Life-course determinants of bone mass in young adults from a transitional rural community in India: the Andhra Pradesh Children and Parents Study (APCAPS).
BACKGROUND
Undernutrition and physical inactivity are both associated with lower bone mass.


OBJECTIVE
This study aimed to investigate the combined effects of early-life undernutrition and urbanized lifestyles in later life on bone mass accrual in young adults from a rural community in India that is undergoing rapid socioeconomic development.


METHODS
This was a prospective cohort study of participants of the Hyderabad Nutrition Trial (1987-1990), which offered balanced protein-calorie supplementation to pregnant women and preschool children younger than 6 y in the intervention villages. The 2009-2010 follow-up study collected data on current anthropometric measures, bone mineral density (BMD) measured by dual-energy X-ray absorptiometry, blood samples, diet, physical activity, and living standards of the trial participants (n = 1446, aged 18-23 y).


RESULTS
Participants were generally lean and had low BMD [mean hip BMD: 0.83 (women), 0.95 (men) g/cm²; lumbar spine: 0.86 (women), 0.93 (men) g/cm²]. In models adjusted for current risk factors, no strong evidence of a positive association was found between BMD and early-life supplementation. On the other hand, current lean mass and weight-bearing physical activity were positively associated with BMD. No strong evidence of an association was found between BMD and current serum 25-hydroxyvitamin D or dietary intake of calcium, protein, or calories.


CONCLUSIONS
Current lean mass and weight-bearing physical activity were more important determinants of bone mass than was early-life undernutrition in this population. In transitional rural communities from low-income countries, promotion of physical activity may help to mitigate any potential adverse effects of early nutritional disadvantage.
From the Departments of Non-communicable Disease Epidemiology (MM, RS, SE, and SK), the Department of Medical Statistics (GBP), and Clinical Research (HK), London School of Hygiene and Tropical Medicine, London, United Kingdom; the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (BK); the National Institute of Nutrition, Hyderabad, India (BK and KVR); the Musculoskeletal Research Unit, School of Clinical Sciences (HV and JHT) and the School of Social and Community Medicine (AET, YB-S, and GDS), University of Bristol, Bristol, United Kingdom; St George's University, London, United Kingdom (LB); the Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom (JCW); the Centre for Chronic Disease Control, New Delhi, India (DP); and the South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India (SE).
Mika
M
Matsuzaki
From the Departments of Non-communicable Disease Epidemiology (MM, RS, SE, and SK), the Department of Medical Statistics (GBP), and Clinical Research (HK), London School of Hygiene and Tropical Medicine, London, United Kingdom; the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (BK); the National Institute of Nutrition, Hyderabad, India (BK and KVR); the Musculoskeletal Research Unit, School of Clinical Sciences (HV and JHT) and the School of Social and Community Medicine (AET, YB-S, and GDS), University of Bristol, Bristol, United Kingdom; St George's University, London, United Kingdom (LB); the Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom (JCW); the Centre for Chronic Disease Control, New Delhi, India (DP); and the South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India (SE).
Hannah
H
Kuper
From the Departments of Non-communicable Disease Epidemiology (MM, RS, SE, and SK), the Department of Medical Statistics (GBP), and Clinical Research (HK), London School of Hygiene and Tropical Medicine, London, United Kingdom; the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (BK); the National Institute of Nutrition, Hyderabad, India (BK and KVR); the Musculoskeletal Research Unit, School of Clinical Sciences (HV and JHT) and the School of Social and Community Medicine (AET, YB-S, and GDS), University of Bristol, Bristol, United Kingdom; St George's University, London, United Kingdom (LB); the Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom (JCW); the Centre for Chronic Disease Control, New Delhi, India (DP); and the South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India (SE).
Bharati
B
Kulkarni
From the Departments of Non-communicable Disease Epidemiology (MM, RS, SE, and SK), the Department of Medical Statistics (GBP), and Clinical Research (HK), London School of Hygiene and Tropical Medicine, London, United Kingdom; the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (BK); the National Institute of Nutrition, Hyderabad, India (BK and KVR); the Musculoskeletal Research Unit, School of Clinical Sciences (HV and JHT) and the School of Social and Community Medicine (AET, YB-S, and GDS), University of Bristol, Bristol, United Kingdom; St George's University, London, United Kingdom (LB); the Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom (JCW); the Centre for Chronic Disease Control, New Delhi, India (DP); and the South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India (SE).
