VOLUME 6 - NUMBER 2 - 2026

Relationships between musculoskeletal performance, body composition, and metabolic biomarkers in a pediatric population with obesity

  • Marco Paoletta, Giuseppina Rosaria Umano, Marco Giangrande, Orsola D’Onofrio, Sara Liguori, Antimo Moretti, Francesca Gimigliano, Emanuele Miraglia Del Giudice, Giovanni Iolascon
  • Original article, 92-97
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  • Background: Pediatric obesity is associated not only with metabolic alterations but also with impairments in musculoskeletal health, including reduced muscle function and impaired physical performance. However, the clinical relevance of muscle quality indices in this population remains insufficiently explored. Objective: To investigate the association between relative hand grip strength (HGS) and body mass index standard deviation score (BMI-SDS) in relation to body composition, metabolic profile, and functional performance in children and adolescents with overweight and obesity. Methods: This cross-sectional study included 71 children and adolescents aged 6–18 years evaluated between January and July 2025. We performed anthropometric, biochemical, dual-energy X-ray absorptiometry, and functional assessments. HGS was measured using a dynamometer, and relative muscle strength was expressed as the ratio between HGS and BMI-SDS (HGS/BMI-SDS). Participants were stratified according to the median HGS/BMI-SDS value. Correlations were analyzed using Spearman’s correlation coefficient. Results: Lower HGS/BMI-SDS was associated with higher fat-to-lean mass ratios (total body p=0.03; trunk p=0.04), higher waist-to-height ratio (p=0.01), and higher BMI-SDS (p=0.02). Metabolically, it was associated with higher non-HDL cholesterol (p=0.006) and a trend toward higher glycated hemoglobin (HbA1c) (p=0.07). HGS/BMI-SDS correlated positively with insulin sensitivity (Single-Point Insulin Sensitive Estimator (SPISE), r=0.20; p=0.04) and negatively with HbA1c (r=−0.35; p=0.02) and non-HDL cholesterol (r=−0.40; p=0.09). HGS was positively correlated with Pediatric Balance Scale scores (r=0.44; p=0.0002). Conclusions: Relative HGS is associated with body composition, metabolic profile, and functional balance in pediatric obesity. The HGS/BMI-SDS ratio may represent a simple and clinically useful marker of musculoskeletal and metabolic health in children and adolescents with overweight and obesity.

  • KEY WORDS: Pediatric obesity, sarcopenia, muscle strength, body mass index, body composition, metabolic syndrome.