The University of Akron

From the SelectedWorks of Dr. Laura Richardson, RCEP

September, 2015

Seven-site versus three-site method of body

composition using BodyMetrix ultrasound
compared to dual-energy X-ray absorptiometry
Laura Richardson

Available at: https://works.bepress.com/laura_richardson/2/

Clin Physiol Funct Imaging (2015) doi: 10.1111/cpf.12307

Seven-site versus three-site method of body composition

using BodyMetrix ultrasound compared to dual-energy
X-ray absorptiometry
Marissa N. Baranauskas1, Kelly E. Johnson1,2, Judith A. Juvancic-Heltzel1, Rachele M. Kappler1,
Laura Richardson1, Scott Jamieson1 and Ronald Otterstetter1
1
School of Sport Science and Wellness Education, The University of Akron, Akron, OH, and 2Department of Health, Exercise and Sports Sciences, University of
New Mexico, Albuquerque, NM, USA

Summary

Correspondence Obesity is a steadily growing epidemic affecting all segments of the population
Kelly Johnson, Department Health, Exercise and
including college-aged students. The weight gain that is evidenced amid the tran-
Sport Sciences, University of New Mexico, Johnson
Center, MSC04 2610, Albuquerque, NM
sitional stage of college years increases the risks associated with cardiovascular
87131-0001, USA and metabolic diseases. The BodyMetrixâ BX-2000 (ULTRA) using a seven-site
E-mail: kjohnson4@unm.edu method has been evaluated against dual-energy X-ray absorptiometry (DXA) for
Marissa Baranauskas, School of Sport Science and estimation of body composition, which has yielded conflicting results. To date,
Wellness Education, The University of Akron, no studies have compared the three-site method Jackson and Pollock three-site
Akron, OH 44325-5103, USA
method to DXA.
E-mail: mnb23@zips.uakron.edu
Purpose The purpose of the study was twofold (i) to compare agreement between
Accepted for publication Jackson–Pollock seven site (JP7), Jackson–Pollock three site (JP3) and Pollock
Received 31 December 2014;
accepted 1 September 2015
three site (P3) to predict body fat (%BF) using ULTRA and (ii) and to compare
the three ULTRA methodologies against DXA.
Key words Methods Seventy-six healthy college-aged subjects (ages = 22
08  2
50 years)
body fat; college-aged; Jackson and Pollock; participated in this study. DXA and ULTRA body composition assessments were
obesity; Pollock performed following manufacturer’s instructions to estimate %BF. Paired sample
t-tests were used to assess agreement between JP7, P3 and JP3. Additionally, a
two-tailed sample t-test was performed by sex. ULTRA and DXA results were also
performed for agreement and bivariate correlation.
Results No significant differences between JP7 and P3, P = 0
38, were observed. In
males, no significant differences were observed between JP7 and P3, P = 0
18.
Significant differences were observed in all other pairs, P≤0
001 and between
ULTRA and DXA.
Conclusions The Pollock 3-site method estimates body fat percentage with compara-
ble accuracy to JP7 using ULTRA.

contributing to an obesogenic society (Lhachimi et al., 2013).

Introduction
Obesity levels continue to increase across the lifespan with
adults over 33 per cent and children over 16 per cent (Ogden
et al., 2012, 2013). The United States public perceives child-
hood obesity trends as a serious threat to national health and
known support has been made for public health initiatives to
combat childhood obesity (Evans et al., 2006). Much less
focus resides on providing intervention during a critical time
period defined as the transition from adolescence to young
adulthood. It has been suggested that this time in a person’s
life comes with significant transitional stresses resulting in a
positive energy balance promoting weight gain and thus
Young adults gain significant amounts of weight with the
majority of that weight being fat mass during their transitional
years defined as 18-25 years of age, which is also referred to
as college aged (Hoffman et al., 2006; Gropper et al., 2012).
Increased adiposity is an independent risk factor for cardiovas-
cular and metabolic disease and a stronger predictor of early
mortality than the previously mentioned weight changes alone
(Glaner et al., 2010; Gomez-Ambrosi et al., 2011; Lhachimi
et al., 2013). It has been suggested that long-term behaviour
modifying interventions aimed at young adults, such as body
composition monitoring, is more effective than acute child-
hood intervention strategies in obesity prevention (Lhachimi

