1
|
Khadilkar A, Oza C, Antani M, Shah N, Lohiya N, Khadilkar V, Bhor S, Kajale N, Gondhalekar K, More C, Katapally TR, Mughal Z, Bhawra J, Padidela R. Effect of Calcium and Vitamin D Supplementation (Dairy vs. Pharmacological) on Bone Health of Underprivileged Indian Children and Youth with Type-1 Diabetes: A Randomized Controlled Trial. J Clin Densitom 2024; 27:101468. [PMID: 38325238 DOI: 10.1016/j.jocd.2024.101468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 12/13/2023] [Accepted: 01/18/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Bone health is affected by chronic childhood disorders including type-1 diabetes mellitus (T1DM). We conducted this randomized controlled trial with the objective of investigating the effect of 1-year supplementation of vitamin-D with milk or with pharmacological calcium on bone mass accrual in underprivileged Indian children and youth with T1DM. METHODS 5 to 23year old (n = 203) underprivileged children and youth with T1DM were allocated to one of three groups: Milk (group A-received 200 ml milk + 1000 international unit (IU) vitamin-D3/day), Calcium supplement (group B-received 500 mg of calcium carbonate + 1000 IU of vitamin-D3/day) or standard of care/control (group C). Anthropometry, clinical details, biochemistry, diet (3-day 24-h recall), physical activity (questionnaires adapted for Indian children) and bone health parameters (using dual-energy X-ray absorptiometry and peripheral quantitative computed tomography- DXA and pQCT respectively) were evaluated at enrolment and end of 12 month intervention. RESULTS Total body less head(TBLH) bone mineral content (BMC(g)) and bone mineral density (BMD(gm/cm2)) were significantly higher at end of study in girls in both supplemented groups (TBLHBMC-A-1011.8 ± 307.8, B-983.2 ± 352.9, C-792.8 ± 346.8. TBLHBMD-A-± 0.2, B-0.8 ± 0.2, C-0.6 ± 0.2, p < 0.05). Z score of lumbar spine bone mineral apparent density of supplemented participants of both sexes was significantly higher than controls (Boys- A-0.7 ± 1.1, B-0.6 ± 1.4, C- -0.7 ± 1.1; Girls- A-1.1 ± 1.1, B-0.9 ± 3.4, C- -1.7 ± 1.3, p < 0.05). A significantly higher percentage increase was found in cortical thickness in girls in both supplemented groups (A-17.9 ± 28.6, B-15.3 ± 16.5, C-7.6 ± 26.2); the differences remained after adjusting for confounders. CONCLUSION Supplementation with milk or pharmacological calcium (+vitaminD3) improved bone outcomes-particularly geometry in children with T1DM with more pronounced effect in girls. Pharmacological calcium may be more cost effective in optimising bone health in T1DM in resource limited settings.
Collapse
Affiliation(s)
- Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India; Interdisciplinary school of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India.
| | - Chirantap Oza
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
| | - Misha Antani
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India; Department of Pathology, B.J. Medical College, Ahmedabad, India
| | - Nikhil Shah
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India; Department of Paediatric Endocrinology, Cloud nine hospital, Malad, Mumbai, India
| | - Nikhil Lohiya
- Division of Growth & Endocrinology, Silver Lining Paediatric Super Speciality Centre for Growth Development & Endocrine Care, Nagpur, India
| | - Vaman Khadilkar
- Interdisciplinary school of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India; Jehangir Hospital, Pune, India
| | - Shital Bhor
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
| | - Neha Kajale
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India; Interdisciplinary school of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
| | - Ketan Gondhalekar
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
| | - Chidvilas More
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
| | - Tarun Reddy Katapally
- DEPtH Lab, School of Health Studies, Faculty of Health Sciences, Western University, London, Ontario N6A 3K7, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario N6A 3K7, Canada; Children's Health Research Institute, Lawson Health Research Institute, London, Ontario N6A 4V2, Canada
| | - Zulf Mughal
