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Zhao ZF, Li BY, He Q, Hao JY, Zhang KS, Zhang B, Hu W, Feng HT, Szeto IMY, Chen YM, Zhang GX, Tang XY. Impact of dairy supplementation on bone acquisition in children's limbs: a 12-month cluster-randomized controlled trial and meta-analysis. Arch Osteoporos 2024; 19:65. [PMID: 39043915 DOI: 10.1007/s11657-024-01422-2] [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: 03/12/2024] [Accepted: 07/13/2024] [Indexed: 07/25/2024]
Abstract
The impact of milk on bone health in rural preschoolers is under-researched. This study, through a clinical trial and a meta-analysis, finds that milk supplementation enhances forearm and calcaneus bone acquisition in children, supporting the benefits of daily milk consumption. PURPOSE This study evaluated the impact of dairy supplementation on bone acquisition in children's limbs through a cluster-randomized controlled trial and a meta-analysis. METHODS The trial involved 315 children (4-6 year) from Northwest China, randomized to receive either 390 ml of milk daily (n = 215) or 20-30 g of bread (n = 100) over 12 months. We primarily assessed bone mineral density (BMD) and content (BMC) changes at the limbs, alongside bone-related biomarkers, measured at baseline, the 6th and 12th months. The meta-analysis aggregated BMD or BMC changes in the forearm/legs/calcaneus from published randomized trials involving children aged 3-18 years supplemented with dairy foods (vs. control group). RESULTS Of 278 completed the trial, intention-to-treat analysis revealed significant increases in BMD (4.05% and 7.31%) and BMC (4.69% and 7.34%) in the left forearm at the 6th and 12th months in the milk group compared to controls (P < 0.001). The calcaneus showed notable improvements in BMD (2.01%) and BMC (1.87%) at 6 months but not at 12 months. Additionally, milk supplementation was associated with beneficial changes in bone resorption markers, parathyroid hormone (- 12.70%), insulin-like growth factor 1 (6.69%), and the calcium-to-phosphorus ratio (2.22%) (all P < 0.05). The meta-analysis, encompassing 894 children, indicated that dairy supplementation significantly increased BMD (SMD, 0.629; 95%CI: 0.275, 0.983) and BMC (SMD, 0.616; 95%CI: 0.380, 0.851) (P < 0.05) in the arms, but not in the legs (P > 0.05). CONCLUSION Milk supplementation significantly improves bone health in children's forearms, underscoring its potential as a strategic dietary intervention for bone development. Trial registration NCT05074836.
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Affiliation(s)
- Zi-Fu Zhao
- Inner Mongolia Yili Industrial Group Co., Ltd., Hohhot, China
- Inner Mongolia Dairy Technology Research Institute Co. Ltd., Hohhot, China
| | - Bang-Yan Li
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Qin He
- Institute of Nutrition and Food Hygiene, School of Public Health, Lanzhou University, Lanzhou, Gansu Province, China
| | - Jing-Yu Hao
- Inner Mongolia Yili Industrial Group Co., Ltd., Hohhot, China
- Inner Mongolia Dairy Technology Research Institute Co. Ltd., Hohhot, China
| | - Kai-Shuai Zhang
- Inner Mongolia Yili Industrial Group Co., Ltd., Hohhot, China
| | - Bo Zhang
- Inner Mongolia Yili Industrial Group Co., Ltd., Hohhot, China
| | - Wei Hu
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Hao-Tian Feng
- Inner Mongolia Yili Industrial Group Co., Ltd., Hohhot, China
- Inner Mongolia Dairy Technology Research Institute Co. Ltd., Hohhot, China
| | - Ignatius Man-Yau Szeto
- Inner Mongolia Yili Industrial Group Co., Ltd., Hohhot, China
- Inner Mongolia Dairy Technology Research Institute Co. Ltd., Hohhot, China
| | - Yu-Ming Chen
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, China.
| | - Ge-Xiang Zhang
- Institute of Nutrition and Food Hygiene, School of Public Health, Lanzhou University, Lanzhou, Gansu Province, China.
| | - Xin-Yi Tang
- Department of Pediatrics, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
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Binney N. Reference-Class Problems Are Real: Health-Adjusted Reference Classes and Low Bone Mineral Density. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2024; 49:128-146. [PMID: 38418083 PMCID: PMC10938540 DOI: 10.1093/jmp/jhae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
Elselijn Kingma argues that Christopher Boorse's biostatistical theory (the BST) does not show how the reference classes it uses are objective and naturalistic. Recently, philosophers of medicine have attempted to rebut Kingma's concerns. I argue that these rebuttals are theoretically unconvincing, and that there are clear examples of physicians adjusting their reference classes according to their prior knowledge of health and disease. I focus on the use of age-adjusted reference classes to diagnose low bone mineral density in children. In addition to using the BST's age, sex, and species, physicians also choose to use other factors to define reference classes, such as pubertal status, bone age, body size, and muscle mass. I show that physicians calibrate the reference classes they use according to their prior knowledge of health and disease. Reference classes are also chosen for pragmatic reasons, such as to predict fragility fractures.
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Abstract
To a large extent, the clinical picture of pediatric mastocytosis depends on the age at which it is diagnosed. A neonate with diffuse cutaneous mastocytosis may frequently present in a severe state requiring treatment. Toddlers may require long-term anti-mediator therapy, and this may lead to concerns such as organizing preschool education due to the need for epinephrine injections. A teenager may have to face cutaneous disease persistence or a diagnosis of systemic mastocytosis. Further studies are needed to refine the available treatment options and prognosis for different age groups.
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Affiliation(s)
- Joanna Renke
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdańsk, ul. Skłodowskiej-Curie 3A, 80-210 Gdańsk.
| | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdańsk, ul. Skłodowskiej-Curie 3A, 80-210 Gdańsk
| | - Magdalena Lange
- Department of Dermatology, Venerology and Allergology, Medical University of Gdańsk, ul. Skłodowskiej-Curie 3A, 80-210 Gdańsk
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Tripodi SI, Bergami E, Panigari A, Caissutti V, Brovia C, De Cicco M, Cereda E, Caccialanza R, Zecca M. The role of nutrition in children with cancer. TUMORI JOURNAL 2023; 109:19-27. [PMID: 35722985 PMCID: PMC9896537 DOI: 10.1177/03008916221084740] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In recent years, the influence of nutrition on the health and growth of children has become increasingly important. The relevance of nutrition is even greater for children who are facing cancer. Malnutrition, within the context of undernutrition and overnutrition, may impact not only the effectiveness of treatments and outcomes, but also the quality of life for patients and their families. In this article, we review nutritional assessment methods for children with cancer, focusing on the specific characteristics of this population and analyze the efficacy of nutritional interventions, which include enteral, parenteral, and nutritional education. From our analysis, two important conclusions emerged: i) there is a need to focus our attention on the nutritional status and the body composition of oncologic children, since these factors have a relevant impact on clinical outcomes during treatment as well as after their conclusion; ii) the support of skilled clinical nutrition personnel would be extremely helpful for the global management of these patients.
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Affiliation(s)
- Serena Ilaria Tripodi
- Paediatric Haematology and Oncology,
Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Serena Ilaria Tripodi, Paediatric
Haematology and Oncology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi
19, Pavia, 27100, Italy.
| | - Elena Bergami
- Paediatric Haematology and Oncology,
Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Arianna Panigari
- Paediatric Haematology and Oncology,
Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valentina Caissutti
- Clinical Nutrition and Dietetics Unit,
Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carlotta Brovia
- Clinical Nutrition and Dietetics Unit,
Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marica De Cicco
- Paediatric Haematology and Oncology,
Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Cell Factory, Fondazione IRCCS
Policlinico San Matteo, Pavia, Italy
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit,
Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit,
Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Zecca
- Paediatric Haematology and Oncology,
Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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5
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Barr RD, Antillon-Klussmann F. Cancer and nutrition among children and adolescents in low- and middle-income countries. HEMATOLOGY (AMSTERDAM, NETHERLANDS) 2022; 27:987-993. [PMID: 36094475 DOI: 10.1080/16078454.2022.2115437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE : The primary purpose of this review is to investigate the relationships between cancer and nutrition in children and adolescents living in resource-poor, low- and middle-income countries (LMICs) in order to explore potential opportunities for interventions which could improve clinical outcomes in this population. METHOD : The implications of overlapping age groups of children and adolescents with cancer are examined, as are the adverse influences of under-nutrition and socio-economic deprivation on the efficacy of treatment and cancer survival. Evidence suggestive of novel avenues to enhance prospects for cure, based on increased understanding of the dynamic of nutrition and cancer, is evaluated. RESULT : Cancer adds to the burden of under-nutrition in disadvantaged populations which is reflective, in large measure, on inadequate governmental expenditure on health which demands public-private partnerships and the use of hospital-based foundations. Structured approaches to the measurement of nutritional status and the design of effective programmes of nutritional supplementation are of proven benefit. Initial results from studies of the perturbed gut microbiome hold considerable promise for further gains. CONCLUSION A large minority of children with cancer in LMICs are never diagnosed and the same may be true of adolescents. Investing in the training of nutritionists will have substantial returns as will increasing access to essential medicines. Recognition of these challenges has stimulated WHO and other entities to devise major strategies for comprehensive changes in the care of children and adolescents with cancer in LMICs, offering realistic prospects for improved clinical outcomes.
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Affiliation(s)
- Ronald D Barr
- Departments of Pediatrics and Medicine, McMaster University, Hamilton, Canada
| | - Federico Antillon-Klussmann
- Unidad Nacional de Oncología Pediátrica, and School of Medicine, Francisco Marroquín University, Guatemala, Guatemala
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Abstract
Peak bone mass (PBM) is a key determinant of bone mass and fragility fractures later in life. The increase in bone mass during childhood and adolescence is mainly related to an increase in bone size rather to changes in volumetric bone density. Race, gender, and genetic factors are the main determinants of PBM achievement. Nevertheless, environmental factors such as physical activity, calcium and protein intakes, weight and age at menarche, are also playing an important role in bone mass accrual during growth. Therefore, optimization of calcium and protein intakes and weight-bearing physical activity during growth is an important strategy for optimal acquisition of PBM and bone strength and for contributing to prevent fractures later in life.
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Affiliation(s)
- Thierry Chevalley
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | - René Rizzoli
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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7
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Penido MGMG, Tavares MDS. Beyond kidney stones: Why pediatricians should worry about hypercalciuria. World J Clin Pediatr 2021; 10:137-150. [PMID: 34868890 PMCID: PMC8603641 DOI: 10.5409/wjcp.v10.i6.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/08/2021] [Accepted: 10/31/2021] [Indexed: 02/06/2023] Open
Abstract
The incidence of urolithiasis (UL) is increasing, and it has become more common in children and adolescents over the past few decades. Hypercalciuria is the leading metabolic risk factor of pediatric UL, and it has high morbidity, with or without lithiasis as hematuria and impairment of bone mass. The reduction in bone mineral density has already been described in pediatric idiopathic hypercalciuria (IH), and the precise mechanisms of bone loss or failure to achieve adequate bone mass gain remain unknown. A current understanding is that hypercalciuria throughout life can be considered a risk of change in bone structure and low bone mass throughout life. However, it is still not entirely known whether hypercalciuria throughout life can compromise the quality of the mass. The peak bone mass is achieved by late adolescence, peaking at the end of the second decade of life. This accumulation should occur without interference in order to achieve the peak of optimal bone mass. The bone mass acquired during childhood and adolescence is a major determinant of adult bone health, and its accumulation should occur without interference. This raises the critical question of whether adult osteoporosis and the risk of fractures are initiated during childhood. Pediatricians should be aware of this pediatric problem and investigate their patients. They should have the knowledge and ability to diagnose and initially manage patients with IH, with or without UL.
