The effect of vitamin D supplementation and nutritional intake on skeletal maturity and bone health in socio-economically deprived children
Sprache des Titels:
Purpose 1. To determine the efect of vitamin D supplementation on bone age (BA), a marker of skeletal maturity, and
Bone Health Index (BHI), a surrogate marker of bone density. 2. To characterise the diferences in nutritional intake and
anthropometry between children with advanced vs. delayed BA.
Methods The current study is a post hoc analysis of radiographs obtained as part of a randomised controlled trial. In this
double-blind, placebo-controlled trial, deprived Afghan children (n=3046) aged 1?11 months were randomised to receive
six doses of oral placebo or vitamin D3 (100,000 IU) every 3 months for 18 months. Dietary intake was assessed through
semi-quantitative food frequency questionnaires at two time points. Anthropometric measurements were undertaken at
baseline and 18 months. Serum 25OHD was measured at fve time points on a random subset of 632 children. Knee and
wrist radiographs were obtained from a random subset (n=641), of which 565 wrist radiographs were digitised for post-hoc
analysis of BA and BHI using BoneXpert version 3.1.
Results Nearly 93% (522, male=291) of the images were analysable. The placebo (n=258) and vitamin D (n=264) groups
were comparable at baseline. The mean (±SD) age of the cohort was 2 (±0.3) years. At study completion, there was no
diference in mean 25-hydroxy vitamin D concentrations [47 (95% CI 41, 56) vs. 55 (95% CI 45, 57) nmol/L, p=0.2], mean
(±SD) BA SDS [? 1.04 (1.36) vs. ? 1.14 (1.26) years, p=0.3] or mean (±SD) BHI SDS [? 0.30 (0.86) vs. ? 0.31 (0.80),
p=0.8] between the placebo and vitamin D groups, respectively. Children with advanced skeletal maturity (BA SDS?0)
when compared to children with delayed skeletal maturity (BA SDS<0), had consumed more calories [mean (±SD) calories
805 (±346) vs 723 (±327) kcal/day, respectively, p<0.05], were signifcantly less stunted (height SDS ? 1.43 vs. ? 2.32,
p<0.001) and underweight (weight SDS ? 0.82 vs. ? 1.45, p<0.001), with greater growth velocity (11.57 vs 10.47 cm/
Conclusion Deprived children have signifcant delay in skeletal maturation but no substantial impairment in bone health as
assessed by BHI. BA delay was infuenced by total calorie intake, but not bolus vitamin D supplementation.