided by the University of Alabama. The University of Alabama is listed as the owner of the patent, where MRE and MVF were employed at the time of publication of this manuscript. MRE and MVF are co-owners of made Health and Fitness LLC, to which the patent is licensed for commercial use. The results of the current study do not constitute endorsement of the product by the authors. KS, BH, and CJH declare no potential conflicts of interest.

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Sullivan, K., Hornikel, B., Holmes, C.J. et al. Validity of a 3-compartment body composition model using body volume derived from a novel 2-dimensional image analysis program. Eur J Clin Nutr 76, 111–118 (2022).

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