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Abstract
Nutrition plays an important role in pediatric bone development. Research into dietary factors that influence pediatric bone have focused primarily on vitamin D and calcium; however, recently other nutrients and foods, specifically protein and eggs, have been highlighted for their potential role in bone health. Additionally, there is interest in the inflammatory nature of the diet, as measured by the dietary inflammation index (DII), to impact bone health. Pro-inflammatory diets have been associated with poorer bone mass in adults. It is unknown whether these associations are evident in children. The objective of this dissertation is to utilize existing data to examine the relationships between egg intake, dietary inflammation, and protein consumption on pediatric bone health. Chapter 3 examined the relationship between egg intake and bone outcomes, measured by peripheral quantitative computed tomography (pQCT) in 290 children ages 9-13 years. Egg intake was a positive predictor of mid-radius cortical bone mineral content (CtBMC) and the association between egg and CtBMC was mediated through fat-free soft tissue. Additionally, egg intake was positively correlated with the biomarker of bone turnover, osteocalcin. Chapter 4 addressed the relationship between DII-scores and bone outcomes, measured by pQCT in 290 boys and girls ages 9-13 years. There were no relationships between DII-scores and cortical bone outcomes or serum inflammation; however, the biomarker of inflammation, monocyte chemoattractant protein-1 was negatively associated with tibia cortical thickness. Chapter 5 is a systematic review investigating the role of protein consumption on bone in 5,620 boys and girls. There was only one randomized controlled trial included in the systematic review; therefore, the effect of protein on pediatric bone was given a limited grade (grade C). These data are the first to investigate the role of both egg and the DII-scores on childhood bone and to systematically review the association between protein intake and pediatric bone. Randomized controlled trials and prospective studies are needed to determine whether egg and protein intake and elevated serum inflammation influence long-term bone health. Findings from this dissertation provided preliminary evidence to support the funding of the SCENE (Skeletal and Cognitive Effects of Nutrition from Eggs) intervention study.