Influence of weight status on bone mineral content measured by DXA in children

Not Only Metabolic Complications of Childhood Obesity

The increasing incidence of obesity in the pediatric population requires attention to its serious complications. It turns out that in addition to typical, well-known metabolic complications, obesity as a systemic disease carries the risk of equally serious, although less obvious, non-metabolic complications, such as cardiovascular diseases, polycystic ovary syndrome, chronic kidney disease, asthma, thyroid dysfunction, immunologic and dermatologic conditions, and mental health problems. They can affect almost all systems of the young body and also leave their mark in adulthood. In addition, obesity also contributes to the exacerbation of existing childhood diseases. As a result, children suffering from obesity may have a reduced quality of life, both physically and mentally, and their life expectancy may be shortened. It also turns out that, in the case of obese pregnant girls, the complications of obesity may also affect their unborn children. Therefore, it is extremely important to take all necessary actions to prevent the growing epidemic of obesity in the pediatric population, as well as to treat existing complications of obesity and detect them at an early stage. In summary, physicians treating a child with a systemic disease such as obesity must adopt a holistic approach to treatment.

Weight change patterns across adulthood in relation to osteoporosis and fracture among non-obese individuals

Weight change was an influencing factor of osteoporosis and fracture in a controversial way. Based on a nationally representative data, we found that weight change from obesity in midlife to non-obesity in late adulthood was associated with a reduction in the risk of osteoporosis and wrist fracture in male, but not in female.

INTRODUCTION

Obesity is usually recognized as a protective factor to osteoporosis and osteoporotic fracture. However, it is still unclear whether historical weight status was associated with the risk of osteoporosis and fracture. The aim of this study was to investigate the relationship between weight change patterns across adulthood and the prevalence of osteoporosis and fracture.

METHODS

Data from the National Health and Nutrition Examination Survey (NHANES) with 8725 US adults aged ≥ 40 years were analyzed in this study. Weight change patterns were categorized as "stable non-obese," "obese with earlier weight gain," "obese with recent weight gain," and "revert to non-obese" based on the body mass index (BMI) at 25 years old, 10 years prior to baseline and at baseline. Body mineral density (BMD) was measured using dual x-ray absorptiometry (DXA), and osteoporosis was diagnosed based on the World Health Organization criteria. Self-reported occurrence of osteoporotic fractures were determined by questionnaires.

RESULTS

Compared with subjects in "stable non-obese" group, obese with earlier weight gain were positively related to the increase of BMD in both genders, while elevated BMD was only observed in female of "obese with recent weight gain" group and in male of "revert to non-obese" group after multiple adjustment. Moreover, changing from the obesity to non-obesity in the 10 years period before baseline was associated with a 81.6% lower risk of osteoporosis (odds ratio (OR) 0.184, 95% confidence interval (CI) 0.037-0.914 (P = 0.039)) and a 69.8% lower risk of wrist fracture (OR 0.302, 95%CI 0.120-0.757 (P = 0.012)) in male, but not in female.

CONCLUSION

Weight change from obesity in midlife to non-obesity in late adulthood was associated with a reduction in the risk of osteoporosis and wrist fracture in male. Our findings support the importance of investigating the mechanism of weight change in different life period.

Inverted U-Shaped Relationship between Obesity Parameters and Bone Mineral Density in Korean Adolescents

As the association between obesity and bone health remains controversial in children and adolescents, we investigate the effects of obesity parameters on bone mineral density (BMD) in 2060 Korean adolescents who participated in the 2008-2011 Korea National Health and Nutrition Examination Survey (KNHANES). Multiple regression analysis and analysis of covariance (ANCOVA) were conducted to examine both the linear and non-linear associations between total-body-less-head (TBLH) BMD and four obesity parameters: body mass index, waist circumference, waist-to-height ratio, and total-body fat mass (FM). In a multiple linear regression analysis adjusted for age, menarcheal status (in females only), and total-body lean mass, there was no significant linear association between obesity parameters and TBLH BMD, except for total-body FM in males. However, upon adding a second-order polynomial term for each obesity parameter, a significant quadratic relationship between all obesity parameters and TBLH BMD was observed, with the corresponding quadratic term being negative. The results of ANCOVA also revealed an inverted U-shaped relationship between each obesity parameter and TBLH BMD. Our findings suggest the existence of an optimal range of obesity parameters for developing or maintaining optimal bone health in Korean Adolescents. Deviation from this range, in either direction (being underweight or having obesity), may compromise bone health.

