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. 2025 Dec;20(12):e70051.
doi: 10.1111/ijpo.70051. Epub 2025 Aug 29.

Development and Application of Children's Sex- and Age-Specific Fat-Mass and Muscle-Mass Reference Curves From Dual-Energy X-Ray Absorptiometry Data for Predicting Cardiometabolic Risk

Stephanie Tanasia Saputra  1 , Andraea Van Hulst  2 , Mélanie Henderson  3   4   5 , Simone Brugiapaglia  1 , Claudia Faustini  1 , Lisa Kakinami  1   6
Affiliations

Development and Application of Children's Sex- and Age-Specific Fat-Mass and Muscle-Mass Reference Curves From Dual-Energy X-Ray Absorptiometry Data for Predicting Cardiometabolic Risk

Stephanie Tanasia Saputra et al. Pediatr Obes. 2025 Dec.

Abstract

Background: A dual-energy x-ray absorptiometry (DXA)-derived phenotype classification based on fat mass and muscle mass has been developed for adults. We extended this to a paediatric population.

Methods: Children's (≤ 17 years) DXA data in NHANES (n = 6120) were used to generate sex- and age-specific deciles of appendicular skeletal muscle mass index and fat mass index with the Lambda Mu Sigma method. Four phenotypes (high [H] or low [L], adiposity [A] and muscle mass [M]: HA-HM, HA-LM, LA-HM, LA-LM) were identified based on being above/below the median compared to same-sex and same-age peers. These reference curves were applied to the QUALITY cohort (n = 630, 8-10 years of age in 2005) to assess whether the phenotypes correctly identified cardiometabolic risk at baseline, follow-up (2008-2010), and their longitudinal changes. Multiple linear regression models were adjusted for age, sex, and Tanner's stage.

Results: Compared to the LA-HM reference group, the HA-HM phenotype was associated with less favourable HDL, triglycerides, and HOMA-IR at baseline and first follow-up, but not in their changes. The HA-LM phenotype was associated with less favourable HOMA-IR at baseline and first follow-up.

Conclusions: Results suggest that phenotypes based on fat and muscle mass may have clinical utility in children and should be further investigated.

Keywords: adiposity; cardiometabolic risk; dual‐energy x‐ray absorptiometry; reference curves; youth.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
ASMI and FMI reference curves for female (A, B) and male (C, D) age 8–17 years.
See this image and copyright information in PMC

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