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Determinants of bone mineral content and bone area in Indian preschool children

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Abstract

The objective of this study was to examine the lifestyle factors that influence total body bone mineral content (TB BMC) and total body bone area (TB BA) in Indian preschool children. TB BMC and TB BA were measured by dual-energy X-ray absorptiometry (Lunar DPX PRO) in 71 apparently healthy children aged 2–3 years. A fasting blood sample was analyzed for serum concentrations of ionized calcium (iCa), intact parathyroid hormone (iPTH), phosphorus (iP) and 25-hydroxyvitamin D3 (25 OHD). Dietary intake of energy, protein, calcium and phosphorus was estimated from a 3-day diet recall. The daily physical activity and sunlight exposure were recorded by a questionnaire. The study children were shorter than their age-gender matched WHO counterparts with a mean height for age Z score of –1.3 ± 1.5. The mean dietary intake of calcium was 46% of the Indian recommended dietary intakes (RDI). Seventy-three percent of children had low iCa concentrations, and 57% were deficient in vitamin D. Generalized linear model analysis revealed that height, lean body mass, weight, activity, sunlight exposure in minutes and dietary intakes of calcium, zinc and iron were the significantly influencing factors (p < 0.05) of TB BMC and TB BA. In conclusion, attaining optimal height for age, achieving the goals of overall nutrition with adequate calcium, iron and zinc intakes as well as adequate physical activity and sunlight exposure play an important role in achieving better TB BMC and TB BA in preschool children.

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References

  1. Glastre C, Braillon P, David L, Cochat P, Meunier PJ, Delmas PD (1990) Measurement of bone mineral content of the lumbar spine by dual energy X-ray absorptiometry in normal children: correlations with growth parameters. J Clin Endocrinol Metab 70:1330–1333

    Article  PubMed  CAS  Google Scholar 

  2. Ruiz JC, Mandel C, Garabedian M (1995) Influence of spontaneous calcium intake and physical exercise on the vertebral and femoral bone mineral density of children and adolescents. J Bone Miner Res 10:675–682

    Article  PubMed  CAS  Google Scholar 

  3. VandenBergh MF, DeMan SA, Witteman JC, Hofman A, Trouerbach WT, Grobbee DE (1995) Physical activity, calcium intake, and bone mineral content in children in The Netherlands. J Epidemiol Community Health 49:299–304

    Article  PubMed  CAS  Google Scholar 

  4. Lee WT, Leung SS, Lui SS, Lau J (1993) Relationship between long-term calcium intake and bone mineral content of children from birth to 5 years. Br J Nutr 70:235–248

    Article  PubMed  CAS  Google Scholar 

  5. Thomas KA, Cook SD, Bennett JT, Whitecloud TS 3rd, Rice JC (1991) Femoral neck and lumbar spine bone mineral densities in a normal population 3–20 years of age. J Pediatr Orthop 11:48–58

    Article  PubMed  CAS  Google Scholar 

  6. Cheng JCY, Mahmood A, Hui PW (1993) Bone mineral content in Chinese children. J Hong Kong Med Assoc 45:209–214

    Google Scholar 

  7. Zanchetta JR, Plotkin H, Alvarez Filgueira ML (1995) Bone mass in children: normative values for the 2–20-year-old population. Bone 16:393S–399S

    PubMed  CAS  Google Scholar 

  8. Patel DN, Pettifor JM, Becker PJ, Grieve C, Leschner K (1992) The effect of ethnic group on appendicular bone mass in children. J Bone Miner Res 7:263–272

    Article  PubMed  CAS  Google Scholar 

  9. Chaturvedi A, Garg OP, Choudhary B, Garg P (1993) Bone mineral content in normal and malnourished children. Indian Pediatr 30:489–494

    PubMed  CAS  Google Scholar 

  10. Horlick M, Thornton J, Wang J, Levine LS, Fedun B, Pierson RN Jr (2000) Bone mineral in prepubertal children: gender and ethnicity. J Bone Miner Res 15:1393–1397

