Tianna Beare

Cross-sectional versus longitudinal associations of lean and fat mass with pQCT bone outcomes in children.

CONTEXT Cross-sectional associations for lean mass (LM) and fat mass (FM) with bone may not reflect longitudinal associations. OBJECTIVE Cross-sectional and longitudinal associations of LM and FM with radial bone measurements in children were compared. DESIGN AND PARTICIPANTS We conducted a longitudinal study on 370 (232 females) children, 8-18 yr of age. MAIN OUTCOME MEASURES LM and FM were measured by dual-energy absorptiometry. Peripheral quantitative computed tomography at the 4% radius (4R) and 20% radius (20R) measured bone mineral content (BMC), volumetric bone mineral density (vBMD), area, and strength [polar stress strain index (pSSI)]. RESULTS Males at 20R had negative FM cross-sectional and longitudinal associations with cortical area and BMC and pSSI (P < 0.02); negative cross-sectional association with total area (P < 0.001); and negative longitudinal association with cortical thickness (P < 0.001). Females at 20R had FM cross-sectional association with total area, cortical BMC, and pSSI and longitudinal associations with cortical BMC and area, vBMD, and pSSI that went from positive to negative with age and, in some cases, varied with menarche. Both sexes at 4R had a negative FM cross-sectional association with BMC and area (P < 0.001) but negative longitudinal association with vBMD (P < 0.05). LM associations with bone outcomes were generally positive, except for negative longitudinal associations with cortical BMC and vBMD in young females (P < 0.01). LM associations were greater magnitude than FM associations and often depended on age. CONCLUSIONS For males and older females, cross-sectional associations indicated a reduced bone size with higher FM, whereas longitudinal associations showed a decrease in cortical area without changes in bone size. LM was positively associated with BMC and area.

Resistant starch type 4-enriched diet lowered blood cholesterols and improved body composition in a double blind controlled cross-over intervention.

A metabolic health crisis is evident as cardiovascular diseases (CVD) remain the leading cause of mortality in the United States. Effects of resistant starch type 4 (RS4), a prebiotic fiber, in comprehensive management of metabolic syndrome (MetS) remain unknown. This study examined the effects of a blinded exchange of RS4-enriched flour (30% v/v) with regular/control flour (CF) diet on multiple MetS comorbidities. In a double blind (participants-investigators), placebo-controlled, cluster cross-over intervention (n = 86, age≥18, 2-12 week interventions, 2-week washout) in the United States, individuals were classified as having MetS (With-MetS) or not (No-MetS) following International Diabetes Federation (IDF)-criteria. RS4 consumption compared with CF resulted in 7.2% (p = 0.002) lower mean total cholesterol, 5.5% (p = 0.04) lower non-HDL, and a 12.8% (p < 0.001) lower HDL cholesterol in the With-MetS group. No-MetS individuals had a 2.6% (p = 0.02) smaller waist circumference and 1.5% (p = 0.03) lower percent body fat following RS4 intervention compared to CF. A small but significant 1% increase in fat-free mass was observed in all participants combined (p = 0.02). No significant effect of RS4 was observed for glycemic variables and blood pressures. RS4 consumption improved dyslipidemia and body composition. Incorporation of RS4 in routine diets could offer an effective strategy for public cardio-metabolic health promotion.

