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Influence of weight status on bone mineral content measured by DXA in children. BMC Pediatr 2021; 21:185. [PMID: 33879114 PMCID: PMC8056645 DOI: 10.1186/s12887-021-02665-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/12/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Childhood obesity is a public health problem with repercussions in later life. As tissue formation peaks in childhood we determined how weight status influences bone mineral content. MATERIAL AND METHODS We studied 553 children aged 4-18 years over 10 years (46.8% girls). We measured age, weight, height and through bone densitometry (DXA), bone mineral content (BMC), bone mineral density (BMD), and waist, arm and hip circumferences. The patients were divided into groups using the body mass index z-score: underweight, normal weight, overweight, obese and very obese. RESULTS BMC and BMD values were highest in the normal-weight and overweight groups. Logistic regression showed bone mineralization was inversely associated with waist circumference, the association being positive for weight and age. No differences were found according to sex. DISCUSSION Studies of the relationship between weight and bone mineralization report contradictory results, often because of different study designs. Moreover, studies in children are either few or with small samples. Our findings in a large sample show the importance of weight status in bone mineralization given the risk of bone fractures or osteoporosis. CONCLUSIONS Weight status influenced bone mineralization. BMC and BMD decreased in children with a higher degree of obesity. Waist circumference correlated negatively with bone mineralization.
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Gou GH, Tseng FJ, Wang SH, Chen PJ, Shyu JF, Pan RY. Nutritional factors associated with femoral neck bone mineral density in children and adolescents. BMC Musculoskelet Disord 2019; 20:520. [PMID: 31699056 PMCID: PMC6839089 DOI: 10.1186/s12891-019-2901-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/17/2019] [Indexed: 12/16/2022] Open
Abstract
Background Nutritional factors including vitamin D, magnesium, and fat are known to affect bone mineral accrual. This study aimed to evaluate associations between dietary nutrient intakes (both macronutrients and micronutrients) and bone mineral density (BMD) in children and adolescents. Methods Data for this cross-sectional, population-based study were derived from the National Health and Nutrition Examination Survey (NHANES). Participants aged from 8 to 19 years were included. The primary outcome was femoral neck BMD. Results Multivariate analyses revealed that for participants aged 8 to 11, daily sodium intake was significantly and positively associated with femoral neck BMD (B = 0.9 × 10− 5, p = 0.031); in particular, subgroup analyses by sex found that in male participants aged 8–11, daily total cholesterol intake (B = 5.3 × 10− 5, p = 0.030) and calcium intake (B = − 2.0 × 10− 5, p < 0.05) were significantly associated with femoral neck BMD in a positive and negative manner, respectively, but neither were observed in female participants of this age group. In contrast, daily intakes of vitamin D and magnesium were significantly and positively associated with femoral neck BMD in female participants aged 8–11 (B = 246.8 × 10− 5 and 16.3 × 10− 5, p = 0.017 and 0.033, respectively). For participants aged 16 to 19, daily total fat intake was significantly and negatively associated with femoral neck BMD (B = − 58 × 10− 5, p = 0.048); further stratification by sex found that magnesium and sodium intakes were significantly and positively associated with femoral neck BMD only in females of this age group (B = 26.9 × 10− 5 and 2.1 × 10− 5, respectively; both p < 0.05). However, no significant associations between daily nutrient intakes and femoral neck BMD were identified in participants aged 12–15 before or after subgroup stratification. Conclusion The study found that associations of specific nutrition-related variables with BMD of the femoral neck is dependent upon age and gender.
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Affiliation(s)
- Guo-Hau Gou
- Graduate Institute of Medical Sciences, National Defense Medical Center, No. 161, Sec.6 Minquan E. Rd., Neihu Dist., Taipei, 11490, Taiwan, Republic of China.,Department of Nursing, Hsin Sheng Junior College of Medical Care and Management, Taoyuan, 32544, Taiwan, Republic of China
| | - Feng-Jen Tseng
- Department of Orthopedics, Hualien Armed Force Hospital, Hualien, 971, Taiwan, Republic of China.,Department of Life Science and the Institute of Biotechnology, National Dong Hwa University, Hualien, 974, Taiwan, Republic of China
| | - Sheng-Hao Wang
- Graduate Institute of Medical Sciences, National Defense Medical Center, No. 161, Sec.6 Minquan E. Rd., Neihu Dist., Taipei, 11490, Taiwan, Republic of China.,Department of Orthopaedics, Tri-Service General Hospital, National Defense Medical Center, Taipei, 11490, Taiwan, Republic of China
| | - Pao-Ju Chen
- Department of Nursing, Hsin Sheng Junior College of Medical Care and Management, Taoyuan, 32544, Taiwan, Republic of China
| | - Jia-Fwu Shyu
- Department of Biology and Anatomy, National Defense Medical Center, Taipei, 11490, Taiwan, Republic of China
| | - Ru-Yu Pan
- Graduate Institute of Medical Sciences, National Defense Medical Center, No. 161, Sec.6 Minquan E. Rd., Neihu Dist., Taipei, 11490, Taiwan, Republic of China. .,Department of Orthopaedics, Tri-Service General Hospital, National Defense Medical Center, Taipei, 11490, Taiwan, Republic of China.
