ArticleNutrients2021
The "Fat but Fit" Paradigm and Bone Health in Young Adults: A Cluster Analysis.
Article in Nutrients, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed, 12 citations in OpenAlex.
- Population-Level Heterogeneity in People with Obesity: A Cross-Sectional Cluster Analysis of a Population-Based Registry.Journal of clinical medicine · 2026Article
- Distribution of Muscle Mass and Fat Mass to Identify the Risk of Sarcopenia and Sarcopenic Obesity in Adults via Machine Learning.Healthcare (Basel, Switzerland) · 2026Article
- The association between relative fat mass (RFM) and lumbar bone density in US adults: Insight from 2011-2018 NHANES.PloS one · 2025Article
- Clustered Cardiometabolic Risk and the "Fat but Fit Paradox" in Adolescents: Cross-Sectional Study.Nutrients · 2024Article
- Negative association between Body Roundness Index and bone mineral density: insights from NHANES.Frontiers in nutrition · 2024Article
- Independent and joint associations of cardiorespiratory fitness and weight status with health-related quality of life among Brazilian adolescents.Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2023Article
- Article
- Physical, Psychological, and Body Composition Differences between Active and Sedentary Adolescents According to the "Fat but Fit" Paradigm.International journal of environmental research and public health · 2022Article
- Novel Insight into the Relationship Between Muscle-Fat and Bone in Type 2 Diabetes Ranging from Normal Weight to Obesity.Diabetes, metabolic syndrome and obesity : targets and therapy · 2022Article
Corrections and comments
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Authors and funding
7 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The fat but fit paradox has suggested that obese individuals with good fitness levels have lower cardiometabolic risk compared to individuals with normal weight but lower fitness levels. This paradigm has not been explored in the context of bone health. The aim of this study was to test whether categories of fat but fit paradigm assessed by body fat percentage and handgrip strength holds up in young adults and to analyze the relationship between fat but fit categories and bone outcomes. Cluster cross-sectional analyses of data from 499 young adults aged 18 to 30 from Toledo and Cuenca, Spain were conducted. Body fat percentage, handgrip strength, bone mineral content (BMC), bone mineral density (BMD), and dietary nutrients such as, proteins, magnesium, calcium, phosphorus, potassium, and vitamin D were assessed. Cluster analysis of body fat percentage and handgrip z scores resulted in a classification of four clusters that could be interpreted according to Fat Unfit (FU), Unfat Unfit (UU), Fat Fit (FF) and Unfat Fit (UF) categories. ANCOVA models showed that young adults in clusters with higher handgrip strength levels (FF, UF) and with higher key bone nutrients levels (UF) had significantly higher total BMC values than their peers in the UU and FU cluster categories, after controlling for sex, age and height. This study provides two novel conclusions in relation to the fat but fit paradigm: first, it confirms the construct of the four clusters of body fat percentage and handgrip strength, and second, it reinforces the predictive validity of the fat but fit paradigm categories, indicating the positive effect, although it may not just be a causal relationship, of muscular strength and key bone nutrients on counteracting the negative effect of obesity on bone health.
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