Purpose: To evaluate the feasibility and accuracy of body-fat assessment using standardized skinfold-thickness assessment versus dual-energy X-ray absorptiometry (DXA) in Paralympic athletes. Method: In this cross-sectional study, body composition was assessed in 49 male and female Paralympic athletes (Para cycling, Para skiing, Para swimming, wheelchair basketball, and wheelchair tennis) by a whole-body DXA scan and skinfold-thickness measurements conducted according to International Society for the Advancement of Kinanthropometry (ISAK) standards. Correlation and Bland-Altman analyses were conducted to compare both methods. Results: DXA was feasible in all athletes, while the sums of 4, 7, and 8 skinfolds were obtained in 88%, 73%, and 73% of the athletes, respectively. Median DXA-derived body-fat percentage was 16.3% (13.4%-20.5%) in males and 27.8% (21.1%-33.4%) in females. Strong correlations were found between DXA-derived body-fat percentage and the sum of 4 (r = .85), 7 (r = .83), and 8 (r = .83) skinfolds. However, skinfold-based prediction equations for estimating body-fat percentage were associated with substantial negative bias (-2.0% to -7.9%) and large individual error compared with DXA. Conclusion: DXA is a feasible method for assessing body composition in Paralympic athletes, while ISAK skinfold measurements face some challenges due to disability-related landmarking issues. Despite these limitations, skinfold thickness remains strongly associated with DXA-derived body fat. It is recommended to measure all skinfolds that can be reliably obtained according to ISAK standards and interpret them as a cumulative "sum of feasible sites," rather than enforcing a universal skinfold metric across all Paralympic athletes.
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