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Lee J, Yoon I, Cha H, Kim HJ, Ryu OH. Inverted U-Shaped Relationship between Obesity Parameters and Bone Mineral Density in Korean Adolescents. J Clin Med 2023; 12:5869. [PMID: 37762810 PMCID: PMC10532009 DOI: 10.3390/jcm12185869] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/29/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
As the association between obesity and bone health remains controversial in children and adolescents, we investigate the effects of obesity parameters on bone mineral density (BMD) in 2060 Korean adolescents who participated in the 2008-2011 Korea National Health and Nutrition Examination Survey (KNHANES). Multiple regression analysis and analysis of covariance (ANCOVA) were conducted to examine both the linear and non-linear associations between total-body-less-head (TBLH) BMD and four obesity parameters: body mass index, waist circumference, waist-to-height ratio, and total-body fat mass (FM). In a multiple linear regression analysis adjusted for age, menarcheal status (in females only), and total-body lean mass, there was no significant linear association between obesity parameters and TBLH BMD, except for total-body FM in males. However, upon adding a second-order polynomial term for each obesity parameter, a significant quadratic relationship between all obesity parameters and TBLH BMD was observed, with the corresponding quadratic term being negative. The results of ANCOVA also revealed an inverted U-shaped relationship between each obesity parameter and TBLH BMD. Our findings suggest the existence of an optimal range of obesity parameters for developing or maintaining optimal bone health in Korean Adolescents. Deviation from this range, in either direction (being underweight or having obesity), may compromise bone health.
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Affiliation(s)
- Jongseok Lee
- School of Artificial Intelligence Convergence, Hallym University, Chuncheon 24253, Republic of Korea; (I.Y.); (H.C.); (H.-J.K.)
| | - Insang Yoon
- School of Artificial Intelligence Convergence, Hallym University, Chuncheon 24253, Republic of Korea; (I.Y.); (H.C.); (H.-J.K.)
| | - Hwajung Cha
- School of Artificial Intelligence Convergence, Hallym University, Chuncheon 24253, Republic of Korea; (I.Y.); (H.C.); (H.-J.K.)
| | - Ho-Jung Kim
- School of Artificial Intelligence Convergence, Hallym University, Chuncheon 24253, Republic of Korea; (I.Y.); (H.C.); (H.-J.K.)
| | - Ohk-Hyun Ryu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Chuncheon 24253, Republic of Korea
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Ben Tahar S, Garnier J, Eller K, DiMauro N, Piet J, Mehta S, Bajpayee AG, Shefelbine SJ. Adolescent obesity incurs adult skeletal deficits in murine induced obesity model. J Orthop Res 2023; 41:386-395. [PMID: 35578981 DOI: 10.1002/jor.25378] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/06/2022] [Accepted: 05/14/2022] [Indexed: 02/04/2023]
Abstract
Adolescent obesity has risen dramatically in the last few decades. While adult obesity may be osteoprotective, the effects of obesity during adolescence, which is a period of massive bone accrual, are not clear. We used a murine model of induced adolescent obesity to examine the structural, mechanical, and compositional differences between obese and healthy weight bone in 16-week-old female C57Bl6 mice. We also examined the effects of a return to normal weight after skeletal maturity (24 weeks old). We found obese adolescent bone exhibited decreased trabecular bone volume, increased cortical diameter, increased ultimate stress, and increased brittleness (decreased plastic energy to fracture), similar to an aging phenotype. The trabecular bone deficits remained after return to normal weight after skeletal maturity. However, after returning to normal diet, there was no difference in ultimate stress nor plastic energy to fracture between groups as the normal diet group increased ultimate stress and brittleness. Interestingly, compositional changes appeared in the former high-fat diet mice after skeletal maturity with a lower mineral to matrix ratio compared to normal diet mice. In addition there was a trend toward increased fluorescent advanced glycation endproducts in the former high-fat diet mice compared to normal diet mice but this did not reach significance (p < 0.05) due to the large variability. The skeletal consequences of adolescent obesity may have lasting implications for the adult skeleton even after return to normal weight. Given the rates of adolescent obesity, skeletal health should be a concern.
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Affiliation(s)
- Soha Ben Tahar
- Department of Bioengineering, Northeastern University, Boston, Massachusetts, USA
| | - Julien Garnier
- Department of Bioengineering, Northeastern University, Boston, Massachusetts, USA
| | - Kerry Eller
- Department of Bioengineering, Northeastern University, Boston, Massachusetts, USA
| | - Nicole DiMauro
- Department of Bioengineering, Northeastern University, Boston, Massachusetts, USA
| | - Judith Piet
- Department of Bioengineering, Northeastern University, Boston, Massachusetts, USA
| | - Shihkar Mehta
- Department of Bioengineering, Northeastern University, Boston, Massachusetts, USA
| | - Ambika G Bajpayee
- Department of Bioengineering, Northeastern University, Boston, Massachusetts, USA
| | - Sandra J Shefelbine
- Department of Bioengineering, Northeastern University, Boston, Massachusetts, USA.,Department of Mechanical and Industrial Engineering, Northeastern University, Boston, Massachusetts, USA
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Bergamo RR, Páscoa MA, Hespanhol JE, de Moraes AM, Guerra-Júnior G. Positive association of lean mass and negative association of protein intake on bone mass and bone geometry of adolescent soccer players. Nutrition 2023; 105:111857. [PMID: 36308916 DOI: 10.1016/j.nut.2022.111857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the association of food consumption and body composition on bone parameters in adolescent soccer players. METHODS There were 148 male soccer players 12 to 18 y who participated in the study. Body composition was assessed by dual energy x-ray absorptiometry, comprising bone mineral density (BMD) and bone mineral content (BMC) of total body without head (TBLH), lumbar spine (L1-L4), and right femoral neck (RFN). The bone geometry variables measured were femoral strength index (FSI), buckling ratio (BR), section modulus (Z), cross-sectional moment of inertia (CSMI), and cross-sectional area (CSA). Food intake was analyzed using the 24-h food recall. Somatic maturation was estimated by the peak height velocity equation. For the statistical analysis, the stepwise multiple linear regression was used, with P < 0.05. RESULTS Regarding food consumption, there was a high protein intake and low calcium intake. Lean mass was a predictor of BMC of TBLH (R2 = 0.524), L1-L4 (R2 = 0.492), and RFN (R2 = 0.405); BMD of L1-L4 (R2 = 0.407) and RFN (R2 = 0.27); Z (R2 = 0.683), CSMI (R2 = 0.630), and CSA (R2 = 0.640). There was a negative correlation between protein intake with bone mass and bone geometry parameters. CONCLUSION In adolescent soccer players, lean mass was a predictor of bone parameters, and high protein intake was negatively associated with bone mass and geometry.
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Affiliation(s)
- Raiany Rosa Bergamo
- Laboratory of Growth and Development (LabCreD), Pediatrics Research Center (CIPED), Faculty of Medical Sciences (FCM), University of Campinas (Unicamp), Campinas, Sao Paulo, Brazil.
| | - Mauro Alexandre Páscoa
- Laboratory of Growth and Development (LabCreD), Pediatrics Research Center (CIPED), Faculty of Medical Sciences (FCM), University of Campinas (Unicamp), Campinas, Sao Paulo, Brazil
| | | | - Anderson Marques de Moraes
- Faculty of Physical Education (FEF), Pontifical Catholic University of Campinas (PUCCAMP), Campinas, Sao Paulo, Brazil
| | - Gil Guerra-Júnior
- Laboratory of Growth and Development (LabCreD), Pediatrics Research Center (CIPED), Faculty of Medical Sciences (FCM), University of Campinas (Unicamp), Campinas, Sao Paulo, Brazil
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Mengel E, Tamme R, Remmel L, Purge P, Mäestu E, Jürimäe J, Tillmann V. Pubertal increment in insulin resistance is negatively related to lumbar bone mineral density in 18-year-old males. Osteoporos Int 2023; 34:161-170. [PMID: 36367566 DOI: 10.1007/s00198-022-06591-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 10/26/2022] [Indexed: 11/13/2022]
Abstract
UNLABELLED Transient insulin resistance seen during puberty is expected to favour body growth, but our results show that increment in insulin resistance even in physiological ranges during puberty might compromise lumbar spine bone mineral density accrual independently of body composition parameters, and therefore adult bone quality might be challenged. INTRODUCTION Insulin resistance (IR) might have a compromising effect on growing bone, and therefore adult bone quality might be challenged. The aim of the present study was to identify whether increases in IR during puberty contribute to bone mineral characteristics in males independently of body composition parameters. METHODS This is a retrospective cohort-based longitudinal observational study. Data from 85 subjects were included. Boys were studied annually during their pubertal years (12 years at baseline) and at follow-up at the age of 18 years. Anthropometry, bone age, fasting blood samples, body composition, total body, and lumbar spine bone mineral characteristics were measured. Insulin resistance was determined by homeostatic model assessment of IR (HOMA-IR). Multiple regression analysis was performed to determine the effect of changes in HOMA-IR during pubertal years as a longitudinal predictor to fixed bone mineral outcome variables at the age of 18 years. All models were adjusted to potential clinically justified confounding variables. RESULTS After adjustment to baseline bone indices and body composition-related predictors, the pubertal increment in the HOMA-IR was a negative independent predictor of lumbar spine bone mineral areal density (β = - 0.202, p = 0.005) and lumbar spine bone mineral apparent density (β = - 0.235, p = 0.005) in 18-year-old males. CONCLUSIONS Pubertal increment in IR has a potential diminishing effect on lumbar spine bone mineral density accrual independently of body composition parameters. Further studies are needed to clarify whether monitoring HOMA-IR during puberty may identify subjects at increased risk of low peak bone mass and possible osteoporosis in the future.
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Affiliation(s)
- Eva Mengel
- Institute of Clinical Medicine, University of Tartu, 51007, Tartu, Estonia.
