Kushtrim Berisha¹, Visar Ganiu², Mitrichka Dzambazovska Stardelova³

https://doi.org/10.46733/PESH2514211b

Abstract

Childhood increases in body fat are often accompanied by a decline in physical functioning, but we still do not know clearly which anthropometric indicators predict muscular fitness most accurately in school-aged children. This study aimed to compare the relationship between several commonly used and newer bodycomposition indices and children’s performance in various muscular fitness tasks. The study involved children aged 6 to 10 years, who underwent standard anthropometric measurements together with tests assessing muscular strength, power, and local endurance. The indices examined in the analysis included BMI, WHtR, the Conicity Index (C-index), the Tri-Ponderal Mass Index (TMI), Relative Fat Mass for children (RFMp), and the ratio of handgrip strength to BMI (Grip-to-BMI). Multiple linear regression was applied to evaluate the extent to which each index explained variations in muscular fitness outcomes. The findings of this study show that indicators that integrate the relationship between muscle strength and body mass, as well as those that more accurately assess adipose tissue, are the most useful for predicting motor fitness in children. TMI and RFMp, which reflect adiposity more accurately, also demonstrated stable associations with strength and endurance results. Taken together, the results indicate that indices that blend muscular strength with body mass, or those that offer a more precise estimate of body fat, provide clearer insight into children’s motor fitness. These observations may help improve early screening practices and support the design of more individualized intervention programs, in which Grip-to-BMI, TMI, and RFMp could.

Keywords: adiposity, muscular fitness, TMI, RFMp, Grip-to-BMI

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References

Ashwell, M. & Gibson, S. Waist-to-height ratio as an indicator of “early health risk”: Simpler and more predictive than using a “matrix” based on BMI and waist circumference. BMJ Open, 6:e010159, 2016.

Black, N.E.; Vehrs, P.R.; Fellingham, G.W.; George, J.D. & Hager, R. Prediction of VO₂max in children and adolescents using

exercise testing and physical activity questionnaire data. Res. Q. Exerc. Sport, 87(1), 89-100, 2016.

Cadenas-Sanchez, C., Intemann, T., Artero, E. G., Sánchez-López, M., Moliner-Urdiales, D., Castro-Piñero, J., … & Ortega, F. B. (2017). Assessing physical FITness In PREschool children: fitness reference standards from the PREFIT Project. Medicine and Science in Sports and Exercise.

Castro-Piñero, J., Artero, E. G., España-Romero, V., Ortega, F. B., Sjöström, M., Suni, J., & Ruiz, J. R. (2010). Criterion-related validity of field-based fitness tests in youth: a systematic review. British journal of sports medicine, 44(13), 934-943.

Chen, R., Ji, L., Ma, L., Chen, Y., Duan, J., Ma, M., Sun, Y., Tai, J., & Meng, L. (2023). Accuracy and capability of tri-ponderal mass index in assessing cardio-metabolic risk factors in Chinese children and adolescents aged 3 to 17 years, compared with body mass index. Chinese medical journal, 136(11), 1339–1348. https://doi.org/10.1097/CM9.000000000000

Cohen, J. (2013). Statistical power analysis for the behavioral sciences. Academic press.

Cole, T. J., & Green, P. J. (1992). Smoothing reference centile curves: the LMS method and penalized likelihood. Statistics in medicine, 11(10), 1305-1319.

Cole, T. J., Freeman, J. V., & Preece, M. A. (1998). British 1990 growth reference centiles for weight, height, body mass index and head circumference fitted by maximum penalized likelihood. Statistics in medicine, 17(4), 407-429.

De Oliveira, M. R., Seabra, A., Freitas, D., Eisenmann, J. C., & Maia, J. (2014). Physical fitness percentile charts for children aged 6-10 from Portugal. J Sports Med Phys Fitness, 54(6), 780-792.

Donnelly, J. E., Hillman, C. H., Castelli, D., Etnier, J. L., Lee, S., Tomporowski, P., … & Szabo-Reed, A. N. (2016). Physical activity, fitness, cognitive function, and academic achievement in children: a systematic review. Medicine and science in sports and exercise, 48(6), 1197.

Figueiredo, A. J., Gonçalves, C. E., Coelho E Silva, M. J., & Malina, R. M. (2009). Youth soccer players, 11–14 years: maturity, size, function, skill and goal orientation. Annals of human biology, 36(1), 60-73.

