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Appendicular lean mass (ALM) was measured from previously obtained dual energy x\u2010ray absorptiometry (DXA) scans and used to calculate ALM index (ALM (kg)\/weight (kg)\u2009\u00d7\u2009100). Metabolic outcomes included MRI\u2010based fat distribution (hepatic fat fraction [HFF], visceral and subcutaneous fat mass), fasting and glucose\u2010stimulated laboratory assessments of insulin sensitivity, secretion, and glycemia, as obtained in the parent studies. The relationships between ALM index and metabolic outcomes were studied using multivariable linear regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      ALM was calculated in 304 adolescents\u2014228 with OO (mean age 15.2\u2009\u00b1\u20092.4\u2009years, Tanner stage 4.5\u2009\u00b1\u20091.1, 88.2% female) and 76 HW (13.7\u2009\u00b1\u20092.6\u2009years, Tanner stage 3.4\u2009\u00b1\u20091.2, 59.2% female). Mean ALM index was significantly lower in OO than HW (23.7%\u2009\u00b1\u20092.9% vs. 31.8%\u2009\u00b1\u20094.5%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). ALM index had a significant association with square\u2010root\u2010transformed HFF (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009\u22120.09, SE\u2009=\u20090.03,\n                      <jats:italic>t<\/jats:italic>\n                      \u2010value\u2009=\u2009\u22122.92,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). ALM index was negatively associated with fasting C\u2010peptide (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01) but not with other markers of insulin sensitivity\/glycemia.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Low ALM index had a significant association with hepatic steatosis in adolescents with OO, bringing attention to the interplay between muscle mass and hepatic steatosis in this population. This finding has potential implications for optimal management of metabolic dysfunction\u2010associated steatotic liver disease (MASLD), while the relationship between muscle mass and insulin sensitivity\/glycemia requires further attention.<\/jats:p>\n                    <jats:p>\n                      <jats:bold>Trail Registration:<\/jats:bold>\n                      ClinicalTrials.gov identifiers: NCT03717935 (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT03717935\">https:\/\/clinicaltrials.gov\/study\/NCT03717935<\/jats:ext-link>\n                      ), NCT03041129 (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT03041129\">https:\/\/clinicaltrials.gov\/study\/NCT03041129<\/jats:ext-link>\n                      ), NCT02157974 (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT02157974\">https:\/\/clinicaltrials.gov\/study\/NCT02157974<\/jats:ext-link>\n                      ), NCT01775813 (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT01775813\">https:\/\/clinicaltrials.gov\/study\/NCT01775813<\/jats:ext-link>\n                      ) and NCT03919929 (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT03919929\">https:\/\/clinicaltrials.gov\/study\/NCT03919929<\/jats:ext-link>\n                      )\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ijpo.70108","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:34:26Z","timestamp":1776818066000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Relative Skeletal Muscle Mass Is Associated With Hepatic Steatosis in Adolescents With Overweight and Obesity"],"prefix":"10.1111","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3061-1449","authenticated-orcid":false,"given":"Julia M.","family":"Boster","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Pediatric Liver Center, Digestive Health Institute and Section of Pediatric Gastroenterology, Hepatology &amp; 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