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Silva LSD, Menezes AMB, Barros FC, Wehrmeister FC, Silva HDGD, Horta BL. [Association between birth conditions and bone mineral density in adults from the 1982 and 1993 birth cohorts in Pelotas, Rio Grande do Sul State, Brazil]. CAD SAUDE PUBLICA 2024; 40:e00085523. [PMID: 38477728 DOI: 10.1590/0102-311xpt085523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/19/2023] [Indexed: 03/14/2024] Open
Abstract
This study assessed the association of birth weight, gestational age, and intrauterine growth with bone mineral density (BMD) at 22 and 30 years of age in the 1982 and 1993 birth cohorts in Pelotas, Rio Grande do Sul State, Brazil. BMD was measured by dual-energy X-ray absorptiometry (DXA) and the association was assessed using analysis of variance. Multiple linear regression was used to control for confounding factors: sex; household income at birth; maternal smoking during pregnancy; maternal schooling; maternal ethnicity/skin color; and pre-pregnancy body mass index. The study tested whether body fat in adulthood was a mediator of the association analyzed, using the G-computation Formula. A total of 6,803 participants from the 1982 and 1993 cohorts were evaluated at 30 and 22 years of age, respectively. Birth weight was associated with BMD at all sites, with a greater difference at the femoral neck. Individuals born weighing less than 2,000g had on average -0.036g/cm2 (95%CI: -0.064; -0.008) of BMD in the femoral neck than individuals weighing more than 3,500g. Individuals with an intrauterine growth z-score at least 1.28 standard deviation below the mean had an average of -0.013g/cm2 (95%CI: -0.024; -0.002) of BMD in the lumbar spine compared with individuals with an above-average z-score. The mediation analysis showed that body fat in adulthood did not mediate the association. Birth conditions have been associated with BMD in adulthood and the identification of early factors related to bone loss is essential due to the demographic inversion that has been taking place in low- and middle-income countries.
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2
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Dao T, Robinson DL, Doyle LW, Lee PVS, Olsen J, Kale A, Cheong JLY, Wark JD. Quantifying Bone Strength Deficits in Young Adults Born Extremely Preterm or Extremely Low Birth Weight. J Bone Miner Res 2023; 38:1800-1808. [PMID: 37850817 PMCID: PMC10946901 DOI: 10.1002/jbmr.4926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 08/28/2023] [Accepted: 10/13/2023] [Indexed: 10/19/2023]
Abstract
The long-term bone health of young adults born extremely preterm (EP; <28 weeks' gestation) or extremely low birth weight (ELBW; <1000 g birth weight) in the post-surfactant era (since the early 1990s) is unclear. This study investigated their bone structure and estimated bone strength using peripheral quantitative computed tomography (pQCT)-based finite element modeling (pQCT-FEM). Results using this technique have been associated with bone fragility in several clinical settings. Participants comprised 161 EP/ELBW survivors (46.0% male) and 122 contemporaneous term-born (44.3% male), normal birth weight controls born in Victoria, Australia, during 1991-1992. At age 25 years, participants underwent pQCT at 4% and 66% of tibia and radius length, which was analyzed using pQCT-FEM. Groups were compared using linear regression and adjusted for height and weight. An interaction term between group and sex was added to assess group differences between sexes. Parameters measured included compressive stiffness (kcomp ), torsional stiffness (ktorsion ), and bending stiffness (kbend ). EP/ELBW survivors were shorter than the controls, but their weights were similar. Several unadjusted tibial pQCT-FEM parameters were lower in the EP/ELBW group. Height- and weight-adjusted ktorsion at 66% tibia remained lower in EP/ELBW (mean difference [95% confidence interval] -180 [-352, -8] Nm/deg). The evidence for group differences in ktorsion and kbend at 66% tibia was stronger among males than females (pinteractions <0.05). There was little evidence for group differences in adjusted radial models. Lower height- and weight-adjusted pQCT-FEM measures in EP/ELBW compared with controls suggest a clinically relevant increase in predicted long-term fracture risk in EP/ELBW survivors, particularly males. Future pQCT-FEM studies should utilize the tibial pQCT images because of the greater variability in the radius possibly related to lower measurement precision. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Thang Dao
- Melbourne Medical SchoolThe University of MelbourneMelbourneAustralia
| | - Dale Lee Robinson
- Department of Biomedical EngineeringUniversity of MelbourneMelbourneAustralia
| | - Lex W Doyle
- Clinical SciencesMurdoch Children's Research InstituteMelbourneAustralia
- Department of Obstetrics and GynecologyUniversity of MelbourneMelbourneAustralia
- Newborn ResearchRoyal Women's HospitalMelbourneAustralia
- Department of PediatricsUniversity of MelbourneMelbourneAustralia
| | - Peter VS Lee
- Department of Biomedical EngineeringUniversity of MelbourneMelbourneAustralia
| | - Joy Olsen
- Clinical SciencesMurdoch Children's Research InstituteMelbourneAustralia
| | - Ashwini Kale
- Department of Medicine, The Royal Melbourne HospitalThe University of MelbourneMelbourneAustralia