Family economic trajectories and body mass index in Indonesia: Evidence from the Indonesian Family Life Surveys 2 to 5

Indonesia faces the double burdens of childhood obesity and malnutrition. A family's socioeconomic status has been suggested to be one of the most influential factors contributing to childhood nutritional problems. This study aimed to: 1) identify the distinct trajectories of family economics; and 2) assess whether a family's economic trajectory influences children's body mass index (BMI). We analyzed trajectory patterns of family economic levels from 1997 to 2015 among 846 children aged under 3 years in 1997 using data from Indonesian Family Life Surveys. Trajectory patterns were identified with Group-Based Trajectory Modeling using the traj plug-in in STATA software. The BMI was classified according to 2007 World Health Organization growth standards. Adjusted relative risk ratios (aRRRs) of family economic level trajectories and children's BMI were calculated using multinomial logistic regressions. We identified three distinct trajectories of family economic level: stable poorest, stable middle, and increasing richest. In the total sample, there were no significant relationships between a family's income trajectory and children's BMI in the adjusted models. A significant relationship existed for male children, but not for female children, of compared to the poorest family trajectory group, male children in the increasing richest trajectory group were more likely to be overweight/obese (aRRR 6.1, 95% confidence interval: 1.22-30.62) after adjusting for age and BMI. The present results highlight the importance of early interventions to minimize the potential adverse impacts of excessive BMI later in adulthood.

The Impact of Metabolic Syndrome on Bone Mass in Men: Systematic Review and Meta-Analysis

Studies to date have yielded conflicting results on associations between components of metabolic syndrome (MetS) and bone mineral density (BMD), particularly in men. This current systematic review and meta-analysis addresses the existing gap in the literature and aims to evaluate bone mineral density (BMD) at the femoral neck (FN) and lumbar spine (LS) in men diagnosed with MetS. The two study authors independently searched PubMed, Cinahl, Embase, and Web of Science up to 8 February 2022 for studies in English. The inclusion criteria were (i) diagnosis of MetS according to the NCEP-ATP III 2001 criteria; (ii) adult male demographic; (iii) analyzable data on BMD in at least two sites using dual-energy X-ray absorptiometry (DXA), and (iv) original observational studies. Case reports and non-English articles were excluded. We analyzed the results of seven studies providing data on bone density in men with MetS. Results: Based on random effect weights, the mean BMD of the femoral neck and lumbar spine were 0.84 and 1.02, respectively. The mean lumbar spine T-score was -0.92. In meta-regression analysis, the variances in mean BMD in the lumbar spine and femoral neck could not be significantly explained by BMI (lumbar BMD: Q = 1.10, df = 1, p = 0.29; femoral neck BMD: Q = 0.91, df = 1, p = 0.34). Our meta-analysis suggests normal bone mass in adult males with MetS. Due to the high heterogeneity in the seven analyzed studies and the lack of control groups in these studies, further research is needed to fully elucidate the associations between MetS and its components and BMD in men.

Vitamin D and Bone fragility in Individuals with Osteogenesis Imperfecta: A Scoping Review

Vitamin D affects several body functions, and thus general health, due to its pleiotropic activity. It plays a key role in bone metabolism, and its deficiency impacts bone development, leading to bone fragility. In osteogenesis imperfecta (OI), a group of hereditary connective tissue disorders characterized by bone fragility, additional factors, such as vitamin D deficiency, can affect the expression of the phenotype and aggravate the disorder. The aim of this scoping review was to assess the incidence of vitamin D deficit in OI patients and the association between vitamin D status and supplementation in individuals affected by OI. We searched the PubMed Central and Embase databases and included studies published between January/2000 and October/2022 evaluating vitamin D measurement and status (normal, insufficiency, deficiency) and supplementation for OI. A total of 263 articles were identified, of which 45 were screened by title and abstract, and 10 were included after a full-text review. The review showed that low levels of vitamin D was a frequent finding in OI patients. Vitamin D supplementation was mainly indicated along with drug therapy and calcium intake. Even if widely used in clinical practice, vitamin D supplementation for OI individuals still needs a better characterization and harmonized frame for its use in the clinical setting, as well as further studies focusing on its effect on bone fragility.