© 2015 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd 1
2 Body composition site method comparison of ultrasound to DXA, M. N. Baranauskas et al.
et al., 2013). College students generally have access to body
mass index (BMI) classification charts for the purpose of mon-
itoring body mass changes, which are readily visible in cam-
pus health centres and recreation facilities. BMI has shown to
misclassify individuals and is not an accurate predictor of adi-
pose tissue percentage (Glaner et al., 2010; Gomez-Ambrosi
et al., 2011; Loenneke et al., 2012, 2012). An alternative
method of estimating body composition among large
populations is skinfold thickness (SKF) and has been used
with comparable accuracy and more practicality compared to
dual-energy X-ray absorptiometry (DXA), a criterion for body
composition assessment (Ball et al., 2006). Ultrasound
(ULTRA) is a newly accepted device for body composition
assessment that combines similar accuracy of DXA with the
portability of SKF in varied populations (Pineau et al., 2007;
Duz et al., 2009). Portable ultrasound technology has been
evaluated for the purpose of body composition assessment
using various single sites of measurement and body density
formulas with conflicting results when compared to DXA.
Johnson et al. (2014) evaluated the use of the portable Body-
Metrix BX-2000 (IntelaMetrix, CA USA) ultrasound against
DXA in a population of college-aged students using a modi-
fied Jackson–Pollock seven-site equation. Results of the study
found the ULTRA to underestimate %BF, while also question-
ing its use as a valid measurement of estimating per cent body
fat (%BF) when compared with DXA (Johnson et al., 2014).
Supporting the Johnson et al. (2014) study, findings from
Loenneke et al. (2014a,b)demonstrated significant differences
between Jackson–Pollock three-site and one-site bicep meth-
ods when compared with DXA in estimating %BF in a popula-
tion of female college gymnasts. Additionally, Duz et al.
(2009) found ULTRA to significantly underestimate %BF
using Jackson–Pollock three-site method versus DXA among
college-aged students. The purpose of the present study was
twofold 1) to compare the seven-site (JP7) ultrasound % BF
estimation to two different three-site methods first a Jackson–
Pollock equation (JP3) and then a Pollock (P3) equation and
2) to validate all three methods (JP7, JP3 and P3) against DXA
estimates of % BF.
Subjects and methods
A convenience sample of college-aged men and women gave
informed consent to participate in this study (n = 76;
male = 33 and female = 43). Participants ranged from ages
18 to 35 years were recreationally active and of normal
weight as shown in Table 1. The study was approved by the
Institutional Review Board at The University of Akron.
Subjects completed a screening process of medical history,
Table 1 Participant physical characteristics.
Participants Age (Years) Height (cm) Weight (kg)
N = 76 22
08  2
50 171
44  12
10 70
35  16
12
© 2015 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd
(Gledhill, 2002), and the Godin Physical Activity Question-
naire (Godin & Shephard, 1985). Participants were excluded
from the study if they had any known medical conditions or
physical impairments that would affect their participation in
testing procedures or if they were taking medications that
could possibly affect body composition. Forty-eight hours
prior to testing, participants were instructed to maintain nor-
mal hydration the day before testing, abstain from exercise
and food and drink 4 h prior to all testing. Prior to body
composition analysis procedures, anthropometric measure-
ments of participant’s body mass barefoot and standing height
(Detecto Cardinal Scale Manufacturing Co., Webb City, MO,
USA) were measured to the nearest 0
01 kg and 0
1 cm,
respectively.
Ultrasound
The experimental investigator assessed body composition using
the BodyMetrixâ BX2000 System (IntelaMetrix, Concord, CA,
USA). The BodyMetrixâ is an A-mode, 2
5 MHz portable ultra-
sound that emits high-frequency sound waves to penetrate body
tissues. Differentiation of body tissue interfaces is determined
based on thickness of tissue and the length of time it takes for
the ultrasonic waves to pass through and reflect back into the
sound head transducer. Ultrasound was performed according to
IntelaMetrix manufacturing instructions. A thin layer of ultra-
sound gel was applied to the wand head and then placed per-
pendicular to the point of skin contact at each of the seven
observation sites. Local averaging of the measured signal was
conducted by moving the wand head in small circles approxi-
mately 5 mm from the observation site for roughly 5 s. Sites
for the ultrasound body composition analysis were assessed
using the BodyMetrix modified seven-site Jackson–Pollock
(JP7) proprietary equation that includes the chest, midaxilla,
suprailiac, abdomen, thigh, triceps and subscapula. Bodyview
Software (IntelaMetrix, Concord, CA, USA) was employed to
derive manufacturer supplied Jackson–Pollock three-site (JP3)
and Pollock three-site (P3) body composition assessments from
the modified Jackson–Pollock seven-site measurements.
Dual-energy X-ray absorptiometry
A licensed operator performed body composition analysis
using the GEâ Prodigy bone densitometer (enCORE 2010
software v.13.50.040 (GE/Lunar Corp, Madison, WI, USA),
which was calibrated to manufacturer specifications once per
day. Participants were instructed to remove all jewellery and
metals prior to lying quietly in a supine position with their
arms at their sides on the scanning bed. The tightly controlled
X-ray beams of the densitometer scanned the entire body infe-
riorly from the caudal region. Assessment was completed in
10–20 min. Assessment via DXA provided estimates of fat
mass, fat-free mass and per cent body fat, and only %BF was
used for analysis in this study.
 Body composition site method comparison of ultrasound to DXA, M. N. Baranauskas et al. 3