Giuriato, M., Codella, R., Lovecchio, N., Carnevale Pellino, V., Vandoni, M., & Nevill, A. M. (2021). Speed agility trends in children according to growth: A new approach to evaluate speed agility in children. Annals of Human Biology, 48(4), 271-279.

Giuriato, M., Kawczynski, A., Mroczek, D., Lovecchio, N., & Nevill, A. (2021). Allometric association between physical fitness test results, body size/shape, biological maturity, and time spent playing sports in adolescents. PloS one, 16(4), e0249626.

Gontarev, S., Kalac, R., Velickovska, L. A., & Zivkovic, V. (2018). Physical Fitness Reference Standards in Macedonian Children And Adolescent: The Makfit Study. Nutricion hospitalaria.

Haga, M. (2008). The relationship between physical fitness and motor competence in children. Child: care, health and development, 34(3), 329-334.

Howley, E. T. (2001). Type of activity: resistance, aerobic and leisure versus occupational physical activity. Medicine and science in sports and exercise, 33(6 Suppl), S364-9.

Jeffreys, I. (2011). A task-based approach to developing context-specific agility. Strength & Conditioning Journal, 33(4), 52-59.

Kolimechkov, S., Petrov, L., & Alexandrova, A. (2019). Alpha-fit test battery norms for children and adolescents from 5 to 18 years of age obtained by a linear interpolation of existing European physical fitness references. European Journal of Physical Education and Sport Science.

Lang, J. J., Zhang, K., Agostinis-Sobrinho, C., Andersen, L. B., Basterfield, L., Berglind, D., … & Fraser, B. J. (2023). Top 10 international priorities for physical fitness research and surveillance among children and adolescents: a Twin-Panel Delphi study. Sports Medicine, 53(2), 549-564.

Lee, H.J.; Shim, Y.S.; Yoon, J.S.; Jeong, H.R.; Kang, M.J. & Hwang, I.T. Distribution of waist-to-height ratio and cardiometabolic risk in children and adolescents: A population-based study. Sci. Rep., 11:9524, 2021.

Llagjeviq-Govori, A., Gontarev, S., Saiti, A., Novacevska, S., Dimitrievska, J. K., & Nedelkovski, V. Association between body mass index, muscle-to-fat ratio, and handgrip strength-to-BMI ratio with physical fitness in children from North Macedonia. Nutricion hospitalaria.

Lo, K.; Huang, Y.Q.; Shen, G.; Huang, J.Y.; Liu, L.; Yu, Y.L.; Chen, C.L. & Feng, Y.Q. Effects of waist-to-height ratio, waist circumference, and body mass index on the risk of chronic diseases, all-cause, cardiovascular, and cancer mortality. Postgrad. Med. J., 97:306-311, 2021.

Lubans, D. R., Morgan, P. J., Cliff, D. P., Barnett, L. M., & Okely, A. D. (2010). Fundamental movement skills in children and adolescents: review of associated health benefits. Sports medicine, 40, 1019-1035.

Malina, R. M., Bouchard, C., & Bar-Or, O. (2004). Growth, maturation, and physical activity. Human kinetics.

Manzano-Carrasco, S., Garcia-Unanue, J., Haapala, E. A., Felipe, J. L., Gallardo, L., & Lopez-Fernandez, J. (2023). Relationships of BMI, muscle-to-fat ratio, and handgrip strength-to-BMI ratio to physical fitness in Spanish children and adolescents. European journal of pediatrics, 182(5), 2345–2357. https://doi.org/10.1007/s00431-023-04887-4

Milanovic, I., Janic, S. R., Zivkovic, M. Z., & Mirkov, D. M. (2019). Health-related physical fitness levels and prevalence of obesity in Serbian elementary schoolchildren. Nutrición hospitalaria: Organo oficial de la Sociedad española de nutrición parenteral y enteral, 36(2), 253-260.

Niederer, I., Kriemler, S., Gut, J., Hartmann, T., Schindler, C., Barral, J., & Puder, J. J. (2011). Relationship of aerobic fitness and motor skills with memory and attention in preschoolers (Ballabeina): a cross-sectional and longitudinal study. BMC pediatrics, 11(1), 1-9.

