The Saturation Effect of Obesity on Bone Mineral Density for Older People: The NHANES 2017-2020

Association between body mass index and lumbar spine volumetric bone mineral density in diabetic and non-diabetic patients

BACKGROUND

The association between body mass index (BMI) and bone mineral density (BMD) has shown inconsistent results, varying by sex and skeletal site. Despite normal or elevated bone mass, individuals with type 2 diabetes have an increased risk of hip and vertebral fractures.

AIM

To assess lumbar spine trabecular volumetric BMD (vBMD) across different BMI categories in individuals with and without diabetes.

METHODS

This cross-sectional study included 966 men over 50 years old and 1001 postmenopausal women from the Pinggu Metabolic Disease Study. The vBMD of lumbar vertebrae 2 through 4 was measured using quantitative computed tomography. Total adipose tissue, subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and lumbar skeletal muscle area were also quantified.

RESULTS

In men with obesity (P = 0.038) and overweight (P = 0.032), vBMD was significantly higher in the diabetes group compared to non-diabetic men. After adjusting for age and sex, no significant saturation effect between BMI and BMD was found in participants with diabetes or in women without diabetes. However, a BMI threshold of 22.33 kg/m² indicated a saturation point for vBMD in non-diabetic men. Independent predictors of vBMD in men included age (r = -0.387, P < 0.001), BMI (r = 0.130, P = 0.004), and VAT (r = -0.145, P = 0.001). For women, significant predictors were age (r = -0.594, P < 0.001), BMI (r = 0.157, P = 0.004), VAT (r = -0.112, P = 0.001), and SAT (r = -0.068, P = 0.035).

CONCLUSION

The relationship between BMI and trabecular vBMD differs in individuals with and without diabetes. Overweight and obese men with diabetes exhibit higher vBMD.

Obesity and menopause

Obesity is not a choice or a result of lack of willpower, but a multifactorial, chronic, progressive, and relapsing disease. During menopause, hormonal and body composition changes lead to greater visceral adiposity, that aggravates women's health at a cardiometabolic, mechanic and mental level. Adiposity has been identified as an important modifier of reproductive hormones. During female midlife, obesity has been associated with menstrual cycle alterations (anovulatory cycles ending with abnormal bleedings), menopausal symptoms including hot flashes, poor quality of sleep, aches and joint pain, genitourinary symptoms, and reduced quality of life. However, the relationships between weight, the menopausal process, aging, and hormone levels remain poorly understood. Women with obesity have an increased risk of thromboembolic disease when using menopause hormone therapy (MHT), and it is probably the main medical condition to prescribe or not MHT. However, this risk depends on the route and type of MHT. The use of estrogen-only or combined transdermal MHT does not increase the risk of a thrombotic event in women with obesity.

Exploring the impact of body mass index on the accuracy of vertebral bone quality in determining bone mineral density in patients undergoing lumbar fusion surgery

OBJECTIVE

To investigate whether body mass index (BMI) affects the accuracy of vertebral bone quality (VBQ) in determining bone mineral density (BMD) in patients undergoing lumbar fusion surgery.

METHODS

In this retrospective study, patients with preoperative noncontrast T1-weighted MRI were included. Restricted Cubic Spline (RCS) was employed to explore the nonlinear relationship between BMI and VBQ. Then patients were stratified according to the threshold of BMI. Pearson correlation analysis and linear regression were used to analyze the correlation between VBQ and the BMD in different groups. Receiver operating characteristic (ROC) analysis to calculate the area under the curve (AUC) was used to assess diagnostic efficacy according to BMI.

RESULTS

A total of 328 patients (201 female and 127 male patients) with a mean age of 68.3 ± 3.3 years were included in the study. Significant nonlinear relationship was observed given the results of RCS. In patients with BMI < 23.8 kg/m2, the correlation coefficient between VBQ and the lowest BMD was - 0.32 and significant distribution difference of VBQ score was observed between osteoporosis and normal as well as osteopenia subgroups. However, in patients with BMI ≥ 23.8 kg/m2, the correlation coefficient between VBQ and the lowest BMD was - 0.39 and significant distribution difference of VBQ score was observed in all three subgroups. In addition, the ROC analysis revealed that the predictive performance in determining low BMD was superior in patients with BMI ≥ 23.8 kg/m2 (AUC 0.80 vs. AUC 0.66, p = 0.034).

CONCLUSIONS

In this study, significant nonlinear relationship between BMI and VBQ was observed. Compared with patients with BMI < 23.8 kg/m2, VBQ has better discrimination between higher BMI (≥ 23.8 kg/m2) patients with low BMD and those with normal bone density.