- Department of Paediatric Endocrinology & Metabolic Bone Diseases, Royal Manchester Children's Hospital, Oxford Road, Manchester M13 9WL, UK; The Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Jasmin Bhawra
- School of Occupational and Public Health, Faculty of Community Services, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Raja Padidela
- Department of Paediatric Endocrinology & Metabolic Bone Diseases, Royal Manchester Children's Hospital, Oxford Road, Manchester M13 9WL, UK; The Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| |
Collapse
|
2
|
Soliman AT, Yassin M, Alyafei F, Alaaraj N, Hamed N, Osman S, Soliman N. Nutritional studies in patients with β-thalassemia major: A short review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2023; 94:e2023187. [PMID: 37326258 PMCID: PMC10308461 DOI: 10.23750/abm.v94i3.14732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Patients with β-thalassemia major (BTM) had variable prevalence of undernutrition and abnormal body composition. Methods: We performed an electronic search in PubMed, Scopus, Research gate, and Web of Sciences to evaluate the prevalence of nutritional disorders in patients with BTM worldwide in relation to their body composition and possible etiological factors. In addition, we reviewed the published nutritional intervention studies. Results: 22 studies on the prevalence of undernutrition (12 countries) and 23 nutritional intervention studies were analyzed. Undernutrition occurred in a considerable number of patients but varied greatly among different countries (from 5.2% to 70%). The lower middle income (LMI) countries (India, Pakistan, Iran, Egypt) had higher prevalence, while (high -middle and high income (Turkey, Greece, North America, USA, Canada) had lower prevalence. Even in patients with normal BMI, abnormalities of body composition are common with decreased muscle mass, lean-body mass, and bone mineral density. 65% to 75% of them had lower energy intake with low levels of circulating nutrients, minerals (zinc, selenium, and copper), and vitamins (D, E) versus controls. Increased macro and micronutrient requirements decreased absorption and /or increased loss or excretion are etiologic factors. Undernutrition was associated with short stature and lower quality of life (QOL). High prevalence of endocrinopathies, poor transfusion regimen (tissue hypoxia), improper chelation, and lack of maternal education, represented important risk factors in the production of poor growth in weight and stature. CONCLUSIONS Timely detection of undernutrition in patients with BTM and proper nutritional intervention could prevent growth delay and comorbidities.
Collapse
|
3
|
Yoon JS, Seo YJ, Kwon EB, Lee HJ, Kang MJ, Hwang IT. Association between uric acid and height during growth hormone therapy in children with idiopathic short stature. Front Endocrinol (Lausanne) 2022; 13:1025005. [PMID: 36531458 PMCID: PMC9755161 DOI: 10.3389/fendo.2022.1025005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Serum uric acid (UA) within appropriate levels is reported to be beneficial in patients with idiopathic short stature (ISS). This study aimed to evaluate the association between serum UA levels and height standard deviation scores (SDS) in patients with ISS during growth hormone (GH) therapy. METHODS A longitudinal study (LG Growth Study) of 182 children (mean age: 7.29±2.60 years) with ISS was performed. All participants were in the prepubertal stage and treated with GH, and the data within a treatment period of 30 months were analyzed. RESULTS In the adjusted Pearson's correlation, UA was significantly correlated with height SDS after controlling for sex, age, and body mass index (BMI) SDS (r=0.22, p=0.007). In the adjusted multiple regression analyses, the height SDS was significantly associated with UA after controlling for sex, age, and BMI SDS (β=0.168, p=0.007). Within the 30-month treatment period, the UA levels significantly increased as the height SDS increased, and the mean UA levels at baseline and 30 months after treatment were 3.90±0.64 mg/dL and 4.71±0.77 mg/dL, respectively (p=0.007). DISCUSSION In conclusion, UA is related to height SDS, and GH treatment leads to a significant increase in UA without hyperuricemia. Elevated UA is considered a favorable outcome of GH therapy, and further studies are needed to determine its role as a monitoring tool.
