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Matsuzaki M, Kuper H, Kulkarni B, Radhakrishna KV, Viljakainen H, Taylor AE, Sullivan R, Bowen L, Tobias JH, Ploubidis GB, Wells JC, Prabhakaran D, Davey Smith G, Ebrahim S, Ben-Shlomo Y, Kinra S. Life-course determinants of bone mass in young adults from a transitional rural community in India: the Andhra Pradesh Children and Parents Study (APCAPS). Am J Clin Nutr 2014; 99:1450-9. [PMID: 24695898 PMCID: PMC4021785 DOI: 10.3945/ajcn.113.068791] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Undernutrition and physical inactivity are both associated with lower bone mass. OBJECTIVE This study aimed to investigate the combined effects of early-life undernutrition and urbanized lifestyles in later life on bone mass accrual in young adults from a rural community in India that is undergoing rapid socioeconomic development. DESIGN This was a prospective cohort study of participants of the Hyderabad Nutrition Trial (1987-1990), which offered balanced protein-calorie supplementation to pregnant women and preschool children younger than 6 y in the intervention villages. The 2009-2010 follow-up study collected data on current anthropometric measures, bone mineral density (BMD) measured by dual-energy X-ray absorptiometry, blood samples, diet, physical activity, and living standards of the trial participants (n = 1446, aged 18-23 y). RESULTS Participants were generally lean and had low BMD [mean hip BMD: 0.83 (women), 0.95 (men) g/cm²; lumbar spine: 0.86 (women), 0.93 (men) g/cm²]. In models adjusted for current risk factors, no strong evidence of a positive association was found between BMD and early-life supplementation. On the other hand, current lean mass and weight-bearing physical activity were positively associated with BMD. No strong evidence of an association was found between BMD and current serum 25-hydroxyvitamin D or dietary intake of calcium, protein, or calories. CONCLUSIONS Current lean mass and weight-bearing physical activity were more important determinants of bone mass than was early-life undernutrition in this population. In transitional rural communities from low-income countries, promotion of physical activity may help to mitigate any potential adverse effects of early nutritional disadvantage.
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Affiliation(s)
- Mika Matsuzaki
- From the Departments of Non-communicable Disease Epidemiology (MM, RS, SE, and SK), the Department of Medical Statistics (GBP), and Clinical Research (HK), London School of Hygiene and Tropical Medicine, London, United Kingdom; the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (BK); the National Institute of Nutrition, Hyderabad, India (BK and KVR); the Musculoskeletal Research Unit, School of Clinical Sciences (HV and JHT) and the School of Social and Community Medicine (AET, YB-S, and GDS), University of Bristol, Bristol, United Kingdom; St George's University, London, United Kingdom (LB); the Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom (JCW); the Centre for Chronic Disease Control, New Delhi, India (DP); and the South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India (SE)
| | - Hannah Kuper
- From the Departments of Non-communicable Disease Epidemiology (MM, RS, SE, and SK), the Department of Medical Statistics (GBP), and Clinical Research (HK), London School of Hygiene and Tropical Medicine, London, United Kingdom; the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (BK); the National Institute of Nutrition, Hyderabad, India (BK and KVR); the Musculoskeletal Research Unit, School of Clinical Sciences (HV and JHT) and the School of Social and Community Medicine (AET, YB-S, and GDS), University of Bristol, Bristol, United Kingdom; St George's University, London, United Kingdom (LB); the Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom (JCW); the Centre for Chronic Disease Control, New Delhi, India (DP); and the South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India (SE)
| | - Bharati Kulkarni
- From the Departments of Non-communicable Disease Epidemiology (MM, RS, SE, and SK), the Department of Medical Statistics (GBP), and Clinical Research (HK), London School of Hygiene and Tropical Medicine, London, United Kingdom; the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (BK); the National Institute of Nutrition, Hyderabad, India (BK and KVR); the Musculoskeletal Research Unit, School of Clinical Sciences (HV and JHT) and the School of Social and Community Medicine (AET, YB-S, and GDS), University of Bristol, Bristol, United Kingdom; St George's University, London, United Kingdom (LB); the Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom (JCW); the Centre for Chronic Disease Control, New Delhi, India (DP); and the South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India (SE)
| | - K V Radhakrishna
