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

Background: 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. Methods: 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. Results: 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. Conclusions: 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.