Preseason Body Composition Phenotypes and In-Season Injury Burden in Male Professional Basketball: A Retrospective Cohort Study

Professional basketball entails high physical demands and a complex injury profile in which injury burden and time-loss distribution critically affect player availability. This study explored the association between preseason anthropometric body composition and in-season injury burden in male professional basketball and explored body phenotypes linked to greater injury accumulation. A retrospective longitudinal cohort design was applied using official injury records and standardized ISAK anthropometric assessments collected during preseason. Players from two male professional teams (first team, ACB; second team, LEB Plata) were included. Outcomes were the number of injuries and observed days lost during the season. Associations were assessed using Pearson correlations, principal component analysis (PCA), team-stratified logistic regression, and unsupervised k-means clustering. Injury burden demonstrated a highly skewed distribution, with a small subset of players accounting for a large proportion of total days lost. Preseason adiposity markers showed strong internal coherence, with PCA identifying a dominant component reflecting an adiposity gradient. Higher preseason body fat percentage was associated with a greater likelihood of high injury burden (≥3 injuries/season) in both teams. Clustering revealed two phenotypes: a higher-adiposity, higher-burden profile and a lower-adiposity, lower-burden profile. These exploratory findings suggest that preseason body composition, particularly adiposity, may be related to injury burden in male professional basketball. However, given the limited sample size and exploratory design, the results should be interpreted cautiously and considered hypothesis-generating. Precompetitive body phenotyping may therefore provide preliminary information for identifying players potentially at elevated risk of recurrent injury accumulation and reduced competitive availability.