ArticleScientific reports2026
Independent association between relative fat mass and total bone mineral density in U.S. adolescents: a cross-sectional study adjusting for Appendicular Lean Mass Index.
Article in Scientific reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
The relationship between adiposity and bone health, often referred to as the "obesity paradox," remains a subject of debate. Relative fat mass (RFM) has recently emerged as a more accurate surrogate for body fat percentage than the Body Mass Index (BMI). However, the independent association between RFM and bone mineral density (BMD) in the adolescent population, particularly after rigorously accounting for lean mass, remains ambiguous, particularly concerning the independent metabolic influence of adiposity. This cross-sectional study evaluated 3,933 adolescents (aged 12-19 years) from the 2011-2018 National Health and Nutrition Examination Survey (NHANES). Multiple imputation was applied to manage missing covariates. We employed weighted multivariate linear regression to assess the association between RFM and total BMD. Appendicular Lean Mass Index (ALMI) was integrated as a core covariate to isolate the metabolic influence of adiposity from its mechanical loading effects. In the unadjusted model, RFM showed no significant correlation with total BMD (β = 0.001, P = 0.122). However, after adjusting for ALMI and other potential confounders, a significant negative association emerged. In the fully adjusted model, each one-unit increase in RFM was associated with a 0.005 g/cm
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