{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T06:12:23Z","timestamp":1790143943347,"version":"4.0.1"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Gonadotropin-releasing hormone analogue (GnRHa)-induced gonadal suppression is an established component of gender-affirming care for transgender and gender-diverse (TGD) adolescents. Impaired bone health has been documented in treatment-na\u00efve TGD adolescents prior to GnRHa intervention, yet its nutritional determinants remain poorly characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To characterize nutritional status, body composition, and bone mineral density (BMD) in treatment-na\u00efve TGD adolescents prior to GnRHa initiation, and to identify predictors of lumbar spine BMD z-scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cross-sectional study included 147 treatment-na\u00efve TGD adolescents (59 AMAB[TGD-Female] and 88 AFAB[TGD-Male]) attending a national pediatric gender clinic. Assessments included anthropometrics, body composition, 24-h dietary calcium intake (compared to the age-specific dietary reference intake [DRI]), micronutrient status, physical activity, sleep duration, and lumbar spine BMD z-scores by dual-energy X-ray absorptiometry. Multiple linear regression identified predictors of BMD z-score, with sex assigned at birth included as a covariate. Descriptive analyses were conducted by sex assigned at birth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The median age was 15.5 years (IQR, 14.1\u201316.7), and 83.7% were fully pubertal. The median daily calcium intake was 400 mg\/d (31% of the DRI), with 99.3% consuming below the DRI. Vitamin D deficiency\/insufficiency was present in 91.5% of participants. Of the 102 participants with complete micronutrient data, 63.7% had \u2265 2 nutritional deficiencies. Body composition assessment revealed a below-average muscle-to-fat ratio in both groups (median z-score \u22120.74) and a higher fat mass percentage in AFAB compared to AMAB adolescents (28.6% vs. 17.4%;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001). The overall median BMD z-score was \u22120.70 (IQR, \u22121.30 to 0.10), with the AMAB adolescents having lower BMD z-scores than the AFAB adolescents (\u22121.00 vs. \u22120.40;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.001), and 55.8% of the former having below-average\/low BMD values compared with 33.0% of the latter (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.015). The multivariable regression revealed that the BMI z-score (\n                      <jats:italic>B<\/jats:italic>\n                      = 0.403;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001) and sex assigned at birth (\n                      <jats:italic>B<\/jats:italic>\n                      = 0.372;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.019) were the only independent predictors of the BMD z-score (R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.344, adjusted R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.318).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Treatment-na\u00efve TGD adolescents exhibit nutritional deficiencies, unfavorable body composition, and reduced BMD prior to GnRHa initiation, particularly those assigned male at birth. BMI z-scores and sex assigned at birth independently predicted BMD, highlighting the need for targeted pre-treatment nutritional and lifestyle interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1937542","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:49:55Z","timestamp":1790142595000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Nutritional status, body composition and bone health in treatment-na\u00efve transgender and gender-diverse adolescents"],"prefix":"10.3389","volume":"13","author":[{"given":"Yael","family":"Issan","sequence":"first","affiliation":[{"name":"The Institute of Pediatric Endocrinology, Diabetes and Metabolism, Dana-Dwek Children\u2019s Hospital, Tel Aviv Sourasky University Medical Center","place":["Tel Aviv, Israel"]},{"name":"The Nutrition and Dietetics Unit, Tel Aviv Sourasky University Medical 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