Statistical analyses
Univariate paired sample t-tests for the total sample and by
sex were performed between JP7 and JP3, JP7 and P3 and JP3
and P3 set with 95% confidence intervals expressed as
mean  SD. Additionally, paired sample t-tests and Pearson
correlation coefficients were conducted to investigate the
agreement between JP7 and DXA, JP3 and DXA and P3 and
DXA. Acceptable statistical significance was set a priori at
P<0
05 for all tests. Statistical analyses were performed using
SPSS (IBM version 19, SPSS Inc., Chicago, IL, USA).

Results Figure 1 %BF by condition, *P<0
05.

Participant characteristics are depicted in Table 1. The sample
consisted of 76 participants, males (n = 33), females
(n = 43).
Table 3 Paired sample t-test split by sex comparing JP7 versus P3,
A paired sample t-test revealed no significant difference JP7 versus JP3 and JP3 versus P3.
between %BF using the ULTRA JP7 equation and P3 equation
t (76) = 0
89, P = 0
38. However, a significant difference Sex %BF t P
was observed between JP7 and JP3 t (76) = 3
76, P = 0
00.
Additionally, significant differences were observed between Male (N = 33)
Pair 1
JP3 and P3 equation for %BF at t (76) = 3
30, P = 0
001. JP7 15
47  3
76 1
374 0
179
Results of significant and non-significant differences are pre- P3 14
74  4
93
sented in Table 2 and Fig. 1. Pair 2
Table 3, Figs 2 and 3 reveal the results of a paired sample JP7 15
47  3
76 3
202 0
003
t-test split by sex. There were significant differences in both JP3 16
44  4
62
Pair 3
males and females between JP7 and JP3 (P≤0
003), P3 and P3 14
74  4
93 2
892 0
007
JP3 (P≤0
007) and JP7 and P3 in females only (P = 0
014). JP3 16
44  4
62
However, no significant differences were observed between Female (N = 43)
JP7 and P3 for males P = 0
179. Pair 1
Table 4 depicts results of a paired sample t-test comparing JP7 25
79  3
54 2
576 0
014
P3 26
89  3
63
%BF using ULTRA JP7, P3 and JP3 compared with DXA. Sig- Pair 2
nificant differences between JP7 versus DXA (P<0
000), P3 JP7 25
79  3
54 7
616 0
000
versus DXA (P<0
000) and JP3 versus DXA (P<0
001) were P3 22
73  3
43
observed. JP7 and DXA were most closely correlated r = 0.82. Pair 3
P3 and DXA (r = 0.81), in addition to JP3 and DXA P3 26
89  3
63 9
244 0
000
JP3 22
73  3
43
(r = 0.78), were also strongly correlated.
P<0
05.
Table 2 Paired sample t-test comparing JP7 versus P3, JP7 versus
JP3 and JP3 versus P3.

