Lean Mass Appears to Be More Strongly Associated with Bone Health than Fat Mass in Urban Black South African Women

The Cervical Vertebral Bone Quality Score Is a Novel Reliable Index Reflecting the Condition of Paraspinal Muscles and Predicting Loss of Cervical Lordosis After Open-Door Laminoplasty

OBJECTIVE

Recently, the MRI-based cervical vertebral bone quality (C-VBQ) scoring system has demonstrated accuracy in reflecting cervical bone quality and predicting postoperative complications from cervical spine surgery. Studies have shown that cervical bone quality is closely linked to loss of cervical lordosis (LCL) after open-door laminoplasty. Additionally, research on lumbar VBQ indicates a strong correlation between lumbar VBQ scores and lumbar paraspinal muscle quality. However, the relationship of C-VBQ score to cervical paraspinal muscles and LCL remains unclear. Therefore, this study aimed to explore the relationship between C-VBQ score and cervical paraspinal muscle-related parameters as well as postoperative LCL, in addition to exploring the risk factors associated with LCL.

METHODS

A total of 101 patients who underwent standard C3-C7 open-door laminoplasty at our institution from 2012 to 2022 were included in this study. The LCL group was defined as loss of cervical lordosis > 5° at 1-year postoperative follow-up. Cervical X-rays were obtained to measure the C2-7 Cobb angle, C2-7 sagittal vertical axis (SVA), T1 slope, and cervical range of motion (ROM). The relative cross-sectional area (RCSA) and degree of fat infiltration (DFF) of the deep cervical extensors, flexors, and all muscles were measured using image J software. Cervical CT Hounsfield unit (HU) and C-VBQ values were measured on preoperative CT and MRI T1-weighted mid-sagittal images, respectively. Then, demographics, cervical sagittal parameters, ROM, paraspinal muscle-related parameters, CT-HU and C-VBQ values were assessed for their correlation with LCL, and multivariate linear analysis was used to determine the risk factors associated with LCL. Finally, the relationship between C-VBQ scores and cervical paraspinal muscle-related parameters was evaluated.

RESULTS

A total of 55 (54.45%) patients were included in the LCL group due to loss of cervical lordosis > 5° at 1-year follow-up. LCL was positively correlated to the preoperative T1 slope, Flexion ROM, C2-7 ROM, Flexion/Extension ROM, Flexion muscles DFF, Extension muscles DFF, Average DFF, and C-VBQ scores, while it was negatively correlated to Extension ROM, Extension muscles RCSA, Total RCSA, and CT-HU values. Furthermore, Flexion/Extension ROM, Total RCSA, Average DFF, CT-HU, and C-VBQ values were independent risk factors for LCL. In addition, C-VBQ scores were significantly correlated with RCSA and DFF of Flexion and Extension muscles.

CONCLUSIONS

This study is the first to find a significant correlation between C-VBQ scores and cervical paraspinal muscle quality. The C-VBQ score is a comprehensive indicator that reflects the quality of the cervical bone and paravertebral muscles, and it is a novel predictor of LCL after open-door laminoplasty.

Using QCT for the prediction of spontaneous age- and gender-specific thoracolumbar vertebral fractures and accompanying distant vertebral fractures

PURPOSE

To investigate the value and age- and gender-specific threshold values of bone mineral density (BMD) by quantitative computed tomography (QCT) for the prediction of spontaneous thoracolumbar vertebral fractures and thoracolumbar junction fractures accompanying distant vertebral fractures.

METHODS

Among the 556 patients included, 68 patients had thoracolumbar vertebral fractures (12 patients with distant vertebral fractures, 56 patients without distant vertebral fractures) and 488 patients had no vertebral fractures. All patients were grouped by gender and age. According to the principle of Youden index, the threshold values were calculated from receiver operating characteristic (ROC) curves.

RESULTS

The threshold values for predicting thoracolumbar vertebral fractures were 89.8 mg/cm3 for all subjects, 90.1 mg/cm3 for men, and 88.6 mg/cm3 for women. The threshold values for men aged < 60 years old and ≥ 60 years old were 117.4 mg/cm3 and 87.5 mg/cm3, respectively. The threshold values for women aged < 60 years old and ≥ 60 years old were 88.6 and 68.4 mg/cm3, respectively. The threshold value for predicting spontaneous thoracolumbar junction fractures with distant vertebral fractures was 62.7 mg/cm3.

