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Alghadir AH, Gabr SA, Iqbal A. Hand grip strength, vitamin D status, and diets as predictors of bone health in 6-12 years old school children. BMC Musculoskelet Disord 2023; 24:830. [PMID: 37872520 PMCID: PMC10594896 DOI: 10.1186/s12891-023-06960-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Vitamin D and calcium-rich foods, exposure to sunlight, and physical activities (PA) play a pivotal role in promoting the production of sufficient vitamin D and improving grip strength needed for better bone health among school children. PURPOSE This study aimed to determine the effects of hand grip muscle strength (HGS), vitamin D in addition to diets, and PA on bone health status among 6-12 years old schoolchildren. METHODS This study was based on a cross-sectional observational design, which was descriptive in nature. A diverse sample of 560 elementary school children aged 6-12 years old were invited to participate in this descriptive cross-sectional study. The Dual-Energy X-Ray Absorptiometry (DXA), QUS technique, and ACTi graph GT1M accelerometer were used respectively as a valid tools to identify BMD, BMC, and other parameters of bone health like c-BUA values and bone stiffness (SI), and physical activity (PA) of all individuals participated in this study. In addition, a hydraulic dynamometer was used to measure hand grip strength among the participants. Moreover, an immunoassay technique was used to measure the serum levels of vitamin 25(OH)D level, and bone metabolism markers; NTX, DPD, Ca, and sBAP in all participants. Bone loss (osteoporosis) was cross-sectionally predicted in 19.64% of the total population, most of whom were girls (14.3% vs. 5.4% for boys; P = 0.01). Compared to boys, the incidence of osteoporosis was higher and significantly correlated in girls with lower HGS, deficient vitamin D, inadequate vitamin D and Ca intake, greater adiposity, poor PA, and lower sun exposure. Also, in girls, lower vitamin 25(OH)D levels, and poor HGS were shown to be significantly associated with lower values of BMD, BMC, SI, and higher values of bone resorption markers; NTX, DPD, and sBAP and lower serum Ca than do in boys. The findings suggested that deficient vitamin D, lower HGS, adiposity, PA, and sun exposure as related risk factors to the pravelence of bone loss among school children, particularly in girls. In addition, these parameters might be considered diagnostic non-invasive predictors of bone health for clinical use in epidemiological contexts; however, more studies are required.
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Affiliation(s)
- Ahmad H Alghadir
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh, 11433, Saudi Arabia
| | - Sami A Gabr
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh, 11433, Saudi Arabia
| | - Amir Iqbal
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh, 11433, Saudi Arabia.
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Brailey G, Metcalf B, Lear R, Price L, Cumming S, Stiles V. A comparison of the associations between bone health and three different intensities of accelerometer-derived habitual physical activity in children and adolescents: a systematic review. Osteoporos Int 2022; 33:1191-1222. [PMID: 35089364 PMCID: PMC9106641 DOI: 10.1007/s00198-021-06218-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/14/2021] [Indexed: 12/02/2022]
Abstract
Positive associations have been identified between bone outcomes and accelerometer-derived moderate (MPA) and vigorous (VPA) physical activity (PA) in youth; however, it remains unclear which intensity is most beneficial. This systematic review aimed to summarise accelerometer-derived methods used to estimate habitual PA in children and adolescents and determine whether the magnitude of association was consistently stronger for a particular intensity (MPA/MVPA/VPA). Observational studies assessing associations between accelerometer-derived MPA and/or MVPA and VPA with bone outcomes in children and adolescents (≤ 18 years) were identified in MEDLINE, EMBASE, Web of Science, SPORTDiscus and the Cochrane Central Register of Controlled Trials. Thirty articles were included (total n = 20,613 (10,077 males), 4-18 years). Chi-square tests determined whether the proportion of significant associations and strongest within-study associations differed significantly between intensities. Results demonstrated that accelerometer methods were highly variable between studies. Of the 570 associations analysed, 186 were significant (p < 0.05). The proportion of within-study strongest associations differed by PA intensity (3 × 2 χ2 = 86.6, p < 0.001) and was significantly higher for VPA (39%) compared to MVPA (5%; 2 × 2 χ2 = 55.3, p < 0.001) and MPA (9%, 2 × 2 χ2 = 49.1, p < 0.001). Results indicated a greater benefit of VPA over MPA/MVPA; however, variability in accelerometer-derived methods used prevents the precise bone-benefitting amount of VPA from being identified. Long epochs and numerous intensity cut-point definitions mean that bone-relevant PA has likely been missed or misclassified in this population. Future research should explore the use of shorter epochs (1 s) and identify bone-specific activity intensities, rather than using pre-defined activity classifications more relevant to cardiovascular health.
