Adhering to Life's Essential 8 Is Associated With Greater Bone Mineral Accrual During Childhood and Adolescence

Cardiovascular disease and osteoporosis both originate from childhood and share several risk factors. However, the relationship between cardiovascular health (CVH) and bone mass remains unclear in children.

Data of 11 468 (50.7% male) Chinese children aged 6 to 18 were obtained from a nationwide cross-sectional survey during 2013 to 2019. CVH was assessed based on 8 metrics (4 behavioral metrics: diet, physical activity, nicotine exposure, sleep health; and 4 factor metrics: body mass index, blood lipids, blood glucose, blood pressure) according to Life's Essential 8 construct. Scores for CVH behavior and CVH factor were categorized as low (0-49), moderate (50-79), or high (80-100). Bone mineral content and bone mineral density for the total body less head and lumbar spine were measured using dual-energy X-ray absorptiometry.

In unadjusted models, subjects with high CVH behavior but low CVH factor scores showed higher level and greater growth rate of bone mass than their counterparts. After adjustment for covariates, subjects with high scores of CVH behavior or CVH factor demonstrated 0.165 to 0.427 higher Z-score of total body less head bone mineral content than those with low scores. Consistent relationships were also found for other bone measures among CVH behavior categories. Moreover, low bone mass risks were 29% to 34% lower in subjects with moderate or high scores of CVH behavior than those with low scores.

High CVH, especially high CVH behaviors, is significantly associated with greater and faster accrual of childhood bone minerals. These results suggest that behavioral guidance for promoting optimal CVH may optimize bone mass accretion in early life.