Clinical and physical characteristics of thinness in adolescents: the HELENA study

PURPOSE

Thinness in adolescence has not been studied as extensively as overweight or obesity. The aim of this study was to assess the prevalence, characteristics, and health impacts of thinness in a European adolescent population.

METHODS

This study included 2711 adolescents (1479 girls, 1232 boys). Blood pressure, physical fitness, sedentary behaviors, physical activity (PA), and dietary intake were assessed. A medical questionnaire was used to report any associated diseases. A blood sample was collected in a subgroup of the population. Thinness and normal weight were identified using the IOTF scale. Thin adolescents were compared with adolescents of normal weight.

RESULTS

Two hundred and fourteen adolescents (7.9%) were classified as being thin; the prevalence rates were 8.6% in girls and 7.1% in boys. Systolic blood pressure was significantly lower in adolescents with thinness. The age at the first menstrual cycle was significantly later in thin female adolescents than in those with normal weight. Upper-body muscular strength measured in performance tests and time spent in light PA were significantly lower in thin adolescents. The Diet Quality Index was not significantly lower in thin adolescents, but the percentage of adolescents who skipped breakfast was higher in adolescents with a normal weight (27.7% vs 17.1%). Serum creatinine level and HOMA-insulin resistance were lower and vitamin B12 level was higher in thin adolescents.

CONCLUSIONS

Thinness affects a notable proportion of European adolescents with no physical adverse health consequences.

The relationship between metabolic syndrome and bone mineral density in adolescents: analysis of the National Health and Nutrition Examination Survey

OBJECTIVES

The purpose of this study was to observe the relationship between metabolic syndrome (MetS) and height (Ht) adjusted Z-scores for areal bone mineral density (aBMD) in adolescents.

METHODS

A retrospective study was conducted on the United States adolescents aged 12-17 years. Data were extracted from the National Health and Nutrition Examination Survey (NHANES) 2011-2012, 2013-2014 and 2015-2016 cycles. Ht adjusted Z-scores for aBMD were calculated.

RESULTS

A total of 969 adolescents (493 boys and 476 girls), aged 14.5 ± 1.7 years were enrolled in this study. After control for age, gender, race, 25-hydroxyvitamin D [25(OH)D], and lean body mass index (LBMI) Z-score, adolescents with MetS had significantly lower levels of total body (less head) aBMD Ht-Z-adjusted Z-score than adolescents with one, two components of MetS and without component of MetS (p<0.05) and significantly lower levels of lumbar spine aBMD Ht-Z-adjusted Z-score than adolescents with one component of MetS and without component of MetS (p<0.05). There were significantly negative associations between total body (less head) aBMD Ht-Z-adjusted Z-score and waist circumference (WC) (β=-0.027, p<0.001, R²=0.057) and homeostasis model assessment insulin resistance (HOMA-IR) (β=-0.225, p<0.001, R²=0.016). There were significantly negative associations between lumbar spine aBMD Ht-Z-adjusted Z-score and WC (β=-0.039, p<0.001, R²=0.058) and HOMA-IR (β=-0.251, p<0.001, R²=0.008).

CONCLUSIONS

The present study demonstrates that MetS may have a negative effect on bone mineral density in adolescents. Abdominal obesity and insulin resistance play a major role on the decline of aBMD in adolescents.

Relationships between Body Weight Status and Serum Levels of Adipokine, Myokine and Bone Metabolism Parameters in Healthy Normal Weight and Thin Children

Optimal body weight and body composition for age are relevant to child development and healthy life. Changes in lean mass and fat mass as well as its distribution are associated with alterations in the secretion of myokines and adipokines by muscle and adipose tissues. These factors are very important for bone health. The aim of the study was to assess serum leptin, adiponectin, resistin, visfatin and omentin as adipokines and myostatin and irisin as myokines with regard to their associations with bone parameters in healthy normal weight and thin children. We studied 81 healthy prepubertal children (aged 5 to 9 years) divided into three groups: group A—35 children with a BMI z-score between +1 and −1 SD; group B—36 children with a BMI z-score between −1 and −2 SD; and group C—10 thin children with a BMI z-score of <−2 SD. We observed significantly (p < 0.001) lower fat mass, fat/lean mass ratio and bone mineral density (BMD) across weight status with the lowest values in the group of thin children. We noticed significantly (p < 0.05) lower concentrations of 25-hydroxyvitamin D, resistin and high-molecular-weight (HMW) adiponectin but higher levels of myostatin as the BMI z-score deceased. We found that BMI and leptin levels were directly correlated with fat mass, lean mass, bone mineral content (BMC) and BMD. Resistin levels were negatively associated with lean mass, while visfatin concentrations were positively related to total BMD. In healthy prepubertal children there were differences in body composition and in bone mineral density across decreasing BMI status. We suggest that changes in serum myostatin and 25-hydroxyvitamin D levels may play a role in bone status of thin children. Moreover, significant relations between adipokines and bone parameters may confirm crosstalk between fat tissue and bone in these children.