CONCLUSIONS

QCT provides a good ability to predict age- and gender-specific spontaneous thoracolumbar vertebral fractures, and to further predict spontaneous thoracolumbar junction fractures with distant vertebral fractures.

Accelerometer-Measured Physical Activity Data Sets (Global Physical Activity Data Set Catalogue) That Include Markers of Cardiometabolic Health: Systematic Scoping Review

BACKGROUND

Cardiovascular disease accounts for 17.9 million deaths globally each year. Many research study data sets have been collected to answer questions regarding the relationship between cardiometabolic health and accelerometer-measured physical activity. This scoping review aimed to map the available data sets that have collected accelerometer-measured physical activity and cardiometabolic health markers. These data were then used to inform the development of a publicly available resource, the Global Physical Activity Data set (GPAD) catalogue.

OBJECTIVE

This review aimed to systematically identify data sets that have measured physical activity using accelerometers and cardiometabolic health markers using either an observational or interventional study design.

METHODS

Databases, trial registries, and gray literature (inception until February 2021; updated search from February 2021 to September 2022) were systematically searched to identify studies that analyzed data sets of physical activity and cardiometabolic health outcomes. To be eligible for inclusion, data sets must have measured physical activity using an accelerometric device in adults aged ≥18 years; a sample size >400 participants (unless recruited participants in a low- and middle-income country where a sample size threshold was reduced to 100); used an observational, longitudinal, or trial-based study design; and collected at least 1 cardiometabolic health marker (unless only body mass was measured). Two reviewers screened the search results to identify eligible studies, and from these, the unique names of each data set were recorded, and characteristics about each data set were extracted from several sources.

RESULTS

A total of 17,391 study reports were identified, and after screening, 319 were eligible, with 122 unique data sets in these study reports meeting the review inclusion criteria. Data sets were found in 49 countries across 5 continents, with the most developed in Europe (n=53) and the least in Africa and Oceania (n=4 and n=3, respectively). The most common accelerometric brand and device wear location was Actigraph and the waist, respectively. Height and body mass were the most frequently measured cardiometabolic health markers in the data sets (119/122, 97.5% data sets), followed by blood pressure (82/122, 67.2% data sets). The number of participants in the included data sets ranged from 103,712 to 120. Once the review processes had been completed, the GPAD catalogue was developed to house all the identified data sets.

CONCLUSIONS

This review identified and mapped the contents of data sets from around the world that have collected potentially harmonizable accelerometer-measured physical activity and cardiometabolic health markers. The GPAD catalogue is a web-based open-source resource developed from the results of this review, which aims to facilitate the harmonization of data sets to produce evidence that will reduce the burden of disease from physical inactivity.

The Impact of Human Immunodeficiency Virus and Menopause on Bone Mineral Density: A Longitudinal Study of Urban-Dwelling South African Women

An estimated 25% of South African women live with human immunodeficiency virus (HIV). Antiretroviral therapy roll-out has improved life expectancy, so many more women now reach menopause. We aimed to quantify changes in bone mineral density (BMD) during the menopausal transition in urban-dwelling South African women with and without HIV and determine whether HIV infection modified the effect of menopause on BMD changes. A 5-year population-based longitudinal study recruited women aged 40-60 years residing in Soweto and collected demographic and clinical data, including HIV status, anthropometry, and BMD, at baseline and at 5-year follow-up. All women were staged as pre-, peri-, or postmenopausal at both time points. Multivariable linear regression assessed relationships and interactions between HIV infection, menopause, and change in BMD. At baseline, 450 women had mean age 49.5 (SD 5.7) years, 65 (14.4%) had HIV, and 140 (31.1%), 119 (26.4%), and 191 (42.4%) were pre-, peri-, and postmenopausal, respectively; 34/205 (13.6%) women ≥50 years had a total hip (TH) or lumbar spine (LS) T-score ≤ -2.5. At follow-up 38 (8.4%), 84 (18.7%), and 328 (72.9%) were pre-, peri-, and postmenopausal. Those with HIV at baseline lost more total body (TB) BMD (mean difference -0.013 [95% confidence interval -0.026, -0.001] g/cm2 , p = 0.040) and gained more weight 1.96 [0.32, 3.60] kg; p = 0.019 than HIV-uninfected women. After adjusting for age, baseline weight, weight change, and follow-up time, the transition from pre- to postmenopause was associated with greater TB BMD losses in women with HIV (-0.092 [-0.042, -0.142] g/cm2 ; p = 0.001) than without HIV (-0.038 [-0.016, -0.060] g/cm2 , p = 0.001; interaction p = 0.034). Similarly, in women who were postmenopausal at both time points, those with HIV lost more TB BMD (-0.070 [-0.031, -0.108], p = 0.001) than women without HIV (-0.036 [-0.015, -0.057], p = 0.001, interaction p = 0.049). Findings were consistent but weaker at the LS and TH. Menopause-related bone loss is greater in women with HIV, suggesting women with HIV may be at greater risk of osteoporotic fractures. HIV services should consider routine bone health assessment in midlife women as part of long-term HIV care delivery. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Relationship between geriatric nutritional risk index and osteoporosis in type 2 diabetes in Northern China

