The Relationship between Bone Mineral Density and Dietary Intake in Moroccan Children with Juvenile Idiopathic Arthritis


Background and objective: The aim of this study was to evaluate the association between dietary intake and bone mineral density in children with juvenile idiopathic arthritis (JIA). Methods: A cross-sectional study carried out in Morocco between May 2010 and June 2011, covering out patients with JIA. The characteristics of patients were collected. The nutritional status was assessed by a food questionnaire including data of food intake during 7 consecutive days using 24-hour dietary recall. Food intake was quantified using the software Bilnut (Bilnut version 2.01, 1991). Bone mineral density (BMD in g/cm2) was measured by DXA method (X-ray absorptiometry) on a Lunar Prodigy. Results: The study consisted of 33 patients with JIA (4 - 16 years old). The median age of patients was 10.4 ± 4.3 years. Median disease duration was 2 (1 - 4.5) years. The group of patients with low dietary intake of proteins was associated with low BMD (p = 0.03). Low BMD was related with low intake of magnesium (p = 0.007) and vitamin C (p = 0.04) in children aged between 4 and 9 years. Low intake of vitamin E and folate was associated with high BMD in the other range of children (p < 0.001). Conclusion: This study suggests that low intake of protein and of some micronutrients (magnesium, vitamin C, vitamin E and folate) influence bone mass in children with JIA. Prospective studies with a larger number of patients seem to be necessary in order to confirm our findings.

Share and Cite:

A. Hassani, S. Rostom, D. Badri, I. Bouaadi, A. Barakat, B. Chkirat, K. Elkari, R. Bahiri, B. Amine and N. Hajjaj-Hassouni, "The Relationship between Bone Mineral Density and Dietary Intake in Moroccan Children with Juvenile Idiopathic Arthritis," International Journal of Clinical Medicine, Vol. 3 No. 5, 2012, pp. 400-406. doi: 10.4236/ijcm.2012.35075.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] America’s bone health: the state of osteoporosis and low bone mass in our nation. A report of the National Osteoporosis Foundation.2002
[2] McDonagh JE . Osteoporosis in juvenile idiopathic arthritis. Curr Opin Rheumatol 2001; 13:399- 404
[3] Cashman KD . Calcium intake, calcium bioavailability and bone health. Br J Nutr 2002, 87:S169–77
[4] Cassidy JT, Petty RE . Chronic arthritis in childhood. In: Textbook of Pediatric Rheumatology, 5th ed. Cassidy JT, Petty RE (eds). Philadelphia: Elsevier Saunders 2005 pp. 206–60.
[5] M. Alonso Franch ,M.P.Redondo Del R?o L. Sua′rez Cortina. Nutricio′n infantily saludo′sea An Pediatr(Barc). 2010; 72(1):80.e1–80.e11
[6] Rabinovich CE. Bone mineral status in juvenile rheumatoid arthritis. J Rheumatol. 2000; 27 Suppl 58:34–8.
[7] Caetano MC, Ortiz TT, Terreri MT, et al. In-adequate dietary intake of children and adolescents with juvenile idiopathic arthritis and systemic lupus erythematosus. J Pediatr. 2009; 85(6):509-515
[8] RomeraM, SerraL. Nutricio′n y osteoporosis. En: SerraLl, et al. editores. Nutricio′n y Salud Pu′blica. Masson 1995 SA;1995. p. 269–75
[9] Michaelsson K, Holmberg L, Mallmin H, et al. Diet and hip fracture risk: a case-control study. Study Group of the Multiple Risk Survey on Swedish Women for Eating Assessment. Int J Epidemiol. 1995; 24 : 771-82.
[10] Nieves JW. Nutrition and osteoporosis. In: Cummings S, Cosman F, Jamal S, eds. Osteoporosis: an evidence based approach to the prevention and management. Philadelphia 2002: American College of Physicians.
[11] International League of Associations for Rheumatology classification of juvenile idiopathic arthritis. J Rheumatol. 2004; 31(2):390-2.
[12] Rostom S, Amine B, Bensabbah R, et al. Psychometric properties evaluation of the childhood health assessment questionnaire (CHAQ) in Moroccan juvenile idiopathic arthritis. Rheumatol Int. 2010 ;30(7):879-85
[13] Wacker W, Barden HS. Pediatric reference data for male and female total body and spine BMD and BMC . 2001 Meeting of the International Society of Clinical Densitometry.
[14] Bhudhikanok GS, Wang MC, Eckert K, et al. Differences in bone mineral in young Asian and Caucasian Americans may reflect differences in bone size. J Bone Miner Res. 1996; 11: 1545–56.
[15] Lewiecki EM, Gordon CM, Baim S, et al. International Society for Clinical Densitometry 2007 adult and pediatric official positions. Bone. 2008; 43: 1115-21.
[16] El Kari K., Borghos L., Benajiba N., et al. Daily vitamin A intake and nutritional disorders in preschool children: case of the northwest area of morocco. Report of the XXII International Vitamin A Consultative Group Meeting 2004 T38; P: 54
[17] Guy Nantel and Kraisid Tontisirin. Human vitamin and mineral requirements. Report of a joint FAO/WHO expert consultation food and nutrition division 2001. (Web page accessed on 4 January 2011)
[18] Hammer DL, Kraemer HC, Wilson DM, et al . Standardized percentile curves of body-mass-index for children and adolescents. Am J Clin Nutr. 1991; 145:259-63.
[19] Daniela Maria Alves Chaud; Maria Odete Esteves Hilário; Gianni Yanaguibashi; Olga Maria Silverio Amancio. Avalia??es dietética e antropométrica em pacientes com artrite reumatóide juvenile Rev. Assoc. Med. Bras 2003 vol.49 no.2
[20] Geinoz G, Rapin CH, Rizzoli R, et al. Relationship between bone mineral density and dietary intakes in the elderly. Osteoporos Int. 1993; 3: 242-8.
[21] Marianne Sarazin1, Christian Alexandre1, Thierry Thomas. Influence des apports en oligoéléments, protéines, lipides, glucides et vitamines sur le métabolisme Osseux. Rev Rhum. 2000; 67 : 486-97
[22] Zhang Q, Ma G, Greenfield H et al. The association between dietary protein intake and bone mass accretion in pubertal girls with low calcium intakes.Br J Nutr. 2010; 103(5):714-23.
[23] Vatanparast H, Bailey DA, Baxter-Jones AD et al . The effects of dietary protein on bone mineral mass in young adults may be modulated by adolescent calcium intake. J Nutr. 2007; 137(12):2674-9.
[24] Jeannette M Beasley, Laura E Ichikawa, Brett A Ange et al. Is protein intake associated with bone mineral density in youngwomen? Scholes Am J Clin Nutr. 2010; 91(5):1311-6.
[25] Sa’eed Bawa The Significance of Soy Protein and Soy Bioactive Compounds in the Prophylaxis and Treatment of Osteoporosis. Journal of Osteoporosis Volume 2010, Article ID 891058, 8 pages
[26] R.L. Corwin. Effects of dietary fats on bone health in advanced age. Prostaglandins, Leukotrienes and Essential Fatty Acids 68. 2003. 379–386
[27] Rebecca L. Corwin, Terryl J. Hartman, Steven A. Maczuga et al. Dietary Saturated Fat Intake Is Inversely Associated with Bone Density in Humans: Analysis of NHANES III. J. Nutr. 2006; 136: 159–165
[28] M.C. Kruger, D.F. Horrobin, Calcium metabolism, osteoporosis and essential fatty acids: a review, Prog. Lipid Res. 1997; 36 131–151.
[29] Rubinacci A, Porrini M, Sirtori P et al. Nutrients, anthropometric characteristics and osteoporosis in women in the recent and late postmenopausal period. 1992; 83(9):497-506
[30] Tj?derhane L, Larmas M . A high sucrose diet decreases the mechanical strength of bones in growing rats. J Nutr. 1998; 128 : 1807-10.
[31] Rude RK, Kirchen ME, Gruber HE et al. Magnesium deficiency induces bone loss in the rat. Miner Electrolyte Metabol. 1998; 24 : 314-20.
[32] Jeri W Nieves . Osteoporosis: the role of micronutrients1–4. Am J Clin Nutr. 2005; 81(suppl):1232S–9S
[33] Tucker KL, Hannan MT, Chen H et al. Potassium, magnesium, and fruit and vegetable intakes are associated with greater bone mineral density in elderly men and women. AmJ Clin Nutr. 1999; 69:727–36.
[34] Nielsen, FH. Studies on the relationship between boron and magnesium which possibly affects the formation and maintenance of bones. MagTr Elem. 1990; 9:61–9.
[35] Stendig-Lindberg G, Tepper R, Leichter I. Trabecular bone density in a two year controlled trial of peroral magnesium in osteoporosis. Magnes Res. 1993; 6:155– 63.
[36] Jackson RD, Bassford T, Cauley J, et al. The impact of magnesium intake on fractures: results from the women’s health initiative observational study (WHI-OS). ASBMR 2003
[37] Odaland LM, Mason RL, Alexeff AI. Bone density and dietary findings of 409 Tennessee subject. I. Bone density considerations Am J Clin Nutr. 1972; 25:905–907.
[38] Leveille SG, LaCroix AZ, Koepsell TD, et al. Dietary vitamin C and bone mineral density in postmenopausal women in Washington State, USA. J Epidemiol Community Health. 1997; 51:479–85.
[39] Celia J Prynne, Gita D Mishra, Maria A O’Connell et al. Fruit and vegetable intakes and bone mineral status: a cross-sectional study in 5 age and sex cohorts. J Clin Nutr. 2006; 83:1420–8
[40] Kaptoge S, Welch A, McTaggart A et al. Effects of dietary nutrients and food groups on bone loss from the proximal femur in men and women in the 7th and 8th decades of age. Osteoporos Int. 2003; 14:418 –28.
[41] Chan R, Woo J, Lau W, Leung J et al . Effects of lifestyle and diet on bone health in young adult Chinese women living in Hong Kong and Beijing. Food Nutr Bull. 2009; 30(4):370-8.
[42] Farrell VA, Harris M, Lohman TG et al. Comparison between dietary assessment methods for determining associations between nutrient intakes and bone mineral density in postmenopausal women. J Am Diet Assoc. 2009; 109(5):899-904.
[43] Rejnmark L, Vestergaard P, Hermann AP et al. Dietary intake of folate, but not vitamin B2 or B12, is associated with increased bone mineral density 5 years after the menopause: results from a 10-year follow-up study in early postmenopausal women.Calcif Tissue Int. 2008; 82(1):1-11
[44] A. Rivas1, A. Romero2, M. Mariscal1 et al. Validation of questionnaires for the study of food habits and bone mass. Nutr Hosp. 2009; 24(5):521-8

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.