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Kim HY, Jung HW, Hong H, Kim JH, Shin CH, Yang SW, Lee YA. The Role of Overweight and Obesity on Bone Health in Korean Adolescents with a Focus on Lean and Fat Mass. J Korean Med Sci 2017; 32:1633-1641. [PMID: 28875607 PMCID: PMC5592177 DOI: 10.3346/jkms.2017.32.10.1633] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/21/2017] [Indexed: 02/01/2023] Open
Abstract
As the associations between pediatric overweight/obesity and bone health remain controversial, we investigated the effects of overweight/obesity as well as lean mass (LM) and fat mass (FM) on bone parameters in adolescents. Bone parameters were evaluated using dual-energy X-ray absorptiometry (DXA) data of 982 adolescents (aged 12-19 years) from the Korea National Health and Nutrition Examination Survey (2009-2010). Z-scores for LM, FM, bone mass, bone mineral density (BMD), and bone mineral apparent density (BMAD) using Korean pediatric reference values were used for analysis. Adolescents with overweight/obesity had significantly higher bone mass and density of the total-body-less-head (TBLH), lumbar spine, and femur neck than underweight or normal-weight adolescents (P < 0.001) after adjusting for vitamin D deficiency, calcium intake, and insulin resistance in both sexes. LM was positively associated with bone parameters at all skeletal sites in both sexes (P < 0.001). FM was negatively related to TBLH BMD in boys (P = 0.018) but was positively associated to BMD and BMAD of the lumbar spine and femur neck in girls. In conclusion, overweight/obesity and LM play a positive role in bone health in adolescents. The effect of FM on bone parameters is sex- and site-specific.
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Affiliation(s)
- Hwa Young Kim
- Department of Pediatrics, Kangwon National University Hospital, Chuncheon, Korea
| | - Hae Woon Jung
- Department of Pediatrics, Kyung Hee University Medical Center, Seoul, Korea
| | - Hyunsook Hong
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
| | - Jae Hyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Sei Won Yang
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Young Ah Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.
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Yi KH, Hwang JS, Kim EY, Lee JA, Kim DH, Lim JS. Reference values for bone mineral density according to age with body size adjustment in Korean children and adolescents. J Bone Miner Metab 2014; 32:281-9. [PMID: 23832576 DOI: 10.1007/s00774-013-0488-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 05/23/2013] [Indexed: 10/26/2022]
Abstract
Bone acquisition failure during growth or low bone mineral density (BMD) in childhood and adolescence might increase future osteoporosis risk. To identify these children and adolescents, appropriate reference values are necessary. The robust reference values must be community based as well as sex-, age-, and ethnicity specific. In addition, body size adjustment is necessary because individuals demonstrate different body sizes and different tempos of growth, which affect measured BMD. We aimed to provide reference data with body size adjustment of Korean children and adolescents. We used dual-energy X-ray absorptiometry data of 1,650 subjects (aged 10-20 years; 788 female) from the Korea National Health and Nutrition Examination Survey (2009-2010). The BMD of each region of interest (ROI), including the lumbar spine, total body less head, total body, and femoral neck, were obtained. We calculated the mean and percentiles for each ROI. Because height and weight variations were high and correlated independently with BMD within the same age group, we developed equations to calculate the "predicted BMD Z score." Although 12.8-17.9 % of subjects with short stature showed a low measured BMD Z score depending on the measured site, only 2.6 % of those of short stature had a low adjusted BMD Z score after applying the predicted BMD Z score. We also compared the BMD of children and adolescents of other ethnicities using the same device. This study provided robust reference values for the assessment and monitoring of bone health in Korean children and adolescents. Additionally, it extended the knowledge of bone acquisition in Asian children and adolescents.
