Accurate measurement of body composition between lean and adipose tissue mass and distribution of lipid burden may be important in the care of nutritional problems in patients observed in clinical practice and the measurement of outcomes in clinical research. In this review, we discuss the most accurate imaging methods for use as clinical tools in measurement of body composition and distribution. Dual-energy x-ray absorptiometry (DXA) is a non-invasive technique for assessment of body composition, and the radiation exposure is relatively minimal. However, measurements are influenced by thickness of tissue and lean tissue hydration. Computed tomography (CT) is a gold-standard imaging method for body composition analysis at the tissue-organ level, however the radiation generated by the CT scan is relatively high, thus it should not be considered for a measurement, which can be repeated frequently. Magnetic resonance imaging (MRI) has been a useful modality in the assessment of body composition changes in various clinical studies. However, limitations of MRI for assessment of body composition are related to its high cost and technical expertise necessary for analysis. Proper methods for measurement of body composition in specific medical situations like sarcopenia should be evaluated for determination of comparative validity and accuracy, within the context of cost-effectiveness in patient care. In conclusion, an ideal body imaging method would have a significant utility for earlier detection of nutritional risks, while overcoming the limitations of current imaging studies such as DXA, CT, and MRI.