We aimed to validate in-body bioelectrical impedance analysis (BIA) measures with dual-energy X-ray absorptiometry (DXA) as reference and describe the body composition (BC) profiling of Tibetan adults.

This cross-sectional study included 855 participants (391 men and 464 women). Correlation and Bland–Altman analyses were performed for method agreement of in-body BIA and DXA. BC were described by obesity and metabolic status.

In-body BIA and DXA have not been employed to characterise the BC of the Tibetan population living in the Qinghai–Tibet Plateau.

A total of 855 Tibetan adults, including 391 men and 464 women, were enrolled in the study.

Concordance correlation coefficient for total fat mass (FM) and total lean mass (LM) between in-body BIA and DXA were 0·91 and 0·89. The bias of in-body BIA for percentages of total FM and total LM was 0·91 % (2·46 %) and –1·74 % (–2·80 %) compared with DXA, respectively. Absolute limits of agreement were wider for total FM in obese men and women and for total LM in overweight men than their counterparts. Gradience in the distribution of total and regional FM content was observed across different BMI categories and its combinations with waist circumference and metabolic status.

In-body BIA and DXA provided overall good agreement at the group level in Tibetan adults, but the agreement was inferior in participants being overweight or obese.