Relationships among diet, physical activity, and dual plane dual-energy X-ray absorptiometry bone outcomes in pre-pubertalgirls
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In pre-pubertal girls, nutrient intakes and non-aquatic organized activity were evaluated as factors in vertebral body bone mass, structure, and strength. Activity, vitamin B12, and dietary fiber predicted bone outcomes most consistently. Exercise and vitamin B12 appear beneficial, whereas high fiber intake appears to be adverse for vertebral body development.
Childhood development sets the baseline for adult fracture risk. Most studies evaluate development using postero-anterior (pa) dual-energy X-ray absorptiometry (DXA) areal bone mineral density, bone mineral content, and bone mineral apparent density. In a prior analysis, we demonstrated that pa DXA reflects posterior element properties, rather than vertebral body fracture sites, such that loading is associated with subtle differences in vertebral body geometry, not 3D density. The current analysis is restricted to pre-pubertal girls, for a focused exploration of key nutrient intakes and physical activity as factors in dual plane indices of vertebral body geometry, density, and strength.
This cross-sectional analysis used paired pa and supine lateral (lat) lumbar spine DXA scans to assess “3D” vertebral body bone mineral apparent density (palatBMAD), “3D” index of structural strength in axial compression (palatIBS), and fracture risk index (palatFRI). Diet data were collected using the Youth/Adolescent Questionnaire (YAQ, 1995); organized physical activity was recorded via calendar-based form. Pearson correlations and backward stepwise multiple linear regression analyzed associations among key nutrients, physical activity, and bone outcomes.
After accounting for activity and key covariates, fiber, unsupplemented vitamin B12, zinc, carbohydrate, vitamin C, unsupplemented magnesium, and unsupplemented calcium intake explained significant variance for one or more bone outcomes (p < 0.05). After adjustment for influential key nutrients and covariates, activity exposure was associated with postero-anterior (PA) areal bone mineral density, pa bone mineral content, PA width, lateral (LAT) BMC, “3D” bone cross-sectional area (coronal plane), “3D” palatIBS, and palatFRI benefits (p < 0.05).
Physical activity, fiber intake, and unsupplemented B12 intake appear to influence vertebral body bone mass, density, geometry, and strength in well-nourished pre-pubertal girls; high fiber intakes may adversely affect childhood vertebral body growth.
KeywordsChildren Nutrition Exercise Female Bone geometry Bone density
Dual-energy X-ray absorptiometry
Paired pa and lat scan calculated results
Postero-anterior areal bone mineral density
Postero-anterior bone mineral content
Lateral bone mineral content
Lateral vertebral depth (out of pa scan plane)
Lateral vertebral body height
“3D” bone cross-sectional area (coronal plane)
“3D” index of structural strength in axial compression
“3D” vertebral body bone mineral apparent density
palat fracture risk index
We acknowledge the assistance of the following individuals with data collection: Cathy Riley, Eileen Burd, Amy Allen, Tina Craig, and Kristy Kmack. This research was supported by NIAMS (R01 AR54145) and bridge funding from the University of Wisconsin (Department of Orthopedics and Rehabilitation, School of Medicine and Public Health).
Compliance with ethical standards
The study was approved by the Institutional Review Board of SUNY Upstate Medical University and complies with US bioethical legislation and the ethical standards of the Declaration of Helsinki. Written parental consent and child assent were obtained.
Conflicts of interest
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