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Affiliation(s)
- Gemma Brailey
- Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK.
| | - Brad Metcalf
- Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Rebecca Lear
- Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Lisa Price
- Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Sean Cumming
- Department for Health, University of Bath, Bath, UK
| | - Victoria Stiles
- Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
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Amato A, Proia P, Caldara GF, Alongi A, Ferrantelli V, Baldassano S. Analysis of Body Perception, Preworkout Meal Habits and Bone Resorption in Child Gymnasts. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042184. [PMID: 33672264 PMCID: PMC7926894 DOI: 10.3390/ijerph18042184] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 12/13/2022]
Abstract
The beneficial effects of physical activity on body image perception and bone are debated among artistic gymnasts. Gymnasts seem to be at greater risk of developing body dissatisfaction, eating disorders and osteoporosis due to inadequate nutrition and attention to the appearance of the body. The objective of this work was to investigate the association between the artistic gymnast and a more favorable body image compared to their sedentary peers and if a preworkout high-carbohydrate meal (HCM; 300 kcal, 88% carbohydrates, 9% protein, 3% fat) or high-protein meal (HPM; 300 kcal, 55% carbohydrates, 31% protein, 13% fat) is able to attenuate bone resorption in young rhythmic gymnasts. Twenty-eight preadolescent female gymnasts were examined. Self-esteem tests were used to analyze body image perception. Preworkout eating habits were examined by short food frequency questions (FFQ) validated for children. The biomarker of the bone resorption C-terminal telopeptide region of collagen type 1 (CTX) was measured in the urine (fasting, postmeal and postworkout). Gymnasts reported higher satisfaction with their body appearance compared to sedentary peers. Of the gymnasts, 30% did not have a preworkout meal regularly, and the timing of the consumption was variable. Bone resorption was decreased by the HCM, consumed 90 min before the training, with respect to the HPM. The study suggests that playing artistic gymnastics is associated with a positive body self-perception in a child. The variability in preworkout meal frequency and timing need attention to prevent inadequate eating habits in light of the ability of the HCM to reduce acute bone resorption.
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Affiliation(s)
- Alessandra Amato
- Department of Psychological, Pedagogical and Educational Sciences, Sport and Exercise Sciences Research Unit, University of Palermo, 90128 Palermo, Italy; (A.A.); (P.P.)
| | - Patrizia Proia
- Department of Psychological, Pedagogical and Educational Sciences, Sport and Exercise Sciences Research Unit, University of Palermo, 90128 Palermo, Italy; (A.A.); (P.P.)
| | - Gaetano Felice Caldara
- Istituto Zooprofilattico Sperimentale della Sicilia, 90129 Palermo, Italy; (G.F.C.); (A.A.); (V.F.)
- Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy
| | - Angelina Alongi
- Istituto Zooprofilattico Sperimentale della Sicilia, 90129 Palermo, Italy; (G.F.C.); (A.A.); (V.F.)
| | - Vincenzo Ferrantelli
- Istituto Zooprofilattico Sperimentale della Sicilia, 90129 Palermo, Italy; (G.F.C.); (A.A.); (V.F.)
| | - Sara Baldassano
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, 90128 Palermo, Italy
- Correspondence:
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Yamakita M, Ando D, Akiyama Y, Sato M, Suzuki K, Yamagata Z. Association of objectively measured physical activity and sedentary behavior with bone stiffness in peripubertal children. J Bone Miner Metab 2019; 37:1095-1103. [PMID: 31214840 DOI: 10.1007/s00774-019-01021-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 06/07/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Physical activity (PA) is a key factor of bone mass acquisition in peripubertal children. Sedentary behavior (SB) has been shown to influence bone outcomes. This study aimed to examine the association between objectively measured PA and SB and bone stiffness in Japanese children. MATERIALS AND METHODS Participants were fifth-grade children aged 10-11 years from Project Koshu. The stiffness index (SI) of the calcaneus was measured by quantitative ultrasound; PA and SB were evaluated by an accelerometer. Each PA parameter was divided into sex-specific tertile or stratified by recommended PA guideline [≥ 60 min/day of moderate-to-vigorous PA (MVPA)]. The SI was compared among PA and SB through analysis of covariance with Bonferroni correction. RESULTS Of 174 children, complete data were obtained from 134 (60 boys and 74 girls). The SI in boys was higher in the highest tertile of MVPA than that in the other groups. A similar association was found in girls but was not significant. Children who met the PA guideline had higher SI than those who did not, but there was no significant difference. A negative relation was observed in girls, with the SI gradually decreasing along with increasing SB (p for trend = 0.038). This association was not observed among boys. CONCLUSION This study suggests that MVPA is positively associated with bone stiffness in Japanese schoolchildren in boys and SB is negatively associated with that in girls. Reducing SB might be a brief modifiable factor for preventing lower peak bone mass in girls, in addition to increasing MVPA.
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Affiliation(s)
- Mitsuya Yamakita
- College of Liberal Arts and Sciences, Kitasato University, Sagamihara, Kanagawa, 252-0373, Japan.
