Habitual and low-impact activities are associated with better bone outcomes and lower body fat in older women

Discovering the Physio-Pathological Mechanisms of Interaction between Bone Mineral Density, Muscle Mass, and Visceral Adipose Tissue in Female Older Adults through Structural Equation Modeling

This study aims to examine the relation between visceral adipose tissue (VAT), as a proxy for metabolically unhealthy obesity, muscle, as a proxy for muscle quality and sarcopenia, and bone, as a proxy for bone mineral density and osteoporosis. Other variables, such metabolic syndrome, nutritional status, number of diseases, kidney and liver function and inflammation were assessed as direct or indirect effects. This study used structural equation modeling (SEM) in a sample of 713 older women (mean age 82.1 ± 6.3). The results indicate a positive statistically significant association between bone and muscle mass (β = 0.195, <0.001) and nutritional status and muscle mass (β = 0.139, p < 0.001), but negative association between age with muscle mass (β = −0.509, p < 0.001) and nutritional status (estimates: −2.264, p < 0.001). A negative association between VAT and muscle mass was also reported (β = −1.88, p < 0.001). A negative statistically significant association was reported between bone mineral density and functional status (β = −1.081, p < 0.001), and a positive association between functional status and muscle mass (β = 9.000, p < 0.001). In addition, functional status was positively statistically associated with cognitive performance (β = 0.032, p < 0.001). The SEM method demonstrates that the VAT, muscle mass and bone mineral density are associated, but the form of the relation is different in relation to different factors, such as nutritional status, mental and functional status, age, and number of pathologies, having different impacts on metabolic outcomes. SEM is a feasible technique for understanding the complex mechanisms of frailty in the elderly.

Cardiometabolic Indices after Weight Loss with Calcium or Dairy Foods: Secondary Analyses from a Randomized Trial with Overweight/Obese Postmenopausal Women

The role of dairy foods and calcium/vitamin D supplements in cardiometabolic diseases is unknown. The objective of this secondary analysis is to investigate cardiometabolic risk factors changes after a 6-month weight-loss intervention in overweight/obese postmenopausal women divided in three groups: Ca+vitamin D supplements (S); low-fat dairy foods (D; 4−5 servings/day); or control/placebo pills (C), as complements to hypocaloric diets. The original study focused on bone/body composition. This analysis included blood pressure (BP), and serum triglycerides, lipids (including apoproteins Apo1 and ApoB), adipokines, and C-reactive protein in n = 97 participants who finished with complete data points. Systolic BP decreased 5.1%, 4.8%, and 1.8% in S, D, and C groups, respectively (p < 0.05 for S and D vs. baseline and vs. C at 6 months). Reduction in triglycerides and ratio of total cholesterol (TC)/high-density lipoproteins cholesterol (HDL-C) was the highest in S, while the reduction in TC and LDL-C was the highest in D group (all p < 0.05). Leptin and ApoB significantly decreased and adiponectin and ApoA1 increased in all groups. In conclusion, although the C group’s participants experienced an improvement in some of the cardiometabolic indices with weight loss, those in the S and D groups showed significantly better results in most of the outcomes, indicating the beneficial effects of low-fat dairy foods and/or Ca+vitamin D intake as complements to a hypocaloric diet.

Nutritional and Behavioral Approaches to Body Composition and Low-Grade Chronic Inflammation Management for Older Adults in the Ordinary and COVID-19 Times

As more insight is gained into personalized health care, the importance of personalized nutritional and behavioral approaches is even more relevant in the COVID-19 era, in addition to the need for further elucidation regarding several diseases/conditions. One of these concerning body composition (in this context; bone, lean and adipose tissue) is osteosarcopenic adiposity (OSA) syndrome. OSA occurs most often with aging, but also in cases of some chronic diseases and is exacerbated with the presence of low-grade chronic inflammation (LGCI). OSA has been associated with poor nutrition, metabolic disorders and diminished functional abilities. This paper addresses various influences on OSA and LGCI, as well as their mutual action on each other, and provides nutritional and behavioral approaches which could be personalized to help with either preventing or managing OSA and LGCI in general, and specifically in the time of the COVID-19 pandemic. Addressed in more detail are nutritional recommendations for and roles of macro- and micronutrients and bioactive food components; the microbiome; and optimal physical activity regimens. Other issues, such as food insecurity and nutritional inadequacy, circadian misalignment and shift workers are addressed as well. Since there is still a lack of longer-term primary studies in COVID-19 patients (either acute or recovered) and interventions for OSA improvement, this discussion is based on the existing knowledge, scientific hypotheses and observations derived from similar conditions or studies just being published at the time of this writing.

