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Fetal and childhood growth patterns associated with bone mass in school-age children: the Generation R Study
Denise Hm Heppe1, Carolina Medina-Gomez, Johan C de Jongste
1The Generation R Study Group, Erasmus Medical Centre, Rotterdam, The Netherlands; Department of Pediatrics, Erasmus Medical Centre, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
Insights
Childhood growth significantly impacts bone development more than fetal growth. Compensatory growth in infancy can reverse negative effects of restricted fetal growth on bone mineral accrual.
Area of Science:
- Pediatric Bone Health
- Growth and Development
- Nutritional Epidemiology
Background:
- Low birth weight is linked to reduced bone accrual in children and lower peak bone mass in adults.
- Understanding longitudinal growth's impact on bone properties is crucial for long-term skeletal health.
Purpose of the Study:
- To investigate how different patterns of fetal and early childhood growth influence bone properties at school age.
- To analyze the association between longitudinal growth trajectories and bone mineral content, bone area, and bone mineral density.
Main Methods:
- Utilized data from 5431 children in a prospective cohort study.
- Measured fetal growth via ultrasound and childhood growth from birth to 4 years.
- Employed conditional growth modeling to analyze repeated growth measures and bone outcomes (BMC, BA, BMD) at age 6 via DXA.
Main Results:
- Fetal weight gain and femur length growth, along with all height and weight growth from birth to 4 years, positively correlated with BMC, BA, and BMD.
- Childhood growth, particularly in the first year of life, showed a stronger influence on bone measures than fetal growth.
- Small for gestational age (SGA) children had lower BMC and BA, while large for gestational age (LGA) children had higher BMC and BA; these differences diminished with compensatory infant growth.
Conclusions:
- Both fetal and childhood growth patterns are associated with bone mineral accrual, with infancy being the most influential period.
- Compensatory infant growth can effectively counteract adverse effects of fetal growth restriction on bone development.
- Early life growth monitoring and interventions may be key for optimizing skeletal health outcomes.
Abstract:
Low birth weight is associated with lower bone accrual in children and peak bone mass in adults. We assessed how different patterns of longitudinal fetal and early childhood growth influence bone properties at school age. In 5431 children participating in a population-based prospective cohort study, we measured fetal growth by ultrasound at 20 and 30 weeks gestation, and childhood growth at birth, 1, 2, 3, and 4 years of age. We analyzed these growth measurements in relation to total body (less head) BMD measured by DXA at age 6. We used conditional growth modeling; a technique which takes into account correlation between repeatedly measured growth measures. Our results showed that estimated fetal weight gain, femur length growth between 20 and 30 weeks of gestation, femur length growth between 30 weeks and birth, as well as all height and weight growth measurements from birth to 4 years of age were all positively associated with BMC, bone area (BA), and BMD (all p < 0.01). Fetal femur length growth between 30 weeks and birth was positively associated with BMC and BA (both p < 0.001), but not with BMD. Overall, childhood growth measurements exerted a larger influence on bone measures than fetal growth measures. The strongest effect estimate was observed during the first year of life. Children born small (<10th percentile) for gestational age (SGA) had lower BMC and BA, but not BMD, than children born appropriate for gestational age (AGA), whereas children born large (>90th percentile) for gestational age (LGA) had higher BMC and BA (all p < 0.001). These differences were no longer present in children showing subsequent accelerated and decelerated infant growth, respectively. We conclude that both fetal and childhood growth patterns are associated with bone mineral accrual, showing the strongest effect estimates in infancy. Compensatory infant growth counteracts the adverse consequences of fetal growth restriction on bone development.
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