| | - Daisuke Ando
- Division of Human Sciences, Faculty of Education, Graduate School Department of Interdisciplinary Research, University of Yamanashi, Kofu, Yamanashi, Japan
| | - Yuka Akiyama
- Division of Medicine, Department of Health Sciences, Basic Science for Clinical Medicine, Graduate School Department of Interdisciplinary Research, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Miri Sato
- Center for Birth Cohort Studies, Graduate School Department of Interdisciplinary Research, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Kohta Suzuki
- Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Zentaro Yamagata
- Division of Medicine, Department of Health Sciences, Basic Science for Clinical Medicine, Graduate School Department of Interdisciplinary Research, University of Yamanashi, Chuo, Yamanashi, Japan
- Center for Birth Cohort Studies, Graduate School Department of Interdisciplinary Research, University of Yamanashi, Chuo, Yamanashi, Japan
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Correa-Rodríguez M, Schmidt-Rio Valle J, de la Fuente-Vílchez ÁM, Rueda-Medina B. Analysis of lifestyle and bone mineralization in a population of Spanish young adults. Colomb Med (Cali) 2018; 49:213-218. [PMID: 30410195 PMCID: PMC6220484 DOI: 10.25100/cm.v49i2.2056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 09/07/2018] [Accepted: 09/18/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To analyze the environmental factors (nutritional status, levels of physical activity and nutritional habits) and their possible association with bone mass in a population of young adults. METHODS The study population consisted of 200 subjects (117 women and 83 men) aged between 18 and 25 years (mean age 20.4 years ±2.2 years). Body composition parameters were measured by an electronic balance (TANITA BC-418MA), nutritional habits were estimated by 72-h dietary recall, level of physical activity was assessed by the International Physical Activity Questionnaire (IPAQ) and bone mass was measured by ultrasonography at the calcaneus. RESULTS There were significant differences in bone mass values according to gender (p= 0.013). Despite the fact that 70% of the subjects had a body mass index (BMI) within the normal range, 20% had overweight or obesity. 49% of the individuals had a moderate level of physical activity, although women had lower levels of physical activity than men (17.9% vs 8.4%). Most diets among young adults were hyperprotic, hyperlipidic and low-carbohydrates, with low-calcium and fiber intakes and high-phosphorus. Analysis of bone mass according to BMI showed higher values as the weight category rises, with significant differences in women. Higher values of bone mass were shown as the level of physical activity was higher, showing significant differences in males. CONCLUSION Our results show that BMI and level of physical activity are significantly associated with bone health in a population of young adults, suggesting the relevance of promoting healthy lifestyles as a strategy for the early prevention of osteoporosis.
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Affiliation(s)
- María Correa-Rodríguez
- Departamento de Enfermería. Facultad de Ciencias de la Salud. Universidad de Granada, Granada, España
| | | | | | - Blanca Rueda-Medina
- Departamento de Enfermería. Facultad de Ciencias de la Salud. Universidad de Granada, Granada, España
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A Cross-Sectional Study of the Association between Autoantibodies and Qualitative Ultrasound Index of Bone in an Elderly Sample without Clinical Autoimmune Disease. J Immunol Res 2018; 2018:9407971. [PMID: 29854851 PMCID: PMC5952466 DOI: 10.1155/2018/9407971] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/05/2018] [Accepted: 03/17/2018] [Indexed: 12/15/2022] Open
Abstract
Bone loss is characteristic of the ageing process and a common complication of many autoimmune diseases. Research has highlighted a potential role of autoantibodies in pathologic bone loss. The confounding effects of immunomodulatory drugs make it difficult to establish the contribution of autoantibodies amongst autoimmune disease sufferers. We attempted to examine the relationship between autoantibodies and bone mass in a population of 2812 elderly participants without clinical autoimmune disease. Serum samples were assayed for a panel of autoantibodies (anti-nuclear, extractable nuclear antigen, anti-neutrophil cytoplasmic, thyroid peroxidase, tissue transglutaminase, anti-cardiolipin, rheumatoid factor, and cyclic citrullinated peptide). Bone mass was measured using quantitative ultrasound (QUS) of the calcaneus. The relationship between each autoantibody and bone mass was determined using linear regression models. Anti-nuclear autoantibodies were the most prevalent, positive in approximately 11%, and borderline in roughly 23% of our sample. They were also the only autoantibody observed to be significantly associated with QUS index in the univariate analysis (n = 1628; r = -0.20; 95% CI: -0.40-0.00; p = 0.046). However, statistical significance was lost after adjustment for various other potential confounders. None of the other autoantibodies was associated with QUS index in either univariate or multivariate analysis. We are limited by the cross-sectional nature of the study and the low prevalence of autoantibodies in our nonclinical sample.
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Szmodis M, Zsákai A, Bosnyák E, Protzner A, Trájer E, Farkas A, Szőts G, Tóth M. Reference data for ultrasound bone characteristics in Hungarian children aged 7-19 years. Ann Hum Biol 2017; 44:704-714. [PMID: 29037074 DOI: 10.1080/03014460.2017.1390152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Backround: Osteoporosis is a common disease and physical activity (PA) has a favourable influence on bone status. AIM To establish normative data for calcaneal quantitative ultrasound (QUS) bone characteristics in children and to analyse the relationships between PA, anthropometric and bone parameters. SUBJECTS AND METHODS Hungarian children aged 7-19 (n = 2674; 1325 girls, 1349 boys) provided PA, anthropometric and bone data. QUS parameters were registered with Sonost3000 densitometer (speed of sound: SOS, m/s; broadband ultrasound attenuation: BUA, dB/MHz; bone quantity index (BQI = αSOS + βBUA). Reference centiles of QUS parameters were constructed by LMS method. Multivariate linear regression models were used to analyse the relationships. RESULTS QUS bone parameters increased with age. There were no gender differences, except in 11- and 19-year-old children, where boys showed higher values. SOS (1497.15 ± 15.72 vs 1494.05 ± 14.81 m/s) and BQI (65.31 ± 16.71 vs 62.26 ± 15.78) were higher in athletic children. The regression model revealed significant relations between SOS and age, relative muscle mass and PA; BUA correlated with gender, morphological age, BMI, relative muscle mass and PA. CONCLUSIONS Changes in the bone parameters among 7-19-year-old Hungarian children depended on age, anthropometric dimensions and the level of PA. The normative data could be used for monitoring QUS bone parameters in children, leading to more effective interventions for healthy bones.