Oja, L., & Jürimäe, T. (1997). Assessment of motor ability of 4-and 5-year-old children. American Journal of Human Biology: The Official Journal of the Human Biology Association, 9(5), 659-664.

Ortega, F. B. (2015). Cadenas-Sá nchez C, Sá nchez-Delgado G, Mora-Gonzá lez J, Martınez-Té llez B, Artero EG, et al. Systematic review and proposal of a field-based physical fitness-test battery in preschool children: the PREFIT battery. Sports Med, 45(4), 533-55.

Ortega, F. B., Artero, E. G., Ruiz, J. R., Vicente-Rodriguez, G., Bergman, P., Hagströmer, M., … & Castillo, M. J. (2008). Reliability of health-related physical fitness tests in European adolescents. The HELENA Study. International journal of obesity, 32(5), S49-S57.

Ortega, F. B., Leskošek, B., Gil-Cosano, J. J., Mäestu, J., Tomkinson, G. R., Ruiz, J. R., … & Jurak, G. (2023). European fitness landscape for children and adolescents: updated reference values, fitness maps and country rankings based on nearly 8 million test results from 34 countries gathered by the FitBack network. British journal of sports medicine, 57(5), 299-310.

Ortega, F. B., Ruiz, J. R., Castillo, M. J., & Sjöström, M. (2008). Physical fitness in childhood and adolescence: a powerful marker of health. International journal of obesity, 32(1), 1-11.

Ortega, F. B., Ruiz, J. R., Castillo, M. J., Moreno, L. A., González-Gross, M., Wärnberg, J., … & Avena Group. (2005). Low level of physical fitness in Spanish adolescents. Relevance for future cardiovascular health (AVENA study). Revista Española de Cardiología (English Edition), 58(8), 898-909.

Ortega, F. B., Ruiz, J. R., Labayen, I., Lavie, C. J., & Blair, S. N. (2018). The Fat but Fit paradox: what we know and don’t know about it. British Journal of Sports Medicine, 52(3), 151-153.

Paek, J.K.; Kim, J.; Kim, K. & Lee, S.Y. Usefulness of relative fat mass in estimating body adiposity in Korean adult population. Endocr. J., 66:723-729, 2019.

Paineau, D., Chiheb, S., Banu, I., Valensi, P., Fontan, J. E., Gaudelus, J., … & Boulier, A. (2008). Comparison of field methods to estimate fat mass in children. Annals of human biology, 35(2), 185-197.

Palacio-Agüero, A., Díaz-Torrente, X., & Quintiliano Scarpelli Dourado, D. (2020). Relative handgrip strength, nutritional status and abdominal obesity in Chilean adolescents. PloS one, 15(6), e0234316. https://doi.org/10.1371/journal.pone.0234316

Palou, P., Muntaner-Mas, A., Cantallops, J., Borràs, P. A., Labayen, I., Jiménez-Pavón, D., … & Vidal-Conti, J. (2019). A single question of parent-reported physical activity levels estimates objectively measured physical fitness and body composition in preschool children: the PREFIT project. Frontiers in Psychology, 10, 1585.

Rodriguez, G., Moreno, L. A., Blay, M. G., Blay, V. A., Fleta, J., Sarria, A., & Bueno, M. (2005). Body fat measurement in adolescents: comparison of skinfold thickness equations with dual-energy X-ray absorptiometry. European journal of clinical nutrition, 59(10), 1158-1166.

Ross, R.; Blair, S.N.; Arena, R.; Church, T.S.; Després, J.-P.; Franklin, B.A. & Lavie, C.J. Importance of assessing cardiorespiratory fitness in clinical practice: A case for fitness as a clinical vital sign: A scientific statement from the American Heart Association. Circulation, 134:e653-e699, 2016.

Ruiz, J. R., Castro-Piñero, J., España-Romero, V., Artero, E. G., Ortega, F. B., Cuenca, M. M., … & Castillo, M. J. (2011). Field-based fitness assessment in young people: the ALPHA health-related fitness test battery for children and adolescents. British journal of sports medicine, 45(6), 518-524.

Ruiz, J. R., Ramirez-Lechuga, J., Ortega, F. B., Castro-Pinero, J., Benitez, J. M., Arauzo-Azofra, A., … & HELENA Study Group. (2008). Artificial neural network-based equation for estimating VO2max from the 20 m shuttle run test in adolescents. Artificial intelligence in medicine, 44(3), 233-245.