High bone density in young Hutterite children

We previously reported greater than average aBMD in adult Hutterites; however, it is unknown whether higher aBMD occurs at younger ages. We examined Hutterite children to test the hypotheses that aBMD Z-scores in younger (<15 years) Hutterite children would be similar to reference data; but greater in older children after they enter the adult workforce at age 15. A secondary aim was to determine lifestyle factors associated with bone measures among Hutterite children. Hip, femoral neck, and spine BMC and aBMD were measured in 323 Hutterite children aged 8 through 19 years: 186 (108 girls) were <15 years (younger) and 137 (87 girls) were >or=15 years (older). Anthropometric measurements and activity and dietary recalls were obtained. Overall, children were lighter (Z=-0.29+/-0.72 [mean+/-SD]), shorter (Z=-0.15+/-0.86, and had lower BMIs (Z=-0.27+/-0.70) than other South Dakota children residing in the same counties (all, p<or=0.002). Older girls and boys had higher percent time in moderate+vigorous activity (21+/-10% and 29+/-11% [mean+/-SD]) than younger girls and boys (15+/-10% and 18+/-10%, both p<0.001). Younger girls and boys had high hip aBMD Z-scores (0.30+/-1.0, 0.44+/-0.97; both greater than 0 at p<or=0.002). Younger males had low spine Z-score (-0.27+/-1.15, p=0.04). None of the Z-scores for the older ages were different from 0. Controlling for covariates, miles walked/day and grip strength were associated with greater hip bone area among girls (both, p<0.05). Grip strength was associated with hip and femoral neck BMC and hip aBMD among boys (all, p<0.05). Femoral neck bone area was inversely associated with calcium intake among boys (p<or=0.05), while higher hip BMC and spine BMC and aBMD were associated with increased vitamin D intake (all, p<or=0.05). Lean mass was an independent predictor of all bone measures, while fat mass was inversely associated with most measures of bone area. In summary, contrary to our hypothesis younger Hutterite children had greater hip aBMD Z scores than the normative DXA database, whereas older children did not. We speculate that high activity levels during the rapid growth phase leads to increased bone turnover and bone size; following bone consolidation later in young adulthood this will result in greater bone size and aBMD.

Rural vs. non-rural differences and longitudinal bone changes by DXA and pQCT in men aged 20-66 years: A population-based study

The purpose of this research was to determine whether there were differences in estimated means and rates of change in BMC, bone area, BMD and measures of bone geometry among men (n=544) from three distinct populations (Hutterite [rural], rural non-Hutterite, non-rural), and whether activity levels or calcium intake explain these population differences. Men were enrolled in the South Dakota Rural Bone Health Study and followed for 7.5 years to estimate means and rates of change in bone mass, density, size and geometry. Femoral neck (FN) and spine measurements were obtained every 18 months by DXA and distal radius (4% and 20%) measurements by pQCT. Activity measurements and calcium intake were obtained quarterly for the first 3 years and at 54, 72, and 90 months. Rural men had greater percent time in moderate plus vigorous activity (mean ± SD: 22 ± 10 vs. 15 ± 8%, p<0.001) and greater lean mass (69 ± 9 vs. 66 ± 10 kg, p=0.05) than non-rural men. Both rural populations (Hutterite and rural men) had larger femoral neck (FN) bone area and greater 20% radius cross-sectional area than non-rural men ([least square means ± SE] FN area: 5.90 ± 0.02 and 5.86 ± 0.02 vs. 5.76 ± 0.03 cm(2), p<0.001 and p=0.03 respectively and cross-sectional area: 171.0 ±1.3 and 165.5 ± 1.5 vs. 150.3 ± 1.6mm(2), both p<0.001). Despite lower cortical vBMD in Hutterite and rural men compared to non-rural men (1182 ± 2 and 1187 ± 2 vs. 1192 ± 2 mm(2), p<0.001 and p=0.06 respectively), bone strength (pSSI) was greater (429 ± 5 and 422 ± 5 vs. 376 ± 6 mm(3), both p<0.001). The rates of change in femoral neck BMC and aBMD and trabecular vBMD also differed by rural lifestyle, with greater losses among non-rural men in their 20s and 60s compared to both Hutterite and rural populations (time-by-age-by-group interactions, both p<0.01). Physical activity was not found to be a potential mediator of population differences. Baseline calcium intake was associated with FN aBMD (p=0.04), and increases in calcium intake were associated with spine BMC (p=0.04) and inversely associated with cortical area (p=0.02). There was some evidence for mediation by either baseline calcium intake or changes in calcium intake over the study period, but the influence on population differences were negligible. We speculate that rural-non-rural differences in bone occur earlier in life or are a result of factors that have not yet been identified.