K V
KV
Radhakrishna
From the Departments of Non-communicable Disease Epidemiology (MM, RS, SE, and SK), the Department of Medical Statistics (GBP), and Clinical Research (HK), London School of Hygiene and Tropical Medicine, London, United Kingdom; the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (BK); the National Institute of Nutrition, Hyderabad, India (BK and KVR); the Musculoskeletal Research Unit, School of Clinical Sciences (HV and JHT) and the School of Social and Community Medicine (AET, YB-S, and GDS), University of Bristol, Bristol, United Kingdom; St George's University, London, United Kingdom (LB); the Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom (JCW); the Centre for Chronic Disease Control, New Delhi, India (DP); and the South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India (SE).
Heli
H
Viljakainen
From the Departments of Non-communicable Disease Epidemiology (MM, RS, SE, and SK), the Department of Medical Statistics (GBP), and Clinical Research (HK), London School of Hygiene and Tropical Medicine, London, United Kingdom; the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (BK); the National Institute of Nutrition, Hyderabad, India (BK and KVR); the Musculoskeletal Research Unit, School of Clinical Sciences (HV and JHT) and the School of Social and Community Medicine (AET, YB-S, and GDS), University of Bristol, Bristol, United Kingdom; St George's University, London, United Kingdom (LB); the Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom (JCW); the Centre for Chronic Disease Control, New Delhi, India (DP); and the South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India (SE).
Amy E
AE
Taylor
From the Departments of Non-communicable Disease Epidemiology (MM, RS, SE, and SK), the Department of Medical Statistics (GBP), and Clinical Research (HK), London School of Hygiene and Tropical Medicine, London, United Kingdom; the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (BK); the National Institute of Nutrition, Hyderabad, India (BK and KVR); the Musculoskeletal Research Unit, School of Clinical Sciences (HV and JHT) and the School of Social and Community Medicine (AET, YB-S, and GDS), University of Bristol, Bristol, United Kingdom; St George's University, London, United Kingdom (LB); the Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom (JCW); the Centre for Chronic Disease Control, New Delhi, India (DP); and the South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India (SE).
Ruth
R
Sullivan
From the Departments of Non-communicable Disease Epidemiology (MM, RS, SE, and SK), the Department of Medical Statistics (GBP), and Clinical Research (HK), London School of Hygiene and Tropical Medicine, London, United Kingdom; the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (BK); the National Institute of Nutrition, Hyderabad, India (BK and KVR); the Musculoskeletal Research Unit, School of Clinical Sciences (HV and JHT) and the School of Social and Community Medicine (AET, YB-S, and GDS), University of Bristol, Bristol, United Kingdom; St George's University, London, United Kingdom (LB); the Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom (JCW); the Centre for Chronic Disease Control, New Delhi, India (DP); and the South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India (SE).
Liza
L
Bowen
From the Departments of Non-communicable Disease Epidemiology (MM, RS, SE, and SK), the Department of Medical Statistics (GBP), and Clinical Research (HK), London School of Hygiene and Tropical Medicine, London, United Kingdom; the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (BK); the National Institute of Nutrition, Hyderabad, India (BK and KVR); the Musculoskeletal Research Unit, School of Clinical Sciences (HV and JHT) and the School of Social and Community Medicine (AET, YB-S, and GDS), University of Bristol, Bristol, United Kingdom; St George's University, London, United Kingdom (LB); the Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom (JCW); the Centre for Chronic Disease Control, New Delhi, India (DP); and the South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India (SE).
Jon H
JH
Tobias
From the Departments of Non-communicable Disease Epidemiology (MM, RS, SE, and SK), the Department of Medical Statistics (GBP), and Clinical Research (HK), London School of Hygiene and Tropical Medicine, London, United Kingdom; the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (BK); the National Institute of Nutrition, Hyderabad, India (BK and KVR); the Musculoskeletal Research Unit, School of Clinical Sciences (HV and JHT) and the School of Social and Community Medicine (AET, YB-S, and GDS), University of Bristol, Bristol, United Kingdom; St George's University, London, United Kingdom (LB); the Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom (JCW); the Centre for Chronic Disease Control, New Delhi, India (DP); and the South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India (SE).