BACKGROUND

Osteoporosis is a very common bone disease in the elderly population and can lead to fractures and disability. Malnutrition can lead to osteoporosis. The geriatric nutritional risk index (GNRI) is a tool used to assess the risk of malnutrition and complications associated with nutritional status in older patients and is a crucial predictor of many diseases. Hence, this study investigated the association between the GNRI and the presence of osteoporosis and assessed the value of this index for predicting osteoporosis in patients with type 2 diabetes mellitus (T2DM).

METHODS

This cross-sectional study enrolled 610 elderly patients with T2DM. General and laboratory data of the patients were collected, along with their measurements of bone mineral density (BMD). The GNRI was calculated based on ideal body weight and serum albumin (ABL) levels. Correlation analysis was performed to determine the relationship between the GNRI and BMD and bone metabolism indices. The GNRI predictive value for osteoporosis development was analyzed through logistic regression analysis and by creating a receiver operating characteristic curve (ROC), calculating the area under the curve (AUC).

RESULTS

All patients were divided into the no-nutritional risk and nutritional risk groups. Compared with the no-nutritional risk group, the nutritional risk group had a longer diabetes course, older age, higher HbA1c levels, higher prevalence of osteoporosis; lower BMI, ABL,triglyceride (TG),Calcium (Ca),25-hydroxy-vitamin-D(25(OH)D),and parathyroid hormone(PTH) and lower femoral neck BMD,total hip BMD (P < 0.05). All patients were also assigned to the non-osteoporosis and osteoporosis groups. The non-osteoporosis group had higher GNRI values than the osteoporosis group (P < 0.05). Correlation analysis revealed a positive correlation between the GNRI and lumbar BMD, femoral neck BMD, and total hip BMD (P < 0.05). After the adjustment for confounding factors, Spearman's correlation analysis revealed that the GNRI was positively correlated with Ca, 25(OH)D, and PTH and negatively correlated with alkaline phosphatase (ALP) and procollagen of type-1 N-propeptide (P1NP). Regression analysis exhibited that the GNRI was significantly associated with osteoporosis. The ROC curve analysis was performed using the GNRI as the test variable and the presence of osteoporosis as the status variable. This analysis yielded an AUC for the GNRI of 0.695 and was statistically significant (P < 0.05).

CONCLUSIONS

A lower GNRI among T2DM patients in northern China is associated with a higher prevalence of osteoporosis.

Association between fat mass by bioelectrical impedance analysis and bone mass by quantitative ultrasound in relation to grip strength and serum 25-hydroxyvitamin D in postmenopausal Japanese women: the Unzen study

Background

Whether fat mass or lean mass affects bone mass in postmenopausal women is controversial. This study aimed to explore the association between body composition measured by bioelectrical impedance analysis (BIA) and bone mass measured by quantitative ultrasound (QUS) in postmenopausal women in Japan.

Methods

We conducted a cross-sectional study, The Unzen Study, on 382 community-dwelling postmenopausal Japanese women (mean (standard deviation) age: 68.2 (7.2) years) who participated in periodic health examinations. The stiffness index (SI) was measured using QUS, and body composition (e.g., fat mass and muscle mass) was measured using BIA. Grip strength was measured. Fasting blood samples were collected, and 25-hydroxyvitamin D (25(OH)D), tartrate-resistant acid phosphatase-5b (TRACP-5b), and parathyroid hormone (PTH) levels were measured. Data on current smoking, alcohol consumption, exercise, and any comorbidities (heart disease, lung disease, stroke, or diabetes mellitus) were collected.

Results

The SI increased with increasing quartiles of fat mass and muscle mass (both p for trend <  0.001), respectively. There were positive correlations between SI and log (25(OH)D) or grip strength. Fat mass significantly correlated with grip strength. Multiple linear regression analysis showed that higher fat mass was independently and significantly associated with higher SI after adjusting for age, height, comorbidity, current smoking, alcohol consumption, exercise, log (25(OH)D), log (TRACP-5b), log (PTH), and grip strength (p = 0.001). In contrast, no association was observed between muscle mass and SI.