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Affiliation(s)
- Márta Szmodis
- a Department of Health Sciences and Sport Medicine , University of Physical Education , Budapest , Hungary
| | - Annamária Zsákai
- b Department of Biological Anthropology , Eötvös Loránd University , Budapest , Hungary
| | - Edit Bosnyák
- a Department of Health Sciences and Sport Medicine , University of Physical Education , Budapest , Hungary
| | - Anna Protzner
- a Department of Health Sciences and Sport Medicine , University of Physical Education , Budapest , Hungary
| | - Emese Trájer
- a Department of Health Sciences and Sport Medicine , University of Physical Education , Budapest , Hungary
| | - Anna Farkas
- a Department of Health Sciences and Sport Medicine , University of Physical Education , Budapest , Hungary
| | - Gábor Szőts
- a Department of Health Sciences and Sport Medicine , University of Physical Education , Budapest , Hungary
| | - Miklós Tóth
- a Department of Health Sciences and Sport Medicine , University of Physical Education , Budapest , Hungary.,c Department of Medical Chemistry , Semmmelweis University , Budapest , Hungary.,d Faculty of Health Sciences , University of Pécs , Pécs , Hungary
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Kambas A, Leontsini D, Avloniti A, Chatzinikolaou A, Stampoulis T, Makris K, Draganidis D, Jamurtas AZ, Tournis S, Fatouros IG. Physical activity may be a potent regulator of bone turnover biomarkers in healthy girls during preadolescence. J Bone Miner Metab 2017; 35:598-607. [PMID: 27838794 DOI: 10.1007/s00774-016-0794-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 09/25/2016] [Indexed: 10/20/2022]
Abstract
This study investigated the effects of different levels of habitual physical activity (PA) assessed by pedometry on bone turnover markers of preadolescent girls according to a cross-sectional experimental design. Sixty prepubertal girls of similar chronological age, bone age, maturity level, and nutritional status were assigned to a low PA (LPA; n = 25), a moderate PA (MPA; n = 17), or a high PA (HPA; n = 18) group. Dual-energy X-ray absorptiometry was used to measure areal bone mineral density (BMD) and bone mineral content (BMC) of the lumbar spine (L2-L4) and dominant hip (femoral neck and trochanter). Blood was collected for the measurement of alkaline phosphatase (ALP), bone-specific ALP (BSAP), procollagen type I N-terminal propeptide (PINP), C-terminal telopeptide of collagen I (CTX), parathyroid hormone (PTH), osteocalcin, thyroid-stimulating hormone, estradiol, testosterone, luteinizing hormone, and follicle-stimulating hormone concentrations. ANOVA revealed that the HPA group (18,695 ± 1244 steps per day) had a lower daily energy intake and body mass than the MPA group (10,774 ± 521 steps per day) and the LPA group (7633 ± 1099 steps per day). The HPA group had higher (P < 0.05) lumbar and hip BMD and hip BMC than the LPA group and higher (P < 0.05) lumbar BMD than the MPA group. The MPA group had higher (P < 0.05) hip BMC than the LPA group. The HPA group had greater (P < 0.05) values of BSAP, PINP, and ALP and lower (P < 0.05) values of PTH and CTX than the LPA group but not the MPA group. A partial correlation analysis (adjusted for body mass index) revealed a positive correlation of steps per day with BMD and BSAP concentration and a negative correlation with PTH and CTX concentration. In conclusion, PA increases BMD and BMC of premenarcheal girls by favoring bone formation over bone resorption.
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Affiliation(s)
- Antonis Kambas
- Department of Physical Education and Sport Science, Democritus University of Thrace, Komotini, Greece
| | - Diamanda Leontsini
- Department of Physical Education and Sport Science, Democritus University of Thrace, Komotini, Greece
| | - Alexandra Avloniti
- Department of Physical Education and Sport Science, Democritus University of Thrace, Komotini, Greece
| | - Athanasios Chatzinikolaou
- Department of Physical Education and Sport Science, Democritus University of Thrace, Komotini, Greece
| | - Theodoros Stampoulis
- Department of Physical Education and Sport Science, Democritus University of Thrace, Komotini, Greece
| | | | - Dimitrios Draganidis
- School of Physical Education and Sports Sciences, University of Thessaly, Karies, Trikala, 42100, Greece
| | - Athanasios Z Jamurtas
- School of Physical Education and Sports Sciences, University of Thessaly, Karies, Trikala, 42100, Greece
- Institute of Human Performance and Rehabilitation, Center for Research and Technology, Thessaly, Trikala, Greece
| | - Symeon Tournis
- Laboratory of Research of Musculoskeletal System "Th. Garofalidis", University of Athens, KAT Hospital, Athens, Greece
| | - Ioannis G Fatouros
- School of Physical Education and Sports Sciences, University of Thessaly, Karies, Trikala, 42100, Greece.
