- Email: [email protected]
Effects of nutrition on ultrasound measurements of bone density
150
Abstracts / 36 (2005) 111-154
activity levels. Future research is needed to determine if inequalities in school facilities or programs play a role in the observed ethnic disparities in adolescent physical activity levels or if there are other factors such as social norms contributing to these differences. Support: This research was funded by the Robert Wood Johnson Foundation, NICHD grant 5T32 HD 043034 – 02 and the MCHB Leadership Education in Adolescent Health Training Program.
PII: S1054-139X(04)00380-5 77.
EFFECTS OF NUTRITION ON ULTRASOUND MEASUREMENTS OF BONE DENSITY Andrea A. Pettinato, M.D., Keith J. Loud, M.D.,C.M., Stephanie K. Bristol, B.S., Henry A. Feldman, Ph.D., and Catherine M. Gordon, M.D., M.Sc. Div. of Adolescent Medicine, Children’s Hospital Boston, Boston, MA. Purpose: Quantitative ultrasound (QUS) evaluation of bone is attractive for use in adolescents because of the absence of radiation, but its availability is limited in the U.S. due to the lack of pediatric data. The purpose of this study was to evaluate associations between speed of sound (SOS) measurements of the radius and tibia via QUS and demographic, anthropometric and nutritional variables. Methods: We enrolled 135 healthy adolescents and young adults aged 11–26 years during routine visits to an urban adolescent clinic. Participants completed a semi-structured interview for demographic information and health history, as well as a self-administered, validated nutritional questionnaire. Weight, height, and clinician-reported sexual maturity ratings (SMR) were recorded. The main outcomes, SOS at the distal radius and mid-shaft tibia, were measured on the non-dominant limb using the Omnisense 7000P device (Sunlight Med. Ltd., Tel-Aviv, Israel). Pearson correlation analyses and multiple linear regression were carried out using SPSS software. Results: The sample was 51% female and 46% African-American, 23% Hispanic, 19% Caucasian, 5% Asian, and 7% other selfreported ethnicity; mean ⫾ SD age was 17.2 ⫾ 2.5 years. For participants with SMR data (123/135), 99 (80%) had achieved SMR 5; 96% of females were post-menarcheal (mean ⫾ SD age at menarche 12.3 ⫾ 1.3 years). Mean ⫾ SD daily dietary intakes of calcium and vitamin D were 1205 ⫾ 758 mg and 243 ⫾ 187 IU, respectively. Intake of total calcium (r ⫽ 0.45, p ⬍0.0001), milk (r ⫽ 0.59, p⬍0.0001), and soda (r ⫽ 0.47, p⬍0.0001) reported in the semi-structured interview were positively correlated with data obtained on the validated nutritional questionnaire. There were moderate correlations between age and SOS at the radius (r ⫽ 0.56, p ⬍ 0.0001), and at the tibia (r ⫽ 0.53, p ⬍ 0.0001). Participants with SMR 5 had a significantly higher SOS than those who were less mature at both the radius (p ⬍ 0.0001) and tibia (p ⬍ 0.0001). There were no significant associations between SOS and self-reported ethnicity, BMI, calcium or vitamin D intake, or age at menarche. Using multiple linear regression controlling for these factors, age remained associated with SOS at the distal radius (p ⬍ 0.0001) and tibia (p ⬍ 0.0001), and BMI was a significant correlate at the tibia (p ⫽ 0.039). Conclusions: These findings suggest that skeletal QUS measurements follow a similar age distribution to bone mineral density
measurements by dual-energy x-ray absorptiometry among healthy adolescents. A higher BMI was positively associated with SOS of the tibia, a weight-bearing site. Adolescents in our sample did not, on average, meet the recommended daily allowances for calcium and vitamin D (i.e., 1300 mg elemental calcium and 400 IU vitamin D). The correlation between information obtained from interviews and by questionnaire suggests that data obtained through routine histories in clinical practice provide reliable information on the dietary intake of teenagers. Support: NIH Grant M01-RR-2172, MCHB Project 5-T71MC00009-13, DOD Grant-U.S. Army, Bone Health and Military Readiness, McCarthy Family Fndn.
PII: S1054-139X(04)00381-7 78.
