# Sex‐ and Age‐Specific Associations Between Visceral Fat‐to‐Muscle Ratio and Bone Mineral Density in Children and Adolescents

## TL;DR

The study finds that the balance between visceral fat and muscle mass affects bone density in children and teens, with differences based on age and sex.

## Contribution

The study reveals sex- and age-specific associations between visceral fat-to-muscle ratio and bone mineral density in children.

## Key findings

- Visceral fat showed a positive correlation with bone density before adjustments but a negative one afterward.
- Muscle mass was positively linked to bone density, especially in younger girls.
- The visceral fat-to-muscle ratio was negatively associated with bone density in older boys.

## Abstract

Childhood and adolescence are critical periods for skeletal development, yet the sex‐ and age‐specific relationships between body composition and bone mineral density (BMD) remain inadequately explored.

This study analyzed data from 6328 participants aged 8–19 years from the NHANES (2011–2018) using dual‐energy X‐ray absorptiometry to assess visceral adipose tissue area (VATA), skeletal muscle mass (SMM), and total BMD. Multivariate linear regression models were employed to examine the associations, accounting for potential confounders.

Initial analyses indicated a positive correlation between VATA and BMD, which reversed after covariate adjustment. SMM consistently showed positive correlations with BMD, particularly in girls aged 8–11 years. The visceral adipose tissue to SMM ratio exhibited significant negative correlations with BMD, especially in boys aged 12–19 years.

These findings highlight the critical importance of balanced body composition for skeletal health during development, suggesting that targeted interventions to optimize muscle mass and reduce visceral fat may enhance bone density in children and adolescents.