Factors Related to Bone Mineral Content Among Adolescents in Seoul

서울시 일부 청소년의 골질량 관련요인

  • Shin, Sang-Ah (Department of Public Health Nutrition Graduate School of Public Health, Seoul National University) ;
  • Hong, Kyung-Eui (Department of Public Health Nutrition Graduate School of Public Health, Seoul National University) ;
  • Choi, Hyun-Jeong (Department of Public Health Nutrition Graduate School of Public Health, Seoul National University) ;
  • Roh, Ji-Hyun (Department of Public Health Nutrition Graduate School of Public Health, Seoul National University) ;
  • Joung, Hyo-Jee (Department of Public Health Nutrition Graduate School of Public Health, Seoul National University)
  • Published : 2008.03.31

Abstract

The purpose of this study was to investigate factors related to bone mineral contents (BMC) at os calcis of adolescents. The subjects were 604 students (327 boys and 277 girls) between 7th and 9th grade in Seoul, Korea. The mean age was 14.2 ${\pm}$ 0.9 years. General characteristics were collected by a questionnaire, bone mineral contents (BMC) were measured in os calcis by Duel Energy X-ray Absorptiometry (PIXI, General Electronics, USA) and height and weight were measured by bioelectrical impedance analysis method (Inbody 4.0, Biospace Co. Ltd, Seoul, Korea). Mean BMC of os calsis were 2.241 g. Height (p <.0001), weight (p <.0001I), BMC (p <.0001I) ofboys were higher than those of girls. Percent body fat of girls, however, was higher than that of boys (p <.0001). Anthropometric measurement, pocket money, sibling, experience of fracture, pubertal stage, intake of supplements, physical or outdoors activity, and eating habit had significant influence on BMC of boys. Anthropometric measurement, physical or outdoors activity, and eating habit had significant influence on BMC of girls. Multivariate regression with adjustment for sex and age showed that BMC was associated positively with height, BMI, frequency of regular activity, and intake of spinach or radish leaves (all p <0.05), and negatively with percent body fat (p <.0000 and Korean traditional diet pattern (p = 0.01). On the basis of these results, it is recommended to develop nutrition education and physical activity program for adolescents to improve BMC and prevent osteoporosis.

청소년기의 골건강에 영향을 줄 수 있는 신체계측치와 사회경제적 요인, 출생 당시의 모체의 건강상태 및 모유수유, 대상자의 건강상태, 생활습관 및 식습관 요인을 분석한 본 연구의 결과를 요약하면 다음과 같다. 1) 조사 대상자의 평균 연령은 14.2세, 신장 162.7 cm, 체중 57.3 kg이었고, 비만 및 과체중 유별률은 27.3%였다 우측 종골의 골밀도는 0.518% $g/cm^2$, 골질량은 2.241 g이었다. 2) 월 3만원 이상 용돈을 사용하는 남학생의 골질량이 3만원 이하 용돈을 사용하는 남학생에 비해서 유의하게 높았고, 형제가 없는 남학생의 경우 골질량이 유의하게 높았다. 출생시 어머니의 나이가 30세 이전인 학생들의 골질량이 유의하지는 않지만 높은 경향이 있었다. 3) 골절 경험이 있는 남학생의 골질량이 골절 경험이 없는 남학생에 비해 유의하게 높았고, 2차 성징이 늦은 남학생의 골질량이 높았다. 영양제를 섭취하지 않은 남학생의 골질량이 높았고, 활동적인 신체 활동과 규칙적인 운동, 야외활동을 많이 하는 학생들의 골질량이 유의하게 높았다. 4) 다양한 음식을 골고루 섭취하는 남학생의 골질량이 유의하게 높았고, 충분한 물을 섭취할 때 남학생과 여학생의 골질량이 유의하게 높았다. 밥 위주의 전통식을 하루 두끼 이상 섭취하는 여학생의 골질량이 유의하게 낮았다. 치즈, 생선류, 시금치 및 무청나물의 섭취가 대상자들의 골질량에 관련성이 있었다. 5) 다중회귀분석 모델에서 신장, BMI, 운동 횟수, 시금치 또는 무청나물의 섭취횟수의 골질량 설명력은 64.9%였다. 이상의 연구 결과에서 청소년기 골질량 향상을 위해서는 규칙적인 운동과 신체활동으로 체지방률을 낮추고, 칼슘 급원 식품과 더불어 다양한 음식을 골고루 섭취하도록 해야 할 것이다. 따라서 본 연구의 결과를 토대로 청소년기 학생들에게 골질량 향상을 위해 신체 활동 증가를 통한 생활 습관 교육 프로그램과 올바른 식습관 형성을 위한 식사 교육 프로그램을 실시한다면 이들이 성인이 되었을 때 발생할 수 있는 골감소증 및 골다공증을 예방할 수 있을 것으로 사료된다.

