Journal
AMERICAN JOURNAL OF CLINICAL NUTRITION
Volume 90, Issue 4, Pages 1104-1111Publisher
AMER SOC CLINICAL NUTRITION
DOI: 10.3945/ajcn.2009.28025
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Funding
- Commonwealth Education Trust (United Kingdom)
- Commonwealth Institute (Australia)
- National Health
- Medical Research Council (NHMRC) Career Development Award [425849, 229320]
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Background: The influence of adiposity on upper-limb bone strength has rarely been studied in children, despite the high incidence of forearm fractures in this population. Objective: The objective was to compare the influence of muscle and fat tissues on bone strength between the upper and lower limbs in prepubertal children. Design: Bone mineral content, total bone cross-sectional area, cortical bone area (CoA), cortical thickness (CoTh) at the radius and tibia (4% and 66%, respectively), trabecular density (TrD), bone strength index (4% sites), cortical density (CoD), stress-strain index, and muscle and fat areas (66% sites) were measured by using peripheral quantitative computed tomography in 427 children (206 boys) aged 7-10 y. Results: Overweight children (n = 93) had greater values for bone variables (0.3-1.3 SD; P < 0.0001) than did their normal-weight peers, except for CoD 66% and CoTh 4%. The between-group differences were 21-87% greater at the tibia than at the radius. After adjustment for muscle cross-sectional area, TrD 4%, bone mineral content, CoA, and CoTh 66% at the tibia remained greater in overweight children, whereas at the distal radius total bone cross-sectional area and CoTh were smaller in overweight children (P < 0.05). Overweight children had a greater fat-muscle ratio than did normal-weight children, particularly in the forearm (92 +/- 28% compared with 57 +/- 17%). Fat-muscle ratio correlated negatively with all bone variables, except for TrD and CoD, after adjustment for body weight (r = -0.17 to -0.54; P < 0.0001). Conclusions: Overweight children had stronger bones than did their normal-weight peers, largely because of greater muscle size. However, the overweight children had a high proportion of fat relative to muscle in the forearm, which is associated with reduced bone strength. Am J Clin Nutr 2009;90:1104-11.
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