Methodological standards for body composition—an expert-endorsed guide for research and clinical applications: levels, models, and terminology

Body composition assessment is widely used in both research and clinical practice, yet confusion over basic concepts and terminology persists, leading to inaccurate assessments, comparisons, and interpretations. To address this concern, an international working group was formed to clarify basic concepts, standardize terminology, and provide guidance on the use and interpretation of body composition assessment. This initial publication addresses methodological standards, focusing on summarizing body composition levels and models, and introducing standardized terms and definitions. Body composition is organized into 5 distinct levels, ranging from atomic to whole-body, with each higher level encompassing the components of the preceding less complex levels. As a result, terms that describe components at different levels should not be used interchangeably. For example, the use of the molecular-level term "lean body mass" is discouraged because it inaccurately refers to fat-free mass (FFM), lean mass, or lean soft tissue (LST). FFM includes all compartments at the molecular level except fat (nonpolar lipids; mainly triglycerides), and FFM also contains nonfat (or polar) lipids. The term "lean mass" is equivalent to FFM, but not to LST, as FFM includes bone mineral content. Additionally, skeletal muscle is classified at the tissue-organ level and should not be confused with the molecular-level components FFM and LST. Likewise, fat mass and adipose tissue are different components: fat mass, mainly triglycerides, is assessed at the molecular level, whereas adipose tissue is measured at the tissue-organ level. Models are also specific to each level. It is crucial for researchers and clinicians to have a clear understanding of what each body component entails and to use accurate terminology to ensure precise assessment, reporting, and interpretation of body composition data.