Keywords

References

  1. WHO study group. WHO Technical Report series: Assessment of fracture risk and its application to screening for postmenopausal osteoporosis; 1994. p.843
  2. WHO Technical Report Series 916, Diet, nutrition and the prevention of chronic diseases; 2003
  3. Lee WS, Park HM, Bae DH, Prevalence of osteoporosis in Korean women. J Korean Society of Menopause 2003; 9(4): 339- 346
  4. WHO/FAO joint committee. Vitamin and mineral requirement in human nutrition. 2nd ed. Rome: WHO publication; 2004
  5. Choi H. Nutrition, 2nd Ed. Seoul: Kyomunsa; 2003
  6. Ott SM. Attainment of peak bone mass [Editorial]. J Clin Endoclinol Metab 1990; 71: 1082, 1990 https://doi.org/10.1210/jcem-71-5-1082
  7. Hansen MA, Overgaarf K, Riis BJ, Christiansen C. Role of peak bone mass and bone loss in postmenopausal osteoporosis: 12 year study. Br Med J 1991; 303: 961-964 https://doi.org/10.1136/bmj.303.6808.961
  8. Turner CH, Robling AG. Exercises for improving bone strength. Br J Sports Med 2005; 39: 188-189 https://doi.org/10.1136/bjsm.2004.016923
  9. Kohrt WM, Bloomfield SA, Little KD, et al. American College of Sports Medicine Position Stand: physical activity and bone health. Med Sci Sports Exerc 2004; 36: 1985-1996 https://doi.org/10.1249/01.MSS.0000142662.21767.58
  10. Strong WB, Malina RM, Blimkie CJR, et al. Evidence based physical activity for school-age youth. J Pediatr 2005; 146: 732-737 https://doi.org/10.1016/j.jpeds.2005.01.055
  11. Greer FR, Krebs NF. Committee on Nutrition, American Academy of Pediatrics. Optimizing bone health and calcium intakes of infants, children and adolescents. Pediatrics 2006; 117: 578- 585 https://doi.org/10.1542/peds.2005-2822
  12. Manzoni P, Brambilla P, Pietrobelli A. Influence of body composition on bone mineral content in childhood and adolescents. Am J Clin Nutr 1996; 64: 603-607 https://doi.org/10.1093/ajcn/64.4.603
  13. Goulding A, Taylor RW, Jones IE, et al. Overweight and obese children have low bone mass and area for their weight. Int J Obes Relat Metab Disord 2000; 24: 627-632 https://doi.org/10.1038/sj.ijo.0801207
  14. Lanou AJ, Berkow SE, Barnard ND. Calcium, dairy products and bone health in children and young adults: a reevaluation of the evidence. Pediatrics 2005; 115: 736-743 https://doi.org/10.1542/peds.2004-0548
  15. Dawson-Hughes B, Harris SS, Krall EA, Dallal GE. Effect of withdrawal of calcium and vitamin D supplements on bone mass in elderly men and women. Am J Clin Nutr 2000; 72: 745-750 https://doi.org/10.1093/ajcn/72.3.745
  16. Children and adolescents: evidence for varying effects of sexual maturation and physical activity. J Pediatr 1994; 125: 201-207 https://doi.org/10.1016/S0022-3476(94)70193-8
  17. Kasperk CH, Wakley GK, Hierl T, Ziegler R. Gonadal and adrenal androgens are potent regulators of human bone cell metabolism in vitro. J Bone Miner Res 1997; 12: 464-471 https://doi.org/10.1359/jbmr.1997.12.3.464
  18. Loud KJ, Gordon CM. Adolescence: bone disease. In: Walker WA, Watkins JB, Duggan C, eds. Nutrition in Pediatrics. 3rd ed. Hamilton, Ontario: BC Decker; 2003. p.883-896
  19. Ahn HS, Kim SH, Lee SS. A study of factors affecting bone mineral density in Korean adolescents: anthropometric measurements, lifestyle, and other environmental factors. Korean J Nutr 2005; 38(3): 242-250
  20. Song YJ, Paik HY. Effect of dietary factors on bone mineral density in Korean college women. Korean J Nutr 2002; 35(4): 464-472
  21. Yu CH, Lee YS, Lee JS. Some factors affection bone density of Korean college women. Korean J Nutr 1998; 31(1): 36-45
  22. Jones G, Riley M, Dwyer T. Breastfeeding in early life and bone mass in prepubertal children: a longitudinal study. Osteoporos Int 2000; 11(2): 146-152 https://doi.org/10.1007/PL00004176
  23. Ministry of Health and Welfare, 2005 National health and nutrition survey report, Seoul; 2006
