Osteoporosis
Conditions
Keywords
fiber, calcium absorption, bone mass, adolescents
Brief summary
The primary aim of this proposal is to determine the effects of soluble corn fiber (SCF) supplementation for 1 year on bone metabolism in growing adolescents compared to controls. For the proposed study, a randomized double-blinded placebo controlled clinical trial will be conducted in 236 healthy adolescents aged 10-13 years, equally randomly assigned to one of four intervention groups: SCF (12 g/d), SCF + calcium (12 g/d of SCF + 600 mg/d of elemental calcium), placebo (0 g/d of SCF or of calcium), and placebo + calcium (0 g/d of SCF + 600 mg/d of elemental calcium); all administered twice a day. Bone mass will be assessed at baseline at 6 months and at 12 months and bone related biomarkers and fecal microbiome will be assessed at baseline and at 12 months.
Detailed description
The adolescent period is crucial for optimizing future bone health because bone accumulates rapidly during these years and accounts for up to half of adult peak bone mass. Calcium intake during this period is critical for adequate bone mineralization but this is the nutrient most deficient in the diets of adolescents. A strategy to maximize bone mineralization during this critical period is to increase the absorption of the calcium being consumed. This could be achieved by supplementing diets with certain non-digestible carbohydrates, such as soluble corn fiber (SCF). The primary aim of this study is to determine the effects of SCF supplementation for 1 year on bone metabolism in growing adolescents compared to controls. A randomized double-blinded placebo controlled clinical trial will be conducted in 236 healthy adolescents aged 10-13 years, equally randomly assigned to one of four intervention groups: SCF (12 g/d), SCF + calcium (12 g/d of SCF + 600 mg/d of elemental calcium), placebo (0 g/d of SCF or of calcium), and placebo + calcium (0 g/d of SCF + 600 mg/d of elemental calcium); all administered twice a day. Bone mass will be assessed at baseline at 6 months and at 12 months and bone related biomarkers and fecal microbiome will be assessed at baseline and at 12 months. The treatments will be provided in the form of flavored drinks twice per day (this was previously used in a short-term study among adolescents with excellent acceptance). Bone mass and anthropometric measurements will be assessed at baseline, at 6 months and at 12 months and bone related biomarkers and fecal microbiome will be assessed at baseline and at 12 months. Assessment visits will be conducted in the Clinical Research Center of the Stempel School of Public Health at Florida International University. We will also have short home visits at 3 and 9 months to collect unused supplements and provide more supplements. In all visits, participants will complete several questionnaires, such as general health, diet and activity questionnaire. Compliance will be evaluated at all visits and also in real time using a study mobile app. The primary outcome is change in bone mineral content (BMC) measured using Dual-energy X-ray absorptiometry (DXA) The secondary outcomes include biochemical markers reflecting vitamin D status, calcium homeostasis and bone, such as serum calcium, phosphorus, creatinine, osteocalcin, carboxy-terminal collagen crosslinks (CTX), parathyroid hormone (PTH), bone specific alkaline phosphatase, 25-(OH) vitamin D3, 1,25-(OH)2 vitamin D3, and insulin growth factor 1 (IGF-I) and urinary calcium, phosphorus, creatinine and N-telopeptide cross-links.
Interventions
Participants will consume a supplement with 12 g/day of SCF for 12 months
Participants will consume a supplement with 12 g/day of SCF + calcium carbonate (600 mg/day) for 12 months
Participants will consume a supplement without SCF or calcium carbonate for 12 months
Participants will consume a supplement without SCF + calcium carbonate (600 mg/day) for 12 months
Sponsors
Study design
Intervention model description
we are testing a fiber and calcium supplement so it is not a drug
Eligibility
Inclusion criteria
* Body mass index between the 5th and 85th percentiles for age and sex based on the Centers for Disease Control Growth Charts.
Exclusion criteria
* Subjects with any chronic illness requiring regular medication use. * Those taking calcium supplements (\>500 mg/d) and vitamin D supplements (\>400 IU/d) on a regular basis
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Whole Body Bone Mineral Content (BMC) | 12 months | Participants underwent a bone scan at baseline and after 12-months in the intervention using a dual energy x-ray absorptiometry (DXA) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Spine BMC | 12 months | Participants underwent a bone scan at baseline and after 12-months in the intervention using a dual energy x-ray absorptiometry (DXA) |
Countries
United States
Participant flow
Recruitment details
Although 213 were recruited (signed consent form), only 177 completed the randomization visit and were randomized.
Pre-assignment details
Randomization was pre-determined using a block randomization document, which was computer generated.
