Abstract
BACKGROUND: Childhood and adolescence are critical developmental periods during which dietary protein plays a crucial role in musculoskeletal health. While the significance of protein in muscle development is well acknowledged, the complex associations between dietary protein intake and musculoskeletal parameters during these stages remain incompletely elucidated. METHODS: This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014 cycles, including 3,455 children and adolescents aged 8-19 years. Dietary protein intake was assessed through two 24-hour dietary recalls. Appendicular lean mass index (ALMI) and combined grip strength were measured as indicators of musculoskeletal health. Multivariate linear regression models and smooth curve fitting techniques were employed to analyze associations. RESULTS: Higher protein intake was positively associated with both ALMI (β = 0.003, 95% CI: 0.002, 0.004, p < 0.001) and combined grip strength (β = 0.043, 95% CI: 0.027, 0.058, p < 0.001) in fully adjusted models. Notably, sex-specific effects were observed, with stronger associations in boys, particularly in the 8-11 years age group. CONCLUSIONS: This study reveals significant positive associations between dietary protein intake and musculoskeletal health indicators in children and adolescents, with pronounced sex-specific effects. These findings underscore the importance of adequate protein intake during critical developmental periods and may inform targeted nutritional strategies for optimizing long-term musculoskeletal health.