- Bone and Mineral Medicine, Department of Diabetes and EndocrinologyThe Royal Melbourne HospitalMelbourneAustralia
| | - Jeanie LY Cheong
- Clinical SciencesMurdoch Children's Research InstituteMelbourneAustralia
- Department of Obstetrics and GynecologyUniversity of MelbourneMelbourneAustralia
- Newborn ResearchRoyal Women's HospitalMelbourneAustralia
| | - John D Wark
- Department of Medicine, The Royal Melbourne HospitalThe University of MelbourneMelbourneAustralia
- Bone and Mineral Medicine, Department of Diabetes and EndocrinologyThe Royal Melbourne HospitalMelbourneAustralia
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Sandboge S, Kuula J, Björkqvist J, Hovi P, Mäkitie O, Kajantie E. Bone mineral density in very low birthweight adults-A sibling study. Paediatr Perinat Epidemiol 2022; 36:665-672. [PMID: 35333415 PMCID: PMC9543339 DOI: 10.1111/ppe.12876] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/22/2022] [Accepted: 03/06/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Children and adults born very low birthweight (VLBW, <1500 g) at preterm gestations have lower bone mineral density (BMD) and/or bone mineral content (BMC) than those born at term, but causality remains unknown. OBJECTIVES Our aim was to assess BMD and BMC in adults born at VLBW in a sibling comparison setting to account for shared genetic and environmental confounders. METHODS We conducted a cohort study of 77 adults born VLBW and 70 same-sex term-born siblings at mean age of 29 years. The primary outcome variables were BMD Z-scores, and BMC, of the femoral neck, lumbar spine, and whole body, measured using dual-energy X-ray absorptiometry. We analysed data by linear mixed models. RESULTS The VLBW adults had a 0.25 (95% CI 0.02, 0.47) Z-score unit lower femoral neck BMD, and 0.35 (95% CI 0.16, 0.54) grams lower femoral neck BMC than their term-born siblings, after adjustment for sex, age, and maternal smoking. Additional adjustment for adult body size attenuated the results. Lumbar spine, and whole body BMC were also lower in the VLBW group. CONCLUSIONS Individuals born at VLBW had lower BMC values at all three measurement sites, as well as lower femoral neck BMD Z-scores, compared to term-born siblings, partly explained by their smaller adult body size, but the differences were smaller than those reported previously with unrelated controls. This suggests that genetic or environmental confounders explain partly, but not exclusively, the association between preterm VLBW birth and adult bone mineralisation.
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Affiliation(s)
- Samuel Sandboge
- Population Health UnitFinnish Institute for Health and WelfareHelsinki and OuluFinland,Psychology/Welfare SciencesFaculty of Social SciencesUniversity of TampereTampereFinland
| | - Juho Kuula
- Population Health UnitFinnish Institute for Health and WelfareHelsinki and OuluFinland,Department of RadiologyMedical Imaging CenterUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Johan Björkqvist
- Population Health UnitFinnish Institute for Health and WelfareHelsinki and OuluFinland
| | - Petteri Hovi
- Population Health UnitFinnish Institute for Health and WelfareHelsinki and OuluFinland,Pediatric Research CenterChildren's HospitalUniversity of Helsinki and HUS Helsinki University HospitalHelsinkiFinland
| | - Outi Mäkitie
- Pediatric Research CenterChildren's HospitalUniversity of Helsinki and HUS Helsinki University HospitalHelsinkiFinland,Folkhälsan Research CenterInstitute of GeneticsHelsinkiFinland,Research Program for Clinical and Molecular MetabolismFaculty of MedicineUniversity of Helsinki HelsinkiFinland,Department of Molecular Medicine and SurgeryKarolinska Institutet, and Clinical GeneticsKarolinska University HospitalStockholmSweden
| | - Eero Kajantie
- Population Health UnitFinnish Institute for Health and WelfareHelsinki and OuluFinland,Pediatric Research CenterChildren's HospitalUniversity of Helsinki and HUS Helsinki University HospitalHelsinkiFinland,PEDEGO Research UnitMRC OuluOulu University Hospital and University of OuluOuluFinland,Department of Clinical and Molecular MedicineNorwegian University of Science and TechnologyTrondheimNorway
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4
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Haikerwal A, Doyle LW, Patton G, Garland SM, Cheung MM, Wark JD, Cheong JLY. Bone health in young adult survivors born extremely preterm or extremely low birthweight in the post surfactant era. Bone 2021; 143:115648. [PMID: 32950698 DOI: 10.1016/j.bone.2020.115648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/18/2020] [Accepted: 09/12/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Most infants born extremely preterm (EP; <28 weeks' gestation) or extremely low birthweight (ELBW; <1000 g birthweight) in the post surfactant era (early 1990s) are now surviving into adulthood. Preterm birth/low birthweight are risk factors for reduced bone growth and mineralisation in infants and children. However, little is known about their bone health around peak bone mass and through adult life. OBJECTIVE To compare bone health (bone mineral measures, bone structure and strength) in young adults born EP/ELBW with controls (>2499 g birthweight), and within the EP/ELBW group examine perinatal and later variables associated with long term bone health. METHODS