Association between skeletal muscle index and the risk of short stature in school-age children

doi:10.11852/zgetbjzz2025-0375

Abstract

Abstract: Objective To investigate the independent effect of skeletal muscle index (SMI) on the risk of short stature in school-age children, and to analyze the moderating effects of age and sex. Methods Based on health check-up data from the Children's Hospital of Soochow University (2016—2022), 1 324 children aged 6 - 12 years were included (331 with short stature and 993 controls).Body composition was measured using bioelectrical impedance analysis (BIA), and SMI was calculated as skeletal muscle mass/height².Multivariable logistic regression analysis was performed to assess the association between SMI and short stature risk, adjusting for age, sex, percentage of body fat (PBF), and BMI-for-age Z-score (BAZ).Sensitivity analysis was conducted using quartile grouping and restricted cubic splines (RCS) to examine the dose-response relationship.Subgroup analysis was performed to test the interaction effects of age and sex. Results For every 1-unit increase in SMI, the risk of short stature decreased by 78% (OR=0.22, 95%CI: 0.14 - 0.35).After full adjustment, the risk in the highest quartile (Q4) was 87% lower than that in the lowest quartile (Q1) (OR=0.13, 95%CI: 0.08 - 0.21), with a significant dose-response trend (P_{for trend}<0.001).RCS analysis revealed a linear negative correlation between SMI and short stature risk (P_nonlinear=0.307).Subgroup analysis indicated that the protective effect of SMI was significantly stronger in boys than in girls (P_for _interaction<0.01), while no significant moderating effect of age was observed (P_for _interaction＞0.05). Conclusions SMI is an independent protective factor against the risk of short stature in children, with its effect showing sex heterogeneity, suggesting the critical role of skeletal muscle mass in height growth, particularly in boys.This study supports the inclusion of SMI in the child growth assessment system, providing a basis for the early identification of high-risk populations and the implementation of sex-specific interventions.

Key words: short stature, skeletal muscle index, body composition analysis, child health

摘要： 目的探讨骨骼肌指数(SMI)对学龄期儿童矮小风险的独立影响,并分析年龄与性别的调节作用。方法基于苏州市儿童医院2016—2022年健康体检数据,纳入6~12岁儿童1 324例(矮小331例,对照组993例)。采用生物电阻抗分析(BIA)测定体成分,计算SMI(骨骼肌质量/身高²)。通过多因素logistic回归分析SMI与矮小风险的关联,并调整年龄、性别、体脂百分比(PBF)及年龄别BMI的Z分数(BAZ)。敏感性分析采用四分位数分组及限制性立方样条(RCS)验证剂量反应关系,通过亚组分析检验年龄与性别的交互效应。结果 SMI每增加1单位,矮小风险降低78%(OR=0.22,95%CI:0.14~0.35);完全调整后最高四分位组(Q4)的矮小风险较最低四分位组(Q1)降低87%(OR=0.13, 95%CI:0.08~0.21),且剂量反应趋势显著(P_趋势<0.001)。RCS显示SMI与矮小风险呈线性负相关(非线性P值=0.307)。亚组分析显示,SMI的保护作用男性中显著强于女性(P_交互<0.01),而年龄无显著调节效应(P_交互>0.05)。结论 SMI是儿童矮小风险的独立保护因子,其效应具有性别异质性,提示男性儿童骨骼肌质量对身高生长的关键作用。本研究支持将SMI纳入儿童生长评估体系,为早期识别矮小高危人群及实施性别差异化干预提供依据。

关键词: 矮小症, 骨骼肌指数, 体成分分析, 儿童健康

CLC Number:

R179.1

ZHAO Huijuan, ZHAO Lu, LI Chenyi, ZHOU Yi, WANG Yan, CAI Shizhong. Association between skeletal muscle index and the risk of short stature in school-age children[J]. Chinese Journal of Child Health Care, 2026, 34(1): 53-58.

赵慧娟, 赵璐, 李晨怡, 周亦, 王艳, 蔡世忠. 骨骼肌指数与学龄期儿童矮小风险的关联研究[J]. 中国儿童保健杂志, 2026, 34(1): 53-58.