- Tartu Health Care College, 50411, Tartu, Estonia.
| | - Reeli Tamme
- Institute of Clinical Medicine, University of Tartu, 51007, Tartu, Estonia
- Children's Clinic of Tartu University Hospital, 50406, Tartu, Estonia
| | - Liina Remmel
- Institute of Sports Sciences and Physiotherapy, University of Tartu, 51007, Tartu, Estonia
| | - Priit Purge
- Institute of Sports Sciences and Physiotherapy, University of Tartu, 51007, Tartu, Estonia
| | - Evelin Mäestu
- Institute of Sports Sciences and Physiotherapy, University of Tartu, 51007, Tartu, Estonia
| | - Jaak Jürimäe
- Institute of Sports Sciences and Physiotherapy, University of Tartu, 51007, Tartu, Estonia
| | - Vallo Tillmann
- Institute of Clinical Medicine, University of Tartu, 51007, Tartu, Estonia
- Children's Clinic of Tartu University Hospital, 50406, Tartu, Estonia
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Wang GX, Fang ZB, Li HL, Liu DL, Chu SF, Zhao HX. Effect of obesity status on adolescent bone mineral density and saturation effect: A cross-sectional study. Front Endocrinol (Lausanne) 2022; 13:994406. [PMID: 36313745 PMCID: PMC9613945 DOI: 10.3389/fendo.2022.994406] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/28/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The effect of obesity status on bone mineral density (BMD) in adolescents and whether there is a saturation effect is still insufficient. A cross-sectional study of adolescents aged 12-19 was conducted to investigate them. METHODS Weighted multivariate linear regression models were used to assess the relationship between obesity status and BMD via datasets from the National Health and Nutrition Examination Survey 2011-2018. The nonlinear relationships and saturation values were ascertained by fitting smooth curves and analyzing saturation effects. At the same time, the subgroup stratified analysis was also performed. RESULTS 4056 adolescents were included in this study. We found that body mass index (BMI) and waist circumference (WC) were significantly associated with total BMD, which remained significant in subgroups stratified by age, gender, standing height, and ethnicity. We also noticed an inverse correlation between left leg fat/lean mass and left leg BMD, which was only significant in males and other races. Fitting smooth curve and saturation effect analysis showed that BMI, WC, left leg fat/lean mass, and BMD had a specific saturation effect. There was a saturation effect on bone mineral density in adolescents with a BMI of 22 kg/m2, a WC of 70.5 cm, or a left leg fat/lean mass of 0.2994. CONCLUSIONS We found a positive saturation effect of BMI and WC with BMD and a negative saturation effect of left leg fat/lean mass with BMD. Appropriate obesity status allows adolescents to have better bone mass development but not excessive obesity.
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Affiliation(s)
- Gao-Xiang Wang
- Department of Endocrinology, Shenzhen Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Shenzhen, China
- Department of Endocrinology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Ze-Bin Fang
- Department of Endocrinology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
- Department of Endocrinology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Hui-Lin Li
- Department of Endocrinology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
- *Correspondence: Hui-Lin Li, ; De-Liang Liu,
| | - De-Liang Liu
- Department of Endocrinology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
- *Correspondence: Hui-Lin Li, ; De-Liang Liu,
| | - Shu-Fang Chu
- Department of Endocrinology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Heng-Xia Zhao
- Department of Endocrinology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
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Julian V, Costa D, O'Malley G, Metz L, Fillon A, Miguet M, Cardenoux C, Dutheil F, Boirie Y, Duclos M, Courteix D, Pereira B, Thivel D. Bone Response to High-Intensity Interval Training versus Moderate-Intensity Continuous Training in Adolescents with Obesity. Obes Facts 2022; 15:46-54. [PMID: 34864737 PMCID: PMC8820153 DOI: 10.1159/000519271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Since adolescents with obesity are prone to bone fragility during weight loss, the aim was to compare the impact of high-intensity interval training (HIIT) versus moderate-intensity continuous training (MICT) on bone density, geometry, and strength. METHODS Sixty-one adolescents were randomly assigned to 2 cycling trainings (HIIT and MICT) and a control (CTR, without training) group. Anthropometry, dual-energy X-ray absorptiometry with hip structural analysis and the trabecular bone score (TBS) were assessed before and after the 16-week intervention. RESULTS Body mass index (BMI) and fat mass (FM) percentage decreased at T1 versus T0 in both training groups (p < 0.001 for HIIT, p = 0.01 for MICT), though to a larger extent in HIIT (p < 0.05). Total body bone mineral density (BMD) and bone mineral content (BMC) increased in both training groups (p < 0.001), but to a greater extent in HIIT for BMC (p < 0.05). Lumbar spine BMD and BMC increased in both training groups (p < 0.001 for HIIT, p < 0.01 for MICT), with a time × group interaction between HIIT and CTR (p < 0.05) only. TBS increased in both training groups (p < 0.01 for HIIT, p < 0.05 for MICT). Hip BMD and BMC increased in both HIIT (p < 0.001 and p < 0.01) and MICT (p < 0.01 and p < 0.05). At the narrow neck (NN), endocortical diameter, width (p < 0.01), cross-sectional moment of inertia, and section modulus (Z) (p < 0.05) increased only in the HIIT group, such as BMD and Z (p < 0.05) at the intertrochanteric region (IT) and average cortical thickness (p < 0.001) and width (p < 0.05) at the femoral shaft. At the NN and IT, the buckling ratio decreased only in the HIIT group (p < 0.05), predicting higher resistance to fracture. CONCLUSIONS In addition to inducing greater BMI and FM percentage decreases in comparison to MICT, HIIT improves multisite bone density, geometry, and strength, which heighten the justification for HIIT as part of weight loss interventions in adolescents with obesity.
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Affiliation(s)
- Valérie Julian
- Department of Sport Medicine and Functional Explorations, University Teaching Hospital of Clermont-Ferrand, Diet and Musculoskeletal Health Team, CRNH, INRA, University of Clermont Auvergne, Clermont-Ferrand, France
- *Valérie Julian,
| | - Daniela Costa
- University of Coimbra, FCDEF, CIDAF, Coimbra, Portugal
- Portuguese Foundation for Science and Technology (SFRH/BD/136193/2018), Lisbon, Portugal
| | - Grace O'Malley
- School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, W82GO Child and Adolescent Weight Management Service, Dublin, Ireland
| | - Lore Metz
- Laboratory AME2P, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Alicia Fillon
- Laboratory AME2P, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Maud Miguet
- Laboratory AME2P, University of Clermont Auvergne, Clermont-Ferrand, France
| | | | - Frédéric Dutheil
- Department of Occupational Medicine, University Teaching Hospital of Clermont-Ferrand, LAPSCO − Laboratory of Social and Cognitive Psychology, Clermont-Ferrand, France
| | - Yves Boirie
- Department of Clinical Nutrition, University Teaching Hospital of Clermont-Ferrand, Diet and Musculoskeletal Health Team, CRNH, INRA, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Martine Duclos
- Department of Sport Medicine and Functional Explorations, University Teaching Hospital of Clermont-Ferrand, Diet and Musculoskeletal Health Team, CRNH, INRA, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Daniel Courteix
- Laboratory AME2P, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Bruno Pereira
- Department of Biostatistics, University Teaching Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - David Thivel
- Laboratory AME2P, University of Clermont Auvergne, Clermont-Ferrand, France
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Julian V, O'Malley G, Metz L, Weghuber D, Courteix D, Fillon A, Boirie Y, Duclos M, Pereira B, Thivel D. Does the severity of obesity influence bone density, geometry and strength in adolescents? Pediatr Obes 2021; 16:e12826. [PMID: 34171175 DOI: 10.1111/ijpo.12826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/12/2021] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Relationships between the severity of obesity and bone health remain underexplored. OBJECTIVES To compare whole-body and localized bone mineral content (BMC) and density (BMD), trabecular bone score (TBS) and hip geometry and strength between adolescents with obesity versus extreme obesity. METHODS This cross-sectional study included 154 adolescents (12-15 years, 62% females) who were classified as having obesity (OG, [95th-99th] percentile) or extreme obesity (EOG, >99th percentile). Fat mass (FM), lean mass (LM), BMC, BMD for total-body-less-head (TBLH), lumbar spine (LS), hip, TBS and geometric and strength indices at the narrow-neck (NN), femoral shaft (FS) and intertrochanteric regions (IT) were assessed by Dual-X-ray Absorptiometry (DXA). RESULTS There was no significant sex-interaction. For both sexes, TBLH BMC and BMD were not different between groups. TBS was lower in EOG compared with OG in both sexes in univariate analysis and after adjustment with maturation and body weight (p < 0.05). Hip BMD was significantly higher in the EOG compared to OG only after adjustment with maturation and fat mass percentage (p < 0.05 for men, p < 0.01 for women). For both sexes, TBLH, LS and hip BMC and BMD positively correlated with weight, BMI, LM and FM. TBS negatively correlated with BMI-percentile in both sexes, with a negative correlation with FM for males alone. Hip BMC and BMD, BMD, ACT and CSA at the three hip sites positively correlated with BMI-percentile in males. CONCLUSIONS Extreme obesity impacts bone health depending on anatomical sites, altering lumbar trabecular bone in both males and females adolescents.
