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Glatt DU, McSorley E, Pourshahidi LK, Revuelta Iniesta R, McCluskey J, Beggan L, Slevin M, Gleeson N, Cobice DF, Dobbin S, Magee PJ. Vitamin D Status and Health Outcomes in School Children in Northern Ireland: Year One Results from the D-VinCHI Study. Nutrients 2022; 14:nu14040804. [PMID: 35215452 PMCID: PMC8875093 DOI: 10.3390/nu14040804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/03/2022] [Accepted: 02/09/2022] [Indexed: 12/13/2022] Open
Abstract
(1) Background: Vitamin D status has never been investigated in children in Northern Ireland (UK). (2) Methods: Children (4-11 years) (n = 47) were recruited from November 2019 to March 2020 onto the cross-sectional study. Anthropometry was assessed. Plasma 25-hydroxyvitamin D (25(OH)D) was analysed. Vitamin D intake, parental knowledge and perceptions, participant habits, physical activity and sedentary behaviour were established via questionnaire. Muscle strength was assessed via isometric grip strength dynamometry and balance via dominant single-leg and tandem stance. Parathyroid hormone, bone turnover markers (OC, CTX and P1NP), glycated haemoglobin and inflammatory markers (CRP, IFN-γ, IL-10, IL-12p70, IL-13, IL-1β, IL-2, IL-4, IL-6, IL-8 and TNF-α) were analysed. (3) Results: Mean (SD) 25(OH)D was 49.17 (17.04) nmol/L (n = 47); 44.7% of the children were vitamin D sufficient (25(OH)D >50 nmol/L), 48.9% were insufficient (25-50 nmol/L) and 6.4% were deficient (<25 nmol/L). 25(OH)D was positively correlated with vitamin D intake (µg/day) (p = 0.012, r = 0.374), spring/summer outdoor hours (p = 0.006, r = 0.402) and dominant grip strength (kg) (p = 0.044, r = 0.317). Vitamin D sufficient participants had higher dietary vitamin D intake (µg/day) (p = 0.021), supplement intake (µg/day) (p = 0.028) and spring/summer outdoor hours (p = 0.015). (4) Conclusion: Over half of the children were vitamin D deficient or insufficient. Wintertime supplementation, the consumption of vitamin D rich foods and spring/summer outdoor activities should be encouraged to minimise the risk of vitamin D inadequacy.
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Affiliation(s)
- Dominique Ulrike Glatt
- Department of Dietetics and Nutrition, Queen Margaret University, Edinburgh EH21 6UU, UK; (J.M.); (N.G.)
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine BT52 1SA, UK; (E.M.); (L.K.P.); (L.B.); (M.S.)
- Correspondence: (D.U.G.); (R.R.I.); (P.J.M.)
| | - Emeir McSorley
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine BT52 1SA, UK; (E.M.); (L.K.P.); (L.B.); (M.S.)
| | - L. Kirsty Pourshahidi
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine BT52 1SA, UK; (E.M.); (L.K.P.); (L.B.); (M.S.)
| | - Raquel Revuelta Iniesta
- Department of Sports and Health Sciences, University of Exeter, Exeter EX1 2LU, UK
- Correspondence: (D.U.G.); (R.R.I.); (P.J.M.)
| | - Jane McCluskey
- Department of Dietetics and Nutrition, Queen Margaret University, Edinburgh EH21 6UU, UK; (J.M.); (N.G.)
| | - Laura Beggan
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine BT52 1SA, UK; (E.M.); (L.K.P.); (L.B.); (M.S.)
- Mass Spectrometry Centre, Biomedical Sciences Research Institute (BMSRI), Ulster University, Coleraine BT52 1SA, UK; (D.F.C.); (S.D.)
| | - Mary Slevin
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine BT52 1SA, UK; (E.M.); (L.K.P.); (L.B.); (M.S.)
| | - Nigel Gleeson
- Department of Dietetics and Nutrition, Queen Margaret University, Edinburgh EH21 6UU, UK; (J.M.); (N.G.)
| | - Diego F. Cobice
- Mass Spectrometry Centre, Biomedical Sciences Research Institute (BMSRI), Ulster University, Coleraine BT52 1SA, UK; (D.F.C.); (S.D.)
| | - Sara Dobbin
- Mass Spectrometry Centre, Biomedical Sciences Research Institute (BMSRI), Ulster University, Coleraine BT52 1SA, UK; (D.F.C.); (S.D.)
| | - Pamela J. Magee
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine BT52 1SA, UK; (E.M.); (L.K.P.); (L.B.); (M.S.)