Conclusions

Fat mass, but not muscle mass, was a significant determinant of SI in community-dwelling postmenopausal Japanese women.

Bone, fat, and muscle interactions in health and disease

Energy metabolism is a point of integration among the various organs and tissues of the human body, not only in terms of consumption of energy substrates but also because it concentrates a wide interconnected network controlled by endocrine factors. Thus, not only do tissues consume substrates, but they also participate in modulating energy metabolism. Soft mesenchymal tissues, in particular, play a key role in this process. The recognition that high energy consumption is involved in bone remodeling has been accompanied by evidence showing that osteoblasts and osteocytes produce factors that influence, for example, insulin sensitivity and appetite. Additionally, there are significant interactions between muscle, adipose, and bone tissues to control mutual tissue trophism. Not by chance, trophic and functional changes in these tissues go hand in hand from the beginning of an individual's development until aging. Likewise, metabolic and nutritional diseases deeply affect the musculoskeletal system and adipose tissue. The present narrative review highlights the importance of the interaction of the mesenchymal tissues for bone development and maintenance and the impact on bone from diseases marked by functional and trophic disorders of adipose and muscle tissues.

The association between serum vitamin D and body composition in South African HIV-infected women

BACKGROUND

HIV and antiretroviral therapy (ART) alter vitamin D metabolism, and may be associated with bone loss.

OBJECTIVES

The aim of this study was to determine the association between serum 25-hydroxyvitamin D (25(OH)D) and body composition in postmenopausal South African women living with HIV and on ART.

METHOD

In this 2-year longitudinal study on 120 women conducted in the North West province of South Africa, serum 25(OH)D concentration, bone mineral density (BMD) at three sites, lean mass and percentage of body fat (%BF) were measured by dual-energy X-ray absorptiometry (DXA). Multivariable linear mixed models were used to assess the association between serum 25(OH)D and body composition over 2 years. Linear mixed models were also used to determine the longitudinal association between lean mass, %BF and BMD.

RESULTS

Vitamin D deficiency and insufficiency increased from baseline (10.2% and 19.5%) to 11.5% and 37.5%, respectively, after 2 years. Serum 25(OH)D decreased significantly, however, with a small effect size of 0.39 (P = 0.001), whilst total BMD (effect size 0.03, P = 0.02) and left hip femoral neck (FN) BMD (effect size 0.06, P = 0.0001) had significant small increases, whereas total spine BMD did not change over the 2 years. Serum 25(OH)D had no association with any BMD outcomes. Lean mass had a stronger positive association with total spine and left FN BMD than %BF.

CONCLUSION

Serum 25(OH)D was not associated with any BMD outcomes. Maintenance of lean mass could be important in preventing bone loss in this vulnerable group; however, longer follow-up may be necessary to confirm the association.

Factors Associated with Bone Mineral Density and Bone Resorption Markers in Postmenopausal HIV-Infected Women on Antiretroviral Therapy: A Prospective Cohort Study

The study aimed to determine factors associated with changes in bone mineral density (BMD) and bone resorption markers over two years in black postmenopausal women living with human immunodeficiency virus (HIV) on antiretroviral therapy (ART). Women (n = 120) aged > 45 years were recruited from Potchefstroom, South Africa. Total lumbar spine and left femoral neck (LFN) BMD were measured with dual energy X-ray absorptiometry. Fasting serum C-Telopeptide of Type I collagen (CTx), vitamin D and parathyroid hormone were measured. Vitamin D insufficiency levels increased from 23% at baseline to 39% at follow up. In mixed linear models serum CTx showed no change from baseline to end (p = 0.363, effect size = 0.09). Total and LFN BMD increased significantly over two years, but effect sizes were small. No significant change in spine BMD over time was detected (p = 0.19, effect size = 0.02). Age was significantly positively associated with CTx over time, and negatively with total and LFN BMD. Physical activity (PA) was positively associated with LFN BMD (p = 0.008). Despite a decrease in serum vitamin D, BMD and CTx showed small or no changes over 2 years. Future studies should investigate PA interventions to maintain BMD in women living with HIV.