Weight-adjusted waist index associated with bone mineral density in rheumatoid arthritis patients: a cross-sectional study

The research examined the association between weight-adjusted waist index (WWI) and bone mineral density (BMD) in individuals with rheumatoid arthritis, considering the impact of obesity on bone health. The association between WWI and BMD was examined utilizing weighted linear regression and smoothed curve fitting with data from NHANES 2005-2010, 2013-2014, and 2017-2018. Subgroup analysis verified the stability of the results. The study included a cohort of 983 rheumatoid arthritis patients. A significant negative correlation was found between WWI and BMD at the total femur, femoral neck, and lumbar spine (β = -0.03, 95% CI (-0.04, -0.02), p < 0.001; β = -0.02, 95% CI (-0.04, -0.01), p = 0.001; β = -0.04, 95% CI (-0.06, -0.02), p < 0.001). This negative association was not significantly influenced by factors like age, gender, race, education, PIR, diabetes, hypertension, sleep disorders, alcohol consumption, or smoking status (p > 0.05 for interaction). The findings indicate a negative correlation between WWI and BMD in the rheumatoid arthritis population. Key Points •A negative correlation was found between WWI and BMD at the total femur, femoral neck, and lumbar spine in the rheumatoid arthritis population.

Six Weeks to Wellness: The Role of Breathing Exercises Based on Motor Development Pattern in Improving Fitness and Quality of Life in Overweight Elderly Women

Background: Being overweight is a major global health epidemic of the 20th and 21st centuries, which can affect the movement system function of older adult women. This study evaluated the effects of a breathing exercise based on motor development patterns on functional fitness and quality of life in overweight older adult women. Methods: A randomized controlled trial was conducted with 40 community-dwelling women aged 65-75. Participants were randomly assigned to an intervention group, which completed a 6-week breathing exercise program (three supervised and three home-based sessions per week), or a control group, which maintained usual routines. Outcome measures included cardiovascular fitness, upper and lower body flexibility, muscle strength, dynamic balance, and quality of life, assessed at baseline and post-intervention. Results: The intervention group showed significant improvements in cardiovascular fitness (p < .001, ES = 0.652), upper body flexibility (p < .001, ES = 0.652), lower body flexibility (p < .001, ES = 0.538), upper body strength (p < .001, ES = 0.538), lower body strength (p < .001, ES = 0.538), and dynamic balance (p < .001, ES = 0.475) compared to the control group. Quality of life also significantly improved in the intervention group (p < .001, ES = 0.475). Conclusion: Breathing exercises based on motor development patterns significantly enhance functional fitness and quality of life in overweight older adult women. Incorporating these exercises into regular physical activity routines may promote health and independence in older adults. Further research should explore long-term benefits and optimal exercise parameters for older adults.

The saturation effect of body mass index on total lumbar bone mineral density for adults: The NHANES 2011-2020

To explore the association between body mass index (BMI) and total lumbar bone mineral density (BMD) in adults. This study included 9927 participants from 2011 to 2020 National Health and Nutrition Examination Survey (NHANES). The date on BMI, total lumbar BMD and other covariates were collected. Multivariate linear regression analyses were performed to evaluate the association between BMI and total lumbar BMD. Smoothing curve fitting and saturation effects analysis models were used to analyze the nonlinear relationships and saturation values. Multivariate linear regression analyses revealed that BMI was positively linked to total lumbar BMD in non-adjusted models (β = 0.003, 95% CI: 0.003-0.003, P < .00001). After adjusting for gender and race (β = 0.003, 95% CI: 0.003-0.004, P < .00001) and all covariates (β = 0.004, 95% CI: 0.003-0.004, P < .00001), the association still existed. Smoothing curve fitting showed that there was nonlinear correlation between BMI and total lumbar BMD with saturation effect. The BMI saturation value was 21.2 kg/m2 in the total lumbar BMD based on saturation effects analysis models. There was nonlinear positive correlation between BMI and total lumbar BMD with saturation effect. For adults, keeping the BMI at a reasonable value (21.2 kg/m2) would obtain an optimal balance between BMI and total lumbar BMD.

The relationship between weight-adjusted-waist index and total bone mineral density in adults aged 20-59

Introduction

According to reports, obesity has a significant impact on bone health. And the weight-adjusted-waist index (WWI), superior to BMI and waist circumference (WC), is a new obesity indicator arising in recent years. This research investigated the relationship between WWI and total bone mineral density (BMD) for adults aged 20 to 59.