- Correspondence: (D.U.G.); (R.R.I.); (P.J.M.)
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Christofaro DGD, Tebar WR, Saraiva BTC, da Silva GCR, Dos Santos AB, Mielke GI, Ritti-Dias RM, Mota J. Comparison of bone mineral density according to domains of sedentary behavior in children and adolescents. BMC Pediatr 2022; 22:72. [PMID: 35105341 PMCID: PMC8805312 DOI: 10.1186/s12887-022-03135-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Somatic maturation and the age at onset of puberty are closely related to bone mineral density (BMD), and are potential confounders of the associations between physical activity, sedentary behavior (SB) and BMD in adolescents. Thus the aim was compare BMD at different anatomical sites according to different domains of SB. METHODS The sample consisted of 88 young people (54 boys and 34 girls; 9.5 ± 1.5 years). The self-reported SB was measured by the time spent on TV, computer, video game and smartphone. BMD at each location and throughout the body was assessed by DEXA. Physical activity was assessed by a questionnaire. The comparison of the different types of BMD sites according to the SB levels for each screen device and the total SB were analyzed by Covariance Analysis (ANCOVA). RESULTS Whole-body BMD was higher in young people with low total SB (Total BMD = 0.957 ± 0.042) than in those with moderate (Total BMD = 0.921 ± 0.053) and high SB (Total BMD = 0.929 ± 0.051) (p-value = 0.011). Children and adolescents with low total SB had higher BMD legs (0.965 ± 0.056) than young people with high total SB (BMD legs = 0.877 ± 0.209), but this relationship was attenuated when the analyzes were adjusted for physical activity (p-value = 0.068). CONCLUSION Adolescents with high sedentary behavior tend to have lower whole body bone mineral density than those with low sedentary behavior.
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Affiliation(s)
- Diego Giulliano Destro Christofaro
- School of Technology and Sciences, Presidente Prudente, São Paulo State University (Unesp), Roberto Simonsen street, number 305, Presidente Prudente, Sao Paulo, 19.060-900, Brazil.
| | - William Rodrigues Tebar
- School of Technology and Sciences, Presidente Prudente, São Paulo State University (Unesp), Roberto Simonsen street, number 305, Presidente Prudente, Sao Paulo, 19.060-900, Brazil
| | - Bruna Thamyres Ciccotti Saraiva
- School of Technology and Sciences, Presidente Prudente, São Paulo State University (Unesp), Roberto Simonsen street, number 305, Presidente Prudente, Sao Paulo, 19.060-900, Brazil
| | - Gabriela Caroline Rodrigues da Silva
- School of Technology and Sciences, Presidente Prudente, São Paulo State University (Unesp), Roberto Simonsen street, number 305, Presidente Prudente, Sao Paulo, 19.060-900, Brazil
| | - Amanda Barbosa Dos Santos
- School of Technology and Sciences, Presidente Prudente, São Paulo State University (Unesp), Roberto Simonsen street, number 305, Presidente Prudente, Sao Paulo, 19.060-900, Brazil
| | - Gregore Iven Mielke
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | | | - Jorge Mota
- Research Center on Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
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Navabi B, Tang K, Khatchadourian K, Lawson ML. Pubertal Suppression, Bone Mass, and Body Composition in Youth With Gender Dysphoria. Pediatrics 2021; 148:peds.2020-039339. [PMID: 34497118 DOI: 10.1542/peds.2020-039339] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Puberty onset and development contribute substantially to adolescents' bone mass and body composition. Our objective with this study was to examine the effects of gonadotropin-releasing hormone agonists (GnRHa) on these puberty-induced changes among youth with gender dysphoria (GD). METHODS Medical records of the endocrine diversity clinic in an academic children's hospital were reviewed for youth with GD seen from January 2006 to April 2017 with at least 1 baseline dual-energy radiograph absorptiometry measurement. RESULTS At baseline, transgender females had lower lumbar spine (LS) and left total hip (LTH) areal bone mineral density (aBMD) and LS bone mineral apparent density (BMAD) z scores. Only 44.7% of transgender youth were vitamin D sufficient. Baseline vitamin D status was associated with LS, LTH aBMD, and LS BMAD z scores. Post-GnRHa assessments revealed a significant drop in LS and LTH aBMD z scores (transgender males and transgender females) without fractures and LS BMAD (transgender males), an increase in gynoid (fat percentage), and android (fat percentage) (transgender males and transgender females), and no changes in BMI z score. CONCLUSIONS GnRHa monotherapy negatively affected bone mineral density of youth with GD without evidence of fractures or changes in BMI z score. Transgender youth body fat redistribution (android versus gynoid) were in keeping with their affirmed gender. The majority of transgender youth had vitamin D insufficiency or deficiency with baseline status associated with bone mineral density. Vitamin D supplementation should be considered for all youth with GD.