A geographic cohort comprising all 297 survivors born EP/ELBW in 1991-92 in the state of Victoria, Australia, and 260 contemporaneous controls (>2499 g birthweight) were recruited into a longitudinal study from birth. At age 25 years, investigations included dual energy X ray absorptiometry and peripheral quantitative computed tomography to measure bone, muscle and soft tissue variables, and fasting blood samples to measure serum 25 hydroxyvitamin D (25(OH)D) and bone turnover markers (BTM). Linear regression analysis, with models fitted using generalised estimating equations, was used to compare outcomes between groups, adjusting for height and weight. RESULTS Compared with controls (n = 129), young adults born EP/ELBW (n = 162) had lower areal bone mineral density (g/cm2) (mean difference [MD] -0.044; 95% confidence interval [CI] -0.076,-0.013) and Z-scores (MD -0.53; 95% CI -0.75, -0.30) in the femoral neck, and lower total hip Z-score (MD -0.35; 95% CI -0.54, -0.15) after adjusting for height and weight. EP/ELBW males generally displayed more bone and soft tissue deficits than females, compared with their respective controls. Within the EP/ELBW group, early growth, male sex, height and lean mass, muscle measures, 25(OH)D levels, and BTM were independently associated with bone mineral measures, structure or strength. CONCLUSIONS Young adults born EP/ELBW had evidence of impaired bone health around the age of peak bone mass compared with controls. Further follow-up of the EP/ELBW groups will determine if they have a heightened low-trauma fracture risk in later life.
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Affiliation(s)
- Anjali Haikerwal
- Newborn Services, The Royal Women's Hospital, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.
| | - Lex W Doyle
- Newborn Services, The Royal Women's Hospital, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Obstetrics and Gynecology, The Royal Women's Hospital, The University of Melbourne, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - George Patton
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia
| | - Suzanne M Garland
- Department of Obstetrics and Gynecology, The Royal Women's Hospital, The University of Melbourne, Melbourne, Australia; Centre for Women's Infectious Diseases Research, The Royal Women's Hospital, Parkville, Australia; Infection & Immunity Theme, Murdoch Children's Research Institute, Parkville, Australia
| | - Michael M Cheung
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Heart Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Cardiology, Royal Children's Hospital, Melbourne, Australia
| | - John D Wark
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia; Bone and Mineral Medicine, The Royal Melbourne Hospital, Melbourne, Australia
| | - Jeanie L Y Cheong
- Newborn Services, The Royal Women's Hospital, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Obstetrics and Gynecology, The Royal Women's Hospital, The University of Melbourne, Melbourne, Australia
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DEMİRBAŞ F, ENGİN ARISOY A, DEMİR H. The Long-Term Effect of Very Low Birth Weight and Prematurity On Bone Mineral Density In 5-7 Years Old Children. DICLE MEDICAL JOURNAL 2020. [DOI: 10.5798/dicletip.755695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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6
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Xie LF, Alos N, Cloutier A, Béland C, Dubois J, Nuyt AM, Luu TM. The long-term impact of very preterm birth on adult bone mineral density. Bone Rep 2018; 10:100189. [PMID: 30627597 PMCID: PMC6319299 DOI: 10.1016/j.bonr.2018.100189] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/05/2018] [Accepted: 12/11/2018] [Indexed: 12/31/2022] Open
Abstract
Introduction Preterm infants are at increased risk of osteopenia of prematurity due to insufficient bone mineral accretion. Data on long term effects of prematurity on bone health are conflicting. This study aimed to compare bone mineral density (BMD) in young adults born very preterm and full-term controls and to examine factors associated with long-term bone health. Methods This observational cross-sectional study enrolled 101 young adults (18–29 years) born <29 weeks of gestation and 95 sex- and age-matched full-term controls. Participants underwent dual-energy X-ray absorptiometry to measure areal BMD and body composition. Generalized estimated equations were used to compare groups adjusting for height Z-score, lean body mass and fat mass. Results Adults born preterm were shorter and lighter than full-term controls. Areal BMD was reduced at the lumbar spine, the femoral neck and whole body in the preterm versus full-term group, but after adjustment, areal BMD Z-score was only significantly lower at the femoral neck by −0.3 unit (95% confidence interval −0.6 to −0.0). Low BMD (Z-score ≤ −1 standard deviation) at any site was observed in 53% of adults born preterm versus 28% of full-term controls, but this was not statistically significantly different. We did not identify any neonatal factors associated with lower BMD within the preterm group. Conclusions Very preterm birth is associated with lower areal BMD at the femoral neck in young adulthood, even after accounting for body size. Whether this will translate into higher risk of osteoporotic fractures later in life remains unknown.
