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BACKGROUND: Skeletal muscle is key to motor development and represents a major metabolic end organ that aids glycaemic regulation. OBJECTIVES: To create gender-specific reference curves for fat-free mass (FFM) and appendicular (limb) skeletal muscle mass (SMMa) in children and adolescents. To examine the muscle-to-fat ratio in relation to body mass index (BMI) for age and gender. METHODS: Body composition was measured by segmental bioelectrical impedance (BIA, Tanita BC418) in 1985 Caucasian children aged 5-18.8 years. Skeletal muscle mass data from the four limbs were used to derive smoothed centile curves and the muscle-to-fat ratio. RESULTS: The centile curves illustrate the developmental patterns of %FFM and SMMa. While the %FFM curves differ markedly between boys and girls, the SMMa (kg), %SMMa and %SMMa/FFM show some similarities in shape and variance, together with some gender-specific characteristics. Existing BMI curves do not reveal these gender differences. Muscle-to-fat ratio showed a very wide range with means differing between boys and girls and across fifths of BMI z-score. CONCLUSIONS: BIA assessment of %FFM and SMMa represents a significant advance in nutritional assessment since these body composition components are associated with metabolic health. Muscle-to-fat ratio has the potential to provide a better index of future metabolic health.

Original publication




Journal article


Pediatr Obes

Publication Date





249 - 259


Bioelectrical impedance, centiles, fat-free mass, skeletal muscle mass, Absorptiometry, Photon, Adipose Tissue, Adolescent, Body Composition, Body Mass Index, Body Weight, Child, Child, Preschool, Electric Impedance, Female, Glucose, Homeostasis, Humans, Male, Muscle, Skeletal, Nutritional Status, Reference Values, United Kingdom