Higher BMC and areal BMD in children and grandchildren of individuals with hip or knee replacement

The relationship between aBMD and osteoarthritis (OA) remains unclear. We compared aBMD, BMC and bone size among children and grandchildren of Hutterites with hip or knee replacement (n=23 each) to children and grandchildren of age- and sex-matched controls (178 children and 267 grandchildren). There were no differences in anthropometric measures or activity levels between case and control probands, but femoral neck (FN) and spine (LS) aBMD and Z-scores were greater in cases than controls (0.89 vs. 0.80 g/cm2; 1.15 vs. 1.03 g/cm2; 1.5 vs. 0.8; 2.4 vs. 1.2: all p<0.05). Hip, FN and LS aBMD (1.05 vs. 0.97, 0.92 vs. 0.84, 1.15 vs. 1.03 g/cm2), BMC (34.1 vs. 32.0, 4.58 vs. 4.27, 69.5 vs. 62.4 g) and Z-scores (1.0 vs. 0.4; 0.9 vs. 0.2; 1.3 vs. 0.2) were greater in daughters of cases than controls (hip BMC p=0.06, others p<0.05); there were no differences between sons. Grandchildren (aged 8-39 years) were categorized as growing (premenarcheal or male<14 years) or not growing (> or =2 years post-menarcheal or males> or =18 years): 33 were not classified. Post-menarcheal, but not premenarcheal, granddaughters of cases had greater hip, FN and LS aBMD Z-scores (0.7 vs. -0.1; 0.6 vs. -0.1; 0.8 vs. -0.3); greater hip and spine aBMD (1.03 vs. 0.95, 1.10 vs. 0.98 g/cm2); greater femoral neck and spine BMC (4.77 vs. 4.21, 66.7 vs. 55.4 g); and greater spine bone area (60.7 vs. 56.6 cm2) compared to granddaughters of controls (all, p<0.05), which remained significant when height, weight, and age were included as covariates. Growing grandsons of cases were taller and heavier than control grandsons, and a greater hip aBMD among grandsons of cases (0.88 vs. 0.76 g/cm2) was the only bone difference that remained significant after taking into account body size differences. Grandsons who were not growing had greater spine bone area (1.19 vs. 1.08 cm2) if their grandparent had OA compared to grandsons whose grandparents did not have OA. We speculate that there is a genetic basis for OA that leads to early differences in growth patterns among boys and greater peak bone mass and aBMD among girls.

Pedometer Readings and Self-Reported Walking Distances in a Rural Hutterite Population

PURPOSE This study assessed the accuracy with which a rural population reported daily walking distances using a 7-day activity recall questionnaire obtained quarterly compared to pedometer readings. METHODS Study participants were 48 Hutterite men and women aged 11-66 years. FINDINGS Pedometer-miles quartiles were associated with self-reported daily miles (P=.008) and self-reported previous-year average miles (P=.03) quartiles. Among males, the relationship between pedometer-miles and self-reported daily miles differed depending upon walking pace, with a stronger correlation at a faster pace (interaction, P=.006). Among females, pedometer-miles correlated with age and remained associated with self-reported daily and previous-year average miles when age was in the statistical model (P=.006 and .008). The difference between pedometer-miles and self-reported previous-year average miles tended to increase with age (P=.06). CONCLUSIONS SDPAR may be a useful instrument in measuring miles walked/day among rural populations.

Longitudinal Growth and pQCT Measures in Hutterite Children and Grandchildren Are Associated With Prevalence of Hip or Knee Replacement Resulting From Osteoarthritis in Parents and Grandparents