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Affiliation(s)
- Valérie Julian
- Department of Sport Medicine and Functional Explorations, University Teaching Hospital of Clermont-Ferrand, Diet and Musculoskeletal Health Team, CRNH, INRA, University of Clermont Auvergne, Clermont-Ferrand, France.,Department of Pediatrics, Paracelsus Medical School, Salzburg, Austria
| | - Grace O'Malley
- School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,W82GO Child and Adolescent Weight Management Service, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Lore Metz
- Laboratory AME2P, University of Clermont Auvergne, Aubière, France
| | - Daniel Weghuber
- Department of Pediatrics, Paracelsus Medical School, Salzburg, Austria
| | - Daniel Courteix
- Laboratory AME2P, University of Clermont Auvergne, Aubière, France
| | - Alicia Fillon
- Laboratory AME2P, University of Clermont Auvergne, Aubière, France
| | - Yves Boirie
- Department of Clinical Nutrition, University Teaching Hospital of Clermont-Ferrand, Diet and Musculoskeletal Health Team, CRNH, INRA, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Martine Duclos
- Department of Sport Medicine and Functional Explorations, University Teaching Hospital of Clermont-Ferrand, Diet and Musculoskeletal Health Team, CRNH, INRA, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Bruno Pereira
- Department of Biostatistics, University Teaching Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - David Thivel
- Laboratory AME2P, University of Clermont Auvergne, Aubière, France
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Association between Body Composition and Bone Mineral Density in Children and Adolescents: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212126. [PMID: 34831882 PMCID: PMC8618958 DOI: 10.3390/ijerph182212126] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/16/2021] [Indexed: 11/16/2022]
Abstract
Background: Bone mass acquisition during growth is a major determinant of the risk of developing osteoporosis later in life. Body composition is an anthropometric determinant of bone mineral density (BMD) and significantly influences its development during childhood and adolescence. Objective: This study aimed to systematically examine the association between body composition and bone mineral density in children and adolescents. Methods: Observational studies addressing this association were identified from PubMed (MEDLINE), Embase, Scopus and the Cochrane Library (up to January 2021). The study populations consisted of healthy children and adolescents. The DerSimonian and Laird method was used to compute pooled estimates of effect size and the respective 95% confidence intervals for upper limbs, femoral neck (FN), lumbar spine (LS) and total body, respectively. Subgroup analyses were further performed based on age, sex and ethnicity. Results: Thirty-one published studies were eligible for inclusion in this systematic review and meta-analysis, including three longitudinal studies. The combined population from all the studies amounted to 21,393 (11,205 males and 10,188 females). The pooled estimates of the correlation coefficients for lean mass (LM) and BMD ranged from 0.53 to 0.74 (p < 0.050), and the pooled regression coefficients ranged from 0.23 to 0.79 for FN, LS and total body (p < 0.050). For fat mass (FM), the pooled correlation coefficients ranged from 0.10 to 0.50 (p < 0.050) and the pooled regression coefficient was only significant for FN BMD with a weak strength (pooled β = 0.07, p < 0.050). The pooled regression coefficients for body fat percentage (BF%) were between −0.54 and −0.04 (p < 0.050). The subgroup analysis revealed a stronger association in Asians than in Caucasians for LM and in males compared to females for BF% (p < 0.050). Conclusions: This systematic review and meta-analysis supports a positive association between LM and BMD. BF% appears to have a deleterious effect on bone acquisition in children and adolescents.
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Wang L, Xu Z, Li N, Meng X, Wang S, Yu C, Leng J, Zhao M, Li W, Deng Y. The association between overweight and obesity on bone mineral density in 12 to 15 years old adolescents in China. Medicine (Baltimore) 2021; 100:e26872. [PMID: 34397903 PMCID: PMC8360441 DOI: 10.1097/md.0000000000026872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 07/14/2021] [Indexed: 01/04/2023] Open
Abstract
Overweight/obesity can influence bone mineral accretion, but the conclusions are not consistent. We aimed to examine the association between bone mineral density (BMD) levels and body mass index (BMI) in 12 to 15 years old adolescents.We performed a cross-sectional study including 8365 adolescents. BMD was evaluated using a quantitative ultrasound device. Z scores for BMI were evaluated using World Health Organization references. Logistic regression models were performed to evaluate the association between BMD levels and BMI.Totally 1866 (22.3%) adolescents had low /reduced BMD, and boys had a higher rate than girls (72.6% vs 27.4%, P < .001). The rates of thinness, normal weight, overweight, and obesity were 2.8%, 57.1%, 22.3%, and 17.8%, respectively. The multivariable-adjusted (age, sex, systolic blood pressure, and height Z score) ORs (95% CIs) of low/reduced BMD associated with BMI groups (thinness, normal [reference], overweight, and obesity) were 0.59 (0.39-0.89), 1.00, 1.61 (1.41-1.84), and 1.98 (1.69-2.30), respectively (Ptrend < .001). This positive association existed in boys and girls though the differences were not significant between normal weight and thin girls. The multivariable-adjusted ORs for each 1-unit increase in BMI Z score were 1.36 (1.24-1.49) for girls, and 1.23 (1.16-1.30) for boys, and 1.26 (1.20-1.32) for all participants.We observed a positive association between BMI and low/reduced BMD in 12 to 15 years old adolescents. More attention should be paid on overweight and obese adolescents to reduce the risk of low BMD. Further studies are needed to explore the mechanisms of this association.
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Affiliation(s)
- Leishen Wang
- Tianjin Women and Children's Health Center, No. 96, Guizhou Rd, Heping District, Tianjin, China
| | - Zhongxian Xu
- Health and Family Planning Service Center for Women and Children in Dongli District, No. 7, Xianfeng Rd, Dongli District, Tianjin, China
| | - Nan Li
- Tianjin Women and Children's Health Center, No. 96, Guizhou Rd, Heping District, Tianjin, China
| | - Xuemei Meng
- Health and Family Planning Service Center for Women and Children in Dongli District, No. 7, Xianfeng Rd, Dongli District, Tianjin, China
| | - Shuo Wang
- Tianjin Women and Children's Health Center, No. 96, Guizhou Rd, Heping District, Tianjin, China
| | - Chengshu Yu
- Health and Family Planning Service Center for Women and Children in Dongli District, No. 7, Xianfeng Rd, Dongli District, Tianjin, China
| | - Junhong Leng
- Tianjin Women and Children's Health Center, No. 96, Guizhou Rd, Heping District, Tianjin, China
| | - Ming Zhao
- Health and Family Planning Service Center for Women and Children in Dongli District, No. 7, Xianfeng Rd, Dongli District, Tianjin, China
| | - Weiqin Li
- Tianjin Women and Children's Health Center, No. 96, Guizhou Rd, Heping District, Tianjin, China
| | - Yanmei Deng
- Health and Family Planning Service Center for Women and Children in Dongli District, No. 7, Xianfeng Rd, Dongli District, Tianjin, China
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Seo YG, Kim Y, Lim H, Kang MJ, Park KH. Relationship Between Bone Mineral Density and Body Composition According to Obesity Status in Children. Endocr Pract 2021; 27:983-991. [PMID: 34144210 DOI: 10.1016/j.eprac.2021.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/03/2021] [Accepted: 06/09/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To analyze the relationship between body composition, metabolic parameters, and bone mineral density (BMD) according to sex and the degree of obesity in children and adolescents. METHODS A total of 236 subjects with obesity, aged 10 to 15 years (36.9% girls), were enrolled. Obesity was classified into simple (SmOb) and extreme (ExOb) forms. The BMD of the total body, less head, was measured by dual energy x-ray absorptiometry, and the BMD z-score was used to evaluate the relationship of body composition with metabolic parameters. RESULTS BMD z-scores were higher in subjects with ExOb than in those with SmOb. Lean mass index (LMI), body mass index z-score, and vitamin D intake showed positive relationships, whereas percentage of body fat and serum leptin level showed negative relationships with BMD z-scores in boys. In girls, LMI and body mass index z-score showed positive relationships with BMD z-scores. In multivariable linear regressions, serum leptin level showed negative relationships with BMD z-score, only in boys. In addition, positive relationships of LMI and negative relationships of percentage of body fat with BMD z-scores were observed in subjects with SmOb. However, positive relationships of LMI with BMD z-scores were attenuated in subjects with ExOb. CONCLUSION High BMD appears to be positively associated with lean mass in children and adolescents with obesity, which might be a natural protective mechanism to withstand the excess weight. However, excessive body fat appears to be negatively associated with BMD, which might attenuate the positive relationship between lean mass and BMD in subjects with ExOb.
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Affiliation(s)
- Young-Gyun Seo
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - YoonMyung Kim
- University College, Yonsei University International Campus, Incheon, Republic of Korea
| | - Hyunjung Lim
- Department of Medical Nutrition, Kyung Hee University, Yongin, Republic of Korea
| | - Min Jae Kang
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea.
| | - Kyung Hee Park
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea.
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11
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Pubertal Physical Activity and Cardiorespiratory Fitness in Relation to Late Adolescent Body Fatness in Boys: A 6-Year Follow-Up Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094881. [PMID: 34063732 PMCID: PMC8125597 DOI: 10.3390/ijerph18094881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/30/2021] [Accepted: 05/02/2021] [Indexed: 11/17/2022]
Abstract
There is a lack of studies investigating whether objectively measured physical activity (PA) and cardiorespiratory fitness (CRF) in puberty is associated with healthier body composition in late adolescence. The study sample included 71 boys, who were measured at puberty (mean age of 12.1 years) and again at late adolescence (mean age of 18.1 years). Physical activity was measured by accelerometry, and total PA, moderate-to-vigorous PA (MVPA), and sedentary time (SED) were calculated, while CRF was assessed by a peak oxygen consumption test. Body composition was measured by dual-energy X-ray absorptiometry, and body fat percentage (%BF), fat mass index (FMI), trunk fat mass index (TFMI), and fat-free mass index (FFMI) were calculated. Body mass index (BMI) and SED time increased, while MVPA, total PA, and CRF decreased from puberty to late adolescence. A relatively high degree of tracking for BMI and CRF, and a low tracking for PA from puberty to late adolescence was observed. Only the CRF value at puberty negatively predicted adolescent BF% (β = -0.221; p = 0.015), FMI (β = -0.212; p = 0.006), and TFMI (β = -0.189; p = 0.015) values. Adolescents whose CRF was above the median at puberty had lower BMI, BF%, FMI, and TFMI in comparison to those whose CRF was below the median at puberty. In conclusion, measured CRF and PA values decreased from puberty to late adolescence. Pubertal CRF predicted body fatness indices six years later in healthy adolescents.
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12
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Influence of weight status on bone mineral content measured by DXA in children. BMC Pediatr 2021; 21:185. [PMID: 33879114 PMCID: PMC8056645 DOI: 10.1186/s12887-021-02665-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/12/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Childhood obesity is a public health problem with repercussions in later life. As tissue formation peaks in childhood we determined how weight status influences bone mineral content. MATERIAL AND METHODS We studied 553 children aged 4-18 years over 10 years (46.8% girls). We measured age, weight, height and through bone densitometry (DXA), bone mineral content (BMC), bone mineral density (BMD), and waist, arm and hip circumferences. The patients were divided into groups using the body mass index z-score: underweight, normal weight, overweight, obese and very obese. RESULTS BMC and BMD values were highest in the normal-weight and overweight groups. Logistic regression showed bone mineralization was inversely associated with waist circumference, the association being positive for weight and age. No differences were found according to sex. DISCUSSION Studies of the relationship between weight and bone mineralization report contradictory results, often because of different study designs. Moreover, studies in children are either few or with small samples. Our findings in a large sample show the importance of weight status in bone mineralization given the risk of bone fractures or osteoporosis. CONCLUSIONS Weight status influenced bone mineralization. BMC and BMD decreased in children with a higher degree of obesity. Waist circumference correlated negatively with bone mineralization.
