Early Malnutrition and the Risk of Osteoporosis in Adulthood: A Large-Scale Cross-Sectional Study

Academic Background

Osteoporosis is a chronic, systemic metabolic bone disease characterized by reduced bone density and deterioration of bone microstructure, leading to a significantly increased risk of fractures. Globally, approximately 9 million fractures are related to osteoporosis each year, with about 30% of women over the age of 50 experiencing osteoporotic fractures. Osteoporosis not only severely impacts patients’ quality of life but also imposes a substantial economic burden. Although existing research has shown that lifestyle, dietary habits, and hormone levels are closely related to the occurrence of osteoporosis, the impact of early malnutrition on the risk of osteoporosis in adulthood remains unclear.

China experienced severe food shortages between 1959 and 1961, during which individuals born in this period may have faced the risk of malnutrition during their early developmental stages. Therefore, studying the impact of early malnutrition on osteoporosis in adulthood holds significant public health importance. This study aims to explore the relationship between early malnutrition exposure and the risk of osteoporosis and fractures in adulthood through a large-scale cross-sectional analysis.

Source of the Paper

This paper was co-authored by Hongbin Xu, Haitao Zhang, Remila Aimaiti, and others, with the research team affiliated with Longhua Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University, and other institutions. The paper was published online on August 29, 2024, in the journal International Journal of Surgery, titled “Early-life malnutrition exposure associated with higher osteoporosis risk in adulthood: a large-scale cross-sectional study.”

Research Process

Study Subjects and Grouping

This study is based on data from the China Community-based Cohort of Osteoporosis (CCCO), which included 22,018 participants. Through multistage stratified random sampling, 12,789 participants were ultimately included in the analysis. Participants were divided into six groups based on their birth dates: non-exposed group (born between October 1, 1962, and September 30, 1972), fetal exposure group (born between October 1, 1959, and September 30, 1961), early childhood exposure group (born between October 1, 1956, and September 30, 1958), mid-childhood exposure group (born between October 1, 1954, and September 30, 1956), late childhood exposure group (born between October 1, 1949, and September 30, 1954), and adolescent exposure group (born between October 1, 1940, and September 30, 1949). To minimize age-related biases, the non-exposed group and the adolescent exposure group were combined into an “age-matched group.”

Data Collection and Measurements

Each participant completed a structured questionnaire through face-to-face interviews, collecting demographic data (such as gender, age, education level, marital status, household income, etc.) and lifestyle factors (such as smoking, alcohol consumption, and physical activity). Additionally, participants provided self-reported medical conditions (e.g., hyperlipidemia, hypertension, diabetes, malignancies, and fracture history) and details on medication and supplement use (e.g., anti-osteoporosis drugs and calcium supplements).

Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry (DXA). All devices were of the same model and underwent annual calibration to ensure accuracy. Osteoporosis was diagnosed based on a T-score of ≤ -2.5.

Data Analysis

The study employed multiple logistic regression models to analyze the relationship between early malnutrition exposure and the risk of osteoporosis and fractures. All models were adjusted for potential confounding factors, including gender, age, education level, marital status, household income, smoking, alcohol consumption, residential region, chronic diseases (e.g., hyperlipidemia, hypertension, diabetes), physical activity, calcium supplement use, and anti-osteoporosis medication use. Additionally, stratified analyses were conducted based on gender, body mass index (BMI), education level, and geographic region.

Key Findings

Prevalence of Osteoporosis and Fractures

The results showed that the prevalence of osteoporosis in the non-exposed group, fetal exposure group, early childhood exposure group, mid-childhood exposure group, late childhood exposure group, and adolescent exposure group was 31.276%, 34.803%, 36.569%, 40.340%, 39.378%, and 41.585%, respectively. The incidence of fractures also showed a similar upward trend, with the late childhood exposure group having a significantly higher risk of fractures compared to the age-matched group (OR = 1.155, 95% CI: 1.033–1.291, p = 0.01127).

Early Malnutrition Exposure and Osteoporosis Risk

After adjusting for confounding factors, the risk of osteoporosis significantly increased in the fetal exposure group, early childhood exposure group, mid-childhood exposure group, and late childhood exposure group, with OR values of 1.223 (95% CI: 1.035–1.445), 1.208 (95% CI: 1.052–1.386), 1.249 (95% CI: 1.097–1.421), and 1.101 (95% CI: 1.001–1.210), respectively. Stratified analyses further revealed that the association between early malnutrition exposure and osteoporosis risk was more pronounced among participants with lower education levels or those who were overweight or obese.

External Validation

The study also conducted external validation using the China Northwest Cohort (CNC), and the results were consistent with those from the CCCO cohort, further supporting the association between early malnutrition exposure and osteoporosis risk.

Conclusions and Significance

This study demonstrates that early malnutrition exposure is significantly associated with an increased risk of osteoporosis in adulthood, particularly among individuals exposed during the fetal period and childhood (early, mid, and late stages). This finding provides new evidence for the Developmental Origins of Health and Disease (DOHaD) theory, emphasizing the importance of early nutrition for bone health. The study also highlights that health education and weight management can mitigate the negative effects of early malnutrition on bone health.

Research Highlights

1. Large-Scale Sample: This study is based on large-scale data from the CCCO and CNC cohorts, enhancing the reliability and generalizability of the results.
2. Precise Measurements: The use of DXA, the gold standard for BMD measurement, ensured data accuracy.
3. Stratified Analysis: Stratified analyses by gender, BMI, education level, and geographic region revealed differences in the association between early malnutrition exposure and osteoporosis risk across subgroups.
4. External Validation: External validation through the CNC cohort further supported the robustness of the findings.

Application Value

This study provides important evidence for public health policy formulation, recommending the strengthening of early nutritional interventions, particularly promoting health education and weight management in high-risk populations to reduce the incidence of osteoporosis. Additionally, the findings offer a scientific basis for early screening and prevention of osteoporosis.

Other Valuable Information

The study also found that early malnutrition exposure is associated with insulin resistance and β-cell dysfunction, which may be potential mechanisms underlying the increased risk of osteoporosis. Future research could further explore these mechanisms to provide new insights for the prevention and treatment of osteoporosis.