- From the Departments of Non-communicable Disease Epidemiology (MM, RS, SE, and SK), the Department of Medical Statistics (GBP), and Clinical Research (HK), London School of Hygiene and Tropical Medicine, London, United Kingdom; the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (BK); the National Institute of Nutrition, Hyderabad, India (BK and KVR); the Musculoskeletal Research Unit, School of Clinical Sciences (HV and JHT) and the School of Social and Community Medicine (AET, YB-S, and GDS), University of Bristol, Bristol, United Kingdom; St George's University, London, United Kingdom (LB); the Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom (JCW); the Centre for Chronic Disease Control, New Delhi, India (DP); and the South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India (SE)
| | - Heli Viljakainen
- From the Departments of Non-communicable Disease Epidemiology (MM, RS, SE, and SK), the Department of Medical Statistics (GBP), and Clinical Research (HK), London School of Hygiene and Tropical Medicine, London, United Kingdom; the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (BK); the National Institute of Nutrition, Hyderabad, India (BK and KVR); the Musculoskeletal Research Unit, School of Clinical Sciences (HV and JHT) and the School of Social and Community Medicine (AET, YB-S, and GDS), University of Bristol, Bristol, United Kingdom; St George's University, London, United Kingdom (LB); the Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom (JCW); the Centre for Chronic Disease Control, New Delhi, India (DP); and the South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India (SE)
| | - Amy E Taylor
- From the Departments of Non-communicable Disease Epidemiology (MM, RS, SE, and SK), the Department of Medical Statistics (GBP), and Clinical Research (HK), London School of Hygiene and Tropical Medicine, London, United Kingdom; the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (BK); the National Institute of Nutrition, Hyderabad, India (BK and KVR); the Musculoskeletal Research Unit, School of Clinical Sciences (HV and JHT) and the School of Social and Community Medicine (AET, YB-S, and GDS), University of Bristol, Bristol, United Kingdom; St George's University, London, United Kingdom (LB); the Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom (JCW); the Centre for Chronic Disease Control, New Delhi, India (DP); and the South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India (SE)
| | - Ruth Sullivan
- From the Departments of Non-communicable Disease Epidemiology (MM, RS, SE, and SK), the Department of Medical Statistics (GBP), and Clinical Research (HK), London School of Hygiene and Tropical Medicine, London, United Kingdom; the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (BK); the National Institute of Nutrition, Hyderabad, India (BK and KVR); the Musculoskeletal Research Unit, School of Clinical Sciences (HV and JHT) and the School of Social and Community Medicine (AET, YB-S, and GDS), University of Bristol, Bristol, United Kingdom; St George's University, London, United Kingdom (LB); the Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom (JCW); the Centre for Chronic Disease Control, New Delhi, India (DP); and the South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India (SE)
| | - Liza Bowen
- From the Departments of Non-communicable Disease Epidemiology (MM, RS, SE, and SK), the Department of Medical Statistics (GBP), and Clinical Research (HK), London School of Hygiene and Tropical Medicine, London, United Kingdom; the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (BK); the National Institute of Nutrition, Hyderabad, India (BK and KVR); the Musculoskeletal Research Unit, School of Clinical Sciences (HV and JHT) and the School of Social and Community Medicine (AET, YB-S, and GDS), University of Bristol, Bristol, United Kingdom; St George's University, London, United Kingdom (LB); the Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom (JCW); the Centre for Chronic Disease Control, New Delhi, India (DP); and the South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India (SE)
| | - Jon H Tobias
- From the Departments of Non-communicable Disease Epidemiology (MM, RS, SE, and SK), the Department of Medical Statistics (GBP), and Clinical Research (HK), London School of Hygiene and Tropical Medicine, London, United Kingdom; the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (BK); the National Institute of Nutrition, Hyderabad, India (BK and KVR); the Musculoskeletal Research Unit, School of Clinical Sciences (HV and JHT) and the School of Social and Community Medicine (AET, YB-S, and GDS), University of Bristol, Bristol, United Kingdom; St George's University, London, United Kingdom (LB); the Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom (JCW); the Centre for Chronic Disease Control, New Delhi, India (DP); and the South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India (SE)
| | - George B Ploubidis
- From the Departments of Non-communicable Disease Epidemiology (MM, RS, SE, and SK), the Department of Medical Statistics (GBP), and Clinical Research (HK), London School of Hygiene and Tropical Medicine, London, United Kingdom; the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (BK); the National Institute of Nutrition, Hyderabad, India (BK and KVR); the Musculoskeletal Research Unit, School of Clinical Sciences (HV and JHT) and the School of Social and Community Medicine (AET, YB-S, and GDS), University of Bristol, Bristol, United Kingdom; St George's University, London, United Kingdom (LB); the Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom (JCW); the Centre for Chronic Disease Control, New Delhi, India (DP); and the South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India (SE)