Ruiz, J.R.; Castro-Piñero, J.; Artero, E.G.; Ortega, F.B.; Sjöström, M.; Suni, J. & Castillo, M.J. Predictive validity of health-related fitness in youth: A systematic review. Br. J. Sports Med., 43:909-923, 2009.

Ruiz, J.R.; Sui, X.; Lobelo, F.; Lee, D.C.; Morrow, J.R.; Jackson, A.W. & Blair, S.N. Muscular strength and adiposity as predictors of adulthood cancer mortality in men. Cancer Epidemiol. Biomarkers Prev., 18(5):1468-1476, 2009.

Schmidt, R. A., & Lee, T. D. (2005). Motor control and learning: A behavioral emphasis: Human kinetics Champaign.

Shen, S.; Lu, Y.; Qi, H.; Li, F.; Shen, Z.; Wu, L. & Yao, W. Waist-to-height ratio is an effective indicator for comprehensive cardiovascular health. Sci. Rep., 7:43046, 2017.

Sheppard, J. M., & Young, W. B. (2006). Agility literature review: Classifications, training and testing. Journal of sports sciences, 24(9), 919-932.

Steffl, M.; Chrudimsky, J. & Tufano, J.J. Using relative handgrip strength to identify children at risk of sarcopenic obesity. PLoS One, 12(5):e0177006, 2017.

Sylejmani, B.; Maliqi, A.; Veseli, R.; Gontarev, S. & Georgiev, G. Standing-long-jump test application in identifying female adolescents at risk of sarcopenic obesity. Int. J. Morphol., 42(2), 2024.

The Finnish National Board of Education. Move! – monitoring system for physical functional capacity, 2021. Available: www.oph.fi/en/move [Accessed 12 May 2022]

Tomkinson, G. R., Carver, K. D., Atkinson, F., Daniell, N. D., Lewis, L. K., Fitzgerald, J. S., … & Ortega, F. B. (2018). European normative values for physical fitness in children and adolescents aged 9–17 years: results from 2 779 165 Eurofit performances representing 30 countries. British journal of sports medicine, 52(22), 1445-1456.

Tomkinson, G. R., Lang, J. J., Tremblay, M. S., Dale, M., LeBlanc, A. G., Belanger, K., … & Léger, L. (2017). International normative 20 m shuttle run values from 1 142 026 children and youth representing 50 countries. British journal of sports Medicine, 51(21), 1545-1554.

Vicente-Rodríguez, G., Rey-López, J. P., Ruíz, J. R., Jiménez-Pavón, D., Bergman, P., Ciarapica, D., … & HELENA Study Group. (2011). Interrater reliability and time measurement validity of speed–agility field tests in adolescents. The Journal of Strength & Conditioning Research, 25(7), 2059-2063.

Wang, H.; Liu, A.; Zhao, T.; Gong, X.; Pang, T.; Zhou, Y. & Teng, W. Comparison of anthropometric indices for predicting the risk of metabolic syndrome and its components in Chinese adults: A prospective, longitudinal study. BMJ Open, 7:e016062, 2017.

Wang, Y.; Chen, S.; Lavie, C.J.; Zhang, J. & Sui, X. An overview of non-exercise estimated cardiorespiratory fitness: Estimation equations, cross-validation, and application. J. Sci. Sport Exerc., 1:38-53, 2019.

Woolcott, O.O. & Bergman, R.N. Relative fat mass (RFM) as a new estimator of whole-body fat percentage—A cross-sectional study in American adult individuals. Sci. Rep., 8:10980, 2018.

Young, W. B., James, R., & Montgomery, I. (2002). Is muscle power related to running speed with changes of direction?. Journal of sports medicine and physical fitness, 42(3), 282-288.

Zadarko-Domaradzka, M., Sobolewski, M., & Zadarko, E. (2023). Comparison of Several Anthropometric Indices Related to Body Fat in Predicting Cardiorespiratory Fitness in School-Aged Children – A Single-Center Cross-Sectional Study. Journal of Clinical Medicine, 12(19), 6226.

Zaqout, M., Vyncke, K., Moreno, L. A., De Miguel-Etayo, P., Lauria, F., Molnar, D., … & Michels, N. (2016). Determinant factors of physical fitness in European children. International journal of public health, 61, 573-582.