    Article  PubMed  CAS  Google Scholar 

  11. Lee WTK, Leung SSF, Ng MY, Wang SF, Xu YC, Zeng WP, Lau J (1993) Bone mineral content of two populations of Chinese children with different calcium intakes. Bone Miner 23:195–206

    Article  PubMed  CAS  Google Scholar 

  12. Janz KF, Letuchy EM, Eichenberger Gilmore JM, Burns TL, Torner JC, Willing MC, Levy SM (2009) Early physical activity provides sustained bone health benefits later in childhood. Med Sci Sports Exerc (Epub ahead of print)

  13. Specker B, Binkley T (2003) Randomized trial of physical activity and calcium supplementation on bone mineral content in 3 to 5 year old children. J Bone Miner Res 18:885–892

    Article  PubMed  CAS  Google Scholar 

  14. Johnston CC Jr, Miller JZ, Slemenda CW, Reister TK, Hui S, Christian JC, Peacock M (1992) Calcium supplementation and increases in bone mineral density in children. N Engl J Med 327:82–87

    Article  PubMed  Google Scholar 

  15. Bonjour JP (2005) Dietary protein: an essential nutrient for bone health. J Am Coll Nutr 24:526S–536S

    PubMed  CAS  Google Scholar 

  16. Budek AZ, Hoppe C, Ingstrup H, Michaelsen KF, Bügel S, Mølgaard C (2007) Dietary protein intake and bone mineral content in adolescents—The Copenhagen Cohort Study. Osteoporos Int 18:1661–1667

    Article  PubMed  CAS  Google Scholar 

  17. Bhatia V (2008) Dietary calcium intake—a critical reappraisal. Indian J Med Res 127:269–273

    PubMed  CAS  Google Scholar 

  18. Mishra RN, Mishra CP, Sen P, Singh TB (2001) Nutritional status and dietary intake of pre-school children in urban slums of Varanasi. Indian J Community Med 26:90–93

    Google Scholar 

  19. Sidhu BK, Kaur B, Bagga V (1993) A study of dietary practices of pre-school Children attending anganwadies in urban slum of Patiala (Punjab). Indian J Maternal Child Health 4:31–37

    CAS  Google Scholar 

  20. Ekbote VH, Khadilkar AV, Mughal MZ, Hanumante N, Sanwalka N, Khadilkar VV, Chiplonkar SA, Kant S, Ganacharya R (2010) Sunlight exposure and development of rickets in Indian toddlers. Indian J Pediatr 77:61–65

    Article  PubMed  CAS  Google Scholar 

  21. Harinarayan CV, Ramalakshmi T, Prasad UV, Sudhakar D (2008) Vitamin D status in Andhra Pradesh: a population based study. Indian J Med Res 127:211–218

    PubMed  CAS  Google Scholar 

  22. Wagner CL, Greer FR and the Section on Breastfeeding and Committee on Nutrition (2008) Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics 122:1142–1152

    Google Scholar 

  23. Garza C, De Onis M (2004) WHO Multicentre Growth Reference Study Group Rationale for developing a new international growth reference. Food Nutr Bull 25:S5–S14

    PubMed  Google Scholar 

  24. Gopalan C, Ramasastri BB, Balasubramanyam SC (1998) Nutritive value of Indian Food. Indian Council of Medical Research, National Institute of Nutrition, Hyderabad

    Google Scholar 

  25. Chiplonkar SA, Agte VV (2007) Extent of error in estimating nutrient intakes from food tables versus laboratory estimates of cooked foods. Asia Pac J Clin Nutr 16:227–239

    PubMed  CAS  Google Scholar 

  26. Barbosa N, Sanchez CE, Vera JA, Perez W, Thalabard JC, Rieu M (2007) A physical activity questionnaire: reproducibility and validity. J Sports Sci Med 6:505–518

    Google Scholar 

  27. CDC physical activity for everyone. http://www.cdc.gov/physicalactivity/everyone/guidelines/what_counts.html

  28. Pesce MA (2008) Reference ranges for laboratory tests and procedures. In: Kliegman RM, Behram RE, Jenson HB, Stanton BF (eds) Nelson textbook of pediatrics, vol 18. Elsevier, New Delhi, pp 2944–2949

