Physical Activity, Physical Fitness, Body Composition, and Nutrition Are Associated with Bone Status in University Students

Impact of high fat and low lean mass phenotype on bone mineral content: A cross-sectional study of Chinese adolescent population

BACKGROUND AND OBJECTIVE

Research on body composition phenotypes and bone health in adolescents is limited. Hence, this study aimed to analyze the relationship between different body composition phenotypes, bone mineral content, and bone metabolism markers in Chinese adolescents.

METHODS

In this cross-sectional study, 1852 adolescents aged 12 to 18 years were selected from six schools in Yinchuan City between 2017 and 2020 using stratified cluster random sampling. The participant's body composition and bone mineral content (BMC) were measured using bioelectrical impedance analysis (BIA). Serum bone metabolic markers (OC, CTX, and Ca) were measured. Based on their FMI and LMI, individuals were categorized into four body composition phenotypes: low fat mass-low lean mass (LFMI-LLMI), low fat mass-high lean mass (LFMI-HLMI), high fat mass-high lean mass (HFMI-HLMI), high fat mass-low lean mass (HFMI-LLMI).

RESULTS

There was a statistically significant difference between the four different body composition phenotypes with BMC, CTX and Ca in boys (all P < 0.05), similar conclusions were found in girls, except the OC and CTX. After adjusting for age, gender, smoking, drinking, and others, compared with the LFMI-HLMI reference group, the two high FMI groups (HFMI-LLMI and HFMI-HLMI) had a greater negative correlation with BMC, while the low BMC risk of the HFMI-LLMI group was the highest (OR = 33.28; 95%CI: 11.12-99.63; P < 0.001). The correlation between BMC of different body composition phenotypes in boys was greater than that in girls. HFMI-HLMI is a risk phenotype negatively associated with Ca content (β = -0.12; 95%CI: -0.19 to -0.04; P < 0.05). Regardless of body composition level, BMC was always negatively correlated with fat mass (LLMI: β = -0.27; 95%CI: -0.32-0.21; HLMI: β = -0.52, 95%CI: -0.65-0.40) and positively correlated with lean mass (LFMI: β =0.24; 95%CI: 0.20-0.28; HFMI: β =0.23, 95%CI:0.13-0.33) (all P < 0.001). The fat mass showed different correlations with OC and CTX in girls and boys based on LLMI or HLMI (all P < 0.05).

CONCLUSION

HFMI-LLMI is a risk phenotype of low BMC in Chinese adolescents, and the relationship between fat mass and bone metabolism markers is affected by lean body mass and gender.

Body composition phenotypes and bone health in young adults: A cluster analysis

BACKGROUND AND AIMS

Lean mass is considered the best predictor of bone mass, as it is an excellent marker of bone mechanical stimulation, and changes in lean mass are highly correlated with bone outcomes in young adults. The aim of this study was to use cluster analysis to examine phenotype categories of body composition assessed by lean and fat mass in young adults and to assess how these body composition categories are associated with bone health outcomes.

METHODS

Cluster cross-sectional analyses of data from 719 young adults (526 women) aged 18-30 years from Cuenca and Toledo, Spain, were conducted. Lean mass index (lean mass (kg)/height (m)2), fat mass index (fat mass (kg)/height (m)2), bone mineral content (BMC) and areal bone mineral density (aBMD) were assessed by dual-energy X-ray absorptiometry.

RESULTS

A cluster analysis of lean mass and fat mass index z scores resulted in a classification of a five-category cluster solution that could be interpreted according to the body composition phenotypes of individuals as follows: high adiposity-high lean mass (n = 98), average adiposity-high lean mass (n = 113), high adiposity-average lean mass (n = 213), low adiposity-average lean mass (n = 142), and average adiposity-low lean mass (n = 153). ANCOVA models showed that individuals in clusters with a higher lean mass had significantly better bone health (z score: 0.764, se: 0.090) than their peers in other cluster categories (z score: -0.529, se: 0.074) after controlling for sex, age, and cardiorespiratory fitness (p < 0.05). Additionally, subjects belonging to the categories with a similar average lean mass index but with high or low-adiposity levels (z score: 0.289, se: 0.111; z score: 0.086, se: 0.076) showed better bone outcomes when the fat mass index was higher (p < 0.05).

CONCLUSIONS

This study confirms the validity of a body composition model using a cluster analysis to classify young adults according to their lean mass and fat mass indices. In addition, this model reinforces the main role of lean mass on bone health in this population and that in phenotypes with high-average lean mass, factors associated with fat mass may also have a positive effect on bone status.

