Nutrition influences bone development from infancy through toddler years

During the last decade a greater appreciation has developed for determining factors that influence bone accretion in healthy children. Nutritional factors that may contribute to bone accretion in infants and toddlers include maternal nutritional status during pregnancy, type of infant feeding, calcium and phosphorus content of infant formula, introduction of weaning foods, and diet during the toddler and preschool years. Maternal vitamin D deficiency during pregnancy is associated with disturbances in neonatal calcium homeostasis, and maternal calcium deficiency leads to reduced neonatal bone mineral content (BMC). Preterm infants are at increased risk of osteopenia, and, although the use of high mineral formula has reduced the risk of osteopenia in these infants, it has not eliminated it. The reason for the long-term bone deficiency among preterm infants is not clear, although lower physical activity levels have been suggested as a potential cause. Studies find that human milk-fed infants have lower bone accretion than do formula-fed infants; that the greater the mineral content of formula, the greater the bone accretion; and that the inclusion of palm olein oil in infant formula may reduce bone mineral accretion. Bone accretion is not influenced by the timing of the introduction of weaning foods, despite higher serum parathyroid hormone (PTH) concentrations among infants who receive solids earlier. There is evidence of calcium intake-by-gene and calcium intake-by-physical activity interactions among toddlers and young children. The long-term effects of these early nutritional influences on later bone health are unknown.