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A total of 2256 Spanish children and adolescents (aged 5\u201318) from rural areas participating in an extracurricular sport in different municipal sports schools participated in this study. Participants were divided into children (5\u201310\u00a0years) and adolescents (11\u201318\u00a0years), boys and girls, and across four different time points (2018, 2019, 2020, 2021). Data on anthropometric measures (BMI, MFR, appendicular skeletal muscle mass) and physical fitness (handgrip strength, cardiorespiratory fitness, and vertical jump) were collected. Boys who were overweight, but especially boys with obesity, had higher absolute handgrip strength in children and adolescents than their normal weight counterparts in 2020 and 2021. Boys and girls with normal weight presented higher cardiorespiratory fitness and vertical jump than their overweight and obese peers over the years. The MFR was directly correlated with the cardiorespiratory fitness and vertical jump variables, but not with handgrip strength, in boys and girls. The handgrip strength-to-BMI ratio in both sexes was positively correlated to the different physical fitness parameters.<\/jats:p><jats:p><jats:italic>\u00a0 Conclusion<\/jats:italic>: BMI, MFR, and handgrip strength-to-BMI can be used as health and physical fitness indicators in this population.<jats:table-wrap><jats:table><jats:tbody>\n                    <jats:tr>\n                      <jats:td colspan=\"2\"><jats:bold>What is Known:<\/jats:bold><jats:italic>\u2022 BMI is the main indicator commonly used as a proxy for obesity for many years. Nevertheless, it cannot differentiate between fat mass and fat-free mass.<\/jats:italic><jats:italic>\u2022 There are other indicators such as MFR and handgrip strength-to-BMI that might be more accurate and can serve to monitor the health and fitness of children and adolescents.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                    <jats:tr>\n                      <jats:td colspan=\"2\"><jats:bold>What is New:<\/jats:bold><jats:italic>\u2022 MFR showed a positive and significant correlation with cardiorespiratory fitness and vertical jump in both sexes. On the other hand, the handgrip strength-to-BMI presented a positive correlation with cardiorespiratory fitness, vertical jump, and handgrip strength.<\/jats:italic><jats:italic>\u2022 The use of these indicators obtained through different parameters of body composition and physical fitness can serve as a tool to identify the relationships of the paediatric population with physical fitness.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                  <\/jats:tbody><\/jats:table><\/jats:table-wrap><\/jats:p>","DOI":"10.1007\/s00431-023-04887-4","type":"journal-article","created":{"date-parts":[[2023,3,7]],"date-time":"2023-03-07T07:04:00Z","timestamp":1678172640000},"page":"2345-2357","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":40,"title":["Relationships of BMI, muscle-to-fat ratio, and handgrip strength-to-BMI ratio to physical fitness in Spanish children and adolescents"],"prefix":"10.1007","volume":"182","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1468-7398","authenticated-orcid":false,"given":"Samuel","family":"Manzano-Carrasco","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1741-5566","authenticated-orcid":false,"given":"Jorge","family":"Garcia-Unanue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5096-851X","authenticated-orcid":false,"given":"Eero A.","family":"Haapala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2029-1277","authenticated-orcid":false,"given":"Jose Luis","family":"Felipe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6296-6121","authenticated-orcid":false,"given":"Leonor","family":"Gallardo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9489-3249","authenticated-orcid":false,"given":"Jorge","family":"Lopez-Fernandez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,3,7]]},"reference":[{"key":"4887_CR1","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/S2352-4642(19)30323-2","volume":"4","author":"R Guthold","year":"2020","unstructured":"Guthold R, Stevens GA, Riley LM, Bull FC (2020) Global trends in insufficient physical activity among adolescents: a pooled analysis of 298 population-based surveys with 1\u00b76 million participants. 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