Quantitative Ultrasound Examination (QUS) of the Calcaneus in Long-Term Martial Arts Training on the Example of Long-Time Practitioners of Okinawa Kobudo/Karate Shorin-Ryu

Quantitative research of bone tissue related to physical activity (PA) and sport has a preventive dimension. Increasing the parameters of bone tissue strength, especially reaching the maximum value of peak bone strength in childhood, adolescence, and early adulthood due to practicing sports can contribute to maintaining bone health throughout life. Practicing martial arts (tai chi, traditional karate, judo, and boxing) can effectively improve the quality of bone and reduce the risk of falls and fractures. The study aimed to evaluate the calcaneus bones among Okinawa Kobudo/Karate Shorin-Ryu practitioners using the quantitative ultrasound method as an indicator for assessing bone fracture risk. Forty-four adult martial arts practitioners with a mean age of 36.4 participated in this study. Quantitative ultrasound (QUS) with a portable Bone Ultrasonometer was used in this study. Speed of sound (SOS), broadband ultrasound attenuation (BUA), and the stiffness index (SI) were measured. Subjects were assigned to two groups of black and color belts, according to the advancement in Kobudo/karate practice. The measurements of the SI, BUA, SOS, T-score, and Z-score were significantly higher in subjects from the advanced, long-term practice (black belts) (p < 0.05). The long-term martial arts training in traditional karate and Kobudo significantly impacts the parameters of the calcaneus quantitative ultrasound measurements. Significantly higher bone density was observed among the black belt holders. Long-term practice subjects achieved results far beyond the norm for their age groups. Further studies using non-invasive methods of bone quantification are needed to determine the specific conditions for preventing osteoporosis through physical activity, sports, and martial arts, particularly the duration of the activity, the magnitude of loads, and other related factors.

Positive association of lean mass and negative association of protein intake on bone mass and bone geometry of adolescent soccer players

OBJECTIVE

The aim of this study was to evaluate the association of food consumption and body composition on bone parameters in adolescent soccer players.

METHODS

There were 148 male soccer players 12 to 18 y who participated in the study. Body composition was assessed by dual energy x-ray absorptiometry, comprising bone mineral density (BMD) and bone mineral content (BMC) of total body without head (TBLH), lumbar spine (L1-L4), and right femoral neck (RFN). The bone geometry variables measured were femoral strength index (FSI), buckling ratio (BR), section modulus (Z), cross-sectional moment of inertia (CSMI), and cross-sectional area (CSA). Food intake was analyzed using the 24-h food recall. Somatic maturation was estimated by the peak height velocity equation. For the statistical analysis, the stepwise multiple linear regression was used, with P < 0.05.

RESULTS

Regarding food consumption, there was a high protein intake and low calcium intake. Lean mass was a predictor of BMC of TBLH (R² = 0.524), L1-L4 (R² = 0.492), and RFN (R² = 0.405); BMD of L1-L4 (R² = 0.407) and RFN (R² = 0.27); Z (R² = 0.683), CSMI (R² = 0.630), and CSA (R² = 0.640). There was a negative correlation between protein intake with bone mass and bone geometry parameters.

CONCLUSION

In adolescent soccer players, lean mass was a predictor of bone parameters, and high protein intake was negatively associated with bone mass and geometry.

Body Composition Profiles of Applicants to a Physical Education and Sports Major in Southeastern Mexico

This study aimed to determine the body composition profile of candidates applying for a Physical Education and Sports major. 327 young adults (F: 87, M: 240) participated in this cross-sectional study. Nutritional status and body composition analysis were performed, and the profiles were generated using an unsupervised machine learning algorithm. Body mass index (BMI), percentage of fat mass (%FM), percentage of muscle mass (%MM), metabolic age (MA), basal metabolic rate (BMR), and visceral fat level (VFL) were used as input variables. BMI values were normal-weight although VFL was significantly higher in men (<0.001; η² = 0.104). MA was positively correlated with BMR (0.81 [0.77, 0.85]; p < 0.01), BMI (0.87 [0.84, 0.90]; p < 0.01), and VFL (0.77 [0.72, 0.81]; p < 0.01). The hierarchical clustering analysis revealed two significantly different age-independent profiles: Cluster 1 (n = 265), applicants of both sexes that were shorter, lighter, with lower adiposity and higher lean mass; and, Cluster 2 (n = 62), a group of overweight male applicants with higher VFL, taller, with lower %MM and estimated energy expended at rest. We identified two profiles that might help universities, counselors and teachers/lecturers to identify applicants in which is necessary to increase physical activity levels and improve dietary habits.