Bone Diseases in Patients with Chronic Liver Disease

Osteoporosis is a frequently observed complication in patients with chronic liver disease, particularly liver cirrhosis and cholestatic liver diseases. In addition, osteoporosis is critical in patients receiving a liver transplant. Nevertheless, few studies have evaluated bone diseases in patients with more frequently observed chronic liver disease, such as chronic viral hepatitis, nonalcoholic fatty liver disease and alcoholic liver disease. Osteoporosis is a disease caused by an imbalance in the activities of osteoblasts and osteoclasts. Over the last few decades, many advances have improved our knowledge of the pathogenesis of osteoporosis. Importantly, activated immune cells affect the progression of osteoporosis, and chronic inflammation may exert an additional effect on the existing pathophysiology of osteoporosis. The microbiota of the intestinal tract may also affect the progression of bone loss in patients with chronic liver disease. Recently, studies regarding the effects of chronic inflammation on dysbiosis in bone diseases have been conducted. However, mechanisms underlying osteoporosis in patients with chronic liver disease are complex and precise mechanisms remain unknown. The following special considerations in patients with chronic liver disease are reviewed: bone diseases in patients who underwent a liver transplant, the association between chronic hepatitis B virus infection treatment and bone diseases, the association between sarcopenia and bone diseases in patients with chronic liver disease, and the association between chronic liver disease and avascular necrosis of the hip. Few guidelines are currently available for the management of low bone mineral density or bone diseases in patients with chronic liver disease. Due to increased life expectancy and therapeutic advances in chronic liver disease, the importance of managing osteoporosis and other bone diseases in patients with chronic liver disease is expected to increase. Consequently, specific guidelines need to be established in the near future.

Role of Calcium and Low-Fat Dairy Foods in Weight-Loss Outcomes Revisited: Results from the Randomized Trial of Effects on Bone and Body Composition in Overweight/Obese Postmenopausal Women

Several studies have investigated the possibility of dairy foods and calcium (Ca) mediating weight and body composition, but a consensus has not been reached. We aimed to investigate weight-loss-related outcomes during intervention with low-fat dairy foods or Ca + vitamin D supplements, both as complements to hypocaloric diets. Overweight/obese Caucasian, early-postmenopausal women (n = 135) were recruited for a 6 month energy-restricted weight loss study complemented with either low-fat dairy foods (D; 4–5 servings/day), or Ca + vitamin D supplements (S); both to amount a total of ~1500 mg/day and 600 IU/day of Ca and vitamin D, respectively, or placebo pills (C). Bone mineral density (BMD) and lean and fat tissue were measured by Lunar iDXA. Serum and urinary markers of bone turnover were analyzed. Diet and physical activity were assessed with 3-day records. Participants on average lost ~4%, ~3%, and ~2% of body weight, fat, and lean tissue, respectively. The significantly better outcomes were noticed in participants in the D group regarding body composition (fat loss/lean tissue preservation) and in participants in the S group regarding the BMD outcomes, compared to those in the C group. Therefore, increasing low-fat dairy foods to 4–5 servings/day and/or increasing Ca & vitamin D intake by supplements (in those who are at the borderline dietary intake) may be beneficial for weight loss/maintenance and may lead to more favorable bone and body composition outcomes in postmenopausal women during moderate weight loss.

Associations among Geriatric Nutrition Risk Index, bone mineral density, body composition and handgrip strength in patients receiving hemodialysis

OBJECTIVES

Malnutrition occurs as a complication of hemodialysis (HD) and has been identified as a risk factor for osteoporosis, sarcopenia, and low physical performance. The aim of this study was to assess the associations among nutrition, bone mineral density (BMD), body composition, and handgrip strength (HGS) in patients receiving HD.

METHODS

We enrolled 164 patients receiving HD who have undergone the dual energy x-ray absorptiometry (DXA) examination, categorized according to baseline Geriatric Nutritional Risk Index (GNRI) values calculated by serum albumin levels and body weight index. GNRI was used to evaluate nutritional status, and DXA to investigate BMD and body composition. Additionally, HGS test was performed. Multiple stepwise linear regression analysis was used to identify the factors associated with BMD, T-score, and HGS.