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Affiliation(s)
- Kyung Hee Yi
- Department of Pediatrics, Wonkwang University Sanbon Medical Center, Sanbon, Republic of Korea
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Kalkwarf HJ, Abrams SA, DiMeglio LA, Koo WWK, Specker BL, Weiler H. Bone densitometry in infants and young children: the 2013 ISCD Pediatric Official Positions. J Clin Densitom 2014; 17:243-57. [PMID: 24674638 DOI: 10.1016/j.jocd.2014.01.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 01/08/2014] [Indexed: 11/19/2022]
Abstract
Infants and children <5 yr were not included in the 2007 International Society for Clinical Densitometry Official Positions regarding Skeletal Health Assessment of Children and Adolescents. To advance clinical care of very young children, the International Society for Clinical Densitometry 2013 Position Development Conference reviewed the literature addressing appropriate methods and skeletal sites for clinical dual-energy X-ray absorptiometry (DXA) measurements in infants and young children and how results should be reported. DXA whole-body bone mineral content and bone mineral density for children ≥3 yr and DXA lumbar spine measurements for infants and young children 0-5 yr were identified as feasible and reproducible. There was insufficient information regarding methodology, reproducibility, and reference data to recommended forearm and femur measurements at this time. Appropriate methods to account for growth delay when interpreting DXA results for children <5 yr are currently unknown. Reference data for children 0-5 yr at multiple skeletal sites are insufficient and are needed to enable interpretation of DXA measurements. Given the current scarcity of evidence in many areas, it is likely that these positions will change over time as new data become available.
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Affiliation(s)
- Heidi J Kalkwarf
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Steven A Abrams
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Linda A DiMeglio
- Department of Pediatrics, Section of Pediatric Endocrinology and Diabetology, Indiana University, Indianapolis, IN, USA
| | - Winston W K Koo
- Department of Pediatrics, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Bonny L Specker
- Ethel Austin Martin Program in Human Nutrition, South Dakota State University, Brookings, SD, USA
| | - Hope Weiler
- School of Dietetics and Human Nutrition, McGill University, Montreal, QC, Canada
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Gracia-Marco L, Ortega FB, Jiménez-Pavón D, Rodríguez G, Castillo MJ, Vicente-Rodríguez G, Moreno LA. Adiposity and bone health in Spanish adolescents. The HELENA study. Osteoporos Int 2012; 23:937-47. [PMID: 21562873 DOI: 10.1007/s00198-011-1649-3] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 04/18/2011] [Indexed: 11/30/2022]
Abstract
UNLABELLED While the association of lean mass (LM) with bone mass is well understood, the association of fat mass (FM) with bone mass is controversial. Our results support that adolescents with higher levels of adiposity have greater bone mass, but this association is fully explained by their higher levels of LM. INTRODUCTION We aimed (1) to study the independent association of FM and LM with bone mass and (2) to study the differences in bone mass by weight status in adolescents, after controlling for relevant confounders, such as physical activity (PA), calcium intake, and LM. METHODS Participants were 330 adolescents (167 boys, 12.5-17.5 years) from the HELENA study. The relationships of FM (DXA, n = 330; BodPod, n = 282) and LM (DXA, n = 330) with different bone variables (whole body, total hip, lumbar spine, and femoral neck) were analyzed by linear regression, and differences between weight status were analyzed by ANCOVA. RESULTS Fat mass (DXA) was positively associated with bone variables in both sexes, after adjustment for height, calcium intake, and sexual maturation. Additional adjustment by PA slightly increases the associations. However, adjustment for LM inverted these associations. Similar results were obtained using BodPod instead of DXA for assessing FM. Overweight/obese adolescents had higher BMC than their non-overweight peers in most of regions studied. Additional adjustment for PA slightly increased the differences between weight status groups, while adjusting for LM inverted the associations. LM was strong and positively associated with all bone variables in both sexes. Additional adjustment for PA or FM did not change the results. CONCLUSIONS Adolescents with higher levels of adiposity have greater bone mass, but this association is explained by their higher levels of LM.
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Affiliation(s)
- L Gracia-Marco
- GENUD Growth, Exercise, Nutrition and Development Research Group, University of Zaragoza, 50009 Zaragoza, Spain.
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