Impact of COVID-19 Confinement on Physical Activity and Sedentary Behaviour in Spanish University Students: Role of Gender

During the COVID-19 pandemic, entire populations were instructed to live in home-confinement to prevent the expansion of the disease. Spain was one of the countries with the strictest conditions, as outdoor physical activity was banned for nearly two months. This study aimed to analyse the changes in physical activity and sedentary behaviours in Spanish university students before and during the confinement by COVID-19 with special focus on gender. We also analysed enjoyment, the tools used and motivation and impediments for doing physical activity. An online questionnaire, which included the International Physical Activity Questionnaire Short Form and certain "ad hoc" questions, was designed. Students were recruited by distributing an invitation through the administrative channels of 16 universities and a total of 13,754 valid surveys were collected. Overall, university students reduced moderate (-29.5%) and vigorous (-18.3%) physical activity during the confinement and increased sedentary time (+52.7%). However, they spent more time on high intensity interval training (HIIT) (+18.2%) and mind-body activities (e.g., yoga) (+80.0%). Adaptation to the confinement, in terms of physical activity, was handled better by women than by men. These results will help design strategies for each gender to promote physical activity and reduce sedentary behaviour during confinement periods.

The effect of physical activity intervention and nutritional habits on anthropometric measures in elementary school children: the health oriented pedagogical project (HOPP)

BACKGROUND

Overweight and obesity are a burden of the modern world that requires urgent action. Prevention has proven to be efficient in the fight against overweight and obesity. As many children gain excessive weight at an early age, intervention during school years are important. While daily physical activity (PA) is known to have an influence on overweight and obesity prevention, the importance of a healthy lifestyle, including dietary habits, should not be underestimated. The aim of this study was to assess how a combination of daily PA and healthy/unhealthy diet affect the anthropometric measures of 4th graders in Norway.

METHODS

The Health Oriented Pedagogical Project (HOPP) is a longitudinal intervention in primary school children, which includes increased amount of daily physical activity during teaching- active learning. Assessed were weight, muscle and bone mass, as well as fat mass, using a bio-impedance Tanita scale. A dietary survey, Ungkost 2000, with 18 multiple-choice questions was used to evaluate the overall nutrition characteristics of the children.

RESULTS

Between 2015 and 2018, a total of 917 (intervention group n = 614, control group n = 303) 4th graders from nine different schools from the south-east part of Norway participated. We observed that daily PA and a regular healthy diet increases-while an unhealthy diet decreases-muscle and bone mass despite daily PA. Daily PA appears to counteract some of the effects of an unhealthy diet on weight and fat mass. In addition, daily PA and a regular intake of fruits and berries lowers weight and fat mass in children with overweight.

CONCLUSION

Combination of daily 45-minute of PA and a healthy diet leads to reductions in body weight and incease in muscle and bone mass in elementary school children.

Protein, lysine and vitamin D: critical role in muscle and bone health

Optimum body composition in terms of higher muscle and bone mass is crucial for balancing metabolic activities for sustainability of healthy human life. Individuals with lesser muscle mass respond poorly to stressed states such as traumatic injury, sepsis and advanced cancers. Most common diseases like obesity, heart disease, cancer and diabetes can be prevented by muscle mass modification. The nutrients like protein, lysine, calcium and vitamin D play a critical role in the maintenance of muscle mass and bone health. Poor dietary protein quality owing to high amounts of cereals and little animal foods have a marked negative impact on health in resource-limited settings. Lysine intake in developing countries is low mainly due to lesser food intake, consumption of cereals as staple diet and processing loss of lysine. Furthermore, lysine intakes have been shown to be marginal in low socio-economic groups which are of even greater concern. Cereal-based diets and cereal-based food subsidy programs offer low quality proteins and pose a risk of quality protein deficiency. Diets lacking in vitamin D contribute to vitamin D deficiency which is prevalent in epidemic proportions in large part of the world. Cereal-based vegetarian diets are responsible for lesser bioaccessibility of calcium as well. For obtaining optimal health, optimal muscle mass should be maintained at a younger age, which can be achieved by improving nutritional quality of diets. Dietary and medicinal supplementation of lysine, calcium and vitamin D may improve the body composition of young adult women in the form of proportionally more muscle mass, bone mass and lesser fat mass, which in turn, may prove helpful in improving general well-being, physical fitness as well as preventing metabolic diseases in developing countries.

Adequacy of calcium intake in Spanish population according age groups

This review shows the estimated calcium intake in Spain in recent years. Our results indicate that adolescents and the elderly are at risk of insufficient calcium intake. By using the national and the European recommendations, this work contributes to map and compare population's dietary calcium intake in the European countries. PURPOSE AND METHODS : The present work aims to examine calcium intake in the healthy Spanish population of any age and analyze its adequacy to the calcium Recommended Dietary Intake (RDI) for different groups in Spanish population, as well to the Adequate Intake (AI) or Population Reference Intake (PRI) estimated by European Food Safety Authority (EFSA). Forty-three studies published in the last 5 years were eligible for review. RESULTS AND CONCLUSIONS: The results show that infants and children exceed Spanish and EFSA dietary recommendations, adults meet more that 80% of the RDI and EFSA recommendations, and the estimated average calcium intake in the adolescent and elderly groups does not reach 75% of the recommended intake. Representative national studies with a common methodology to estimate calcium intake are needed.