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Affiliation(s)
- Behdad Navabi
- Division of Endocrinology and Metabolism, Department of Pediatrics.,CHEO Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Ken Tang
- CHEO Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Karine Khatchadourian
- Division of Endocrinology and Metabolism, Department of Pediatrics.,CHEO Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Margaret L Lawson
- Division of Endocrinology and Metabolism, Department of Pediatrics .,CHEO Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Lambert BS, Cain MT, Heimdal T, Harris JD, Jotwani V, Petak S, McCulloch PC. Physiological Parameters of Bone Health in Elite Ballet Dancers. Med Sci Sports Exerc 2021; 52:1668-1678. [PMID: 32079918 DOI: 10.1249/mss.0000000000002296] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Stress fractures are common among elite ballet dancers whereby musculoskeletal health may be affected by energy balance and overtraining. PURPOSE This study aimed to characterize bone health in relation to stress fracture history, body composition, eating disorder risk, and blood biomarkers in professional male and female ballet dancers. METHODS A single cohort of 112 dancers (male: 55, 25 ± 6 yr; female: 57, 24 ± 6 yr) was recruited. All participants underwent bone and body composition measures using dual-energy x-ray absorptiometry. In a subset of our cohort (male: 30, 24 ± 6 yr; female, 29, 23 ± 5 yr), a blood panel, disordered eating screen, menstrual history, and stress fracture history were also collected. Age-matched Z scores and young-adult T scores were calculated for bone mineral density (BMD) and body composition. Independent-samples t-tests and Fisher's exact tests were used to compare BMD, Z-scores, T scores, and those with and without history of stress fractures. A 1 × 3 ANOVA was used to compare BMD for those scoring 0-1, 2-6, and 7+ using the EAT26 questionnaire for eating disorder risk. Regression was used to predict BMD from demographic and body composition measures. RESULTS Female dancers demonstrated reduced spinal (42nd percentile, 10%T < -1) and pelvic (16th percentile, 76%T < -1) BMD. Several anthropometric measures were predictive of BMD (P < 0.05, r = 0.65-0.81, standard error of estimate = 0.08-0.10 g·cm, percent error = 6.3-8.5). Those scoring >1 on EAT26 had lower BMD than did those with a score of 0-1 (P < 0.05). CONCLUSIONS Professional female ballet dancers exhibit reduced BMD, fat mass, and lean mass compared with the general population whereby low BMD and stress fractures tend to be more prevalent in those with a higher risk of disordered eating. Anthropometric and demographic measures are predictive of BMD in this population.
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Affiliation(s)
- Bradley S Lambert
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX
| | - Michael T Cain
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX
| | - Tyler Heimdal
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX
| | - Joshua D Harris
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX
| | - Vijay Jotwani
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX
| | - Steven Petak
- Department of Endocrinology, Houston Methodist Hospital, Houston, TX
| | - Patrick C McCulloch
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX
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Abstract
Vitamin D has important roles in calcium metabolism and in the prevention of rickets and osteomalacia; low levels of 25-hydroxyvitamin D are common in the general population and amongst pregnant women. Whilst there is a wealth of observational evidence linking vitamin D deficiency to a wide range of disease outcomes, there are currently few high-quality randomised controlled trials to confirm any causal associations, although many are currently in progress. Furthermore, currently, the vast majority of published guidelines recommend standard supplemental vitamin D doses for children and pregnant women, yet there is increasing recognition that individual characteristics and genetic factors may influence the response to supplementation. As such, future research needs to concentrate on documenting definite beneficial clinical outcomes of vitamin D supplementation, and establishing personalised dosing schedules and demonstrating effective approaches to optimising initiation and adherence.
