Cristina Julián-Almárcegui

Combined effects of interaction between physical activity and nutrition on bone health in children and adolescents: a systematic review

CONTEXT Osteoporosis is a major public health concern worldwide. Understanding the roles of diet and physical activity in ensuring adequate bone mass accrual during childhood and adolescence may help identify strategies to reduce the risk of osteoporotic fractures later in life. OBJECTIVE The present systematic review was conducted to provide an overview of the current knowledge of the combined effects of physical activity and diet on bone mass accrual in children and adolescents. DATA SOURCES Data were obtained via searches of the PubMed, EMBASE, SPORTDiscus, and ISI Web of Science databases. STUDY SELECTION Studies published in English and Spanish between 1887 and August 2013 were eligible for inclusion. Two investigators evaluated the studies against the inclusion and exclusion criteria. A total of 14 studies (7 cross-sectional and 7 experimental) were included in the review. DATA EXTRACTION The Pedro score and the Black and Downs checklist were used to evaluate the methodological quality of the experimental and the cross-sectional studies, respectively. Study characteristics were summarized in accordance with the reviews PICO criteria. DATA SYNTHESIS Significant exercise-by-calcium interaction was detected at several different bone sites. CONCLUSIONS Although the results of cross-sectional studies were inconsistent, the results of randomized controlled trials showed that exercise has the potential to improve bone health under conditions of adequate calcium intake.

Comparison of different approaches to calculate nutrient intakes based upon 24-h recall data derived from a multicenter study in European adolescents

AbstractPurpose The European “Healthy Lifestyle in Europe by Nutrition in Adolescence” (HELENA) project evaluated two different approaches to harmonize the matching procedures between 24-h recall data and food composition databases. In the first approach, the 24-h recall data were linked to the local/national food composition databases using standardized procedures, while in the second approach, the 24-h recall data were linked to the German BLS database which includes a larger food list. The aim of this paper was to compare the intakes of energy and eight nutrient components calculated via both approaches. Methods Two non-consecutive 24-h recalls were performed in 1268 adolescents. Energy, carbohydrates, proteins, fat, fiber, water, alcohol, calcium and vitamin C were calculated via the two approaches at individual level. Paired samples t test and Pearson’s correlations were used to compare the mean intakes of energy and the eight mentioned nutrients and to investigate the possible associations between the two approaches.ResultsSmall but significant differences were found between the intakes of energy and the eight food components when comparing both approaches. Very strong and strong correlations (0.70–0.95) were found between both methods for all nutrients.ConclusionThe dietary intakes obtained via the two different linking procedures are highly correlated for energy and the eight nutrients under study.

Correlates of dietary energy misreporting among European adolescents: the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study

This study examined the correlates of dietary energy under-reporting (UR) and over-reporting (OV) in European adolescents. Two self-administered computerised 24-h dietary recalls and physical activity data using accelerometry were collected from 1512 adolescents aged 12·5-17·5 years from eight European countries. Objective measurements of height and weight were obtained. BMI was categorised according to Cole/International Obesity Task Force (IOTF) cut-off points. Diet-related attitudes were assessed via self-administered questionnaires. Reported energy intake (EI) was compared with predicted total energy expenditure to identify UR and OV using individual physical activity objective measures. Associations between misreporting and covariates were examined by multilevel logistic regression analyses. Among all, 33·3 % of the adolescents were UR and 15·6 % were OV when considering mean EI. Overweight (OR 3·25; 95 % CI 2·01, 5·27) and obese (OR 4·31; 95 % CI 1·92, 9·65) adolescents had higher odds for UR, whereas underweight individuals were more likely to over-report (OR 1·67; 95 % CI 1·01, 2·76). Being content with their own figures (OR 0·61; 95 % CI 0·41, 0·89) decreased the odds for UR, whereas frequently skipping breakfast (OR 2·14; 95 % CI 1·53, 2·99) was linked with higher odds for UR. Those being worried about gaining weight (OR 0·55; 95 % CI 0·33, 0·92) were less likely to OV. Weight status and psychosocial weight-related factors were found to be the major correlates of misreporting. Misreporting may reflect socially desirable answers and low ability to report own dietary intakes, but also may reflect real under-eating in an attempt to lose weight or real over-eating to reflect higher intakes due to growth spurts. Factors influencing misreporting should be identified in youths to clarify or better understand diet-disease associations.