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Affiliation(s)
- Li Feng Xie
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Nathalie Alos
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada.,Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Anik Cloutier
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Chanel Béland
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Josée Dubois
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada.,Department of Radiology, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Anne Monique Nuyt
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada.,Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Thuy Mai Luu
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada.,Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada
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7
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Kotecha SJ, Lowe J, Kotecha S. Effect of foetal and infant growth and body composition on respiratory outcomes in preterm-born children. Paediatr Respir Rev 2018; 28:55-62. [PMID: 29343422 DOI: 10.1016/j.prrv.2017.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 12/13/2017] [Indexed: 01/21/2023]
Abstract
Body composition and growth outcomes of preterm-born subjects have been studied by many researchers. In general, preterm-born children have lower height and weight especially in infancy. Despite showing potential for catch-up growth, they continue to lag behind their term counterparts in adolescence and adulthood. The various methods of studying body composition and the differing gestations and ages at which it is assessed may go some way to explaining the inconsistent results observed in different studies. In addition, there is a paucity of data on the effects of foetal and infant growth and of body composition on later respiratory outcomes. In largely term-born subjects, foetal growth and growth trajectories appear to have differential effects on later respiratory outcomes. Early weight gain in infancy appears to be associated with increased respiratory symptoms in childhood but catch-up growth in infancy appears to be associated with possible improved lung function status.
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Affiliation(s)
- Sarah J Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK
| | - John Lowe
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK
| | - Sailesh Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK.
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8
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Bone Mineral Density According to Dual Energy X-ray Absorptiometry is Associated with Serial Serum Alkaline Phosphatase Level in Extremely Low Birth Weight Infants at Discharge. Pediatr Neonatol 2017; 58:251-257. [PMID: 27780689 DOI: 10.1016/j.pedneo.2016.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/03/2016] [Accepted: 05/04/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND To examine bone mineral density in extremely low birth weight infants at discharge and investigate whether serial measurements of serum alkaline phosphatase (ALP) and phosphate can predict bone mineralization. METHODS The individuals were 70 preterm infants. Serum calcium, phosphate, and ALP were measured at weekly intervals during admission in extremely low birth weight infants (mean gestational age, 25.3±2.1 weeks; birth weight, 812.8±141.1 g). Bone mineral apparent density (BMAD) of the lumbar spine was prospectively evaluated by dual energy X-ray absorptiometry at discharge (n=70). RESULTS BMAD was classified as poor (< 25th percentile) at < 0.014 g/cm3, fair (25th-75th percentile) at < 0.014-0.021 g/cm3, and good (> 75th percentile) at > 0.021 g/cm3, based on the distribution of BMAD values in infants with noncomplicated courses of prematurity (n=43). In a further multivariate analysis, the number of total parenteral nutrition days, phosphate at 2 postnatal weeks and 3 postnatal weeks, and ALP at 4 postnatal weeks and 5 postnatal weeks had an impact on bone mineral density at the lumbar spine, independent of gestational age and body weight. Peak ALP activities exceeding 650 IU/L revealed low bone mineral density with 80% sensitivity and 64% specificity (AUC, 0.70; p=0.005). CONCLUSION Serial measurements of serum ALP and phosphate are associated with decreased bone mineralization by dual energy X-ray absorptiometry at discharge in extremely low birth weight infants.
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Buttazzoni C, Rosengren B, Tveit M, Landin L, Nilsson JÅ, Karlsson M. Preterm Children Born Small for Gestational Age are at Risk for Low Adult Bone Mass. Calcif Tissue Int 2016; 98:105-13. [PMID: 26472429 DOI: 10.1007/s00223-015-0069-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 10/01/2015] [Indexed: 10/22/2022]
Abstract
Cross-sectional studies suggest that premature birth and low birth weight may both be associated with low peak bone mass. We followed bone traits in preterm individuals and controls for 27 years and examined the effects of birth weight relative to gestational age [stratified as small for gestational age (SGA) or appropriate for gestational (AGA)] on adult bone mineral density (BMD). We measured distal forearm BMC (g/cm) and BMD (g/cm(2)) with single-photon absorptiometry (SPA) in 46 preterm children (31 AGA and 15 SGA) at mean age 10.1 years (range 4-16) and in 84 healthy age-matched children. The measurements were repeated 27 years later with the same SPA apparatus but then also with dual energy absorptiometry and peripheral computed tomography (pQCT). Preterm individuals were shorter (p = 0.03) in adulthood than controls. Preterm AGA individuals had similar BMC and BMD height-adjusted Z-scores in adulthood compared to controls. Preterm SGA individuals had lower distal forearm BMC and BMD height-adjusted Z-scores in adulthood than both controls and preterm AGA individuals. Preterm SGA individuals had lower gain from childhood to adulthood in distal forearm BMC height-adjusted Z-scores than controls (p = 0.03). The deficits in preterm SGA individuals in adulthood were also captured by DEXA in height-adjusted femoral neck (FN) BMC Z-score and height-adjusted FN BMD Z-score and by pQCT in tibial cross-sectional area (CSA) Z-score and stress strain index (SSI) Z-score, where all measurements were lower than controls (all p values <0.05). Preterm SGA individuals are at increased risk of reaching low adult bone mass, at least partly due to a deficit in the accrual of bone mineral during growth. In our cohort, we were unable to find a similar risk in preterm AGA individuals.