Participants by arm
| Arm | Count |
|---|---|
| Soluble Corn Fiber (SCF) + Calcium This group received 12 g/d of soluble corn fiber (SCF) + 600 mg/d of elemental calcium carbonate, administered twice a day
Soluble Corn Fiber (SCF) + Calcium: Participants consumed a supplement with 12 g/day of SCF + calcium carbonate (600 mg/day) for 12 months | 45 |
| Soluble Corn Fiber (SCF) Without Calcium This group received 12 g/d of soluble corn fiber (SCF) + 600 mg/d of elemental calcium carbonate, administered twice a day
Soluble Corn Fiber (SCF) without Calcium: Participants consumed a supplement with 12 g/day of SCF for 12 months | 43 |
| Placebo This group received a similar supplement without SCF or calcium, administered twice a day
Placebo: Participants consumed a supplement without SCF or calcium carbonate for 12 months | 43 |
| Placebo + Calcium This group received a similar supplement without SCF + 600 mg/d of elemental calcium carbonate, administered twice a day
Placebo + calcium: Participants consumed a supplement without SCF + calcium carbonate (600 mg/day) for 12 months | 46 |
| Total | 177 |
Baseline characteristics
| Characteristic | Total | Soluble Corn Fiber (SCF) + Calcium | Soluble Corn Fiber (SCF) Without Calcium | Placebo | Placebo + Calcium |
|---|---|---|---|---|---|
| Age, Continuous | 12.1 years STANDARD_DEVIATION 1.51 | 11.9 years STANDARD_DEVIATION 1.35 | 12.1 years STANDARD_DEVIATION 1.51 | 12.0 years STANDARD_DEVIATION 1.23 | 12.4 years STANDARD_DEVIATION 1.4 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 128 Participants | 36 Participants | 32 Participants | 33 Participants | 27 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 49 Participants | 9 Participants | 11 Participants | 10 Participants | 19 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Height | 151.7 cm STANDARD_DEVIATION 10.4 | 151.8 cm STANDARD_DEVIATION 10.8 | 151.8 cm STANDARD_DEVIATION 11 | 149.1 cm STANDARD_DEVIATION 11.1 | 154.1 cm STANDARD_DEVIATION 8.36 |
| Race (NIH/OMB) American Indian or Alaska Native | 5 Participants | 3 Participants | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) Asian | 6 Participants | 2 Participants | 1 Participants | 1 Participants | 2 Participants |
| Race (NIH/OMB) Black or African American | 22 Participants | 6 Participants | 3 Participants | 8 Participants | 5 Participants |
| Race (NIH/OMB) More than one race | 7 Participants | 4 Participants | 0 Participants | 0 Participants | 3 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 57 Participants | 13 Participants | 15 Participants | 18 Participants | 11 Participants |
| Race (NIH/OMB) White | 80 Participants | 17 Participants | 24 Participants | 15 Participants | 24 Participants |
| Sex: Female, Male Female | 85 Participants | 25 Participants | 17 Participants | 23 Participants | 20 Participants |
| Sex: Female, Male Male | 92 Participants | 20 Participants | 26 Participants | 20 Participants | 26 Participants |
| Tanner stage | 2.70 score STANDARD_DEVIATION 1.23 | 2.73 score STANDARD_DEVIATION 1.35 | 2.57 score STANDARD_DEVIATION 1.24 | 2.74 score STANDARD_DEVIATION 1.23 | 2.76 score STANDARD_DEVIATION 1.13 |
| Weight | 46.3 kg STANDARD_DEVIATION 11.2 | 46.8 kg STANDARD_DEVIATION 11.5 | 46.7 kg STANDARD_DEVIATION 10.6 | 44.6 kg STANDARD_DEVIATION 12.4 | 47.1 kg STANDARD_DEVIATION 10.6 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 45 | 0 / 43 | 0 / 43 | 0 / 46 |
| other Total, other adverse events | 3 / 45 | 1 / 43 | 0 / 43 | 3 / 46 |
| serious Total, serious adverse events | 0 / 45 | 0 / 43 | 0 / 43 | 0 / 46 |
Outcome results
Change in Whole Body Bone Mineral Content (BMC)
Participants underwent a bone scan at baseline and after 12-months in the intervention using a dual energy x-ray absorptiometry (DXA)
Time frame: 12 months
Population: A total of 151 children completed the 12 months visit. Results are presented as change from baseline to the 12 months visit.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Soluble Corn Fiber (SCF) + Calcium | Change in Whole Body Bone Mineral Content (BMC) | 20.1 grams | Standard Deviation 11.8 |
| Soluble Corn Fiber (SCF) Without Calcium | Change in Whole Body Bone Mineral Content (BMC) | 18.6 grams | Standard Deviation 10.5 |
| Placebo | Change in Whole Body Bone Mineral Content (BMC) | 17.3 grams | Standard Deviation 9.2 |
| Placebo + Calcium | Change in Whole Body Bone Mineral Content (BMC) | 20.7 grams | Standard Deviation 10.6 |
Change in Spine BMC
Participants underwent a bone scan at baseline and after 12-months in the intervention using a dual energy x-ray absorptiometry (DXA)
Time frame: 12 months
Population: A total of 151 children completed the 12 months visit, but data from 1 child in the placebo+calcium group for BMC lumbar spine was not included as the DXA machine gave an error and it was not resolved in time and the child did not come back. Results are presented as change from baseline to the 12 months visit.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Soluble Corn Fiber (SCF) + Calcium | Change in Spine BMC | 21.8 grams | Standard Deviation 14.5 |
| Soluble Corn Fiber (SCF) Without Calcium | Change in Spine BMC | 18.7 grams | Standard Deviation 10.8 |
| Placebo | Change in Spine BMC | 22.4 grams | Standard Deviation 13.2 |
| Placebo + Calcium | Change in Spine BMC | 23.8 grams | Standard Deviation 16.1 |