The effect of vitamin D supplementation and nutritional intake on skeletal maturity and bone health in socio-economically deprived children

• Published in: European journal of nutrition 2021-09, Vol.60 (6), p.3343-3353
• Main Authors: Uday, Suma, Manaseki-Holland, Semira, Bowie, Jessica, Mughal, Mohamed Zulf, Crowe, Francesca, Högler, Wolfgang
• Format: Article
• Language: English
• Subjects: Anthropometry; Bone density; Calories; Chemistry; Chemistry and Materials Science; Children; Dietary intake; Dietary supplements; Maturity; Nutrition; Original Contribution; Placebos; Radiography; Underweight; Vitamin D; Vitamin D3; Wrist
• ISSN: 1436-6207; 1436-6215
• DOI: 10.1007/s00394-021-02511-5

Purpose 1. To determine the effect of vitamin D supplementation on bone age (BA), a marker of skeletal maturity, and Bone Health Index (BHI), a surrogate marker of bone density. 2. To characterise the differences in nutritional intake and anthropometry between children with advanced vs. delayed BA. Methods The current study is a post hoc analysis of radiographs obtained as part of a randomised controlled trial. In this double-blind, placebo-controlled trial, deprived Afghan children ( n  = 3046) aged 1–11 months were randomised to receive six doses of oral placebo or vitamin D3 (100,000 IU) every 3 months for 18 months. Dietary intake was assessed through semi-quantitative food frequency questionnaires at two time points. Anthropometric measurements were undertaken at baseline and 18 months. Serum 25OHD was measured at five time points on a random subset of 632 children. Knee and wrist radiographs were obtained from a random subset ( n  = 641), of which 565 wrist radiographs were digitised for post-hoc analysis of BA and BHI using BoneXpert version 3.1. Results Nearly 93% (522, male = 291) of the images were analysable. The placebo ( n  = 258) and vitamin D ( n  = 264) groups were comparable at baseline. The mean (± SD) age of the cohort was 2 (± 0.3) years. At study completion, there was no difference in mean 25-hydroxy vitamin D concentrations [47 (95% CI 41, 56) vs. 55 (95% CI 45, 57) nmol/L, p  = 0.2], mean (± SD) BA SDS [− 1.04 (1.36) vs. − 1.14 (1.26) years, p  = 0.3] or mean (± SD) BHI SDS [− 0.30 (0.86) vs. − 0.31 (0.80), p  = 0.8] between the placebo and vitamin D groups, respectively. Children with advanced skeletal maturity (BA SDS ≥ 0) when compared to children with delayed skeletal maturity (BA SDS