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Ludwa IA, Mongeon K, Sanderson M, Gracia Marco L, Klentrou P. Testing the Functional Model of Bone Development: Direct and Mediating Role of Muscle Strength on Bone Properties in Growing Youth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063154. [PMID: 33803781 PMCID: PMC8003175 DOI: 10.3390/ijerph18063154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 11/29/2022]
Abstract
This study examines the functional model of bone development in peri-pubertal boys and girls. Specifically, we implemented a mixed-longitudinal design and hierarchical structural models to provide experimental evidence in support of the conceptual functional model of bone development, postulating that the primary mechanical stimulus of bone strength development is muscle force. To this end, we measured radial and tibial bone properties (speed of sound, SOS), isometric grip and knee extensors strength, bone resorption (urinary NTX concentration), body mass index (BMI), somatic maturity (years from peak height velocity) and skeletal maturity (bone age) in 180 children aged 8–16 years. Measurements were repeated 2–4 times over a period of 3 years. The multilevel structural equation modeling of 406 participant-session observations revealed similar results for radial and tibial SOS. Muscle strength (i.e., grip strength for the radial and knee extension for tibial model) and NTX have a significant direct effect on bone SOS (β = 0.29 and −0.18, respectively). Somatic maturity had a direct impact on muscle strength (β = 0.24) and both a direct and indirect effect on bone SOS (total effect, β = 0.30). Physical activity and BMI also had a significant direct impact on bone properties, (β = 0.06 and −0.18, respectively), and an additional significant indirect effect through muscle strength (β = 0.01 and 0.05, respectively) with small differences per bone site and sex. Muscle strength fully mediated the impact of bone age (β = 0.14) while there was no significant effect of energy intake on either muscle strength or bone SOS. In conclusion, our results support the functional model of bone development in that muscle strength and bone metabolism directly affect bone development while the contribution of maturity, physical activity, and other modulators such as BMI, on bone development is additionally modulated through their effect on muscle strength.
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Affiliation(s)
- Izabella A. Ludwa
- Centre for Bone and Muscle Health, Brock University, St. Catharines, ON L2S 3A1, Canada;
| | - Kevin Mongeon
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Malcolm Sanderson
- Department of Kinesiology, Brock University, St. Catharines, ON L2S 3A1, Canada;
| | - Luis Gracia Marco
- Department of Physical Education and Sports, PROFITH “PROmoting FITness and Health through Physical Activity” Research Group, Sport and Health University Research Institute (iMUDS), University of Granada, 18071 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | - Panagiota Klentrou
- Centre for Bone and Muscle Health, Brock University, St. Catharines, ON L2S 3A1, Canada;
- Department of Kinesiology, Brock University, St. Catharines, ON L2S 3A1, Canada;
- Correspondence: ; Tel.: +1-905-688-5550 (ext. 4538)
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14
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Szmodis M, KÄlbli K, Kaj M, KirÁly A, AlmÁsi G, CsÁnyi T. Bone characteristics and physical fitness in children and adolescents with visual impairment. J Sports Med Phys Fitness 2021; 62:81-89. [PMID: 33615761 DOI: 10.23736/s0022-4707.21.12078-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lower habitual physical activity in adolescents with visual impairment (VI) have detrimental effect on their general health such as bone quality and physical fitness. The aim of this study was to demonstrate the bone quality in children with VI and to analyze the correlations of their bone characteristics with anthropometric and physical fitness tests. METHODS The participants (N=38) were adolescents (14.85±2.79yrs) with low vision (n=18) or blindness (n=20). Dual-energy-X-ray absorptiometry (DEXA) was used to measure bone mineral density (BMD), bone mineral content (BMC) of the total body and L1-L4 of the lumbar spinal region. After anthropometry physical fitness was examined by laboratory test (VO2peak) and field tests (strength and running). RESULTS Height, weight, body mass index (BMI), VO2peak were similar in the two groups. Blind boys showed significant higher handgrip strength. Estimated VO2peak (from 20-m shuttle running test) was significantly lower in blind children (43.84±4.42ml/kg/min) than in children with low vision (35.08±5.23ml/kg/min;p<0.001). BMD and BMC did not differ in subgroups, Z-score of total body BMD was significantly lower in blind children. Means of Z-score in L1-L4 lumbal spinal region were negative values and similar in blind and low vision adolescents' subgroups. A linear regression model in the collective group revealed significant associations of BMD (r2=0.538;p=0.0001) and BMC (r2=0.698;p=0.048) with BMI and handgrip strength test. CONCLUSIONS Adolescents with VI have generally decreased bone health and physical fitness level. BMI and handgrip strength are predictors of total body BMD and BMC. Suggesting that these measures may be adequate to estimate bone health.
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Affiliation(s)
- Márta Szmodis
- Department of Health Sciences and Sports Medicine, University of Physical Education, Budapest, Hungary -
| | - Katalin KÄlbli
- Hungarian School Sport Federation, Budapest, Hungary.,Bárczi Gusztáv Faculty of Special Needs Education, Eötvös Loránd University, Budapest, Hungary
| | - Mónika Kaj
- Hungarian School Sport Federation, Budapest, Hungary
| | - Anita KirÁly
- Hungarian School Sport Federation, Budapest, Hungary.,Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary
| | - Gábor AlmÁsi
- Department of Health Sciences and Sports Medicine, University of Physical Education, Budapest, Hungary
| | - Tamás CsÁnyi
- Hungarian School Sport Federation, Budapest, Hungary.,Faculty of Primary and Pre-School Education, Eötvös Loránd University, Budapest, Hungary
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15
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Bone response to eccentric versus concentric cycling in adolescents with obesity. Obes Res Clin Pract 2020; 14:554-560. [PMID: 33121896 DOI: 10.1016/j.orcp.2020.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/10/2020] [Accepted: 10/06/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Because adolescents with obesity are susceptible to bone fragility during weight loss (WL), we evaluated the impact of eccentric (ECC) versus classical concentric (CON) training at the same oxygen consumption (V˙O2) on bone density, geometry and strength. METHODS Thirty five adolescents were included into 2 training (CON and ECC cycling) and a control (CTR, without training) groups. Anthropometry, dual-energy X-ray absorptiometry, hip structural analysis and quantitative bone ultrasound were assessed before and after the 12-week intervention. RESULTS The trainings promoted significant improvements in body mass index, total fat (FM) and lean mass (LM), with better improvements for FM and LM in the ECC group (p < 0.05). Leg LM percentage increased only in the ECC group (p < 0.05). Total body bone mineral content and density increased in both training groups (p < 0.001) with significant time x group interactions only between ECC and CTR (p < 0.05). Buckling ratio at the intertrochanteric region and femoral shaft increased only in CTR and CON groups (p < 0.05). Speeds of sounds at the calcaneum increased only in ECC group (p < 0.01). CONCLUSIONS Bone fragility, from a compromised relationship between density, geometry and strength, might be prevented with the ECC modality.
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16
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Kondiboyina V, Raine LB, Kramer AF, Khan NA, Hillman CH, Shefelbine SJ. Skeletal Effects of Nine Months of Physical Activity in Obese and Healthy Weight Children. Med Sci Sports Exerc 2020; 52:434-440. [PMID: 31479005 PMCID: PMC6962537 DOI: 10.1249/mss.0000000000002148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Obesity during adolescence has multisystem health consequences. The objective of this work was to determine whether preadolescent overweight/obese children's bones respond to a 9-month physical activity intervention by increasing bone density similar to healthy weight children. METHODS Participants included overweight/obese (BMI > 85%) and healthy weight (15% < BMI < 85%) preadolescents (8-9 yr old). Participants in the physical activity group participated in a 9-month physical activity curriculum every day after school. The wait list control group received no intervention. Both groups had overweight/obese children and healthy weight controls. Whole-body bone mineral content, area, and bone mineral apparent density (BMAD) were assessed using dual x-ray absorptiometry) at the beginning and end of the 9-month trial in the physical activity and control group. RESULTS Overweight/obese preadolescent children had higher BMAD than healthy weight children (P < 0.001 for spine, leg, and whole body). However, the density/weight (BMAD/lean mass) was lower in overweight/obese children than that in healthy weight children, indicating that the density of bones in overweight/obese children may not compensate sufficiently for the excessive load due to weight. The change in BMAD over 9 months was greater in healthy weight children than overweight/obese children in the whole body and leg, but not the lumbar spine. Physical activity caused a site-specific increase in bone density, affecting the legs more than the lumbar spine, but there was no significant difference in the effect of exercise between the healthy weight and the overweight/obese group. CONCLUSIONS The smaller change in BMAD over the 9 months and lower BMAD per unit lean mass in overweight/obese compared with healthy weight children may indicate a slower rate of bone mass accrual, which may have implications for bone health during skeletal growth in obese/overweight children.
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Affiliation(s)
| | - Lauren B Raine
- Department of Psychology, Northeastern University, Boston, MA
| | | | - Naiman A Khan
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL
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Cetin N, Gencler A, Sivrikoz IA. Bone mineral density and vitamin D status in children with remission phase of steroid-sensitive nephrotic syndrome. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2019; 30:853-862. [PMID: 31464242 DOI: 10.4103/1319-2442.265461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Children with idiopathic nephrotic syndrome are primarily treated with glucocorticoids (GCs), but long-term GC use can lead to undesired side effects. We investigated the bone mineral density (BMD) and 25-hydroxyvitamin D (25-OH D) levels in children with the remission phase of steroid-sensitive nephrotic syndrome (SSNS). This study included 32 patients with SSNS who had not received GC treatment in the last 6 months and a control group of 20 healthy children. Serum levels of calcium, phosphate, alkaline phosphatase, 25-(OH)D, and parathyroid hormone (PTH) were measured. BMD was determined in the lumbar spinal region using dual-energy X-ray absorptiometry (DEXA). Serum 25-(OH)D levels were lower in the SSNS patients than in the healthy children (P <0.05), with 22 patients (68.8%) having Z-scores <-1. The Z-scores were positively correlated with 25-(OH)D levels (r = 0.424, P <0.05). PTH levels were higher in patients with osteoporosis than in patients with Z-scores ≥-1 (P <0.05). Bone mineral content and BMD were positively correlated with the age of diagnosis (P <0.01). Receiver-operating characteristic curve analysis showed that the cutoff value of 25-(OH)D levels for predicting low BMD was 14.67 ng/mL with a sensitivity of 90% and a specificity of 64%. The area under the curve (AUC ± standard error) was 0.868 ± 0.064 (95% confidence interval: 0.742-0.994, P = 0.001). Decreased 25-(OH)D levels and the negative effects of long-term GC treatment on BMD persist in SSNS remission phase. Levels of 25-(OH)D <14.67 ng/mL could predict abnormal DEXA scans in children with SSNS remission phase.