References

[1] Korhonen PE, Kautiainen H, Eriksson JG.The shorter the person, the higher the blood pressure: A birth cohort study[J].J Hypertens, 2017, 35(6):1170-1177.
[2] Bosy-Westphal A, Plachta-Danielzik S, Dörhöfer RP, et al.Short stature and obesity: Positive association in adults but inverse association in children and adolescents[J].Br J Nutr, 2009, 102(3):453-461.
[3] Casaña-Granell S, Lacomba-Trejo L, Montoya-Castilla I, et al.Adolescence and short stature: Factors in adjustment to the diagnosis[J].Qual Life Res, 2021, 30(8):2275-2286.
[4] Weber DR, Leonard MB, Zemel BS.Body composition analysis in the pediatric population[J].Pediatr Endocrinol Rev, 2012, 10(1):130-139.
[5] Bufano A, Cartocci A, Benenati N, et al.New specific skeletal muscle mass index cut-offs for the assessment of sarcopenia in patients with severe obesity[J].Front Endocrinol (Lausanne), 2024, 15:1369584.
[6] Prins M, Hawkesworth S, Wright A, et al.Use of bioelectrical impedance analysis to assess body composition in rural Gambian children[J].Eur J Clin Nutr, 2008, 62(9):1065-1074.
[7] Janssen I, Heymsfield SB, Baumgartner RN, et al.Estimation of skeletal muscle mass by bioelectrical impedance analysis[J].J Appl Physiol (1985), 2000, 89(2):465-471.
[8] 李辉,季成叶,宗心南,等.中国0～18岁儿童、青少年体块指数的生长曲线[J].中华儿科杂志,2009,47(7):493-498.
Li H, Ji CY, Zong XN, et al.Body mass index growth curves for Chinese children and adolescents aged 0 to 18 years[J].Chin J Pediatr,2009,47(7):493-498.(in Chinese)
[9] Wu D, Shi L, Xu Q, et al.The different effects of skeletal muscle and fat mass on height increment in children and adolescents aged 6-11 years: A cohort study from China[J].Front Endocrinol (Lausanne), 2022, 13:915490.
[10] Kraemer WJ, Ratamess NA, Hymer WC, et al.Growth hormone(s), testosterone, insulin-like growth factors, and cortisol: Roles and integration for cellular development and growth with exercise[J].Front Endocrinol (Lausanne), 2020, 11:33.
[11] Yang G, Yang Q, Li Y, et al.Association between the growth hormone/insulin-like growth factor-1 axis and muscle density in children and adolescents of short stature[J].Front Endocrinol (Lausanne), 2022, 13:920200.
[12] Bresciani E, Rizzi L, Coco S, et al.Growth hormone secretagogues and the regulation of calcium signaling in muscle[J].Int J Mol Sci, 2019, 20(18):4361.
[13] López-Alvarenga JC, Montesinos-Cabrera RA, Velázquez-Alva C, et al.Short stature is related to high body fat composition despite body mass index in a Mexican population[J].Arch Med Res, 2003, 34(2):137-140.
[14] Pataky MW, Dasari S, Michie KL, et al.Impact of biological sex and sex hormones on molecular signatures of skeletal muscle at rest and in response to distinct exercise training modes[J].Cell Metab, 2023, 35(11):1996-2010.e6.
[15] Kraemer WJ, Ratamess NA, Nindl BC.Recovery responses of testosterone, growth hormone, and IGF-1 after resistance exercise[J].J Appl Physiol, 2017, 122(3):549-558.
[16] Urban RJ.Growth hormone and testosterone: Anabolic effects on muscle[J].Horm Res Paediatr, 2011, 76 Suppl 1:81-83.
[17] Griggs RC, Kingston W, Jozefowicz RF, et al.Effect of testosterone on muscle mass and muscle protein synthesis[J].J Appl Physiol (1985), 1989, 66(1):498-503.
[18] Anderson LJ, Liu H, Garcia JM.Sex differences in muscle wasting[M]//Mauvais-Jarvis F.Sex and gender factors affecting metabolic homeostasis, diabetes and obesity.Cham: Springer International Publishing, 2017:153-197.
[19] Mauvais-Jarvis F, Clegg DJ, Hevener AL.The role of estrogens in control of energy balance and glucose homeostasis[J].Endocr Rev, 2013, 34(3):309-338.
[20] Alonso LC, Rosenfield RL.Oestrogens and puberty[J].Best Pract Res Clin Endocrinol Metab, 2002, 16(1):13-30.
[21] Mitamura R, Yano K, Suzuki N, et al.Diurnal rhythms of luteinizing hormone, follicle-stimulating hormone, testosterone, and estradiol secretion before the onset of female puberty in short children[J].J Clin Endocrinol Metab, 2000, 85(3):1074-1080.
[22] 中华医学会儿科学分会内分泌遗传代谢学组.矮身材儿童诊治指南[J].中华儿科杂志, 2008, 46(6): 428-430.
Subspecialty Group of Endocrinologic, Hereditary and Metabolic Diseases, Society of Pediatrics, Chinese Medical Association.Guidelines for diagnosis and treatment of children with short stature[J].Chin J Pediatr, 2008, 46(6):428-430.(in Chinese)
[23] Mauras N, Ross J, Mericq V.Management of growth disorders in puberty: GH, GnRHa, and aromatase inhibitors: A clinical review[J].Endocr Rev, 2023, 44(1):1-13.
[24] Maghnie M, Ranke MB, Geffner ME, et al.Safety and efficacy of pediatric growth hormone therapy: Results from the full KIGS cohort[J].J Clin Endocrinol Metab, 2022, 107(12):3287-3301.
[25] Zheng X, Liu X, Guo Y, et al.Physical exercise and epigenetic modifications in skeletal muscle, brain, and heart[J].Epigenetics Chromatin, 2025, 18:12.
[26] Deldicque L.Protein intake and exercise-induced skeletal muscle hypertrophy: An update[J].Nutrients, 2020, 12(7):2023.
[27] Ito T, Sugiura H, Ito Y, et al.Relationship between the skeletal muscle mass index and physical activity of Japanese children: A cross-sectional, observational study[J].PLoS One, 2021,16(5):e0251025.
[28] Davis JA, Mohebbi M, Collier F, et al.Diet quality and a traditional dietary pattern predict lean mass in Australian women: Longitudinal data from the Geelong Osteoporosis Study[J].Prev Med Rep,2021,21:101316.
[29] Davis JA, Mohebbi M, Collier F, et al.The role of diet quality and dietary patterns in predicting muscle mass and function in men over a 15-year period[J].Osteoporos Int,2021,32(11):2193-2203.