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Affiliation(s)
- Christian Buttazzoni
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, 205 02, Malmō, Sweden.
| | - Björn Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, 205 02, Malmō, Sweden
| | - Magnus Tveit
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, 205 02, Malmō, Sweden
| | - Lennart Landin
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, 205 02, Malmō, Sweden
| | - Jan-Åke Nilsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, 205 02, Malmō, Sweden
| | - Magnus Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, 205 02, Malmō, Sweden
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10
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Luu TM, Katz SL, Leeson P, Thébaud B, Nuyt AM. Preterm birth: risk factor for early-onset chronic diseases. CMAJ 2015; 188:736-746. [PMID: 26644500 DOI: 10.1503/cmaj.150450] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Thuy Mai Luu
- Department of Pediatrics (Luu, Nuyt), Centre hospitalier universitaire Sainte-Justine Research Center, Montréal, Que.; Department of Pediatrics (Katz), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Cardiovascular Medicine (Leeson), University of Oxford, Oxford, United Kingdom; Department of Pediatrics (Thébaud), Ottawa Hospital Research Institute, Ottawa, Ont.
| | - Sherri L Katz
- Department of Pediatrics (Luu, Nuyt), Centre hospitalier universitaire Sainte-Justine Research Center, Montréal, Que.; Department of Pediatrics (Katz), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Cardiovascular Medicine (Leeson), University of Oxford, Oxford, United Kingdom; Department of Pediatrics (Thébaud), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Paul Leeson
- Department of Pediatrics (Luu, Nuyt), Centre hospitalier universitaire Sainte-Justine Research Center, Montréal, Que.; Department of Pediatrics (Katz), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Cardiovascular Medicine (Leeson), University of Oxford, Oxford, United Kingdom; Department of Pediatrics (Thébaud), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Bernard Thébaud
- Department of Pediatrics (Luu, Nuyt), Centre hospitalier universitaire Sainte-Justine Research Center, Montréal, Que.; Department of Pediatrics (Katz), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Cardiovascular Medicine (Leeson), University of Oxford, Oxford, United Kingdom; Department of Pediatrics (Thébaud), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Anne-Monique Nuyt
- Department of Pediatrics (Luu, Nuyt), Centre hospitalier universitaire Sainte-Justine Research Center, Montréal, Que.; Department of Pediatrics (Katz), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Cardiovascular Medicine (Leeson), University of Oxford, Oxford, United Kingdom; Department of Pediatrics (Thébaud), Ottawa Hospital Research Institute, Ottawa, Ont
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Mata Zubillaga D, Rodríguez Fernández C, Rodríguez Fernández L, de Paz Fernández J, Arboleda Franco S, Alonso Patiño F. Evaluation of isometric force in lower limbs and body composition in preterm infants. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.anpede.2014.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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12
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Paulsson-Björnsson L, Adams J, Bondemark L, Devlin H, Horner K, Lindh C. The impact of premature birth on the mandibular cortical bone of children. Osteoporos Int 2015; 26:637-44. [PMID: 25266484 DOI: 10.1007/s00198-014-2898-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 09/08/2014] [Indexed: 11/27/2022]
Abstract
SUMMARY Children born prematurely often have reduced skeletal mineralization. The aim in this study was to compare the cortical thickness of the lower jaw on radiographs of 8- to 10-year-old children with histories of preterm or full term births. There were no significant differences in cortical thickness between full term and preterm children at this age. INTRODUCTION The purpose of this study was to compare the cortical thickness of the mandible on panoramic radiographs of 8- to 10-year-old children with histories of preterm or full term births. METHODS Panoramic radiography was performed on 36 extremely preterm, 38 very preterm and 42 full term children at the age of 8 to 10 years. Five observers independently measured the mandibular cortical width on the panoramic radiographs at four defined sites bilaterally. Altogether, 928 sites were available. Measurements were performed twice on a random 24% of the sites by four observers. One-way analysis of variance with Tukey's post hoc test was used to test differences between groups. Intraclass correlation coefficient (ICC) was calculated for interobserver agreement while intra-observer agreement was expressed as measurement precision. RESULTS Significant differences of mandibular cortical width were found between extremely preterm and very preterm children for five of the eight measurement sites with the very preterm showing the highest value. No significant differences were found between full term and either very preterm or extremely preterm except for one measurement site, with the extremely preterm showing the lowest value. ICC varied between 0.30 and 0.83 for the different sites (mean 0.62). The precision of a single measurement varied between 0.11 and 0.45 mm (mean 0.25 mm). CONCLUSIONS From the evidence that very preterm children had significantly thicker mandibular cortices than extremely preterm children, we suggest that these findings may reflect the effect of mineral supplementation provided to premature infants, causing a 'shifting up' of bone mineral status relative to the full term peer group while maintaining the difference between very preterm and extremely preterm born children.