Influence of Mediterranean Diet Adherence and Physical Activity on Bone Health in Celiac Children on a Gluten-Free Diet

We aimed to assess the influence of the Mediterranean Diet adherence and physical activity (PA) on body composition, with a particular focus on bone health, in young patients with celiac disease (CD). The CD group (n = 59) included children with CD with a long (>18 months, n = 41) or recent (<18 months, n = 18) adherence to a gluten-free diet (GFD). The non-celiac group (n = 40) included non-celiac children. After adjusting for potential confounders, the CD group showed lower body weight (p = 0.034), lean mass (p = 0.003), bone mineral content (p = 0.006), and bone Z-score (p = 0.036) than non-celiac children, even when the model was further adjusted for adherence to a GFD for at least 18 months. Among CD children, spending greater time in vigorous physical activity was associated with higher lean mass (p = 0.020) and bone mineral density with evidence of statistical significance (p = 0.078) regardless of the time they followed a GFD. In addition, a greater Mediterranean Diet adherence was associated with a higher bone Z-score (p = 0.020). Moreover, lean mass was strongly associated with bone mineral density and independently explained 12% of its variability (p < 0.001). These findings suggest the importance of correctly monitoring lifestyle in children with CD regarding dietary habits and PA levels to improve lean mass and, consequently, bone quality in this population.

Lean body mass, body fat percentage, and handgrip strength as predictors of bone mineral density in postmenopausal women

Objective:

This study was conducted to assess lean body mass, body fat percentage, and handgrip strength in the prediction of bone mineral density (BMD) in postmenopausal women.

Materials and Methods:

This cross-sectional study included 102 postmenopausal women aged between 45 and 80 years (mean age 58) who were screened for osteoporosis using a dual-energy X-ray absorptiometry scan at the lumbar spine. The lean body mass, body fat percentage, and handgrip strength were calculated.

Results:

The lean body mass, body fat percentage, and handgrip strength were having a positive association (correlation coefficient: 0.48, 0.29, and 0.3, respectively) with BMD.

Conclusion:

Lean body mass, body fat percentage, and handgrip strength can detect early loss of BMD in postmenopausal women leading to early screening for osteoporosis resulting in early interventions minimizing BMD loss over a much longer period after menopause.

Determinants of Bone Health Status in a Multi-Ethnic Population in Klang Valley, Malaysia

Background and objectives: Studies on osteoporosis risk factors are limited in Malaysia, so this study assesses the factors associated with bone health assessed using dual-energy X-ray absorptiometry (DXA) among Malaysians aged ≥40 years. Subjects and Methods: Data on demography, medical history, dietary and lifestyle practices of 786 Malaysians (51.4% women) aged ≥40 years recruited in Klang Valley were obtained. Their body composition and bone health were determined using DXA. The association between risk factors and bone health status was assessed using binary logistic regression. Results: The prevalence of suboptimal bone health and osteoporosis was higher in women (59.4% and 16.1%) than men (40.8% and 8.4%). Overall, the predictors of suboptimal bone health and osteoporosis among the subjects were increased age and higher fat mass. Lower monthly income was positively associated with osteoporosis. Being menopausal was a risk factor for both suboptimal bone health and osteoporosis in women. Women with no formal education were more likely to get osteoporosis. Being a smoker and Chinese were positively related to suboptimal bone health among men. Meanwhile, predictors of osteoporosis among men were regular alcohol and dairy product consumption, higher fat mass and having a tertiary education. Conclusions: This study calls for immediate and effective interventions for middle-aged and elderly populations with risk factors to halt the progression of bone loss.

Magnesium Intake Predicts Bone Turnover in Postmenopausal Black South African Women

This prospective study investigated the association between nutrient intake, dietary patterns, and changes in bone turnover and bone mineral density (BMD) in postmenopausal urban black South African women over two years. These women (n = 144) underwent BMD measurements at the distal radius, lumbar spine, femoral neck (FN), as well as a biochemical analysis which included the parathyroid hormone (PTH), 25-hydroxyvitamin D, C-Telopeptide of type I collagen (CTX-1) in 2010 and 2012. Their dietary intake was assessed in 2010 using a food frequency questionnaire, and sociodemographic and health information was collected. Four dietary patterns explained 54.4% of the variance of dietary intake, namely staple foods and processed meats, home cooking, snacking, and high sugar. Dietary magnesium negatively correlated with CTx-1 in 2012 (r = −0.21, p = 0.02), calcium correlated with distal radius BMD in 2010 (r = 0.22, p = 0.01) and 2012 (r = 0.24, p = 0.005), and the snacking dietary pattern score correlated with FN BMD in 2010 (r = 0.18, p = 0.03) and 2012 (r = 0.21, p = 0.02). The baseline CTx-1 and dietary magnesium intake predicted 22% of the variance in percentage change of CTx-1 over two years (p < 0.001).The magnesium intake predicted short-term bone resorption over two years.