Bone mineral density and body composition in normal weight, overweight and obese children

BACKGROUND

There is a possibility that excess body fat affects bone mass gain and may compromise skeletal health in obese children. The purpose of the study was to identify the relationship between bone mineral density (BMD) and body composition in normal weight, overweight and obese children.

METHODS

This was a cross-sectional study of 6- to 11-year-old children who attended the hospital's outpatient clinic. They were apparently healthy and had no history of prematurity, low birth weight, or chronic diseases. Body mass index (BMI) was used to identify subjects as normal weight, overweight or obese. BMD and body composition were assessed by dual energy X-ray absorptiometry. The BMD values (total and lumbar spine) were compared between normal weight, overweight and obese children. Correlation coefficients were calculated, and multivariate models were performed.

RESULTS

Forty-nine children were included: 16 with normal weight, 15 that were overweight and 18 with obesity; the mean age was 8.4 ± 1.7 years. All the participants had a normal BMD (> - 2 SD). BMD was higher in obese children and had a positive correlation with total and trunk lean mass in the three study groups (p < 0.001). In obese children, an inverse correlation of lumbar spine BMD (Z score) with total and trunk fat mass (p < 0.05) was identified. In the multivariate models (with the whole group), the total lean mass was the only significant variable that explained BMD variability.

CONCLUSIONS

BMD in obese children was higher than that in normal weight children, which is explained by their greater lean mass and not by excess body fat. In obese children, a higher fat mass was related to a lower lumbar spine BMD. Lean mass had a direct correlation with BMD in the three study groups and was the most important predictor of BMD, reflecting the importance of strengthening the muscular system through performing physical activity and practicing a healthy lifestyle.

Long-Term Follow-Up of Three Family Members with a Novel NNT Pathogenic Variant Causing Primary Adrenal Insufficiency

Nicotinamide nucleotide transhydrogenase (NNT) deficiency causes primary adrenal insufficiency (PAI) and possibly some extra-adrenal manifestations. A limited number of these patients were previously described. We present the clinical and genetic characteristics of three family members with a biallelic novel pathogenic variant in the NNT gene. The patients were followed until the ages of 21.6, 20.2, and 4.2 years. PAI was diagnosed in the eldest two brothers after an Addisonian crisis and the third was diagnosed at the age of 4.5 months in the asymptomatic stage due to the genetic screening of family members. Whole exome sequencing with a targeted interpretation of variants in genes related to PAI was performed in all the patients. The urinary steroid metabolome was determined by gas chromatography–mass spectrometry in the asymptomatic patient. The three patients, who were homozygous for c.1575dup in the NNT gene, developed isolated glucocorticoid deficiency. The urinary steroid metabolome showed normal excretion of cortisol metabolites. The adolescent patients had slow pubertal progression with low–normal testicular volume, while testicular endocrine function was normal. Bone mineral density was in the range for osteopenia in both grown-up siblings. Echocardiography revealed no structural or functional heart abnormalities. This article is among the first with a comprehensive and chronologically-detailed description of patients with NNT deficiency.

Compliance of functional exercises in school-age children with limb fractures: implication for nursing countermeasures

Background

Functional exercises is very essential to the recovery of patients with fracture. We aimed to evaluate the compliance of functional exercises in school-age children with limb fracture, to provide evidence to the clinical management and nursing care of children with limb fracture.

Methods

School-age children with limb fractures treated in our hospital from January 1, 2020 to June 30, 2021 were selected. The characteristics and postoperative functional exercise compliance of included children were analyzed. Pearson correlation and Logistic regression analysis were conducted to analyze the influencing factors of compliance to functional exercises.

