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Guzel Y, Atakan MM, Areta JL, Turnagol HH, Kosar SN. Ten weeks of low-volume walking training improve cardiometabolic health and body composition in sedentary postmenopausal women with obesity without affecting markers of bone metabolism. Res Sports Med 2024; 32:331-343. [PMID: 35996845 DOI: 10.1080/15438627.2022.2113877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/12/2022] [Indexed: 10/15/2022]
Abstract
This study aimed to determine the effects of walking exercise to induce a mild energy deficit and to improve body composition and metabolic status in postmenopausal women (PMW) with obesity as means of minimizing endocrine disruption and maintaining bone health. Twenty-four PMW with obesity (age: 55.0 ± 3.7 y, BMI: 32.9 ± 4.2 kg/m2, percent body fat: 46.2 ± 3.6%) were randomly assigned into either exercise (n = 12) or control (n = 12) groups. Exercise group participated in a-10 week supervised progressive walking programme and control group maintained regular habits. Pre- and post-training assessments included body composition, bone mass, peak oxygen uptake (V ˙ O2peak), osteocalcin, bone alkaline phosphatase (BAP), type I collagen cross-linked C-telopeptide (CTX)glucose, glycated haemoglobin (HbA1c)), leptin and adiponectin. Results: Following the training program, body weight (2.6%; p < 0.001), fat mass (4.5%; p = 0.002), resting glucose (6.8%; p = 0.017), and HbA1c (3.7%; p = 0.047) decreased, while relative V ˙ O2peak (16%; p < 0.001) increased in the exercise group. Leptin, adiponectin, CTX, osteocalcin or BAP did not change in either group. In conclusion, small dose of aerobic exercise improves key markers of metabolic health in PMW with obesity without negatively affecting markers of bone metabolism.
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Affiliation(s)
- Yasemin Guzel
- Division of Exercise Nutrition and Metabolism, Faculty of Sport Sciences, Hacettepe University, Ankara, Turkey
| | - Muhammed M Atakan
- Division of Exercise Nutrition and Metabolism, Faculty of Sport Sciences, Hacettepe University, Ankara, Turkey
| | - Jose L Areta
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Huseyin H Turnagol
- Division of Exercise Nutrition and Metabolism, Faculty of Sport Sciences, Hacettepe University, Ankara, Turkey
| | - Sukran N Kosar
- Division of Exercise Nutrition and Metabolism, Faculty of Sport Sciences, Hacettepe University, Ankara, Turkey
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2
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Cowgill L, Harrington L, MacKinnon M, Kurki HK. Gains in relative cortical area during growth and their relationship to nutrition, body size, and physical activity. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2023; 182:177-193. [PMID: 37377180 DOI: 10.1002/ajpa.24805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 03/17/2023] [Accepted: 05/27/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVES In studies of growth in the past, low percentage of cortical area (%CA) is commonly attributed to poor general health, due to factors including poor nutrition, low socioeconomic status, or other physiological stressors. What constitutes low relative cortical dimensions has not been established across a diverse range of human skeletal samples. This study examines %CA in a large immature skeletal sample to establish typical variation in humans with consideration of both body mass and subsistence strategy. MATERIALS AND METHODS Percentage of cortical area was calculated at the midshaft of the humerus, femur, and tibia in seven skeletal samples. Age at death was estimated from dental development, and body mass from bone dimensions. Patterns of %CA with age and log-transformed body mass were examined in the pooled sample and compared among samples using LOESS regression, Welch's ANOVA, and Kruskal-Wallis tests. RESULTS Across all samples, %CA displays a generally non-linear pattern, but variation in %CA with age was high, particularly in samples with lower levels of %CA. There was no relationship between %CA and age-adjusted body mass. DISCUSSION The lack of a relationship between %CA and body mass suggests that %CA should not be used as an indicator of mechanical loading. The variation present across samples implies that appositional bone growth is affected by physiological stress in varying ways. Without a deeper understanding of what is "typical" for long bone development, it is impossible to draw conclusions about individual or population level health.
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Affiliation(s)
- Libby Cowgill
- Department of Anthropology, University of Missouri, Columbia, Missouri, USA
| | - Lesley Harrington
- Department of Anthropology, University of Alberta, Edmonton, Alberta, Canada
| | - Marla MacKinnon
- Department of Anthropology, University of Victoria, Victoria, British Columbia, Canada
| | - Helen K Kurki
- Department of Anthropology, University of Victoria, Victoria, British Columbia, Canada
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3
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Mohebbi R, Shojaa M, Kohl M, von Stengel S, Jakob F, Kerschan-Schindl K, Lange U, Peters S, Thomasius F, Uder M, Kemmler W. Exercise training and bone mineral density in postmenopausal women: an updated systematic review and meta-analysis of intervention studies with emphasis on potential moderators. Osteoporos Int 2023:10.1007/s00198-023-06682-1. [PMID: 36749350 DOI: 10.1007/s00198-023-06682-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/20/2023] [Indexed: 02/08/2023]
Abstract
The aim of this systematic review and meta-analysis was (1) to determine exercise effects on bone mineral density (BMD) in postmenopausal women and (2) to address the corresponding implication of bone and menopausal status or supervision in postmenopausal women. A comprehensive search of eight electronic databases according to the PRISMA statement up to August 9, 2022, included controlled exercise trials ≥ 6 months. BMD changes (standardized mean differences: SMD) at the lumbar spine (LS), femoral neck (FN), and total hip (TH) were considered as outcomes. Study group comparisons were conducted for osteopenia/osteoporosis versus normal BMD, early versus late postmenopausal women, and predominantly supervised versus predominantly non-supervised study arms. We applied an inverse heterogeneity (IVhet) model. In summary, 80 studies involving 94 training and 80 control groups with a pooled number of 5581 participants were eligible. The IVhet model determined SMDs of 0.29 (95% CI: 0.16-0.42), 0.27 (95% CI: 0.16-0.39), and 0.41 (95% CI: 0.30-0.52) for LS, FN, and THBMD, respectively. Heterogeneity between the trial results varied from low (I2 = 20%, TH BMD) to substantial (I2 = 68%, LS-BMD). Evidence for publication bias/small study effects was negligibly low (FN-, TH-BMD) to high (LSBMD). We observed no significant differences (p > .09) for exercise effects on LS-, FN-, or TH-BMD-LS between studies/study arms with or without osteopenia/osteoporosis, early versus late postmenopausal women, or predominantly supervised versus non-supervised exercise programs. Using robust statistical methods, the present work provides further evidence for a positive effect of exercise on BMD in postmenopausal women. Differences in bone status (osteopenia/osteoporosis versus normal bone), menopausal status (early versus late postmenopausal), and supervision (yes versus no) did not significantly affect the exercise effects on BMD at LS or proximal femur.
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Affiliation(s)
- Ramin Mohebbi
- Institute of Medical Physics, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Mahdieh Shojaa
- Department Population-Based Medicine, Institute of Health Science, University Hospital Tübingen, Tübingen, Germany
- Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany
| | - Matthias Kohl
- Department of Medical and Life Sciences, University of Furtwangen, Schwenningen, Germany
- Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany
| | - Simon von Stengel
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
- Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany
| | - Franz Jakob
- Bernhard-Heine-Centrum Für Bewegungsforschung, University of Würzburg, Würzburg, Germany
- Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany
| | - Katharina Kerschan-Schindl
- Austrian Society for Bone and Mineral Research, Vienna, Austria
- Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany
| | - Uwe Lange
- German Society for Physical and Rehabilitative Medicine, Dresden, Germany
- Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany
| | - Stefan Peters
- German Association for Health-Related Fitness and Exercise Therapy (DVGS), Hürth-Efferen, Germany
- Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany
| | - Friederike Thomasius
- Osteology Umbrella Association Germany, Austria, Switzerland
- Frankfurt Center of Bone Health, Frankfurt, Germany
- Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
- Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany
| | - Wolfgang Kemmler
- Institute of Medical Physics, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany.
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany.
- Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany.
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Effects of physical exercise on bone mineral density in older postmenopausal women: a systematic review and meta-analysis of randomized controlled trials. Arch Osteoporos 2022; 17:102. [PMID: 35896850 DOI: 10.1007/s11657-022-01140-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/05/2022] [Indexed: 02/03/2023]
Abstract
Osteoporosis or decreased bone mineral density (BMD) is the most important risk factor for fractures, especially in older postmenopausal women (PMW). However, the interactions between exercise training and bone mineral density are not completely understood. We evaluated the effects of physical exercise on BMD in women aged ≥ 60 years postmenopausal. PURPOSE This systematic review and meta-analysis sets out to determine the effects of physical exercise on BMD in older postmenopausal women. METHODS A systematic search was conducted in Medline, Science Direct, Cochrane, PubMed, CINAHL, Google Scholar, Scopus, and ProQuest up to December 25, 2021. Fifty-three studies, which assessed a total of 2896 participants (mean age: between 60 and 82 years), were included and analyzed using a random-effects model to estimate weighted mean differences (WMD) with 95% confidence intervals (CI). RESULTS The meta-analysis found that exercise training significantly (p < 0.05) increased femoral neck (WMD: 0.01 g/cm2; 95% CI, 0.00 to 0.01], p = 0.0005; I2 = 57%; p < 0.0001), lumbar spine (WMD: 0.01 g/cm2, 95% CI, 0.01 to 0.02], I2 = 81%; p = 0.0001), and trochanter (WMD: 0.01 g/cm2, 95% CI 0.00, 0.02]; p = 0.009; I2 = 17%; p = 0.23). There were no significant differences between the intervention and control groups for total body and total hip BMD. CONCLUSION Our findings suggest that exercise training may improve bone mineral density in older PMW. This improvement is mediated by increases in the femoral neck, lumbar spine, and trochanter BMD. Further long-term studies are required to confirm these findings.
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Yazdanpanah Z, Beigrezaei S, Mohseni-Takalloo S, Soltani S, Rajaie SH, Zohrabi T, Kaviani M, Forbes SC, Baker JS, Salehi-Abargouei A. Does exercise affect bone mineral density and content when added to a calorie-restricted diet? A systematic review and meta-analysis of controlled clinical trials. Osteoporos Int 2022; 33:339-354. [PMID: 34643754 DOI: 10.1007/s00198-021-06187-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/29/2021] [Indexed: 10/20/2022]
Abstract
The effects of exercise in conjunction with weight-loss diets on bone health are mixed. Our objective was to systematically review and meta-analyze controlled clinical trials in adults investigating the addition of exercise to a weight-loss diet compared with a calorie-matched weight-loss diet without exercise on bone measures. Online databases including PubMed/MEDLINE, EMBASE, ISI (Web of Science), Scopus, and Google Scholar were searched up to April 2021 with no restriction. A random effects model was used to calculate the overall estimates. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Fourteen eligible controlled clinical trials were included in the systematic review. The meta-analysis revealed that, compared to weight-loss diets alone, the addition of exercise did not improve total body bone mineral density (BMD) [weighted mean difference (WMD) = 0.002 g/cm2, P = 0.62, n = 8], lumbar BMD (WMD = 0.007 g/cm2, P = 0.44, n = 9), total hip BMD (WMD = 0.015 g/cm2, P = 0.14, n = 4) and total bone mineral content (BMC) (WMD = - 11.97 g, P = 0.29, n = 7). Subgroup analysis revealed that resistance exercise in conjunction with hypocaloric diets positively affects total BMD compared to an energy restrictive diet alone (WMD = 0.01 g/cm2, P = 0.003, n = 3). Overall, it appears that only resistance exercise beneficially affects total BMD during a calorie-restricted diet in adults. Further well-controlled and long-term clinical trials are still needed to confirm these results. PROSPERO registration number: CRD42020173434.
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Affiliation(s)
- Zeinab Yazdanpanah
- Department of Nutrition, Faculty of Health, School of Public Health, Shahid Sadoughi University of Medical Sciences, PO Code 8915173160 , Yazd, Iran
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Sara Beigrezaei
- Department of Nutrition, Faculty of Health, School of Public Health, Shahid Sadoughi University of Medical Sciences, PO Code 8915173160 , Yazd, Iran
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Sahar Mohseni-Takalloo
- Department of Nutrition, Faculty of Health, School of Public Health, Shahid Sadoughi University of Medical Sciences, PO Code 8915173160 , Yazd, Iran
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Noncommunicable Diseases Research Center, Bam University of Medical Sciences, Bam, Iran
| | - Sepideh Soltani
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Seyede Hamide Rajaie
- Department of Nutrition, Faculty of Health, School of Public Health, Shahid Sadoughi University of Medical Sciences, PO Code 8915173160 , Yazd, Iran
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Tayebeh Zohrabi
- Department of Nutrition, Faculty of Health, School of Public Health, Shahid Sadoughi University of Medical Sciences, PO Code 8915173160 , Yazd, Iran
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mojtaba Kaviani
- School of Nutrition and Dietetics, Faculty of Pure & Applied Science, Acadia University, Wolfville, NS, Canada
| | - Scott C Forbes
- Department of Physical Education Studies, Faculty of Education, Brandon University, Brandon, MB, Canada
| | - Julien S Baker
- Centre for Health and Exercise Science Research, Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Amin Salehi-Abargouei
- Department of Nutrition, Faculty of Health, School of Public Health, Shahid Sadoughi University of Medical Sciences, PO Code 8915173160 , Yazd, Iran.
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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6
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Serra MC, Ryan AS. Bone Mineral Density Changes during Weight Regain following Weight Loss with and without Exercise. Nutrients 2021; 13:nu13082848. [PMID: 34445008 PMCID: PMC8400683 DOI: 10.3390/nu13082848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/11/2021] [Accepted: 08/18/2021] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to compare changes in bone mineral density (BMD) over a 6 month follow up (period of weight regain) in overweight, postmenopausal women having previously completed a 6 month weight loss (WL) intervention with and without aerobic exercise (AEX). Women (BMI > 25 kg/m2) underwent VO2max and DEXA scans at baseline, after 6 months of WL or AEX + WL, and at 12 months ad libitum follow up. Both groups lost ~9% body weight from 0 to 6 months and regained ~2% from 6 to 12 months, while losing ~4% of appendicular lean mass (ALM) across the 12-month study duration. VO2max increased 10% from 0 to 6 months and declined 12% from 6 to 12 months for AEX + WL, with no changes for WL. Total body (p < 0.01) and total femur (p = 0.03) BMD decreased similar between groups across time (combined groups: 0-6 months: total body: -1.2% and total femur: -1.2%; 6-12 months: total body: -0.26% and total femur: -0.09%). Less ALM loss and greater VO2max increases during the WL phase were associated with attenuated BMD loss at various anatomical sites during periods of weight regain (6-12 months) p's < 0.05). Results suggest that BMD loss may continue following WL, despite weight regain. Further, this study adds to the literature by suggesting that preventing declines in muscle quality and function during WL may attenuate the loss of BMD during weight regain. Future studies are needed to identify mechanisms underlying WL-induced bone loss so that effective practices can be designed to minimize the loss of BMD during WL and weight maintenance in older women.
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Affiliation(s)
- Monica C. Serra
- Division of Geriatrics, Gerontology & Palliative Medicine and the Sam & Ann Barshop Institute for Longevity & Aging Studies, Department of Medicine, UT Health San Antonio, San Antonio, TX 78229, USA
- San Antonio Geriatric Research Education and Clinical Center (GRECC), South Texas Veterans Health Care System, San Antonio, TX 78229, USA
- Correspondence: ; Tel.: +1-210-949-9759
| | - Alice S. Ryan
- Division of Gerontology and Palliative Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
- Baltimore GRECC, VA Maryland Health Care System, Baltimore, MD 21201, USA
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7
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Wherry SJ, Miller RM, Jeong SH, Beavers KM. The Ability of Exercise to Mitigate Caloric Restriction-Induced Bone Loss in Older Adults: A Structured Review of RCTs and Narrative Review of Exercise-Induced Changes in Bone Biomarkers. Nutrients 2021; 13:1250. [PMID: 33920153 PMCID: PMC8070587 DOI: 10.3390/nu13041250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 11/17/2022] Open
Abstract
Despite the adverse metabolic and functional consequences of obesity, caloric restriction- (CR) induced weight loss is often contra-indicated in older adults with obesity due to the accompanying loss of areal bone mineral density (aBMD) and subsequent increased risk of fracture. Several studies show a positive effect of exercise on aBMD among weight-stable older adults; however, data on the ability of exercise to mitigate bone loss secondary to CR are surprisingly equivocal. The purpose of this review is to provide a focused update of the randomized controlled trial literature assessing the efficacy of exercise as a countermeasure to CR-induced bone loss among older adults. Secondarily, we present data demonstrating the occurrence of exercise-induced changes in bone biomarkers, offering insight into why exercise is not more effective than observed in mitigating CR-induced bone loss.
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Affiliation(s)
- Sarah J. Wherry
- Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), Aurora, CO 80045, USA
| | - Ryan M. Miller
- Department of Internal Medicine, Sections on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA;
| | - Sarah H. Jeong
- Z. Smith Reynolds Library, Wake Forest University, Winston-Salem, NC 27109, USA;
| | - Kristen M. Beavers
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC 27109, USA
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8
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Jensen VFH, Mølck AM, Dalgaard M, McGuigan FE, Akesson KE. Changes in bone mass associated with obesity and weight loss in humans: Applicability of animal models. Bone 2021; 145:115781. [PMID: 33285255 DOI: 10.1016/j.bone.2020.115781] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/05/2020] [Accepted: 11/27/2020] [Indexed: 12/21/2022]
Abstract
The implications of obesity and weight loss for human bone health are not well understood. Although the bone changes associated with weight loss are similar in humans and rodents, that is not the case for obesity. In humans, obesity is generally associated with increased bone mass, an outcome which is exacerbated by advanced age and menopause. In rodents, by contrast, bone mass decreases in proportion to severity and duration of obesity, and is influenced by sex, age and mechanical load. Despite these discrepancies, rodents are frequently used to model the situation in humans. In this review, we summarise the existing knowledge of the effects of obesity and weight loss on bone mass in humans and rodents, focusing on the translatability of findings from animal models. We then describe how animal models should be used to broaden the understanding of the relationship between obesity, weight loss, and skeletal health in humans. Specifically, we highlight the aspects of study design that should be considered to optimise translatability of the rodent models of obesity and weight loss. Notably, the sex, age, and nutritional status of the animals should ideally match those of interest in humans. With these caveats in mind, and depending on the research question asked, our review underscores that animal models can provide valuable information for obesity and weight-management research.
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Affiliation(s)
- Vivi F H Jensen
- Lund University, Department of Clinical Sciences Malmö and Skåne University Hospital, Department of Orthopedics, Inga Marie Nilssons Gata 22, 205 02 Malmö, Sweden.
| | - Anne-Marie Mølck
- Novo Nordisk A/S, Department of Safety Sciences, Imaging & Data Management, Novo Nordisk Park 1, 2760 Maaloev, Denmark
| | - Majken Dalgaard
- Novo Nordisk A/S, Department of Safety Sciences, Imaging & Data Management, Novo Nordisk Park 1, 2760 Maaloev, Denmark
| | - Fiona E McGuigan
- Lund University, Department of Clinical Sciences Malmö and Skåne University Hospital, Department of Orthopedics, Inga Marie Nilssons Gata 22, 205 02 Malmö, Sweden
| | - Kristina E Akesson
- Lund University, Department of Clinical Sciences Malmö and Skåne University Hospital, Department of Orthopedics, Inga Marie Nilssons Gata 22, 205 02 Malmö, Sweden
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9
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Lobene AJ, Panda S, Mashek DG, Manoogian ENC, Hill Gallant KM, Chow LS. Time-Restricted Eating for 12 Weeks Does Not Adversely Alter Bone Turnover in Overweight Adults. Nutrients 2021; 13:nu13041155. [PMID: 33807284 PMCID: PMC8065778 DOI: 10.3390/nu13041155] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 11/16/2022] Open
Abstract
Weight loss is a major focus of research and public health efforts. Time-restricted eating (TRE) is shown to be effective for weight loss, but the impact on bone is unclear. Short-term TRE studies show no effect on bone mineral density (BMD), but no study has measured bone turnover markers. This secondary analysis examined the effect of 12 weeks of TRE vs. unrestricted eating on bone turnover and BMD. Overweight and obese adults aged 18–65 y (n = 20) were randomized to TRE (ad libitum 8-h eating window) or non-TRE. Serum N-terminal propeptide of type I collagen (P1NP), cross-linked N-telopeptide of type I collagen (NTX), and parathyroid hormone (PTH) levels were measured and dual-energy X-ray absorptiometry (DXA) scans were taken pre- and post-intervention. In both groups, P1NP decreased significantly (p = 0.04) but trended to a greater decrease in the non-TRE group (p = 0.07). The treatment time interaction for bone mineral content (BMC) was significant (p = 0.02), such that BMC increased in the TRE group and decreased in the non-TRE group. Change in P1NP was inversely correlated with change in weight (p = 0.04) overall, but not within each group. These findings suggest that TRE does not adversely affect bone over a moderate timeframe. Further research should examine the long-term effects of TRE on bone.
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Affiliation(s)
- Andrea J. Lobene
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA;
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE 19713, USA
- Correspondence:
| | - Satchidananda Panda
- Salk Institute for Biological Studies, La Jolla, CA 92037, USA; (S.P.); (E.N.C.M.)
| | - Douglas G. Mashek
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN 55455, USA;
- Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, University of Minnesota, Minneapolis, MN 55455, USA;
| | | | - Kathleen M. Hill Gallant
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA;
- Department of Food Science and Nutrition, University of Minnesota, St. Paul, MN 55108, USA
| | - Lisa S. Chow
- Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, University of Minnesota, Minneapolis, MN 55455, USA;
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10
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Kemmler W, Shojaa M, Kohl M, von Stengel S. Effects of Different Types of Exercise on Bone Mineral Density in Postmenopausal Women: A Systematic Review and Meta-analysis. Calcif Tissue Int 2020; 107:409-439. [PMID: 32785775 PMCID: PMC7546993 DOI: 10.1007/s00223-020-00744-w] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/31/2020] [Indexed: 01/22/2023]
Abstract
In this sub-analysis of a comprehensive meta-analysis, we aimed to determine the effect of different types of exercise on (areal) bone mineral density (BMD) in postmenopausal women. A systematic review of the literature according to the PRISMA statement included (a) controlled trials, (b) with at least one exercise and one control group, (c) intervention ≥ 6 months, (d) BMD assessments at lumbar spine (LS), femoral neck (FN) or total hip (TH), (e) in postmenopausal women. Eight electronic databases were scanned without language restrictions up to March 2019. The present subgroup analysis was conducted as a mixed-effect meta-analysis with "type of exercise" as the moderator. The 84 eligible exercise groups were classified into (a) weight bearing (WB, n = 30) exercise, (b) (dynamic) resistance exercise (DRT, n = 18), (c) mixed WB&DRT interventions (n = 36). Outcome measures were standardized mean differences (SMD) for BMD-changes at LS, FN and TH. All types of exercise significantly affect BMD at LS, FN and TH. SMD for LS average 0.40 (95% CI 0.15-0.65) for DRT, SMD 0.26 (0.03-0.49) for WB and SMD 0.42 (0.23-0.61) for WB&DRT. SMD for FN were 0.27 (0.09-0.45) for DRT, 0.37 (0.12-0.62) for WB and 0.35 (0.19-0.51) for WB&DRT. Lastly, SMD for TH changes were 0.51 (0.28-0.74) for DRT, 0.40 (0.21-0.58) for WB and 0.34 (0.14-0.53) for WB&DRT. In summary, we provided further evidence for the favorable effect of exercise on BMD largely independent of the type of exercise. However, in order to generate dedicated exercise recommendations or exercise guideline, meta-analyses might be a too rough tool.
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Affiliation(s)
- Wolfgang Kemmler
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Henkestrasse 91, 91052, Erlangen, Germany.
| | - Mahdieh Shojaa
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Henkestrasse 91, 91052, Erlangen, Germany
| | - Matthias Kohl
- Department of Medical and Life Sciences, University of Furtwangen, Schwenningen, Germany
| | - Simon von Stengel
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Henkestrasse 91, 91052, Erlangen, Germany
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11
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Shojaa M, Von Stengel S, Schoene D, Kohl M, Barone G, Bragonzoni L, Dallolio L, Marini S, Murphy MH, Stephenson A, Mänty M, Julin M, Risto T, Kemmler W. Effect of Exercise Training on Bone Mineral Density in Post-menopausal Women: A Systematic Review and Meta-Analysis of Intervention Studies. Front Physiol 2020; 11:652. [PMID: 32655410 PMCID: PMC7325605 DOI: 10.3389/fphys.2020.00652] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/22/2020] [Indexed: 12/17/2022] Open
Abstract
Osteoporosis is a major health problem in post-menopausal women (PMW). Exercise training is considered a cost-effective strategy to prevent osteoporosis in middle aged-older people. The purpose of this study is to summarize the effect of exercise on BMD among PMW. A comprehensive search of electronic databases was conducted through PubMed, Scopus, Web of Science, Cochrane, Science Direct, Eric, ProQuest, and Primo. BMD changes (standardized mean differences: SMD) of the lumbar spine (LS) femoral neck (FN) and/or total hip were considered as outcome measures. After subgroup categorization, statistical methods were used to combine data and compare subgroups. Seventy-five studies were included. The pooled number of participants was 5,300 (intervention group: n = 2,901, control group: n = 2,399). The pooled estimate of random effect analysis was SMD = 0.37, 95%-CI: 0.25–0.50, SMD = 0.33, 95%-CI: 0.23–0.43, and SMD = 0.40, 95%-CI: 0.28–0.51 for LS, FN, and total Hip-BMD, respectively. In the present meta-analysis, there was a significant (p < 0.001), but rather low effect (SMD = 0.33–0.40) of exercise on BMD at LS and proximal femur. A large variation among the single study findings was observed, with highly effective studies but also studies that trigger significant negative results. These findings can be largely attributed to differences among the exercise protocols of the studies. Findings suggest that the true effect of exercise on BMD is diluted by a considerable amount of studies with inadequate exercise protocols.
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Affiliation(s)
- Mahdieh Shojaa
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Simon Von Stengel
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Daniel Schoene
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Kohl
- Department of Medical and Life Sciences, Institute of Precision Medicine, Furtwangen University, Furtwangen im Schwarzwald, Germany
| | - Giuseppe Barone
- Department for Life Quality Studies, University of Bologna, Bologna, Italy
| | - Laura Bragonzoni
- Department for Life Quality Studies, University of Bologna, Bologna, Italy
| | - Laura Dallolio
- Department of Biomedical and Neuromotor Science, University of Bologna, Bologna, Italy
| | - Sofia Marini
- Department for Life Quality Studies, University of Bologna, Bologna, Italy
| | - Marie H Murphy
- School of Sport, Faculty of Life and Health Sciences, Ulster University, Coleraine, United Kingdom
| | - Aoife Stephenson
- School of Sport, Faculty of Life and Health Sciences, Ulster University, Coleraine, United Kingdom
| | - Minna Mänty
- Department of Public Health, University of Helsinki, Helsinki, Finland.,Department of Strategy and Research, Vantaa, Finland
| | - Mikko Julin
- Department of Physiotherapy, Laurea University of Applied Sciences, Espoo, Finland
| | - Tapani Risto
- Department of Physiotherapy, Laurea University of Applied Sciences, Espoo, Finland
| | - Wolfgang Kemmler
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
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12
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Yarizadeh H, Asadi S, Baharlooi H, Setayesh L, Kakavandi NR, Hambly C, Djafarian K, Mirzaei K. Beneficial impact of exercise on bone mass in individuals under calorie restriction: a systematic review and Meta-analysis of randomized clinical trials. Crit Rev Food Sci Nutr 2020; 61:553-565. [PMID: 32180431 DOI: 10.1080/10408398.2020.1739620] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background: A major therapeutic goal in weight management should be total body fat reduction whereas as preserving lean body mass and bone mass density. It is uncertain if an exercise program reduces the adverse effects of calorie restriction-induced weight loss in adults.Objective: The aim of the present study was to evaluate the differences in bone mass between adults who enrolled in a calorie restriction or an exercise-calorie restriction induced weight loss program.Data sources: Both PubMed and Scopus libraries were searched up to February 2020.Methods: Systematic reviews and a meta-analysis were carried out of randomized clinical trials (published to February 2020) on differences in bone mineral density and content (BMD and BMC) of adults who lost weight by calorie restriction alone (CR) or exercise-calorie restriction (CR-E). The study quality was calculated using the Cochrane scoring system. Retrieved data were pooled when weight mean differences (WMDs) were computed between two groups for BMD and BMC at various sites of the body.Results: Thirteen studies, with a total of 852 participants were included. Available evidence found significantly higher BMD at the hip (WMD: 0.03 g/cm2, 95%CI: 0.01 to 0.04, p < 0.001) and femoral neck WMD: 0.03 g/cm2, 95%CI: 0.01 to 0.05, p < 0.001) and total body BMC (WMD: 0.13 kg/cm2, 95%CI: -0.10 to 0.36, p < 0.001) in the CR-E compared to the CR weight loss group. In contrast, all changes in total body BMD (WMD: 0.00 g/cm2, 95%CI: -0.01 to 0.02, p = 0.57) and lumbar spine BMD (WMD: 0.00 g/cm2, 95%CI: -0.01 to 0.01, p = 0.89) were not statistically significant.Limitations: Little evidence was available for different sexes separately. Most individuals were postmenopausal females and no subgroup analysis could be conducted based on menopausal status.Conclusion: This study suggests that physical training can preserve and even significantly increase the bone mass of the hip and femoral neck during weight reduction. Of note, various exercise modalities affected BMD at different sites. Similar results were not found for lumbar spine and total body BMD.
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Affiliation(s)
- Habib Yarizadeh
- Students' Scientific Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Sara Asadi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Hussein Baharlooi
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Setayesh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Nader Rahimi Kakavandi
- Halal Research Center of IRI, FDA, Iran.,Department of Toxicology & Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Catherine Hambly
- Institute of Biological and Environmental Sciences, University of Aberdeen, Aberdeen
| | - Kurosh Djafarian
- Clinical Nutrition Department, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Khadijeh Mirzaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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13
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Beavers KM, Walkup MP, Weaver AA, Lenchik L, Kritchevsky SB, Nicklas BJ, Ambrosius WT, Stitzel JD, Register TC, Shapses SA, Marsh AP, Rejeski WJ. Effect of Exercise Modality During Weight Loss on Bone Health in Older Adults With Obesity and Cardiovascular Disease or Metabolic Syndrome: A Randomized Controlled Trial. J Bone Miner Res 2018; 33:2140-2149. [PMID: 30088288 PMCID: PMC6545884 DOI: 10.1002/jbmr.3555] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/21/2018] [Accepted: 07/07/2018] [Indexed: 01/08/2023]
Abstract
The objective of this study was to determine the ability of either aerobic or resistance training to counter weight-loss-associated bone loss in older adults. There were 187 older adults (67 years, 70% women, 64% white) with obesity (BMI = 34.5 ± 3.7 kg/m2 ) and cardiovascular disease and/or metabolic syndrome who were randomized to participate in an 18-month, community-based trial, with a follow-up assessment at 30 months. Intervention arms included: weight loss alone (WL; 7% to 10% baseline weight), WL plus aerobic training (WL + AT), and WL plus resistance training (WL + RT), as well as DXA-acquired total hip, femoral neck, and lumbar spine areal bone mineral density (aBMD), and trabecular bone score (TBS). Biomarkers of bone turnover (procollagen type 1 N-terminal propeptide, C-terminal telopeptide of type 1 collagen) were measured at baseline, 6, 18, and 30 (aBMD and TBS only) months. CT-acquired hip and spine volumetric BMD (vBMD), cortical thickness, and bone strength were measured in a subset at baseline (n = 55) and 18 months. Total hip aBMD was reduced by 2% in all groups at 18 months, with a primary analysis showing no significant treatment effects for any DXA, biomarker, or CT outcome. After adjustment for WL and follow-up at 30 months, secondary analyses revealed that total hip [-0.018 (-0.023 to -0.012) g/cm2 versus -0.025 (-0.031 to -0.019) g/cm2 ; p = 0.05] and femoral neck [-0.01 (-0.009 to 0.008) g/cm2 versus -0.011 (-0.020 to -0.002) g/cm2 ; p = 0.06] aBMD estimates were modestly attenuated in the WL + RT group compared with the WL group. Additionally, lumbar spine aBMD was increased in the WL [0.015 (0.007 to 0.024) g/cm2 ] and the WL + RT [0.009 (0.000 to 0.017) g/cm2 ] groups compared with the WL + AT [-0.003 (-0.012 to 0.005)g/cm2 ] group; both p ≤ 0.01. Community-based exercise does not prevent bone loss during active WL in older adults; however, adding RT may help minimize long-term hip bone loss. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Kristen M Beavers
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Michael P Walkup
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ashley A Weaver
- Department of Bioengineering, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Leon Lenchik
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stephen B Kritchevsky
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Barbara J Nicklas
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Walter T Ambrosius
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Joel D Stitzel
- Department of Bioengineering, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Thomas C Register
- Department of Pathology-Comparative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Sue A Shapses
- Department of Nutrition, Rutgers University, New Brunswick, NJ, USA
| | - Anthony P Marsh
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
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14
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Beavers KM, Beavers DP, Martin SB, Marsh AP, Lyles MF, Lenchik L, Shapses SA, Nicklas BJ. Change in Bone Mineral Density During Weight Loss with Resistance Versus Aerobic Exercise Training in Older Adults. J Gerontol A Biol Sci Med Sci 2017; 72:1582-1585. [PMID: 28379325 DOI: 10.1093/gerona/glx048] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Indexed: 11/12/2022] Open
Abstract
Background To examine the effect of exercise modality during weight loss on hip and spine bone mineral density (BMD) in overweight and obese, older adults. Methods This analysis compared data from two 5-month, randomized controlled trials of caloric restriction (CR; inducing 5-10% weight loss) with either resistance training (RT) or aerobic training (AT) in overweight and obese, older adults. Participants in the RT + CR study underwent 3 days/week of 8 upper/lower body exercises (3 sets, 10 repetitions at 70% 1 RM) and participants in the AT+CR study underwent 4 days/week of treadmill walking (30 min at 65-70% heart rate reserve). BMD at the total hip, femoral neck, and lumbar spine was assessed via dual-energy X-ray absorptiometry at baseline and 5 months. Results A total of 123 adults (69.4 ± 3.5 years, 67% female, 81% Caucasian) participated in the RT+CR (n = 60) and AT+CR (n = 63) interventions. Average weight loss was 5.7% (95% CI: 4.6-6.7%) and 8.2% (95% CI: 7.2-9.3%) in RT+CR and AT+CR groups, respectively. After adjustment for age, gender, race, baseline BMI and BMD, and weight change, differential treatment effects were observed for total hip and femoral neck (both p < .05), but not lumbar spine. Total hip (1.83 [-3.90, 7.55] mg/cm2) and femoral neck (9.14 [-0.70, 18.98] mg/cm2) BMD was unchanged in RT+CR participants, and modestly decreased in AT+CR participants (total hip: -7.01 [-12.73, -1.29] mg/cm2; femoral neck: -5.36 [-14.92, 4.20] mg/cm2). Conclusions Results suggest performing resistance, rather than aerobic, training during CR may attenuate loss of hip and femoral neck BMD in overweight and obese older adults. Findings warrant replication from a long-term, adequately powered, RCT.
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Affiliation(s)
- Kristen M Beavers
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Daniel P Beavers
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Sarah B Martin
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Anthony P Marsh
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Mary F Lyles
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Winston-Salem, North Carolina
| | - Leon Lenchik
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Sue A Shapses
- Department of Nutritional Sciences, Rutgers University, New Brunswick, New Jersey
| | - Barbara J Nicklas
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Winston-Salem, North Carolina
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15
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Soltani S, Hunter GR, Kazemi A, Shab-Bidar S. The effects of weight loss approaches on bone mineral density in adults: a systematic review and meta-analysis of randomized controlled trials. Osteoporos Int 2016; 27:2655-2671. [PMID: 27154437 DOI: 10.1007/s00198-016-3617-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 04/26/2016] [Indexed: 12/15/2022]
Abstract
UNLABELLED We assessed the impact of weight loss strategies including calorie restriction and exercise training on BMD in adults using a systematic review of randomized controlled trials. Weight reduction results in reduced BMD at the hip, but has less effect on the spine. Both calorie restriction and a combination of calorie restriction and exercise result in a decrease in hip bone density, whereas weight loss response to exercise training without dietary restriction leads to increased hip BMD. INTRODUCTION Findings are not consistent on the effect of weight loss on bone mineral density (BMD). We conducted a systematic review on the randomized controlled trials to assess the effect of weight loss strategies, including calorie restriction and exercise programs on BMD in adults. METHODS A structured and comprehensive search of MEDLINE and EMBASE databases was undertaken up to March 2016. Study-specific mean differences (MD) were pooled using a random-effects model. Subgroup analysis and meta-regression were used to find possible sources of between-study heterogeneity. RESULTS Thirty-two randomized controlled trials met predetermined inclusion criteria. The meta-analysis revealed no significant difference on total BMD (MD 0.007, 95 % CI -0.020-0.034, p = 0.608). In contrast, the pooled data of studies showed a significant effect of weight loss on hip BMD (MD -0.008, 95 % CI -0.09 to -0.006 g/cm(2), p < 0.001) and also lumbar spine BMD (MD -0.018 g/cm(2), 95 % CI -0.019 to -0.017, p < 0.001). BMD in the hip site decreased after more than 4 months, especially in those who were obese. Moreover, calorie restriction interventions longer than 13 months showed a significant decreased in lumbar spine BMD. CONCLUSION Weight loss led to significant decreases at the hip and lumbar spine BMD but not at the total. Weight loss response following calorie restriction resulted in a decrease in hip and lumbar spine bone density especially more than 1 year; whereas an exercise-induced weight loss did not.
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Affiliation(s)
- S Soltani
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Hemaat Highway, 1449614535, Tehran, Iran
| | - G R Hunter
- Department of Human Studies School of Education, University of Alabama at Birmingham, EB 205 1720 2nd Ave South, Birmingham, AL, 34294-1250, USA
| | - A Kazemi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P. O. Box 14155/6117, Amir Abad, Keshavarz Boulevard, Tehran, Iran
| | - S Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P. O. Box 14155/6117, Amir Abad, Keshavarz Boulevard, Tehran, Iran.
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16
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Mason C, Tapsoba JDD, Duggan C, Imayama I, Wang CY, Korde L, McTiernan A. Effects of Vitamin D3 Supplementation on Lean Mass, Muscle Strength, and Bone Mineral Density During Weight Loss: A Double-Blind Randomized Controlled Trial. J Am Geriatr Soc 2016; 64:769-78. [PMID: 27060050 PMCID: PMC4840082 DOI: 10.1111/jgs.14049] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To compare the effects of 12 months of vitamin D3 supplementation with that placebo on lean mass, bone mineral density (BMD), and muscle strength in overweight or obese postmenopausal women completing a structured weight-loss program. DESIGN Double-blind, placebo-controlled randomized clinical trial. SETTING Fred Hutchinson Cancer Research Center, Seattle, Washington. PARTICIPANTS Postmenopausal women aged 50 to 75 with a body mass index (BMI) of 25 kg/m(2) or greater and a serum 25-hydroxyvitamin D (25(OH)D) concentration between 10.0 and 32.0 ng/mL (insufficient) (N = 218). INTERVENTION Oral vitamin D3 2,000 IU/d or placebo in combination with a lifestyle-based weight loss intervention consisting of a reduction of 500 kcal to 1,000 kcal per day and 225 min/wk of moderate- to vigorous-intensity aerobic exercise. MEASUREMENTS Serum 25(OH)D, body composition, and muscle strength were measured before randomization (baseline) and at 12 months. Mean changes of the groups were compared (intention to treat) using generalized estimating equations. RESULTS Change in 25(OH)D was significantly different between the vitamin D and placebo groups at 12 months (13.6 ng/mL vs -1.3 ng/mL, P < .001), but no differences in change in lean mass (-0.8 kg vs -1.1 kg, P = .53) or BMD of the spine (-0.01 g/cm(2) vs 0.0 g/cm(2) , P = .82) or right femoral neck (both -0.01 g/cm(2) , P = .49) were detected between the groups. Leg strength decreased in the vitamin D group but not in the placebo group (-2.6 pounds vs 1.8 pounds, P = .03). In women randomized to vitamin D, achieving repletion (25(OH)D ≥ 32 ng/mL) did not alter results. CONCLUSION Vitamin D3 supplementation during weight-loss decreased leg strength but did not alter changes in lean mass or BMD in postmenopausal women with vitamin D insufficiency.
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Affiliation(s)
- Caitlin Mason
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jean De Dieu Tapsoba
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Catherine Duggan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Ikuyo Imayama
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Ching-Yun Wang
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
- School of Public Health, University of Washington, Seattle, WA
| | - Larissa Korde
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | - Anne McTiernan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
- School of Public Health, University of Washington, Seattle, WA
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17
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Bouaziz W, Schmitt E, Kaltenbach G, Geny B, Vogel T. Health benefits of endurance training alone or combined with diet for obese patients over 60: a review. Int J Clin Pract 2015; 69:1032-49. [PMID: 25963846 DOI: 10.1111/ijcp.12648] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The prevalence of obesity is rapidly increasing in older patients and it is ubiquitous in many developed countries. Obesity is related to various negative health outcomes, making it a major public health target for intervention. PURPOSE The aim of this study was to explore and summarise the literature that addresses endurance training alone or combined with nutrition interventions to combat obesity in obese patients over age 60. METHODS We searched online electronic databases up to September 2014 for original observational and intervention studies published between 1995 and 2014 on the relationship between endurance training alone or combined with a diet in obese patients over 60 regarding health outcomes. RESULTS Twenty-six studies examined interventions aimed specifically at promoting endurance training alone or combined with diet for older obese patients over 60. These studies demonstrated a positive effect of this intervention on the primary prevention of cardiovascular disease, and a significant beneficial effect on the lipid profile. Improvement of body composition and insulin sensitivity, and a reduction in blood pressure were also well established. CONCLUSIONS Overall, this review demonstrates a positive effect of endurance training alone or combined with diet on health outcomes and metabolic benefits in older adults. Clinicians can now use this evidence to formulate actions to encourage the older obese to profit from the health benefits of endurance training and diet. This will not only help reduce the dramatic increase in the number of older obese but also help prevent sarcopenic obesity, which is a complex challenge for healthcare professionals.
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Affiliation(s)
- W Bouaziz
- Geriatric Department, University Hospital, Strasbourg, France
- Department of Physiology and EA-3072, Faculty of Medicine, Strasbourg University, Strasbourg, France
| | - E Schmitt
- Geriatric Department, University Hospital, Strasbourg, France
- Department of Physiology and EA-3072, Faculty of Medicine, Strasbourg University, Strasbourg, France
| | - G Kaltenbach
- Geriatric Department, University Hospital, Strasbourg, France
| | - B Geny
- Department of Physiology and EA-3072, Faculty of Medicine, Strasbourg University, Strasbourg, France
- Functional Explorations Department, University Hospital, Strasbourg, France
| | - T Vogel
- Geriatric Department, University Hospital, Strasbourg, France
- Department of Physiology and EA-3072, Faculty of Medicine, Strasbourg University, Strasbourg, France
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18
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Pop LC, Sukumar D, Tomaino K, Schlussel Y, Schneider SH, Gordon CL, Wang X, Shapses SA. Moderate weight loss in obese and overweight men preserves bone quality. Am J Clin Nutr 2015; 101:659-67. [PMID: 25733651 PMCID: PMC4340066 DOI: 10.3945/ajcn.114.088534] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Weight loss (WL) negatively affects bone mineral density (BMD) in older populations and has specifically been shown in women. OBJECTIVE In this prospective controlled trial, we examined variables of bone quality and endocrine changes after intentional WL in men. DESIGN Thirty-eight overweight and obese [mean ± SD body mass index (in kg/m²): 31.9 ± 4.4; age: 58 ± 6 y] men were recruited to either WL through caloric restriction or weight maintenance (WM) for 6 mo. RESULTS There was a -7.9 ± 4.4% and +0.2 ± 1.6% change in body weight in the WL and WM groups, respectively. There was a greater increase in femoral neck and total body BMD and bone mineral content (BMC) in the WM group than in the WL group (P-interaction effect < 0.05). In contrast, there was a trend for the tibia cortical thickness and area to decrease more in the WM group than in the WL group (P ≤ 0.08). There was a decrease in the periosteal circumference in both groups over time (P < 0.01) and no statistically significant changes in trabecular bone. Circulating total, free, and bioavailable estradiol decreased in the WL group compared with the WM group, and changes were different between groups (P < 0.05). Serum total and bioavailable testosterone increased in both groups (P < 0.01). Serum 25-hydroxyvitamin D increased to a similar extent in both groups (P < 0.05). CONCLUSIONS Moderate WL in overweight and obese men did not decrease BMD at any anatomical site or alter cortical and trabecular bone and geometry. Also, despite increased BMD at some sites when maintaining excess body weight, cortical bone showed a trend in the opposite direction.
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Affiliation(s)
- L Claudia Pop
- From the Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ (LCP, DS, KT, YS, and SAS); the Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (SHS and XW); and the Department of Radiology, McMaster University, Hamilton, Ontario, Canada (CLG)
| | - Deeptha Sukumar
- From the Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ (LCP, DS, KT, YS, and SAS); the Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (SHS and XW); and the Department of Radiology, McMaster University, Hamilton, Ontario, Canada (CLG)
| | - Katherine Tomaino
- From the Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ (LCP, DS, KT, YS, and SAS); the Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (SHS and XW); and the Department of Radiology, McMaster University, Hamilton, Ontario, Canada (CLG)
| | - Yvette Schlussel
- From the Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ (LCP, DS, KT, YS, and SAS); the Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (SHS and XW); and the Department of Radiology, McMaster University, Hamilton, Ontario, Canada (CLG)
| | - Stephen H Schneider
- From the Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ (LCP, DS, KT, YS, and SAS); the Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (SHS and XW); and the Department of Radiology, McMaster University, Hamilton, Ontario, Canada (CLG)
| | - Chris L Gordon
- From the Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ (LCP, DS, KT, YS, and SAS); the Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (SHS and XW); and the Department of Radiology, McMaster University, Hamilton, Ontario, Canada (CLG)
| | - Xiangbing Wang
- From the Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ (LCP, DS, KT, YS, and SAS); the Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (SHS and XW); and the Department of Radiology, McMaster University, Hamilton, Ontario, Canada (CLG)
| | - Sue A Shapses
- From the Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ (LCP, DS, KT, YS, and SAS); the Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (SHS and XW); and the Department of Radiology, McMaster University, Hamilton, Ontario, Canada (CLG)
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19
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Jakhotia KA, Shimpi AP, Rairikar SA, Mhendale P, Hatekar R, Shyam A, Sancheti PK. Suryanamaskar: An equivalent approach towards management of physical fitness in obese females. Int J Yoga 2015; 8:27-36. [PMID: 25558131 PMCID: PMC4278132 DOI: 10.4103/0973-6131.146053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In India, obesity is highly prevalent in women as compared to men. As the obesity epidemic spreads, there are growing concerns about efficient obesity management. AIMS To compare between circuit training (CT), treadmill (TM) walking and suryanamaskar (SN) training in weight management and physical fitness enhancement in obese females. SETTINGS AND DESIGNS Comparative controlled study conducted in a community setting. MATERIALS AND METHODS 119 females of age between 20 and 40 years of body mass index (BMI) between 25.1 and 34.9 kg/m(2). 87 participants completed the study. Group 1: CT; group 2: TM walking; group 3: Modified SN; group 4: Control. OUTCOME MEASURES Body composition, cardio-respiratory and muscle endurance, flexibility. STATISTICAL ANALYSIS Within-group data was analyzed with the paired t-test. P =0.05. Analysis between the groups was done using one way ANOVA test. Analysis between the groups was done using ANCOVA test controlling for baseline differences only for those variables that have significant differences at baseline. For those which do not have significant difference at baseline, RMANOVA was done at end of 8 weeks. RESULTS Reducation in mean body weight in CT group (2.2%), TM (1.7%) and SN (1.6%), (P < 0.05), BMI in all the three groups (P < 0.01), total body fat % in the CT (5%) and SN (3.7%), (P < 0.01), metabolic age with CT (2%) and TM (2%), (P = 0.001). Improvement in muscle mass in CT (4%, P = 0.009), VO2max in CT group by 17.2%, SN (14%), TM group (8%) (P < 0.05). Upper limb Muscle endurance in CT (51.3%), SN group (51.24%) and in TM group (40%), (P = 0.05), in lower limb TM (21.2%) and SN (24.5%) (P = 0.05), flexibility in SN (12.4%, P = 0.0001). CONCLUSIONS All three methods were effective in weight and physical fitness management. CT and SN were more effective in improving cardio-respiratory fitness and upper limb muscle endurance while only SN was effective in improving body flexibility.
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Affiliation(s)
- Komal A Jakhotia
- Department of Community Physiotherapy, Sancheti Healthcare Academy, Sancheti Institute College of Physiotherapy, Maharashtra, India
| | - Apurv P Shimpi
- Department of Community Physiotherapy, Sancheti Healthcare Academy, Sancheti Institute College of Physiotherapy, Maharashtra, India
| | - Savita A Rairikar
- Department of Community Physiotherapy, Sancheti Healthcare Academy, Sancheti Institute College of Physiotherapy, Maharashtra, India
| | - Priyanka Mhendale
- Department of Community Physiotherapy, Sancheti Healthcare Academy, Sancheti Institute College of Physiotherapy, Maharashtra, India
| | - Renuka Hatekar
- Department of Community Physiotherapy, Sancheti Healthcare Academy, Sancheti Institute College of Physiotherapy, Maharashtra, India
| | - Ashok Shyam
- Department of Orthopedics, Sancheti Institute of Orthopaedics and Rehabilitation, Thube Park, Shivaji Nagar, Pune, Maharashtra, India
| | - Parag K Sancheti
- Department of Orthopedics, Sancheti Institute of Orthopaedics and Rehabilitation, Thube Park, Shivaji Nagar, Pune, Maharashtra, India
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Biochemical markers for assessment of calcium economy and bone metabolism: application in clinical trials from pharmaceutical agents to nutritional products. Nutr Res Rev 2014; 27:252-67. [PMID: 25394580 PMCID: PMC4307651 DOI: 10.1017/s0954422414000183] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Nutrition plays an important role in osteoporosis prevention and treatment. Substantial progress in both laboratory analyses and clinical use of biochemical markers has modified the strategy of anti-osteoporotic drug development. The present review examines the use of biochemical markers in clinical research aimed at characterising the influence of foods or nutrients on bone metabolism. The two types of markers are: (i) specific hormonal factors related to bone; and (ii) bone turnover markers (BTM) that reflect bone cell metabolism. Of the former, vitamin D metabolites, parathyroid hormone, and insulin-like growth factor-I indicate responses to variations in the supply of bone-related nutrients, such as vitamin D, Ca, inorganic phosphate and protein. Thus modification in bone remodelling, the key process upon which both pharmaceutical agents and nutrients exert their anti-catabolic or anabolic actions, is revealed. Circulating BTM reflect either osteoclastic resorption or osteoblastic formation. Intervention with pharmacological agents showed that early changes in BTM predicted bone loss and subsequent osteoporotic fracture risk. New trials have documented the influence of nutrition on bone-tropic hormonal factors and BTM in adults, including situations of body-weight change, such as anorexia nervosa, and weight loss by obese subjects. In osteoporosis-prevention studies involving dietary manipulation, randomised cross-over trials are best suited to evaluate influences on bone metabolism, and insight into effects on bone metabolism may be gained within a relatively short time when biochemical markers are monitored.
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The independent and combined effects of intensive weight loss and exercise training on bone mineral density in overweight and obese older adults with osteoarthritis. Osteoarthritis Cartilage 2014; 22:726-33. [PMID: 24742955 PMCID: PMC4051847 DOI: 10.1016/j.joca.2014.04.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/27/2014] [Accepted: 04/04/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the effects of dietary-induced weight loss (D) and weight loss plus exercise (D + E) compared to exercise alone (E) on bone mineral density (BMD) in older adults with knee osteoarthritis (OA). DESIGN Data come from 284 older (66.0 ± 6.2 years), overweight/obese (body mass index (BMI) 33.4 ± 3.7 kg/m2), adults with knee OA enrolled in the Intensive Diet and Exercise for Arthritis (IDEA) study. Participants were randomized to 18 months of walking and strength training (E; n = 95), dietary-induced weight loss targeting 10% of baseline weight (D; n = 88) or a combination of the two (D + E; n = 101). Body weight and composition (DXA), regional BMD, were obtained at baseline and 18 months. RESULTS E, D, and D + E groups lost 1.3 ± 4.5 kg, 9.1 ± 8.6 kg and 10.4 ± 8.0 kg, respectively (P < 0.01). Significant treatment effects were observed for BMD in both hip and femoral neck regions, with the D and D + E groups showing similar relative losses compared to E (both P < 0.01). Despite reduced BMD, fewer overall participants had T-scores indicative of osteoporosis after intervention (9 at 18 months vs 10 at baseline). Within the D and D + E groups, changes in hip and femoral neck, but not spine, BMD correlated positively with changes in body weight (r = 0.21 and 0.54 respectively, both P ≤ 0.01). CONCLUSIONS Weight loss via an intensive dietary intervention, with or without exercise, results in bone loss at the hip and femoral neck in overweight and obese, older adults with OA. Although the exercise intervention did not attenuate weight loss-associated reductions in BMD, classification of osteoporosis and osteopenia remained unchanged. CLINICAL TRIAL REGISTRATION NUMBER NCT00381290.
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Inacio M, Ryan AS, Bair WN, Prettyman M, Beamer BA, Rogers MW. Gluteal muscle composition differentiates fallers from non-fallers in community dwelling older adults. BMC Geriatr 2014; 14:37. [PMID: 24666603 PMCID: PMC4101852 DOI: 10.1186/1471-2318-14-37] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 03/13/2014] [Indexed: 12/25/2022] Open
Abstract
Background Impaired balance, loss of mobility and falls are major problems associated with changes in muscle in older adults. However, the extent to which muscle composition and related performance measures for different lower limb muscles are associated with falls in older individuals is unclear. This study evaluated lower limb muscle attenuation, intramuscular adipose tissue (IMAT) infiltration and muscle performance in older fallers and non-fallers. Methods For this cross-sectional study, fifty-eight community dwelling older individuals (>65 years) were classified into fallers (n = 15) or non-fallers (n = 43). Computed tomography (CT) was used to determine muscle attenuation and intramuscular adipose tissue (IMAT) of multiple thigh and hip muscles. Muscle performance was assessed with isokinetic dynamometry. Results For both groups, Rectus Femoris showed the highest muscle attenuation and lowest IMAT infiltration, and Gluteus Maximus and Gluteus Medius/Minimus muscles had the lowest muscle attenuation and highest IMAT infiltration. Fallers exhibited lower muscle attenuation and higher IMAT infiltration than non-faller participants in most muscles, where the gluteal muscles were the most affected (p < 0.05). Fallers also showed a lower peak hip abduction torque (p < 0.05). There were significant associations (r = 0.31 to 0.53) between joint torques and muscle composition, with the strongest associations between Gluteus Medius/Minimus and hip abduction strength. Conclusions While fallers were generally differentiated from non-fallers by muscle composition, the most affected muscles were the proximal gluteal muscles of the hip joint accompanied by lower hip abduction strength, which may contribute to impaired balance function and increased risk for falls.
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Affiliation(s)
| | | | | | | | | | - Mark W Rogers
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA.
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Armamento-Villareal R, Aguirre L, Napoli N, Shah K, Hilton T, Sinacore DR, Qualls C, Villareal DT. Changes in thigh muscle volume predict bone mineral density response to lifestyle therapy in frail, obese older adults. Osteoporos Int 2014; 25:551-8. [PMID: 23892583 PMCID: PMC3903658 DOI: 10.1007/s00198-013-2450-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 06/14/2013] [Indexed: 12/14/2022]
Abstract
UNLABELLED We studied the relationships among strength, muscle mass, and bone mineral density (BMD) with lifestyle change. Lifestyle therapy consisted of exercise, diet, and diet plus exercise. Diet was by caloric restriction to induce and maintain a weight loss of 10 % from baseline body weight. Exercise attenuated weight loss-induced muscle and bone losses. Exercise improved strength despite muscle loss in patients on diet and exercise. Changes in strength did not correlate with changes in BMD. However, changes in thigh muscle volume correlated with, and predicted changes in hip BMD. INTRODUCTION Losses of hip BMD and lean body mass are major complications of lifestyle therapy in frail, obese older adults; however, the contribution of mechanical strain loss from muscle loss is poorly defined. We determined the effect of changes in thigh muscle volume and muscle strength on BMD in frail, obese older adults undergoing lifestyle therapy aimed at intentional weight loss with or without exercise. METHODS One hundred seven obese older adults were randomized to control, diet, exercise, and diet-exercise groups for 1 year. Thigh muscle volume was measured by magnetic resonance imaging, BMD by DXA, knee strength by dynamometry, total strength by one-repetition maximum (1-RM), and bone markers by immunoassay. RESULTS Thigh muscle volume decreased in the diet group (-6.2 ± 4.8 %) and increased in the exercise group (2.7 ± 3.1 %), while it was not significantly different from the control in the diet-exercise group. Changes in hip BMD followed similar pattern as those in thigh muscle volume. Knee extension and flexion increased in the exercise group (23 ± 20 %; 25 ± 19 %) and diet-exercise group (20 ± 19 %; 20.6 ± 27 %) but were unchanged in the control and diet groups. Changes in thigh muscle volume correlated with changes in hip BMD (r = 0.55, P = <0.001) and were an independent predictor of changes in hip BMD (β = 0.12, P = 0.03) in the multiple regression analyses after accounting for demographic factors and changes in weight and physical activity. There were no correlations between BMD changes and knee strength, 1-RM, and sclerostin changes. CONCLUSIONS Changes in thigh muscle volume predict hip BMD changes in obese older patients undergoing lifestyle therapy. The effect of exercise in attenuating thigh muscle loss when added to diet may in part account for the reduction in weight loss-induced bone loss in the diet-exercise group.
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Affiliation(s)
- R. Armamento-Villareal
- New Mexico VA Health Care System, Albuquerque, NM, USA
- University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - L. Aguirre
- New Mexico VA Health Care System, Albuquerque, NM, USA
| | - N. Napoli
- Campus Biomedico, Rome, Italy
- Washington University School of Medicine, St. Louis, MO, USA
| | - K. Shah
- University of Rochester School of Medicine, Rochester, NY, USA
| | | | - D. R. Sinacore
- Washington University School of Medicine, St. Louis, MO, USA
| | - C. Qualls
- University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - D. T. Villareal
- New Mexico VA Health Care System, Albuquerque, NM, USA,
- University of New Mexico School of Medicine, Albuquerque, NM, USA
- Washington University School of Medicine, St. Louis, MO, USA
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Colleran HL, Wideman L, Lovelady CA. Effects of energy restriction and exercise on bone mineral density during lactation. Med Sci Sports Exerc 2013; 44:1570-9. [PMID: 22460469 DOI: 10.1249/mss.0b013e318251d43e] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
UNLABELLED Modest energy restriction combined with resistance training (RT) has been shown in nonlactating women to protect bone during periods of weight loss. However, there is a paucity of research on dietary interventions and exercise in lactating women aimed at promoting bone health and weight loss. PURPOSE This study aimed to investigate the effects of energy restriction and exercise on bone mineral density (BMD) and hormones during lactation. METHODS At 4 wk postpartum, participants were randomized to either a 16-wk intervention (diet restricted by 500 kcal and RT 3 d·wk) group (IG = 14) or minimal care group (CG = 13). Measurements included BMD by DXA, three 24-h dietary recalls, and hormones. Repeated-measures ANOVA was used to test for group differences over time. RESULTS Energy intake decreased more in IG (613 ± 521 kcal) than CG (171 ± 435 kcal) (P = 0.03). IG lost more weight (5.8 ± 3.5 kg vs CG = 1.6 ± 5.4 kg, P = 0.02). BMD decreased over time, P < 0.01, with no group differences in lumbar spine (IG = 3.4% ± 2.5%, CG = 3.7% ± 3.3%) or hip (IG and CG = 3.1 ± 1.8%). Prolactin and estradiol decreased over time in both groups, P < 0.01. Basal growth hormone remained stable; however, there was a significant increase in growth hormone response to exercise in IG. CONCLUSIONS These results suggest that moderate energy restriction combined with RT promotes weight loss with no adverse effects on BMD during lactation.
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Affiliation(s)
- Heather L Colleran
- Department of Nutrition, University of North Carolina at Greensboro, Greensboro, NC 27402-6170, USA
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Gerbaix M, Metz L, Mac-Way F, Lavet C, Guillet C, Walrand S, Masgrau A, Vico L, Courteix D. A well-balanced diet combined or not with exercise induces fat mass loss without any decrease of bone mass despite bone micro-architecture alterations in obese rat. Bone 2013; 53:382-90. [PMID: 23318975 DOI: 10.1016/j.bone.2013.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 12/15/2012] [Accepted: 01/02/2013] [Indexed: 11/24/2022]
Abstract
The association of a well-balanced diet with exercise is a key strategy to treat obesity. However, weight loss is linked to an accelerated bone loss. Furthermore, exercise is known to induce beneficial effects on bone. We investigated the impact of a well-balanced isoenergetic reducing diet (WBR) and exercise on bone tissue in obese rats. Sixty male rats had previously been fed with a high fat/high sucrose diet (HF/HS) for 4months to induce obesity. Then, 4 regimens were initiated for 2months: HF/HS diet plus exercise (treadmill: 50min/day, 5days/week), WBR diet plus exercise, HF/HS diet plus inactivity and WBR diet plus inactivity. Body composition and total BMD were assessed using DXA and visceral fat mass was weighed. Tibia densitometry was assessed by Piximus. Bone histomorphometry was performed on the proximal metaphysis of tibia and on L2 vertebrae (L2). Trabecular micro-architectural parameters were measured on tibia and L2 by 3D microtomography. Plasma concentration of osteocalcin and CTX were measured. Both WBR diet and exercise had decreased global weight, global fat and visceral fat mass (p<0.05). The WBR diet alone failed to alter total and tibia bone mass and BMD. However, Tb.Th, bone volume density and degree of anisotropy of tibia were decreased by the WBR diet (p<0.05). Moreover, the WBR diet had involved a significant lower MS/BS and BFR/BS in L2 (p<0.05). Exercise had significantly improved BMD of the tibia possibly by inhibiting the bone resorption, as evidenced by no change in plasma osteocalcin levels, a decrease of CTX levels (p<0.005) and trabecular osteoclast number (p<0.05). In the present study a diet inducing weight and fat mass losses did not affected bone mass and BMD of obese rats despite alterations of their bone micro-architecture. The moderate intensity exercise performed had improved the tibia BMD of obese rats without any trabecular and cortical adaptation.
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Affiliation(s)
- Maude Gerbaix
- Clermont Université, Université Blaise Pascal, EA 3533, Laboratoire des Adaptations Métaboliques à l'Exercice en conditions Physiologiques et Pathologiques (AME2P), BP 80026, F-63171 Aubière Cedex, France.
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Hamilton KC, Fisher G, Roy JL, Gower BA, Hunter GR. The effects of weight loss on relative bone mineral density in premenopausal women. Obesity (Silver Spring) 2013; 21:441-8. [PMID: 23404937 PMCID: PMC3630243 DOI: 10.1002/oby.20052] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 08/06/2012] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This study compared BMD relative to body weight following a ∼6-month weight loss program and a 1-year weight maintenance phase in premenopausal women and determined whether African American (AA) and European-American (EA) women's BMD respond similarly during weight loss. DESIGN AND METHODS Premenopausal women (n = 115, 34 ± 5 years) were evaluated in an overweight state (BMI between 27 and 30 kg/m(2) ), following an 800 kcal/day diet/exercise program designed to reduce BMI<25 kg/m(2) , and 1-year following weight loss. RESULTS BMD relative to body weight (Z-scores) increased after weight loss, but decreased during the 1-year weight maintenance phase. All 1-year follow-up BMD Z-scores were increased (except L1) compared to baseline measurements (P < 0.05). These sites included the hip neck (+0.088, P = 0.014), total hip (+0.099, P = 0.001), L2 (+0.127, P = 0.013), L3 (+0.135, P = 0.014), and L4 (+0.199, P = 0.002). AAs had significantly higher absolute BMD at all sites (P < 0.05) compared to EAs, but no time by race interactions were evident during weight loss (except in L3). CONCLUSION These results may indicate that weight loss is safe with regard to bone health for overweight premenopausal women.
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Affiliation(s)
- Kara C Hamilton
- Department of Human Studies, University of Alabama-Birmingham, Birmingham, AL, USA.
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Brzozowska MM, Sainsbury A, Eisman JA, Baldock PA, Center JR. Bariatric surgery, bone loss, obesity and possible mechanisms. Obes Rev 2013; 14:52-67. [PMID: 23094966 DOI: 10.1111/j.1467-789x.2012.01050.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Revised: 09/15/2012] [Accepted: 09/17/2012] [Indexed: 12/14/2022]
Abstract
Bariatric surgery remains the most effective treatment for severely obese patients. However, the potential long-term effects of bariatric surgical procedures on health, including bone health, are only partially understood. The goal of this review was to present data on the impact of bariatric surgery on bone metabolism and to analyse possible reasons for the loss of bone mass that frequently occurs after bariatric surgery. Such factors include nutritional deficiencies, rapid weight loss per se, effects of fat-derived adipokines and gut-derived appetite-regulatory hormones. However, the relative roles of these factors in skeletal regulation and the mechanisms by which they work are not yet fully defined. Our review was focussed on the complex relationship between body weight, fat mass and bone mass, as well as peripheral and central mediators potentially involved in the dual regulation of both energy and bone homeostasis. We also review the data on the inverse relationship between central obesity, bone marrow fat and osteoporosis. As the number of bariatric operations increases, it is imperative to recognize mechanisms responsible for bariatric surgery-induced bone loss, with careful monitoring of bone health including long-term fracture incidence in patients undergoing these procedures.
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Affiliation(s)
- M M Brzozowska
- Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia
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Abstract
Excess body weight due to obesity has traditionally been considered to have a positive effect on bone; however, more recent findings suggest that bone quality is compromised. Both obesity and caloric restriction increase fracture risk and are regulated by endocrine factors and cytokines that have direct and indirect effects on bone and calcium absorption. Weight reduction will decrease bone mass and mineral density, but this varies by the individual's age, gender, and adiposity. Dietary modifications, exercise, and medications have been shown to attenuate the bone loss associated with weight reduction. Future obesity and weight loss trials would benefit from assessment of key hormones, adipokine and gut peptides that regulate calcium absorption, and bone mineral density and quality by using sensitive techniques in high-risk populations.
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Affiliation(s)
- Sue A Shapses
- Department of Nutritional Sciences, Rutgers University, New Brunswick, New Jersey 08901, USA.
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Shenoy S, Dhawan N, Sandhu JS. Effect of Exercise Program and Calcium Supplements on Low Bone Mass among Young Indian Women- A Comparative Study. Asian J Sports Med 2012; 3:193-9. [PMID: 23012639 PMCID: PMC3445647 DOI: 10.5812/asjsm.34690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 03/21/2012] [Indexed: 11/16/2022] Open
Abstract
Purpose Low bone mass is a major health concern among young women nowadays due to sedentary lifestyle and lack of calcium rich food intake. Therefore there is an increase in the incidence of LBM among young university women so our main purpose of study was to compare effects of exercise program and calcium supplements on bone mass in young women. Methods This single blinded, cross sectional study included data collection in the form of SOS T-scores at distal radius for 104 young university women of mean age 22.3 years using Sunlight Omnisense Bone Sonometer 7000S. Of these, 62 women with low bone mass were included in a 3 month study but 60 subjects completed the study. They were randomly divided into 3 groups: exercise group (n=21), calcium supplementation group (n=21) and control group (n=20). All participants were evaluated pre and post protocol for T-score distal radius and midshaft tibia. Results After measuring SOS T-score of 104 subjects; we found that 60.57% had low bone mass and remaining 39.43% had normal bone mass. After 3 months, the exercise group showed significant improvement in distal radius SOS T-score (t=5.10, P<0.001), at midshaft tibia (t=3.71, P<0.001) followed by improvement in calcium group at distal radius (t=6.28, P<0.001), midshaft tibia (t=2.33, P<0.05) as compared to control group which showed a marginal increase. Conclusions Exercise group showed more improvement in T-scores than calcium and control group. Exercise is important modifiable factor to improve bone accretion at this age and reduce risk of developing osteoporosis related debilitating conditions later in life.
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Affiliation(s)
- Shweta Shenoy
- Faculty of Sports Medicine and Physiotherapy, Guru Nanak Dev University, Amritsar, Punjab
- Corresponding Author:Address: Faculty of Sports Medicine and Physiotherapy, Guru Nanak Dev University, Amritsar, Punjab. E-mail:
| | - Neha Dhawan
- Faculty of Sports Medicine and Physiotherapy, Guru Nanak Dev University, Amritsar, Punjab
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Calderon-Garcia JF, Lavado-Garcia JM, Martin RR, Moran JM, Canal-Macias ML, Pedrera-Zamorano JD. Bone ultrasound and physical activity in postmenopausal Spanish women. Biol Res Nurs 2012; 15:416-21. [PMID: 22997347 DOI: 10.1177/1099800412459800] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We studied the effects of moderate physical activity on bone mass in healthy postmenopausal women as assessed by quantitative bone ultrasound. We enrolled a total of 326 postmenopausal women (60.95 ± 8.51 years old and 13.02 ± 9.52 years since menopause) and categorized them by weekly physical activity in their leisure time (sedentary, moderate, and active). We administered a questionnaire on general health and diet and measured bone density by ultrasound on phalanges II-V in the nondominant hand. We found no significant difference in the amplitude-dependent speed of sound (Ad-SoS; p > .05) between sedentary and active women. We concluded that the changes induced by moderate physical activity on bone mass are minimal in healthy postmenopausal women.
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Affiliation(s)
- Julian F Calderon-Garcia
- 1Metabolic Bone Diseases Research Group, School of Nursing and Occupational Therapy, University of Extremadura, Caceres, Spain
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Villareal DT, Apovian CM, Kushner RF, Klein S. Obesity in Older Adults: Technical Review and Position Statement of the American Society for Nutrition and NAASO, The Obesity Society. ACTA ACUST UNITED AC 2012; 13:1849-63. [PMID: 16339115 DOI: 10.1038/oby.2005.228] [Citation(s) in RCA: 344] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Obesity causes serious medical complications and impairs quality of life. Moreover, in older persons, obesity can exacerbate the age-related decline in physical function and lead to frailty. However, appropriate treatment for obesity in older persons is controversial because of the reduction in relative health risks associated with increasing body mass index and the concern that weight loss could have potential harmful effects in the older population. This joint position statement from the American Society for Nutrition and NAASO, The Obesity Society reviews the clinical issues related to obesity in older persons and provides health professionals with appropriate weight-management guidelines for obese older patients. The current data show that weight-loss therapy improves physical function, quality of life, and the medical complications associated with obesity in older persons. Therefore, weight-loss therapy that minimizes muscle and bone losses is recommended for older persons who are obese and who have functional impairments or medical complications that can benefit from weight loss.
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Affiliation(s)
- Dennis T Villareal
- Division of Geriatrics and Nutritional Sciences, Center for Human Nutrition, Washington University School of Medicine, St. Louis, MO 63110, USA
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Gómez-Cabello A, Ara I, González-Agüero A, Casajús JA, Vicente-Rodríguez G. Effects of training on bone mass in older adults: a systematic review. Sports Med 2012; 42:301-25. [PMID: 22376192 DOI: 10.2165/11597670-000000000-00000] [Citation(s) in RCA: 200] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
It is widely recognized that the risk of fractures is closely related to the typical decline in bone mass during the ageing process in both women and men. Exercise has been reported as one of the best non-pharmacological ways to improve bone mass throughout life. However, not all exercise regimens have the same positive effects on bone mass, and the studies that have evaluated the role of exercise programmes on bone-related variables in elderly people have obtained inconclusive results. This systematic review aims to summarize and update present knowledge about the effects of different types of training programmes on bone mass in older adults and elderly people as a starting point for developing future interventions that maintain a healthy bone mass and higher quality of life in people throughout their lifetime. A literature search using MEDLINE and the Cochrane Central Register of Controlled Trials databases was conducted and bibliographies for studies discussing the effect of exercise interventions in older adults published up to August 2011 were examined. Inclusion criteria were met by 59 controlled trials, 7 meta-analyses and 8 reviews. The studies included in this review indicate that bone-related variables can be increased, or at least the common decline in bone mass during ageing attenuated, through following specific training programmes. Walking provides a modest increase in the loads on the skeleton above gravity and, therefore, this type of exercise has proved to be less effective in osteoporosis prevention. Strength exercise seems to be a powerful stimulus to improve and maintain bone mass during the ageing process. Multi-component exercise programmes of strength, aerobic, high impact and/or weight-bearing training, as well as whole-body vibration (WBV) alone or in combination with exercise, may help to increase or at least prevent decline in bone mass with ageing, especially in postmenopausal women. This review provides, therefore, an overview of intervention studies involving training and bone measurements among older adults, especially postmenopausal women. Some novelties are that WBV training is a promising alternative to prevent bone fractures and osteoporosis. Because this type of exercise under prescription is potentially safe, it may be considered as a low impact alternative to current methods combating bone deterioration. In other respects, the ability of peripheral quantitative computed tomography (pQCT) to assess bone strength and geometric properties may prove advantageous in evaluating the effects of training on bone health. As a result of changes in bone mass becoming evident by pQCT even when dual energy X-ray absortiometry (DXA) measurements were unremarkable, pQCT may provide new knowledge about the effects of exercise on bone that could not be elucidated by DXA. Future research is recommended including longest-term exercise training programmes, the addition of pQCT measurements to DXA scanners and more trials among men, including older participants.
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Affiliation(s)
- A Gómez-Cabello
- GENUD-Growth, Exercise, NUtrition and Development Research Group, Universidad de Zaragoza, Huesca, Spain
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Villalon KL, Gozansky WS, Van Pelt RE, Wolfe P, Jankowski CM, Schwartz RS, Kohrt WM. A losing battle: weight regain does not restore weight loss-induced bone loss in postmenopausal women. Obesity (Silver Spring) 2011; 19:2345-50. [PMID: 21852813 PMCID: PMC3760414 DOI: 10.1038/oby.2011.263] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Previously, we reported significant bone mineral density (BMD) loss in postmenopausal women after modest weight loss. It remains unclear whether the magnitude of BMD change in response to weight loss is appropriate (i.e., proportional to weight loss) and whether BMD is recovered with weight regain. We now report changes in BMD after a 1-year follow-up. Subjects (n = 23) in this secondary analysis were postmenopausal women randomized to placebo as part of a larger trial. They completed a 6-month exercise-based weight loss program and returned for follow-up at 18 months. Dual-energy X-ray absorptiometry (DXA) was performed at baseline, 6, and 18 months. At baseline, subjects were aged 56.8 ± 5.4 years (mean ± s.d.), 10.0 ± 9.2 years postmenopausal, and BMI was 29.6 ± 4.0 kg/m(2). They lost 3.9 ± 3.5 kg during the weight loss intervention. During follow-up, they regained 2.9 ± 3.9 kg. Six months of weight loss resulted in a significant decrease in lumbar spine (LS) (-1.7 ± 3.5%; P = 0.002) and hip (-0.04 ± 3.5%; P = 0.03) BMD that was accompanied by an increase in a biomarker of bone resorption (serum C-terminal telopeptide of type I collagen, CTX: 34 ± 54%; P = 0.08). However, weight regain was not associated with LS (0.05 ± 3.8%; P = 0.15) or hip (-0.6 ± 3.0%; P = 0.81) bone regain or decreased bone resorption (CTX: -3 ± 37%; P = 0.73). The findings suggest that BMD lost during weight reduction may not be fully recovered with weight regain in hormone-deficient, postmenopausal women. Future studies are needed to identify effective strategies to prevent bone loss during periods of weight loss.
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Affiliation(s)
- Karen L Villalon
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Denver, Aurora, Colorado, USA.
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Shah K, Armamento-Villareal R, Parimi N, Chode S, Sinacore DR, Hilton TN, Napoli N, Qualls C, Villareal DT. Exercise training in obese older adults prevents increase in bone turnover and attenuates decrease in hip bone mineral density induced by weight loss despite decline in bone-active hormones. J Bone Miner Res 2011; 26:2851-9. [PMID: 21786319 PMCID: PMC3206995 DOI: 10.1002/jbmr.475] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Weight loss therapy to improve health in obese older adults is controversial because it causes further bone loss. Therefore, it is recommended that weight loss therapy should include an intervention such as exercise training (ET) to minimize bone loss. The purpose of this study was to determine the independent and combined effects of weight loss and ET on bone metabolism in relation to bone mineral density (BMD) in obese older adults. One-hundred-seven older (age >65 years) obese (body mass index [BMI] ≥ 30 kg/m(2) ) adults were randomly assigned to a control group, diet group, exercise group, and diet-exercise group for 1 year. Body weight decreased in the diet (-9.6%) and diet-exercise (-9.4%) groups, not in the exercise (-1%) and control (-0.2%) groups (between-group p < 0.001). However, despite comparable weight loss, bone loss at the total hip was relatively less in the diet-exercise group (-1.1%) than in the diet group (-2.6%), whereas BMD increased in the exercise group (1.5%) (between-group p < 0.001). Serum C-terminal telopeptide (CTX) and osteocalcin concentrations increased in the diet group (31% and 24%, respectively), whereas they decreased in the exercise group (-13% and -15%, respectively) (between-group p < 0.001). In contrast, similar to the control group, serum CTX and osteocalcin concentrations did not change in the diet-exercise group. Serum procollagen propeptide concentrations decreased in the exercise group (-15%) compared with the diet group (9%) (p = 0.04). Serum leptin and estradiol concentrations decreased in the diet (-25% and -15%, respectively) and diet-exercise (-38% and -13%, respectively) groups, not in the exercise and control groups (between-group p = 0.001). Multivariate analyses revealed that changes in lean body mass (β = 0.33), serum osteocalcin (β = -0.24), and one-repetition maximum (1-RM) strength (β = 0.23) were independent predictors of changes in hip BMD (all p < 0.05). In conclusion, the addition of ET to weight loss therapy among obese older adults prevents weight loss-induced increase in bone turnover and attenuates weight loss-induced reduction in hip BMD despite weight loss-induced decrease in bone-active hormones.
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Affiliation(s)
- Krupa Shah
- Division of Geriatrics and Nutritional Science, Washington University School of Medicine, St. Louis, MO, USA
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Sullivan TR, Duque G, Keech AC, Herrmann M. An old friend in a new light: the role of osteocalcin in energy metabolism. Cardiovasc Ther 2011; 31:65-75. [PMID: 21975009 DOI: 10.1111/j.1755-5922.2011.00300.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Accumulating evidence suggests interactions between bone and energy metabolism, which may affect the risk of cardiovascular disease. Recent animal studies indicate that osteocalcin (OC) plays a key role in the coordinated regulation of glucose and insulin metabolism while insulin receptors on osteoblasts may regulate bone turnover and circulating OC levels. Association studies, weight loss interventions, and observational data lend some support to the existence and relevance of these mechanisms in humans. However, corroborating evidence from pharmacologic interventions in either bone or glucose metabolism is limited by the number, design, and complex pharmacological effects of the drugs used. Furthermore, such clinical trials are complicated by the alteration of metabolic feedback mechanisms in the insulin resistant state. Purpose-designed studies are needed to further establish the existence and significance of the role of OC and its subfractions in human insulin metabolism. In this review we summarize existing animal evidence regarding the role of OC and its subfractions in bone and energy metabolism and assess current clinical trial evidence relating to the significance and consequences of this relationship in humans.
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Affiliation(s)
- Tim R Sullivan
- Hornsby Kuring-gai Hospital, Northern Sydney Health Service, Hornsby, Australia
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Abstract
Weight loss is common in older people. It is associated with increased morbidity and mortality, particularly when unintentional, excessive (>5% body weight), or associated with low body weight (body mass index <22 kg/m(2)). It is often unrecognized, the associated adverse effects not appreciated, and underlying causes not addressed. Intentional weight loss by overweight older people is probably appropriate only when functional problems have resulted from the excess weight. It is important to include, wherever possible, exercise in weight-loss measures to preserve skeletal muscle mass.
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Affiliation(s)
- Ian M Chapman
- Division of Medicine, Royal Adelaide Hospital, University of Adelaide, Level 6, Eleanor Harrald Building, North Terrace, Adelaide 5000, Australia.
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Weinheimer EM, Sands LP, Campbell WW. A systematic review of the separate and combined effects of energy restriction and exercise on fat-free mass in middle-aged and older adults: implications for sarcopenic obesity. Nutr Rev 2010; 68:375-88. [DOI: 10.1111/j.1753-4887.2010.00298.x] [Citation(s) in RCA: 243] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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38
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Uusi-Rasi K, Rauhio A, Kannus P, Pasanen M, Kukkonen-Harjula K, Fogelholm M, Sievänen H. Three-month weight reduction does not compromise bone strength in obese premenopausal women. Bone 2010; 46:1286-93. [PMID: 19857618 DOI: 10.1016/j.bone.2009.10.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 10/09/2009] [Accepted: 10/13/2009] [Indexed: 10/20/2022]
Abstract
Weight loss is claimed to cause bone loss. This prospective 12-month study evaluated effects of 3-month group-based weight loss with VLED on body composition, bone mass and strength (DXA and pQCT), muscle performance and biomarkers of bone turnover. The assessments were done at baseline and at 3 and 12 months. Sixty-two women of the recruited 75 obese (BMI>30) premenopausal women who completed the study were divided into 3 groups based on the tertiles of weight loss at 3 months. The group means of weight losses were 15.5% (Large), 10.5% (Medium) and 5.9% (Low). Statistical analyses were based on analysis of covariance. Bone turnover increased during the weight reduction period in all groups but practically returned to baseline during the weight maintenance phase. In general, mean bone changes remained marginal (approximately +/-1%) and the amount of weight reduction was not associated with bone loss. The only notable change was the 4% decline in bending strength at the distal radius. These results indicate that in obese premenopausal women, 3-month weight reduction resulted in increased bone turnover but was not deleterious for bone mass or strength at 3 months or after 9-month weight maintenance.
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Affiliation(s)
- Kirsti Uusi-Rasi
- The UKK Institute for Health Promotion Research, Tampere, Finland.
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Genton L, Melzer K, Pichard C. Energy and macronutrient requirements for physical fitness in exercising subjects. Clin Nutr 2010; 29:413-23. [PMID: 20189694 DOI: 10.1016/j.clnu.2010.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 01/04/2010] [Accepted: 02/01/2010] [Indexed: 01/22/2023]
Abstract
Optimal nutritional intakes are critical for health- and skill-related physical fitness. This review details the effect of energy restriction and supplementation on physical fitness, discusses the optimal chronic macronutrient intakes for physical fitness in exercising subjects and finally overviews the impact of short-term intakes of carbohydrate and protein, before, during and after exercise, on physical fitness of athletes. The present standings highlight that it is essential that health care givers personalize nutritional advice to meet the specific needs of exercising individuals while applying the described recommendations. It reminds the difficulty of providing straight nutritional recommendations for physical fitness on the basis of evidence-based medicine.
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Affiliation(s)
- Laurence Genton
- Clinical Nutrition, Geneva University Hospital, Rue Gabrielle Perret-Gentil 24, 1211 Geneva 14, Switzerland
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Rector RS, Loethen J, Ruebel M, Thomas TR, Hinton PS. Serum markers of bone turnover are increased by modest weight loss with or without weight-bearing exercise in overweight premenopausal women. Appl Physiol Nutr Metab 2010; 34:933-41. [PMID: 19935856 DOI: 10.1139/h09-098] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Weight loss improves metabolic fitness and reduces morbidity and mortality; however, weight reduction also reduces bone mineral density (BMD) and increases bone turnover. Weight-bearing aerobic exercise may preserve bone mass and maintain normal bone turnover during weight reduction. We investigated the impact of weight-bearing and nonweight-bearing exercise on serum markers of bone formation and breakdown during short-term, modest weight loss in overweight premenopausal women. Subjects (n = 36) were assigned to 1 of 3 weight-loss interventions designed to produce a 5% reduction in body weight over 6 weeks: (i) energy restriction only (n = 11; DIET); (ii) energy restriction plus nonweight-bearing exercise (n = 12, CYCLE); or (iii) energy restriction plus weight-bearing exercise (n = 13, RUN). Bone turnover markers were measured in serum collected at baseline and after weight loss. All groups achieved a ~5% reduction in body weight (DIET = 5.2%; CYCLE = 5.0%; RUN = 4.7%). Osteocalcin (OC) and C-terminal telopeptide of type I collagen (CTX) increased with weight loss in all 3 groups (p < 0.05), whereas bone alkaline phosphatase was unaltered by the weight-loss interventions. At baseline, OC and CTX were positively correlated (r = 0.36, p = 0.03), but the strength of this association was diminished (r = 0.30, p = 0.06) after weight loss. Modest weight loss, regardless of method, resulted in a significant increase in both OC and CTX. Low-impact, weight-bearing exercise had no effect on serum markers of bone formation or resorption in premenopausal women during weight loss. Future studies that examine the effects of high-impact, weight-bearing activity on bone turnover and BMD during weight loss are warranted.
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Affiliation(s)
- R Scott Rector
- Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65211, USA
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41
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Abstract
Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease in developed countries and is increasing in prevalence with the rise of diabetes and obesity. In addition to obesity and age, gender may also influence the prevalence and severity of NAFLD. However, mechanisms underlying gender-based differences in NAFLD have not been clearly defined. Furthermore, alterations in body composition, fat distribution and/or hormonal or metabolic changes that occur following menopause and in the setting of polycystic ovary syndrome may influence the development and progression of NAFLD. In this article, we will summarize known gender differences as well as the proposed mechanisms for gender differences in NAFLD, review two women-specific issues that may influence the prevalence and severity of NAFLD, menopause and polycystic ovary syndrome, and discuss potential therapeutic options for women with NAFLD who are postmenopausal or have polycystic ovary syndrome.
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Affiliation(s)
- Ayako Suzuki
- Division of Gastroenterology & Hepatology, Duke University Medical Center, Durham, NC 27710, USA.
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Silverman NE, Nicklas BJ, Ryan AS. Addition of aerobic exercise to a weight loss program increases BMD, with an associated reduction in inflammation in overweight postmenopausal women. Calcif Tissue Int 2009; 84:257-65. [PMID: 19280097 PMCID: PMC2926800 DOI: 10.1007/s00223-009-9232-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Accepted: 02/14/2009] [Indexed: 01/23/2023]
Abstract
Increased inflammation and weight loss are associated with a reduction in bone mineral density (BMD). Aerobic exercise may minimize the loss of bone and weight loss may contribute to a decrease in cytokines. We tested the hypothesis that aerobic exercise in combination with a weight loss program would decrease circulating concentrations of inflammatory markers, thus mediating changes in BMD. This was a nonrandomized controlled trial. Eighty-six overweight and obese postmenopausal women (50-70 years of age; BMI, 25-40 kg/m(2)) participated in a weight loss (WL; n = 40) or weight loss plus walking (WL + AEX; n = 46) program. Outcome measures included BMD and bone mineral content of the femoral neck and lumbar spine measured by dual energy X-ray absorptiometry, interleukin-6, tumor necrosis factor-alpha, soluble receptors of IL-6, and TNF-alpha (sTNFR1 and sTNFR2; receptors in a subset of the population), VO(2) max, fat mass, and lean mass. Weight decreased in the WL (p < 0.001) and WL + AEX (p < 0.001) groups. VO(2) max increased (p < 0.001) after WL + AEX. There was a 2% increase in femoral neck BMD in the WL + AEX group (p = 0.001), which was significantly different from the WL group. The change in sTNFR1 was significantly associated with the change in femoral neck BMD (p < 0.05). The change in VO(2) max was an independent predictor of the change in femoral neck BMD. Our findings suggest that the addition of aerobic exercise is recommended to decrease inflammation and increase BMD during weight loss in overweight postmenopausal women.
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Affiliation(s)
- Natalie E. Silverman
- University of Maryland School of Medicine and the Geriatric Research, Education and Clinical Center of the Baltimore Veterans Affairs Medical Center, GRECC (BT/18/GR), 10 North Greene Street, Baltimore, MD 21201-1524, USA
| | - Barbara J. Nicklas
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Alice S. Ryan
- University of Maryland School of Medicine and the Geriatric Research, Education and Clinical Center of the Baltimore Veterans Affairs Medical Center, GRECC (BT/18/GR), 10 North Greene Street, Baltimore, MD 21201-1524, USA
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Use of dual-energy X-ray absorptiometry in obese individuals: The possibility to estimate whole body composition from DXA half-body scans. Radiography (Lond) 2009. [DOI: 10.1016/j.radi.2008.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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44
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Park HA, Kim HJ, Kim TJ, Park JJ, Park JK. Weight and Bone Mineral Density - The Summary of Epidemiological Evidence -. Korean J Fam Med 2009. [DOI: 10.4082/kjfm.2009.30.3.167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Hyun Ah Park
- Department of Family Medicine, Inje University College of Medicine, Seoul, Korea
| | - Hye Jin Kim
- Department of Family Medicine, Inje University College of Medicine, Seoul, Korea
| | - Tae Jun Kim
- Department of Obstetrics and Gynecology, Miz-Medi Hospital, Seoul, Korea
| | - Jin Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Kyun Park
- Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, USA
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Villareal DT, Shah K, Banks MR, Sinacore DR, Klein S. Effect of weight loss and exercise therapy on bone metabolism and mass in obese older adults: a one-year randomized controlled trial. J Clin Endocrinol Metab 2008; 93:2181-7. [PMID: 18364384 PMCID: PMC2435639 DOI: 10.1210/jc.2007-1473] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Accepted: 03/14/2008] [Indexed: 01/23/2023]
Abstract
BACKGROUND Although weight loss and exercise ameliorates frailty and improves cardiac risk factors in obese older adults, the long-term effect of lifestyle intervention on bone metabolism and mass is unknown. OBJECTIVE The objective was to evaluate the effects of diet-induced weight loss in conjunction with exercise on bone metabolism and mass in obese older adults. DESIGN AND SETTING We conducted a one-year randomized, controlled clinical trial in a university-based research center. PARTICIPANTS Twenty-seven frail, obese (body mass index = 39 +/- 5 kg/m(2)), older (age 70 +/- 5 yr) adults participated in the study. INTERVENTION Participants were randomly assigned to diet and exercise (treatment group; n = 17) or no therapy (control group; n = 10). OUTCOME MEASURES Body weight decreased in the treatment group but not in the control group (-10 +/- 2 vs. +1 +/- 1%, P < 0.001). Compared with the control group, the treatment group had greater changes in bone mass, bone markers, and hormones, including 1) bone mineral density (BMD) in total hip (0.1 +/- 2.1 vs. -2.4 +/- 2.5%), trochanter (0.2 +/- 3.3 vs. -3.3 +/- 3.1%), and intertrochanter (0.3 +/- 2.7 vs. -2.7 +/- .3.0%); 2) C-terminal telopeptide (12 +/- 35 vs. 101 +/- 79%) and osteocalcin (-5 +/- 15 vs. 66 +/- 61%); and 3) leptin (2 +/- 12 vs. -30 +/- 25%) and estradiol (0.1 +/- 14% vs. -14 +/- 21%) (all P < 0.05). Changes in weight (r = 0.55), bone markers (r = -0.54), and leptin (r = 0.61) correlated with changes in hip BMD (all P < 0.05). CONCLUSION Weight loss, even when combined with exercise, decreases hip BMD in obese older adults. It is not known whether the beneficial effects of weight loss and exercise on physical function lower the overall risk of falls and fractures, despite the decline in hip BMD.
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Affiliation(s)
- Dennis T Villareal
- Division of Geriatrics and Nutritional Science, Center for Human Nutrition, Washington University School of Medicine, 4488 Forest Park Boulevard, St. Louis, MO 63108, USA.
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Sanada K, Miyachi M, Tabata I, Miyatani M, Tanimoto M, Oh TW, Yamamoto K, Usui C, Takahashi E, Kawano H, Gando Y, Higuchi M. Muscle mass and bone mineral indices: does the normalized bone mineral content differ with age? Eur J Clin Nutr 2008; 63:465-72. [DOI: 10.1038/sj.ejcn.1602977] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Stettler N, Berkowtiz RI, Cronquist JL, Shults J, Wadden TA, Zemel BS, Leonard MB. Observational study of bone accretion during successful weight loss in obese adolescents. Obesity (Silver Spring) 2008; 16:96-101. [PMID: 18223619 DOI: 10.1038/oby.2007.17] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess bone mineral content (BMC) among obese adolescents who lose weight during a critical period for bone accretion. METHODS AND PROCEDURES Whole body, lumbar spine, lower, and upper limb BMC were measured in 62 obese adolescents who completed an intensive 12-month weight loss trial. BMC was adjusted for height (z -scores) using data from a reference group of 66 adolescents (who were 18% overweight). RESULTS At baseline, the BMC of the obese group was higher than the reference group. During the 12-month weight loss program, unadjusted BMC increased among the obese adolescents, despite successful weight loss. After adjustment for height, whole body BMC did not change significantly from baseline to 12 months (mean +/- s.d.: 1.08 +/- 0.67 to 1.06 +/- 0.67, P = 0.7). Region-specific BMC-for-height however decreased for the lower (1.07 +/- 0.57 to 0.95 +/- 0.59, P < 0.001) and upper (1.29 +/- 0.56 to 1.18 +/- 0.57, P = 0.01) limbs, but lumbar spine BMC-for-height increased (0.14 +/- 1.06 to 0.40 +/- 0.94, P < 0.001). These changes were largely and independently explained by changes in lean and fat mass. DISCUSSION This study confirms that obese adolescents have high BMC for height and suggests that, unlike adults, their BMC continues to increase during weight loss and remains higher than the BMC of a reference group. After adjustment for growth-related changes, lower and upper limb BMC appears to decrease, while lumbar spine BMC appears to increase. These results suggest that to optimize the health benefits of weight loss among obese adolescents, their bone health should be better understood and addressed.
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Affiliation(s)
- Nicolas Stettler
- Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
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Park HA, Lee JS, Kuller LH, Cauley JA. Effects of weight control during the menopausal transition on bone mineral density. J Clin Endocrinol Metab 2007; 92:3809-15. [PMID: 17635939 DOI: 10.1210/jc.2007-1040] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND Studies of weight loss and changes in bone mineral density (BMD) have primarily been short-term trials in obese subjects. OBJECTIVE We examined the effects of a 5-yr intervention designed to prevent menopausal weight gain or promote modest weight loss on BMD in premenopausal women participating in the Women's Healthy Lifestyle Project. DESIGN We enrolled 373 premenopausal women (age 44-50 yr) and randomly assigned them to either lifestyle intervention (175 women, low-fat dietary modification, weight loss, and physical activity intervention) or control group (198 women). BMD and body weight were measured at baseline, annual follow-up visits (18, 30, 42, and 54 months), and two postintervention follow-ups (66 and 78 months). BMD was measured by dual x-ray absorptiometry. RESULTS Over the 54 months of intervention, women in the intervention group lost 0.4 kg, whereas control women gained 2.6 kg (P = 0.011). The intervention group experienced significantly greater hip bone loss (-0.20%/yr) than the control group (-0.03%/yr). During the postintervention, differences in rates of bone loss disappeared. When considering both menopausal status and use of hormone therapy (HT), the annualized BMD changes were lower in women reporting HT use; nevertheless, among women on HT, those who lost more than 3% body weight experienced greater total hip BMD loss (-0.25%/yr) compared with those who gained weight (-0.02%/yr) (P = 0.025). CONCLUSIONS Women randomized to a lifestyle intervention aimed at preventing menopausal weight gain or promoting modest weight loss experienced greater rates of hip bone loss than control women.
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Affiliation(s)
- Hyun A Park
- Seoul Paik Hospital, College of Medicine, University of Inje, Seoul 100-032, Korea
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49
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Abstract
Undernutrition is common in older people and has serious adverse effects. Weight loss and low body weight are key markers. Correctable causes, such as depression, are common and should be sought. Structured efforts to encourage food intake, together with nutritional supplements, often are of benefit. It is hoped that a better understanding of the underlying mechanisms will lead to targeted treatments. Overweight and obesity also are common in older people, and are associated with morbidity and impaired function. It is probably appropriate to recommend weight loss to obese older people who have associated comorbidities, particularly reduced mobility, but seldom, if ever, for increased weight alone.
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Affiliation(s)
- Ian McPhee Chapman
- Department of Medicine, University of Adelaide, Level 6, Eleanor Harrald Building, Royal Adelaide Hospital, North Terrace, 5000 Adelaide, Australia.
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Evans EM, Mojtahedi MC, Kessinger RB, Misic MM. Simulated change in body fatness affects Hologic QDR 4500A whole body and central DXA bone measures. J Clin Densitom 2006; 9:315-22. [PMID: 16931350 DOI: 10.1016/j.jocd.2006.04.117] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2006] [Accepted: 04/21/2006] [Indexed: 11/23/2022]
Abstract
Changes in body fatness may impact the accuracy of dual energy X-ray absorptiometry (DXA) measures of bone mineral content (BMC) and bone mineral density (BMD). The aim of this study was to determine if DXA can accurately assess BMC and BMD with changes in exogenous fat (lard) placed to simulate weight change. Whole body (WB), lumbar spine (LS), and proximal femur (PF) DXA scans (Hologic QDR 4500A) were performed on 30 elderly (52-83 yr) and 60 young (18-40 yr) individuals (i.e., 45 females and 45 males) of varying body mass index (mean+/-standard deviation: 26.1+/-4.9 kg/m2). When scans were repeated with lard packets (2.54 cm thick, 25.4x17.8 cm, 1 kg), WB BMD decreased 1.1% and 1.6% after chest and thigh packet placement, respectively (p=0.001), PF BMD increased 0.7% (p=0.02) and LS BMD decreased 1.6% (p=0.001) primarily due to a 2.2% reduction in LS BMC (p<0.001). Initial LS BMC and trunk mass were related to error in LS BMC measures due to lard-loading (r=0.64 and 0.45, respectively, p<0.001). We conclude that on average simulated weight change minimally impacts PF bone measures and moderately impacts WB and LS bone measures; however, individual variability in measurement error was noteworthy and may be impacted by body thickness.
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Affiliation(s)
- Ellen M Evans
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
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