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The purpose of this investigation was to determine the validity of 4-compartment (4C) model body fat percent (BF%) estimates when using dual energy x-ray absorptiometry (DXA) derived body volume (BV) equations (4C-DXA1 and 4C-DXA2) in adults with varying body mass index (BMI) and waist circumference (WC) classifications. Each model was compared to a criterion 4C model with air-displacement plethysmography (ADP) generated BV (4C-ADP). Participants were categorized as normal weight (n = 40; NW = BMI<25.0kg/m 2 ); overweight (n = 40; OW BMI  = BMI≥25.0 kg/m 2 ); and overweight with at-risk WC (n = 35; OW BMI+WC  = BMI≥25.0 kg/m 2  and WC≥88.0cm for women and 102.0cm for men). 4C-DXA1 produced lower BF% than that derived using the 4C-ADP in NW (CE = -3.0%; p<0.001) while 4C-DXA2 was significantly higher (CE = 4.8%; p<0.001). The SEE and 95% limits of agreement (LOA) were lower for 4C-DXA2 (1.24% and ±2.5%, respectively) than 4C-DXA1 (2.59% and ±5.0%, respectively) and proportional bias was present for both (p<0.05). 4C-DXA1 BF% was not significant in OW BMI  (CE = -0.5%; p = 0.112) whereas 4C-DXA2 was higher (CE = 4.5%; p<0.001). The SEE and 95% LOA were lower for 4C-DXA2 (1.20% and ±2.9%, respectively) than 4C-DXA1 (1.92% and ±3.9%, respectively) in OW BMI . Proportional bias was present for 4C-DXA1 (p = 0.007), but not 4C-DXA2 (p = 0.832). 4C-DXA1 and 4C-DXA2 produced significantly higher BF% in OW BMI+WC  (CE = 2.2 and 2.3%, respectively; both p<0.001). The SEE and 95% LOA remained lower for 4C-DXA2 (1.15% and ±2.5%, respectively) than 4C-DXA1 (1.84% and ±3.8%, respectively). There was proportional bias for 4C-DXA2 (p = 0.020), but not 4C-DXA1 (p = 0.183) in OW BMI+WC . Only one prediction model (i.e., 4C-DXA1 in OW BMI+WC ) revealed valid estimates of BF%. Practitioners are encouraged to use criteria for both BMI and WC when utilizing DXA-derived BV in 4C-models for normal and overweight populations.

Validity of DXA body volume equations in a four-compartment model for adults with varying body mass index and waist circumference classifications