RESULTS

Compared with patients with tertile 1 of GNRI, those with tertile 3 of GNRI tend to have higher lumbar spine BMD and T-score, higher femoral neck BMD, higher total hip BMD, higher left distal mid-third radius BMD and T-score, higher fat mass index, higher android-to-gynoid ratio, higher lean mass index, and higher HGS. An increase in GNRI tertile was associated with an increase of BMD and a decrease of osteoporosis prevalence. The GNRI was positively correlated with BMD and T-score, body composition, and HGS. Low lean mass index and high parathyroid hormone were significantly associated with low BMD and T-score. Additionally, high GNRI and high left distal mid-third radius BMD were significantly associated with high HGS.

CONCLUSIONS

The present study demonstrated that good nutrition, indicated as high GNRI, resulted in higher BMD and T-score, lean mass index, and HGS in patients receiving HD. Using GNRI to evaluate nutritional status and using DXA to investigate BMD and body composition in patients receiving HD is important to bone health and physical performance.

Osteosarcopenic obesity in women: impact, prevalence, and management challenges

Osteosarcopenic obesity syndrome (OSO) has recently been identified as a condition encompassing osteopenia/osteoporosis, sarcopenia and obesity. OSO is especially deleterious in older adults (even if they are not obese by conventional measures), due to age-related redistribution of fat and its infiltration into bone and muscle. Osteoporosis and bone fractures in elderly increase the risk of sarcopenia, which, through decreased mobility, increases the risk of more falls and fractures, creating a vicious cycle. Obesity plays a dual role: to a certain extent, it promotes bone and muscle gains through mechanical loading; in contrast, increased adiposity is also a source of pro-inflammatory cytokines and other endocrine factors that impair bone and muscle. As the elderly population increases, changes in lifestyle to delay the onset of OSO, or prevent OSO, are warranted. Among these changes, dietary patterns and physical activity modifications are the first ones to be implemented. The typical Western diet (and lifestyle) promotes several chronic diseases including OSO, by facilitating a pro-inflammatory state, largely via the imbalance in omega-6/omega-3 fatty acid ratio and low-fiber and high-processed food consumption. Nutritional modifications to prevent and/or alleviate the OSO syndrome include adequate intake of protein, calcium, magnesium and vitamin D and increasing consumptions of foods containing omega-3 polyunsaturated fatty acids and fiber. Certain types of physical activity, often decreased in overweight/obese women and in elderly, might preserve bone and muscle, as well as help in reducing body fat accrual and fat infiltration. Habitual daily activities and some alternative modes of exercise may be more appropriate for older adults and play a crucial role in preventing bone and muscle loss and maintaining optimal weight. In conclusion, older adults who suffer from OSO syndrome may benefit from combined efforts to improve diet and physical activity, and such recommendations should be fostered as part of public health programs.

Objectively measured physical activity is associated with parameters of bone in 70-year-old men and women

As the world's population ages, the occurrence of osteoporosis-related fractures is projected to increase. Low areal bone mineral density (aBMD), a well-known risk factor for fractures, may be influenced by physical activity (PA). In this cross-sectional study, we aimed to investigate potential associations between objective measures of PA and bone properties, in a population-based cohort of 1228 70-year-old men and women. We measured volumetric BMD (vBMD, mg/cm(3)) together with cross-sectional area (CSA, mm(2)) by peripheral quantitative computed tomography at sites located 4% and 66% in the distal-proximal trajectory at the tibia and radius. We also measured aBMD (g/cm(2)) by dual energy X-ray absorptiometry at the femoral neck, lumbar spine (L1-L4) and radius. Participants wore triaxial accelerometers for 7 consecutive days to obtain objective estimates of PA. The intensity of the objective PA was divided into light (100-1951 counts/min [CPM]), moderate (1952-5724 cpm) and vigorous (≥ 5725 cpm). Maximal accelerations for the anterior-posterior (z), medio-lateral (x), and vertical (y) axes were also separately assessed. Associations were investigated using bivariate correlations and multiple linear regression, adjusted for height, weight and sex. Vigorous PA showed the strongest association with femoral neck aBMD (β=0.09, p<0.001), while both moderate and vigorous PAs were associated with cortical area and trabecular vBMD in the weight-bearing tibia (all p<0.05). Peak vertical accelerations were associated significantly with cortical area (β=0.09, p<0.001) and trabecular vBMD (β=0.09, p=0.001) of the tibia, whereas peak anterior-posterior accelerations showed no correlation with these properties. No positive association was found between objectively measured PA and bone parameters of the radius. In conclusion, vertical accelerations and moderate to vigorous PA independently predict bone properties, especially in the weight-bearing tibia, in 70-year-old men and women.