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Affiliation(s)
- Maria Goretti Moreira Guimarães Penido
- Pediatric Nephrology Unit, Nephrology Center, Santa Casa de Belo Horizonte Hospital, CEP 30150320, Belo Horizonte, Minas Gerais, Brazil
- Pediatric Nephrology Unit, Pediatric Department, Clinics Hospital, Universidade Federal de Minas Gerais, CEP 30130100, Belo Horizonte, Minas Gerais, Brazil
| | - Marcelo de Sousa Tavares
- Pediatric Nephrology Unit, Nephrology Center, Santa Casa de Belo Horizonte Hospital, CEP 30150320, Belo Horizonte, Minas Gerais, Brazil
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8
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Yuan C, Qu C, Ji W. Vitamin D supplementation for improving children with bone mineral density: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23475. [PMID: 33350731 PMCID: PMC7769342 DOI: 10.1097/md.0000000000023475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 11/02/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Osteoporosis is usually one of the less perceived complications of chronic illness among children. Previous studies have shown that vitamin D supplementation may be valuable to bone density, especially among children with a deficiency of vitamin D. Yet, the results often remain inconsistent. Therefore, the present study investigates the clinical therapeutic effects of vitamin D supplementation to enhance children with bone mineral density. METHODS We will search the randomised controlled experiment literature of vitamin D supplementation for bone mineral density, focusing on children, in 3 distinct English databases (EMBASE, MEDLINE via PubMed, and Cochrane Library) and 2 specific Chinese databases (China National Knowledge Infrastructure (CNKI) and WanFang databases). Additionally, we intend to explore the Clinical Trials.gov, reference lists of identified publication and the grey literature. Accordingly, we will use 2 independent authors to screen the literature, extract data, and research quality assessment. We will carry out all statistical analyses using RevMan 5.3 software. RESULTS We will systematically evaluate the clinical therapeutic effects of vitamin D supplementation to enhance children with bone mineral density. CONCLUSION The present study will summarise the currently published pieces of evidence of vitamin D supplementation for bone mineral density in children to further comprehend its promotion and application. ETHICS AND DISSEMINATION The present study is a systematic review and meta-analysis founded upon existing or published studies; therefore, ethical approval is not applicable. OSF REGISTRATION NUMBER October 24, 2020. osf.io/7vtey. (https://osf.io/7vtey/).
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9
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Barr RD, Stevens MCG. The influence of nutrition on clinical outcomes in children with cancer. Pediatr Blood Cancer 2020; 67 Suppl 3:e28117. [PMID: 32134218 DOI: 10.1002/pbc.28117] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/14/2019] [Accepted: 11/19/2019] [Indexed: 12/14/2022]
Abstract
Adequate and appropriate nutrition is essential for growth and development in children; all put at risk in those with cancer. Overnutrition and undernutrition at diagnosis raise the risk of increased morbidity and mortality during therapy and beyond. All treatment modalities can jeopardize nutritional status with potentially adverse effects on clinical outcomes. Accurate assessment of nutritional status and nutrient balance is essential, with remedial interventions delivered promptly when required. Children with cancer in low- and middle-income countries (LMICs) are especially disadvantaged with concomitant challenges in the provision of nutritional support. Cost-effective advances in the form of ready-to-use therapeutic foods (RUTF) may offer solutions. Studies in LMICs have defined a critical role for the gut microbiome in the causation of undernutrition in children and have demonstrated a beneficial effect of selected RUTF in redressing the imbalanced microbiota and improving nutritional status. Challenges in high-income countries relate both to concerns about the potential disadvantage of preexisting obesity in those newly diagnosed and to undernutrition identified at diagnosis and during treatment. Much remains to be understood but the prospects are bright for offsetting malnutrition in children with cancer, resulting in enhanced opportunity for healthy survival.
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Affiliation(s)
- Ronald D Barr
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Michael C G Stevens
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.,NIHR Cancer and Nutrition Collaboration, Southampton, United Kingdom
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10
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Differences in areal bone mineral density between metabolically healthy and unhealthy overweight/obese children: the role of physical activity and cardiorespiratory fitness. Pediatr Res 2020; 87:1219-1225. [PMID: 31822016 DOI: 10.1038/s41390-019-0708-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 07/03/2019] [Accepted: 11/02/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To examine whether areal bone mineral density (aBMD) differs between metabolically healthy (MHO) and unhealthy (MUO) overweight/obese children and to examine the role of moderate-to-vigorous physical activity (MVPA) and cardiorespiratory fitness (CRF) in this association. METHODS A cross-sectional study was developed in 188 overweight/obese children (10.4 ± 1.2 years) from the ActiveBrains and EFIGRO studies. Participants were classified as MHO or MUO based on Jolliffe and Janssen's metabolic syndrome cut-off points for triglycerides, glucose, high-density cholesterol and blood pressure. MVPA and CRF were assessed by accelerometry and the 20-m shuttle run test, respectively. Body composition was measured by dual-energy X-ray absorptiometry. RESULTS In model 1 (adjusted for sex, years from peak high velocity, stature and lean mass), MHO children had significantly higher aBMD in total body less head (Cohen's d effect size, ES = 0.34), trunk (ES = 0.43) and pelvis (ES = 0.33) than MUO children. These differences were attenuated once MVPA was added to model 1 (model 2), and most of them disappeared once CRF was added to the model 1 (model 3). CONCLUSIONS This novel research shows that MHO children have greater aBMD than their MUO peers. Furthermore, both MVPA and more importantly CRF seem to partially explain these findings.
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11
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Zhang YY, Hughes J, Grafenauer S. Got Mylk? The Emerging Role of Australian Plant-Based Milk Alternatives as A Cow's Milk Substitute. Nutrients 2020; 12:E1254. [PMID: 32354190 PMCID: PMC7281999 DOI: 10.3390/nu12051254] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/22/2020] [Accepted: 04/26/2020] [Indexed: 12/12/2022] Open
Abstract
Growing ethical, environmental and health concerns have encouraged demand for novel plant-based milk alternatives, yet it remains nebulous whether these products are nutritionally adequate as cow's milk replacements. The aim of this study was to conduct a cross-sectional survey of plant-based milk alternatives available in major Australian supermarkets and selected niche food retailers from November 2019 to January 2020 and assess two dietary scenarios (adolescents and older women) where dairy serves were substituted for plant-based alternatives against Australian Estimated Average Requirements (EAR). We collected compositional data from nutrition panels in juxtaposition with derivatives from the Australian Food Composition database, with a total of 115 products, including tree nuts and seeds (n = 48), legumes (n = 27), coconut (n = 10), grains (n = 19) and mixed sources (n = 10). Just over 50% of products were fortified, but only 1/3 contained similar calcium content to cow's milk. Indiscriminate substitutions might reduce intakes of protein and micronutrients, particularly vitamin A, B2, B12, iodine and zinc, and lead to reductions >50% of the EARs for protein, zinc and calcium in the chosen dietary scenarios. To avoid unintended dietary outcomes, it is vital that consumers make pragmatic decisions regarding dietary replacements for cow's milk.
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Affiliation(s)
- Yianna Y. Zhang
- School of Agriculture and Food, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, VIC 3052, Australia
- CSIRO Agriculture & Food, 671 Sneydes Road, Werribee, VIC 3030, Australia
| | - Jaimee Hughes
- Grains & Legumes Nutrition Council, Mount Street, North Sydney, NSW 2060, Australia
| | - Sara Grafenauer
- Grains & Legumes Nutrition Council, Mount Street, North Sydney, NSW 2060, Australia
- School of Medicine, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia
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12
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Abstract
Introduction: Obesity compromises survival in children with cancer in high-income countries (HICs) and is accompanied often by sarcopenia. In low and middle-income countries (LMICs), where the great majority of children live, the prevalence of under-nutrition is as high as 95% in those with cancer. Nutritional support improves clinical outcomes, including survival.Areas covered: This narrative review describes the evolution of attention to nutrition in children with cancer and the increasing understanding of this relationship. An initial focus on obesity in children with acute leukemias in HICs has been matched more recently by a recognition of the negative effect of under-nutrition on survival in children with cancer in LMICs. These observations have stimulated explorations of underlying mechanisms, including dysbiosis of the gut microbiome, and structured nutritional interventions to redress adverse outcomes.Expert opinion: Studies of the gut microbiome and metabolome have yielded important information on the pathogenesis of malnutrition in children, providing new avenues for interventions. Combinations of plant products that are inexpensive and readily available in LMICs have been shown to 'mature' the microbiome and the corresponding plasma proteome in children with acute malnutrition, offering the prospect of cost-effective remedies that are tested in children with cancer.
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Affiliation(s)
- Ronald D Barr
- Division of Hematology and Oncology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Elena J Ladas
- Division of Hematology-Oncology/Stem Cell Transplant, Department of Pediatrics, Columbia University, Irving Medical Centre, New York, USA
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14
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Joseph T, Ting J, Butler G. The effect of GnRH analogue treatment on bone mineral density in young adolescents with gender dysphoria: findings from a large national cohort. J Pediatr Endocrinol Metab 2019; 32:1077-1081. [PMID: 31472062 DOI: 10.1515/jpem-2019-0046] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 07/17/2019] [Indexed: 11/15/2022]
Abstract
Background More young people with gender dysphoria (GD) are undergoing hormonal intervention starting with gonadotropin-releasing hormone analogue (GnRHa) treatment. The impact on bone density is not known, with guidelines mentioning that bone mineral density (BMD) should be monitored without suggesting when. This study aimed to examine a cohort of adolescents from a single centre to investigate whether there were any clinically significant changes in BMD and bone mineral apparent density (BMAD) whilst on GnRHa therapy. Methods A retrospective review of 70 subjects aged 12-14 years, referred to a national centre for the management of GD (2011-2016) who had yearly dual energy X-ray absorptiometry (DXA) scans. BMAD scores were calculated from available data. Two analyses were performed, a complete longitudinal analysis (n=31) where patients had scans over a 2-year treatment period, and a larger cohort over the first treatment year (n=70) to extend the observation of rapid changes in lumbar spine BMD when puberty is blocked. Results At baseline transboys had lower BMD measures than transgirls. Although there was a significant fall in hip and lumbar spine BMD and lumbar spine BMAD Z-scores, there was no significant change in the absolute values of hip or spine BMD or lumbar spine BMAD after 1 year on GnRHa and a lower fall in BMD/BMAD Z-scores in the longitudinal group in the second year. Conclusions We suggest that reference ranges may need to be re-defined for this select patient cohort. Long-term BMD recovery studies on sex hormone treatment are needed.