Lean Body Mass in the Prediction of Bone Mineral Density in Postmenopausal Women

Owing to conflicting results of the association between body composition and bone mineral density (BMD), we investigated the relationship between fat mass (FM), lean mass (LM), and BMD in New Zealand postmenopausal women. We hypothesized that increased LM will indicate a higher BMD. A cross-sectional study was performed examining the associations between body composition, anthropometric measures, activity energy expenditure, and bone health status (using dual-energy X-ray absorptiometry [DXA]). A total of 127 healthy postmenopausal women aged between 54 and 81 years. Both FM and LM were significantly associated with BMD at all sites. However, LM, not FM, was the strongest predictor of femoral neck (FN) BMD (β = 0.497, p < 0.001), hip BMD (β = 0.495, p < 0.001), spine BMD (β = 0.449, p < 0.001), and whole body BMD (β = 0.406, p < 0.001). Age was negatively associated with FN and hip BMD. LM was positively associated with FN, spine, hip, and whole body BMD. Our findings suggest the need to increase LM rather than FM highlighting the importance of physical activity for this age group.

Changes in food intake from 2005 to 2010 by a cohort of black rural and urban African men and women in the North West Province of South Africa: the PURE-NWP-SA study

OBJECTIVE

We have shown that nutrient intakes of rural and urban black Africans in the North West Province (NWP) of South Africa (SA) followed the typical nutrition transition pattern upon urbanization and modernization. The current study aimed to examine and report on the changes in food intakes from 2005 to 2010 in rural and urban black South Africans participating in the PURE-NWP-SA study.Design/Setting/SubjectsThe PURE-NWP-SA study recruited 2010 volunteers aged 35-70 years in 2005, from which detailed food intakes, measured with a validated quantified FFQ, for 1858 participants were available. In 2010, food intakes of a cohort of 1154 of these participants were measured.

RESULTS

Median energy intake increased in men and women in both rural and urban areas from 2005 to 2010. Changes in food intake were interpreted keeping these changes in energy intake and the contribution of foods and food groups to total energy intake in mind. No 'new' foods were eaten in 2010, but more participants consumed certain foods and products in 2010 than in 2005. Beneficial changes were increased intakes of vegetables, fruit and milk in most groups. The contribution of cooked staple porridges and bread made from fortified maize and bread flour decreased and therefore also did their contribution to micronutrient intakes.

CONCLUSIONS

By promoting and supporting observed beneficial changes such as increased intakes of milk, vegetables and fruit by appropriate policies and educational interventions, it should be possible to steer the nutrition transition in this population into a positive direction.

Accelerated nutrition transition in the North West Province of South Africa: results from the Prospective Urban and Rural Epidemiology (PURE-NWP-SA) cohort study, 2005 to 2010

OBJECTIVE

South Africa (SA) is in the midst of a health transition characterized by a quadruple burden of diseases and a nutrition transition. The existing nutrition transition in SA, accompanied by the coexistence of under- and overnutrition in the population, motivated the present study. Its objectives were to measure and report the changes in nutrient intakes of rural and urban black Africans over time to assess the impact of urbanization and modernization of lifestyles on dietary intakes and non-communicable disease (NCD) risk.

DESIGN

The PURE-NWP-SA study recruited 2000 black South African volunteers aged 35-70 years in 2005, of which detailed nutrient intakes from 1858 participants were available. In 2010 nutrient intakes of a cohort of 1154 participants were measured.

RESULTS

Median energy intake increased over time. In 2010, rural participants consumed the amount of energy (men 9·7 MJ/d; women 9·1 MJ/d) that urban participants consumed in 2005 (men 9·9 MJ/d; women 9·0 MJ/d). The nutrition transition was characterized by increases in the percentage of energy from animal protein, total fat (rural men and women), saturated (not urban women) and monounsaturated fat, as well as added sugar. Despite the higher energy intake, not all the participants met total micronutrient needs in 2010.

CONCLUSIONS

The PURE nutrient intake data confirmed that the nutrition transition in the North West Province of SA is extremely rapid in rural areas. The shift towards higher energy intakes, an animal food-based diet, higher intakes of fat and lower intake of fibre, at the cost of lower plant protein and starchy food intakes, could increase the risk of NCD.

