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Kim, Kang, Park, and Hwang: The Association between Changes in Food and Nutrient Intakes and Changes in Bone Metabolic Indicators in Postmenopausal Women with Osteopenia after a 12-week Intervention of Nutrition Education and Aerobic Exercise
Original Article

Korean Journal of Community Nutrition 2013; 18(3): 213-222.

Published online: 30 June 2013

DOI: https://doi.org/10.5720/kjcn.2013.18.3.213

The Association between Changes in Food and Nutrient Intakes and Changes in Bone Metabolic Indicators in Postmenopausal Women with Osteopenia after a 12-week Intervention of Nutrition Education and Aerobic Exercise

Seo-Jin Kim, Suh-Jung Kang1, Yoon Jung Park2, Ji-Yun Hwang3

Department of Foodservice Management and Nutrition, Sangmyung University, Seoul, Korea.

1Department of Sports Science, Sangmyung University, Seoul, Korea.

2Department of Nutrition Science and Food Management, Ewha Womans University, Seoul, Korea.

3Nutrition Education Major, Graduate School of Education, Sangmyung University, Seoul, Korea.

Corresponding author: Ji-Yun Hwang, Nutrition Education Major, Graduate School of Education, Sangmyung University, 7 Hongji-dong, Jongno-gu, Seoul 110-743, Korea. Tel: (02) 781-7521, Fax: (02) 2287-0104, jiyunhk@smu.ac.kr

Received 18 January 2013       Revised 11 April 2013       Accepted 20 May 2013

Copyright © 2013 The Korean Society of Community Nutrition

(open-access):

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Few studies investigated the effects of nutrition education and exercises in women with osteopenia. This study examined the relationship between changes in dietary intakes and changes in indicators related to bone health in postmenopausal women with osteopenia (-2.5 ≤ T-score ≤ 1) after a 12-week intervention. Thirty-one postmenopausal women aged > 50 years residing in Seoul were recruited and participated in nutritional education regarding bone health and general nutrition practices and aerobic exercises (three times a week; 60 min per session). Twenty-five subjects completed the study and were eligible for the analysis. Bone mineral density (BMD) at femoral neck was measured by dual energy x-ray absorptiometry. Serum calcium, osteocalcin, and intact parathyroid hormone (PTH) were also measured. Dietary intake was estimated by using a one-day 24 recall by a clinical dietitian. After 12 weeks, meat consumption increased (P = 0.028) but vegetable intake decreased (P = 0.005). Intakes of animal protein (P = 0.024), vitamin B1 (P = 0.012) and vitamin B2 (P = 0.047) increased, and sodium intake decreased (P = 0.033). Intact PTH (P = 0.002) decreased and osteocalcin (P = 0.000) increased, however, BMD decreased (P = 0.000). Changes in mushroom consumption were positively correlated with femoral neck BMD (r = 0.673, P = 0.003). Changes in animal iron intake were negatively correlated with intact PTH (r = -0.488, P = 0.013) but were positively correlated with osteocalcin (r = 0.541, P = 0.005). These results suggested that the association between animal iron intake and biochemical markers of bone turnover may play an important role in bone metabolism. Further studies are needed to shed light on complicated mechanisms of diet, hormonal levels of bone metabolism, and bone density.

Keywords: bone health, intervention, iron intake, nutrition education, hormone

Figures and Tables

Table 1
Nutrition education program for bone health
kjcn-18-213-i001
Table 2
Age and anthropometrics, indicators related to bone mineral density (BMD), and dietary behaviors related to bone health from baseline to follow-up in subjects with osteopenia (n = 25)
kjcn-18-213-i002

1) Dietary quality was assessed by Mini Dietary Assessment (Oh et al. 2007)

Table 3
Food group intake from baseline to follow-up in subjects with osteopenia (n = 25)
kjcn-18-213-i003
Table 4
Nutrient intake from baseline to follow-up in subjects with osteopenia (n = 25)
kjcn-18-213-i004

1) The proportion of subject whose intake was less than the Korean estimated energy requirements for females in her age (Korean Nutrition Society 2010).

2) The proportion of subject whose intake of both animal and plant sources was less than the Korean estimated average requirements for females in her age (Korean Nutrition Society 2010).

3) The proportion of subject whose intake was less than the Korean estimated average requirements for females in her age (Korean Nutrition Society 2010).

1),2),3) Statistical tests to examine differences in frequencies before and after intervention were not conducted (expected frequencies < 5)

Table 5
Correlation between food group intakes change and change of indicators related to bone mineral density(BMD) (n = 25)
kjcn-18-213-i005

1) Data were available for 21 subjects.

Table 6
Correlation between nutrient intakes change and change of indicators related to bone mineral density(BMD)
kjcn-18-213-i006

1) Data were available for 21 subjects.