Results

A total of 328 children with limb fracture were included, the incidence of compliance to functional exercise was only 35.98%. Pearson correlation analysis showed that age(r = 0.707), only child of family(r = 0.537), guardians(r = 0.642) and type of temperament(r = 0.635) were correlated with compliance to functional exercises in school-age children with limb fractures (all p < 0.05). Logistic regression analysis indicated that age ≤ 10y (OR2.913, 95%CI2.091 ~ 3.611), only child of family (OR2.006, 95%CI1.683 ~ 2.558), guarded by grandparents (OR1.512, 95%CI1.201 ~ 2.118), non-easy-going temperament (OR4.127, 95%CI3.811 ~ 4.902) were the influencing factors of non-compliance to functional exercises in children with limb fracture (all p < 0.05).

Conclusions

School-age children have poor compliance with functional exercises after limb fractures, and there are many influencing factors. For children with those risks, health care providers should actively intervene in nursing to improve children’s exercise compliance and the rehabilitation effect.

Body composition and bone mineral density by Dual Energy X-ray Absorptiometry: Reference values for young children

BACKGROUND & AIMS

Childhood obesity is a global public health threat, with an alarming rise in incidence. Obesity at young age has short-term and long-term morbidity. It is, therefore, important to accurately assess body composition throughout infancy and childhood to identify excess adiposity. However, reference values for age 2-5 years, needed to interpret measurements and identify young children at risk, are lacking. Our primary objective was to fill the current gap in reference values by constructing sex-specific body composition reference values and charts for fat mass (FM), fat mass percentage (FM%), fat mass index (FMI), lean body mass (LBM), lean body mass index (LBMI) and total body less head bone mineral density (BMD_TBLH) for children aged 2-5 years using Dual-Energy X-ray Absorptiometry (DXA).

METHODS

We performed 599 accurate DXA-measurements in 340 term-born children aged 2-5 years, using Lunar Prodigy with Encore software (V14.1). Using GAMLSS, sex-specific reference values and charts were created for FM, FM%, FMI, LBM, LBMI and BMD_TBLH.

RESULTS

Sex-specific body composition reference values and charts for age 2-5 years were constructed. In boys and girls, FM and LBM increased from age 2-5 years (all p ≤ 0.001), but body size-corrected FM% and FMI decreased (all p ≤ 0.023). LBMI remained similar between 2 and 5 years of age. Girls had higher FM, FM% and FMI and lower LBM and LBMI compared to boys. BMC and BMD_TBLH increased with age between 2 and 5 years of age (all p < 0.001) and were similar for boys and girls.

CONCLUSIONS

We present sex-specific reference values and charts for body composition and total body bone mineral density measured by DXA, based on a large cohort of healthy children aged 2-5 years. These longitudinal references can be used for clinical practice and research purposes to monitor body composition and bone mineral density development and identify children at risk for excess adiposity.

Analysis of the Association between Fat Mass Distribution and Bone Mass in Chinese Male Adolescents at Different Stages of Puberty

Background: Bone mineral acquisition during adolescence is crucial for maximizing peak bone mass. Fat mass (FM) and bone mass are closely related. This study investigated the association of FM distribution with bone mass in Chinese male adolescents. Method: A total of 693 male adolescents aged 10–18 years were recruited from a secondary school in Jiangmen, China. Their bone mass and body composition were measured by quantitative ultrasound and bioelectrical impedance analysis, respectively. The associations of the measures of fat distribution with bone parameters, i.e., broadband ultrasound attenuation, speed of sound (SOS), and stiffness index (SI), were analyzed using multiple linear regression. Age, height, body mass index, stage of puberty, physical activity, sedentary behavior, dietary energy intake, and dietary calcium and vitamin D intake were adjusted in the model. Further subgroup analyses of prepubertal and pubertal participants were conducted. Results: The measures of fat distribution showed negative associations with SOS and SI in total subjects (p < 0.010). In prepubertal boys, the measures of fat distribution were only associated with SOS (β = −0.377 to −0.393, p < 0.050). In pubertal boys, the measures of fat distribution had associations with all bone parameters (β = −0.205 to −0.584, p < 0.050). The strongest association was between trunk FM and SOS (β = −0.584, p < 0.001). Conclusion: This study supported that the measures of fat distribution were negatively associated with bone parameters in Chinese male adolescents. Trunk FM had the strongest association with bone parameter. These associations appear to be stronger in pubertal boys than in prepubertal boys.