Kajale Neha A, Oza Chirantap, Ladkat Dipali, Gondhalekar Ketan, Katapally Tarun R, Bhawra Jasmin, Mansukhani Nina, Bapat Anita, Khadilkar Vaman, Khadilkar Anuradha
Department of Paediatric Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India.
Interdisciplinary School of Health Sciences, Savitribai Phule University, Pune, Maharashtra, India.
Indian J Endocrinol Metab. 2024 Jul-Aug;28(4):397-404. doi: 10.4103/ijem.ijem_424_23. Epub 2024 Aug 28.
Adolescence is a critical period for the accrual of bone mass. However, few studies have assessed the bone geometry in slum-dwelling girls/young women. We thus conducted this study: (1) to assess bone health in Indian adolescent girls and young women residing in slum vs nonslum (NS) areas and (2) to identify factors associated with poor bone health.
This cross-sectional case-control study was performed on 110 apparently healthy unmarried, nonpregnant, nonlactating, postmenarchal adolescent girls and young women aged 11 to 24 years residing in urban slums with the same number of age-matched controls from NS areas. Anthropometric, dietary, physical-activity and bone-health parameters (using dual-energy X-ray absorptiometry and peripheral quantitative computed tomography-DXA and pQCT-respectively) were evaluated using standard protocols. A value of < 0.05 was considered statistically significant.
Slum girls were significantly shorter and lighter and had lower dietary intakes of calcium and protein after adjusting for total daily calorie intake than NS girls ( < 0.05). Areal bone-mineral density (BMD) at lumber spine (0.940 ± 0.13 vs1.042 ± 0.15 g/cm), femur and total body (less-head), bone-mineral apparent density adjusted for volume at the lumbar spine (0.295 ± 0.04 vs 0.319 ± 0.04 g/cm) and height-adjusted bone density at femur (0.862 ± 0.011 vs 0.905 ± 0.011 g/cm) were significantly lower in slum dwelling participants as compared to their NS counterparts ( < 0.05). After adjusting for confounders like sunlight exposure, anthropometric parameters and dietary calcium intake, area of dwelling was still a significant factor for the difference in BMD.
The potential determinants of poor bone density and geometry in girls and young women residing in slums include residential location, dietary habits, and physical activity levels. Despite adjustments for confounding factors, differences in bone health between those in slum and nonslum areas suggest adaptations developed over generations of deprivation in these individuals, necessitating urgent intervention.
青春期是骨量积累的关键时期。然而，很少有研究评估居住在贫民窟的女孩/年轻女性的骨骼几何结构。因此，我们开展了本研究：（1）评估居住在贫民窟与非贫民窟（NS）地区的印度青春期女孩和年轻女性的骨骼健康状况；（2）确定与骨骼健康不佳相关的因素。
本横断面病例对照研究对110名年龄在11至24岁、明显健康的未婚、未孕、非哺乳期、月经初潮后的青春期女孩和年轻女性进行，她们居住在城市贫民窟，同时选取了相同数量来自NS地区的年龄匹配对照。使用标准方案评估人体测量学、饮食、身体活动和骨骼健康参数（分别使用双能X线吸收法和外周定量计算机断层扫描——DXA和pQCT）。P值<0.05被认为具有统计学意义。
在调整每日总热量摄入后，贫民窟女孩明显更矮、更轻，钙和蛋白质的饮食摄入量低于NS女孩（P<0.05）。与NS地区的同龄人相比，贫民窟居住参与者的腰椎骨面积骨密度（BMD）（0.940±0.13 vs 1.042±0.15g/cm）、股骨和全身（头部除外）、腰椎体积校正后的骨矿物质表观密度（0.295±0.04 vs 0.319±0.04g/cm）以及股骨高度校正后的骨密度（0.862±0.011 vs 0.905±0.011g/cm）均显著更低（P<0.05）。在调整阳光暴露、人体测量参数和饮食钙摄入量等混杂因素后，居住区域仍是BMD差异的一个重要因素。
居住在贫民窟的女孩和年轻女性骨密度和几何结构不佳的潜在决定因素包括居住地点、饮食习惯和身体活动水平。尽管对混杂因素进行了调整，但贫民窟和非贫民窟地区人群之间的骨骼健康差异表明，这些个体经过几代人的贫困生活后形成了适应性变化，因此需要紧急干预。