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Affiliation(s)
- Tobin Joseph
- Department of Paediatric and Adolescent Endocrinology, University College London Hospital, London, UK
| | - Joanna Ting
- Department of Paediatric and Adolescent Endocrinology, University College London Hospital, London, UK
| | - Gary Butler
- Department of Paediatric and Adolescent Endocrinology, University College London Hospital, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK.,Gender Identity Development Service, Tavistock and Portman NHS Trust, London, UK
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15
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Cetin N, Gencler A, Sivrikoz IA. Bone mineral density and vitamin D status in children with remission phase of steroid-sensitive nephrotic syndrome. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2019; 30:853-862. [PMID: 31464242 DOI: 10.4103/1319-2442.265461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Children with idiopathic nephrotic syndrome are primarily treated with glucocorticoids (GCs), but long-term GC use can lead to undesired side effects. We investigated the bone mineral density (BMD) and 25-hydroxyvitamin D (25-OH D) levels in children with the remission phase of steroid-sensitive nephrotic syndrome (SSNS). This study included 32 patients with SSNS who had not received GC treatment in the last 6 months and a control group of 20 healthy children. Serum levels of calcium, phosphate, alkaline phosphatase, 25-(OH)D, and parathyroid hormone (PTH) were measured. BMD was determined in the lumbar spinal region using dual-energy X-ray absorptiometry (DEXA). Serum 25-(OH)D levels were lower in the SSNS patients than in the healthy children (P <0.05), with 22 patients (68.8%) having Z-scores <-1. The Z-scores were positively correlated with 25-(OH)D levels (r = 0.424, P <0.05). PTH levels were higher in patients with osteoporosis than in patients with Z-scores ≥-1 (P <0.05). Bone mineral content and BMD were positively correlated with the age of diagnosis (P <0.01). Receiver-operating characteristic curve analysis showed that the cutoff value of 25-(OH)D levels for predicting low BMD was 14.67 ng/mL with a sensitivity of 90% and a specificity of 64%. The area under the curve (AUC ± standard error) was 0.868 ± 0.064 (95% confidence interval: 0.742-0.994, P = 0.001). Decreased 25-(OH)D levels and the negative effects of long-term GC treatment on BMD persist in SSNS remission phase. Levels of 25-(OH)D <14.67 ng/mL could predict abnormal DEXA scans in children with SSNS remission phase.
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Affiliation(s)
- Nuran Cetin
- Department of Pediatric Nephrology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Aylin Gencler
- Department of Pediatric Nephrology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Ilknur Ak Sivrikoz
- Department of Nuclear Medicine, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
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Fayet-Moore F, Cassettari T, McConnell A, Kim J, Petocz P. Australian children and adolescents who were drinkers of plain and flavored milk had the highest intakes of milk, total dairy, and calcium. Nutr Res 2019; 66:68-81. [PMID: 30979662 DOI: 10.1016/j.nutres.2019.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 01/22/2019] [Accepted: 03/01/2019] [Indexed: 10/27/2022]
Abstract
Dairy is important for children and adolescents' bone development and nutritional needs, and it is not known how the type of milk consumed relates to overall dietary intakes. This study assessed the hypothesis that Australian children and adolescents who drink milk have greater milk, dairy, and micronutrient intakes compared to those who consume milk in other ways or avoid milk. A secondary analysis using day 1 data from the 2011-2012 National Nutrition and Physical Activity Survey was performed (n = 2812, 2-18 years). Children were classified as plain or flavored milk drinkers, other milk drinkers (eg, smoothies, milkshakes), nondrinkers of milk (eg. on cereal), or milk avoiders. Intakes of total dairy, milk, calcium, free sugars, and sugar-sweetened beverages were determined and adjusted for confounders. Milk consumption was popular (81%), and the majority (63%) of milk consumers were drinkers, and of those, 46% were plain, 32% were flavored, and 21% were other milk drinkers. Flavored and plain milk drinkers had higher total daily milk (480, 95% confidence interval [CI] 459-501 and 445, 95% CI 427-462 g, respectively), dairy (2.8, 95% CI 2.7-2.9 and 2.6, 95% CI 2.5-2.7 servings, respectively), and calcium (1049 ± 18 and 980 ± 15 mg, respectively) intakes than all other groups. Plain milk drinkers (10.7%, SD 6.2%) had a lower proportion of daily energy from free sugars than all other groups, but there was no difference in free sugars intake between plain and flavored milk drinkers, and there were no differences in anthropometric measures across groups. Plain and flavored milk drinkers and nondrinkers of milk had the lowest prevalence of sugar-sweetened beverages intake (P < .001). Plain milk drinkers followed by flavored milk drinkers had the most favorable milk, dairy, and nutrient intakes.
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Affiliation(s)
- Flavia Fayet-Moore
- Nutrition Research Australia, Level 13 167 Macquarie St, Sydney, New South Wales 2000, Australia.
| | - Tim Cassettari
- Nutrition Research Australia, Level 13 167 Macquarie St, Sydney, New South Wales 2000, Australia.
| | - Andrew McConnell
- Nutrition Research Australia, Level 13 167 Macquarie St, Sydney, New South Wales 2000, Australia.
| | - Jean Kim
- Nestlé Australia Ltd, 1 Homebush Bay Dr, Rhodes, New South Wales 2138.
| | - Peter Petocz
- Department of Statistics, Macquarie University, Sydney, New South Wales 2109, Australia.
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Dawkins JC, Carpinello O, Hill M, DeCherney AH. Phenotypic variations in X chromosome mutations: Two case reports. Case Rep Womens Health 2019; 21:e00084. [PMID: 30591909 PMCID: PMC6305762 DOI: 10.1016/j.crwh.2018.e00084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/17/2018] [Indexed: 11/23/2022] Open
Abstract
Turner syndrome (TS) affects 1 in 2500 females. Monosomy X is the most common etiology, classically presenting with hypoestrogenemia and short stature. We present two cases of partial X chromosome deletions that do not reflect the typical phenotype of TS. Patient 1 presented at age 17 with primary amenorrhea, cognitive delay and tall stature. Patient 2 presented at age 16 with primary amenorrhea, normal intelligence and average stature. Patient 1's karyotype revealed isodicentric X chromosome [46 X, idic(X)(q21)]. Patient 2's karyotype revealed [46 X,del(X)(q13.3)]. The stature of these patients was not affected. Estrogen therapy was required to provide secondary sexual changes promote bone health. Advances in technology and reproductive health provide an opportunity to make more specific recommendations for patients previously mistakenly diagnosed with TS.
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Affiliation(s)
| | - Olivia Carpinello
- Program in Reproductive Endocrinology and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Micah Hill
- Program in Reproductive Endocrinology and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Alan H. DeCherney
- Program in Reproductive Endocrinology and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
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18
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Tian L, Wang C, Xie Y, Wan S, Zhang K, Yu X. High Fructose and High Fat Exert Different Effects on Changes in Trabecular Bone Micro-structure. J Nutr Health Aging 2018; 22:361-370. [PMID: 29484349 DOI: 10.1007/s12603-017-0933-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To compare the effects of high-fat diet (HFD) and high-fructose diet (HFrD) on bone metabolism at different time points, dynamically observe the bone histology and femur trabecular micro-architecture, and analyze the underlying mechanisms. METHODS Sixty -Five male 6- to 7-week-old C57BL/6J mice were given HFD, HFrD, or standard diets (SD) for 8, 16, and 24 weeks. Micro-computed tomography (μCT) and bone histology were used to measure bone mass and trabecular micro-structure. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to determine the expression of genes related to bone and lipid metabolisms. RESULTS Compared to SD mice, femoral trabecular bone mass was significantly increased in both HFrD mice and HFD mice at 8 weeks, it continued to be higher in HFrD mice at 16 and 24 weeks with the highest level at 16 weeks, but it was significantly decreased in HFD mice at 16 and 24 weeks. HFD mice showed more epididymal fat accumulation than HFrD mice. mRNA expression of Runx2 was up-regulated at 8 and 16 weeks, but down-regulated at 24 weeks similarly in both HFrD mice and HFD mice. mRNA expression of MMP9 and CTSK was up-regulated at 8 and 16 weeks in HFD mice, but down-regulated at 24 weeks in both HFrD mice and HFD mice. CONCLUSIONS Our data indicated that the HFrD and HFD had different modulating effects on bone mass. After short-term feeding, both HFrD and HFD showed positive effects on bone mass; however, after long-term feeding, bone mass was decreased in HFD mice. In contrast, the bone mass was first increased and then decreased in the HFrD mice. On the basis of these findings, we speculated that chronic consumption of fat and fructose would exert detrimental effects on bone mass which might a combination action of body mass, fat mass, and bone formation/bone resorption along with proinflammatory factor and bone marrow environment.
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Affiliation(s)
- L Tian
- Xijie Yu, MD, PhD. Laboratory of Endocrinology and Metabolism, Department of Endocrinology, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, 610041 Chengdu, P.R. China, E-mail: or , Tel.: +86-28-8542-2362, Fax: +86-28-8542-3459
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19
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Saki F, Ranjbar Omrani G, Jeddi M, Bakhshaieshkaram M, Dabbaghmanesh MH. Investigating the Prevalence of Low Bone Mass in Children of Southern Iran and Its Associated Factors. Int J Endocrinol Metab 2017; 15:e14099. [PMID: 29344033 PMCID: PMC5750445 DOI: 10.5812/ijem.14099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/27/2017] [Accepted: 07/03/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Improving peak bone mass and bone strength in the first years of life and enhancing it during young adulthood could prevent osteoporosis and fractures in the last years of life. We evaluated the prevalence of low bone mass in the lumbar and femoral neck and its associated factors in southern Iranian children. METHODS This is a cross-sectional study on healthy Iranian children aged 9 - 18 years old during 2011 - 2012. Dual energy X-ray absorptiometry (DEXA) was used for measuring bone mineral density (BMD). BMD Z-score ≤ -2 was considered as low. Anthropometric data, physical activity, sun exposure, puberty, and mineral biochemical parameters were assessed. Data were analyzed using SPSS v.15. RESULTS 477 normal children, including 236 (49.5%) girls and 241 (50.5%) boys, aged 13.8 ± 2.7 years were enrolled. Prevalence of low bone mass (LBM) in the femoral and lumbar region was 10.7% and 18.7%, respectively. The prevalence of LBM in femur of girls is twice more than boys. Fat mass index, BMI Z-score, and physical activity were associated with lumbar low bone mass. BMI Z-score and physical activity were associated with femoral low bone mass. CONCLUSIONS High prevalence of low bone mineral density in children 9 to 18 years in south of the country is concerned and is needed to plan for prevention and treatment. BMI-Z score, fat mass index, and physical activity were the 3 most important preventive factors in developing low bone mass in children.