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Affiliation(s)
- Rebecca J Moon
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
- Paediatric Endocrinology, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Justin H Davies
- Paediatric Endocrinology, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
- National Institute for Health Research (NIHR) Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK.
- National Institute for Health Research (NIHR) Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
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Wielandt T, van den Wyngaert T, Uijttewaal JR, Huyghe I, Maes M, Stassijns G. Bone mineral density in adolescent elite ballet dancers. J Sports Med Phys Fitness 2019; 59:1564-1570. [PMID: 31215202 DOI: 10.23736/s0022-4707.19.09700-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Data documenting BMD in pre-professional adolescent ballet dancers is limited. This cross-sectional study assesses bone mineral density (BMD) in young adolescent elite ballet dancers and compares BMD values between males and females (with and without normal menarche) and body composition between dancers with and without low Z-score. METHODS Cross-sectional study of third year ballet students (female=23; male=15; mean age 14.7 years; SD: 0.5) of The Royal Ballet School of Antwerp (Belgium) training 22 hours a week. They completed questionnaires and underwent dual energy X-ray absorptiometry (DXA) to measure BMD and body composition. Each female participant completed questionnaires assessing menstrual status. RESULTS DXA revealed that 12 out of 38 (32%) of the dancers had Z-score <-1. On average, male dancers had a lower BMD compared to an age-matched reference population (mean Z-score -0.9; SD 0.5), with 7 out of 15 having Z-score <-1. Overall, absolute BMD values were highest in the legs, followed by spine and arms. Dancers with Z-score <-1 had a significantly lower total mass. 43% of female ballet dancers had not yet had their first period and 39% had oligomenorrhea, but no significant differences between groups was detected. CONCLUSIONS A third of adolescent elite ballet dancers had low to very low Z-score. Nearly 2 out of 3 dancers with a Z-score <-1 were males, showing that low BMD is not limited to female dancers. Among female dancers menstrual dysfunction was frequent, without apparent impact on BMD or body composition in the studied age group.
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Affiliation(s)
- Tim Wielandt
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Physical Medicine and Rehabilitation, Antwerp University Hospital, Edegem, Belgium
| | - Tim van den Wyngaert
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Johanna R Uijttewaal
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Physical Medicine and Rehabilitation, Antwerp University Hospital, Edegem, Belgium
| | - Ivan Huyghe
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Michiel Maes
- Department of Neurology, Heilig-Hart Hospital, Lier, Belgium
| | - Gaëtane Stassijns
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium - .,Department of Physical Medicine and Rehabilitation, Antwerp University Hospital, Edegem, Belgium
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Rønne MS, Heidemann M, Lylloff L, Schou AJ, Tarp J, Laursen JO, Jørgensen NR, Husby S, Wedderkopp N, Mølgaard C. Bone Mass Development in Childhood and Its Association with Physical Activity and Vitamin D Levels. The CHAMPS-Study DK. Calcif Tissue Int 2019; 104:1-13. [PMID: 30178125 DOI: 10.1007/s00223-018-0466-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 08/12/2018] [Indexed: 12/12/2022]
Abstract
This longitudinal study examined associations of bone mass with physical activity and vitamin D level over more than 6 years through puberty. A total of 663 participants (320 boys) with mean age 9.6 years at baseline (10-17 years at follow-up), underwent dual energy X-ray absorptiometry, anthropometry and blood samples for vitamin D at least twice during the study period (with three possible time-points). Physical activity was assessed using accelerometers at follow-up. A positive association was found between percent time spent at vigorous physical activity and total-body less head bone mineral content (β = 5.8, p = 0.002). The magnitude of this association increased with maturational development; thus physical activity may have a greater influence on bone mass in the more mature participants. The vitamin D levels were also positively associated with bone mass. A high degree of tracking was observed with changes in anthropometric Z scores predictive of deviation from tracking. No environmental factor predicted deviation from tracking.
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Affiliation(s)
- Maria Sode Rønne
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, 5000, Odense C, Denmark.
- Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 3, 5000, Odense C, Denmark.
| | - Malene Heidemann
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, 5000, Odense C, Denmark
| | - Louise Lylloff
- Department of Clinical Biochemistry, Rigshospitalet, Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark
- Department of Clinical Biochemistry, Hospital Unit West, Gl. Landevej 61, 7400, Herning, Denmark
| | - Anders J Schou
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, 5000, Odense C, Denmark
| | - Jakob Tarp
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Jens Ole Laursen
- Emergency Department, Hospital of South Jutland, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark
| | - Niklas Rye Jørgensen
- Department of Clinical Biochemistry, Rigshospitalet, Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark
- OPEN, Odense Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark, J.B.Winsløws Vej 9 A, 3, 5000, Odense C, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, 5000, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 3, 5000, Odense C, Denmark
| | - Niels Wedderkopp
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
- Department of Orthopaedics, Hospital of Southwestern Denmark, Finsensgade 34, 6700, Esbjerg, Denmark
| | - Christian Mølgaard
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23C, 5000, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 3, 5000, Odense C, Denmark
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Nørre Allé 51, 2200, Copenhagen, Denmark
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Diniz TA, Agostinete RR, Costa P, Saraiva BTC, Sonvenso DK, Freitas IF, Fernandes RA, Christofaro DGD. Relationship between total and segmental bone mineral density and different domains of physical activity among children and adolescents: cross-sectional study. SAO PAULO MED J 2017; 135:444-449. [PMID: 28832809 PMCID: PMC10027243 DOI: 10.1590/1516-3180.2017.0042070417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 04/07/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND This study aimed to investigate the relationship between total and segmental bone mineral density (BDM) and physical activity (PA) in different domains (school, leisure and sports) among adolescents and children. DESIGN AND SETTING Cross-sectional study in the Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP). METHODS The study sample consisted of 173 children and adolescents (10.31 ± 1.87 years). The BMDs for the whole body (WB) and the regions of the trunk and legs were measured using dual energy X-ray absorptiometry (DXA). PA was measured using the Baecke questionnaire. A regression model was used to analyze the relationship between all the BMDs and the different domains of PA. RESULTS 41.5% of the adolescents had high percentages of body fat. Regarding the comparison between physically active and insufficiently active adolescents, there were no statistically significant differences in any BMD variables (P > 0.05). The BMD of the legs showed positive relationships with the total PA (β = 0.009; P = 0.013) and sports PA (β = 0.010; P = 0.049) after insertion of the confounders. Similarly, the WB BMD showed the same relationships (total PA: β = 0.005; P = 0.045; and sports PA: β = 0.008; P = 0.049). No relationship was found between leisure and school PA and any of the BMDs (P > 0.05). CONCLUSION The results indicated that practice of sport was related to higher BMD values, independent of sex, age and body fatness.
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Affiliation(s)
- Tiego Aparecido Diniz
- Doctoral Student, Department of Cell and Developmental Biology, Institute of Biomedical Sciences, University of São Paulo, São Paulo (SP), Brazil
| | - Ricardo Ribeiro Agostinete
- Master's Student, Department of Physiotherapy, Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Presidente Prudente (SP), Brazil
| | - Paulo Costa
- Master's Student, Department of Physiotherapy, Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Presidente Prudente (SP), Brazil
| | - Bruna Thamyres Ciccotti Saraiva
- Master's Student, Department of Physical Exercise, Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), São Paulo (SP), Brazil
| | - Diego Kanashiro Sonvenso
- Undergraduate Student, Department of Physical Exercise, Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), São Paulo (SP), Brazil
| | - Ismael Forte Freitas
- Associate Professor, Department of Physical Exercise, Department of Physical Education, Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Presidente Prudente (SP), Brazil
| | - Rômulo Araujo Fernandes
- Associate Professor, Department of Physical Exercise, Department of Physical Education, Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Presidente Prudente (SP), Brazil
| | - Diego Giulliano Destro Christofaro
- Associate Professor, Department of Physical Exercise, Department of Physical Education, Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Presidente Prudente (SP), Brazil
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Haimi M, Kremer R. Vitamin D deficiency/insufficiency from childhood to adulthood: Insights from a sunny country. World J Clin Pediatr 2017; 6:1-9. [PMID: 28224090 PMCID: PMC5296623 DOI: 10.5409/wjcp.v6.i1.1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 07/15/2016] [Accepted: 10/09/2016] [Indexed: 02/06/2023] Open
Abstract