  24. Jeon KY, Choi YS. The Occurrence of Osteoporosis and Osteopenia between Two Groups with Different Socioeconomic Conditions. Korean J Medicine 1996; 50(4): 855-530
  25. Elliot JR, Gilchrist NL, Wells JE. The effect of socioeconomic status on bone density in a male caucasian population. Bone 1996; 18(4): 371-373 https://doi.org/10.1016/8756-3282(96)00006-3
  26. Park JN, Kim KH, Lee SS. A study of factors affecting bone mineral density in children: Antropometric measurements, socioeconomic factors, family history, and other environmental factors. Korean J Nutr 2004: 37(1): 52-60
  27. Barker DJP. Mothers, babies and health in later life, 2nd ed., Edinburgh: Churchill Livingstone; 1998
  28. Barker DJP. Fetal origins of coronary heart disease. BMJ 1995; 311: 171-174 https://doi.org/10.1136/bmj.311.6998.171
  29. Cooper C, Eriksson JG, Forsen T, Osmond C, Tuomilehto J, Barker DJ. Maternal height, childhood growth and risk of hip fracture in later life: a longitudinal study. Osteoporos Int 2001; 12: 623-629 https://doi.org/10.1007/s001980170061
  30. Jones G, Rilet M, Dwyer T. Breastfeeding in Early Life and Bone Mass in Prepubertal Children: A Longitudinal Study. Osteoporos Int 2000; 11(2): 146-152 https://doi.org/10.1007/PL00004176
  31. Ma DQ, Jones G. Clinical risk factors but not bone density are associated with prevalent fractures in prepubertal children. J Paediatr Child Health 2002; 38: 497-500 https://doi.org/10.1046/j.1440-1754.2002.00037.x
  32. You MH, Son BS, Park JA, Yang WH, Kim JO, Jang BK. Patterns of bone mineral density and its causal factors among Korean adult women. Korean J Sanitation 2006; 21(2): 47-52
  33. Lee EJ, Son SM. Dietary risk factors related to bone mineral density in the postmenopausal women with low bone mineral density. Korean J Community Nutrition 2004; 9(5): 644-653
  34. Winzenberg T, Shaw K, Fryer J, Jones G. Effects of calcium supplementation on bone density in healthy children: meta-analysis of radomised controlled trials. Br Med J 2006; 333: 775-778 https://doi.org/10.1136/bmj.38950.561400.55
  35. Lloyd T, Petit MA, Lin HM, Beck TJ. Lifestyle factors and the development of bone mass and bone strength in young women. J Pediatric 2004; 144: 776-782
  36. Ward KA, Roberts SA, Adams JE, Mughal MZ. Bone geometry and density in the skeleton of pre-pubertal gymnasts and school children. Bone 2005; 36: 1012-1018 https://doi.org/10.1016/j.bone.2005.03.001
  37. Valdimarsson O, Linden C, Johnell O, Gardsell P, karlsson MK. Daily physical education in the school curriculum in prepubertal girls during 1 year is followed by an increase in bone mineral accrual and bone width-Data from the Prospective Controlled Malmo Pediatric Osteoporosis Prevention Study. Calcif Tissue Int 2006; 78: 65-71 https://doi.org/10.1007/s00223-005-0096-6
  38. Park SJ, Ahn Y, Kim HM, Joo SE, Oh KS, Park C. The association of dietary patterns with bone mineral density in middleaged women: A cohort of Korean genome epidemiology study. Korean J Community Nutrition 2007; 12(3): 352-360
  39. Kim MS, Koo J. Analysis of factors affecting bone mineral density with different age among adult women in Seoul area. Korean J Community Nutrition 2007; 12(5): 559-568
  40. Bae YJ, Kim EY, Cho HK, Kim MH, Choi MK, Sung MK, Sung CJ. Relation among dietary habits, nutrient intakes and bone mineral density in Korean normal and obese elementary students. Korean J Community Nutrition 2006; 11(1): 14-24
  41. Choi YJ, Im R, La SH, Choi MK. Correlation between nutrient intakes and bone mineral density in carpus of female university students. J Korean Dietetic Assoc 2006; 12(1): 10-17
  42. Choi SN, Chung NY, Song CH, Kim SR. Bone density and nutrient intake of university students. Korean J Food Culture 2007; 22(6): 841-847
  43. Song YJ, Paik HY, Yu CH. Factors affecting bone mineral density by dietary pattern group for some Korean college women. Korean J Nutr 2006; 39(5): 460-466