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Affiliation(s)
- Forough Saki
- Shiraz Endocrinology and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Marjan Jeddi
- Shiraz Endocrinology and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marzie Bakhshaieshkaram
- Endocrine and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Dabbaghmanesh
- Shiraz Endocrinology and Metabolism Research Center, Endocrinologist, Shiraz University of Medical Sciences, Shiraz, Iran
- Corresponding author: Mohammad Hossein Dabbaghmanesh, Endocrinology and Metabolism Research Center, Nemazee Hospital, P.O. Box 71345-1744, Shiraz, Iran. Tel/Fax: +98-7136473268, E-mail:
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20
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Sung KH, Chung CY, Lee KM, Cho BC, Moon SJ, Kim J, Park MS. Differences in Body Composition According to Gross Motor Function in Children With Cerebral Palsy. Arch Phys Med Rehabil 2017; 98:2295-2300. [PMID: 28465219 DOI: 10.1016/j.apmr.2017.04.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 12/09/2016] [Accepted: 04/03/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess differences in body composition according to gross motor function in children with cerebral palsy (CP) compared with healthy controls. DESIGN Retrospective case-control study. SETTING Tertiary referral center for CP. PARTICIPANTS Participants (N=146) comprised consecutive patients with CP (n=100; mean age, 11.5±4.2y) who were admitted for orthopedic surgery between May 2014 and March 2016 and typically developing children (TDC, n=46; control group). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Bioelectrical impedance analysis (BIA) was used to assess body composition, including body fat, soft lean mass (SLM), fat-free mass (FFM), skeletal muscle mass (SMM), body cell mass (BCM), bone mineral content (BMC), and basal metabolic rate. Body composition measures were compared according to Gross Motor Function Classification System (GMFCS) level, as well as between children with CP and TDC. RESULTS Children with CP with GMFCS levels IV and V had a lower height, weight, and body mass index than those with GMFCS levels I to III. Children with CP with GMFCS levels IV and V had a significantly lower SLM, SLM index, FFM, FFM index, SMM, SMM index, BCM, BCM index, BMC, and BMC index than those with GMFCS levels I to III and TDC. GMFCS level significantly affected SLM and BMC. CONCLUSIONS Body composition analysis using BIA showed that nonambulatory children with CP had significantly lower FFM, SLM, SMM, BCM, and BMC than ambulatory children with CP and TDC. However, further study is required to allow the use of BIA as a valid nutritional assessment tool in patients with CP.
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Affiliation(s)
- Ki Hyuk Sung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Sungnam, Korea
| | - Chin Youb Chung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Sungnam, Korea
| | - Kyoung Min Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Sungnam, Korea
| | - Byung Chae Cho
- Department of Orthopaedic Surgery, Seoul Jaeil Hospital, Jisan-dong, Pyeongtack, Korea
| | - Seung Jun Moon
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Sungnam, Korea
| | - Jaeyoung Kim
- Department of Orthopaedic Surgery, H Plus Yangji Hospital, Seoul, Korea
| | - Moon Seok Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Sungnam, Korea.
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Chen MH, Wang JD, Chou CM, Lin CC. Factors Determining Bone Mineral Density in Patients with Biliary Atresia after a Successful Kasai Operation. Pediatr Neonatol 2017; 58:128-134. [PMID: 27364859 DOI: 10.1016/j.pedneo.2016.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 12/17/2015] [Accepted: 01/08/2016] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Hepatic osteodystrophy is a common complication in patients with chronic liver disease, however, bone mineral status in patients with biliary atresia has rarely been investigated. METHODS Twenty-nine children with biliary atresia were enrolled in our study and their demographic data, bone mineral density (BMD) of lumbar spine and bilateral femoral neck, and biochemical parameters were measured and analyzed. RESULTS The majority of our patients had osteopenia or osteoporosis over at least one part of the skeleton although none had jaundice. Instead of T helper 1 cell cytokine, interleukin (IL)-4 had a significant negative correlation with BMD of the right femoral neck (β = -0.251, p = 0.027) and left femoral neck (β = -0.299, p = 0.012) independently by multiple linear regression analysis. CONCLUSION We conclude that chronic inflammation with increased expression of IL-4 may be an important factor for compromised bone health in patients with biliary atresia.
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Affiliation(s)
- Ming-Huei Chen
- Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jiaan-Der Wang
- Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chia-Man Chou
- Department of Pediatric Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chieh-Chung Lin
- Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan.
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22
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Tosun A, Erisen Karaca S, Unuvar T, Yurekli Y, Yenisey C, Omurlu IK. Bone mineral density and vitamin D status in children with epilepsy, cerebral palsy, and cerebral palsy with epilepsy. Childs Nerv Syst 2017; 33:153-158. [PMID: 27757568 DOI: 10.1007/s00381-016-3258-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 09/19/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE We aimed to evaluate the relationship between bone mineral density (BMD) disorders and possible risk factors in patients with epilepsy only (EO), cerebral palsy only (CPO), and cerebral palsy-epilepsy (CP + E). METHODS A total of 122 patients [EO (n = 54), CPO (n = 30), CP + E (n = 38)] and 30 healthy children were evaluated. BMD was only measured in patient groups, not in control subjects. BMD of lumbar vertebrae was determined by dual energy X-ray absorptiometry (DXA). An abnormal BMD was defined as low or low normal BMD. RESULTS Low BMD rate in EO, CPO, and CP + E group was 3.7, 50, and 39.5 %, respectively. Abnormal BMD values were significantly related to inadequate dietary Ca intake (p = 0.017), severe intellectual disability (p < 0.001), and immobility (p = 0.018). In multivariate regression analysis, the risk of abnormal BMD was higher (3.9-fold) in patients not able to walk independently than the others (p = 0.029). However, serum Ca-Vitamin D levels, insufficient exposure to sunlight, low BMI, and use of AED were not correlated with abnormal BMD. CONCLUSION Abnormal BMD is a common problem in patients with CP and CP + E. Abnormal BMD was related to the severity of CP, but not to vitamin D levels or AED treatment.
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Affiliation(s)
- Ayse Tosun
- Department of Pediatrics, Division of Child Neurology, Medical School, Adnan MenderesUniversity, 09100, Kepez, Aydin, Turkey.
| | | | - Tolga Unuvar
- Department of Pediatric Endocrinology, School of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Yakup Yurekli
- Department of Nuclear Medicine, School of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Cigdem Yenisey
- Department of Biochemistry, School of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Imran Kurt Omurlu
- Department of Biostatistics and Medical Informatics, School of Medicine, Adnan Menderes University, Aydin, Turkey
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23
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Matsushita M, Kitoh H, Mishima K, Kadono I, Sugiura H, Hasegawa S, Nishida Y, Ishiguro N. Low bone mineral density in achondroplasia and hypochondroplasia. Pediatr Int 2016; 58:705-8. [PMID: 26716907 DOI: 10.1111/ped.12890] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 12/08/2015] [Accepted: 12/17/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Achondroplasia (ACH) and hypochondroplasia (HCH) are the most common form of short-limb skeletal dysplasias caused by activated fibroblast growth factor receptor 3 (FGFR3) signaling. Although decreased bone mass was reported in gain-of-function mutation in Fgfr3 mice, both disorders have never been described as osteoporotic. In the present study, we evaluated bone mineral density (BMD) in ACH and HCH patients. METHODS We measured spinal BMD (L1-L4) in 18 ACH and four HCH patients with an average age of 19.8 ± 7.5 years (range, 10-33 years). BMD Z-score in each individual was calculated for normalizing age and gender. Correlation between body mass index (BMI) and BMD was analyzed. Moreover, BMD and Z-score were compared between ACH patients and HCH patients. RESULTS The average BMD of ACH/HCH patients was 0.805 ± 0.141 g/cm(2) (range, 0.554-1.056 g/cm(2) ), resulting in an average Z-score of -1.1 ± 0.8 (range, -2.4 to 0.6) of the standard value. A slightly positive correlation was observed between BMI and BMD (r = 0.45; P = 0.13). There was no significant difference in BMD and Z-score between ACH and HCH patients. CONCLUSION Spinal BMD was reduced in ACH/HCH patients, and was mildly correlated with individual BMI. We should carefully monitor BMD and examine osteoporosis-related symptoms in adolescent and adult ACH/HCH patients. © 2016 Japan Pediatric Society.
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Affiliation(s)
- Masaki Matsushita
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Kitoh
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenichi Mishima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Izumi Kadono
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Sugiura
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sachi Hasegawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshihiro Nishida
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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24
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Lin CM, Fan HC, Chao TY, Chu DM, Lai CC, Wang CC, Chen SJ. Potential effects of valproate and oxcarbazepine on growth velocity and bone metabolism in epileptic children- a medical center experience. BMC Pediatr 2016; 16:61. [PMID: 27142370 PMCID: PMC4855910 DOI: 10.1186/s12887-016-0597-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 04/21/2016] [Indexed: 11/18/2022] Open
Abstract
Background Children with longstanding use of antiepileptic drugs (AEDs) are susceptible to developing low bone mineral density and an increased fracture risk. However, the literature regarding the effects of AEDs on growth in epileptic children is limited. The aim of this study was to investigate the potential effects of valproate (VPA) and/or oxcarbazepine (OXC) therapy on growth velocity and bone metabolism. Methods Seventy-three ambulatory children (40 boys and 33 girls) with epilepsy, aged between 1 and 18 years (mean age 9.8 ± 4.1 years), were evaluated for growth velocity before and for 1 year after VPA and/or OXC treatment. The bone resorption marker serum tartrate-resistant acid phosphatase 5b (TRAcP5b) and the bone formation marker serum bone-specific alkaline phosphatase (BAP) were measured post-AEDs therapy for 1 year. Results The difference in growth velocity (ΔHt) and body weight change (ΔWt) between pre- and post-AEDs treatment were -1.0 ± 2.8 cm/year (P < 0.05) and 0.1 ± 3.9 kg/year (P = 0.84), respectively. The study population had serum TRAcP5b-SDS of -1.6 ± 1.2 and BAP-SDS of 1.7 ± 3.7 compared with sex- and age-matched healthy children. Significant correlation between serum TRAcP 5b and BAP activities was noted (r = 0.60, p < 0.001). There was a positive correlation between growth velocity and serum TRAcP 5b activity after AED treatment (r = 0.42, p < 0.01). No correlation was found between ΔHt, ΔWt, serum TRAcP 5b, BAP activity and types of AEDs. Conclusion Growth velocity was significantly decreased in epileptic children after 1 year of VPA and/or OXC treatment. The effect of VPA and/or OXC therapy on dysregulation of bone metabolism might play a crucial role in physical growth. Electronic supplementary material The online version of this article (doi:10.1186/s12887-016-0597-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chien-Ming Lin
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No.325, Cheng-Kung Road, Section 2, Nei-Hu, Taipei, 114, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, No.161, Cheng-Kung Road, Section 6, Nei-Hu, Taipei, 114, Taiwan
| | - Hueng-Chuen Fan
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No.325, Cheng-Kung Road, Section 2, Nei-Hu, Taipei, 114, Taiwan.,Department of Pediatrics, Tungs' Taichung MetroHarbor Hospital, No.699, Section 1, Zhongqi Road, Wuqi Township, Taichung, 435, Taiwan
| | - Tsu-Yi Chao
- Graduate Institute of Medical Sciences, National Defense Medical Center, No.161, Cheng-Kung Road, Section 6, Nei-Hu, Taipei, 114, Taiwan.,Division of Hematology/Oncology, Department of Internal Medicine, Taipei Medical University, Shuang Ho Hospital, No.291, Zhongzheng Road, Zhonghe District, New Taipei City, 235, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, No.252, Wu Hsing Street, Taipei, 110, Taiwan
| | - Der-Ming Chu
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No.325, Cheng-Kung Road, Section 2, Nei-Hu, Taipei, 114, Taiwan
| | - Chi-Chieh Lai
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No.325, Cheng-Kung Road, Section 2, Nei-Hu, Taipei, 114, Taiwan
| | - Chih-Chien Wang
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No.325, Cheng-Kung Road, Section 2, Nei-Hu, Taipei, 114, Taiwan
| | - Shyi-Jou Chen
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No.325, Cheng-Kung Road, Section 2, Nei-Hu, Taipei, 114, Taiwan.