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Koedijk JB, van Rijswijk J, Oranje WA, van den Bergh JP, Bours SP, Savelberg HH, Schaper NC. Sedentary behaviour and bone health in children, adolescents and young adults: a systematic review. Osteoporos Int 2017; 28:2507-2519. [PMID: 28547135 PMCID: PMC5550522 DOI: 10.1007/s00198-017-4076-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 05/03/2017] [Indexed: 12/16/2022]
Abstract
Sedentary behaviour (SB) is increasing in Western societies and some studies suggest a deleterious effect of SB on bone. The aim of this systematic review was to examine the association between SB and bone health in children, adolescents and young adults. Electronic databases (PubMed, MEDLINE, PsycINFO and Science Citation Index) were searched for relevant articles up to January 9, 2017. Studies were included when results on bone health (e.g. strength, mass and structure) and either subjectively (questionnaires) or objectively (accelerometry) measured SB were reported in healthy participants ≤24 years. Two reviewers independently screened titles and abstracts for eligibility, rated methodological quality and extracted data. Seventeen observational studies were included. Several studies that used DXA or quantitative ultrasound suggested that objectively measured SB was negatively associated with lower extremity bone outcomes, such as femoral neck bone mineral density. The magnitude of this negative association was small and independent of moderate-to-vigorous physical activity. In contrast to the lower extremities, there was insufficient evidence for an association of lumbar spine bone outcomes with objectively measured SB. In high-quality studies that used DXA, no association was observed between objectively measured SB and total body bone outcomes. In studies using questionnaires, none of these relationships were observed. Well-designed longitudinal studies, objectively measuring SB, are needed to further unravel the effect of SB, physical activity and their interaction on bone health.
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Affiliation(s)
- J. B. Koedijk
- Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - J. van Rijswijk
- Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - W. A. Oranje
- Division of Endocrinology, Department of Internal Medicine, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - J. P. van den Bergh
- Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands
- Division of Endocrinology, Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
| | - S. P. Bours
- Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - H. H. Savelberg
- Department of Human Biology and Human Movement Sciences, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - N. C. Schaper
- Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands
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10
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Ludwa IA, Falk B, Ward WE, Gammage KL, Klentrou P. Mechanical, biochemical, and dietary determinants of the functional model of bone development of the radius in children and adolescents. Appl Physiol Nutr Metab 2017; 42:780-787. [PMID: 28273428 DOI: 10.1139/apnm-2016-0666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study examined the degree to which various mechanical, biochemical, and dietary factors are related to nonweight bearing bone properties in 172 healthy peri-pubertal children (age, 11.7 ± 2.0 years). Dominant radial speed of sound (rSOS) was measured by transaxial quantitative ultrasound at distal radius. Potential modulating factors included somatic maturity offset (years from age of peak height velocity), grip strength, forearm lean cross-sectional area (CSA), physical activity, nutritional intake, and amino-terminal cross-linking propeptide (NTx), reflecting bone resorption. In a hierarchical regression, grip strength adjusted for CSA was the second most important predictor of rSOS after the maturity offset (β = 0.22 and β = 0.33, respectively; R2 = 0.16). When relative grip strength was added to the model the contribution of sex was no longer significant. Calcium intake was a significant predictor of rSOS only after NTx was accounted for in the model (β = 0.17, R2 = 0.21). This may suggest that calcium's effects on the muscle-bone unit may be modulated through bone resorption. In the final model, relative grip strength together with maturity offset, dietary calcium, and NTx explained up to 21% of the variance in rSOS in this cohort of children. Therefore, during the peri-pubertal stage, size-adjusted forearm muscle strength is related to radial bone strength after controlling for maturity, with calcium intake having a potential indirect association through NTx.
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Affiliation(s)
- Izabella A Ludwa
- Department of Kinesiology, Brock University, St. Catharines, ON L2S 3A1, Canada.,Department of Kinesiology, Brock University, St. Catharines, ON L2S 3A1, Canada
| | - Bareket Falk
- Department of Kinesiology, Brock University, St. Catharines, ON L2S 3A1, Canada.,Department of Kinesiology, Brock University, St. Catharines, ON L2S 3A1, Canada
| | - Wendy E Ward
- Department of Kinesiology, Brock University, St. Catharines, ON L2S 3A1, Canada.,Department of Kinesiology, Brock University, St. Catharines, ON L2S 3A1, Canada
| | - Kimberley L Gammage
- Department of Kinesiology, Brock University, St. Catharines, ON L2S 3A1, Canada.,Department of Kinesiology, Brock University, St. Catharines, ON L2S 3A1, Canada
| | - Panagiota Klentrou
- Department of Kinesiology, Brock University, St. Catharines, ON L2S 3A1, Canada.,Department of Kinesiology, Brock University, St. Catharines, ON L2S 3A1, Canada
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VLACHOPOULOS DIMITRIS, BARKER ALANR, WILLIAMS CRAIGA, ARNGRíMSSON SIGURBJA, KNAPP KARENM, METCALF BRADS, FATOUROS IOANNISG, MORENO LUISA, GRACIA-MARCO LUIS. The Impact of Sport Participation on Bone Mass and Geometry in Male Adolescents. Med Sci Sports Exerc 2017; 49:317-326. [DOI: 10.1249/mss.0000000000001091] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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12
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Pulina G, Francesconi AHD, Stefanon B, Sevi A, Calamari L, Lacetera N, Dell’Orto V, Pilla F, Ajmone Marsan P, Mele M, Rossi F, Bertoni G, Crovetto GM, Ronchi B. Sustainable ruminant production to help feed the planet. ITALIAN JOURNAL OF ANIMAL SCIENCE 2016. [DOI: 10.1080/1828051x.2016.1260500] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Giuseppe Pulina
- Dipartimento di Agraria, University of Sassari, Sassari, Italy
| | | | - Bruno Stefanon
- Dipartimento di Scienze Agroalimentari, Ambientali e Animali, University of Udine, Udine, Italy
| | - Agostino Sevi
- Dipartimento di Scienze Agrarie, degli Alimenti e dell’Ambiente, University of Foggia, Foggia, Italy