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Affiliation(s)
- Nuran Cetin
- Department of Pediatric Nephrology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Aylin Gencler
- Department of Pediatric Nephrology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Ilknur Ak Sivrikoz
- Department of Nuclear Medicine, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
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18
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Szmodis M, Bosnyák E, Protzner A, Szőts G, Trájer E, Tóth M. Relationship between physical activity, dietary intake and bone parameters in 10-12 years old Hungarian boys and girls. Cent Eur J Public Health 2019; 27:10-16. [PMID: 30927391 DOI: 10.21101/cejph.a5140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Physical activity (PA) and adequate macro- and micronutrient intake have favourable influence on the bone status. The aim of this study was to analyse the relationships among PA, anthropometric data, dietary intake and ultrasound bone characteristics in children. METHODS 10-12 years old Hungarian children (N = 123, 59 girls, 64 boys) provided physical activity, diet, anthropometric and bone data. PA was measured with accelerometer (Actigraph GT3X+). Diet was evaluated with three-day, 24-hour food recall. Calcaneal quantitative ultrasound (QUS) bone parameters were registered with Sonost3000 bone densitometer. RESULTS Nutrition and anthropometry did not differ by gender. The values of broadband ultrasound attenuation (BUA) were significantly higher in boys. Girls spent significantly more time being sedentary, boys had greater light, moderate, vigorous, and moderate to vigorous physical activity (MVPA) levels. The children accumulated more than twice the suggested amount of public health guidelines for MVPA. QUS parameters correlated significantly with vigorous physical activity in boys, and with age, height, weight, fat percentage, and body mass index (BMI) for both genders. There was no significant relationship between nutrition and QUS; however, inadequate vitamin K intake correlated with less favourable bone parameters. Multiple linear regression analysis confirmed the importance of vigorous PA - speed of sound (SOS): β = 0.358, p = 0.006; BUA: β = 0.340, p = 0.007; bone quality index (BQI): β = 0.377, p = 0.002; vitamin K intake - SOS: β = 0.256, p = 0.025; BUA: β = 0.235, p = 0.033; BQI: β = 0.295, p = 0.007; BMI - SOS: β = 0.207, p = 0.064; BUA: β = 0.455, p < 0.001; BQI: β = 0.284, p = 0.008; and age - SOS: β = 0.450, p < 0.001; BUA: β = 0.318, p = 0.004; BQI: β = 0.444, p < 0.001). CONCLUSIONS Changes in the characteristics of ultrasound bone parameters among 10-12 years old children mainly depended on the amount of intense PA, adequate vitamin K intake and anthropometric variables related to age.
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Affiliation(s)
- Márta Szmodis
- University of Physical Education, Department of Health Sciences and Sports Medicine, Budapest, Hungary
| | - Edit Bosnyák
- University of Physical Education, Department of Health Sciences and Sports Medicine, Budapest, Hungary
| | - Anna Protzner
- University of Physical Education, Department of Health Sciences and Sports Medicine, Budapest, Hungary
| | - Gábor Szőts
- University of Physical Education, Department of Health Sciences and Sports Medicine, Budapest, Hungary
| | - Emese Trájer
- University of Physical Education, Department of Health Sciences and Sports Medicine, Budapest, Hungary
| | - Miklós Tóth
- University of Physical Education, Department of Health Sciences and Sports Medicine, Budapest, Hungary
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19
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Marin-Puyalto J, Mäestu J, Gómez-Cabello A, Lätt E, Remmel L, Purge P, Vicente-Rodríguez G, Jürimäe J. Frequency and duration of vigorous physical activity bouts are associated with adolescent boys' bone mineral status: A cross-sectional study. Bone 2019; 120:141-147. [PMID: 30355511 DOI: 10.1016/j.bone.2018.10.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/17/2018] [Accepted: 10/18/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Vigorous physical activity (VPA) has been proven to promote osteogenesis in adolescents; however the specifics of the optimal pattern of frequency and duration of VPA are unknown. The main goal of the present study was to analyze the associations of different length of VPA bouts with bone health. METHODS 180 healthy male adolescents (11-13 years) had their bone mineral content and density assessed by dual-energy X-ray absorptiometry scans at the whole body, femoral neck (FN) and lumbar spine and their physical activity measured by an accelerometer during one week. RESULTS VPA was the intensity with the strongest associations with bone mineral parameters especially at the FN. Subjects whose longest VPA bout was 5 min or above had higher FN bone mineral density (BMD) than those who did not complete any 5-min bout and these differences were greater with participants who reached 15 consecutive minutes of VPA (>15': 0.977 ± 0.020 g/cm2; 5'-15': 0.907 ± 0.009 g/cm2; <5': 0.876 ± 0.009 g/cm2; all p < 0.05). When comparing the relevance of VPA bouts and volume of physical activity, the group with low volume and having a VPA bout had better FN BMD compared to the group with high volume but no VPA bout. Additionally, the group with both high volume and VPA bout showed better FN BMD than the rest of the groups. CONCLUSIONS VPA may be the most effective activity intensity to improve bone mineral density and content of adolescent boys, with greater benefits if VPA periods either long or frequent.
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Affiliation(s)
- Jorge Marin-Puyalto
- Faculty of Health and Sport Science (FCSD), Department of Physiatry and Nursing, Universidad de Zaragoza, Ronda Misericordia 5, 22001 Huesca, Spain; GENUD (Growth, Exercise, Nutrition and Development) Research Group, Zaragoza, Spain; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Spain; Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain; EXERNET red de investigación en ejercicio físico y salud para poblaciones especiales, Spain.
| | - Jarek Mäestu
- Institute of Sport Pedagogy and Coaching Sciences, Centre of Behavioral, Social and Health Sciences, University of Tartu, Tartu, Estonia
| | - Alba Gómez-Cabello
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Zaragoza, Spain; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Spain; Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain; EXERNET red de investigación en ejercicio físico y salud para poblaciones especiales, Spain; Centro Universitario de la Defensa, Zaragoza, Spain
| | - Evelin Lätt
- Institute of Sport Pedagogy and Coaching Sciences, Centre of Behavioral, Social and Health Sciences, University of Tartu, Tartu, Estonia
| | - Liina Remmel
- Institute of Sport Pedagogy and Coaching Sciences, Centre of Behavioral, Social and Health Sciences, University of Tartu, Tartu, Estonia
| | - Priit Purge
- Institute of Sport Pedagogy and Coaching Sciences, Centre of Behavioral, Social and Health Sciences, University of Tartu, Tartu, Estonia
| | - German Vicente-Rodríguez
- Faculty of Health and Sport Science (FCSD), Department of Physiatry and Nursing, Universidad de Zaragoza, Ronda Misericordia 5, 22001 Huesca, Spain; GENUD (Growth, Exercise, Nutrition and Development) Research Group, Zaragoza, Spain; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Spain; Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain; EXERNET red de investigación en ejercicio físico y salud para poblaciones especiales, Spain
| | - Jaak Jürimäe
- Institute of Sport Pedagogy and Coaching Sciences, Centre of Behavioral, Social and Health Sciences, University of Tartu, Tartu, Estonia
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Liang X, Wu C, Zhao H, Liu L, Du Y, Li P, Wen Y, Zhao Y, Ding M, Cheng B, Cheng S, Ma M, Zhang L, Guo X, Shen H, Tian Q, Zhang F, Deng HW. Assessing the genetic correlations between early growth parameters and bone mineral density: A polygenic risk score analysis. Bone 2018; 116:301-306. [PMID: 30172743 PMCID: PMC6298225 DOI: 10.1016/j.bone.2018.08.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/22/2018] [Accepted: 08/29/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The relationships between early growth parameters and bone mineral density (BMD) remain elusive now. In this study, we performed a large scale polygenic risk score (PRS) analysis to evaluate the potential impact of early growth parameters on the variations of BMD. METHODS We used 2286 Caucasian subjects as cohort 1 and 3404 Framingham Heart Study (FHS) subjects as cohort 2 in this study. BMD at ulna & radius, hip and spine were measured using dual energy X-ray absorptiometry. BMD values were adjusted for age, sex, height and weight as covariates. Genome-wide single-nucleotide polymorphism (SNP) genotyping of the 2286 Caucasian subjects was performed using Affymetrix Human SNP Array 6.0. The GWAS datasets of early growth parameters were driven from the Early Growth Genetics Consortium, including birth weight (BW), birth head circumference (BHC), childhood body mass index (CBMI), pubertal height growth related indexes and tanner stage. Polygenic Risk Score (PRSice) and linkage disequilibrium (LD) score regression analysis were conducted to assess the genetic correlation between early growth parameters and BMD. RESULTS We detected significant genetic correlations in cohort 1, such as total spine BMD vs. CBMI (p value = 1.51 × 10-4, rg = 0.4525), right ulna and radius BMD vs. CBMI (p value = 1.51 × 10-4, rg = 0.4399) and total body BMD vs. tanner stage (p value = 7.00 × 10-4, rg = -0.0721). For cohort 2, significant correlations were observed for total spine BMD vs. height change standard deviation score (SDS) between 8 years and adult (denoted as PGF + PGM) (p value = 3.97 × 10-4, rg = -0.1425), femoral neck BMD vs. the timing of peak height velocity by looking at the height change SDS between age 14 years and adult (denoted as PTF + PTM) (p value = 7.04 × 10-4, rg = -0.2185), and total spine BMD vs. PTF + PTM (p value = 6.86 × 10-4, rg = -0.2180). CONCLUSION Our study results suggest that some early growth parameters could affect the variations of BMD.
