{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:38:24Z","timestamp":1761007104432,"version":"build-2065373602"},"reference-count":28,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T00:00:00Z","timestamp":1760745600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JFMK"],"abstract":"<jats:p>Background: Body surface area is a key determinant of cardiac morphology and function, but it is often underestimated in the interpretation of athlete\u2019s cardiac phenotypes. Aims: This study aimed to assess the role of anthropometric characteristics and whether particularly high vs. low body surface area (BSA) is associated with distinct morpho-functional and cardiometabolic features in elite athletes. Methods: We retrospectively included 2518 Olympic athletes. All underwent a pre-participation screening, including physical examination, ECG, blood analysis, echocardiography, and cardiopulmonary exercise testing. Participants were grouped by sex-specific BSA percentiles: Group A (&lt;5th percentile), Group B (25th\u201375th), and Group C (&gt;95th percentile). Functional, echocardiographic, and cardio-metabolic parameters were compared among groups. Results: In male athletes, Group C showed higher resting systolic blood pressure (123.8 \u00b1 10.4 mmHg) than Group B (117.4 \u00b1 9.6, p &lt; 0.0001) and Group A (110.4 \u00b1 13, p &lt; 0.0001), and a higher prevalence of dyslipidemia (31.7% vs. 11.1% in Group B and 4% in Group A, p = 0.031). Despite greater LVEDD (59 \u00b1 3 mm in Group C vs. 55 \u00b1 2.9 in B and 51.1 \u00b1 3.1 in A, p &lt; 0.0001) and LV mass (p &lt; 0.0001), functional performance was lower in Group C, with VO2 max\/kg of 35.2 \u00b1 13.2 mL\/min\/kg vs. 44 \u00b1 7.1 in B, and 47.8 \u00b1 7.3 in A (p &lt; 0.0001). Similar trends were observed in females for morpho-functional parameters, though lipid profiles did not significantly differ among groups (p &gt; 0.05). Conclusions: Anthropometric traits significantly influence the cardiovascular and metabolic phenotype of elite athletes. Our findings support the integration of anthropometric profiling into the routine cardiovascular assessment of athletes, especially those at the extremes of body size, to better interpret physiological adaptations and risk profiles.<\/jats:p>","DOI":"10.3390\/jfmk10040405","type":"journal-article","created":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T10:44:10Z","timestamp":1760957050000},"page":"405","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Impact of Body Surface Area on Morpho-Functional and Cardiometabolic Parameters in a Large Cohort of Olympic Athletes: Distinct Bodies, Distinct Physiology"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9158-5440","authenticated-orcid":false,"given":"Giuseppe","family":"Di Gioia","sequence":"first","affiliation":[{"name":"Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy"},{"name":"Department of Movement, Human and Health Sciences, University of Rome \u201cForo Italico\u201d, Piazza Lauro De Bosis, 15, 00135 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Rosaria","family":"Squeo","sequence":"additional","affiliation":[{"name":"Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7291-2450","authenticated-orcid":false,"given":"Armando","family":"Ferrera","sequence":"additional","affiliation":[{"name":"Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucrezia","family":"Macori","sequence":"additional","affiliation":[{"name":"Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5697-1844","authenticated-orcid":false,"given":"Margherita","family":"Rigillo","sequence":"additional","affiliation":[{"name":"BIOMETRA Department, University of Milan, 20129 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raffaella","family":"Spada","sequence":"additional","affiliation":[{"name":"Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Pelliccia","sequence":"additional","affiliation":[{"name":"Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S446","DOI":"10.1097\/00005768-200106001-00013","article-title":"Individual Differences in Response to Regular Physical Activity","volume":"33","author":"Bouchard","year":"2001","journal-title":"Med. 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