| | - Jonathan C Wells
- From the Departments of Non-communicable Disease Epidemiology (MM, RS, SE, and SK), the Department of Medical Statistics (GBP), and Clinical Research (HK), London School of Hygiene and Tropical Medicine, London, United Kingdom; the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (BK); the National Institute of Nutrition, Hyderabad, India (BK and KVR); the Musculoskeletal Research Unit, School of Clinical Sciences (HV and JHT) and the School of Social and Community Medicine (AET, YB-S, and GDS), University of Bristol, Bristol, United Kingdom; St George's University, London, United Kingdom (LB); the Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom (JCW); the Centre for Chronic Disease Control, New Delhi, India (DP); and the South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India (SE)
| | - Dorairaj Prabhakaran
- From the Departments of Non-communicable Disease Epidemiology (MM, RS, SE, and SK), the Department of Medical Statistics (GBP), and Clinical Research (HK), London School of Hygiene and Tropical Medicine, London, United Kingdom; the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (BK); the National Institute of Nutrition, Hyderabad, India (BK and KVR); the Musculoskeletal Research Unit, School of Clinical Sciences (HV and JHT) and the School of Social and Community Medicine (AET, YB-S, and GDS), University of Bristol, Bristol, United Kingdom; St George's University, London, United Kingdom (LB); the Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom (JCW); the Centre for Chronic Disease Control, New Delhi, India (DP); and the South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India (SE)
| | - George Davey Smith
- From the Departments of Non-communicable Disease Epidemiology (MM, RS, SE, and SK), the Department of Medical Statistics (GBP), and Clinical Research (HK), London School of Hygiene and Tropical Medicine, London, United Kingdom; the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (BK); the National Institute of Nutrition, Hyderabad, India (BK and KVR); the Musculoskeletal Research Unit, School of Clinical Sciences (HV and JHT) and the School of Social and Community Medicine (AET, YB-S, and GDS), University of Bristol, Bristol, United Kingdom; St George's University, London, United Kingdom (LB); the Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom (JCW); the Centre for Chronic Disease Control, New Delhi, India (DP); and the South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India (SE)
| | - Shah Ebrahim
- From the Departments of Non-communicable Disease Epidemiology (MM, RS, SE, and SK), the Department of Medical Statistics (GBP), and Clinical Research (HK), London School of Hygiene and Tropical Medicine, London, United Kingdom; the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (BK); the National Institute of Nutrition, Hyderabad, India (BK and KVR); the Musculoskeletal Research Unit, School of Clinical Sciences (HV and JHT) and the School of Social and Community Medicine (AET, YB-S, and GDS), University of Bristol, Bristol, United Kingdom; St George's University, London, United Kingdom (LB); the Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom (JCW); the Centre for Chronic Disease Control, New Delhi, India (DP); and the South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India (SE)
| | - Yoav Ben-Shlomo
- From the Departments of Non-communicable Disease Epidemiology (MM, RS, SE, and SK), the Department of Medical Statistics (GBP), and Clinical Research (HK), London School of Hygiene and Tropical Medicine, London, United Kingdom; the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (BK); the National Institute of Nutrition, Hyderabad, India (BK and KVR); the Musculoskeletal Research Unit, School of Clinical Sciences (HV and JHT) and the School of Social and Community Medicine (AET, YB-S, and GDS), University of Bristol, Bristol, United Kingdom; St George's University, London, United Kingdom (LB); the Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom (JCW); the Centre for Chronic Disease Control, New Delhi, India (DP); and the South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India (SE)
| | - Sanjay Kinra
- From the Departments of Non-communicable Disease Epidemiology (MM, RS, SE, and SK), the Department of Medical Statistics (GBP), and Clinical Research (HK), London School of Hygiene and Tropical Medicine, London, United Kingdom; the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (BK); the National Institute of Nutrition, Hyderabad, India (BK and KVR); the Musculoskeletal Research Unit, School of Clinical Sciences (HV and JHT) and the School of Social and Community Medicine (AET, YB-S, and GDS), University of Bristol, Bristol, United Kingdom; St George's University, London, United Kingdom (LB); the Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom (JCW); the Centre for Chronic Disease Control, New Delhi, India (DP); and the South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India (SE)
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