Relative Importance of Lean and Fat Mass on Bone Mineral Density in Iranian Children and Adolescents

Body weight is made up of lean and fat mass and both are involved in growth and development. Impression of these two components in bone density accrual has been controversial. The aim of this study was to evaluate the relationship between fat and lean mass and bone density in Iranian children and adolescents. A cross-sectional study was performed on 472 subjects (235 girls, 237 boys) aged 9-18 years old in Fars Province. The participants' weight, height, waist circumference, stage of puberty, and level of physical activity were recorded. Bone Mineral Content (BMC), Bone Mineral Density (BMD), total body fat and lean mass were measured using dual-energy X-ray absorptiometry. Results showed that 12.2% of boys and 12.3% of girls were overweight and 5.5% of boys and 4.7% of girls were obese. Obese individuals had greater total body BMD (0.96 ± 0.11) than normal-weight ones (0.86 ± 0.11) (P < 0.001). We found the greatest correlation between total body BMD and total body lean mass (R = 0.78. P < 0.001) and the least correlation with total body fat percentage (R = 0.03, P = 0.44). Total lean mass in more active boys was 38.1 ± 10.9 and in less active boys was 32.3 ± 11.0 (P < 0.001). The results of multiple regression analysis showed that age and total body lean mass were independent factors of BMD in growing children and adolescents. These findings suggest that lean mass was the most important predictor of BMD in both genders. Physical activity appears to positively impact on lean mass and needs to be considered in physical education and health-enhancing programs in Iranian school children