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Mata Zubillaga D, Rodríguez Fernández C, Rodríguez Fernández LM, de Paz Fernández JA, Arboleda Franco S, Alonso Patiño F. [Evaluation of isometric force in lower limbs and body composition in preterm infants]. An Pediatr (Barc) 2015; 83:229-35. [PMID: 25639163 DOI: 10.1016/j.anpedi.2014.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 11/20/2014] [Accepted: 12/16/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Strength is a physical quality with a clear influence on quality of life. It is determined by the structure of the musculoskeletal system, and depends on the muscular structure. It has been described that prematurity conditions both qualities. The aims of this study are to determine whether prematurity is associated with strength or body composition and evaluate the relationship between prematurity, strength and muscle mass. MATERIAL AND METHODS Case-control study. Participants were premature 7-to-11 year-old children and full-term birth controls. Strength was measured by a strength gauge and body composition from DEXA (duel-energy X-ray absorptiometry) scans. A total of 89 subjects were included and divided into three groups: 30 prematures with birth-weight ≤ 1500g, 29 prematures with birth-weight 1500-2000g, and 30 controls. RESULTS Weight and BMI z-score was lower in the premature group. No differences were found in muscular mass or strength between groups. A ratio was established between strength and weight or muscular mass. It was observed that it was possible for them to move four times their weight, without finding any differences between groups or a relationship with birth-weight. CONCLUSIONS Between 7 and 11 years of age, children who were premature have lower weight and BMI than the rest of the children. However, there were no differences in body composition or strength between preterm children and controls.
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Affiliation(s)
- D Mata Zubillaga
- Unidad de Pediatría, Centro de Salud Ponferrada IV. Ponferrada, León.
| | - C Rodríguez Fernández
- Servicio de Pediatría y Neonatología, Complejo Asistencial Universitario de León, León
| | | | - J A de Paz Fernández
- Facultad de Ciencias de la Educación Física y del Deporte, Universidad de León, León
| | - S Arboleda Franco
- Facultad de Ciencias de la Educación Física y del Deporte, Universidad de León, León
| | - F Alonso Patiño
- Facultad de Ciencias de la Educación Física y del Deporte, Universidad de León, León
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Bone and fat mass in relation to postnatal levels of insulin-like growth factors in prematurely born children at 4 y of age. Pediatr Res 2014; 75:544-50. [PMID: 24441105 DOI: 10.1038/pr.2014.4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 09/27/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND Children born prematurely may be at risk of developing osteopenia. This study investigated whether insulin-like growth factors (IGFs) in the early postnatal period influence bone mass and body composition in prematurely born children. METHODS A total of 74 control (gestational age >36 wk; n = 37) and preterm (gestational age <32 wk; n = 37) infants were investigated (mean age ± SD: 4.59 ± 0.31 y). Bone mineral density, body composition, and markers of bone and mineral metabolism were investigated in relation to postnatal IGF levels. RESULTS After adjusting for confounders, we found no differences in bone mass, but significantly less lean mass, increased fat mass, and increased osteocalcin levels in ex-preterm infants. Forward stepwise multiple analysis revealed that higher late postnatal IGF-II levels predict lumbar spine bone mineral content (P < 0.05) and lean mass (P < 0.05). When the birth weight standard deviation score was included in the analysis, higher early postnatal IGF-I levels predicted both lumbar spine bone mineral density and bone mineral content (P < 0.05). Higher early postnatal IGF binding protein-3 (P < 0.01) predicted increased fat mass at 4-y follow-up. CONCLUSION Ex-preterm children have normal bone mass but different body composition compared with full-term controls. Higher early IGF-I and late postnatal IGF-II concentrations are positive predictors of lumbar spine bone mass.
