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Association of total body fat and fat distribution with bone mineral density among children and adolescents aged 6–17 years from Guangzhou, China

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Abstract

This study aimed to assess the associations of total body fat and fat distribution with bone mineral density (BMD) among children and adolescents in this cross-sectional study. A total of 1032 boys and 897 girls aged 6–17 years were enrolled between May 2019 and June 2019 in Guangzhou, China. BMD, total body fat (fat mass index [FMI] and body fat percentage [BF%]), and fat distribution (trunk-to-limb and android-to-gynoid ratios) were measured by dual-energy X-ray absorptiometry. Inverse probability of treatment weighting regression was used to explore the association between fat and BMD. Traditional regression of covariate adjustment was applied as sensitivity analysis. Regression with inverse probability weighting suggested BF% and android-to-gynoid ratio were negatively associated with BMD in boys (β =  − 0.12 and − 0.16, respectively; P < 0.05). Android-to-gynoid ratio was also inversely associated with BMD in girls (β =  − 0.08, P < 0.05). When stratified by age, the negative associations were retained in boys aged 12–17 years (β =  − 0.23 and − 0.25, respectively; P < 0.001). But for girls, it showed a positive association of FMI with BMD in the 6–9 years group (β = 0.33, P < 0.001) and a negative association between the android-to-gynoid ratio and BMD in the 10–17 years group (β =  − 0.10, P < 0.05). Traditional regression supported the robustness of the results.

  Conclusion: Total body fat is positively associated with BMD in younger girls but inversely associated in older boys. As for abdominal adipose, it is associated with lower BMD in both older boys and girls.

What is Known:

• The lean mass has been consistently positively associated with bone mineral density (BMD) among children and adolescents. However, the impact of fat mass on BMD remained controversial.

• Beyond total body fat, site-specific fat mass, especially abdominal adiposity, might impede bone formation.

What is New:

• The associations of total body fat and fat distribution with BMD in children and adolescents were gender- and age-specific.

• More attention should be paid to the abdominal fat accumulation to promote bone health in older children.

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Availability of data

The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

A/G ratio:

Android-to-gynoid fat ratio

BF%:

Body fat percentage

BMD:

Bone mineral density

DXA:

Dual-energy X-ray absorptiometry

FM:

Fat mass

FMI:

Fat mass index

GPS:

Generalized propensity score

IPTW:

Inverse probability of treatment weighting

LM:

Lean mass

TBLH BMD:

Total body less head bone mineral density

T/L ratio:

Trunk-to-limb fat ratio

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Acknowledgements

We thank all funders of the presented study listed in the funding section as well as all children for their participation in this study and the study team for data collection and processing.

Funding

This work was supported by the National Natural Science Foundation of China (Grant 81874271; 81973110) and by the Science and Technology Innovation Strategy Special Fund of Guangdong Province (Grant pdjh2021a0258).

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, 510310, China

    Wanwen Yao, Jiepeng Luo, Liping Ao, Shuang Lu, Keyuan Lu, Yi Yang & Li Liu

  2. Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China

    Hong Cheng, Junting Liu & Jie Mi

  3. Department of Non-communicable Disease Management, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, 100045, China

    Jie Mi

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  1. Wanwen Yao
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  4. Hong Cheng
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Contributions

Conceptualization, Wanwen Yao, Liping Ao, Hong Cheng, Shuang Lu, Yi Yang, and Li Liu; data curation, Li Liu; formal analysis, Wanwen Yao; funding acquisition, Jie Mi and Li Liu; investigation, Wanwen Yao, Liping Ao, and Shuang Lu; methodology, Wanwen Yao and Jiepeng Luo; project administration, Li Liu; resources, Jie Mi, Yi Yang, and Li Liu; supervision, Hong Cheng, Junting Liu, Jie Mi, Yi Yang, and Li Liu; visualization, Wanwen Yao; writing—original draft, Wanwen Yao; writing— review & editing, Jiepeng Luo, Liping Ao, Hong Cheng, Shuang Lu, Junting Liu, Keyuan Lu, Jie Mi, Yi Yang, and Li Liu.

Corresponding authors

Correspondence to Jie Mi, Yi Yang or Li Liu.

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This study was approved by the Ethics Review Boards of Guangdong Pharmaceutical University (Med Ref No. 2018–27).

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Communicated by Gregorio Milani.

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Yao, W., Luo, J., Ao, L. et al. Association of total body fat and fat distribution with bone mineral density among children and adolescents aged 6–17 years from Guangzhou, China. Eur J Pediatr 182, 1115–1126 (2023). https://doi.org/10.1007/s00431-022-04727-x

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