Methods

Using data from the 2011-2018 NHANES, we looked into the independent link between WWI and total BMD as well as its nonlinearity using weighted multiple linear regression and smooth curve fitting. Two-stage linear regression models were employed to calculate the threshold effects. There were additional subgroup analyses and testing for interactions.

Results

Multiple linear regression studies on a total of 10,372 individuals showed a significant inverse link between WWI and total BMD in adults between 20 and 59 [β = -0.04, 95% CI: (-0.04, -0.03), P<0.0001]. And smoking, race, and chronic kidney disease (CKD) had no significant effect on this negative connection (P for interaction >0.05). In addition, we found a nonlinear relationship between WWI and total BMD in diabetic and CKD patients, for which the saturation point was 11.38 cm/√kg in the CKD patient group and 10.29 cm/√kg in the diabetic patient group.

Conclusion

Our analysis demonstrated a significant inverse association between WWI and total BMD in adults aged 20-59.

Association between Metabolic Syndrome and the Musculoskeletal System

Metabolic syndrome (MetS) and osteoporosis are chronic health disorders worldwide [...].

Association between lean body mass to visceral fat mass ratio and bone mineral density in United States population: a cross-sectional study

BACKGROUND

Studies have explored the correlation between body composition and bone mineral density (BMD), but there has yet to be a consensus. Thus, the present study aims to comprehensively investigate the association between lean body mass, adipose tissue, and BMD.

METHODS

We conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) (2011-2018) with 11,227 subjects. Multiple linear regression, smoothed curve fitting, threshold, and saturation effect analysis were used to explore the association between lean body mass, visceral fat mass, and BMD. Also, we used the lean body mass to visceral fat mass ratio (Log LM/VFM) as a proxy variable to analyze its association with BMD alone.

RESULTS

After adjusting for potential confounding factors, the results showed a positive correlation between lean mass and total BMD (for continuous: β = 0.078, P < 0.001; for quartile: β = 0.138, P < 0.001), while visceral fat mass was negatively correlated (for continuous: β = -0.027, P < 0.001; for quartile: β = -0.065, P < 0.001). A positive correlation was observed when the alternative variable Log LM/VFM was analyzed separately for its association with BMD (for continuous: β = 0.034, P < 0.001; for quartile: β = 0.084, P < 0.001). In addition, subgroup analyses for gender, age, body mass index, hypertension, and diabetes showed that all subgroups except the diabetes subgroup showed a substantial degree of robustness (P < 0.05). The smoothed curve fitting showed a nonlinear relationship between Log LM/VFM and BMD, and there was a threshold effect with a critical value of 2.60.

CONCLUSION

Maintaining a proper ratio of lean body mass and visceral fat mass is beneficial for increasing BMD.

A cross-sectional study from NHANES found a positive association between obesity with bone mineral density among postmenopausal women

PURPOSE

Obesity has been demonstrated to improve bone mineral density (BMD), according to previous research. Nevertheless, there is a dearth of clarity regarding the optimal body mass index (BMI) and waist circumference (WC) for achieving the highest beneficial BMD in postmenopausal women. The objective of this study was to establish the correlation between obesity and BMD.

METHODS

The relationship between BMI, WC, and BMD was examined by using multivariate logistic regression models, fitting smoothing curves and utilizing the latest data from the National Health and Nutrition Examination Survey (NHANES) survey conducted between 2007 and 2018. Furthermore, the analysis of saturation effects was employed to examine the association of nonlinear connections among BMI, WC, and BMD.

RESULTS

The research examined information from a combination of 564 participants. A significant correlation between BMD and BMI as well as WC was observed in our findings. The enduring correlation between BMI and WC with BMD was demonstrated across subgroup analyses categorized by age and race, except among other Hispanic and other race. Furthermore, the smoothing curve fitting indicated that there existed not just a linear correlation among BMI, WC, and BMD, but also a saturation threshold in the association of these three factors.

CONCLUSIONS

Based on our study, we have found a strong and positive relationship between obesity and BMD. According to the results of this research, maintaining obesity at a moderate level in postmenopausal women would result in achieving an optimal equilibrium between obesity and BMD.

Inverse association between low-density lipoprotein cholesterol and bone mineral density in young- and middle-aged people: The NHANES 2011–2018

Objectives

Low-density lipoprotein cholesterol (LDL-C) plays an essential part in bone metabolism. However, the correlation between LDL-C levels and bone mineral density (BMD) is still controversial. This study aimed to explore the relationship between LDL-C levels and lumbar BMD in young- and middle-aged people.

