The cause of skeletal muscle insulin resistance is unclear, but high levels of intramyocellular lipids are often present in affected individuals. We aimed to establish the metabolic, familial, and anthropometric associations of intramyocellular lipid in a pediatric population. We studied 41 boys aged 6.9 -9.9 y and 23 of their mothers by proton magnetic resonance spectroscopy. We related muscle lipid levels to important factors that define an increased risk of developing insulin resistance in adult life. There were significant associations between the boys' intramyocellular lipid and their waist circumference (r ϭ 0.42, p ϭ 0.007), body mass index SD score (r ϭ 0.32, p ϭ 0.04), weight SD score (r ϭ 0.32, p ϭ 0.04), glucose:insulin ratio (rϭ-0.59, p ϭ 0.04), maternal log fasting insulin levels (r ϭ 0.44, p ϭ 0.04), maternal body mass index (r ϭ 0.46, p ϭ 0.03), and maternal intramyocellular lipid (r ϭ 0.62, p ϭ 0.003). In the 41 boys, waist Skeletal muscle insulin resistance is a metabolic abnormality central to the pathogenesis of a cluster of diseases such as type 2 (noninsulin-dependent) diabetes mellitus, dyslipidemia, hypertension, and central obesity. The precise causes of insulin resistance remain uncertain, but both environmental and genetic factors are thought to have a role.Several studies suggest that morphologic abnormalities of skeletal muscle are associated with the development of insulin resistance (1-3). These abnormalities include elevated levels of IMCL (4 -6), an altered proportion of muscle fiber type and decreased capillary density (7-9), abnormalities in capillary structure (10), and an altered fatty acid composition of muscle membranes (2, 11). The temporal relationships of these muscle morphologic abnormalities to the onset of insulin resistance and to the appearance of recognized risk factors associated with the development of the insulin resistance syndrome are not clear.It is possible that some skeletal muscle morphologic abnormalities may precede the development of insulin resistance. For example, infants of mothers with insulin resistance (as determined by maternal fasting insulin levels) have a characteristic muscle membrane fatty acid profile similar to that seen in insulin resistant adults (12). This finding suggests that not only do familial factors play a role in determining muscle membrane composition, but that young children with a high risk of developing insulin resistance in later life may already have a muscle phenotype that is different from those children who are at lower risk. Thus, diseases associated with insulin resistance may have their metabolic antecedents present in early childhood.The advent of a magnetic resonance-based technique to measure IMCL facilitates studies on muscle lipid metabolism in insulin resistant conditions. Previously, the relationships