Bone mineral density and body composition in adolescents with failure to thrive

Andrade, Thiago Sacchetto de; Lopes, Luiz Anderson; Pinheiro, Marcelo de Medeiros; Szejnfeld, Vera Lucia; Taddei, José Augusto de Aguiar Carrazedo

doi:10.1590/S1679-45082010AO1361

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Original Article • Einstein (São Paulo) 8 (2) • Apr-Jun 2010 • https://doi.org/10.1590/S1679-45082010AO1361 copy

Bone mineral density and body composition in adolescents with failure to thrive

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To evaluate bone mineral mass in adolescents with failure to thrive in relation to body composition.

Methods

A case control study involving 126 adolescents (15 to 19 years), in final puberty maturation being 76 eutrophic and 50 with failure to thrive (genetic or constitutional delay of growth), of matching ages, gender and pubertal maturation. The weight, height and calculated Z score for height/age and body mass index; bone mineral content, bone mineral density and adjusted bone mineral density were established for total body, lower back and femur; total fat-free mass and height-adjusted fat-free mass index, total fat mass and height-adjusted. The statistical analyses were performed using the Student's t-test (weight, height and body composition); Mann-Whitney test (bone mass) and multiple linear regression (bone mass determinants).

Results

weight, height and height/age Z-score were significantly higher among eutrophic subjects. Both groups did not show statistically significant differences for fat mass, percentage of fat mass, total fat mass height adjusted and fat-free mass index height sadjusted. However, total free fat maass was smaller for the failure to thrive group.

Conclusions

There was no statistically significant difference for bone mass measurements among adolescents with failure to thrive; however, the factors that determine bone mass formation should be better studied due to the positive correlation with free fat mass detected in these individuals.

Keywords:
Bone density; Body composition; Adolescent; Growth disorders

Anthropometric characteristics	Eutrophic	Failure-to-thrive	p value
Anthropometric characteristics	n = 76 (39M, 37F)	n = 50 (20M, 30F)	p value
Age (years)	16.12 ± 0.98 (14-19)	16.52 ± 1.07 (15-19)	0.032^* * Significant difference and p < 0.05 (Student's t-test);
Height (cm)	167.59 ± 7.91 (153.4-187.5)	154.57 ± 5.91 (144.6-165.1)	<0.001^* * Significant difference and p < 0.05 (Student's t-test);
Z-H/A	-0.15 ± 0.76 (−1.49-1.6)	-1.93 ± 0.33 (−2.85- −1.51)	<0.001^* * Significant difference and p < 0.05 (Student's t-test);
Weight (kg)	57.34 ± 6.84 (43.7-74.05)	49.73 ± 6.67 (36.15-66.1)	<0.001^* * Significant difference and p < 0.05 (Student's t-test);
Birth weight (g)	3307.37 ± 425.28 (2570-4850)	3258.2 ± 492.91 (2560-5000)	0.552
Birth height (cm)	49.62 ± 1.85 (46-54)	48.56 ± 1.48 (46-52)	<0.001^* * Significant difference and p < 0.05 (Student's t-test);
Total fat mass (kg)	10.17 ± 4.93 (2.57-22.25)	9.42 ± 4.44 (2.26-20.54)	0.383
% total fat mass	19.17 ± 9.29 (5.6-38.5)	20.34 ± 9.16 (5-38.5)	0.486
FM/HT (kg/m²)	1.84 ± 0.99 (0.46-4.23)	1.93 ± 0.96 (0.39-3.92)	0.596
Total fat-free mass (kg)	43.65 ± 8.36 (30.21-60.62)	37.09 ± 7.11 (27.55-56.21)	<0.001^* * Significant difference and p < 0.05 (Student's t-test);
FFMI/HT (kg/m²)	6.98 ± 1.04 (5.16-9.28)	6.84 ± 1.01 (4.83-9.04)	0.468

Anthropometric characteristics	Eutrophic	Failure-to-thrive	p value
Anthropometric characteristics	n = 39	n = 20	p value
Age (years)	16.20 ± 0.95 (15-19)	16.95 ± 1.19 (15-19)	0.012^* * Significant difference and p < 0.05 (Student's t-test);
Height (cm)	173.35 ± 5.89 (164-187.5)	161.07 ± 2.52 (157-165.1)	<0.001^* * Significant difference and p < 0.05 (Student's t-test);
Z-H/A	-0.12 ± 0.81 (−1.49-1.6)	-1.92 ± 0.24 (−2.26- −1.54)	<0.001^* * Significant difference and p < 0.05 (Student's t-test);
Weight (kg)	61.13 ± 5.81 (47.55-74.05)	54.11 ± 6.25 (44.5-66.1)	<0.001^* * Significant difference and p < 0.05 (Student's t-test);
Birth weight (g)	3454.61 ± 491.33 (2570-4850)	3166.5 ± 549.13 (2650-5000)	0.045^* * Significant difference and p < 0.05 (Student's t-test);
Birth height (cm)	50.31 ± 1.68 (47-54)	49.1 ± 1.28 (46.5-51)	0.007^* * Significant difference and p < 0.05 (Student's t-test);
Total fat mass (kg)	7.05 ± 3.31 (2.57-13.68)	6.07 ± 3.37 (2.26-12.29)	0.289
% Total fat mass	12.02 ± 5.13 (5.6-23.5)	11.59 ± 5.88 (5-24.6)	0.777
FM/HT (kg/m²) ± SD (95%CI)	1.14 ± 0.56 (0.46-2.47)	1.07 ± 0.63 (0.39-2.56)	0.683
Total fat-free mass (kg)	50.67 ± 4.89 (41.76-60.62)	44.77 ± 4.46 (37.56-56.21)	<0.001^* * Significant difference and p < 0.05 (Student's t-test);
FFMI/HT (kg/m²)	7.74 ± 0.74 (6.31-9.28)	7.80 ± 0.74 (6.50-9.04)	0.747

