RELATIONSHIP OF PHYSICAL ACTIVITY TYPE, NUTRITION, AND BONE MINERAL DENSITY IN KOREAN ADOLESCENTS

Background and Objective

Bone density reaches its peak in the mid-20s and manifests as osteoporosis and osteopenia with aging. Bone density is affected by body mass index, muscle mass, nutritional calcium and vitamin D, as well as lifestyle, type and duration of physical activity, and level of physical strength. The purpose of this study was to investigate the difference in diet and bone density according to physical activity level in growing male and female adolescents.

Material and Methods

This study involved 646 male and 581 female adolescents using data from the Korea National Health and Nutrition Examination in 2009-2011. The measurement of bone density consisted of dual-energy X-ray absorptiometry, and was classified into low-, middle-, and high-density groups at different ages based on total bone mineral density. The Korean version of the International Physical Activity Questionnaire by the World Health Organization was used to measure physical activity level, and a survey regarding strength, exercise, and stretching was conducted. In the nutritional survey, data from a 24-hour recall were analyzed. One-way analysis of variance and chi-square tests were conducted to examine the presence and significance of any differences.

Results

Even though there was no difference among groups in both males and females, there was a significant difference in weight (p<0.05). There was no significant difference among groups by nutritional intake in female adolescents (p>0.05). In males, the high-density group showed significantly higher intake of calories (p=0.032), protein (p=0.015), calcium (p=0.043), and phosphorus (p=0.013) compared with the low group.

There was a significant difference in bone density related to physical activity level. In the low and high bone density groups, the proportion of strength exercises increased to more than 3 times a week was 18.1% and 27.2%, respectively in males (p=0.046), and was 1.0% and 6.1% respectively in females (p=0.014). The proportion of high-intensity exercise 6–7 times a week also showed a significant difference as the low, middle, and high bone density groups showed 5.1%, 5.5%, and 14.1%, respectively (p<0.001).

Conclusion

Among adolescents, bone density in females was affected by strength exercise, and bone density in males was affected by physical activity level and nutrition, showing a clearer tendency in the males. Particularly, regarding physical activity level, high intensity and strength exercise had more positive effects.

bone mineral density, nutrition, physical activity

1. Kanis J, Black D, Cooper C, Dargent P, Dawson-Hughes B, De Laet C, et al. A new approach to the development of assessment guidelines for osteoporosis. Osteoporosis Internat 2002;13(7):527–36.

2. Warming L, Hassager C, Christiansen C. Changes in bone mineral density with age in men and women: a longitu-dinal study. Osteoporosis Internat 2002;13(2):105–12.

3. MacKelvie K, Khan K, McKay H. Is there a critical period for bone response to weight-bearing exercise in children and adolescents? A systematic review. Br J Sports Med 2002;36(4):250–7.

4. Hara S, Yanagi H, Amagai H, Endoh K, Tsuchiya S, Tomura S. Effect of physical activity during teenage years, based on type of sport and duration of exercise, on bone mineral density of young, premenopausal Japanese women. Calcified Tissue Internat 2001;68(1):23–30.

5. Lanou AJ, Berkow SE, Barnard ND. Calcium, dairy products, and bone health in children and young adults: a reevaluation of the evidence. Pediatrics 2005;115(3):736–43.

6. Bowman SA, Vinyard BT. Fast food consumption of US adults: impact on energy and nutrient intakes and overweight status. Journal of the american college of nutrition. 2004;23(2):163-8.

7. Kalkwarf HJ, Khoury JC, Lanphear BP. Milk intake during childhood and adolescence, adult bone density, and osteoporotic fractures in US women. Am J Clin Nutrit 2003;77(1):257–65.

8. Matkovic V, Landoll JD, Badenhop-Stevens NE, Ha

E- Y, Crncevic-Orlic Z, Li B, et al. Nutrition influences skeletal development from childhood to adulthood: a study of hip, spine, and forearm in adolescent females. J Nutrition 2004;134(3):701S–5S.

9. Yu CH, Lee JS, Lee L, Kim SH, Lee SS, Kang SA. Nutritional factors related to bone mineral density in the different age groups of Korean men. Korean J Nutrition 2004;37(2):132–42.