  29. Khadilkar A, Mughal MZ, Hanumante N, Sayyad M, Sanwalka N, Naik S, Fraser WD, Joshi A, Khadilkar V (2009) Oral calcium supplementation reverses the biochemical pattern of parathyroid hormone resistance in underprivileged Indian toddlers. Arch Dis Child 94:932–937

    Article  PubMed  CAS  Google Scholar 

  30. McCullagh P, Nelder J (1989) Generalized linear models. Chapman and Hall/CRC, Boca Raton

    Google Scholar 

  31. Onis MD, Blössner M (1997) WHO Global Database on Child Growth and Malnutrition. World Health Organization/Department of Nutrition for Health and Development, CH-1211 Geneva 27, pp 46–50

  32. Sivakumar B, Narasinga Rao BS (2009) Nutrient requirements and RDI. In: Bamji MS (ed) Textbook of human nutrition, vol 3. Oxford & IBH, New Delhi, pp 154–178

    Google Scholar 

  33. Sachdev HPS (1995) Assessing child malnutrition: some basic issues. NFI Bull 16:1–5

    Google Scholar 

  34. Bruce C (2003) Comparison of anthropometric data to reference standards. In: Anthropometric indicators measurement guide. Food and Nutrition Technical Assistance Project, Academy for Educational Development, Washington, DC, pp 39–42

  35. Specker BL, Johannsen N, Binkley T, Finn K (2001) Total body bone mineral content and tibial cortical bone measures in preschool children. J Bone Miner Res 16:2298–2305

    Article  PubMed  CAS  Google Scholar 

  36. Mølgaard C, Thomsen BL, Michaelsen KF (2001) The influence of calcium intake and physical activity on bone mineral content and bone size in healthy children and adolescents. Osteoporos Int 2:887–894

    Google Scholar 

  37. Boot AM, De Ridder MAJ, Pols HAP, Krenning EP, De Muinck Keizer-Schrama SMPF (1997) Mineral density in children and adolescents: relation to puberty, calcium intake, and physical activity. J Clin Endocrinol Metab 82:57–62

    Article  PubMed  CAS  Google Scholar 

  38. Mølgaard C, Thomsen BL, Michaelsen KF (1998) Influence of weight, age and puberty on bone size and bone mineral content in healthy children and adolescents. Acta Paediatr 87:494–499

    Article  PubMed  Google Scholar 

  39. Chan GM (1991) Dietary calcium and bone mineral status of children and adolescents. Am J Dis Child 145:631–634

    PubMed  CAS  Google Scholar 

  40. Heaney RP, Abrams S, Dawson-Hughes B, Looker A, Marcus R, Matkovic V, Weaver C (2000) Peak bone mass. Osteoporos Int 11:985–1009

    Article  PubMed  CAS  Google Scholar 

  41. Bouglé DL, Sabatier JP, Guaydier-Souquières G, Guillon-Metz F, Laroche D, P Jauzac, Bureau F (2004) Zinc status and bone mineralisation in adolescent girls. J Trace Elem Med Biol 18:17–21

    Article  PubMed  Google Scholar 

  42. Bounds W, Skinner J, Carruth BR, Ziegler P (2005) The relationship of dietary and lifestyle factors to bone mineral indexes in children. J Am Diet Assoc 105:735–741

    Article  PubMed  Google Scholar 

  43. Jones G, Dwyer T (1998) Bone mass in prepubertal children: gender differences and the role of physical activity and sunlight exposure. J Clin Endocrinol Metab 83:4274–4279

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

We thank all the children and their parents for their participation in this study.

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Correspondence to Anuradha V. Khadilkar.

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Ekbote, V.H., Khadilkar, A.V., Chiplonkar, S.A. et al. Determinants of bone mineral content and bone area in Indian preschool children. J Bone Miner Metab 29, 334–341 (2011). https://doi.org/10.1007/s00774-010-0224-x

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  • DOI: https://doi.org/10.1007/s00774-010-0224-x

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