(P17-038-23) Bone Health of Malnourished Guatemalan Indigenous Children With Impaired Growth

Objectives: This study seeks to understand the association between stunting, diet patterns, and bone density among Guatemalan preschool children.

Methods: We conducted a cross sectional study involving 155 children aged 2 to 5 years living in Chichicastenango, Guatemala; of whom 99% were Indigenous. Measurements included height and bone density (speed of sound (SoS) m/s using Sunlight MiniOmni Ultrasound Bone Sonometer) thrice from measurements at the left distal radius and midshaft tibia. Mean SoS of stunted and non-stunted children were compared using t-tests. Regression analysis was used to explore predictors of bone density. Twenty-four hour recalls were used to assess dietary intake. K-means cluster analysis of the dietary data was used to identify dietary patterns.

Results: Over half of the children were stunted (53.5%) (height for age < –2 SD). Overall, boys that were growing adequately had significantly denser bones at the distal radius (3583 m/s±168) than those that were stunted (3451 m/s±212). Boys aged three years who were growing well had a distal radius SoS of 3622 m/s±79; significantly greater than their stunted peers (3383 m/s±144). Two-year old girls who were growing adequately had a mean distal radius SoS of 3339 m/s±200; significantly greater than their stunted peers (3144 m/s±125). Stunted girls and boys aged 2-4 years tended to have less dense distal radius bones than their peers. This trend reversed for five-year old children, indicating possible increased bone mineralization among the older stunted children. Age and stunting predicted bone density among the older children. Their overall diet was characterized by low food and beverage density, but clearly divided into two eating patterns: cereal-based; and dairy, poultry and corn-based. Children that belonged to the dairy, poultry and corn-based dietary pattern had higher bone density at the midshaft tibia (3495±14 compared to 3444±16).

Conclusions: In a low resource setting, stunting affects children's bone size and structure, such that their bones may become stiff and fragile due to increased bone mineralization during the late preschool period. Stunting among Guatemalan Mayan children is likely linked to poor dietary diversity.

Funding Sources: Queen Elizabeth II Scholars