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Miettola S, Hovi P, Andersson S, Strang-Karlsson S, Pouta A, Laivuori H, Järvenpää AL, Eriksson JG, Mäkitie O, Kajantie E. Maternal preeclampsia and bone mineral density of the adult offspring. Am J Obstet Gynecol 2013; 209:443.e1-443.e10. [PMID: 23791691 DOI: 10.1016/j.ajog.2013.06.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 04/02/2013] [Accepted: 06/17/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Preterm birth at very low birthweight (<1500 g) is associated with cardiometabolic risk factors and reduced bone mineral density in the adult offspring. Preeclampsia is a frequent cause of preterm birth and is also associated with cardiometabolic risk factors in the offspring. Whether it is associated with bone mineral density is not known. STUDY DESIGN We evaluated skeletal health in participants of the Helsinki Study of Very Low Birthweight Adults: 144 born at very low birthweight and 139 born at term. From the very low birthweight and term offspring a respective 32 and 11 were born from pregnancy complicated by preeclampsia. We measured bone mineral density at age 18.5 to 27.1 years by dual X-ray absorptiometry. RESULTS Very low birthweight adults exposed to maternal preeclampsia had higher lumbar spine Z score (mean -0.44, compared with -1.07 in very low birthweight unexposed adults, P = .002), femoral neck Z score (-0.05 vs -0.53, P = .003) and whole body bone mineral density Z score (-0.14 vs -0.72, P = .001). Corresponding Z scores for those born at term were -0.02 (preeclampsia) and -0.45 (no preeclampsia) for lumbar spine (P = .2), 0.78 and 0.08 for femoral neck (P = .02) and 0.02 and -0.31 for whole body bone mineral density Z score (P = .08). The results survived adjustment for offspring current height, body mass index, leisure time physical activity, socioeconomic position, smoking, and maternal smoking during pregnancy, and maternal prepregnancy body mass index. CONCLUSION Young adults exposed to maternal preeclampsia have higher bone mineral density than those not exposed. This difference is seen among those born at very low birthweight and seems also to be present among those born at term.
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Parkinson JRC, Hyde MJ, Gale C, Santhakumaran S, Modi N. Preterm birth and the metabolic syndrome in adult life: a systematic review and meta-analysis. Pediatrics 2013; 131:e1240-63. [PMID: 23509172 DOI: 10.1542/peds.2012-2177] [Citation(s) in RCA: 305] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Preterm birth is associated with features of the metabolic syndrome in later life. We performed a systematic review and meta-analysis of studies reporting markers of the metabolic syndrome in adults born preterm. METHODS Reports of metabolic syndrome-associated features in adults (≥18 years of age) born at <37-week gestational age and at term (37- to 42-week gestational age) were included. Outcomes assessed were BMI, waist-hip ratio, percentage fat mass, systolic (SBP) and diastolic (DBP) blood pressure, 24-hour ambulatory SBP and DBP, flow-mediated dilatation, intima-media thickness, and fasting glucose, insulin, and lipid profiles. RESULTS Twenty-seven studies, comprising a combined total of 17,030 preterm and 295,261 term-born adults, were included. In adults, preterm birth was associated with significantly higher SBP (mean difference, 4.2 mm Hg; 95% confidence interval [CI], 2.8 to 5.7; P < .001), DBP (mean difference, 2.6 mm Hg; 95% CI, 1.2 to 4.0; P < .001), 24-hour ambulatory SBP (mean difference, 3.1 mm Hg; 95% CI, 0.3 to 6.0; P = .03), and low-density lipoprotein (mean difference, 0.14 mmol/L; 95% CI, 0.05 to 0.21; P = .01). The preterm-term differences for women was greater than the preterm-term difference in men by 2.9 mm Hg for SBP (95% CI [1.1 to 4.6], P = .004) and 1.6 mm Hg for DBP (95% CI [0.3 to 2.9], P = .02). CONCLUSIONS For the majority of outcome measures associated with the metabolic syndrome, we found no difference between preterm and term-born adults. Increased plasma low-density lipoprotein in young adults born preterm may represent a greater risk for atherosclerosis and cardiovascular disease in later life. Preterm birth is associated with higher blood pressure in adult life, with women appearing to be at greater risk than men.
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Affiliation(s)
- James R C Parkinson
- Section of Neonatal Medicine, Department of Medicine, Imperial College London, London SW10 9NH, United Kingdom
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Wood CL, Wood AM, Harker C, Embleton ND. Bone mineral density and osteoporosis after preterm birth: the role of early life factors and nutrition. Int J Endocrinol 2013; 2013:902513. [PMID: 23662104 PMCID: PMC3639624 DOI: 10.1155/2013/902513] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Accepted: 03/24/2013] [Indexed: 01/22/2023] Open
Abstract
The effects of preterm birth and perinatal events on bone health in later life remain largely unknown. Bone mineral density (BMD) and osteoporosis risk may be programmed by early life factors. We summarise the existing literature relating to the effects of prematurity on adult BMD and the Developmental Origins of Health and Disease hypothesis and programming of bone growth. Metabolic bone disease of prematurity and the influence of epigenetics on bone metabolism are discussed and current evidence regarding the effects of breastfeeding and aluminium exposure on bone metabolism is summarised. This review highlights the need for further research into modifiable early life factors and their effect on long-term bone health after preterm birth.
