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The effect of prepubertal calcium carbonate supplementation on skeletal development in Gambian boys-a 12-year
K A Ward1, T J Cole, M A Laskey
1Nutrition and Bone Health (K.A.W., M.A.L., A.P.), Medical Research Council Human Nutrition Research, Cambridge CB1 9NL, United Kingdom; Population, Policy and Practice Programme (T.J.C.), University College London, Institute of Child Health, London WC1N 1EH, United Kingdom; and Calcium, Vitamin D, and Bone Health (M.C., M.B.M., Y.S., A.P.), Medical Research Council, Keneba, The Gambia.
Insights
Prepubertal calcium supplementation in boys with low dietary intake advanced their growth spurt. However, this one-year intervention showed no lasting impact on bone mineral accrual or size by adulthood.
Area of Science:
- Pediatric Bone Health
- Nutritional Science
- Growth and Development
Background:
- Calcium intake is critical for bone health during growth but varies significantly.
- The effects of increased calcium intake are not well understood in populations with low calcium diets, stunting, and delayed puberty.
Purpose of the Study:
- To investigate the impact of prepubertal calcium supplementation on the timing of peak bone growth velocity.
- To assess the long-term effects of calcium supplementation on bone mineral content and size.
Main Methods:
- A 12-year prospective follow-up study of 80 Gambian boys (aged 8.0-11.9 years) who participated in a randomized, placebo-controlled trial.
- Intervention involved 1 year of daily calcium carbonate supplementation (1000 mg).
- Bone mineral content, bone area, and lean mass were measured using dual-energy x-ray absorptiometry; bone growth was assessed via superimposition models.
Main Results:
- Calcium supplementation led to an earlier age at peak bone growth velocity for whole body bone mineral content and bone area.
- Significant advancements in peak velocity were observed for bone area in the lumbar spine and total hip.
- No significant differences were found in total bone accrued (mineral or size) or growth rate by young adulthood.
Conclusions:
- One year of prepubertal calcium supplementation in boys with a low calcium diet accelerated the adolescent growth spurt.
- The supplementation did not result in lasting changes to bone mineral accrual or bone size into adulthood.
- Findings suggest caution when applying global calcium recommendations to diverse populations with specific nutritional profiles.
Context:
Calcium intake during growth is essential for future bone health but varies widely between individuals and populations. The impact on bone of increasing calcium intake is unknown in a population where low calcium intake, stunting, and delayed puberty are common.
Objective:
To determine the effect of prepubertal calcium supplementation on mean age at peak velocity for bone growth and mineral accrual.
Design And Setting:
Prospective follow-up of boys in rural Gambia, West Africa, who had participated in a double-blind, randomized, placebo-controlled trial of calcium supplementation.
Participants:
Eighty boys, initially aged 8.0-11.9 years, were followed up for 12 years.
Interventions:
Subjects received 1 year of calcium carbonate supplementation (1000 mg daily, 5 d/wk).
Main Outcome Measures:
Dual-energy x-ray absorptiometry measurements were carried out for whole body (WB), lumbar spine, and total hip bone mineral content, bone area (BA), and WB lean mass. Super imposition by translation and rotation models was made to assess bone growth.
Results:
Age at peak velocity was consistently earlier in the calcium group compared to the placebo group, for WB bone mineral content (mean, -6.2 [SE, 3.1]; P = .05), WB BA (mean, -7.0 [SE, 3.2] mo; P = .03), lumbar spine and total hip BA. By young adulthood, supplementation did not change the amount of bone accrued (mineral or size) or the rate of bone growth.
Conclusions:
Twelve months of prepubertal calcium carbonate supplementation in boys with a low calcium diet advanced the adolescent growth spurt but had no lasting effect on bone mineral or bone size. There is a need for caution when applying international recommendations to different populations.
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