Methods

We conducted a cross-sectional study comprising 4,441 participants aged 20–59 from the National Health and Nutrition Examination Survey (NHANES). LDL-C levels and lumbar BMD were used as independent and dependent variables, respectively. We evaluated the correlation between LDL-C levels and lumbar BMD through a weighted multivariate linear regression model. We performed a subgroup analysis of the relationship between LDL-C levels and lumbar BMD based on age, gender, and body mass index (BMI).

Results

After adjusting for confounding factors, LDL-C levels were negatively correlated with lumbar BMD. In subgroup analyses stratified by gender, this negative association was statistically significant in men and women. In the subgroup analysis stratified by age, a negative connection existed in people aged 30–49 years. In the subgroup analysis divided by BMI, there was an inverse correlation in overweight people (25 ≤ BMI &lt; 30).

Conclusions

Our research observed an inverse association between LDL-C levels and lumbar BMD in young- and middle-aged people, especially in people aged 30–49 years and who are overweight. Close monitoring of BMD and early intervention may be required for these people.

Effect of obesity status on adolescent bone mineral density and saturation effect: A cross-sectional study

BACKGROUND

The effect of obesity status on bone mineral density (BMD) in adolescents and whether there is a saturation effect is still insufficient. A cross-sectional study of adolescents aged 12-19 was conducted to investigate them.

METHODS

Weighted multivariate linear regression models were used to assess the relationship between obesity status and BMD via datasets from the National Health and Nutrition Examination Survey 2011-2018. The nonlinear relationships and saturation values were ascertained by fitting smooth curves and analyzing saturation effects. At the same time, the subgroup stratified analysis was also performed.

RESULTS

4056 adolescents were included in this study. We found that body mass index (BMI) and waist circumference (WC) were significantly associated with total BMD, which remained significant in subgroups stratified by age, gender, standing height, and ethnicity. We also noticed an inverse correlation between left leg fat/lean mass and left leg BMD, which was only significant in males and other races. Fitting smooth curve and saturation effect analysis showed that BMI, WC, left leg fat/lean mass, and BMD had a specific saturation effect. There was a saturation effect on bone mineral density in adolescents with a BMI of 22 kg/m², a WC of 70.5 cm, or a left leg fat/lean mass of 0.2994.

CONCLUSIONS

We found a positive saturation effect of BMI and WC with BMD and a negative saturation effect of left leg fat/lean mass with BMD. Appropriate obesity status allows adolescents to have better bone mass development but not excessive obesity.

Association between Sensitivity to Thyroid Hormone Indices and Bone Mineral Density in US Males

OBJECTIVES

Thyroid hormone is acknowledged as a pivotal factor in skeletal development and adult bone maintenance. However, available data about the relationship between sensitivity to thyroid hormone and bone mineral density (BMD) remain limited and conflicting. The purpose of the study was to explore the complex relationship between sensitivity to thyroid hormone indices and BMD using cross-sectional analysis.

METHODS

An overall sample of 3,107 males from the National Health and Nutrition Examination Survey (NHANES) was studied in the study. The thyroid hormone sensitivity indices included free triiodothyronine/tree thyroxine (FT3/FT4), thyroid-stimulating hormone index (TSHI), thyrotroph thyroxine resistance index (TT4RI), and thyroid feedback quantile-based index (TFQI). Given the complex study design and sample weights, the correlation between sensitivity to thyroid hormone indices and BMD was evaluated through multivariate linear regression models, and extra subgroup analyses were performed to examine the robustness of the results.

RESULTS

Among the 3,107 participants, we demonstrated that FT3/FT4 was negatively correlated with lumbar BMD (β = -0.0.35, 95% CI: -0.084-0.013, P < 0.05). In the terms of central sensitivity to thyroid hormone, TFQI showed a significant negative relationship with the BMD of the lumbar (β = -0.018, 95% CI: -0.033 to -0.003, P < 0.05), total femur (β = -0.020, 95% CI: -0.035 to -0.006, P < 0.01), and femur neck (β = -0.018, 95% CI: -0.031 to -0.005, P < 0.01). In the subgroup analyses stratified by body mass index (BMI), the significant negative correlation between TFQI and lumbar BMD remained in the male participants with BMI between 18.5 and 24.9 kg/m².

CONCLUSIONS

Decreased indices of sensitivity to thyroid hormones are strongly associated with increased lumbar BMD, suggesting that the dysfunction of peripheral and central response to thyroid hormone might contribute to bone loss. In addition, FT3/FT4 and TFQI were considered to be the preferable indicators to guide the prevention and clinical treatment of osteoporosis.