Vitamin D is known to be a key regulator of bone metabolism and is associated with muscle strength. Vitamin D deficiency is widely prevalent worldwide. In adults, vitamin D deficiency has been implicated in numerous health conditions including osteoporosis, cancer, diabetes, and autoimmune diseases. Considerable changes have occurred in lifestyles and childhood activities in the past years. Studies have shown that the children population is at high risks of vitamin D deficiency. The objective of this study was to learn about the extent of vitamin D deficiency in children worldwide and especially in sunny country like Israel. In this article we reviewed the extent and severity of vitamin D deficiency worldwide and especially in Israel, through a very comprehensive review of previous reports and research studies done during the last years. We found reports on vitamin D deficiency in children, which was associated with metabolic syndromes and obesity. It was more prevalent in children who spend less time on outdoor activities, in obese children, and in cases when there was imbalance between nutritional intakes and requirements. Vitamin D deficiency is common even in children living in sunny places like Israel. Health professionals should be aware of the fact that although vitamin D deficiency is prevalent in the elderly population, it is also common in children, and can be associated with different illnesses. We encourage supplementation of vitamin D to special populations (pregnant and lactating women, infants, and high risk groups). We also encourage implementation of international food fortification programs.
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Mabey T, Singhatanadgige W, Yingsakmongkol W, Limthongkul W, Honsawek S. Vitamin D and spine surgery. World J Orthop 2016; 7:726-730. [PMID: 27900269 PMCID: PMC5112341 DOI: 10.5312/wjo.v7.i11.726] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 08/09/2016] [Accepted: 08/31/2016] [Indexed: 02/06/2023] Open
Abstract
Vitamin D is crucial for musculoskeletal health, maintenance, and function. Vitamin D insufficiency is common among patients undergoing spine surgery and the ideal vitamin D level for spine surgery has yet to be investigated. There is a high prevalence of hypovitaminosis D in patients with musculoskeletal pain regardless of surgical intervention. With the frequency and costs of spine surgery increasing, it is imperative that efforts are continued to reduce the impact on patients and healthcare services. Studies into vitamin D and its associations with orthopaedic surgery have yielded alarming findings with regards to the prevalence of vitamin D deficiency. Importantly, altered vitamin D status also contributes to a wide range of disease conditions. Therefore, future investigations are still essential for better understanding the relationship between vitamin D and spine surgery outcomes. Whilst further research is required to fully elucidate the extent of the effects of hypovitaminosis D has on surgical outcomes, it is strongly advisable to reduce the impacts by appropriate vitamin D supplementation of deficient and at-risk patients.
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11
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Tønnesen R, Hovind PH, Jensen LT, Schwarz P. Determinants of vitamin D status in young adults: influence of lifestyle, sociodemographic and anthropometric factors. BMC Public Health 2016; 16:385. [PMID: 27170258 PMCID: PMC4863340 DOI: 10.1186/s12889-016-3042-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 04/22/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Very few studies have investigated the determinants of circulating 25-hydroxyvitamin D (25[OH]D) in young adults (18-25 years old) using a set of variables that include lifestyle, sociodemographic, and anthropometric data. Our aim was to investigate the association between these variables and vitamin D status in a sample of untreated young adults. METHODS A total of 738 young adults were enrolled in a (June cross-sectional study 2012 to May 2014) and were recruited from educational institutions in the Copenhagen area. For multivariate logistic regression subjects was categorized based on 25[OH]D in serum into; vitamin D sufficiency (S-25[OH]D > 50 nmol/L), vitamin D insufficiency (25 nmol/L ≤ S-25[OH]D ≤ 50 nmol/L), vitamin D deficiency (S-25[OH]D < 25 nmol/L). Information on lifestyle factors and education was obtained by self-reported questionnaires. RESULTS 700 subjects with a valid measurement of S-25[OH]D and a completed questionnaire was analysed. 238 had vitamin D insufficiency, 135 had vitamin D deficiency of which 13 had severe vitamin D deficiency (S-25[OH]D < 12.5 nmol/L). The relative risk (RR) for vitamin D deficiency was highest for men 2.09 (1.52, 2.87); obese subjects 2.00 (1.27, 3.15); smokers 1.33 (1.02, 1.73); subjects who exercised 0-½ hours a week 1.88 (1.21, 2.94); and subjects who consumed fast food once a week 1.59 (1.05, 2.43). The relative risk was significantly lower for subjects who were studying for a Bachelor's degree (0.40 (0.23, 0.68). For vitamin D insufficiency, the highest RR was again for men 1.31 (1.06, 1.61); obese subjects 1.57 (1.17, 2.11); and subjects who exercised 0-½ hours a week 1.51 (1.11, 2.06). CONCLUSION In this study of young adults, vitamin D deficiency was highly prevalent. Modifiable factors such as smoking, maintenance of normal BMI, and physical activity are all potential targets for interventional trials to determine the causal order; such knowledge would be useful in improving S-25[OH]D in young adults. The small group with severe vitamin D deficiency warrants increased attention.