N = 76 %BF t P

Pair 1
JP7 21
31  6
29 0
885 0
379
P3 21
61  7
38
Pair 2
JP7 21
31  6
29 3
762 0
000
JP3 20
00  5
10
Pair 3
P3 21
61  7
38 3
300 0
001
JP3 20
00  5
10

Values are presented as mean  SD. JP7 = per cent body fat using the
Jackson–Pollock seven-site equation, P3 = per cent body fat using the
Pollock three-site equation, JP3 = body fat percentage using the
Jackson–Pollock three-site equation, %BF = per cent body fat, P<0
05. Figure 2 Paired sample t-test split by sex for males, *P<0
007.

© 2015 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd
4 Body composition site method comparison of ultrasound to DXA, M. N. Baranauskas et al.

muscle and fat, ultrasound is more predisposed to measure-

ment error in differentiation between the tissue interfaces
(Wagner, 2013). Inclusion of the thigh site in Jackson–Pollock
three-site equation may account for the significant difference
observed between the Jackson–Pollock three-site and Jackson–
Pollock seven-site as well as the Jackson–Pollock three-site and
Pollock three-site methods.
Our secondary hypothesis developed following computation
of mean per cent body fat percentages. Johnson et al. (2014)
found ultrasound to underestimate average body fat percent-
age in college-aged individuals using seven measurement sites
when compared with DXA. Our results found the mean aver-
age of per cent body fat when using the Pollock three site to
Figure 3 Paired sample t-test split by sex for females, *P≤0
01. be higher, 21
61%, than that of Jackson–Pollock seven site,
21
31%. Based on the assumption that Jackson–Pollock under-
Discussion estimated per cent body fat when compared with DXA, it was
It was hypothesized that using the three-site method of either hypothesized that the Pollock three-site method would be
Pollock or Jackson–Pollock, to estimate body composition, accurately compared with DXA estimates. While significant
would reflect per cent body fat estimations comparable to a differences were observed (P<0 001) comparing Pollock three
seven-site Jackson–Pollock manufacturer developed equation site to DXA, the correlation coefficient showed a comparable
using BodyMetrix BX-2000. In other anthropometric measure- relationship to DXA (r = 0 816). This relationship was similar
ment technique studies that observed differences in skinfold to that observed among Jackson–Pollock seven site and DXA
generalized equations, the Jackson–Pollock seven-site equation (r = 0 808). Although significant differences were observed
was interchangeably accurate with various three-site equations between Pollock three site and DXA, a strong correlation rela-
(Heyward, 2001; Margotl, 2009). Our findings, however, tionship exists as a post hoc interpretation of results.
showed only the Pollock three-site method to produce non- The Jackson–Pollock three-site method correlated less with
significant body fat percentage estimates when compared with DXA than both Jackson–Pollock three-site and seven-site meth-
Jackson–Pollock seven-site method using BodyMetrix BX- ods r = 0 778. Our results indicated that the Jackson–Pollock
2000. Significant differences were observed among Jackson– three-site method underestimated per cent body fat when
Pollock three-site and Jackson–Pollock seven-site methods. compared with DXA which is agreement with previous studies
The relationship of singular measurement sites to body fat (Lhachimi et al., 2013; Loenneke et al., 2014a,b). The results
distribution patterns is one possible explanation that accounts of the present study also concur with Duz et al. (2009) who
for differences in estimated body fat percentage between the found ULTRA to underestimate per cent body fat when com-
observed generalized prediction equations of Jackson–Pollock pared with DXA in young healthy subjects using the Jackson–
seven site, Jackson–Pollock three site and Pollock three site. Pollock three site. Loenneke et al. (2014a,b) also found the