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Affiliation(s)
- Xiao Liang
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - CuiYan Wu
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Hongmou Zhao
- Department of Orthopedics Surgery, Red Cross Hospital, Xi'an 710054, China
| | - Li Liu
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Yanan Du
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Ping Li
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Yan Wen
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Yan Zhao
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Miao Ding
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Bolun Cheng
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Shiqiang Cheng
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Mei Ma
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Lu Zhang
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Xiong Guo
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Hui Shen
- Center for Bioinformatics and Genomics, Department of Global Biostatistics and Data Science, School of Public Health and Tropical Medicine, Tulane University, USA
| | - Qing Tian
- Center for Bioinformatics and Genomics, Department of Global Biostatistics and Data Science, School of Public Health and Tropical Medicine, Tulane University, USA
| | - Feng Zhang
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China.
| | - Hong-Wen Deng
- Center for Bioinformatics and Genomics, Department of Global Biostatistics and Data Science, School of Public Health and Tropical Medicine, Tulane University, USA.
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Mengel E, Tillmann V, Remmel L, Kool P, Purge P, Lätt E, Jürimäe J. The associations between the changes in serum inflammatory markers and bone mineral accrual in boys with overweight and obesity during pubertal maturation: a 3-year longitudinal study in Estonian boys. Osteoporos Int 2018; 29:2069-2078. [PMID: 29858631 DOI: 10.1007/s00198-018-4580-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 05/16/2018] [Indexed: 01/20/2023]
Abstract
UNLABELLED Adipose tissue produces different inflammatory cytokines which compromise bone mineral accrual during puberty. Vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), interleukin (IL)-8, and interferon-gamma (IFN-γ) are significantly related to bone mineral accrual during pubertal maturation in boys with different BMI values. INTRODUCTION This longitudinal study aims to identify the inflammatory markers that most strongly associate with pubertal bone mineral density (BMD) increment in boys with overweight and obesity (OWB). METHODS Twenty-six OWB and 29 normal-weight boys were followed yearly for 3 years to measure changes in 12 serum inflammatory markers, BMD (by DXA), and apparent volumetric BMD. The OWB group was further divided into two subgroups according to their BMI gain during the 3-year period. Data through time points presented as slopes were used to calculate correlation coefficients to explore the possible relationships between variables of interest. In the whole study group, linear mixed effects (LME) models were also used. RESULTS Increment in serum VEGF concentration was inversely associated with an increase in total body (TB) BMD (r = - 0.82, P = 0.02) and TB bone mineral content (BMC)/height (r = - 0.82, P = 0.02) in those OWB whose BMI gain was higher during pubertal years. In the whole study group, the LME model confirmed the inverse association between VEGF and TB BMC/height (P < 0.05). EGF was inversely associated with LS BMD and LS BMAD (P < 0.05), whereas there was a positive association between IL-8 and TB BMAD and between IFN-γ and LS BMD (P < 0.05). CONCLUSIONS Lower increment in BMD in OWB with higher BMI gain is associated with increasing serum VEGF concentration during pubertal maturation. VEGF, EGF, IL-8, and IFN-γ are significantly associated with BMD during pubertal maturation in boys with different BMI values.
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Affiliation(s)
- E Mengel
- Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, Jakobi 5, 50411, Tartu, Estonia.
- Children's Clinic of Tartu University Hospital, Tartu, Estonia.
| | - V Tillmann
- Children's Clinic of Tartu University Hospital, Tartu, Estonia
- Institute of Clinical Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - L Remmel
- Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, Jakobi 5, 50411, Tartu, Estonia
| | - P Kool
- Institute of Clinical Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - P Purge
- Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, Jakobi 5, 50411, Tartu, Estonia
| | - E Lätt
- Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, Jakobi 5, 50411, Tartu, Estonia
| | - J Jürimäe
- Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, Jakobi 5, 50411, Tartu, Estonia
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22
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Dolan E, Swinton PA, Sale C, Healy A, O'Reilly J. Influence of adipose tissue mass on bone mass in an overweight or obese population: systematic review and meta-analysis. Nutr Rev 2018; 75:858-870. [PMID: 29028271 DOI: 10.1093/nutrit/nux046] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Context The scientific literature shows conflicting evidence about the relationship between adiposity and bone mass in overweight and obese populations. The aim of this review was to quantify the correlation between adipose mass (absolute and relative) and bone mineral density (BMD) in overweight and obese populations. Three databases were searched electronically. In addition, reference lists of relevant articles were screened. A total of 16 studies, comprising 2587 participants and 75 correlation coefficients were selected for inclusion in the review. Data were extracted from each study using a standardized form. Multilevel modeling indicated opposing relationships between BMD and adiposity: absolute adiposity correlated positively, and relative adiposity negatively, with BMD. Sex and age were the primary moderators of these relationships. Strong evidence supported a negative relationship between relative adipose mass and BMD in men (R = -0.37; 95%CI, -0.57 to -0.12) and in those aged less than 25 years (R = -0.28; 95%CI, -0.45 to -0.08). To prevent bone loss in overweight and obese populations, nutrition- and exercise-based interventions that focus on a controlled reduction of adipose mass with concomitant preservation of lean mass are recommended. : PROSPERO no. CRD42015024313.
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Affiliation(s)
- Eimear Dolan
- Applied Physiology & Nutrition Research Group, University of São Paulo, São Paulo, Brazil
| | - Paul A Swinton
- School of Health Sciences, Robert Gordon University, Aberdeen, United Kingdom
| | - Craig Sale
- Musculoskeletal Physiology Research Group, Sport, Health and Performance Enhancement Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Aoife Healy
- CSHER, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, United Kingdom
| | - John O'Reilly
- Department of Sport Science and Physical Education, Chinese University of Hong Kong, Sha Tin, Hong Kong
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23
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Chaplais E, Naughton G, Greene D, Dutheil F, Pereira B, Thivel D, Courteix D. Effects of interventions with a physical activity component on bone health in obese children and adolescents: a systematic review and meta-analysis. J Bone Miner Metab 2018; 36:12-30. [PMID: 28779404 DOI: 10.1007/s00774-017-0858-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 06/27/2017] [Indexed: 12/11/2022]
Abstract
Given the rise in pediatric obesity, clarifications on the relationship between obesity and bone health and on the impact of structured intervention on this relationship are needed. This systematic review and meta-analysis investigated the effect of obesity on bone health and assessed the effect of structured intervention in children and adolescents with obesity. Medline complete, OVID, CINAHL, EMBASE and PubMed databases were searched for studies on obesity and bone health variables up to September 2016, then an update occurred in March 2016. Search items included obesity, childhood, dual energy X-ray absorptiometry and peripheral quantitative computed tomography. Twenty-three studies (14 cross-sectional and nine longitudinal) matched the inclusion criteria. Results from the meta-analysis (cross-sectional studies) confirmed that children and adolescents with obesity have higher bone content and density than their normal weight peers. Results from longitudinal studies remain inconclusive as only 50% of the included studies reported a positive effect of a structured intervention program on bone health. As such, the meta-analysis reported that structured intervention did not influence bone markers despite having beneficial effects on general health in youth with obesity.
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Affiliation(s)
- Elodie Chaplais
- Laboratory of the Metabolic Adaptations to Exercise Under Physiological and Pathological Conditions (AME2P), EA 3533, Blaise Pascal University, 5 Impasse Amelie Murat, TS60026 cs 60026, Aubière Cedex, 63178, Clermont-Ferrand, France.
- School of Exercise Science, Australian Catholic University, Strathfield Campus, Locked Bag 2002, Strathfield, NSW, 2135, Australia.
- School of Exercise Science, Australian Catholic University, Melbourne Campus, Locked Bag 4115, Fitzroy MDC, Fitzroy, VIC, 3065, Australia.
- Clermont University, Clermont-Ferrand, France.
| | - Geraldine Naughton
- School of Exercise Science, Australian Catholic University, Strathfield Campus, Locked Bag 2002, Strathfield, NSW, 2135, Australia
- School of Exercise Science, Australian Catholic University, Melbourne Campus, Locked Bag 4115, Fitzroy MDC, Fitzroy, VIC, 3065, Australia
| | - David Greene
- School of Exercise Science, Australian Catholic University, Strathfield Campus, Locked Bag 2002, Strathfield, NSW, 2135, Australia
- School of Exercise Science, Australian Catholic University, Melbourne Campus, Locked Bag 4115, Fitzroy MDC, Fitzroy, VIC, 3065, Australia
| | - Frederic Dutheil
- Laboratory of the Metabolic Adaptations to Exercise Under Physiological and Pathological Conditions (AME2P), EA 3533, Blaise Pascal University, 5 Impasse Amelie Murat, TS60026 cs 60026, Aubière Cedex, 63178, Clermont-Ferrand, France
- School of Exercise Science, Australian Catholic University, Strathfield Campus, Locked Bag 2002, Strathfield, NSW, 2135, Australia
- CRNH-Auvergne, Clermont-Ferrand, France
- Occupational Medicine, University Hospital CHU G. Montpied, Clermont-Ferrand, France
- School of Exercise Science, Australian Catholic University, Melbourne Campus, Locked Bag 4115, Fitzroy MDC, Fitzroy, VIC, 3065, Australia
- Clermont University, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit (DRCI), University Hospital CHU G. Montpied, 63000, Clermont-Ferrand, France
| | - David Thivel
- Laboratory of the Metabolic Adaptations to Exercise Under Physiological and Pathological Conditions (AME2P), EA 3533, Blaise Pascal University, 5 Impasse Amelie Murat, TS60026 cs 60026, Aubière Cedex, 63178, Clermont-Ferrand, France
- CRNH-Auvergne, Clermont-Ferrand, France
- Clermont University, Clermont-Ferrand, France
| | - Daniel Courteix
- Laboratory of the Metabolic Adaptations to Exercise Under Physiological and Pathological Conditions (AME2P), EA 3533, Blaise Pascal University, 5 Impasse Amelie Murat, TS60026 cs 60026, Aubière Cedex, 63178, Clermont-Ferrand, France
- School of Exercise Science, Australian Catholic University, Strathfield Campus, Locked Bag 2002, Strathfield, NSW, 2135, Australia
- CRNH-Auvergne, Clermont-Ferrand, France
- School of Exercise Science, Australian Catholic University, Melbourne Campus, Locked Bag 4115, Fitzroy MDC, Fitzroy, VIC, 3065, Australia
- Clermont University, Clermont-Ferrand, France
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Kim HY, Jung HW, Hong H, Kim JH, Shin CH, Yang SW, Lee YA. The Role of Overweight and Obesity on Bone Health in Korean Adolescents with a Focus on Lean and Fat Mass. J Korean Med Sci 2017; 32:1633-1641. [PMID: 28875607 PMCID: PMC5592177 DOI: 10.3346/jkms.2017.32.10.1633] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/21/2017] [Indexed: 02/01/2023] Open
Abstract
As the associations between pediatric overweight/obesity and bone health remain controversial, we investigated the effects of overweight/obesity as well as lean mass (LM) and fat mass (FM) on bone parameters in adolescents. Bone parameters were evaluated using dual-energy X-ray absorptiometry (DXA) data of 982 adolescents (aged 12-19 years) from the Korea National Health and Nutrition Examination Survey (2009-2010). Z-scores for LM, FM, bone mass, bone mineral density (BMD), and bone mineral apparent density (BMAD) using Korean pediatric reference values were used for analysis. Adolescents with overweight/obesity had significantly higher bone mass and density of the total-body-less-head (TBLH), lumbar spine, and femur neck than underweight or normal-weight adolescents (P < 0.001) after adjusting for vitamin D deficiency, calcium intake, and insulin resistance in both sexes. LM was positively associated with bone parameters at all skeletal sites in both sexes (P < 0.001). FM was negatively related to TBLH BMD in boys (P = 0.018) but was positively associated to BMD and BMAD of the lumbar spine and femur neck in girls. In conclusion, overweight/obesity and LM play a positive role in bone health in adolescents. The effect of FM on bone parameters is sex- and site-specific.