| | - Luigi Calamari
- Istituto di Zootecnica, University Cattolica del Sacro Cuore, Piacenza, Italy
| | - Nicola Lacetera
- Dipartimento di Scienze Agrarie e Forestali, University of Tuscia, Viterbo, Italy
| | - Vittorio Dell’Orto
- Dipartimento di Scienze Veterinarie per la Salute, la Produzione Animale e la Sicurezza Alimentare, University of Milano, Milan, Italy
| | - Fabio Pilla
- Dipartimento di Agricoltura Ambiente Alimenti, University of Molise, Campobasso, Italy
| | - Paolo Ajmone Marsan
- Istituto di Zootecnica, University Cattolica del Sacro Cuore, Piacenza, Italy
| | - Marcello Mele
- Dipartimento di Scienze Agrarie, Alimentari e Agro-ambientali, University of Pisa, Pisa, Italy
| | - Filippo Rossi
- Istituto di Scienze degli Alimenti e della Nutrizione, University Cattolica del Sacro Cuore, Piacenza, Italy
| | - Giuseppe Bertoni
- Istituto di Zootecnica, University Cattolica del Sacro Cuore, Piacenza, Italy
| | | | - Bruno Ronchi
- Dipartimento di Scienze Agrarie e Forestali, University of Tuscia, Viterbo, Italy
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13
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Cliff DP, Hesketh KD, Vella SA, Hinkley T, Tsiros MD, Ridgers ND, Carver A, Veitch J, Parrish AM, Hardy LL, Plotnikoff RC, Okely AD, Salmon J, Lubans DR. Objectively measured sedentary behaviour and health and development in children and adolescents: systematic review and meta-analysis. Obes Rev 2016; 17:330-44. [PMID: 26914664 DOI: 10.1111/obr.12371] [Citation(s) in RCA: 191] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/27/2015] [Accepted: 12/14/2015] [Indexed: 12/24/2022]
Abstract
Sedentary behaviour has emerged as a unique determinant of health in adults. Studies in children and adolescents have been less consistent. We reviewed the evidence to determine if the total volume and patterns (i.e. breaks and bouts) of objectively measured sedentary behaviour were associated with adverse health outcomes in young people, independent of moderate-intensity to vigorous-intensity physical activity. Four electronic databases (EMBASE MEDLINE, Ovid EMBASE, PubMed and Scopus) were searched (up to 12 November 2015) to retrieve studies among 2- to 18-year-olds, which used cross-sectional, longitudinal or experimental designs, and examined associations with health outcomes (adiposity, cardio-metabolic, fitness, respiratory, bone/musculoskeletal, psychosocial, cognition/academic achievement, gross motor development and other outcomes). Based on 88 eligible observational studies, level of evidence grading and quantitative meta-analyses indicated that there is limited available evidence that the total volume or patterns of sedentary behaviour are associated with health in children and adolescents when accounting for moderate-intensity to vigorous-intensity physical activity or focusing on studies with low risk of bias. Quality evidence from studies with robust designs and methods, objective measures of sitting, examining associations for various health outcomes, is needed to better understand if the overall volume or patterns of sedentary behaviour are independent determinants of health in children and adolescents.
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Affiliation(s)
- D P Cliff
- Early Start Research Institute, Faculty of Social Sciences, School of Education, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - K D Hesketh
- Centre for Physical Activity and Nutrition Research (C-PAN), Deakin University, Burwood, Victoria, Australia
| | - S A Vella
- Early Start Research Institute, Faculty of Social Sciences, School of Education, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - T Hinkley
- Centre for Physical Activity and Nutrition Research (C-PAN), Deakin University, Burwood, Victoria, Australia
| | - M D Tsiros
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - N D Ridgers
- Centre for Physical Activity and Nutrition Research (C-PAN), Deakin University, Burwood, Victoria, Australia
| | - A Carver
- Centre for Physical Activity and Nutrition Research (C-PAN), Deakin University, Burwood, Victoria, Australia.,School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - J Veitch
- Centre for Physical Activity and Nutrition Research (C-PAN), Deakin University, Burwood, Victoria, Australia
| | - A-M Parrish
- Early Start Research Institute, Faculty of Social Sciences, School of Education, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - L L Hardy
- Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - R C Plotnikoff
- Priority Research Centre for Physical Activity and Nutrition, Faculty of Education and Arts, University of Newcastle, Newcastle, Australia
| | - A D Okely
- Early Start Research Institute, Faculty of Social Sciences, School of Education, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - J Salmon
- Centre for Physical Activity and Nutrition Research (C-PAN), Deakin University, Burwood, Victoria, Australia
| | - D R Lubans
- Priority Research Centre for Physical Activity and Nutrition, Faculty of Education and Arts, University of Newcastle, Newcastle, Australia
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14
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Correa-Rodríguez M, Rio-Valle JS, González-Jiménez E, Rueda-Medina B. The Effects of Body Composition, Dietary Intake, and Physical Activity on Calcaneus Quantitative Ultrasound in Spanish Young Adults. Biol Res Nurs 2016; 18:439-44. [PMID: 26933147 DOI: 10.1177/1099800416634884] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Identifying modifiable factors that influence bone gain during early adulthood in order to maximize peak bone mass (PBM) is a potential primary strategy in the prevention of osteoporosis in later life. The present study examined the relationships between body composition, dietary intake and physical activity (PA), and bone health measured by quantitative ultrasound (QUS) at the right calcaneus. The study population consisted of 781 Spanish men and women (age 19.1 ± 3.6). Body composition, dietary intake, PA, and bone strength were assessed. Calcaneus QUS was significantly correlated with age, height, weight, body mass index, lean mass, fat mass, protein intake, and moderate and high PA. No significant correlation between calcium intake and broadband ultrasound attenuation (BUA, dB/MHz) was detected. Linear regression analyses revealed that independent variables accounted for 18.8% of the total variance of calcaneus BUA (p = .000). Lean mass and high PA were significant predictors of BUA variance in young adults (p = .000 and p = .045, respectively). Results indicate that lifestyle choices and their consequences during early adulthood could influence bone mass, particularly PA and lean mass. Furthermore, this study provides novel data about bone mass as indicated by the QUS measurements at the time of PBM acquisition.