The inclusion of the thigh site in the Jackson–Pollock three- Jackson–Pollock three site to underestimate per cent body fat
site method is of notable difference between the equations. when compared with DXA in a population of female
The thigh represents a single site with relatively more muscle gymnasts.
mass than the other sites included in the Jackson–Pollock The significant differences observed among Jackson–Pollock
seven-site formula. Due to the similar acoustic impedance of seven site, Pollock three site and Jackson–Pollock three site
compared with DXA in estimation of per cent adipose tissue
Table 4 Paired sample t-test comparing JP7 versus DXA, P3 versus (P<0.001) may be reflective of a problem of total averaged
DXA and JP3 versus DXA. measurement sites or algorithms rather than ultrasound device
inaccuracy. Fewer sites of measurement with body composi-
N = 76 %BF r t P tion result in less accurate results as prediction equations are
derived from indirect sources of body composition measure-
Pair 1
JP7 21
31  6
29 0.816 6
722 0
000
ment (Heyward, 2001). It may be warranted to test nine sites
DXA 25
19  8
62 of measurement against DXA for greater accuracy. The gener-
Pair 2 alized prediction equations of Jackson–Pollock seven site, Jack-
P3 21
61  7
38 0.808 8
009 0
000 son–Pollock three site and Pollock three site were developed
DXA 25
19  8
62 using regression analysis from data points of hydrostatic
Pair 3
JP3 20
00  5
10 0.778 6
119 0
001
weighing estimates of body composition. It has been sug-
DXA 25
19  8
62 gested that hydrostatically derived equations underestimate
body fat percentage when compared with DXA, which may
P<0.05. be another possible explanation accounting for underestimates

© 2015 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd
 Body composition site method comparison of ultrasound to DXA, M. N. Baranauskas et al. 5

found, while comparing ultrasound per cent body fat to DXA
(Ball et al., 2006).
A potential source of bias that may have threatened the internal
validity of this study was treatment fidelity of the ultrasound
device. There currently lacks a standardized protocol for ultra-
sound assessment of body composition (Wagner, 2013).
Although manufacturing instructions were followed accordingly,
ultrasound application is affected by factors such as the pressure
applied and application angle of the wand (Wagner, 2013).
Conclusion
The purpose of this study was to evaluate the effectiveness of
a portable ultrasound device, BodyMetrix BX-2000, in estimat-
ing body composition in college-aged students for the impor-
tance of disease risk identification. The Pollock three site was
not significantly different than the Jackson–Pollock seven site,
demonstrating that a more time efficient method of body
composition estimation is available using ultrasound. Although
ultrasound estimates of per cent adipose tissue were not
agreeable when compared with DXA, ultrasound technology is
an accessible form of body composition measurement with
less variability than BIA and skinfolds (Heyward, 2001; Heiss
et al., 2009; Dixon et al., 2012). Future directions for research
should include assessments of body composition with nine
sites of measurement against DXA and a criterion such as a
four-component model, using a more diverse sample popula-
tion. Additionally, future research using ULTRA and DXA in
other populations addressing both age and ethnic differences
should be investigated.
Acknowledgments
Acknowledgments for testing location and supplier of materi-
als are made to The University of Akron School of Sport
Science and Wellness Education, Akron, OH, USA.
Conflict of Interest
The authors declare no conflicts of interest.

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© 2015 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd