The American journal of clinical nutrition · 2026
Breastfeeding duration and bone mineral density in childhood: a prospective study within the Growing Up in Singapore Toward healthy Outcomes (GUSTO) cohort.
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Gridneva Zoya, Pang Wei Wei, Vlaskovsky Philip, McEachran Jacki L, Perrella Sharon L, Michael Navin, Gupta Varsha, Yap Fabian, Lee Yung Seng, Vasanwala Rashida Farhad, Wlodek Mary E, Godfrey Keith M, Chong Yap-Seng, Eriksson Johan G, Geddes Donna T, Tint Mya Thway
Аннотация
BACKGROUND: Nutrition contributes to bone mineral density (BMD) during infancy and childhood; however, studies focusing on infant nutrition and BMD relationships in childhood are limited.
OBJECTIVES: This study aimed to examine relationships of any breastfeeding (BF) duration and timing of complimentary foods and beverages (CFB) introduction with BMD outcomes in young Asian children from the Growing Up in Singapore Toward healthy Outcomes (GUSTO) cohort.
METHODS: Healthy term-born children aged 6 y (n = 207) with available BF duration data (months) and dual-energy X-ray (DXA) absorptiometry scans of lumbar spine (LS) and whole body (WB) were included to examine the BF duration and CFB introduction associations with DXA-derived-BMD outcomes; cohort-specific z-scores of areal BMD (aBMD, grams per square centimeter) and bone mineral apparent density (BMAD, grams per cubic centimeter) of WB and LS. Multivariable models utilized regularized regression modeling [least absolute shrinkage and selection operator (LASSO)] to leverage multiple covariates without overfitting the available data.
RESULTS: In univariable models, longer BF duration was associated with lower ZWB-BMD [-0.013 ± 0.006 (SE), P = 0.027] and ZLS-aBMD (-0.012 ± 0.006, P = 0.045); in stratified analyses, longer BF duration was associated with lower ZWB-BMD (-0.023 ± 0.008, P = 0.004), ZWB-BMAD (-0.020 ± 0.007, P = 0.006, and ZLS-aBMD (-0.018 ± 0.008, P = 0.037) in females only. Most associations remained significant in adjusted LASSO models. Later CFB introduction was associated with lower ZWB-BMAD (-0.130 ± 0.065, P = 0.045); in stratified analyses, later CFB introduction was associated with lower ZLS-aBMD (-0.166 ± 0.078, P = 0.037) and ZLS-BMAD (-0.205 ± 0.078, P = 0.010) in males only. These associations were no longer apparent in adjusted LASSO models.
CONCLUSIONS: A longer BF duration and delayed CFB introduction may reflect reduced bone accrual in early childhood, inferred from bone density at age 6 y, and may vary by child's sex. Recognizing these relationships is crucial for optimizing early nutrition to support strong and healthy bone development. This trial was registered at clinicaltrials.gov as NCT01174875 (https://www.
CLINICALTRIALS: gov/study/NCT01174875).
OBJECTIVES: This study aimed to examine relationships of any breastfeeding (BF) duration and timing of complimentary foods and beverages (CFB) introduction with BMD outcomes in young Asian children from the Growing Up in Singapore Toward healthy Outcomes (GUSTO) cohort.
METHODS: Healthy term-born children aged 6 y (n = 207) with available BF duration data (months) and dual-energy X-ray (DXA) absorptiometry scans of lumbar spine (LS) and whole body (WB) were included to examine the BF duration and CFB introduction associations with DXA-derived-BMD outcomes; cohort-specific z-scores of areal BMD (aBMD, grams per square centimeter) and bone mineral apparent density (BMAD, grams per cubic centimeter) of WB and LS. Multivariable models utilized regularized regression modeling [least absolute shrinkage and selection operator (LASSO)] to leverage multiple covariates without overfitting the available data.
RESULTS: In univariable models, longer BF duration was associated with lower ZWB-BMD [-0.013 ± 0.006 (SE), P = 0.027] and ZLS-aBMD (-0.012 ± 0.006, P = 0.045); in stratified analyses, longer BF duration was associated with lower ZWB-BMD (-0.023 ± 0.008, P = 0.004), ZWB-BMAD (-0.020 ± 0.007, P = 0.006, and ZLS-aBMD (-0.018 ± 0.008, P = 0.037) in females only. Most associations remained significant in adjusted LASSO models. Later CFB introduction was associated with lower ZWB-BMAD (-0.130 ± 0.065, P = 0.045); in stratified analyses, later CFB introduction was associated with lower ZLS-aBMD (-0.166 ± 0.078, P = 0.037) and ZLS-BMAD (-0.205 ± 0.078, P = 0.010) in males only. These associations were no longer apparent in adjusted LASSO models.
CONCLUSIONS: A longer BF duration and delayed CFB introduction may reflect reduced bone accrual in early childhood, inferred from bone density at age 6 y, and may vary by child's sex. Recognizing these relationships is crucial for optimizing early nutrition to support strong and healthy bone development. This trial was registered at clinicaltrials.gov as NCT01174875 (https://www.
CLINICALTRIALS: gov/study/NCT01174875).