DO CALCIUM AND VITAMIN D INTAKE INFLUENCE THE EFFECT OF CYCLING ON BONE MASS THROUGH ADOLESCENCE

INTRODUCTION Cycling has been associated with decreased bone mass during adolescence. Calcium (Ca) and vitamin D (VitD) intake are associated to bone mass and may be important confounders when studying bone mass. AIM To clarify the effect that Ca and VitD may have on bone mass in adolescent cyclists. METHODS Bone mineral content (BMC) and density (BMD) of 39 male adolescents (20 cyclists) were measured. Ca and VitD intake were also registered. Different ANCOVA analyses were performed in order to evaluate the influence of Ca and VitD on BMC and BMD. RESULTS Cyclists showed lower values of BMC and BMD than controls at several sites and when adjusting by Ca, Wards triangle BMD appeared also to be lower in cyclists than controls. CONCLUSION Nutritional aspects might partially explain differences regarding bone mass in adolescent cyclists and should be taken into account in bone mass analysis as important confounders.

The nutritional status in adolescent Spanish cyclists

INTRODUCTION Adolescence is an important period of nutritional vulnerability due to the increased dietary requirements. OBJECTIVE To describe the nutritional status of adolescent cyclist and a group of normoactive controls. METHODS The HELENA Dietary Assessment Tool was used to evaluate the nutritional intake of 20 adolescent cyclists and 17 controls. Total energy intake, resting energy expenditure (REE), total energy expenditure (TEE), macronutrients and several micronutrients were registered and compared with dietary guidelines. RESULTS REE was lower and TEE higher in cyclists than in controls (both P < 0.01). Significant differences were observed in phosphorus and vitamin B1 being higher in cyclists (P < 0.05). Most participants, both cyclist and controls, did not reach the diet requirements for macronutrients, vitamins and minerals. CONCLUSION Nutritional status of adolescent cyclists and controls seems not to fulfil the requirements in quantity and quality. Possible implications for actual and future health especially in athlete adolescents need further research.

Comparison of anthropometric measurements of adiposity in relation to cancer risk: a systematic review of prospective studies.

PurposeIn epidemiology, the relationship between increased adiposity and cancer risk has long been recognized. However, whether the association is the same for measures of abdominal or whole body adiposity is unclear. The aim of this systematic review is to compare cancer risk, associated with body mass index (BMI), an indicator of whole body adiposity, with indicators of abdominal adiposity in studies in which these indicators have been directly measured.MethodsWe conducted a systematic search from 1974 (EMBASE) and 1988 (PubMed) to September 2015 with keywords related to adiposity and cancer. Included studies were limited to cohort studies reporting directly measured anthropometry and performing mutually adjusted analyses.ResultsThirteen articles were identified, with two reporting on breast cancer, three on colorectal cancer, three on endometrial cancer, two on gastro-oesophageal cancer, two on renal cancer, one on ovarian cancer, one on bladder cancer, one on liver and biliary tract cancer and one on leukaemia. Evidence suggests that abdominal adiposity is a stronger predictor than whole body adiposity for gastro-oesophageal, leukaemia and liver and biliary tract cancer in men and women and for renal cancer in women. Abdominal adiposity was a stronger predictor for bladder and colorectal cancer in women, while only BMI was a predictor in men. In contrast, BMI appears to be a stronger predictor for ovarian cancer. For breast and endometrial cancer, both measures were predictors for cancer risk in postmenopausal women.ConclusionsOnly few studies used mutually adjusted and measured anthropometric indicators when studying adiposity–cancer associations. Further research investigating cancer risk and adiposity should include more accurate non-invasive indicators of body fat deposition and focus on the understudied cancer types, namely leukaemia, ovarian, bladder and liver and biliary tract cancer.