Impact of physical activity, anthropometric, body composition, and dietary factors on bone stiffness in German university students

BACKGROUND

Bone density in the young-adult life is associated with risk for osteoporosis in later life. Next to genetic factors, lifestyle seems to play an important role for bone health. Aim of the study was to clarify the relationship between various lifestyle factors and bone parameters in university students.

METHODS

In 233 women and 52 men (age: 22.7±3.1 vs. 24.0±3.2 years; BMI: 22.2±2.9 vs. 24.2±3.1 kg∙m^-2) the following parameters were assessed: calcaneal Stiffness Index ([SI]; quantitative ultrasound), body composition (bioelectrical impedance analysis), actual and past physical activity level ([PAL]; standardized questionnaire), and food/nutrient intake (3-day dietary record). Sex differences (Mann-Whitney-U-tests), relationships between SI and lifestyle factors (Spearman's rank correlation), and the influence of the factors on the variance of SI (multiple linear regression) were tested (α=0.05).

RESULTS

6.9% of the women and 5.8% of the men were classified as osteopenic (-2.5< T score <-1). Significant correlations between SI and BMI, absolute fat mass and fat-free mass, actual PAL, and physical activity during adolescence were found in women (r=0.18-0.24, all P<0.05), but not in men. Food/nutrient parameters did not significantly correlate with bone outcomes (P>0.05). In multiple regression analysis physical activity during adolescence, actual PAL, and BMI explained 8% of the variance of SI (P<0.0001): SI=32.2+3.5∙physical activity during adolescence [1: very low, 2: low, 3: medium, 4: high, 5: very high] +28.5∙PAL+0.8∙BMI [kg∙m^-2].

CONCLUSIONS

Parameters of physical activity seem to be more important for bone health than nutrition factors. Therefore, high levels of physical activity during childhood, adolescence, and early-adult life are highly recommended to improve bone parameters.

Bone Health and Its Relationship with Impact Loading and the Continuity of Physical Activity throughout School Periods

Bone is influenced by physical activity (PA) throughout life, but childhood and adolescence provide a key opportunity to maximize peak bone mass. Thus, it is important to identify the relationship between PA practiced in childhood and young adulthood to design a promotion plan for bone health. The purpose of this study was to analyze the relationship between different impact-loading PAs (and their continuity throughout school periods from childhood to young adulthood) and bone stiffness index (SI). In this cross-sectional study, which was conducted on 145 university students aged 18-21 years, bone measurements were measured by quantitative ultrasonometry (QUS), and PA information was recalled using a self-administered questionnaire. Associations between the SI and the impact of PA performed during secondary school (p = 0.027), high school (p = 0.002), and university (p = 0.016) periods were observed. The continuity of PA over a longer period of time was related to a higher SI (p = 0.007). Those who practiced PA throughout all school periods had a higher SI than those who practiced during primary school only (p = 0.038) or through primary and secondary schools (p = 0.009). These results suggest that impact-loading PA practiced during different school periods is related to higher values of the SI. Therefore, continuous PA from an early age may be an important contributing factor to achieving and maintaining adequate bone health.

A Review of Knowledge, Belief and Practice Regarding Osteoporosis among Adolescents and Young Adults

Osteoporosis is a major public health problem affecting millions of people worldwide. Increasing knowledge, correcting health belief and promoting osteoprotective practices are effective measures for building and maintaining strong bone throughout ones’ life-span. This review aims to summarize the contemporary evidence on the knowledge, beliefs and practice of adolescents and young adults on bone health. We performed literature searches using the PubMed and Scopus databases to identify original studies from 2008 to May 2018 using the search terms “(knowledge OR beliefs OR attitude OR practice OR behaviours OR physical activity OR exercise OR diet OR nutrition) AND (young OR youth OR adolescents OR children OR young adults OR students OR teenager) AND (osteoporosis OR bone health)”. Of the 3206 articles found, 34 met the inclusion criteria. Studies showed that most adolescents and young adults had poor knowledge and expressed disinterest in osteoporosis. They believed that other diseases were more serious than osteoporosis, contributing to low perceived susceptibility and seriousness towards this disease. Popular media emerged as a platform to obtain information regarding osteoporosis. The lack of knowledge and misconceptions about osteoporosis led to poor osteoprotective practices. As a conclusion, the current evidence revealed a lack of awareness about osteoporosis among adolescents and young adults. Educational interventions may be useful to improve the awareness of osteoporosis among this population.