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15
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Correa-Rodríguez M, Schmidt Rio-Valle J, González-Jiménez E, Rueda-Medina B. A Cross-Sectional Study of the Association of VDR Gene, Calcium Intake, and Heel Ultrasound Measures in Early Adulthood. Calcif Tissue Int 2016; 98:226-34. [PMID: 26590811 DOI: 10.1007/s00223-015-0086-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 11/11/2015] [Indexed: 11/27/2022]
Abstract
The acquisition of a high adult peak bone mass (PBM) is considered an important determinant of osteoporotic risk later in life. Genetic and environmental factors determine optimal PBM acquisition in early adulthood. The aim of this study was to test the association of vitamin D receptor (VDR) gene polymorphisms and dietary calcium intake with the bone mass of young adults. The study population comprised a total of 305 individuals (mean age 20.41; SD 2.36) whose bone mass was assessed through heel ultrasound [quantitative ultrasound measurements (QUS)] measurements (BUA, dB/MHz). The FokI G/A, rs9729 G/T, and TaqI G/A polymorphisms were selected as genetic markers of VDR. A significant difference in BUA values was observed according to gender (females 82.96; SD 15.89 vs. males 97.72; SD 16.50; p < 0.00001). The mean dietary calcium intake of the study group (827.84 mg/day; SD 347.04) was lower than the dietary reference intake for young adults (1000 mg/day) and had no association with BUA. None of the three VDR polymorphisms tested showed an association with BUA. Similarly, the analysis of VDR 3' haplotypes, estimated using rs9729 and Taq1 as tag SNPs, did not reveal any significant association with QUS traits. Our results confirm the existence of different heel QUS for women and men, as well as a tendency towards low calcium consumption by young adults, and they also suggest that the VDR gene does not play a major role in the genetic determination of QUS parameter in early adulthood.
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Affiliation(s)
- María Correa-Rodríguez
- Faculty of Health Sciences, University of Granada, Av. Ilustración S/N, 18007, Granada, Spain.
| | | | - Emilio González-Jiménez
- Faculty of Health Sciences, University of Granada, Av. Ilustración S/N, 18007, Granada, Spain
| | - Blanca Rueda-Medina
- Faculty of Health Sciences, University of Granada, Av. Ilustración S/N, 18007, Granada, Spain
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Renz DM, Malich A, Ulrich A, Pfeil A, Mentzel HJ, Streitparth F, Maurer MH, Teichgräber UK, Böttcher J. Reference values for digital X-ray radiogrammetry parameters in children and adolescents in comparison to estimates in patients with distal radius fractures. J Bone Miner Metab 2016; 34:55-64. [PMID: 25687428 DOI: 10.1007/s00774-014-0641-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 11/06/2014] [Indexed: 10/24/2022]
Abstract
The first objective of this study was to determine normative digital X-ray radiogrammetry (DXR) values, based on original digital images, in a pediatric population (aged 6-18 years). The second aim was to compare these reference data with patients suffering from distal radius fractures, whereas both cohorts originated from the same geographical region and were evaluated using the same technical parameters as well as inclusion and exclusion criteria. DXR-BMD and DXR-MCI of the metacarpal bones II-IV were assessed on standardized digital hand radiographs, without printing or scanning procedures. DXR parameters were estimated separately by gender and among six age groups; values in the fracture group were compared to age- and gender-matched normative data using Student's t tests and Z scores. In the reference cohort (150 boys, 138 girls), gender differences were found in bone mineral density (DXR-BMD), with higher values for girls from 11 to 14 years and for boys from 15 to 18 years (p < 0.05). Girls had higher normative metacarpal index (DXR-MCI) values than boys, with significant differences at 11-14 years (p < 0.05). In the case-control investigation, the fracture group (95 boys, 69 girls) presented lower DXR-BMD at 15-18 years in boys and 13-16 years in girls vs. the reference cohort (p < 0.05); DXR-MCI was lower at 11-18 years in boys and 11-16 years in girls (p < 0.05). Mean Z scores in the fracture group for DXR-BMD were -0.42 (boys) and -0.46 (girls), and for DXR-MCI were -0.51 (boys) and -0.53 (girls). These findings indicate that the fully digital DXR technique can be accurately applied in pediatric populations ≥ 6 years of age. The lower DXR-BMD and DXR-MCI values in the fracture group suggest promising early identification of individuals with increased fracture risk, without the need for additional radiation exposure, enabling the initiation of prevention strategies to possibly reduce the incidence of osteoporosis later in life.