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Affiliation(s)
- Rune Tønnesen
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Nordre Ringvej 57, 2600, Copenhagen, Glostrup, Denmark.
| | - Peter Hambak Hovind
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Nordre Ringvej 57, 2600, Copenhagen, Glostrup, Denmark
| | - Lars Thorbjørn Jensen
- Department of Clinical Physiology and Nuclear Medicine, University Hospital of Herlev, Copenhagen, Denmark.,Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Schwarz
- Department of Endocrinology PE and Research Centre of Ageing and Osteoporosis, Rigshospitalet, Copenhagen, Denmark.,Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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12
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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: 2.2] [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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13
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Moon RJ, Harvey NC, Davies JH, Cooper C. Vitamin D and skeletal health in infancy and childhood. Osteoporos Int 2014; 25:2673-84. [PMID: 25138259 PMCID: PMC4224585 DOI: 10.1007/s00198-014-2783-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 06/18/2014] [Indexed: 01/25/2023]
Abstract
During growth, severe vitamin D deficiency in childhood can result in symptomatic hypocalcaemia and rickets. Despite the suggestion from some studies of a secular increase in the incidence of rickets, this observation may be driven more by changes in population demographics than a true alteration to age, sex and ethnicity-specific incidence rates; indeed, rickets remains uncommon overall and is rarely seen in fair-skinned children. Additionally, the impact of less severe vitamin D deficiency and insufficiency has received much interest in recent years, and in this review, we consider the evidence relating vitamin D status to fracture risk and bone mineral density (BMD) in childhood and adolescence. We conclude that there is insufficient evidence to support the suggestion that low serum 25-hydroxyvitamin D [25(OH)D] increases childhood fracture risk. Overall, the relationship between 25(OH)D and BMD is inconsistent across studies and across skeletal sites within the same study; however, there is evidence to suggest that vitamin D supplementation in children with the lowest levels of 25(OH)D might improve BMD. High-quality randomised trials are now required to confirm this benefit.
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Affiliation(s)
- Rebecca J Moon
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK SO16 6YD
- Paediatric Endocrinology, Southampton University Hospitals NHS Foundation Trust, Southampton, UK SO16 6YD
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK SO16 6YD
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD UK
| | - Justin H Davies
- Paediatric Endocrinology, Southampton University Hospitals NHS Foundation Trust, Southampton, UK SO16 6YD
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK SO16 6YD
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD UK
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Nuffield Orthopedic Centre, Headington, Oxford, OX3 7HE
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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: 2.4] [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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Dubnov-Raz G, Ish-Shalom S, Chodick G, Rozen GS, Giladi A, Constantini NW. Osteocalcin is independently associated with body mass index in adolescent girls. Pediatr Obes 2012; 7:313-8. [PMID: 22577088 DOI: 10.1111/j.2047-6310.2012.00058.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 02/09/2012] [Accepted: 02/27/2012] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Osteocalcin is a bone-related protein, recently found to correlate with body mass index (BMI), waist circumference, fat percentage and metabolic syndrome in adults. The aim of this study was to determine the relationship between osteocalcin and BMI in adolescence, a time of significant bone accrual, while considering possible confounders related to bone and body composition. METHODS We analyzed data from 160 female adolescents (mean age 15.1 ± 0.7 years), which were divided into tertiles by osteocalcin levels. Across these three groups, we examined the differences in BMI with relation to age, total daily energy intake, calcium intake, physical activity (PA), total body bone mineral density, parathyroid hormone (PTH), 25(OH)-vitamin D, bone alkaline phosphatase and body fat percentage. RESULTS Mean BMI values differed significantly between participants in the three osteocalcin tertiles, including after adjustment for age, PA, PTH, energy and calcium intakes. Post-hoc analysis revealed that girls in the highest osteocalcin tertile, had a significantly lower BMI than those in the two lower ones (19.3 ± 2.2 vs. 20.6 ± 3.0 and 20.7 ± 2.9 kg m(-2), respectively, P = 0.018). There was no significant difference in energy and calcium intakes, bone mineral density, 25(OH)-vitamin D levels and PTH between study groups. CONCLUSIONS In female adolescents, BMI is inversely related to osteocalcin, even after consideration of several factors that may affect bone and fat mass. As bone mineral density, 25(OH)D and PTH did not differ between groups, it is possible that the relation between osteocalcin and BMI could be unrelated to bone tissue itself.
