RESEARCH ARTICLE BMI as a Mediator of the Relationship between Muscular Fitness and Cardiometabolic Risk in Children: A Mediation Analysis

Objective Muscular fitness levels have been associated with cardiometabolic risk in children, although whether body weight acts as a confounder or as an intermediate variable in this relationship remains controversial. The aim of this study was to examine whether the association between muscular fitness and cardiometabolic risk factors is mediated by bodymass index (BMI). Design and Methods Cross-sectional study using a sample of 1158 schoolchildren aged 8-11 years from the prov-ince of Cuenca, Spain. We measured anthropometrics and biochemical variables and we calculated a muscular fitness index as the sum of z-scores of handgrip dynamometry/weight and standing long jump, and we estimated a previously validated cardiometabolic risk index (CMRI). Linear regression models were fitted for mediation analysis to assess whether the association between muscular fitness and cardiometabolic risk was mediated by BMI. Results Children with normal weight (NW) had a better cardiometabolic risk profile than their over