Anthropometric characteristics	Eutrophic	Failure-to-thrive	p value
Anthropometric characteristics	n = 37	n = 30	p value
Age (years)	16.03 ± 1.01 (14-18)	16.23 ± 0.90 (15-18)	0.387
Height (cm)	161.53 ± 4.49 (153.4-172.8)	150.24 ± 2.53 (144.6-153.3)	<0.001^* * Significant difference and p < 0.05 (Student's t-test);
Z-H/A	-0.17 ± 0.70 (−1.49-1.57)	-1.94 ± 0.39 (−2.85- −1.51)	<0.001^* * Significant difference and p < 0.05 (Student's t-test);
Weight (kg)	53.34 ± 5.46 (43.7-67.25)	46.81 ± 5.24 (36.15-57.15)	<0.001^* * Significant difference and p < 0.05 (Student's t-test);
Birth weight (g)	3152.16 ± 273.47 (2700-3900)	3319.33 ± 450.88 (2560-4800)	0.066
Birth height (cm)	48.89 ± 1.76 (46-52)	48.2 ± 1.52 (46-52)	0.094
Total fat mass (kg)	13.47 ± 4.16 (6.33-22.25)	11.65 ± 3.61 (5.15-20.54)	0.064
% Total fat mass	26.7 ± 6.2 (14.5-38.5)	26.17 ± 5.59 (15-38.5)	0.717
FM/HT (kg/ m²) ± SD (95%CI)	2.57 ± 0.79 (1.22-4.23)	2.51 ± 0.67 (1.23-3.92)	0.708
Total fat-free mass (kg)	36.24 ± 3.23 (30.21-43.31)	31.97 ± 2.15 (27.55-35.36)	<0.001^* * Significant difference and p < 0.05 (Student's t-test);
FFMI/HT (kg/ m²)	6.17 ± 0.63 (5.16-8.51)	6.20 ± 0.54 (4.83-6.93)	0.870

Bone mineral density		Eutrophic	Failure-to-thrive	p value
Bone mineral density		n = 76 (39M, 37F)	n = 50 (20M, 30F)	p value
Total body
	BMC (g)	2445.64 ± 417.32 (1697-3406)	2120.22 ± 333.33 (1583-3129)	<0.001^* * Significant difference and p < 0.05 (Mann-Whitney test)
	BMD (g/cm²)	1.12 ± 0.08 (0.94-1.36)	1.11 ± 0.67 (0.97-1.29)	0.637
Spine (L2L4)
	Bone area (cm²)	41.41 ± 4.83 (29.46-52.62)	36.42 ± 4.35 (28.86-47.13)	<0.001^* * Significant difference and p < 0.05 (Mann-Whitney test)
	BMC (g)	47.41 ± 8.59 (28.87-68.2)	41.30 ± 7.79 (26.96-65.34)	<0.001^* * Significant difference and p < 0.05 (Mann-Whitney test)
	BMAD (g/cm³)	0.36 ± 0.04 (0.27-0.44)	0.38 ± 0.04 (0.28-0.5)	0.009^* * Significant difference and p < 0.05 (Mann-Whitney test)
	BMD (g/cm²)	1.14 ± 0.12 (0.88-1.49)	1.13 ± 0.12 (0.91-1.41)	0.643
Femur
	BMD (g/cm²)	1.07 ± 0.15 (0.78-1.42)	1.06 ± 0.13 (0.82-1.38)	0.990

