Muscle-to-Bone and Soft Tissue-to-Bone Ratio in Children and Adolescents with Obesity

Madeline A. Czeck, William T. Juckett, Aaron S. Kelly, Donald R. Dengel

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1 Scopus citations


Objectives: To explore the total and regional muscle-to-bone ratio in children and adolescents with obesity and compare the muscle-to-bone ratio (MBR) and soft tissue-to-bone ratio (SBR) to their peers with normal weight or overweight. Study design: A total of 219 male and female pediatrics (mean age=12.3±2.5 years) participated in this study. Body composition was assessed with a total body dual X-ray absorptiometry. The MBR was calculated by dividing lean mass by bone mineral content. The SBR was determined by dividing the soft tissue mass (i.e., lean mass+fat mass) by bone mineral content. Differences in total and regional body composition measures between body mass index (BMI) percentile groups was assessed by ANOVA. Results: The obesity group had significantly higher MBR compared to the normal weight group for total (19.24±1.56 vs. 18.26±1.64), arm (17.11±1.67 vs. 15.88±1.81), and leg (18.41±1.68 vs. 16.62±1.55). Similarly, the obesity group had significantly higher MBR in the leg (18.41±1.68) compared to the overweight group (17.24±1.45). However, the overweight group was not significantly different from the normal weight or the obesity group for total and arm MBR. The total, arm, and leg SBR was significantly different between all BMI groups. Across the entire sample, MBR and SBR were negatively associated with high-density lipoprotein. SBR was positively associated with insulin, HOMA-IR, low-density lipoprotein, very low-density lipoprotein, triglycerides, and systolic blood pressure. Conclusions: Children with obesity had a higher MBR and SBR compared to their normal weight peers. In addition, there were significant associations between SBR, higher levels of insulin, atherogenic lipoproteins, and increased systolic blood pressure. Thus, SBR may be useful as a marker for increased cardiometabolic disease risk, though more research in this area is warranted.

Original languageEnglish (US)
Article number101360
JournalJournal of Clinical Densitometry
Issue number2
StatePublished - Apr 1 2023

Bibliographical note

Funding Information:
Research reported in this publication was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number ( R01HL110957 [to A.S.K.]).

Publisher Copyright:
© 2023 The International Society for Clinical Densitometry


  • Body composition ratios
  • Dual X-ray absorptiometry
  • Pediatric obesity


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