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25
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Hands B, Chivers P, McIntyre F, Bervenotti FC, Blee T, Beeson B, Bettenay F, Siafarikas A. Peripheral quantitative computed tomography (pQCT) reveals low bone mineral density in adolescents with motor difficulties. Osteoporos Int 2015; 26:1809-18. [PMID: 25752622 DOI: 10.1007/s00198-015-3071-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 02/06/2015] [Indexed: 12/21/2022]
Abstract
UNLABELLED This is the first reported study to describe local bone mineral density, assess parameters of fracture risk and report history of fractures in adolescents with motor difficulties. Motor difficulties evidenced by poor coordination in adolescence should be considered a new risk factor for below-average bone strength and structure and fracture risk. INTRODUCTION Adolescents with motor difficulties are characterised by poor coordination and low levels of physical activity and fitness. It is possible these deficits translate into below-average bone strength and structure. The objectives of this study were to describe local bone mineral density (BMD), assess parameters of fracture risk (stress-strain index, SSI) and report history of fractures in this group. METHODS Thirty-three adolescents (13 females), mean age of 14.3 (SD = 1.5) years, with motor difficulties underwent peripheral quantitative computed tomography (pQCT) measurements at proximal (66 %) and distal (4 %) sites of the non-dominant radius (R4 and R66) and tibia (T4 and T66). One sample t test was used to compare Z-scores for total BMD, trabecular density, cortical density and stress strain index (SSI) against standardized norms. RESULTS Significant differences were present at R4 total density mean Z-score = -0.85 (SD = 0.7, p < 0.001), R66 cortical density mean Z-score = -0.74 (SD = 1.97, p = 0.038), R66 SSI mean Z-score = -1.00 (SD = 1.08, p < 0.001) and T66 SSI mean Z-score = -0.70 (SD = 1.15, p < 0.001). There was a higher incidence of fractures (26.9 %) compared to the normal population (3-9 %). CONCLUSIONS Motor difficulties in adolescence should be considered a risk factor for below-average bone strength and structure and fracture risk. Strategies are needed to improve bone health in this high-risk-group.
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Affiliation(s)
- B Hands
- Institute for Health Research, The University of Notre Dame Australia, 19 Mouat Street, PO Box 1225, Fremantle, WA, 6959, Australia.
| | - P Chivers
- Institute for Health Research, The University of Notre Dame Australia, 19 Mouat Street, PO Box 1225, Fremantle, WA, 6959, Australia
| | - F McIntyre
- School of Health Science, The University of Notre Dame Australia, 19 Mouat Street, PO Box 1225, Fremantle, WA, 6959, Australia
| | - F C Bervenotti
- Institute for Health Research, The University of Notre Dame Australia, 19 Mouat Street, PO Box 1225, Fremantle, WA, 6959, Australia
| | - T Blee
- School of Health Science, The University of Notre Dame Australia, 19 Mouat Street, PO Box 1225, Fremantle, WA, 6959, Australia
| | - B Beeson
- Department of Diagnostic Imaging, Princess Margaret Hospital, Perth, Australia
| | - F Bettenay
- Department of Diagnostic Imaging, Princess Margaret Hospital, Perth, Australia
| | - A Siafarikas
- Institute for Health Research, The University of Notre Dame Australia, 19 Mouat Street, PO Box 1225, Fremantle, WA, 6959, Australia
- Department of Endocrinology and Diabetes, Princess Margaret Hospital, Perth, Australia
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Vlachopoulos D, Barker AR, Williams CA, Knapp KM, Metcalf BS, Gracia-Marco L. Effect of a program of short bouts of exercise on bone health in adolescents involved in different sports: the PRO-BONE study protocol. BMC Public Health 2015; 15:361. [PMID: 25884762 PMCID: PMC4424564 DOI: 10.1186/s12889-015-1633-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Osteoporosis is a skeletal disease associated with high morbidity, mortality and increased economic costs. Early prevention during adolescence appears to be one of the most beneficial practices. Exercise is an effective approach for developing bone mass during puberty, but some sports may have a positive or negative impact on bone mass accrual. Plyometric jump training has been suggested as a type of exercise that can augment bone, but its effects on adolescent bone mass have not been rigorously assessed. The aims of the PRO-BONE study are to: 1) longitudinally assess bone health and its metabolism in adolescents engaged in osteogenic (football), non-osteogenic (cycling and swimming) sports and in a control group, and 2) examine the effect of a 9 month plyometric jump training programme on bone related outcomes in the sport groups. METHODS/DESIGN This study will recruit 105 males aged 12-14 years who have participated in sport specific training for at least 3 hours per week during the last 3 years in the following sports groups: football (n = 30), cycling (n = 30) and swimming (n = 30). An age-matched control group (n = 15) that does not engage in these sports more than 3 hours per week will also be recruited. Participants will be measured on 5 occasions: 1) at baseline; 2) after 12 months of sport specific training where each sport group will be randomly allocated into two sub-groups: intervention group (sport + plyometric jump training) and sport group (sport only); 3) exactly after the 9 months of intervention; 4) 6 months following the intervention; 5) 12 months following the intervention. Body composition (dual energy X-ray absorptiometry, air displacement plethysmography and bioelectrical impedance), bone stiffness index (ultrasounds), physical activity (accelerometers), diet (24 h recall questionnaire), pubertal maturation (Tanner stage), physical fitness (cardiorespiratory and muscular), bone turnover markers and vitamin D will be measured at each visit. DISCUSSION The PRO-BONE study is designed to investigate the impact of osteogenic and non-osteogenic sports on bone development in adolescent males during puberty, and how a plyometric jump training programme is associated with body composition parameters.
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Affiliation(s)
- Dimitris Vlachopoulos
- Children's Health and Exercise Research Centre. Sport and Health Sciences, University of Exeter, Exeter, UK.
| | - Alan R Barker
- Children's Health and Exercise Research Centre. Sport and Health Sciences, University of Exeter, Exeter, UK.
| | - Craig A Williams
- Children's Health and Exercise Research Centre. Sport and Health Sciences, University of Exeter, Exeter, UK.
| | - Karen M Knapp
- Department of Medical Imaging, College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK. .,University of Exeter Medical School, Exeter, UK.
| | - Brad S Metcalf
- Children's Health and Exercise Research Centre. Sport and Health Sciences, University of Exeter, Exeter, UK. .,University of Exeter Medical School, Exeter, UK.
| | - Luis Gracia-Marco
- Children's Health and Exercise Research Centre. Sport and Health Sciences, University of Exeter, Exeter, UK. .,Growth, Exercise, Nutrition and Development Research Group, University of Zaragoza, Zaragoza, Spain.
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Malvi P, Piprode V, Chaube B, Pote ST, Mittal M, Chattopadhyay N, Wani MR, Bhat MK. High fat diet promotes achievement of peak bone mass in young rats. Biochem Biophys Res Commun 2015; 455:133-8. [PMID: 25450704 DOI: 10.1016/j.bbrc.2014.10.131] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 10/27/2014] [Indexed: 11/16/2022]
Abstract
The relationship between obesity and bone is complex. Epidemiological studies demonstrate positive as well as negative correlation between obesity and bone health. In the present study, we investigated the impact of high fat diet-induced obesity on peak bone mass. After 9 months of feeding young rats with high fat diet, we observed obesity phenotype in rats with increased body weight, fat mass, serum triglycerides and cholesterol. There were significant increases in serum total alkaline phosphatase, bone mineral density and bone mineral content. By micro-computed tomography (μ-CT), we observed a trend of better trabecular bones with respect to their microarchitecture and geometry. This indicated that high fat diet helps in achieving peak bone mass and microstructure at younger age. We subsequently shifted rats from high fat diet to normal diet for 6 months and evaluated bone/obesity parameters. It was observed that after shifting rats from high fat diet to normal diet, fat mass, serum triglycerides and cholesterol were significantly decreased. Interestingly, the gain in bone mineral density, bone mineral content and trabecular bone parameters by HFD was retained even after body weight and obesity were normalized. These results suggest that fat rich diet during growth could accelerate achievement of peak bone mass that is sustainable even after withdrawal of high fat diet.
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Ubago-Guisado E, Gómez-Cabello A, Sánchez-Sánchez J, García-Unanue J, Gallardo L. Influence of different sports on bone mass in growing girls. J Sports Sci 2015; 33:1710-8. [DOI: 10.1080/02640414.2015.1004639] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Barr R, Nayiager T, Gordon C, Marriott C, Athale U. Body composition and bone health in long-term survivors of acute lymphoblastic leukaemia in childhood and adolescence: the protocol for a cross-sectional cohort study. BMJ Open 2015; 5:e006191. [PMID: 25603918 PMCID: PMC4305072 DOI: 10.1136/bmjopen-2014-006191] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 10/28/2014] [Accepted: 10/30/2014] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Success in the treatment of young people with cancer, as measured conventionally by survival rates, is mitigated by late effects of therapy that impose a burden of morbidity and limit life expectancy. Among these adverse sequelae are altered body composition, especially obesity, and compromised bone health in the form of osteoporosis and increased fragility. These outcomes are potentially reversible and even preventable. This study will examine measures of body composition and bone health in long-term survivors of acute lymphoblastic leukaemia (ALL) in childhood and adolescence. These measures will be complemented by measures of physical activity and health-related quality of life (HRQL). METHODS AND ANALYSIS Survivors of ALL who are at least 10 years from diagnosis, following treatment on uniform protocols, will undergo measurements of body mass index; triceps skin fold thickness and mid-upper arm circumference; fat mass, lean body mass, skeletal muscle mass and bone mineral density by dual energy X-ray absorptiometry; trabecular and cortical bone indices and muscle density by peripheral quantitative CT; physical activity by the Habitual Activity Estimation Scale; and HRQL by Health Utilities Index instruments. Descriptive measures will be used for continuous variables and number (percent) for categorical variables. Associations between variables will be assessed using Fisher's exact t test and the χ(2) test; correlations will be tested by the Pearson correlation coefficient. ETHICS AND DISSEMINATION The study is approved by the institutional research ethics board and is supported by a competitive funding award. Dissemination of the results will occur by presentations to scientific meetings and publications in peer-reviewed journals, and by posting summaries of the results on websites accessed by adolescent and young adult survivors of cancer.
