Systematic Review and Meta-Analysis of Measuring Abdominal Subcutaneous Fat Thickness Using an Ultrasound

Authors

  • Nunik Rahayu Universitas Sebelas Maret
  • Dono Indarto Universitas Sebelas Maret
  • Tri Nugraha Susilawati Universitas Sebelas Maret
  • Nurul Huda Zaen Universitas Sebelas Maret

DOI:

https://doi.org/10.37287/ijghr.v8i5.2136

Keywords:

abdomen, reliability, subcutaneous fat, ultrasound

Abstract

Obesity prevalence is rising globally, including in Indonesia. Conventional methods (BMI, WHR, BIA) cannot directly measure subcutaneous fat thickness. Ultrasound (USG) offers a safe, non-invasive alternative. To evaluate the use of ultrasound in measuring subcutaneous fat thickness across all age groups. Articles were searched in ScienceDirect, Scopus, PubMed, Cochrane Library, and Google Scholar following PRISMA guidelines. A random-effects meta-analysis was performed using RevMan 5.4. Articles published from January 1, 2016, to December 31, 2025, using the keywords “subcutaneous fat” OR “adipose tissue” AND “ultrasonography” OR “ultrasound” AND ‘reliability’ OR “Intraclass Correlation Coefficient” OR “ICC”; out of 2,553 articles reviewed, 10. Ten cross-sectional studies across various age groups were analyzed. The pooled ICC was 0.99, indicating near-perfect reliability. Reliability was consistently high in children, adults, and the elderly. USG outperformed skinfold calipers and showed comparable results to MRI, with minimal measurement error (~1 mm). Heterogeneity was high due to differences in USG modes, populations, and operator expertise, but all studies reported reliability above the acceptable threshold. Funnel plot analysis showed high precision and no significant publication bias. Ultrasound is a highly reliable method for measuring abdominal subcutaneous fat thickness across all age groups, making it suitable for widespread application in research and clinical practice.

References

Achamrah, N., Colange, G., Delay, J., Rimbert, A., Folope, V., Petit, A., Grigioni, S., Déchelotte, P., & Coëffier, M. (2018). Comparison of body composition assessment by DXA and BIA according to the body mass index: A retrospective study on 3655 measures. PLoS ONE, 13(7), 1–13. https://doi.org/10.1371/journal.pone.0200465

Anwer, R., Baig, L. A., & Musharraf, M. (2023). Validation of HF-Bioelectrical Impedance Analysis versus Body Mass Index in Classifying Overweight and Obese Pakistani Adults. Journal of Multidisciplinary Healthcare, 16(March), 983–996. https://doi.org/10.2147/JMDH.S378367

Arner, P., Andersson, D. P., Arner, E., Rydén, M., & Kerr, A. G. (2022). Subcutaneous adipose tissue expansion mechanisms are similar in early and late onset overweight/obesity. International Journal of Obesity, 46(6), 1196–1203. https://doi.org/10.1038/s41366-022-01102-6

Chandler, A. J., Dona, S. T., Cintineo, H. P., Mcfadden, B. A., Sanders, D. J., Monaco, R., & Arent, S. M. (2020). Intra- and Inter-Rater Reliability of Assessing Body Composition Using B-Mode Ultrasound in Conjunction with Artificial Intelligence Software. Journal of Exercise and Nutrition, 3(2), 1–8. https://www.journalofexerciseandnutrition.com/index.php/JEN/article/view/60/53

Federation, W. O. (2025). World Obesity Atlas 2025. World Obesity Atlas 2025, March, 1–275.

Gao, Y., Tang, X., Liu, B., & Qiu, L. (2025). Application of ultrasound for quantitative assessment of body fat mass. Clinical Nutrition ESPEN, 67, 635–644. https://doi.org/https://doi.org/10.1016/j.clnesp.2025.03.175

Hoffmann, J., Thiele, J., Kwast, S., Borger, M. A., Schroeter, T., Falz, R., & Busse, M. W. (2022). Measurement of subcutaneous fat tissue: reliability and comparison of caliper and ultrasound via systematic body mapping. Scientific Reports, 12(1). https://doi.org/10.1038/s41598-022-19937-4

