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We aimed to identify critical periods for body composition changes during childhood and adolescence in relation to respiratory outcomes in adolescents.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In a population-based prospective cohort study, we measured body mass index, fat mass index (FMI), lean mass index (LMI) and the ratio of android fat mass divided by gynoid fat mass (A\/G ratio) by dual-energy X-ray absorptiometry at 6, 10 and 13 years. At 13 years, lung function was measured by spirometry, and current asthma was assessed by questionnaire.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Most prominently and consistently, higher FMI and A\/G ratio at age 13 years were associated with lower forced expiratory volume in 1 s (FEV<jats:sub>1<\/jats:sub>)\/forced vital capacity (FVC) and forced expiratory flow after exhaling 75% of FVC (FEF<jats:sub>75<\/jats:sub>) (range Z-score difference \u22120.13 (95% CI \u22120.16 to \u20130.10) to \u22120.08 (95% CI \u22120.11 to \u20130.05) per SD score increase), and higher LMI at all ages was associated with higher FEF<jats:sub>75<\/jats:sub>(range Z-score difference 0.05 (95% CI 0.01 to 0.08) to 0.09 (95% CI 0.06 to 0.13)). Between the ages of 6 and 13 years, normal to high FMI and A\/G ratio were associated with lower FEV<jats:sub>1<\/jats:sub>\/FVC and FEF<jats:sub>75<\/jats:sub>(range Z-score difference \u22120.20 (95% CI \u22120.30 to \u20130.10) to \u22120.17 (95% CI \u22120.28 to \u20130.06)) and high to high LMI with higher FEF<jats:sub>75<\/jats:sub>(range Z-score difference0.32 (95% CI 0.23 to 0.41)). Body composition changes were not associated with asthma.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Adolescents with higher total and abdominal fat indices may have impaired lung function, while those with a higher lean mass during childhood and adolescence may have better small airway function. Public health measures should focus on a healthy body composition in adolescents to minimise respiratory morbidity.<\/jats:p><\/jats:sec>","DOI":"10.1136\/thorax-2023-220014","type":"journal-article","created":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T05:42:29Z","timestamp":1704865349000},"page":"448-456","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Body composition and respiratory outcomes in children: a population-based prospective cohort study"],"prefix":"10.1136","volume":"79","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9822-3103","authenticated-orcid":false,"given":"Tong","family":"Wu","sequence":"first","affiliation":[]},{"given":"Susana","family":"Santos","sequence":"additional","affiliation":[]},{"given":"Hugo G","family":"Quezada\u2010Pinedo","sequence":"additional","affiliation":[]},{"given":"Meike W.","family":"Vernooij","sequence":"additional","affiliation":[]},{"given":"Vincent W.V.","family":"Jaddoe","sequence":"additional","affiliation":[]},{"given":"Stefan","family":"Klein","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6731-9452","authenticated-orcid":false,"given":"Liesbeth","family":"Duijts","sequence":"additional","affiliation":[]},{"given":"Edwin H.G.","family":"Oei","sequence":"additional","affiliation":[]}],"member":"239","published-online":{"date-parts":[[2024,1,5]]},"reference":[{"key":"2025032422450904000_79.5.448.1","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/S2213-2600(18)30100-0","article-title":"Childhood predictors of lung function Trajectories and future COPD risk: a prospective cohort study from the first to the sixth decade of life","volume":"6","author":"Bui","year":"2018","journal-title":"Lancet Respir Med"},{"key":"2025032422450904000_79.5.448.2","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2017-210716"},{"key":"2025032422450904000_79.5.448.3","doi-asserted-by":"crossref","DOI":"10.1186\/s12890-015-0032-0","article-title":"BMI, waist circumference at 8 and 12 years of age and FVC and Fev1 at 12 years of age; 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