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Affiliation(s)
- Ronald Barr
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Hematology-Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Trishana Nayiager
- Division of Hematology-Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Christopher Gordon
- Department of Nuclear Medicine, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Christopher Marriott
- Department of Nuclear Medicine, Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Uma Athale
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Hematology-Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
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Gokce S, Arslantas E. Changing face and clinical features of celiac disease in children. Pediatr Int 2015; 57:107-12. [PMID: 25040342 DOI: 10.1111/ped.12448] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 06/01/2014] [Accepted: 07/03/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this study was to analyze and compare the epidemiological and presenting features, clinical patterns, and complications of celiac disease (CD) in children. METHODS The clinical charts of children with CD were retrospectively analyzed. Data for children who presented during the first time period (January 2005-October 2008; group 1) were compared to those of children who presented during the second time period (November 2008-April 2012; group 2). RESULTS Group 1 and 2 consisted of 96 and 95 children, respectively. There were no differences in gender distribution, weight, or height z-scores between the two groups. Mean age at the time of diagnosis in group 2 (9.3 ± 4.5 years) was significantly higher than in group 1 (6.9 ± 3.9 years; P < 0.001). Non-classical presentation was more frequent in group 2 (P = 0.01). Associated disorders were observed in 49 children (25.7%) overall. There were significantly more children with type 1 diabetes mellitus in group 2 (P = 0.030). In all, 11 patients (5.8%) were overweight (either obese or at risk of obesity) at presentation. Isolated short stature was the presenting feature in 15 children (7.9%) overall, but was more frequently observed in group 2 (P = 0.003). In total, 15 patients (7.9%) presented with refractory iron deficiency anemia; the frequency was similar in both groups. Dual-energy X-ray absorptiometry was performed in 102 patients, and 82 (80.4%) had metabolic bone disease (MBD). CONCLUSION The mode of presentation and clinical features of CD in childhood continue to change. Of note, a substantial percentage of patients were overweight at presentation. MBD is a frequent complication, necessitating routine evaluation.
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Affiliation(s)
- Selim Gokce
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Bezmialem Vakif University, Istanbul, Turkey
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Stagi S, Cavalli L, Seminara S, de Martino M, Brandi ML. The ever-expanding conundrum of primary osteoporosis: aetiopathogenesis, diagnosis, and treatment. Ital J Pediatr 2014; 40:55. [PMID: 24906390 PMCID: PMC4064514 DOI: 10.1186/1824-7288-40-55] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 05/27/2014] [Indexed: 01/07/2023] Open
Abstract
In recent years, as knowledge regarding the etiopathogenetic mechanisms of bone involvement characterizing many diseases has increased and diagnostic techniques evaluating bone health have progressively improved, the problem of low bone mass/quality in children and adolescents has attracted more and more attention, and the body evidence that there are groups of children who may be at risk of osteoporosis has grown. This interest is linked to an increased understanding that a higher peak bone mass (PBM) may be one of the most important determinants affecting the age of onset of osteoporosis in adulthood. This review provides an updated picture of bone pathophysiology and characteristics in children and adolescents with paediatric osteoporosis, taking into account the major causes of primary osteoporosis (PO) and evaluating the major aspects of bone densitometry in these patients. Finally, some options for the treatment of PO will be briefly discussed.
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Affiliation(s)
- Stefano Stagi
- Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy.
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Gallagher CM, Black LJ, Oddy WH. Micronutrient intakes from food and supplements in Australian adolescents. Nutrients 2014; 6:342-54. [PMID: 24424459 PMCID: PMC3916865 DOI: 10.3390/nu6010342] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 12/17/2013] [Accepted: 01/08/2014] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Low micronutrient intakes in adolescents are frequently reported. We assessed micronutrient intakes in adolescents to determine whether supplement use optimises intakes. METHODS Dietary intake was assessed using a food frequency questionnaire in 17 year old participating in the Western Australian Pregnancy Cohort (Raine) Study (n=991). We calculated median daily micronutrient intakes in supplement users and non-users (from food sources only and from food and supplements), along with the percentage of adolescents meeting the Estimated Average Requirements (EAR) or Adequate Intake (AI) where appropriate. RESULTS Intakes of calcium, magnesium, folate and vitamins D and E from food only were low. Although supplements significantly increased micronutrient intakes in supplement users, more than half of supplement users failed to meet the EAR or AI for some key micronutrients. Compared with non-users, supplement users had higher micronutrient intakes from food sources with the exception of vitamins D and B12 and were more likely to achieve the EAR or AI for many micronutrients from food only. CONCLUSIONS Intakes of some key micronutrients were low in this population, even among supplement users. Those facing the greatest risk of micronutrient deficiencies were less likely to use supplements.
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Affiliation(s)
- Caroline M Gallagher
- Telethon Institute for Child Health Research, The University of Western Australia, Perth, Western Australia 6008, Australia.
| | - Lucinda J Black
- Telethon Institute for Child Health Research, The University of Western Australia, Perth, Western Australia 6008, Australia.
| | - Wendy H Oddy
- Telethon Institute for Child Health Research, The University of Western Australia, Perth, Western Australia 6008, Australia.
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Bass EF, Baile CA, Lewis RD, Giraudo SQ. Bone quality and strength are greater in growing male rats fed fructose compared with glucose. Nutr Res 2013; 33:1063-71. [PMID: 24267046 DOI: 10.1016/j.nutres.2013.08.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 08/10/2013] [Accepted: 08/12/2013] [Indexed: 01/18/2023]
Abstract
Optimization of peak bone mass during adolescence is important for osteoporosis prevention. Studies in rodents and humans have demonstrated the harmful effects of sugar intake on bone health. With the high levels of sucrose in the diets of adolescents, it is necessary to understand the influence of glucose and fructose on growing bones. This study compared the effects of dietary glucose and fructose on bone formation, microarchitecture, and strength. Because of the different metabolic effects of glucose and fructose, we hypothesized that their individual effects on bone would be different. Eighteen male Sprague-Dawley rats (age, 60 days) were randomly assigned to high-fructose (n = 9; 40% fructose, 10% glucose) or high-glucose diet (n = 9; 50% glucose) for 12 weeks. Bone measurements included histology and histomorphometry of trabecular bone in the distal femur and a 3-point bending test of the whole tibia. Whole liver mass and postprandial serum glucose, insulin, and triglycerides were used to assess differences in energy metabolism between the diets. There were no differences in food intake, body weight, or visceral adiposity between groups, but fructose consumption led to heavier livers (P = .001) and elevated serum triglycerides (P = .00). The distal femurs of fructose-fed rats had greater bone volume (bone volume/total volume; P = .03), lower bone surface (bone surface/bone volume; P = .02), and thicker trabeculae (trabecular thickness; P = .01). The tibias of the fructose-fed rats also withstood a greater maximum flexure load (P = .032). These results indicate that consumption of the high-fructose diet resulted in stronger bones with enhanced microarchitecture than consumption of the high-glucose diet.
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Affiliation(s)
- Erica F Bass
- Department of Foods and Nutrition, University of Georgia, Athens, GA, USA
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Kok DHJ, Sakkers RJB, Pruijs HEH, Joosse P, Castelein RM. Bone mineral density in developing children with osteogenesis imperfecta: a longitudinal study with 9 years of follow-up. Acta Orthop 2013; 84:431-6. [PMID: 23992144 PMCID: PMC3768047 DOI: 10.3109/17453674.2013.831321] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Osteogenesis imperfecta (OI) is a heritable disorder of connective tissue caused by a defect in collagen type I synthesis. For bone, this includes fragility, low bone mass, and progressive skeletal deformities, which can result in various degrees of short stature. The purpose of this study was to investigate development of bone mineral density in children with OI. PATIENTS AND METHODS Development of lumbar bone mineral density was studied retrospectively in a cohort of 74 children with OI. Mean age was 16.3 years (SD 4.3). In 52 children, repeated measurements were available. Mean age at the start of measurement was 8.8 years (SD 4.1), and mean follow-up was 9 years (SD 2.7). A longitudinal data analysis was performed. In the total cohort (74 children), a cross-sectional analysis was performed with the latest-measured BMD. Age at the latest BMD measurement was almost equal for girls and boys: 17.4 and 17.7 years respectively. RESULT Mean annual increase in BMD in the 52 children was 0.038 g/cm(2)/year (SD 0.024). Annual increase in BMD was statistically significantly higher in girls, in both the unadjusted and adjusted analysis. In cross-sectional analysis, in the whole cohort the latest-measured lumbar BMD was significantly higher in girls, in the children with OI of type I, in walkers, and in those who were older, in both unadjusted and adjusted analysis. INTERPRETATION During 9 years of follow-up, there appeared to be an increase in bone mineral density, which was most pronounced in girls. One possible explanation might be a later growth spurt and older age at peak bone mass in boys.
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Affiliation(s)
- Dieke H J Kok
- Department of Orthopaedic Surgery, Wilhelmina Children’s Hospital, University Medical Center Utrecht,Department of Sports Medicine, Rijnland Hospital, Leiderdorp
| | - Ralph J B Sakkers
- Department of Orthopaedic Surgery, Wilhelmina Children’s Hospital, University Medical Center Utrecht
| | - Hans E H Pruijs
- Department of Orthopaedic Surgery, Wilhelmina Children’s Hospital, University Medical Center Utrecht
| | - Pieter Joosse
- Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - René M Castelein
- Department of Orthopaedic Surgery, Wilhelmina Children’s Hospital, University Medical Center Utrecht
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Laudermilk MJ, Manore MM, Thomson CA, Houtkooper LB, Farr JN, Going SB. Vitamin C and zinc intakes are related to bone macroarchitectural structure and strength in prepubescent girls. Calcif Tissue Int 2012; 91:430-9. [PMID: 23076447 PMCID: PMC3496253 DOI: 10.1007/s00223-012-9656-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 09/24/2012] [Indexed: 10/27/2022]
Abstract
The extent to which nutrient intake may influence bone structure and strength during maximal rates of skeletal growth remains uncertain. We examined the relationship of dietary intake of micronutrients and bone macroarchitectural structure in young girls. This cross-sectional analysis included baseline data from 363 fourth- and sixth-grade girls enrolled in the Jump-In study. Nutrient intake was assessed using the Harvard Youth/Adolescent Food Frequency Questionnaire. Volumetric BMD (vBMD), bone geometry, and strength were measured by peripheral quantitative computed tomography. Correlations and regression modeling assessed relations between usual nutrient intake and bone parameters. In fourth-grade girls, metaphyseal and diaphyseal area and circumferences as well as diaphyseal strength were associated with vitamin C intake (r = 0.15-0.19, p < 0.05). Zinc intake was correlated with diaphyseal vBMD (r = 0.15-0.16, p < 0.05). Using multiple linear regression to adjust for important covariates, we observed significant independent associations for vitamin C and zinc with bone parameters. For every milligram per day of vitamin C intake trabecular area increased by 11 %, cortical strength improved by 14 %, and periosteal and endosteal circumferences increased by 5 and 8.6 %, respectively. For every milligram per day of zinc intake, cortical vBMD increased by <1 %. No significant associations were observed in sixth-grade girls. Results of this study suggests that vitamin C and zinc intake are positively associated with objective measures of bone geometry, size, and strength in fourth-grade girls. This indicates that potential differences in micronutrient and bone associations at various age-associated stages of bone maturation may be indicative of competing hormonal influences.
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Affiliation(s)
- Monica J Laudermilk
- Center for Clinical Epidemiology and Biostatistics, The University of Pennsylvania, 423 Guardian Drive, 8th Floor, Blockley Hall, Philadelphia, PA, USA.