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Affiliation(s)
- Hwa Young Kim
- Department of Pediatrics, Kangwon National University Hospital, Chuncheon, Korea
| | - Hae Woon Jung
- Department of Pediatrics, Kyung Hee University Medical Center, Seoul, Korea
| | - Hyunsook Hong
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
| | - Jae Hyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Sei Won Yang
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Young Ah Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.
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25
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Mengel E, Tillmann V, Remmel L, Kool P, Purge P, Lätt E, Jürimäe J. Extensive BMI Gain in Puberty is Associated with Lower Increments in Bone Mineral Density in Estonian Boys with Overweight and Obesity: A 3-Year Longitudinal Study. Calcif Tissue Int 2017; 101:174-181. [PMID: 28374175 DOI: 10.1007/s00223-017-0273-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 03/24/2017] [Indexed: 01/01/2023]
Abstract
The aim of this 3-year prospective study was to examine changes in bone mineral characteristics during pubertal maturation in boys with different BMI values at the beginning of puberty and with different BMI increments during puberty. 26 boys with overweight and obesity (OWB) and 29 normal weight boys (NWB) were studied yearly for 3 years from the age of 11 years to measure the changes in different bone mineral characteristics. The OWB group was further divided into two subgroups according to extensive or non-extensive BMI increment during 3-year period. OWB had higher (P < 0.01) baseline total body (TB) bone mineral density (BMD), TB bone mineral content (BMC), TB BMC for height, lumbar spine (LS) BMD, and LS BMC compared to NWB. Throughout the study period, OWB gained more TB BMD (P = 0.0001), TB BMC (P = 0.0048), TB BMC for height (P = 0.0124), LS BMD (P = 0.0029), and LS BMC (P = 0.0022) compared to NWB. Also during the study period, TB BMD (P = 0.0065), TB BMC (P = 0.0141), TB BMC for height (P = 0.0199), LS BMD (P = 0.0066), LS apparent volumetric BMD (BMAD) (P = 0.0075), and LS BMC (P = 0.017) increased significantly less in those OWB whose BMI increased more extensively. Extensive BMI gain is associated with lower increments in bone mineral characteristics in boys with overweight and obesity. Unfavorable increment in total body fat mass and percentage during pubertal years could be one reason for that.
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Affiliation(s)
- Eva Mengel
- Faculty of Medicine, Institute of Sport Sciences and Physiotherapy, University of Tartu, Jakobi 5, 50411, Tartu, Estonia.
- Children's Clinic of Tartu University Hospital, Tartu, Estonia.
| | - Vallo Tillmann
- Faculty of Medicine, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Children's Clinic of Tartu University Hospital, Tartu, Estonia
| | - Liina Remmel
- Faculty of Medicine, Institute of Sport Sciences and Physiotherapy, University of Tartu, Jakobi 5, 50411, Tartu, Estonia
| | - Pille Kool
- Faculty of Medicine, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Priit Purge
- Faculty of Medicine, Institute of Sport Sciences and Physiotherapy, University of Tartu, Jakobi 5, 50411, Tartu, Estonia
| | - Evelin Lätt
- Faculty of Medicine, Institute of Sport Sciences and Physiotherapy, University of Tartu, Jakobi 5, 50411, Tartu, Estonia
| | - Jaak Jürimäe
- Faculty of Medicine, Institute of Sport Sciences and Physiotherapy, University of Tartu, Jakobi 5, 50411, Tartu, Estonia
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26
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Vaitkeviciute D, Lätt E, Mäestu J, Jürimäe T, Saar M, Purge P, Maasalu K, Jürimäe J. Longitudinal associations between bone and adipose tissue biochemical markers with bone mineralization in boys during puberty. BMC Pediatr 2016; 16:102. [PMID: 27439435 PMCID: PMC4955269 DOI: 10.1186/s12887-016-0647-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 07/15/2016] [Indexed: 08/30/2023] Open
Abstract
Background We investigated longitudinal relationships between the biochemical markers of bone and adipose tissue with bone mineral content (BMC), bone mineral density (BMD), moderate-to-vigorous physical activity (MVPA) and sedentary time (SED) in pubertal boys. Methods Ninety-six boys (11.9 ± 0.6 years old) were measured at baseline, after 12 and 24 months. Body composition (fat mass [FM], lean body mass [LBM]), and whole body (WB), lumbar spine (LS) and femoral neck (FN) BMD and BMC were assessed. Additionally, serum leptin, adiponectin, osteocalcin (OC) and C-terminal telopeptide of type I collagen (CTX) were measured. Results OC had a strong longitudinal inverse effect on changes in WB_BMD (p < 0.001) and LS_BMD (p = 0.021), while CTX had an inverse effect only on changes in FN_BMD (p = 0.011). Leptin had an inverse effect on changes in WB_BMC/WB_BMD (p = 0.001), FN_BMD (p = 0.002) and LS_BMD (p = 0.001). MVPA showed a longitudinal inverse effect on changes in leptin (p = 0.030), however no longitudinal effect of SED to biochemical markers of bone and adipose tissue was found. Conclusions Bone metabolism markers have negative effect on bone mineral accrual during puberty. Increases in MVPA affect leptin, suggesting a positive link of MVPA through leptin metabolism on increases in bone mineralization during puberty.
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Affiliation(s)
- Donvina Vaitkeviciute
- Institute of Sport Sciences and Physiotherapy, Centre of Behavioural, Social and Health Science, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Evelin Lätt
- Institute of Sport Sciences and Physiotherapy, Centre of Behavioural, Social and Health Science, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Jarek Mäestu
- Institute of Sport Sciences and Physiotherapy, Centre of Behavioural, Social and Health Science, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Toivo Jürimäe
- Institute of Sport Sciences and Physiotherapy, Centre of Behavioural, Social and Health Science, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Meeli Saar
- Institute of Sport Sciences and Physiotherapy, Centre of Behavioural, Social and Health Science, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Priit Purge
- Institute of Sport Sciences and Physiotherapy, Centre of Behavioural, Social and Health Science, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Katre Maasalu
- Institute of Clinical Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Jaak Jürimäe
- Institute of Sport Sciences and Physiotherapy, Centre of Behavioural, Social and Health Science, Faculty of Medicine, University of Tartu, Tartu, Estonia. .,Institute of Sport Pedagogy and Coaching Sciences, Centre of Behavioral, Social and Health Sciences, University of Tartu, 5 Jakobi Street, 51014, Tartu, Estonia.
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27
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Remmel L, Tillmann V, Mäestu J, Purge P, Saar M, Lätt E, Maasalu K, Jürimäe T, Jürimäe J. Associations between Bone Mineral Characteristics and Serum Levels of Ghrelin and Peptide YY in Overweight Adolescent Boys. Horm Res Paediatr 2016; 84:6-13. [PMID: 25966775 DOI: 10.1159/000381623] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 03/12/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The role of ghrelin and peptide YY (PYY) in bone mineralization is not fully known. The aim of this study was to determine whether acylated and des-acyl ghrelin and PYY in addition to leptin are related to bone mineral density (BMD) in adolescent overweight boys (OWB) and normal-weight boys (NWB). PARTICIPANTS AND METHODS Fifty- five OWB (BMI >85th percentile) and 154 NWB (BMI <85th percentile) aged 12-16 years participated in this study. Fasting serum acylated and des-acyl ghrelin, PYY, leptin, testosterone levels, total body (TB) and lumbar spine (LS) bone mineral content (BMC), and BMD were measured. TB BMC for height and TB and LS bone mineral apparent density (BMAD) were calculated. RESULTS No differences were seen in acylated and des-acyl ghrelin or PYY levels, while the leptin levels were significantly higher in the OWB compared to the NWB. In the OWB, TB BMAD was positively correlated with acylated ghrelin and leptin, and TB BMC for height was positively correlated with PYY. In the OWB, the variability of TB BMD was determined by TB fat-free mass and des-acyl ghrelin, whereas the variability of TB BMAD was determined by leptin. CONCLUSIONS Des-acyl ghrelin and PYY are involved in the bone mineralization process in puberty, and the impact can vary between normal and overweight subjects.