Background Osteoarthritis (OA) is one of the leading causes of disability in the world. Several genes are associated with the development of OA, and previous studies have shown adult children of individuals with OA have higher areal bone mineral density (BMD). Because childhood is an important period of growth and bone development, and body composition is known to be associated with BMD, we speculated that there may be differences in growth and bone measures among young children with a genetic predisposition to OA. Questions/purposes (1) Do differences exist at baseline in anthropometric and peripheral quantitative CT (pQCT) measurements between children and grandchildren of individuals with OA and controls? (2) Do children and grandchildren of individuals with OA accrue bone longitudinally at a different rate than controls? Methods Longitudinal anthropometric (height, weight) and bone (cortical and trabecular volumetric BMD and cross-sectional area) measurements by pQCT were obtained at baseline and 18 and 36 months on children (n = 178) and grandchildren (n = 230) of 23 individuals with hip or knee arthroplasty resulting from OA and 23 sex-matched controls (16 females each). Grandchildren (age, 8–30 years) were further categorized as growing (premenarcheal or male < 14 years, n = 99) or mature (≥ 2 years postmenarchal or males ≥ 18 years, n = 96). The remaining 35 grandchildren could not be categorized and were excluded. Results Mature granddaughters and grandsons of individuals with OA had greater trabecular volumetric BMD than controls (236 ± 24 and 222 ± 26 mg/cm3, respectively, for granddaughters, difference of 14 [95% confidence interval {CI}, 1-28] mg/cm3, p = 0.041 and 270 ± 22 and 248 ± 30 mg/cm3, respectively, for grandsons, difference of 22 [95% CI, 1-42] mg/cm3, p = 0.040). Greater trabecular volumetric BMD was observed in daughters of individuals with OA compared with daughters of controls (228 ± 28 and 212 ± 33 mg/cm3, respectively, difference of 18 [95% CI, 3-30] mg/cm3, respectively [p = 0.021]). Growing granddaughters and grandsons of controls had greater decreases in cortical volumetric BMD than grandchildren of individuals with OA (time-by-group [T*G] based on mixed model [± standard error] -9.7 ± 4.3 versus -0.8 ± 4.4 mg/cm3/year, respectively, for granddaughters, difference of 9.0 [95% CI, 2.4-15.5] mg/cm3/year, p = 0.007 and -6.8 ± 3.3 versus 4.5 ± 3.4 mg/cm3/year, respectively, for grandsons, difference of 11.3 [95% CI, 4.3-18.3] mg/cm3/year, p = 0.002). Cortical volumetric BMD was maintained in sons of individuals with OA, but decreased in sons of controls (-0.0 ± 1.5 versus -4.3 ± 1.0 mg/cm3/year, respectively, difference of 4.3 [95% CI, 0.7-7.8] mg/cm3/year, p = 0.019 [T*G]). There was a greater apparent decrease in cross-sectional area among daughters of individuals with OA than in controls (-4.6 ± 0.9 versus -1.7 ± 0.9 mm2/year, respectively, difference of -2.9 [95% CI, -5.3 to -0.6] mm2/year, p = 0.015 [T*G]). Conclusions Several anthropometric and bone differences exist between children and grandchildren of individuals with OA and controls. If these differences are confirmed in additional studies, it would be important to identify the mechanism so that preventive measures could be developed and implemented to slow or reduce OA development. Clinical Relevance Differences in growth and bone development may lead to increased loads on cartilage that may predispose offspring to the development of OA. If these differences are confirmed in additional studies, it would be important to identify the mechanism so that preventive measures could be developed and implemented to slow or reduce OA development.

Pregnancy Survey of Smoking and Alcohol Use in South Dakota American Indian and White Mothers

INTRODUCTION American Indian populations are believed to have relatively high tobacco use and alcohol consumption before and during pregnancy compared with other populations despite little evidence. METHODS Population-based survey distributed 2-6 months postpartum to 1,814 South Dakota mothers having a live birth in 2014. Prevalence of self-reported smoking and alcohol use before and during pregnancy were calculated for American Indian and white mothers and AORs were determined controlling for Hispanic status, marital status, age, education, and income. Analysis was completed in 2017-2018. RESULTS Smoking among American Indian mothers was similar to white mothers before and during pregnancy (AOR=1.60, 95% CI=0.95, 2.67 and AOR=0.67, 95% CI=0.37, 1.21, respectively). Among smokers, a higher percentage of American Indian mothers smoked less than six cigarettes/day than white mothers (AOR=6.79, 95% CI=3.21, 14.35, before and AOR=4.85, 95% CI=1.08, 21.7, during pregnancy), and American Indian mothers had greater odds of quitting (AOR=3.60, 95% CI=1.74, 7.43). No difference in relapse rates by race were found (AOR=0.57, 95% CI=0.19, 1.72). Alcohol consumption before pregnancy was less among American Indian than white mothers (AOR=0.53 95% CI=0.30, 0.94), and among those who drank no differences by race in drinks/week were observed (AOR for American Indians drinking more than four drinks/week=1.20, 95% CI=0.56, 2.55) or binge drinking (AOR=1.50, 95% CI=0.75, 3.04). Rates of alcohol consumption during pregnancy and topics covered by healthcare providers during prenatal visits did not differ by race. CONCLUSIONS After adjusting for covariates, no differences by race in smoking rates before or during pregnancy were observed and American Indian mothers who smoked were more likely to smoke fewer cigarettes and quit smoking during pregnancy than white mothers. Lower alcohol consumption among American Indian mothers before pregnancy challenges the commonly held belief of elevated alcohol consumption among American Indians compared with other races.