Effects of clustering of multiple lifestyle-related behaviors on blood pressure in adolescents from two observational studies

BACKGROUD Several lifestyle-related behaviors are associated with cardiovascular health outcomes in adolescents. To examine the associations between clustered lifestyle-related behaviors and blood pressure (BP) levels in adolescents. METHODS Participants were recruited by multistage random cluster in two cross-sectional studies; one conducted in 2006 and 2007 in ten cities from nine European countries: Athens and Heraklion in Greece, Dortmund in Germany, Ghent in Belgium, Lille in France, Pécs in Hungary, Rome in Italy, Stockholm in Sweden, Vienna in Austria, and Zaragoza in Spain; and another conducted in 2007 one city in Brazil (Maringá/PR). Systolic BP (SBP) and diastolic BP (DBP) (outcomes) and clustered behaviors (weekly consumption of fruits and vegetables, weekly consumption of sugar-sweetened beverages, sleep duration, screen time and physical activity) were analyzed. RESULTS The Healthy Eating cluster was negatively associated with DBP in European girls, β=-2.46 (-4.62; -0.30), and with SBP in Brazilian boys, β=-2.79 (-3.10; -0.15). Furthermore, the Unhealthy Eating cluster was associated with increased SBP in European girls, β=4.54 (1.29; 7.79), and in Brazilian boys, β=4.10 (0.80; 7.40). CONCLUSION The Healthy Eating cluster was associated with lower blood pressure, whereas the Unhealthy Eating cluster was associated with increased SBP in adolescents.

Assessing Fat Mass of Adolescent Swimmers Using Anthropometric Equations: A DXA Validation Study

ABSTRACT Purpose: The aim of the present study was to determine which of the published anthropometric equations is the most appropriate to estimate body-fat percentage (BF%) in adolescent swimmers. Method: Eighty-eight swimmers (45 boys, 43 girls) participated in this study. Following the recommendations of the International Society of the Advancement of Kinanthropometry, biceps, triceps, subscapular, iliac-crest, supraspinale, front-thigh, and medial calf skinfold thicknesses were measured. Waist, hip, midthigh, calf, relaxed arm, and arm flexed and tensed girths were also registered. BF% was measured with dual-energy X-ray absorptiometry (DXA) to obtain the reference value. Existing anthropometric equations were applied, and BF% results obtained from anthropometric equations were compared to DXA BF% results with the modified Bland-Altman. Results: The Flavel, Durnin-Rahaman-Siri, and Durnin-Rahaman-Brozek were the only equations that did not demonstrate statistically significant differences when compared with DXA. Conclusion: The present study showed that the best anthropometric equation from existing literature to estimate BF% in swimmers is that proposed by Durnin-Rahaman (independently of applying the Siri or Brozek equation).

Do 6 Months Of Whole Body Vibration Training Improve Bone Mass Acquisition Of Adolescent Swimmers?: 1133 Board #7 June 1, 3: 15 PM - 5: 15 PM.

Whole body vibration (WBV) training has been suggested to be an effective type of training for improving bone mass. PURPOSE: To determine the effects of WBV training on bone mass acquisition in adolescent swimmers. METHODS: Sixty-four swimmers were followed over 8 months. Participants were divided in to two groups: The first group consisted of forty-one swimmers (14.2±1.8 y) who completed a WBV protocol 15 minutes of training 3 days per week during 6 months (WBV training increased each month starting with a peak acceleration of 3.6 g and ending at 11.6 during the last month) while continuing with their habitual water training (VIB). The second group consisted of twenty-three swimmers (15.0±2.2 y) who continued with their regular swimming training (SWI) (both groups performed an average of 10 hours per week of water training). Bone mineral density (BMD) and content (BMC) were measured longitudinally (8 months) by Dual Energy X-ray Absorptiometry at the whole body, lumbar spine and non-dominant hip. Analysis of covariance (ANCOVA) for repeated measures x2 (time) were performed to check differences within groups between pre and post intervention and to determine the effects of the intervention on BMD and BMC values adjusting by change in height and subtotal lean, initial age and final Tanner stage and calcium intake. RESULTS: Six months of WBV training had little effect on bone mass, as no differences were found between VIB and SWI for absolute change or percentage change for BMD values. For BMC, VIB presented higher absolute and percentage changes in both trochanter (7% increase in VIB vs. 3% in SWI) and total hip (6% increase in VIB vs. 3% in SWI) than SWI, although there was no group by time interaction. CONCLUSION: WBV training might entail minor benefits to BMC acquisition in adolescent swimmers. A minimum compliance of sixty percent was needed to improve BMC, which in the present study consisted of attending at least 2 of the 3 weekly days of training. Future studies using WBV should try to perform more sessions per week at higher intensities to determine if this type of training could be highly beneficial to bone or if other high-impact trainings might be more suitable to improve bone mass in this population. Supported by the Spanish ‘Ministerio de Ciencia e Innovación’ ‘Plan Nacional I+D+i 20082011 (Project DEP DEP2011-29093)