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Parker CE, Vivian WJ, Oddy WH, Beilin LJ, Mori TA, O’Sullivan TA. Changes in dairy food and nutrient intakes in Australian adolescents. Nutrients 2012; 4:1794-811. [PMID: 23363991 PMCID: PMC3546608 DOI: 10.3390/nu4121794] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 10/16/2012] [Accepted: 11/05/2012] [Indexed: 11/16/2022] Open
Abstract
Dairy nutrients, such as calcium, are particularly important in adolescence, a critical time for growth and development. There are limited Australian data following individuals through adolescence, evaluating changes in dairy nutrient and dairy product consumption. We used a validated food frequency questionnaire to investigate consumption in adolescents participating in both the 14 and 17 year follow-ups of the Western Australian Pregnancy Cohort (Raine) Study. Most adolescents did not reach age and gender specific recommended daily intakes for calcium or magnesium at 14 years, and this decreased as they aged to 17 years (from 33.0% to 29.2% meeting for calcium, P < 0.05, and from 33.6% to 20.5% meeting for magnesium, P < 0.01). Mean intakes of calcium, potassium, riboflavin and vitamin A also decreased with age (P < 0.01). Mean dairy intake decreased from 536 ± 343 g/day to 464 ± 339 g/day (P < 0.01), due mostly to a decrease in regular milk, although flavoured milk consumption increased in boys. Cheese and butter were the only products to show a significantly increased consumption over the period. Girls decreased from 2.2 to 1.9 serves/day of dairy, while boys remained relatively steady at 2.9 to 2.8 serves/day. Our findings suggest that dairy product consumption decreases over adolescence. This may have implications for bone mass, development and later health.
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Affiliation(s)
- Carole E. Parker
- School of Exercise and Health Science, Edith Cowan University, Joondalup, Western Australia, 6027, Australia; (C.E.P.); (W.J.V.)
| | - Wendy J. Vivian
- School of Exercise and Health Science, Edith Cowan University, Joondalup, Western Australia, 6027, Australia; (C.E.P.); (W.J.V.)
| | - Wendy H. Oddy
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, West Perth, Western Australia, 6005, Australia;
| | - Lawrence J. Beilin
- School of Medicine and Pharmacology Royal Perth Hospital Unit, The University of Western Australia, Perth, 6000, Australia; (L.J.B.); (T.A.M.)
| | - Trevor A. Mori
- School of Medicine and Pharmacology Royal Perth Hospital Unit, The University of Western Australia, Perth, 6000, Australia; (L.J.B.); (T.A.M.)
| | - Therese A. O’Sullivan
- School of Exercise and Health Science, Edith Cowan University, Joondalup, Western Australia, 6027, Australia; (C.E.P.); (W.J.V.)
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, West Perth, Western Australia, 6005, Australia;
- Author to whom correspondence should be addressed; ; Tel.: +61-8-6304-5055; Fax: +61-8-6304-5384
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Pirker-Frühauf UM, Friesenbichler J, Urban EC, Obermayer-Pietsch B, Leithner A. Osteoporosis in children and young adults: a late effect after chemotherapy for bone sarcoma. Clin Orthop Relat Res 2012; 470:2874-85. [PMID: 22806259 PMCID: PMC3441998 DOI: 10.1007/s11999-012-2448-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 06/12/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Premature bone loss after childhood chemotherapy may be underestimated in patients with bone sarcoma. Methotrexate (MTX), a standard agent in osteosarcoma protocols, reportedly reduces bone mineral density (BMD). The literature, however, has reported cases of BMD reduction in patients with Ewing's sarcoma treated without MTX. Thus, it is unclear whether osteoporosis after chemotherapy relates to MTX or to other factors. QUESTIONS/PURPOSES We therefore asked whether (1) young patients with a bone sarcoma had BMD reduction, (2) patients treated with MTX had lower BMD, and (3) other factors (eg, lactose intolerance or vitamin D deficiency) posed additional risks for low BMD. METHODS We retrospectively reviewed 43 patients with malignancies who had dual-energy x-ray absorptiometry (DEXA) (lumbar, femoral); 18 with Ewing's sarcoma (mean age, 26 ± 8 years), and 25 with an osteosarcoma (mean age, 27 ± 10 years). The mean time since diagnosis was 8 ± 4 years in the group with Ewing's sarcoma and 7 ± 5 years in the group with osteosarcoma. At last followup we determined BMD (computing z-scores), fracture rate, and lifestyle, and performed serum analysis. RESULTS BMD reduction was present in 58% of patients (37% had a z-score between -1 and -2 SD, 21% had a z-score less than -2 SD) in at least one measured site. Seven of the 43 patients (16%) had nontrauma or tumor-associated fractures after chemotherapy. Findings were similar in the Ewing and osteosarcoma subgroups. We found vitamin D deficiency in 38 patients (88%) and borderline elevated bone metabolism; lactose intolerance was present in 16 patients (37%). CONCLUSION Doctors should be aware of the possibility of major bone loss after chemotherapy with a risk of pathologic fracture. Vitamin D deficiency, calcium malnutrition, and lactose intolerance may potentiate the negative effects of chemotherapy, and should be considered in long-term patient management. LEVEL OF EVIDENCE Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Jörg Friesenbichler
- Department of Orthopaedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Ernst-Christian Urban
- Division of Paediatric Haemato-Oncology, Department of Paediatrics, Medical University of Graz, Graz, Austria
| | - Barbara Obermayer-Pietsch
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
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Coppola G, Fortunato D, Mainolfi C, Porcaro F, Roccaro D, Signoriello G, Operto FF, Verrotti A. Bone mineral density in a population of children and adolescents with cerebral palsy and mental retardation with or without epilepsy. Epilepsia 2012; 53:2172-7. [DOI: 10.1111/j.1528-1167.2012.03639.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Valtueña J, Gracia-Marco L, Vicente-Rodríguez G, González-Gross M, Huybrechts I, Rey-López JP, Mouratidou T, Sioen I, Mesana MI, Martínez AED, Widhalm K, Moreno LA. Vitamin D status and physical activity interact to improve bone mass in adolescents. The HELENA Study. Osteoporos Int 2012; 23:2227-37. [PMID: 22237816 DOI: 10.1007/s00198-011-1884-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 11/29/2011] [Indexed: 10/14/2022]
Abstract
UNLABELLED The effects of vitamin D concentrations on bone mineral content in adolescents are still unclear. Vitamin D and physical activity (PA) may interact to determine bone mineral content (BMC) in two possible directions; 25(OH)D sufficiency levels improve BMC only in active adolescents, or PA increases BMC in individuals with replete vitamin D levels. INTRODUCTION The effects of suboptimal 25-hydroxycholecalciferol (25(OH)D) concentrations on BMC in adolescents are still unclear. The main aim of this study was to evaluate the influence of 25(OH)D on BMC in adolescents, considering the effect of body composition, sex, age, Tanner stage, season, calcium and vitamin D intakes, physical fitness and PA. METHODS Serum 25(OH)D concentrations, anthropometric measurements, dual energy X-ray absorptiometry measurements, calcium and vitamin D intakes, PA and physical fitness were obtained in 100 Spanish adolescents (47 males), aged 12.5-17.5 years, within the framework of the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study. Relations were examined using ANCOVA and regression analyses including BMC as dependent variable. RESULTS Linear regression of BMC suggested that 25(OH)D concentrations independently influenced total and leg BMC after controlling for age, sex, lean mass, seasonality and calcium intake (B = 0.328, p < 0.05, and B = 0.221, p < 0.05, respectively) in the physically active group. No significant influence of 25(OH)D concentrations on BMC was observed in the inactive group. Significant effect was shown between the interaction of 25(OH)D and PA on BMC for the total body and legs (both p < 0.05). CONCLUSIONS Vitamin D and PA may interact to determine BMC. 25(OH)D sufficiency levels improve bone mass only in active adolescents, or PA has a positive influence on BMC in individuals with replete vitamin D levels.
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Affiliation(s)
- J Valtueña
- Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences-INEF, Technical University of Madrid, C/ Martín Fierro 7, Madrid, Spain.
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Mussa A, Porta F, Baldassarre G, Tuli G, de Terlizzi F, Matarazzo P, Einaudi S, Lala R, Corrias A. Phalangeal quantitative ultrasound in 1,719 children and adolescents with bone disorders. Osteoporos Int 2012; 23:1987-98. [PMID: 21947033 DOI: 10.1007/s00198-011-1794-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 09/05/2011] [Indexed: 11/26/2022]
Abstract
SUMMARY We measured bone properties by phalangeal quantitative ultrasound in 1,719 pediatric patients with bone disorders, classifying them according to fracture status. Quantitative ultrasound discriminated fractured and nonfractured pediatric patients and enabled us to stratify fractured patients into classes according to the severity of the causative trauma (spontaneous, minimal trauma, appropriate trauma fractures). INTRODUCTION The correlation between quantitative bone measurements and fractures is poorly established in pediatric patients with bone disorders. We correlated phalangeal quantitative ultrasound (QUS) and fracture history in children and adolescents with bone disorders and evaluated the ability of QUS to recognize fractured patients. METHODS Amplitude-dependent speed of sound (AD-SoS) and bone transmission time (BTT) were measured in 1,719 pediatric patients with bone disorders and related to fracture history. The patients were classified as (1) spontaneously (77), (2) minimal trauma (101), or (3) appropriate trauma fractured (206), and (4) nonfractured (1,335). The likelihood of fracture according to QUS was calculated as odds ratio per SD decrease (OR/SD), and the effectiveness in discriminating fractured patients was evaluated by receiver operating characteristic (ROC) analysis. The influence of age, sex, puberty, height, and BMI was explored by respective adjustments and multiple logistic regression. RESULTS Fractured patients showed significantly reduced AD-SoS and BTT standard deviation score (-0.32 ± 1.54 and -0.78 ± 1.49) compared to nonfractured subjects (0.43 ± 1.63 and -0.11 ± 1.34). QUS measurements paralleled the causative trauma severity, ranging from the lowest values in spontaneously fractured patients to normal values in appropriate trauma fractured subjects. The OR/SD were increasingly higher in appropriate trauma fractured, minimal trauma fractured, and spontaneously fractured patients. At ROC analysis, both parameters proved to have significant discrimination power in recognizing spontaneously and minimal trauma-fractured patients. CONCLUSIONS QUS identifies fractured pediatric patients with bone disorders, reflecting the severity of the causative trauma with a high discrimination power for fragility fractures.
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Affiliation(s)
- A Mussa
- Division Pediatric Endocrinology, Department of Pediatrics, University of Turin, Turin, Italy.