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Affiliation(s)
- G Dubnov-Raz
- Exercise, Nutrition and Lifestyle Clinic, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel.
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Abstract
PURPOSE OF REVIEW At the turn of the last century, rickets (vitamin D deficiency) was one of the most common musculoskeletal diseases of the paediatric population presenting to physicians. Today, the most common referral pathway for these patients ends in a paediatric orthopaedic outpatient clinic. Vitamin D deficiency is a clinical entity that can affect all children and should be looked for in all children with musculoskeletal symptoms. RECENT FINDINGS The child at risk of rickets is now white, breastfed, protected from the sun and obese. Vitamin D deficiency can present as atypical muscular pain, pathological fractures or slipped upper femoral epiphysis. Obesity is linked with lower vitamin D levels; however, in the paediatric population, this does not necessarily equal clinical disorder. Vitamin D supplements can be used to reduce the risk of pathological fractures in the cerebral palsy child. It should also form part of the differential diagnosis in the work-up of nonaccidental injuries. Children with a low vitamin D present with a higher incidence of fractures from normal activities. Vitamin D levels need to be assessed before any form of orthopaedic surgery, as it can affect growth, both in the diaphysis of the bone and in the growth plate. SUMMARY Vitamin D levels are a key element in the successful practice of paediatric orthopaedics. It is not just the possible cause of disorder presenting to the clinician but also extremely important in ensuring the successful postoperative recovery of the patient.
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Andersen NE, Karl JP, Cable SJ, Williams KW, Rood JC, Young AJ, Lieberman HR, McClung JP. Vitamin D status in female military personnel during combat training. J Int Soc Sports Nutr 2010; 7:38. [PMID: 21156069 PMCID: PMC3017021 DOI: 10.1186/1550-2783-7-38] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 12/14/2010] [Indexed: 11/10/2022] Open
Abstract
Vitamin D is an essential nutrient for maintaining bone health. Recent data suggest that vitamin D and calcium supplementation might affect stress fracture incidence in military personnel. Although stress fracture is a health risk for military personnel during training, no study has investigated changes in vitamin D status in Soldiers during United States (US) Army basic combat training (BCT). This longitudinal study aimed to determine the effects of BCT on 25-hydroxyvitamin D (25(OH)D) and parathyroid hormone (PTH) levels in female Soldiers. Serum 25(OH)D and PTH were assessed in 74 fasted Soldier volunteers before and after an 8-week BCT course conducted between August and October in Columbia, South Carolina. In the total study population, 25(OH)D levels decreased (mean ± SD) from 72.9 ± 30.0 to 63.3 ± 19.8 nmol/L (P < 0.05) and PTH levels increased from 36.2 ± 15.8 to 47.5 ± 21.2 pg/mL (P < 0.05) during BCT. Ethnicity affected changes in vitamin D status (ethnicity-by-time interaction, P < 0.05); 25(OH)D decreased (P < 0.05) in both Hispanic and non-Hispanic whites, but did not change in non-Hispanic blacks. Ethnicity did not affect BCT-induced changes in PTH. These data indicate that vitamin D status in female Soldiers may decline during military training in the late summer and early autumn months in the Southeastern US. Future studies should strive to determine the impact of military clothing and seasonality on vitamin D status, as well as the functional impact of declining vitamin D status on bone health.
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Affiliation(s)
- Nancy E Andersen
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, 01760, USA.
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