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Affiliation(s)
- Diane M Renz
- Department of Radiology, Charité University Medicine Berlin, Campus Virchow Clinic, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Ansgar Malich
- Institute of Diagnostic Radiology, Suedharz Clinic Nordhausen, Dr. Robert-Koch-Str. 39, 99734, Nordhausen, Germany
| | - Andreas Ulrich
- Institute of Diagnostic Radiology, Suedharz Clinic Nordhausen, Dr. Robert-Koch-Str. 39, 99734, Nordhausen, Germany
| | - Alexander Pfeil
- Department of Internal Medicine III, Jena University Hospital, Friedrich-Schiller-University, Erlanger Allee 101, 07740, Jena, Germany
| | - Hans-Joachim Mentzel
- Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich-Schiller-University, Erlanger Allee 101, 07740, Jena, Germany
| | - Florian Streitparth
- Department of Radiology, Charité University Medicine Berlin, Campus Virchow Clinic, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Martin H Maurer
- Department of Radiology, Charité University Medicine Berlin, Campus Virchow Clinic, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Ulf K Teichgräber
- Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich-Schiller-University, Erlanger Allee 101, 07740, Jena, Germany
| | - Joachim Böttcher
- Institute of Diagnostic and Interventional Radiology, SRH Clinic Gera, Str. des Friedens 122, 07548, Gera, Germany
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Herrmann D, Buck C, Sioen I, Kouride Y, Marild S, Molnár D, Mouratidou T, Pitsiladis Y, Russo P, Veidebaum T, Ahrens W. Impact of physical activity, sedentary behaviour and muscle strength on bone stiffness in 2-10-year-old children-cross-sectional results from the IDEFICS study. Int J Behav Nutr Phys Act 2015; 12:112. [PMID: 26377674 PMCID: PMC4574210 DOI: 10.1186/s12966-015-0273-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 08/29/2015] [Indexed: 11/17/2022] Open
Abstract
Background Physical activity (PA), weight-bearing exercises (WBE) and muscle strength contribute to skeletal development, while sedentary behaviour (SB) adversely affects bone health. Previous studies examined the isolated effect of PA, SB or muscle strength on bone health, which was usually assessed by x-ray methods, in children. Little is known about the combined effects of these factors on bone stiffness (SI) assessed by quantitative ultrasound. We investigated the joint association of PA, SB and muscle strength on SI in children. Methods In 1512 preschool (2- < 6 years) and 2953 school children (6–10 years), data on calcaneal SI as well as on accelerometer-based sedentary time (SED), light (LPA), moderate (MPA) and vigorous PA (VPA) were available. Parents reported sports (WBE versus no WBE), leisure time PA and screen time of their children. Jumping distance and handgrip strength served as indicators for muscle strength. The association of PA, SB and muscle strength with SI was estimated by multivariate linear regression, stratified by age group. Models were adjusted for age, sex, country, fat-free mass, daylight duration, consumption of dairy products and PA, or respectively SB. Results Mean SI was similar in preschool (79.5 ± 15.0) and school children (81.3 ± 12.1). In both age groups, an additional 10 min/day in MPA or VPA increased the SI on average by 1 or 2 %, respectively (p ≤ .05). The negative association of SED with SI decreased after controlling for MVPA. LPA was not associated with SI. Furthermore, participation in WBE led to a 3 and 2 % higher SI in preschool (p = 0.003) and school children (p < .001), respectively. Although muscle strength significantly contributed to SI, it did not affect the associations of PA with SI. In contrast to objectively assessed PA, reported leisure time PA and screen time showed no remarkable association with SI. Conclusion This study suggests that already an additional 10 min/day of MPA or VPA or the participation in WBE may result in a relevant increase in SI in children, taking muscle strength and SB into account. Our results support the importance of assessing accelerometer-based PA in large-scale studies. This may be important when deriving dose–response relationships between PA and bone health in children.
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Affiliation(s)
- Diana Herrmann
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359, Bremen, Germany.
| | - Christoph Buck
- Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359, Bremen, Germany.
| | - Isabelle Sioen
- Department of Public Health, Ghent University, 4K3, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Yiannis Kouride
- Research and Education Institute of Child Health, 138 Limassol Ave, #205, 2015, Strovolos, Cyprus.
| | - Staffan Marild
- Department of Paediatrics, Queen Silvia Children's Hospital, University of Gothenburg, Rondvägen 15, 41685, Gothenburg, Sweden.
| | - Dénes Molnár
- Department of Pediatrics, Medical Faculty, University of Pecs, Jozsef A. u. 7, 7623, Pecs, Hungary.
| | - Theodora Mouratidou
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, C/Domingo Miral s/n, 50009, Zaragoza, Spain.
| | - Yannis Pitsiladis
- Centre for Sport and Exercise Science and Medicine (SESAME), University of Brighton, Welkin House, 30 Carlisle Road, Eastbourne, BN20 7SN, UK.
| | - Paola Russo
- Institute of Food Sciences, National Research Council, Via Roma 64, 83100, Avellino, Italy.
| | - Toomas Veidebaum
- Department of Chronic Diseases, Centre of Behavioural and Health Sciences, National Institute for Health Development, Hiiu 42, 11619, Tallinn, Estonia.
| | - Wolfgang Ahrens
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359, Bremen, Germany. .,Faculty of Mathematics and Computer Science, Bremen University, Bibliothekstraße 1, 28359, Bremen, Germany.
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