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Bone age determination in a paediatric population as an indicator of nutritional status
1Fleshman@open.org
Insights
Children in Nepal exhibit significant delays in bone maturation, averaging 28% below their chronological age. This skeletal development delay is strongly linked to poverty and lifelong dietary inadequacy in the community.
Area of Science:
- Pediatric skeletal development
- Nutritional deficiencies
- Public health in developing nations
Background:
- Children in Nepal, particularly tribal groups, were observed to be small for their age.
- Initial observations suggested potential delays in ossification and physeal closure from fracture care X-rays.
Purpose of the Study:
- To quantify the delay in bone maturation among children and adolescents in Nepal.
- To investigate the correlation between skeletal age and chronological age.
- To identify potential contributing factors to observed growth discrepancies.
Main Methods:
- Radiographic assessment of bone age using the "Radiographic Atlas of Skeletal Development of the Hand and Wrist" for 219 patients under 21 with upper limb injuries.
- Analysis of dental age based on deciduous tooth shedding and eruption patterns.
- Collection of physical and sociological data via patient questionnaires.
Main Results:
- Bone maturation delay was prevalent and severe, with average bone age 28% below chronological age.
- 60% of patients fell two standard deviations below the norm for skeletal development.
- Dental age retardation averaged 21%, though eruption patterns showed more variability.
Conclusions:
- Lifelong community dietary inadequacy is the primary driver of small national stature in Nepal.
- Poverty is identified as the major socioeconomic factor influencing skeletal development delays.
- Interventions addressing nutritional deficiencies are crucial for improving child growth and development.
Abstract:
The United Mission to Nepal Tansen Project is in the hill country, 300 km West of Kathmandu. This 40-year-old service centre's major emphasis has been on clinical and community medicine and education. Agronomy, forestry, water resources development, adult literacy, etc., have also been part of the project's outreach. We had long noted that the children of all of the various tribal groups in the area are small for their age as compared with children in developed countries. Fracture care X-rays were examined to reveal delay in ossification and in physeal closure. Using the standards found in the Radiographic Atlas of Skeletal Development of the Hand and Wrist, we quantified this apparent delay by determining the bone age of all patients presenting at the hospital with upper limb injuries requiring X-ray. The collection of data was limited to 100 days and to those under the age of 21. Two hundred and nineteen patients' data were analysed. We found that bone maturation delay was very common and often severe. The average bone age among the 219 was 28% below chronological age. That is, 60% of all fell two standard deviations below the norm: i.e. two-thirds of all 9 year olds had the expected skeletal development of 6 year olds in Boston, USA. Dental age was also analysed using deciduous tooth shedding and tooth eruption patterns. Dental age retardation averaged 21%, but a larger per cent had normal eruption dates. Other physical and sociological data were included in a questionnaire completed for each patient. Among the variables examined, poverty alone appeared to be the major mover. We believe that national small stature is a result of lifelong community dietary inadequacy.