Osteosarcopenic obesity is associated with reduced handgrip strength, walking abilities, and balance in postmenopausal women

We determined the prevalence of osteosarcopenic obesity (loss of bone and muscle coexistent with increased adiposity) in overweight/obese postmenopausal women and compared their functionality to obese-only women. Results showed that osteosarcopenic obese women were outperformed by obese-only women in handgrip strength and walking/balance abilities indicating their higher risk for mobility impairments.

INTRODUCTION

Osteosarcopenic obesity (OSO) is a recently defined triad of osteopenia/osteoporosis, sarcopenia, and adiposity. We identified women with OSO in overweight/obese postmenopausal women and evaluated their functionality comparing them with obese-only (OB) women. Additionally, women with osteopenic/osteoporotic obesity (OO), but no sarcopenia, and those with sarcopenic obesity (SO), but no osteopenia/osteoporosis, were identified and compared. We hypothesized that OSO women will have the lowest scores for each of the functionality measures.

METHODS

Participants (n = 258; % body fat ≥35) were assessed using a Lunar iDXA instrument for bone and body composition. Sarcopenia was determined from negative residuals of linear regression modeled on appendicular lean mass, height, and body fat, using 20th percentile as a cutoff. Participants with T-scores of L1-L4 vertebrae and/or total femur <-1, but without sarcopenia, were identified as OO (n = 99) and those with normal T-scores, but with sarcopenia, as SO (n = 28). OSO (n = 32) included women with both osteopenia/osteoporosis and sarcopenia, while those with normal bone and no sarcopenia were classified as OB (n = 99). Functionality measures such as handgrip strength, normal/brisk walking speed, and right/left leg stance were evaluated and compared among groups.

RESULTS

Women with OSO presented with the lowest handgrip scores, slowest normal and brisk walking speed, and shortest time for each leg stance, but these results were statistically significantly different only from the OB group.

CONCLUSION

These findings indicate a poorer functionality in women presenting with OSO, particularly compared to OB women, increasing the risk for bone fractures and immobility from the combined decline in bone and muscle mass, and increased fat mass.

Osteosarcopenic obesity: the role of bone, muscle, and fat on health

Osteopenia/osteoporosis, sarcopenia, and obesity are commonly observed in the process of aging, and recent evidence suggests a potential interconnection of these syndromes with common pathophysiology. The term osteosarcopenic obesity has been coined to describe the concurrent appearance of obesity in individuals with low bone and muscle mass. Although our understanding of osteosarcopenic obesity's etiology, prevalence, and consequences is extremely limited, it is reasonable to infer its negative impact in a population that is aging in an obesogenic environment. It is likely that these individuals will present with poorer clinical outcomes caused by the cascade of metabolic abnormalities associated with these changes in body composition. Clinical outcomes include but are not limited to increased risk of fractures, impaired functional status (including activities of daily living), physical disability, insulin resistance, increased risk of infections, increased length of hospital stay, and reduced survival. These health outcomes are likely to be worse when compared to individuals with obesity, sarcopenia, or osteopenia/osteoporosis alone. Interventions that utilize resistance training exercise in conjunction with increased protein intake appear to be promising in their ability to counteract osteosarcopenic obesity.

Reducing cardiovascular disease risk in mid-life and older African Americans: a church-based longitudinal intervention project at baseline

INTRODUCTION

African Americans (AAs) experience higher age-adjusted morbidity and mortality than Whites for cardiovascular disease (CVD). Church-based health programs can reduce risk factors for CVD, including elevated blood pressure [BP], excess body weight, sedentary lifestyle and diet. Yet few studies have incorporated older adults and longitudinal designs.

PURPOSES

The aims of this study are to: a) describe a theory-driven longitudinal intervention study to reduce CVD risk in mid-life and older AAs; b) compare selected dietary (fruit and vegetable servings/day, fat consumption), physical activity (PA) and clinical variables (BMI, girth circumferences, systolic and diastolic BP, LDL, HDL, total cholesterol [CHOL] and HDL/CHOL) between treatment and comparison churches at baseline; c) identify selected background characteristics (life satisfaction, social support, age, gender, educational level, marital status, living arrangement and medication use) at baseline that may confound results; and d) share the lessons learned.