CORRELATES OF STRESS FRACTURE AMONG ADOLESCENTS Keith J. Loud, M.D.,C.M., Catherine M. Gordon, M.D., M.Sc., Lyle J. Micheli, M.D., Alison E. Field, Sc.D. Children’s Hospital Boston and Brigham and Women’s Hospital, Boston, Massachusetts. Purpose: Stress fractures are a source of significant morbidity in active populations. Unfortunately, causes of stress fracture have not been explored in those under age 17, nor in the general population. This study examined correlates of stress fracture in a large, population-based national cohort of adolescents. Methods: Cross-sectional analysis of 5570 girls and 4272 boys aged 10 to 17 in the ongoing Growing Up Today Study (GUTS). GUTS participants who completed the 1998 GUTS questionnaire, provided plausible information on height and weight, and whose mothers returned the 1999 mothers’ questionnaire were eligible for analysis. The outcome was any history of a stress fracture, as reported by the participants’ mothers, who are registered nurses participating in the Nurses Health Study II. Exposure information came from the 1998 annual GUTS survey, completed by the participants. Generalized estimating equation (GEE) modeling was utilized to account for covariance between siblings. Results: In 1998, the mean age of the sample was 13.9 years. Approximately 2.7% of both girls and boys had a history of stress fracture. High levels of activity were more common among males, with approximately 25% of the boys reporting engaging in at least 16 hours per week of moderate to vigorous activity, versus 17% of the girls. Boys who participated in ⱖ 16 hrs/wk of activity in 1998 had 4.15 times greater odds of stress fracture history than their same-sex peers who participated in ⬍ 4 hrs/wk [95% confidence interval (CI): 1.85–9.32]. Among the girls, the association was slightly weaker [Odds ratio (OR) ⫽ 1.78, 95% CI: 1.11–2.84]. In both girls [OR ⫽ 1.05, 95% CI: 1.02–1.08 for each hour/week] and boys [OR ⫽ 1.07, 95% CI: 1.03–1.10 for each hour/week], hours per week of high impact activity was significantly associated with stress fracture history, whereas hours/week of non-impact activity was not. The activities with the strongest association with a history of stress fracture among the girls were cheerleading/gymnastics [OR ⫽ 1.11, 95% CI: 1.02–1.21 for each hour/week] and running [OR ⫽ 1.12, 95% CI: 1.04 –1.21 for each hour/week]; among the boys, soccer [OR ⫽ 1.14, 95% CI: 1.06 –1.23 for each hour/week] had the strongest association.
Abstracts / 36 (2005) 111-154
activity levels. Future research is needed to determine if inequalities in school facilities or programs play a role in the observed ethnic disparities in adolescent physical activity levels or if there are other factors such as social norms contributing to these differences. Support: This research was funded by the Robert Wood Johnson Foundation, NICHD grant 5T32 HD 043034 – 02 and the MCHB Leadership Education in Adolescent Health Training Program.
PII: S1054-139X(04)00380-5 77.
EFFECTS OF NUTRITION ON ULTRASOUND MEASUREMENTS OF BONE DENSITY Andrea A. Pettinato, M.D., Keith J. Loud, M.D.,C.M., Stephanie K. Bristol, B.S., Henry A. Feldman, Ph.D., and Catherine M. Gordon, M.D., M.Sc. Div. of Adolescent Medicine, Children’s Hospital Boston, Boston, MA. Purpose: Quantitative ultrasound (QUS) evaluation of bone is attractive for use in adolescents because of the absence of radiation, but its availability is limited in the U.S. due to the lack of pediatric data. The purpose of this study was to evaluate associations between speed of sound (SOS) measurements of the radius and tibia via QUS and demographic, anthropometric and nutritional variables. Methods: We enrolled 135 healthy adolescents and young adults aged 11–26 years during routine visits to an urban adolescent clinic. Participants completed a semi-structured interview for demographic information and health history, as well as a self-administered, validated nutritional questionnaire. Weight, height, and clinician-reported sexual maturity ratings (SMR) were recorded. The main outcomes, SOS at the distal radius and mid-shaft tibia, were measured on the non-dominant limb using the Omnisense 7000P device (Sunlight Med. Ltd., Tel-Aviv, Israel). Pearson correlation analyses and multiple linear regression were carried out using SPSS software. Results: The sample was 51% female and 46% African-American, 23% Hispanic, 19% Caucasian, 5% Asian, and 7% other selfreported ethnicity; mean ⫾ SD