Hoffmann, J., Thiele, J., Kwast, S., Borger, M. A., Schröter, T., Schmidt, J., & Busse, M. (2023). A new approach to quantify visceral fat via bioelectrical impedance analysis and ultrasound compared to MRI. International Journal of Obesity, 48(2), 209–217. https://doi.org/10.1038/s41366-023-01400-7

Holmes, C. J., & Racette, S. B. (2021). The utility of body composition assessment in nutrition and clinical practice: an overview of current methodology. Nutrients, 13(8), 1–16. https://doi.org/10.3390/nu13082493

Kelso, A., Vogel, K., & Steinacker, J. M. (2019). Ultrasound measurements of subcutaneous adipose tissue thickness show sexual dimorphism in children of three to five years of age. Acta Paediatrica, International Journal of Paediatrics, 108(3), 514–521. https://doi.org/10.1111/apa.14496

Kemenkes, R. (2025). Laporan Akuntabilitas Kinerja Instansi Pemerintah Semester 1 Tahun 2025.

LI Ya Mei, Z. Z. Y. (2021). Predicting Metabolic Syndrome Using Anthropometric Indices among Chinese Adolescents with Different Nutritional Status: A Multicenter Cross-sectional Study. Biomedical and Environmental Science, 34(201202010), 673–682. https://doi.org/10.3967/bes2021.095

Liang, Y., Chen, P., Chen, S., Liu, D., Jiang, F., Zhu, Z., Dong, K., Wei, L., & Hou, X. (2023). A greater ratio of thigh subcutaneous fat to abdominal fat is associated with protection against non-alcoholic fatty liver disease. JHEP Reports, 5(7), 100730. https://doi.org/10.1016/j.jhepr.2023.100730

Mechelli, F., Arendt-Nielsen, L., Stokes, M., & Agyapong-Badu, S. (2019). Validity of ultrasound imaging versus magnetic resonance imaging for measuring anterior thigh muscle, subcutaneous fat, and fascia thickness. Methods and Protocols, 2(3), 1–10. https://doi.org/10.3390/mps2030058

Müller, W., Lohman, T. G., Stewart, A. D., Maughan, R. J., Meyer, N. L., Sardinha, L. B. S. B., Kirihennedige, N., Reguant-Closa, A., Risoul-Salas, V., Sundgot-Borgen, J. K., Ahammer, H., Anderhuber, F., Fürhapter-Rieger, A., Kainz, P., Materna, W., Pilsl, U., Pirstinger, W., & Ackland, T. R. (2016). Subcutaneous fat patterning in athletes: Selection of appropriate sites and standardisation of a novel ultrasound measurement technique: Ad hoc working group on body composition, health and performance, under the auspices of the IOC Medical Commission. British Journal of Sports Medicine, 50(1), 45–54. https://doi.org/10.1136/bjsports-2015-095641

Neagu, M., & Neagu, A. (2025). A Decade of Progress in Ultrasound Assessments of Subcutaneous and Total Body Fat: A Scoping Review. Life, 15(2), 1–33. https://doi.org/10.3390/life15020236

Nugroho, P. S. (2020). Jenis Kelamin Dan Umur Berisiko Terhadap Obesitas Pada Remaja Di Indonesia. An-Nadaa: Jurnal Kesehatan Masyarakat, 7(2), 110. https://doi.org/10.31602/ann.v7i2.3581

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. PLoS Medicine, 18(3), 1–15. https://doi.org/10.1371/JOURNAL.PMED.1003583

Raab, R., Hoffmann, J., Spies, M., Geyer, K., Meyer, D., Günther, J., & Hauner, H. (2022). Are pre- and early pregnancy lifestyle factors associated with the risk of preterm birth? A secondary cohort analysis of the cluster-randomised GeliS trial. BMC Pregnancy and Childbirth, 22(1), 230. https://doi.org/10.1186/s12884-022-04513-5

Roever, L. (2018). Evidence Based Medicine and Practice E v id ence B a s e d Me dic in e PICO: Model for Clinical Questions. Evid Based Med Pract, 4(2), 1. https://doi.org/10.4172/2471-9919.1000115

Samouda, H., & Langlet, J. (2022). Body fat assessment in youth with overweight or obesity by an automated bioelectrical impedance analysis device, in comparison with the dual-energy x-ray absorptiometry: a cross sectional study. BMC Endocrine Disorders, 22(1), 1–10. https://doi.org/10.1186/s12902-022-01111-6

