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Original Studies |
Medical Research Council Environmental Epidemiology Unit (University of Southampton), Southampton General Hospital (C.R.G., C.N.M., S.K., C.C.), Southampton, United Kingdom S016 6YD; and Osteoporosis Center, Northern General Hospital (R.E.), Sheffield, United Kingdom S5 7AU
Address all correspondence and requests for reprints to: Prof. Cyrus Cooper, Medical Research Council Environmental Epidemiology Unit (University of Southampton), Southampton General Hospital, Southampton, United Kingdom SO16 6YD. E-mail: cc{at}mrc.soton.ac.uk
| Abstract |
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| Introduction |
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| Subjects and Methods |
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All 143 subjects underwent assessments of bone density and body composition by DXA using a Hologic, Inc., QDR 4,500A instrument (Waltham, MA). Measurements were made of bone mineral content (BMC), bone area, and bone mineral density (BMD) at the lumbar spine, proximal femur, and whole body. We used these measurements to calculate bone mineral apparent density at the lumbar spine and femoral neck using the method of Carter et al. (11). We also made measurements of body composition (whole body fat and lean mass). Measurement precision, expressed as coefficient of variation, was 1.0% for lumbar spine BMD and 3.0% for femoral neck BMD.
We explored the relation between birth weight, adult bone mineral, and body composition measurements and potential confounding variables using ANOVA, partial correlation coefficients, and multiple linear regression. Variables with a skewed distribution were normalized by log transformation.
The study was approved by the North Sheffield local research ethics committee, and all subjects gave written informed consent.
| Results |
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| Discussion |
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Our study was based on 143 participants who agreed to attend a hospital clinic (44%) from among 322 people invited to take part in the study. They were not a representative sample of all people born in Sheffield at the time, because they were born in the hospital when most births took place at home and because they continued to live in the city in which they were born. However, in the statistical analyses all comparisons were made within the group who participated. We do not think that nonresponse or our inability to follow-up all members of the original cohort will have biased the results unless relationships between birth measurements and body composition in adult life differ in nonresponders or in people who have died or moved away. Furthermore, the distribution of body mass index and prevalence of cigarette smoking in these men and women are similar to estimates derived from British population samples of comparable age, such as the General Household Survey (12, 13). We used DXA to estimate whole body bone mineral, lean, and fat mass. This technique has rapidly become a standard method for the noninvasive assessment of body composition. Measurements of bone and soft tissue are highly reproducible (14, 15, 16), and they have been extensively validated both in vivo and in vitro (17, 18, 19). The technique is highly sensitive to the age-related decline in muscle mass (20, 21) as well as to the accumulation of central fat in postmenopausal women (21, 22).
Evidence has now accumulated that the risk of osteoporosis might be modified by environmental influences during early life. Several epidemiological studies have confirmed that infants who are light at 1 yr of age have lower adult bone mineral content at the lumbar spine and proximal femur (5, 6, 23, 24). This relationship has been documented in young adulthood as well as in cohorts aged 6070 yr, in which fracture incidence rates are substantially higher. Finally, a recent Finnish cohort study has demonstrated a direct association between low birth length, poor childhood growth, and later risk of hip fracture (25). These epidemiological studies suggest a discordance between the environmental influences acting on bone growth and mineralization. Weight at 1 yr has tended to predict bone size and total mineral content much better than volumetric assessments of BMD (5, 6).
In previous studies the relationship of weight in infancy to adult bone mass was stronger for weight at 1 yr than for birth weight (6, 26). There are two explanations for this pattern. First, the major genetic and/or environmental influences programming skeletal growth might be timed during early postnatal life; second, these environmental influences act during intrauterine life, but their effects only become apparent when body size begins to track during the first year of postnatal life. In previous cohorts (6), we have been able to pursue environmental determinants of adult bone mass that might act during the months following birth; for example, type of infant nutrition or exposure to infections during childhood and infancy. Neither of these exposures resulted in significant deficits in bone mineral that persisted through to later life. The Sheffield cohort reported here provides some of the highest quality information available on neonatal anthropometry. The data clearly demonstrate that birth weight bears a positive association with adult bone mass, even after adjusting for adult body height. Our findings are consistent with those of an Australian cohort study (27), in which birth weight was found to be a predictor of total body bone mass at age 8 yr. They are also in accord with follow-up studies of premature infants (28), who appear to have deficits in bone size and mineral content during later childhood. We therefore conclude that genetic and/or environmental influences during intrauterine life explain at least in part the previously observed associations between weight at 1 yr and adult bone mass.