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Affiliation(s)
- Liina Remmel
- Faculty of Exercise and Sport Sciences, University of Tartu, Tartu, Estonia
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28
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Wang W, Wang Z, Zhu Z, Zhu F, Qiu Y. Body composition in males with adolescent idiopathic scoliosis: a case-control study with dual-energy X-ray absorptiometry. BMC Musculoskelet Disord 2016; 17:107. [PMID: 26928006 PMCID: PMC4772298 DOI: 10.1186/s12891-016-0968-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/24/2016] [Indexed: 11/18/2022] Open
Abstract
Background In contrast to the well-characterized body growth and development of females with adolescent idiopathic scoliosis (AIS), the pubertal growth pattern of male patients has not been well-documented. Recently, significantly lower body weight (BW) and body mass index (BMI) were reported in males with AIS, and were thought to be related to curve progression. A case–control study was carried out to characterize the body composition and bone status of males with AIS, with the aim of gaining a better understanding of lower BW among these patients. Methods Forty-seven males with AIS and forty age- and gender-matched healthy controls were recruited. Standing height (SH) and BW were measured. The SH of the males who had AIS was corrected using Bjure’s equation, and then the BMI was calculated. Body composition, including subcranial fat mass (FM), lean mass (LM), and bone mineral content (BMC), and bone mineral density (BMD) were analyzed using dual-energy X-ray absorptiometry. The LM index (LMi) and the FM index (FMi) were calculated by dividing the FM and LM by the square of the SH. Logistic regression analysis was employed for comparison between AIS and controls. Results The AIS patients had comparable age and Tanner staging for pubic hair as the controls. After adjustment for age, the AIS patients showed comparable SH but significantly lower BW and BMI than that of the controls. The LM, LMi, BMC and BMD were also significantly lower in the AIS patients than in the controls. However, the difference in BMC between two groups was not significant by adjusting for age, FM and LM. Conclusion The male AIS patients showed abnormal body composition, presenting as significantly lower LM than the controls. The lower BMC observed in the patients might due to the abnormal body composition.
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Affiliation(s)
- Weijun Wang
- Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China.
| | - Zhiwei Wang
- Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China.
| | - Zezhang Zhu
- Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China.
| | - Feng Zhu
- Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China.
| | - Yong Qiu
- Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China.
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Võsoberg K, Tillmann V, Tamm AL, Jürimäe T, Maasalu K, Jürimäe J. Adipocytokine and ghrelin levels in relation to bone mineral density in prepubertal rhythmic gymnasts entering puberty: a 3-year follow-up study. Eur J Appl Physiol 2016; 116:831-9. [PMID: 26879077 DOI: 10.1007/s00421-016-3338-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 02/01/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate changes in bone mineral density (BMD) in rhythmic gymnasts (RG) entering puberty and their age-matched untrained controls (UC) over the 36-month period, and associations with leptin, adiponectin and ghrelin over this period. METHODS Whole body (WB), lumbar spine (LS) and femoral neck (FN) BMD, WB bone mineral content (BMC), and leptin, adiponectin and ghrelin were measured in 35 RG and 33 UC girls at baseline and at 12-month intervals over the next 3 years. The change over the 36 months was calculated (∆ score). RESULTS The pubertal development over the next 36 months was slower in RG compard to UC, while there was no difference in bone age development between the groups. BMD at all sites was higher in RG in comparison with UC at every measurement point. ∆LS BMD and ∆FN BMD, but not ∆WB BMD and ∆WB BMC, were higher in RG compared with UC. None of the measured hormones at baseline or their ∆ scores correlated with ∆BMD and ∆BMC in RG. Baseline fat free mass correlated with ∆WB BMD and ∆WB BMC in RG, while baseline leptin was related to ∆WB BMC, ∆WB BMD and ∆LS BMD in UC. CONCLUSIONS Measured baseline hormones and their ∆ scores did not correlate with increases in bone mineral values in RG entering puberty. Although the pubertal development in RG was slower than in UC, high-intensity training appeared to increase BMD growth and counterbalance negative effects of slow pubertal develpment, lower fat mass and leptin in RG.
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Affiliation(s)
- Kristel Võsoberg
- Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, 18. Ülikooli St., 50090, Tartu, Estonia
| | - Vallo Tillmann
- Department of Pediatrics, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | | | - Toivo Jürimäe
- Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, 18. Ülikooli St., 50090, Tartu, Estonia
| | - Katre Maasalu
- Clinics of Traumatology and Orthopaedics, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Jaak Jürimäe
- Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, 18. Ülikooli St., 50090, Tartu, Estonia.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the recent clinical findings surrounding the muscle-bone relationships in children, while considering muscle adiposity, endocrine factors, and lifestyle influences (i.e., diet and exercise) involved in pediatric musculoskeletal development. RECENT FINDINGS Positive relationships between cortical bone geometry and muscle mass, size and function have been reported. Prospective studies in particular have helped clarify some of the inconsistent relationships between muscle and cortical bone volumetric density. Muscle fat is associated with impaired glucose handling and muscular functionality, which may in turn have a downstream effect on cortical bone growth during adolescence. Lifestyle factors such as healthful diets and higher impact physical activities can promote optimal skeletal development by improving the muscular phenotype and endocrine profile. SUMMARY Muscle and bone are two intricately-related tissue types; however, factors such as sex, maturation, study design, and outcome measures studied can modify this relationship. Further research is warranted to understand the impact of muscle adiposity on cardiometabolic health, muscle function and, subsequently, pediatric musculoskeletal development and fracture risk. Following age-specific diet and physical activity recommendations should be a major focus in obtaining optimal muscle and bone development throughout maturation.
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Affiliation(s)
- Joseph M Kindler
- aDepartment of Foods and Nutrition, College of Family and Consumer Sciences, University of Georgia, Athens bDepartment of Cellular Biology and Anatomy, Medical College of Georgia, Georgia Regents University, Augusta, Georgia, USA
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Physical activity and bone health in schoolchildren: the mediating role of fitness and body fat. PLoS One 2015; 10:e0123797. [PMID: 25915941 PMCID: PMC4411135 DOI: 10.1371/journal.pone.0123797] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 03/06/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The relationship between physical activity (PA) and bone health is well known, although the role of percent body fat (%BF) and fitness as confounders or mediators in this relationship remains uncertain. OBJECTIVE To examine whether the association between PA and bone mineral content (BMC) is mediated by %BF and cardiorespiratory fitness (CRF). METHODS In this cross sectional study, BMC, total %BF (by DXA), vigorous PA (VPA), CRF, age and height were measured in 132 schoolchildren (62 boys, aged 8-11 years). ANCOVA was used to test differences in BMC by %BF, CRF and VPA, controlling for different sets of confounders. Simple mediation analyses and serial multiple mediation analyses were fitted to examine whether the relationship between PA and BMC is mediated by %BF and fitness. RESULTS Children with high %BF had higher total body BMC than their peers after controlling for all sets of confounders. Children with good CRF or VPA had significantly less total body BMC after controlling for age and sex but in children with good CRF this inverse relation disappeared after adjusting by %BF. %BF and CRF both act as a full mediator in the association between VPA and BMC, after inclusion of the potential confounders in the models. CONCLUSION Fitness and %BF seem to have a mediator role on the relationship between physical activity and bone mass.
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Vaitkeviciute D, Lätt E, Mäestu J, Jürimäe T, Saar M, Purge P, Maasalu K, Jürimäe J. Physical activity and bone mineral accrual in boys with different body mass parameters during puberty: a longitudinal study. PLoS One 2014; 9:e107759. [PMID: 25279833 PMCID: PMC4184811 DOI: 10.1371/journal.pone.0107759] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 08/14/2014] [Indexed: 11/27/2022] Open
Abstract
The aim of our longitudinal study was to investigate the relationships between physical activity and bone mass in boys with different body mass status during the years surrounding pubertal growth spurt. Two hundred and six boys entering puberty took part in this study. The subjects were divided into underweight (BMI < 15.35), normal weight (BMI ≥ 15.35-21.22), overweight (BMI ≥ 21.22-26.02) and obese (BMI > 26.02) groups at baseline according to age related categories. Whole-body DXA scans were performed at baseline, after 12 and 24 months to assess body composition (lean body mass, fat mass), and total body (TB), lumbar spine (LS) and femoral neck (FN) bone mineral density (BMD) parameters. Physical activity was measured by 7-day accelerometry. For longitudinal analysis, multilevel fixed effects regression models were constructed. Biological age, height and lean body mass had an effect for explanation of TB BMD, FN BMD and LS BMD. Moderate to vigorous physical activity (MVPA), vigorous physical activity (VPA) and sedentary time (SED) had the significant effect only on FN BMD. Being an underweight boy at the baseline indicated greater chance (p<0.01) to have lower TB BMD in the future (2 years at follow up) development, compared to normal weight (estimates = -0.038), overweight (estimates = -0.061) and obese boys (estimates = -0.106).
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Affiliation(s)
- Donvina Vaitkeviciute
- Institute of Sport Pedagogy and Coaching Sciences, Faculty of Exercise and Sport Sciences, Centre of Behavioral, Social and Health Sciences, University of Tartu, Tartu, Estonia
| | - Evelin Lätt
- Institute of Sport Pedagogy and Coaching Sciences, Faculty of Exercise and Sport Sciences, Centre of Behavioral, Social and Health Sciences, University of Tartu, Tartu, Estonia
| | - Jarek Mäestu
- Institute of Sport Pedagogy and Coaching Sciences, Faculty of Exercise and Sport Sciences, Centre of Behavioral, Social and Health Sciences, University of Tartu, Tartu, Estonia
| | - Toivo Jürimäe
- Institute of Sport Pedagogy and Coaching Sciences, Faculty of Exercise and Sport Sciences, Centre of Behavioral, Social and Health Sciences, University of Tartu, Tartu, Estonia
| | - Meeli Saar
- Institute of Sport Pedagogy and Coaching Sciences, Faculty of Exercise and Sport Sciences, Centre of Behavioral, Social and Health Sciences, University of Tartu, Tartu, Estonia
| | - Priit Purge
- Institute of Sport Pedagogy and Coaching Sciences, Faculty of Exercise and Sport Sciences, Centre of Behavioral, Social and Health Sciences, University of Tartu, Tartu, Estonia
| | - Katre Maasalu
- Department of Traumatology and Orthopedics, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Jaak Jürimäe
- Institute of Sport Pedagogy and Coaching Sciences, Faculty of Exercise and Sport Sciences, Centre of Behavioral, Social and Health Sciences, University of Tartu, Tartu, Estonia
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