Schmid-zalaudek, K., Brix, B., Sengeis, M., Jantscher, A., Fürhapter-rieger, A., Müller, W., Matjuda, E. N., Mungamba, M. M., Nkeh-chungag, B., Fredriksen, P. M., & Goswami, N. (2021). Subcutaneous Adipose Tissue Measured by B-Mode Ultrasound to Assess and Monitor Obesity and Cardio–Metabolic Risk in Children and Adolescents. Biologi, 10(05), 449. https://doi.org/https://doi.org/10.3390/biology10050449

Sengeis, M., Müller, W., Störchle, P., & Führhapter-Rieger, A. (2019). Body weight and subcutaneous fat patterning in elite judokas. Scandinavian Journal of Medicine and Science in Sports, 29(11), 1774–1788. https://doi.org/10.1111/sms.13508

Sommer, I., Teufer, B., Szelag, M., Streit, B. N., Titscher, V., Klerings, I., & Gartlehner, G. (2020). The performance of anthropometric tools to determine obesity : a systematic review and meta ‑ analysis. Scientific Reports, 1–12. https://doi.org/10.1038/s41598-020-69498-7

Störchle, P., Müller, W., Sengeis, M., Ahammer, H., Fürhapter-Rieger, A., Bachl, N., Lackner, S., Mörkl, S., & Holasek, S. (2017a). Standardized Ultrasound Measurement of Subcutaneous Fat Patterning: High Reliability and Accuracy in Groups Ranging from Lean to Obese. Ultrasound in Medicine & Biology, 43(2), 427–438. https://doi.org/https://doi.org/10.1016/j.ultrasmedbio.2016.09.014

Störchle, P., Müller, W., Sengeis, M., Ahammer, H., Fürhapter-Rieger, A., Bachl, N., Lackner, S., Mörkl, S., & Holasek, S. (2017b). Standardized Ultrasound Measurement of Subcutaneous Fat Patterning: High Reliability and Accuracy in Groups Ranging from Lean to Obese. Ultrasound in Medicine & Biology, 43(2), 427–438. https://doi.org/https://doi.org/10.1016/j.ultrasmedbio.2016.09.014

Trang, L. T., Trung, N. N., Chu, D. T., & Hanh, N. T. H. (2019). Percentage body fat is as a good indicator for determining adolescents who are overweight or obese: A cross-sectional study in Vietnam. Osong Public Health and Research Perspectives, 10(2), 108–114. https://doi.org/10.24171/j.phrp.2019.10.2.10

Uchida, K., Sugimoto, T., Tange, C., & Nishita, Y. (2024). The Journal of Nutrition , Health and Aging Association between abdominal adiposity and cognitive decline in older adults : a 10-year community-based study. 28(February). https://doi.org/10.1016/j.jnha.2024.100175

Wagner, D. R., Teramoto, M., Judd, T., Gordon, J., McPherson, C., & Robison, A. (2020). Comparison of A-mode and B-mode Ultrasound for Measurement of Subcutaneous Fat. Ultrasound in Medicine & Biology, 46(4), 944–951. https://doi.org/https://doi.org/10.1016/j.ultrasmedbio.2019.11.018

Widjaja, N. A., Prihaningtyas, R. A., Hanindita, M. H., & Irawan, R. (2019). Demographic Characteristics and Body Mass Index in Obese Adolescents. Jurnal Berkala Epidemiologi, 7(3), 189. https://doi.org/10.20473/jbe.v7i32019.189-196

Wijayanti, D. N., Sukmaningtyas, H., & Fitranti, D. Y. (2018). Kesesuaian Metode Pengukuran Persentase Lemak Tubuh Skinfold Caliper Dengan Metode Biolectrical Impedance Analysis. Diponegoro Medical Journal (Jurnal Kedokteran Diponegoro), 7(2), 1504–1510.

Downloads

Published

2026-09-13

How to Cite

Rahayu, N., Dono Indarto, Susilawati, T. N., & Zaen, N. H. (2026). Systematic Review and Meta-Analysis of Measuring Abdominal Subcutaneous Fat Thickness Using an Ultrasound. Indonesian Journal of Global Health Research, 8(5), 509–518. https://doi.org/10.37287/ijghr.v8i5.2136

Similar Articles

<< < 1 2 3 4 5 6 7 8 9 10 > >> 

You may also start an advanced similarity search for this article.