Boné mineral density		Eutrophic	Failure-to-thrive	p value
Boné mineral density		n= 39	n = 20	p value
Body Total
	BMC (g)	2729.31 ± 357.78 (2037-3406)	2399.9 ± 290.25 (1957-3129)	<0.001^* * Significant difference and p < 0.05 (Mann-Whitney test).
	BMD (g/cm²)	1.15 ± 0.09 (0.97-1.36)	1.13 ± 0.07 (1.01-1.29)	0.471
Spine (L2L4)
	Bone area (cm²)	44.74 ± 3.83 (34.74-52.62)	40.49 ± 3.29 (32.97-47.13)	<0.001^* * Significant difference and p < 0.05 (Mann-Whitney test).
	BMC (g)	51.69 ± 8.76 (35.62-68.2)	46.48 ± 8.49 (35.79-65.34)	0.044^* * Significant difference and p < 0.05 (Mann-Whitney test).
	BMAD (g/cm³)	0.34 ± 0.03 (0.27-0.44)	0.36 ± 0.04 (0.28-0.44)	0.078
	BMD (g/cm²)	1.15 ± 0.14 (0.88-1.49)	1.14 ± 0.14 (0.95-1.41)	0.737
Femur
	BMD (g/cm²)	1.14 ± 0.15 (0.85-1.42)	1.14 ± 0.13 (0.92-1.38)	0.962

Bone mineral density		Eutrophic	Failure-to-thrive	p value
Bone mineral density		n= 37	n= 30	p value
Body Total
	BMC (g)	2146.65 ± 220.56 (1697-2658)	1933.77 ± 206.48 (1583-2367)	<0.001^* * Significant difference and p < 0.05 (Mann-Whitney test).
	BMD (g/cm²)	1.10 ± 0.06 (0.94-1.25)	1.10 ± 0.06 (0.97-1.20)	0.488
Spine (L2L4)
	Bone area (cm²)	37.89 ± 2.89 (29.46-43.88)	33.71 ± 2.42 (28.86-37.81)	<0.001^* * Significant difference and p < 0.05 (Mann-Whitney test).
	BMC (g)	42.9 ± 5.66 (28.87-53.98)	37.86 ± 4.96 (26.96-44.72)	<0.001^* * Significant difference and p < 0.05 (Mann-Whitney test).
	BMAD (g/cm³)	0.38 ± 0.03 (0.31-0.44)	0.40 ± 0.04 (0.33-0.50)	0.149
	BMD (g/cm²)	1.13 ± 0.10 (0.92-1.36)	1.12 ± 0.11 (0.91-1.32)	0.925
Femur
	BMD (g/cm²)	1.00 ± 0.10 (0.78-1.23)	1.01 ± 0.90 (0.82-1.18)	0.449

Dependent variables		Associated independent variables	Adjusted R²	p value
BMC of total body
	Eutrophic	Total fat-free mass (g)	0.670	<0.001
	Failure-to-thrive	Total fat-free mass (g)	0.580	<0.001
BMD of total body
	Eutrophic	Total fat-free mass (g)	0.430	<0.001
	Eutrophic	Z-H/A	-	<0.010
	Failure-to-thrive	Total fat-free mass (g)	0.150	<0.050
BMC L2L4
	Eutrophic	Total fat-free mass (g)	0.570	<0.001
		Z-H/A	-	<0.010
	Failure-to-thrive	Total fat-free mass (g)	0.470	<0.001
BMD L2L4
	Eutrophic	Total fat-free mass (g)	0.520	<0.001
		Z-H/A	-	<0.001
	Failure-to-thrive	Total fat-free mass (g)	0.310	<0.010
BMAD L2L4
	Eutrophic	^* * No significant independent variable was found in the model.	-	-
	Failure-to-thrive	^* * No significant independent variable was found in the model.	-	-
BMD total femur
	Eutrophic	Total fat-free mass (g)	0.380	<0.001
	Eutrophic	Z-H/A	-	<0.010
	Failure-to-thrive	^* * No significant independent variable was found in the model.	-	-

Dependent variables		Associated independent variables	Adjusted R²	p value
BMC of total body
	Eutrophic	Weight (kg)	0.630	<0.001
	Failure-to-thrive	Weight (kg)	0.550	<0.001
	Failure-to-thrive	Total fat-free mass (g)	-	<0.030
BMD of total body
	Eutrophic	Weight (kg)	0.400	<0.001
	Eutrophic	Z-H/A	-	<0.001
	Failure-to-thrive	Weight (kg)	0.210	<0.010
BMC (L2L4)
	Eutrophic	Weight (kg)	0.210	<0.001
	Failure-to-thrive	Total fat-free mass (g)	-	<0.010
	Failure-to-thrive	Age	0.350	<0.030
BMD (L2L4)
	Eutrophic	Weight (kg)	0.120	<0.020
	Failure-to-thrive	Age	0.360	<0.010
	Failure-to-thrive	Z-H/A	-	<0.010
BMAD (L2L4)
	Eutrophic	^* * No significant independent variable was found in the model.	-
	Failure-to-thrive	Height	0.320	<0.010
	Failure-to-thrive	Age	-	<0.030
BMD of total femur
	Eutrophic	Weight (kg)	0.360	<0.001
	Eutrophic	Z-H/A	-	<0.020
	Failure-to-thrive	^* * No significant independent variable was found in the model.	-	-

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[1] Corresponding author: Luiz Anderson Lopes – Rua Loefgreen, 1647 – Vila Clementino – CEP 04040-032 – São Paulo (SP), Brasil – Tel.: (11) 5539 1783 – e-mail: la.lopes@globo.com