It is difficult to disentangle the influences of the genome and
intrauterine environment on birth weight. In a family study performed
over 4 decades ago, Penrose (29) suggested that 62% of
the variation in birth weight between individuals was the result of the
intrauterine environment, 20% was the result of maternal genes, and
18% was the result of fetal genes. These estimates are concordant with
the modest heritability of birth weight (
10%) observed in a
recently published twin study from The Netherlands (30).
Finally, a study of babies born after ovum donation (31)
showed that although their birth weights were strongly related to the
birth weights of the recipient mother, they were unrelated to the
weight of the female donors. Coupled with animal studies
(32, 33, 34), these findings suggest that birth size is
controlled at least in part by the intrauterine environment rather than
by the genetic inheritance from both parents.
There have been no previously published reports of the relationship between birth size and adult body composition measured by DXA; our results point to a significant association between birth weight and adult muscle mass. Indeed, around 25% of the variation in whole body lean mass among men and women, aged 7074 yr, in this cohort was explained by birth weight. This relationship was much more pronounced than that between birth weight and whole body fat mass and remained highly statistically significant after adjusting for age, adult height, and adult weight. Early growth retardation in animal models leads to permanent reductions in the mass of muscle (35, 36, 37, 38), which has been postulated to explain the link between impaired fetal growth and glucose intolerance. Data obtained in human studies are scant. A recent study of young children reported that birth weight was associated with increased lean tissue in the upper arm, as assessed by upper arm muscle-bone area, but that fatness in the upper arm was less affected (39). A study of 191 men, aged 1722 yr (40), reported that thigh muscle-bone area in adulthood was strongly correlated with birth weight, but not with thigh sc fat area, and that the relationship between birth size and adult body mass index was markedly attenuated by adjusting for the muscle-bone measurement. Finally, 2 studies have evaluated the relationship between birth weight and muscle mass or strength in later adulthood. The first of these (41) examined the relationship between birth weight and muscle mass, as estimated by urinary creatine excretion, among 217 men and women, aged 50 yr. Adult muscle mass was predicted by low birth weight and small head circumference, but not by thinness at birth. The second explored the relationship between birth weight, weight at 1 yr, and adult grip strength among 717 British men and women, aged 6074 yr. Strong positive associations were found between both measures of weight in infancy and adult grip strength, such that subjects in the lowest fifth of the distribution of birth weight had 12% lower grip strength than those in the highest fifth of the distribution, after adjusting for age, sex, socio-economic status, and adult height (42). Our results support these observations and suggest that one manifestation of metabolic programming might be the allocation of cells during critical early periods to different body compartments (fat, muscle, and bone). Furthermore, our data suggest that adult bone and muscle mass are more closely interrelated in individuals than either compartment is with adult fat mass. Although this discordance between the development of bone and muscle, on the one hand, and fat, on the other, might stem from different environmental determinants in later life (for example, physical activity), our data suggest differential metabolic programming as an alternative explanation.
In summary, this cohort study suggests that low birth weight is associated with lower adult bone and muscle mass, even after adjusting for adult height. These data add to the evidence that the risk of osteoporosis in later life might be programmed by genetic and/or environmental influences during gestation. The genetic and environmental programming of the skeletal growth trajectory and any concomitant adverse effect on age-related bone loss require further study so that current strategies to prevent osteoporosis may be enhanced.
| Acknowledgments |
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| Footnotes |
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Received June 21, 2000.
Revised October 3, 2000.
Accepted October 3, 2000.
| References |
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