Association of serum uric acid levels with osteoporosis and bone turnover markers in a Chinese population

Recent evidence shows that uric acid is protective against some neurological diseases, but can be detrimental in many metabolic and cardiovascular disorders. In this study, we examined the association between serum uric acid levels and bone metabolism in Chinese males and postmenopausal females. A total of 943 males and 4256 postmenopausal females were recruited in Shanghai. The levels of serum uric acid and bone turnover markers (BTMs) were detected along with other biochemical traits. In addition, the fat distribution was calculated through MRI and image analysis software, and bone mineral density (BMD) was determined using dual-energy X-ray absorptiometry. For postmenopausal females, the prevalence of osteoporosis was significantly lower in the hyperuricemia group compared with the normouricemic group (P=4.65E-06). In females, serum uric acid level was significantly associated with osteoporosis, with odds ratio (OR) and 95% confidence interval (95% CI) of 0.844 [0.763; 0.933] (P=0.0009) after adjusting for age, body mass index, HbA1c, lean mass, visceral and subcutaneous fat areas, albumin, 25-hydroxyvitamin D3 [25(OH)D3], and parathyroid hormone (PTH). In females, serum uric acid level was positively correlated with the BMD of the femoral neck (β±SE: 0.0463±0.0161; P=0.0042), total hip (β±SE: 0.0433±0.0149; P=0.0038) and L1-4 (β±SE: 0.0628±0.0165; P=0.0001) after further adjusting for age, BMI, HbA1c, lean mass, VFA, SFA, albumin, 25(OH)D3 and PTH. Regarding BTMs, serum uric acid level was negatively correlated with N-terminal procollagen of type I collagen (PINP) in females (β±SE: -0.1311±0.0508; P=0.0100). In summary, our results suggest that uric acid has a protective effect on bone metabolism independent of body composition in Chinese postmenopausal females.

Bone Degeneration and Its Recovery in SMP30/GNL-Knockout Mice

Senescence marker protein-30 (SMP30) decreases androgen-independently with aging and is a lactone-hydrolyzing enzyme gluconolactonase (GNL) that is involved in vitamin C biosynthesis. In the present study, bone properties of SMP30/GNL knockout (KO) mice with deficiency in vitamin C synthesis were investigated to reveal the effects of SMP30/GNL and exogenous vitamin C supplementation on bone formation. Mineral content (BMC) and mineral density (BMD) of the mandible and femur of SMP30/GNL KO and wild-type mice at 2 and 3 months of age with or without vitamin C supplementation were measured by dual-energy X-ray absorptiometry. Body and bone weight of both age groups decreased and became significantly lower than those of wild-type mice. The bones of SMP30/GNL KO mice were rough and porous, with BMC and BMD significantly below wild-type. Oral supplementation with vitamin C eliminated differences in body weight, bone weight, BMC, and BMD between SMP30/GNL KO and wild-type mice at each age. These results indicate that bone degeneration in SMP30/GNL KO mice was caused by lack of vitamin C, and that this mouse strain is an appropriate model for bone metabolism in humans, which have no ability to synthesize vitamin C.

Trajectories of Nutritional Status and Cognitive Impairment among Older Taiwanese with Hip Fracture

OBJECTIVE

This paper describes the trajectories of nutritional status and cognitive impairment and their correlation among older Taiwanese over 1 year after hip-fracture surgery.

DESIGN

Secondary analysis of data from a clinical trial evaluating the effects of three types of post-discharge care for 292 older hip-fracture patients (age >60 years).

MEASUREMENTS

Nutritional status was assessed by the Mini Nutritional Assessment before and 1, 3, 6, 12 months after hospital discharge. Cognitive function was measured by the Mini-Mental State Examination before surgery, at hospital discharge, 6 and 12 months after discharge. Trajectories of nutritional status and cognitive impairment were depicted by latent class growth modeling, whereas linkages between nutritional-status and cognitive-impairment trajectories were assessed by multinomial logistic regression.

RESULTS

Nutritional status in general improved significantly, particularly during the first 3 months after discharge. We identified three trajectories of nutritional status: malnourished (15.4%), at risk for malnutrition (38.9%), and well-nourished (45.7%). In contrast, cognitive changes followed four largely linear but distinct trajectories: moderately impaired (12.2%), mildly impaired (27.8%), borderline impaired (21.8%), and cognitively intact (38.2%). Trajectories of nutritional status were significantly associated with cognitive-function trajectories. For instance, relative to malnourished patients, well-nourished patients were 95% less likely (OR=0.05, CI =0.01-0.24) to be moderately cognitively impaired.