METHODS

This study incorporated a longitudinal pre/post with comparison group quasi-experimental design. Community-based participatory research (CBPR) was used to discover ideas for the study, identify community advisors, recruit churches (three treatment, three comparison) in two-counties in North Florida, and randomly select 221 mid-life and older AAs (45+) (n=104 in clinical subsample), stratifying for age and gender. Data were collected through self-report questionnaires and clinical assessments.

RESULTS AND CONCLUSIONS

Dietary, PA and clinical results were similar to the literature. Treatment and comparison groups were similar in background characteristics and health behaviors but differed in selected clinical factors. For the total sample, relationships were noted for most of the background characteristics. Lessons learned focused on community relationships and participant recruitment.

Aerobic exercise and whole-body vibration in offsetting bone loss in older adults

Osteoporosis and its associated fractures are common complications of aging and most strategies to prevent and/or treat bone loss focused on antiresorptive medications. However, aerobic exercise (AEX) and/or whole-body vibration (WBV) might have beneficial effect on bone mass and provide an alternative approach to increase or maintain bone mineral density (BMD) and reduce the risk of fractures. The purpose of this paper was to investigate the potential benefits of AEX and WBV on BMD in older population and discuss the possible mechanisms of action. Several online databases were utilized and based on the available literature the consensus is that both AEX and WBV may increase spine and femoral BMD in older adults. Therefore, AEX and WBV could serve as nonpharmacological and complementary approaches to increasing/maintaining BMD. However, it is uncertain if noted effects could be permanent and further studies are needed to investigate sustainability of either type of the exercise.

Higher habitual sodium intake is not detrimental for bones in older women with adequate calcium intake

Based on the calciuric effect of sodium (Na), it has been speculated, although not proven, that higher Na intake might have a detrimental effect on bone health. The objective was to determine the relationship between Na intake (expressed as urinary Na) and bone mineral density/content (BMD/BMC) during a 3-year study. Participants were healthy, postmenopausal, Caucasian women (n = 136 at baseline) with no medications affecting bone. After baseline screening, half were instructed to reduce sodium intake to approximately 1,500 mg/day (intervention). The other half remained on habitual intake of approximately 3,000 mg/day (control). All subjects were given calcium and vitamin D supplements to achieve recommended levels. Anthropometries, densitometry, blood and 24-h urine analyses, and dietary and activity records were assessed every 6 months. Data were analyzed as a continuum, irrespective of the initial assignment to a control or intervention group, using random effects regressions with repeated measures analysis of variance to examine changes over time. Results showed that subjects with higher Na intake had higher BMD in the forearm and spine at baseline and all subsequent time-points (p < 0.01). In the forearm, time and higher urinary calcium modified results, producing a curvilinear decrease in BMD (p < 0.01). In the spine, more active individuals had higher BMD at all time-points. We conclude that higher sodium intake, within the range consumed, had a positive effect on some skeletal sites and no adverse effect on bone in women who had adequate calcium and vitamin D intake.

Menopause and physical performance--a community-based cross-sectional study

OBJECTIVES

The aim of this study was to test whether menopause is associated with decreased physical performance and to determine the risk factors accounting for a decline in physical performance.

METHODS

We recruited 979 women (mean +/-SD age, 48.4 +/- 3.9 y; range, 43-57 y) from a community population in Taiwan. Menopause status (435 women [44.4%] in premenopause, 253 [25.8%] in perimenopause, and 291 [29.7%] in postmenopause) was determined by menstrual history. All women underwent three dimensions of physical performance assessment: flexibility was evaluated by stand-and-reach and sit-and-reach tests; muscular strength was determined by the grip and pinch strength tests; and balance was assessed by one-legged standing with eyes open or closed.

RESULTS

Flexibility did not vary among women in different menopausal states. Perimenopausal or postmenopausal women had weaker grip strength than premenopausal women (27.7 +/- 6.5, 25.1 +/- 6.5, and 23.5 +/- 6.5 kg for premenopausal, perimenopausal, and postmenopausal states, respectively; P < 0.001) and shorter standing balance time (93.9 +/- 33.7, 88.7 +/- 34.9, and 78.4 +/- 39.5 s for premenopausal, perimenopausal, postmenopausal states, respectively; P < 0.001). In a multivariate analysis, the associations of decreased grip strength and poor balance with menopause status remained significant after adjustment for baseline characteristics.

CONCLUSIONS

Menopause is an independent predictor of decreased muscle strength and balance.