age was 17.2 ⫾ 2.5 years. For participants with SMR data (123/135), 99 (80%) had achieved SMR 5; 96% of females were post-menarcheal (mean ⫾ SD age at menarche 12.3 ⫾ 1.3 years). Mean ⫾ SD daily dietary intakes of calcium and vitamin D were 1205 ⫾ 758 mg and 243 ⫾ 187 IU, respectively. Intake of total calcium (r ⫽ 0.45, p ⬍0.0001), milk (r ⫽ 0.59, p⬍0.0001), and soda (r ⫽ 0.47, p⬍0.0001) reported in the semi-structured interview were positively correlated with data obtained on the validated nutritional questionnaire. There were moderate correlations between age and SOS at the radius (r ⫽ 0.56, p ⬍ 0.0001), and at the tibia (r ⫽ 0.53, p ⬍ 0.0001). Participants with SMR 5 had a significantly higher SOS than those who were less mature at both the radius (p ⬍ 0.0001) and tibia (p ⬍ 0.0001). There were no significant associations between SOS and self-reported ethnicity, BMI, calcium or vitamin D intake, or age at menarche. Using multiple linear regression controlling for these factors, age remained associated with SOS at the distal radius (p ⬍ 0.0001) and tibia (p ⬍ 0.0001), and BMI was a significant correlate at the tibia (p ⫽ 0.039). Conclusions: These findings suggest that skeletal QUS measurements follow a similar age distribution to bone mineral density
measurements by dual-energy x-ray absorptiometry among healthy adolescents. A higher BMI was positively associated with SOS of the tibia, a weight-bearing site. Adolescents in our sample did not, on average, meet the recommended daily allowances for calcium and vitamin D (i.e., 1300 mg elemental calcium and 400 IU vitamin D). The correlation between information obtained from interviews and by questionnaire suggests that data obtained through routine histories in clinical practice provide reliable information on the dietary intake of teenagers. Support: NIH Grant M01-RR-2172, MCHB Project 5-T71MC00009-13, DOD Grant-U.S. Army, Bone Health and Military Readiness, McCarthy Family Fndn.
PII: S1054-139X(04)00381-7 78.
CORRELATES OF STRESS FRACTURE AMONG ADOLESCENTS Keith J. Loud, M.D.,C.M., Catherine M. Gordon, M.D., M.Sc., Lyle J. Micheli, M.D., Alison E. Field, Sc.D. Children’s Hospital Boston and Brigham and Women’s Hospital, Boston, Massachusetts. Purpose: Stress fractures are a source of significant morbidity in active populations. Unfortunately, causes of stress fracture have not been explored in those under age 17, nor in the general population. This study examined correlates of stress fracture in a large, population-based national cohort of adolescents. Methods: Cross-sectional analysis of 5570 girls and 4272 boys aged 10 to 17 in the ongoing Growing Up Today Study (GUTS). GUTS participants who completed the 1998 GUTS questionnaire, provided plausible information on height and weight, and whose mothers returned the 1999 mothers’ questionnaire were eligible for analysis. The outcome was any history of a stress fracture, as reported by the participants’ mothers, who are registered nurses participating in the Nurses Health Study II. Exposure information came from the 1998 annual GUTS survey, completed by the participants. Generalized estimating equation (GEE) modeling was utilized to account for covariance between siblings. Results: In 1998, the mean age of the sample was 13.9 years. Approximately 2.7% of both girls and boys had a history of stress fracture. High levels of activity were more common among males, with approximately 25% of the boys reporting engaging in at least 16 hours per week of moderate to vigorous activity, versus 17% of the girls. Boys who participated in ⱖ 16 hrs/wk of activity in 1998 had 4.15 times greater odds of stress fracture history than their same-sex peers who participated in ⬍ 4 hrs/wk [95% confidence interval (CI): 1.85–9.32]. Among the girls, the association was slightly weaker [Odds ratio (OR) ⫽ 1.78, 95% CI: 1.11–2.84]. In both girls [OR ⫽ 1.05, 95% CI: 1.02–1.08 for each hour/week] and boys [OR ⫽ 1.07, 95% CI: 1.03–1.10 for each hour/week], hours per week of high impact activity was significantly associated with stress fracture history, whereas hours/week of non-impact activity was not. The activities with the strongest association with a history of stress fracture among the girls were cheerleading/gymnastics [OR ⫽ 1.11, 95% CI: 1.02–1.21 for each hour/week] and running [OR ⫽ 1.12, 95% CI: 1.04 –1.21 for each hour/week]; among the boys, soccer [OR ⫽ 1.14, 95% CI: 1.06 –1.23 for each hour/week] had the strongest association.