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Independence of the body composition index from nutritional status affecting bone maturation

Abstract

Background

To examine the characteristics and factors associated with bone maturation among children aged 6–15 years in Shenzhen, stratified by sex, age, and pubertal stage.

Methods

The Evaluation and Monitoring on School-based Nutrition and Growth in Shenzhen, China’ data on body mass index, body composition, bone age (BA), and biochemical examinations were analyzed. The Z-score of BA minus chronological age (ZBA-CA) was calculated for the same sex, age, and pubertal stage.

Results

We included 3780 students aged 6–15 years, comprising 2091 (55.3%) boys and 1689 (44.7%) girls. The proportions of children with BA advancement ≥2 years were 10.1% for boys and 9.9% for girls. We established the standard deviation curves of BA-CA for boys and girls with normal weights at different ages under different pubertal stages. Visceral fat area rank (VFA-R) and relative handgrip strength rank (RHGS-R) correlated positively with ZBA-CA at each quantile in boys, while only VFA-R correlated positively in girls.

Conclusions

Bone maturation should be evaluated according to sex, age, nutritional status, and pubertal stage. VFA-R and RHGS-R were positively correlated with ZBA-CA, independent of the nutritional status.

Impact statement

  • We produced the first standard deviation curves of bone age minus chronological age (BA-CA) for children aged 6–15 years, stratified by sex, age and pubertal stage, to evaluate bone maturation.

  • Our findings revealed that body composition index might affect bone maturation independent of nutritional status.

  • Body mass index, commonly used to evaluate obese children with advanced bone age, does not account for differences and relationship between body composition and bone maturation.

  • These findings offer valuable insights for clinical practice to formulate targeted interventions for slowing down bone maturation and improving growth-related disorders’ management in children.

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Fig. 1: Summary of the major contributing factors affecting bone maturation.
Fig. 2
Fig. 3: Standard deviation curves of BA-CA for boys and girls at different pubertal stages.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank the participants and their parents for participating in this study, as well as the members of the research team for their efforts in recruitment, data collection, and management.

Funding

This work was supported by the High-level Key Clinical Specialty project of Guangdong Provincial Health Commission (supporting construction funds of Shenzhen) (grant number: SZGSP012), Shenzhen Science and Technology Program (grant number: KCXFZ20201221173400002), Guangdong High-level Hospital Construction Fund Clinical Research Project of Shenzhen Children’s Hospital (grant number: LCYJ2022088), and the Sanming Project of Medicine in Shenzhen (grant number: SZSM202411011).

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Author notes

  1. These authors contributed equally: Huiping Su, Yan Li.

Authors and Affiliations

  1. Department of Endocrinology, Shenzhen Children’s Hospital, Shenzhen, China

    Huiping Su, Yan Li, Zhongwei Xu, Yue Shang, Xiu Zhao, Li Wang, Lili Pan, Wei Su, Liping Hou, Yanhua Jiao, Zhuoguang Li, Rongfei Zheng & Zhe Su

  2. Department of Pediatrics, Shenzhen Nanshan Maternity & Child Healthcare Hospital, Shenzhen, China

    Yan Li

  3. Department of Clinical Research, Shenzhen Children’s Hospital, Shenzhen, China

    Qiru Su

Authors

  1. Huiping Su
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  2. Yan Li
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  9. Wei Su
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  14. Zhe Su
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Contributions

Z.S. conceptualized and designed the study. H.P.S. and Y.L. supervised data collection, reviewed the analyses, and wrote all versions of the manuscript. Z.W.X., Y.S., X.Z., L.W., L.L.P., W.S., L.P.H., Y.H.J., Z.G.L. and R.F.Z. coordinated data collection and critically reviewed the manuscript. Q.R.S. contributed to the analysis. All authors have approved the final manuscript as submitted and agreed to be accountable for all aspects of this work.

Corresponding author

Correspondence to
Zhe Su.

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Competing interests

The authors declare no competing interests.

Consent statement

This study was registered with ChiCTR2100051722 in the Chinese Clinical Trial Registry (http://www.chictr.org/cn/). This study was approved by the Ethics Committee of Shenzhen Children’s Hospital (approval number: 202110602). Informed consent was obtained from all subjects involved in the study.

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Su, H., Li, Y., Xu, Z. et al. Independence of the body composition index from nutritional status affecting bone maturation.
Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04169-9

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  • Received: 20 September 2024

  • Revised: 23 April 2025

  • Accepted: 09 May 2025

  • Published: 06 June 2025

  • DOI: https://doi.org/10.1038/s41390-025-04169-9

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