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Affiliation(s)
- Claire L. Wood
- Child Health, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
| | - Alexander M. Wood
- Orthopaedic Department, Wansbeck General Hospital, Woodhorn Lane, Ashington, Northumberland NE63 9JJ, UK
| | - Caroline Harker
- Newcastle University, Framlington Place, Newcastle Upon Tyne NE2 4HH, UK
| | - Nicholas D. Embleton
- Child Health, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
- Newcastle Neonatal Service, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
- Institute of Health and Society, Newcastle University, Framlington Place, Newcastle Upon Tyne NE2 4HH, UK
- *Nicholas D. Embleton:
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Zemel BS. Human biology at the interface of paediatrics: measuring bone mineral accretion during childhood. Ann Hum Biol 2012; 39:402-11. [PMID: 22834897 DOI: 10.3109/03014460.2012.704071] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Professor Tanner established a paradigm for the study of growth and development that demands precise growth measurements, description of normal variability through development to adulthood, consideration of the effects of tempo and the study of factors that influence growth outcomes. The relatively new field of paediatric bone health assessment fits this paradigm and reflects the collaboration of human biologists and paediatricians in understanding the growth of the human skeleton. REVIEW This review describes the reasons for clinical assessment of bone density in children, the technological developments in bone health assessment in children, the development of reference curves and the effects of growth, body composition, pubertal timing, genetics and lifestyle on bone health outcomes.
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Affiliation(s)
- Babette S Zemel
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, The Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, room 1560, Philadelphia, PA 19104-4399, USA.
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Stünkel W, Pan H, Chew SB, Tng E, Tan JH, Chen L, Joseph R, Cheong CY, Ong ML, Lee YS, Chong YS, Saw SM, Meaney MJ, Kwek K, Sheppard AM, Gluckman PD, Holbrook JD. Transcriptome changes affecting Hedgehog and cytokine signalling in the umbilical cord: implications for disease risk. PLoS One 2012; 7:e39744. [PMID: 22808055 PMCID: PMC3393728 DOI: 10.1371/journal.pone.0039744] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 05/25/2012] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Babies born at lower gestational ages or smaller birthweights have a greater risk of poorer health in later life. Both the causes of these sub-optimal birth outcomes and the mechanism by which the effects are transmitted over decades are the subject of extensive study. We investigated whether a transcriptomic signature of either birthweight or gestational age could be detected in umbilical cord RNA. METHODS The gene expression patterns of 32 umbilical cords from Singaporean babies of Chinese ethnicity across a range of birthweights (1698-4151 g) and gestational ages (35-41 weeks) were determined. We confirmed the differential expression pattern by gestational age for 12 genes in a series of 127 umbilical cords of Chinese, Malay and Indian ethnicity. RESULTS We found that the transcriptome is substantially influenced by gestational age; but less so by birthweight. We show that some of the expression changes dependent on gestational age are enriched in signal transduction pathways, such as Hedgehog and in genes with roles in cytokine signalling and angiogenesis. We show that some of the gene expression changes we report are reflected in the epigenome. CONCLUSIONS We studied the umbilical cord which is peripheral to disease susceptible tissues. The results suggest that soma-wide transcriptome changes, preserved at the epigenetic level, may be a mechanism whereby birth outcomes are linked to the risk of adult metabolic and arthritic disease and suggest that greater attention be given to the association between premature birth and later disease risk.
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Affiliation(s)
- Walter Stünkel
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Singapore
| | - Hong Pan
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Singapore
| | - Siew Boom Chew
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Singapore
| | - Emilia Tng
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Singapore
| | - Jun Hao Tan
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Singapore
| | - Li Chen
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Singapore
| | - Roy Joseph
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Singapore
| | - Clara Y. Cheong
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Singapore
| | - Mei-Lyn Ong
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Yap-Seng Chong
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Seang Mei Saw
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Michael J. Meaney
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Singapore
| | - Kenneth Kwek
- Department of Maternal Fetal Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore
| | | | - Peter D. Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Singapore
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Joanna D. Holbrook
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Singapore
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Langman CB. Pediatrics: Measuring pediatric BMD-the bar raised but the glass half full. Nat Rev Endocrinol 2011; 8:5-6. [PMID: 22105020 DOI: 10.1038/nrendo.2011.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Extensive reference data sets of pediatric bone density measurements are now available, together with equations to translate BMD into relevant Z-scores and correct for abnormal stature. So now is the right time to ask: are you thinking about bone density in children correctly?
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