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Do cardiometabolic risk factors mediate the relationship between body composition and bone mineral content in South Indian children aged 5 to 16 years?

European Journal of Clinical Nutrition volume 78, pages 1014–1021 (2024)Cite this article

Subjects

A Correction to this article was published on 12 December 2024

This article has been updated

Abstract

Background/objective

The complex interplay between adiposity, bone health and cardiometabolic risk (CMR) factors is unclear in Indian children. We aimed to investigate the mediating role of number of CMR factors on the relationship between fat % and bone mineral content (BMC) % in South Indian children aged 5–16 years.

Subjects and methods

Healthy children (n = 317), from India, underwent anthropometric, blood biochemistry, blood pressure, along with body composition and BMC assessments using Dual-energy X-ray absorptiometry. Based on the number of CMR factors, children were categorised into three groups: 0, 1 and ≥ 2. Analysis of variance was used to compare the parameters between the CMR groups and mediation analysis was performed to examine if the number of CMR factors mediated the relationship between fat % and BMC %.

Results

The prevalence of 0, 1 and ≥ 2 CMR factors was 42.3%, 33.9% and 23.9% respectively; mean BMC % was lowest in ≥ 2 CMR group. In the whole group, BMC % had significant negative correlation with fat % (r = −0.68, p < 0.0001) and positive correlation with lean % (r = 0.64, p < 0.0001). Adjusted for age and sex, results suggested significant mediating effect of number of CMR factors on the relationship between fat % and BMC % (Average Causal Mediation Effects =−0.002, bootstrapped 95% CI: −0.0039, −0.0001, p < 0.01), but losing significance when adjusted for co-variates.

Conclusion

Number of CMR factors mediates the relationship between fat % and BMC % in Indian children. Further studies are needed to confirm these findings, understand mechanisms and plan appropriate strategies.

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Fig. 1: Prevalence of individual risk factors by CMR factors groups stratified by age and sex.
Fig. 2: Comparison of mean BMC % between the CMR factors in whole group of children.
Fig. 3: Directed Acyclical Graph (DAG) depicting the mediating effect of number of CMR factors on the relationship between fat % and BMC % including the potential covariates.

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Data availability

Additional data can be made available from the corresponding author on reasonable request.

Change history

  • 04 December 2024

    The original online version of this article was revised. In the ‘Statistical Methods’ section, the sentence “Comparison of BMC % between three CMR groups stratified by various ranges of fat %, android fat %, gynoid fat % (<20, 21–30, 31–50 and >40) and waist-to-height ratio (WHtR) cutoff were performed using ANOVA” was corrected to read “Comparison of BMC % between three CMR groups stratified by various ranges of fat %, android fat %, gynoid fat % (<20, 21–30, 31–40 and >40) and waist-to-height ratio (WHtR) cutoff were performed using ANOVA.”

  • 12 December 2024

    A Correction to this paper has been published: https://doi.org/10.1038/s41430-024-01553-2

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Acknowledgements

The authors acknowledge Jayakumar Joseph and the entire study team for their involvement in data collection. We are grateful to all the children who participated in the study.

Funding

The study was supported by the International Atomic Energy Agency (IAEA), Vienna.

Author information

Authors and Affiliations

  1. Division of Nutrition, St John’s Research Institute, St. John’s National Academy of Health Sciences, Bengaluru, Karnataka, India

    Sayeeda Arshiya Farheen, Deepa Puttaswamy, Jini V. Aravind & Rebecca Kuriyan

  2. St. John’s Medical College, St. John’s National Academy of Health Sciences, Bangalore, India

    Poorvikha S

  3. Division of Epidemiology and Biostatistics, St. John’s Research Institute, St. John’s National Academy of Health Sciences, Bengaluru, Karnataka, India

    Sumithra Selvam

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  1. Sayeeda Arshiya Farheen
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Contributions

SAF: data analysis and prepared the different versions of the manuscript. PS: helped in data analysis and contributed to preparing the drafts of the manuscript. SS: performed statistical analysis, interpretation of findings and reviewed the draft. DP: was involved in conducting the research and reviewing the manuscript. JA: was involved in the data collection and reviewed the manuscript. RK: conceptualized, designed and supervised the research, interpretation of results, critically reviewed and edited the draft and has primary responsibility for the final content. Each author had participated sufficiently in the work to take public responsibility of appropriate portions of the content. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Rebecca Kuriyan.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

Ethical approval was obtained from the St John’s Medical College Institutional Ethical committee (reference no.84/2011). Date of approval: Study was approved on 7th July 2011. Informed written consent was obtained from parents and oral assent was obtained from children >10 years of age.

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41430_2024_1494_MOESM1_ESM.docx

Comparison of BMC % between the number of CMR factors stratified by various fat ranges of total fat %, regional fat % distribution and waist-to-height ratio

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Farheen, S.A., S, P., Selvam, S. et al. Do cardiometabolic risk factors mediate the relationship between body composition and bone mineral content in South Indian children aged 5 to 16 years?. Eur J Clin Nutr 78, 1014–1021 (2024). https://doi.org/10.1038/s41430-024-01494-w

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