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Epidemiology
Research
Bone mineral density reference standards for Chinese children aged 3–18: cross-sectional results of the 2013–2015 China Child and Adolescent Cardiovascular Health (CCACH) Study
  1. Junting Liu1,
  2. Liang Wang2,
  3. Jinghui Sun3,
  4. Gongshu Liu4,
  5. Weili Yan5,
  6. Bo Xi6,
  7. Feng Xiong7,
  8. Wenqing Ding8,
  9. Guimin Huang1,
  10. Steven Heymsfield9,
  11. Jie Mi1
  1. 1 Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
  2. 2 Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
  3. 3 Department of Cardiovascular Medicine, The First Hospital of Jilin University, Changchun, China
  4. 4 Project Office, Tianjin Women’s and Children’s Health Center, Tianjin, China
  5. 5 Department of Clinical Epidemiology, Children’s Hospital of Fudan University, Shanghai, China
  6. 6 Department of Public Health, Shandong University, Jinan, China
  7. 7 Department of Endocrinology, Children’s Hospital of Chongqing Medical University, Chongqing, China
  8. 8 Department of Public Health, Ningxia Medical University, Yinchuan, China
  9. 9 Department of Metabolism-Body Composition, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
  1. Correspondence to Dr Jie Mi; Jiemi{at}vip.163.com

Abstract

Objectives No nationwide paediatric reference standards for bone mineral density (BMD) are available in China. We aimed to provide sex-specific BMD reference values for Chinese children and adolescents (3–18 years).

Methods Data (10 818 participants aged 3–18 years) were obtained from cross-sectional surveys of the China Child and Adolescent Cardiovascular Health in 2015, which included four municipality cities and three provinces. BMD was measured using Hologic Discovery Dual Energy X-ray Absorptiometry (DXA) scanner. The DXA measures were modelled against age, with height as an independent variable. The LMS statistical method using a curve fitting procedure was used to construct reference smooth cross-sectional centile curves for dependent versus independent variables.

Results Children residing in Northeast China had the highest total body less head (TBLH) BMD while children residing in Shandong Province had the lowest values. Among children, TBLH BMD was higher for boys as compared with girls; but, it increased with age and height in both sexes. Furthermore, TBLH BMD was higher among US children as compared with Chinese children. There was a large difference in BMD for height among children from these two countries. US children had a much higher BMD at each percentile (P) than Chinese children; the largest observed difference was at P50 and P3 and the smallest difference was at P97.

Conclusions This is the first study to present a sex-specific reference dataset for Chinese children aged 3–18 years. The data can help clinicians improve interpretation, assessment and monitoring of densitometry results.

  • BMD
  • DXA
  • China

This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/bmjopen-2016-014542

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    Footnotes

    • JL and LW contributed equally.

    • JS, GL, WY, BX, FX and WD contributed equally.

    • Contributors JL, LW contributed equally, and they are first co-authors. JS, GL, WY, BX, FX and WD contributed equally, and they are second co-authors. JM had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: JM. Acquisition, analysis or interpretation of data: JS, GL, WY, BX, FX, WD, GH, JM. Drafting of the manuscript: JL, LW. Critical revision of the manuscript for important intellectual content: JL, LW, SH, JM. Statistical analysis: JL, LW. Obtained funding: JM. Administrative, technical or material support: JL, LW, WY, BX, FX, WD, JM. Study supervision: JM.

    • Funding The study was supported by grants from the ’Twelfth Five Year Plan' of the China National Science and Technology (2012BAI03B03), the Beijing Health System Leading Talent Grant (2009108), the Beijing Training Project for the Leading Talents in Science and Technology (2011LJ07).

    • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders. The funding sources had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.

    • Competing interests None declared.

    • Ethics approval Research Ethics Committee of Capital Institute of Pediatrics of China.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Extra data is available by emailing Jiemi@vip.163.com.

    • Correction notice This article has been corrected since it first published. The equal contributors statement has been corrected.

    • Patient consent for publication Parental/guardian consent obtained.