Collapse
|
4
|
Abuohashish HM, AlAsmari AF, Mohany M, Ahmed MM, Al-Rejaie SS. Supplementation of Morin Restores the Altered Bone Histomorphometry in Hyperglycemic Rodents via Regulation of Insulin/IGF-1 Signaling. Nutrients 2021; 13:2365. [PMID: 34371877 PMCID: PMC8308565 DOI: 10.3390/nu13072365] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 11/25/2022] Open
Abstract
Pathological mechanisms underlining diabetic bone defects include oxidative damage and insulin/IGF-1 imbalance. Morin is a bioflavonoid with antioxidant and anti-diabetic effects. This study evaluates morin's protective effects against altered bone histomorphometry in diabetic rats through assessing insulin/IGF-1 pathway as a potential mechanism. Diabetic animals were administered two morin doses (15 and 30 mg/kg) for 5 weeks. Different serum hepatic and renal functions tests were assessed. Bone density and histomorphometry in cortical and trabecular tissues were evaluated histologically. The expressions of insulin, c-peptide and IGF-1 were estimated. In addition, the enzymatic activities of the major antioxidant enzymes were determined. Diabetic-associated alterations in serum glucose, aminotransferases, urea and creatinine were attenuated by morin. Diabetic bone cortical and trabecular histomorphometry were impaired with increased fibrosis, osteoclastic functions, osteoid formation and reduced mineralization, which was reversed by morin; particularly the 30 mg/kg dose. Insulin/IGF-1 levels were diminished in diabetic animals, while morin treatment enhanced their levels significantly. Diabetes also triggered systemic oxidative stress noticeably. The higher dose (30 mg/kg) of morin corrected the endogenous antioxidant enzymatic activities in diabetic rats. Findings indicate the potential value of morin supplementation against hyperglycemia-induced skeletal impairments. Activation of insulin/IGF-1 signaling could be the underlining mechanism behind these effects.
Collapse
Affiliation(s)
- Hatem M. Abuohashish
- Department of Biomedical Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia;
| | - Abdullah F. AlAsmari
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (A.F.A.); (M.M.); (M.M.A.)
| | - Mohamed Mohany
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (A.F.A.); (M.M.); (M.M.A.)
| | - Mohammed M. Ahmed
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (A.F.A.); (M.M.); (M.M.A.)
| | - Salim S. Al-Rejaie
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (A.F.A.); (M.M.); (M.M.A.)
| |
Collapse
|
5
|
Marwaha RK, Garg MK, Gupta S, Khurana AK, Narang A, Shukla M, Arora P, Chadha A, Nayak DD, Manchanda RK. Assessment of insulin like growth factor-1 and IGF binding protein-3 in healthy Indian girls from Delhi and their correlation with age, pubertal status, obesity and thyroid hormonal status. J Pediatr Endocrinol Metab 2017; 30:739-747. [PMID: 28672739 DOI: 10.1515/jpem-2016-0359] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Population specific data and influence of sub-clinical hypothyroidism on insulin like growth factor-1 (IGF-1) and its binding protein-3 (IGFBP-3) in Indian children is lacking. This study was undertaken to evaluate serum IGF-1 and IGFBP-3 and their correlation with age, gender, pubertal status and thyroid functions. METHODS A total of 840 apparently healthy school girls aged 6-18 years, were recruited for the study and underwent assessment of height, weight, body mass index, pubertal status and serum T3, T4, TSH, IGF-1, IGFBP-3 and IGF-1/IGFBP-3 molar ratio. RESULTS The mean serum levels of IGF-1, IGFBP-3 levels and IGF-1/IGFBP-3 molar ratio were 381.8±240.5 ng/mL, 4.19±2.08 μg/mL and 40.5±37.2%, respectively. The serum IGF-1 and IGF-1/IGFBP-3 molar ratio increased significantly (p<0.0001) at 11 years followed by a steady yet non-significant rise till 16 years of age. A similar pattern was observed for IGFBP-3 showing a steep rise at 12 years and peaking at 16 years. Likewise, serum levels of IGF-1 and molar ratio of IGF-1/IGFBP-3 increased significantly with pubertal maturation from stage 1 to 3 and were higher in overweight girls compared to normal weight and obese girls. The growth factors were no different in girls with or without subclinical hypothyroidism. CONCLUSIONS There was no significant impact of age on IGF-1 and IGFBP-3 in pre-pubertal girls. A sudden marked increase at 11 years followed by a gradual rise in growth factors till 16 years is indicative of pubertal initiation and maturation. Subclinical hypothyroidism did not influence growth factors in girls.
Collapse
|