CONCLUSION

A good nutritional-status trajectory after hip fracture was associated with better cognitive function. To treat and care for elderly hip-fractured patients, specific interventions need to target those who are malnourished or at risk of malnutrition to decrease their risk for cognitive impairment.

Osteoporosis: Modern Paradigms for Last Century's Bones

The skeleton is a metabolically active organ undergoing continuously remodelling. With ageing and menopause the balance shifts to increased resorption, leading to a reduction in bone mineral density and disruption of bone microarchitecture. Bone mass accretion and bone metabolism are influenced by systemic hormones as well as genetic and lifestyle factors. The classic paradigm has described osteoporosis as being a “brittle bone” disease that occurs in post-menopausal, thin, Caucasian women with low calcium intakes and/or vitamin D insufficiency. However, a study of black women in Africa demonstrated that higher proportions of body fat did not protect bone health. Isoflavone interventions in Asian postmenopausal women have produced inconsistent bone health benefits, due in part to population heterogeneity in enteric bacterial metabolism of daidzein. A comparison of women and men in several Asian countries identified significant differences between countries in the rate of bone health decline, and a high incidence rate of osteoporosis in both sexes. These studies have revealed significant differences in genetic phenotypes, debunking long-held beliefs and leading to new paradigms in study design. Current studies are now being specifically designed to assess genotype differences between Caucasian, Asian, African, and other phenotypes, and exploring alternative methodology to measure bone architecture.

Association of physical fitness, body composition, cardiometabolic markers and adherence to the Mediterranean diet with bone mineral density in perimenopausal women. The FLAMENCO project

This study aimed to analyse the association of different components of physical fitness, body composition, cardiometabolic markers and the Mediterranean diet with bone mineral density (BMD) in perimenopausal women, and to test which of these components are independently associated with BMD. The sample comprised 197 perimenopausal women (52.6 ± 4.5 years). Physical fitness was assessed with the "Senior Fitness Test" battery and the handgrip strength and Bruce tests. Fat and lean mass and BMD were measured using dual-energy X-ray absorptiometry. We analysed the markers of metabolic syndrome, C-reactive protein, and components of the Mediterranean diet. Handgrip muscle strength (β = 0.212, P = 0.005), body weight (β = 0.244, P = 0.001), BMI (β = 0.180, P = 0.011) and lean mass (β = 0.379, P < 0.001) were positively associated with BMD. No associations were observed between cardiometabolic markers or the Mediterranean diet with BMD (all P > 0.05). When all relevant indicators of BMD were simultaneously considered, lean mass was the only 1 showing an independent association with BMD (β = 0.392, P < 0.001), explaining 14% of the BMD variability. In conclusion, muscle strength might be a marker of BMD in perimenopausal women. However, lean mass was the only factor independently associated with BMD. Future research to determine whether increasing lean mass through specific exercise-based interventions contributes to increasing BMD is warranted.

Associations of Bone Mineral Density with Lean Mass, Fat Mass, and Dietary Patterns in Postmenopausal Chinese Women: A 2-Year Prospective Study

Objective

To assess factors associated with bone mineral density (BMD) in postmenopausal women in a longitudinal study, and to examine the relative contribution of lean mass, fat mass, dietary patterns, and years since menopause to BMD.

Methods

Two hundred and eighty-two postmenopausal women were randomly selected from Hongqi Community Health Center, in Harbin City, China. All participants were followed up from 2009 to 2011. Dietary data were collected using a Food Frequency Questionnaire. BMD of the left hip, the lumbar spine, and the total body, and the body composition were measured by dual-energy X-ray absorptiometry at baseline and follow-up.

Results

Lean mass and fat mass were positively associated with BMD of the spine, hip, and the total body at both baseline and follow-up. The association between fat mass and BMD at the spine at baseline (P = 0.210) and at the spine (P = 0.116) and hip (P = 0.073) in the second year was not statistically significant when height was adjusted. Six dietary patterns were identified but only cereal grains-fruits pattern (P = 0.001 in the spine, P = 0.037 in hip) and milk-root vegetables pattern (P = 0.010 in hip) were associated with BMD of the spine and hip. The linear mixed model of follow-up data showed that lean mass, years since menopause, and age of menophania were the significant determinants of BMD of all sites. Moreover, lean mass was the best determinant of BMD (VIP = 1.936).

Conclusion

Lean mass, years since menopause, age of menophania and dietary patterns are the important determinants of BMD of the spine, hip, and the total body. Lean mass is the best determinant of BMD.