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Plasma and urinary levels of cytokines in patients with idiopathic hypercalciuria. Pediatr Nephrol 2012; 27:941-8. [PMID: 22223141 DOI: 10.1007/s00467-011-2094-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Revised: 12/02/2011] [Accepted: 12/05/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Recent studies suggest that cytokines modulate bone turnover. Idiopathic hypercalciuria (IH) seems to be associated with bone mineral loss. Therefore, the aim of this study was to assess cytokines involved in bone turnover in patients with IH. METHODS Plasma and spot-urine levels of interleukin (IL)-1β, IL-6, IL-8, tumor necrosis factor alpha (TNF-α), transforming growth factor β1 (TGF-β1), and monocyte chemoattractant protein (MCP-1) were measured in 70 children and adolescents with IH and in 37 healthy controls. Patients with IH were subdivided according to their calciuria at the time of sample collection: ≥4 mg/kg/day (persistent IH, n=27) and below 4 mg/kg/day (controlled IH, n=43). Cytokines were determined by enzyme-linked immunoassay. RESULTS Plasma and urinary concentrations of IL-1β, IL-6, IL-8, and TNF-α were undetectable in all groups. No differences were found between controlled and persistent hypercalciuria for plasma and urinary levels of MCP-1 and TGF-β1. On the other hand, MCP-1 levels were significantly higher in both subgroups of IH in comparison to healthy controls. Furthermore, urinary MCP-1 levels of IH patients correlated positively with bone mineral content (p=0.013). CONCLUSION Although cytokine measurements did not allow the differentiation between persistent and controlled IH, our findings suggest that MCP-1 might play a role in patients with IH.
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Aronson E, Stevenson SB. Bone health in children with cerebral palsy and epilepsy. J Pediatr Health Care 2012; 26:193-9. [PMID: 22525999 DOI: 10.1016/j.pedhc.2010.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Revised: 08/19/2010] [Accepted: 08/30/2010] [Indexed: 10/19/2022]
Abstract
Children with disabilities that limit mobility are at increased risk for osteoporosis. In the United States, 10 million people have osteoporosis and 34 million people are estimated to be at risk of acquiring this condition. Typically, bone fragility and osteoporosis have been associated with older adults; however, these problems can also affect children. The childhood and adolescent years are critically important in producing healthy bone mass. Yet cerebral palsy and epilepsy, which are both chronic disorders that frequently coexist, are predictors of muscular and skeletal compromise. Nurse practitioners should be aware of recommendations for promoting and achieving optimal bone health in children with these disabilities and screening patients who are at risk of sustaining fractures.
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Affiliation(s)
- Elizabeth Aronson
- Pediatric Neurology, Slot #512-15, Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR 72202, USA
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Moreira Guimarães Penido MG, de Sousa Tavares M. Bone disease in pediatric idiopathic hypercalciuria. World J Nephrol 2012; 1:54-62. [PMID: 24175242 PMCID: PMC3782196 DOI: 10.5527/wjn.v1.i2.54] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Revised: 11/11/2011] [Accepted: 02/10/2012] [Indexed: 02/06/2023] Open
Abstract
Idiopathic hypercalciuria (IH) is the leading metabolic risk factor for urolithiasis and affects all age groups without gender or race predominance. IH has a high morbidity with or without lithiasis and reduced bone mineral density (BMD), as described previously in pediatric patients as well as in adults. The pathogenesis of IH is complex and not completely understood, given that urinary excretion of calcium is the end result of an interplay between three organs (gut, bone and kidney), which is further orchestrated by hormones, such as 1,25 dihydroxyvitamin D, parathyroid hormone, calcitonin and fosfatonins (i.e., fibroblast growth-factor-23). Usually, a primary defect in one organ induces compensatory mechanisms in the remaining two organs, such as increased absorption of calcium in the gut secondary to a primary renal loss. Thus, IH is a systemic abnormality of calcium homeostasis with changes in cellular transport of this ion in intestines, kidneys and bones. Reduced BMD has been demonstrated in pediatric patients diagnosed with IH. However, the precise mechanisms of bone loss or failure of adequate bone mass gain are still unknown. The largest accumulation of bone mass occurs during childhood and adolescence, peaking at the end of the second decade of life. This accumulation should occur without interference to achieve the peak of optimal bone mass. Any interference may be a risk factor for the reduction of bone mass with increased risk of fractures in adulthood. This review will address the pathogenesis of IH and its consequence in bone mass.
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Affiliation(s)
- Maria Goretti Moreira Guimarães Penido
- Maria Goretti Moreira Guimarães Penido, Marcelo de Sousa Tavares, Department of Pediatrics, Pediatric Nephrology Unit, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Belo Horizonte, CEP 30130100, Minas Gerais, Brazil
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Osteopenia in children with cerebral palsy can be treated with oral alendronate. Childs Nerv Syst 2012; 28:283-6. [PMID: 21928064 DOI: 10.1007/s00381-011-1576-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 09/01/2011] [Indexed: 01/09/2023]
Abstract
PURPOSE Cerebral palsy is one of the most common reasons of osteopenia in childhood. Patients have a significantly decreased bone mineral density, and painful fractures with minor traumas are common. Biphosphonates in the treatment of childhood osteoporosis are increasingly being used. This study aimed to evaluate the efficacy of oral alendronate treatment in children with cerebral palsy. METHODS Twenty-six children (16 boys and 10 girls) aged 3 to 17 years who had quadriplegic cerebral palsy and osteopenia were included in the study. The patients received alendronate (1 mg/kg/week), calcium (600 mg/day), and vitamin D(3) (400 U/day) over a year. A complete blood count, kidney and liver functional tests, plasma calcium, phosphate and alkaline phosphatase levels, and lumbar vertebral bone mineral density were measured before and after treatment. RESULTS Compared with pretreatment values, bone mineral density, serum calcium, and phosphate levels of the patients statistically increased and alkaline phosphatase levels decreased after treatment. No patient needed to interrupt treatment because of side effects. CONCLUSIONS Oral alendronate at a dose of 1 mg/kg/week for the treatment of osteopenia in children with cerebral palsy was found to be safe and effective.
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Longitudinal study of bone mineral density in children with idiopathic hypercalciuria. Pediatr Nephrol 2012; 27:123-30. [PMID: 21779854 DOI: 10.1007/s00467-011-1952-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 06/08/2011] [Accepted: 06/10/2011] [Indexed: 12/18/2022]
Abstract
Children with idiopathic hypercalciuria (IH) may have a reduced bone mineral density (BMD), which could impact on bone health in adulthood. There is currently no strong evidence for a preferred treatment of such children. The aim of our study was to evaluate the BMD z-score before and after treating children and adolescents with IH with potassium citrate and thiazides. The study consisted of a historical cohort of 80 pediatric patients who were evaluated between October 1989 and November 2010. Bone scanning and densitometry measurements were made with dual-emission X-ray absorptiometry. Lumbar-spine BMD (g/cm(2)) and BMD z-score were evaluated before and after treatment. The t test and Mann-Whitney U test were used for statistical analysis. Forty-three boys and 37 girls were followed for a median time of 6.0 years. Median calcium excretion before and after treatment was 5.0 and 2.6 mg/kg/24 h, respectively. The BMD z-score changed significantly from -0.763 ± 0.954 (mean ± SD) to -0.537 ± 0.898 (p < 0.0001) before and after treatment, respectively. The BMD z-score of the patients improved with treatment, suggesting a beneficial effect and potential need for treatment. However, the lack of a control group points to the need for future studies to corroborate this outcome.
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Moretto de Oliveria MR, Cristiane da Silva C, Kurokawa CS, Teixeira Fortes CM, Campos Capela R, Santos Teixeira A, Carlos Dalmas J, Lederer Goldberg TB. Bone mineral density in healthy female adolescents according to age, bone age and pubertal breast stage. Open Orthop J 2011; 5:324-30. [PMID: 21966336 PMCID: PMC3178934 DOI: 10.2174/1874325001105010324] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 07/11/2011] [Accepted: 07/12/2011] [Indexed: 01/12/2023] Open
Abstract
Objectives: This study was designed to evaluate bone mineral density (BMD) in healthy female Brazilian adolescents in five groups looking at chronological age, bone age, and pubertal breast stage, and determining BMD behavior for each classification. Methods: Seventy-two healthy female adolescents aged between 10 to 20 incomplete years were divided into five groups and evaluated for calcium intake, weight, height, body mass index (BMI), pubertal breast stage, bone age, and BMD. Bone mass was measured by bone densitometry (DXA) in lumbar spine and proximal femur regions, and the total body. BMI was estimated by Quetelet index. Breast development was assessed by Tanner’s criteria and skeletal maturity by bone age. BMD comparison according to chronologic and bone age, and breast development were analyzed by Anova, with Scheffe’s test used to find significant differences between groups at P≤0.05. Results: BMD (g·cm-2) increased in all studied regions as age advanced, indicating differences from the ages of 13 to 14 years. This group differed to the 10 and 11 to 12 years old groups for lumbar spine BMD (0.865±0.127 vs 0.672±0.082 and 0.689±0.083, respectively) and in girls at pubertal development stage B3, lumbar spine BMD differed from B5 (0.709±0.073 vs 0.936±0.130) and whole body BMD differed from B4 and B5 (0.867±0.056 vs 0.977±0.086 and 1.040±0.080, respectively). Conclusion: Bone mineralization increased in the B3 breast maturity group, and the critical years for bone mass acquisition were between 13 and 14 years of age for all sites evaluated by densitometry.
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Affiliation(s)
- Maria Regina Moretto de Oliveria
- Clinical and Experimental Pediatrics Research Centre, Department of Pediatrics, Botucatu School of Medicine - UNESP, São Paulo State University, Brazil
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Fintini D, Brufani C, Grossi A, Ubertini G, Fiori R, Pecorelli L, Calzolari A, Cappa M. Gender differences in bone mineral density in obese children during pubertal development. J Endocrinol Invest 2011; 34:e86-91. [PMID: 20855933 DOI: 10.1007/bf03347097] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To investigate whether body mass index (BMI) and body composition can affect peak bone mass in a population of obese (OB) (BMI SDS>2.0) and normal weight (NORM) (BMI-SD score <2.0) pubertal subjects (Tanner stage T3 to T5). PATIENTS AND METHODS 151 subjects (81 OB, age 14.5±2.4 yr) were analyzed using dual-X-ray absorbiometry technique to study Lumbar and whole body bone mineral density (BMD) (areal, normalized for height) and Z-score, lean mass (LM) and lean/fat ratio. RESULTS As a whole group, OB males did not show any significant difference in bone parameters vs NORM, while OB females showed higher bone density parameters (p<0.05). When grouped according to T, while OB males showed higher bone density at T3-4 stage (p<0.01), and lower at T5 (p<0.01) compared to NORM, OB females showed a tendency through increased BMD at T3-4 and T5 although statistically different only at T5. BMD was independently correlated to LM, lean/fat ratio, and testosterone in NORM males and, at lower level, in OB males, while to LM in NORM females and only to age in OB females. CONCLUSION Our data seem to confirm the possible negative influence of obesity on bone density in boys, a possible explanation could be an unfavorable body composition during sexual maturation that seems not to affect bone development in adolescents girls.
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Affiliation(s)
- D Fintini
- Cardiorespiratory and Sport Medicine Unit, Bambino Gesù Children's Hospital, IRCCS, P.za San Onofrio, 4, 00165 Rome, Italy.
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Hepatic osteodystrophy. EGYPTIAN LIVER JOURNAL 2011. [DOI: 10.1097/01.elx.0000397028.40918.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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REZAEIFARID M, SOVEID M, GHAEMI S, KARIMI M. Bone mineral density in Iranian patients with haemophilia: the first experience in southern Iran. Haemophilia 2011; 17:552-3. [DOI: 10.1111/j.1365-2516.2010.02416.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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