George B
GB
Ploubidis
From the Departments of Non-communicable Disease Epidemiology (MM, RS, SE, and SK), the Department of Medical Statistics (GBP), and Clinical Research (HK), London School of Hygiene and Tropical Medicine, London, United Kingdom; the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (BK); the National Institute of Nutrition, Hyderabad, India (BK and KVR); the Musculoskeletal Research Unit, School of Clinical Sciences (HV and JHT) and the School of Social and Community Medicine (AET, YB-S, and GDS), University of Bristol, Bristol, United Kingdom; St George's University, London, United Kingdom (LB); the Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom (JCW); the Centre for Chronic Disease Control, New Delhi, India (DP); and the South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India (SE).
Jonathan C
JC
Wells
From the Departments of Non-communicable Disease Epidemiology (MM, RS, SE, and SK), the Department of Medical Statistics (GBP), and Clinical Research (HK), London School of Hygiene and Tropical Medicine, London, United Kingdom; the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (BK); the National Institute of Nutrition, Hyderabad, India (BK and KVR); the Musculoskeletal Research Unit, School of Clinical Sciences (HV and JHT) and the School of Social and Community Medicine (AET, YB-S, and GDS), University of Bristol, Bristol, United Kingdom; St George's University, London, United Kingdom (LB); the Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom (JCW); the Centre for Chronic Disease Control, New Delhi, India (DP); and the South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India (SE).
Dorairaj
D
Prabhakaran
From the Departments of Non-communicable Disease Epidemiology (MM, RS, SE, and SK), the Department of Medical Statistics (GBP), and Clinical Research (HK), London School of Hygiene and Tropical Medicine, London, United Kingdom; the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (BK); the National Institute of Nutrition, Hyderabad, India (BK and KVR); the Musculoskeletal Research Unit, School of Clinical Sciences (HV and JHT) and the School of Social and Community Medicine (AET, YB-S, and GDS), University of Bristol, Bristol, United Kingdom; St George's University, London, United Kingdom (LB); the Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom (JCW); the Centre for Chronic Disease Control, New Delhi, India (DP); and the South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India (SE).
George
G
Davey Smith
From the Departments of Non-communicable Disease Epidemiology (MM, RS, SE, and SK), the Department of Medical Statistics (GBP), and Clinical Research (HK), London School of Hygiene and Tropical Medicine, London, United Kingdom; the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (BK); the National Institute of Nutrition, Hyderabad, India (BK and KVR); the Musculoskeletal Research Unit, School of Clinical Sciences (HV and JHT) and the School of Social and Community Medicine (AET, YB-S, and GDS), University of Bristol, Bristol, United Kingdom; St George's University, London, United Kingdom (LB); the Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom (JCW); the Centre for Chronic Disease Control, New Delhi, India (DP); and the South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India (SE).
Shah
S
Ebrahim
From the Departments of Non-communicable Disease Epidemiology (MM, RS, SE, and SK), the Department of Medical Statistics (GBP), and Clinical Research (HK), London School of Hygiene and Tropical Medicine, London, United Kingdom; the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (BK); the National Institute of Nutrition, Hyderabad, India (BK and KVR); the Musculoskeletal Research Unit, School of Clinical Sciences (HV and JHT) and the School of Social and Community Medicine (AET, YB-S, and GDS), University of Bristol, Bristol, United Kingdom; St George's University, London, United Kingdom (LB); the Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom (JCW); the Centre for Chronic Disease Control, New Delhi, India (DP); and the South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India (SE).
Yoav
Y
Ben-Shlomo
From the Departments of Non-communicable Disease Epidemiology (MM, RS, SE, and SK), the Department of Medical Statistics (GBP), and Clinical Research (HK), London School of Hygiene and Tropical Medicine, London, United Kingdom; the Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia (BK); the National Institute of Nutrition, Hyderabad, India (BK and KVR); the Musculoskeletal Research Unit, School of Clinical Sciences (HV and JHT) and the School of Social and Community Medicine (AET, YB-S, and GDS), University of Bristol, Bristol, United Kingdom; St George's University, London, United Kingdom (LB); the Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom (JCW); the Centre for Chronic Disease Control, New Delhi, India (DP); and the South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India (SE).
Sanjay
S
Kinra
D000293:Adolescent; D000328:Adult; D000375:Aging / Q000208:ethnology; D015519:Bone Density; D001846:Bone Development; D016723:Bone Remodeling; D015331:Cohort Studies; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India; D008297:Male; D009043:Motor Activity; D024510:Muscle Development; D011446:Prospective Studies; D012423:Rural Health / Q000208:ethnology; D012922:Social Change; D014507:Urbanization; D055815:Young Adult