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Relationship between height age, bone age and chronological age in normal children in the context of nutritional and
Vaman Khadilkar1,2, Chirantap Oza3, Anuradha Khadilkar2,3
1Senior Pediatric Endocrinologist, Jehangir Hospital, Bombay Hospital, Pune, India.
Insights
In healthy Indian children, chronological age, height age, and bone age are closely linked. Nutritional status and puberty significantly influence variations in bone age and height age.
Area of Science:
- Pediatric endocrinology
- Growth and development
- Skeletal maturation
Background:
- Bone age (BA) quantifies skeletal maturation, but its relationship with puberty and nutritional factors, especially in India's context of rapid nutritional transition and rising obesity, is not well understood.
- Understanding these factors is crucial for accurate growth assessment in children.
Purpose of the Study:
- To determine if the difference between chronological age (CA), height age (HA), and bone age (BA) is within one year in healthy Indian children aged 2-17 years.
- To assess the relationship of BA with height, weight, and BMI, considering gender and pubertal status.
Main Methods:
- Cross-sectional study of 804 Indian children (2-17 years).
- Standard anthropometric and pubertal assessments, converted to age/sex-standardized z-scores using Indian references.
- Bone age estimated using the Tanner-Whitehouse (TW3) method.
Main Results:
- Mean z-scores for height, weight, BMI, and BA were -0.3 ± 0.7, -0.7 ± 0.8, -0.1 ± 1.0, and -0.2 ± 0.9, respectively.
- Height age was more delayed in girls, while bone age was more delayed in boys.
- Bone age z-score increased with BMI; post-puberty, BA increased more in girls and HA in boys (p<0.05).
Conclusions:
- Chronological age, height age, and bone age are tightly correlated in healthy Indian children.
- Nutritional status and puberty play significant roles in variations observed in these age parameters.
Introduction:
Bone age (BA) is a quantitative determination of skeletal maturation. The role of puberty in variations in BA is poorly understood as hypothalamic-pituitary-gonadal (HPG) axis maturation and skeletal maturation are regulated in parallel but independently by multiple different factors. In countries like India where there is rapid nutrition transition and increase in prevalence of obesity, their impact on height and BA is not well understood.
Objectives:
To study if in 2-17 year old healthy children, the difference between chronological age (CA), height age (HA) and BA is less than 1 year on either side of the chronological age and to assess relationship of BA with height, weight and BMI with special reference to gender and puberty.
Methods:
This cross-sectional study included 804 preschool/school-going Indian children. Anthropometric measurements and pubertal assessments were performed using standard protocols and were converted to age and sex standardized z-scores using Indian references while BA was estimated by Tanner-Whitehouse (TW3) method. p<0.05 was considered statistically significant.
Results:
The mean age and gender standardized z-scores for height, weight, body mass index (BMI) and BA were -0.3 ± 0.7, -0.7 ± 0.8, -0.1 ± 1.0, and -0.2 ± 0.9 respectively. HA was more delayed in girls while BA was more delayed in boys. The mean BA z-score increased with increasing BMI. After the onset of puberty, there was higher increment in BA in girls and HA in boys (p<0.05).
Conclusions:
HA, BA and CA were tightly correlated in healthy Indian children with a significant role of nutritional status and puberty in causing variation in the same.
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