10. Duncan CS, Blimkie C, Cowell CT, Burke ST, Briody JN, Howman-Giles R. Bone mineral density in adoles-cent female athletes: relationship to exercise type and muscle strength. Med Sci Sports Exercise 2002;34(2): 286–94.

11. Bellew JW, Gehrig L. A comparison of bone mineral density in adolescent female swimmers, soccer players, and weight lifters. Pediatr Phys Ther 2006;18(1):19–22.

12. Nichols DL, Sanborn CF, Love AM. Resistance train-ing and bone mineral density in adolescent females. J Pediatr 2001;139(4):494–500.

13. Medicine ACoS. ACSM’s guidelines for exercise testing and prescription: Lippincott Williams & Wilkins; 2013.

14. WHO. International Physical Activity Questionnaire; Korean 7-item short form; 1998.

15. Prevention KKCfDCa. 5th Koera National Health & Nutrition Examnation survery; Health Survery; 2010.

16. Prevention KKCfDCa. 4th Koera National Health & Nutrition Examnation survery; Health Survery; 2009.

17. Shim YJ, Paik HY. Reanalysis of 2007 Korean na-tional health and nutrition examination survey (2007 KNHANES) results by CAN-Pro 3.0 nutrient database. Korean J Nutrition 2009;42(6):577–95.

18. Walsh J, Henry Y, Fatayerji D, Eastell R. Lumbar spine peak bone mass and bone turnover in men and women: a longitudinal study. Osteopor Internat 2009;20(3):355–62.

19. Hamdy RC, Anderson JS, Whalen KE, Harvill L. Regional differences in bone density of young men involved in different exercises. Med Science Sports Exercise 1994;26(7):884–8.

20. Karlsson MK, Johnell O, Obrant KJ. Bone mineral density in weight lifters. Calcif Tissue Internat 1993;52(3):212–5.

21. Bayramoğlu M, Sözay S, Karataş M, Kılınç Ş. Relation-ships between muscle strength and bone mineral density of three body regions in sedentary postmenopausal women. Rheumatol Internat 2005;25(7):513–7.

22. Sööt T, Jürimäe T, Jürimäe J, Gapeyeva H, Pääsuke M. Relationship between leg bone mineral values and muscle strength in women with different physical activity. J Bone Min Metabol 2005;23(5):401–6.

23. Nickols-Richardson S, Miller L, Wootten D, Ramp W, Herbert W. Concentric and eccentric isokinetic resist-ance training similarly increases muscular strength, fat-free soft tissue mass, and specific bone mineral measurements in young women. Osteopor Internat 2007;18(6):789–96.

24. Snow-Harter C, Bouxsein ML, Lewis BT, Carter DR, Marcus R. Effects of resistance and endurance exercise on bone mineral status of young women: a randomized exercise intervention trial. J Bone Min Res 1992;7(7):761–9.

25. Layne JE, Nelson ME. The effects of progressive resist-ance training on bone density: a review. Med Sci Sport Exercise 1999;31(1):25–30.

26. Blimkie C, Rice S, Webber C, Martin J, Levy D, Gordon 

C. 266 EFFECTS OF RESISTANCE TRAINING ON BONE MASS AND DENSITY IN ADOLESCENT FEMALES. Med Sci Sports Exercise 1993;25(5):S48.

27. Lorentzon M, Mellström D, Ohlsson C. Association of amount of physical activity with cortical bone size and trabecular volumetric BMD in young adult men: the GOOD study. J Bone Min Res 2005;20(11):1936–43.

28. Welten D, Kemper H, Post G, Van Mechelen W, Twisk J, Lips P, et al. Weight-bearing activity during youth is a more important factor for peak bone mass than calcium intake. J Bone Min Res 1994;9(7):1089–96.

29. Abrams SA, Griffin IJ, Hawthorne KM, Gunn SK, Gundberg CM, Carpenter TO. Relationships among vitamin D levels, parathyroid hormone, and calcium absorption in young adolescents. J Clin Endocrinol Metabol 2005;90(10):5576–81.

30. Boot AM, de Ridder MA, Pols HA, Krenning EP, de Muinck Keizer-Schrama SM. Bone mineral density in children and adolescents: relation to puberty, calcium intake, and physical activity 1. J Clin Endocrinol Metabol 1997;82(1):57–62.