Adolescent undernutrition and early adulthood bone mass in an urbanizing rural community in India.

Mika Matsuzaki,Kankipati Vijaya Radhakrishna,Bharati Kulkarni,Sanjay Kinra,Gagandeep Kaur Walia,George Davey Smith,Hannah Kuper,Jonathan C Wells,Vipin Gupta,K V Rameshwar Sarma,Dorairaj Prabhakaran,Poornima Prabhakaran,Yoav Ben-Shlomo,Aastha Aggarwal,George B Ploubidis

doi:10.1007/s11657-015-0232-5

Abstract

SummaryThe long-term effects on bone health of nutritional status in adolescence are unclear. The impact of adolescent and current body mass on bone mass in young adulthood in rural India was assessed. Current lean mass was a more important determinant of bone mass than thinness during adolescence in this population.Purpose/introductionAdolescence is a crucial period for skeletal growth. However, the long-term effects on bone health of nutritional status in adolescence, particularly in the context of nutritional transition, are unclear. The current manuscript assessed the impact of adolescent and current body size on bone mass in young adulthood in an Indian rural community that is undergoing rapid socioeconomic changes.MethodsThe Andhra Pradesh Children and Parents Study is a prospective cohort study in Hyderabad, India. In 2003–2005, the study collected anthropometric and cardiovascular data on adolescents (mean age = 16 years old). The second and third waves of the study in 2009–2012 collected data on current anthropometric measures, areal bone mineral density (aBMD) in hip and lumbar spine (L1–L4) measured by dual-energy X-ray absorptiometry, and living standards of the trial participants who were now young adults (mean age = 22 years old).ResultsThe median body mass index (BMI) of the 722 participants included in this analysis was 16.8 kg/m2 during adolescence, while the median BMI as young adults was 19.3 kg/m2. Lower aBMD during adulthood was associated with lower adolescent BMI (β (95 % confidence interval) for hip aBMD 0.017 (0.013 to 0.022) and LS aBMD 0.012 (0.008 to 0.016)). This association was attenuated upon adjustment for current fat and lean mass (β (95 % CI) for hip aBMD 0.00 (−0.005 to 0.005) and LS aBMD 0.005 (0.000 to 0.01)). There was clear evidence for positive associations between aBMDs and current lean mass.ConclusionsCurrent lean mass was a more important determinant of bone mass than thinness during adolescence in this population. Weight gain during late adolescence and young adulthood coupled with improvement in lean mass may help to mitigate any adverse effects that pre-adulthood undernutrition may have on bone mass accrual.

Highlights

Suboptimal peak bone mass is associated with higher risk of osteoporotic fractures in later life [1, 2]
While there are a number of studies examining association between bone mass in later life and birthweight, there are relatively few studies focusing on the long-term effects of nutritional status during adolescence on adult bone mass [8]
We found no strong evidence for a positive association between areal bone mineral density as young adults and early life nutritional supplementation [26]

Summary

Introduction

Suboptimal peak bone mass is associated with higher risk of osteoporotic fractures in later life [1, 2]. Studies from high income countries have shown that 90 % of peak bone mass is accrued before age 18 in healthy individuals [1, 3, 4]. Skeletal growth during adolescence is an important determinant of peak bone mass. High level of weight-bearing physical activity, and adequate micronutrient intake are some of the key determinants of bone mass accrual [1]. Undernutrition is commonly observed in low and middle income countries (LMICs). Some young adults who experienced undernutrition during childhood and adolescence have attained at least normal body mass index as adults [7]

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Conclusion