Development and Validation of a Skinfold Model for Estimation of Body Density for a Safe Weight Reduction in Young Iranian Wrestlers

BACKGROUND: Adverse effects of excessive body mass reduction among wrestlers dictate minimum weight determination through body composition. Although skinfold equations are essential to estimate body composition in the field setting, they are mostly derived from Western societies and may lack generalizability to other populations. PURPOSE: Previously published skinfold equations lacked external validity in predicting body density of Iranian wrestlers. We aimed to derive a new anthropometric model specific to young Iranian male wrestlers. STUDY DESIGN: Cross-sectional cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: One hundred twenty-six Iranian male wrestlers with at least 1 year of experience and a mean age of 19 ± 4.0 years underwent underwater weight analysis for body density estimation and anthropometric measurements. The previously published equations were validated, followed by new regression modeling, using multivariable fractional polynomials, with body density as the criterion predicted by common anthropometric variables. The final model was validated throughout the modeling procedure using 1000 bootstrap replications. RESULTS: The mean body fat percentage (%BF) was 12.6% (95% CI, 11.9%-13.4%), lower than that of previous studies. Six previously published equations each had significant deviations from the line of identity (all P < 0.001). The new prediction equation combined subscapular, tricipital, and midaxillary skinfolds and body mass index cubed to predict body density. CONCLUSION: The development of ethnicity-specific equations, using statistically unbiased and comprehensive validation methods, is imperative for body composition estimation to determine the minimum weight for regulation of health in athletes. CLINICAL RELEVANCE: Using equations without external validation can bias the prediction of minimum weight, leading to unsafe weight reduction by athletes. Compared with a previous study, much lower mean %BF was found using an ethnicity-specific equation (12.6% vs 15.9%). This difference observed in %BF prediction could affect safe fat reduction in athletes.