Abstract: Objective To analyze the characteristics of bone age development of children and adolescents with different nutritional status, and explore the association between overweight, obesity and emaciation and advanced or delayed bone age. Methods The sample included 7,062(3,310 boys and 3,752 girls) normal children and adolescents aged 4 to 18 years old from the Affiliated Children's Hospital Capital Institute of Pediatrics between January 2012 and February 2019. The bone ages were evaluated by CHN method on left hand radiographs. The body mass index z-value (BMIZ) was calculated by the child growth and nutrition assessment system. According to BMIZ, the subjects were classified into the group of emaciation (BMIZ<-2), excess weight (BMIZ>+1) and obesity(BMIZ>+2). The difference distributions between bone age and chronological age were compared among different genders and nutrition levels, and the risk of advanced bone age in overweight and obese children was analyzed. Results For overweight and obese children and adolescents, the bone age was advanced and for emaciated and normal ones, the bone age conformed to the chronological age. Overweight and obese girls were more advanced than boys (averagely, 1.10 and 1.36 years in advance in overweight boys and girls respectively P=0.000; 1.60 and 1.78 years in advance in obese boys and girls respectively P=0.000). Compared with boys and girls with normal weight, the risk of advanced bone age in overweight and obese boys and girls respectively increased by 2.358 times (95% CI:2.759-4.086) and 2.483 times (95% CI: 2.928-4.144) as well as by 5.820 times (95% CI: 5.066-9.181) and 7.537 times (95% CI: 6.319-11.534) and the risk of delayed bone age in emaciated boys and girls increased by 1.540 times (95% CI: 1.481-4.355) and 3.790 times (95% CI: 2.245-10.221) . Conclusion Excess weight and obesity increased the risk of advanced bone age in boys and girls respectively. In terms of advanced bone age, overweight boys and girls had similar risk, while obese girls had higher risk than boys. Emaciation increased the risk of delayed bone age.