References

1. Akesson K, Vergnaud PH, Delmas PD. Serum osteocalcin increases during fracture healing in elderly women with hip fractures. Bone. 1995; 16:427–430.
2. Campos MS, Barrionuevo M, Alférez MJ, Gómez-Ayala AE, Rodríguez-Matas MC, Lopez Aliaga I, Lisbona F. Interactions among iron, calcium, phosphorus and magnesium in the nutritionally iron-deficient rat. Exp Physiol. 1998; 83(6):771–781.
3. Choi MJ. Effects of nutrient intake and exercise on bone mineral density and bone mineral density in premenopausal women. Korean J Nutr. 2002; 35(4):437–479.
4. Choi YH, Sung CJ. A study on nutrient intakes and serum levels of copper, zinc and manganese in Korean postmenopausal women with different bone mineral density. Korean J Nutr. 2006; 39(5):485–493.
5. Chung HY. Osteoporosis diagnosis and treatment 2007. J Korean Endocr Soc. 2008; 23(2):76–108.
6. Contento IR. Nutrition education - linking research, theory, and practice. Jones & Bartlett Publishers;2010. p. 114–146.
7. Delmas PD. Biochemical markers of bone turnover: methodology and clinical use in osteoporosis. Am J Med. 1991; 91(5B):59S–63S.
8. Delmas PD, Stenner HW, Wahner KG. Increase in serum bone gamma-carboxyglutamic acid protein with aging in women. J Clin Invest. 1983; 71:1316–1321.
9. Evans CE, Chughtai AY, Blumsohn A, Giles M, Eastell R. : The effect of dietary sodium on calcium metabolism in premenopausal and postmenopausal women. Eur J Clin Nutr. 1997; 51(6):394–399.
10. Garnero P, Sornay-Rendu E, Claustrat B, Delmas PD. Biochemical markers of bone turnover, endogenous hormones and the risk of fractures in postmenopausal women: the OFELY study. J Bone Miner Res. 2000; 15(8):1526–1536.
11. Harris MM, Houtkooper LB, Stanford VA, Parkhill C, Weber JL, Flint-Wagner H, Weiss L, Going SB, Lohman TG. Dietary iron is associated with bone mineral density in healthy postmenopausal women. J Nutr. 2003; 133(11):3598–3602.
12. Khosla S, Atkinson EJ, Melton LJ 3rd, Riggs BL. Effects of age and estrogen status on serum parathyroid hormone levels and biochemical markers of bone turnover in women: a population-based study. J Clin Endocrinol Metab. 1997; 82(5):1522–1527.
13. Kim JH, Choi-Kwon S, Park YH, Park KA, Suh MH, Lee SO. The effect of the dietary approaches to stop hypertension (DASH) diet education program on bone mineral density in the middle-aged women: a pilot study. J Korean Biol Nurs Sci. 2010; 12(3):195–205.
14. Kim JM, Jin MR, Kim HW, Chang NS. Associations between daily food and nutrient intake and bone mineral density in men aged 50 years and older. Korean J Nutr. 2011a; 44(5):394–405.
15. Kim KJ, Kim KK, Hwang IC, Lee KS, Suh HS. The relation of plasma osteocalcin and BMI in subjects who visited a health promotion center of a general hospital. Korean J Obes. 2011b; 20(2):51–58.
16. Kim MS, Choi MS, Kim KN. Effect of nutritional education and exercise intervention on reducing and maintaining weight in obese women. Korean J Community Nutr. 2007; 12(1):80–89.
17. Korean Dietetic Association. Manual of medical nutrition therapy. 3rd Edition. Seoul, Korea: Korean Dietetic Association;2008.
18. Korean Nutrition Society. Dietary reference intake for Korean. Seoul, Korea: Korean Nutrition Society;2010.
19. Lee HJ, Lee HO. A study on the bone mineral density and related factors in Korean postmenopausal women. Korean J Nutr. 1999; 32(2):197–203.
20. Ministry of Health, Welfare and Family Affairs & Korea Centers for Disease Control and Prevention. 2011 national health statistics - the 5th Korea national health and nutrition examination survey, The second year. Seoul, Korea: Korea Centers for Disease Control and Prevention;2012.
21. Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster JY, Hodsman AB, Eriksen EF, Ish-Shalom S, Genant HK, Wang O, Mitlak BH. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med. 2001; 344(19):1434–1441.
22. Oh SY, Kim EM, Shin MH, Lee SH, Kim JE, Lee HS, Jo JS, Kim WY. Development and validity of food frequency questionnaire for adults. Proceedings of the Annual Spring Conference. Seoul, Korea: The Korean Society of Health Promotion;2007.
23. Park J, Choi M, Lee S, Choi Y, Park Y. The association between bone mineral density, bone turnover markers and nutrient intake in pre- and postmenopausal women. Korean J Nutr. 2011; 44(1):29–40.
24. Park MJ. Association of bone mineral density with nutrient intake and lifestyles of postmenopausal women in Chungnam. J Korean Home Econ Assoc. 2005; 43(12):61–78.
25. Peterson BA, Klesges RC, Kaufman EM, Cooper TV, Vukadinovich CM. The effects of an educational intervention on calcium intake and bone mineral content in young women with low calcium intake. Am J Health Promot. 2000; 14(3):149–156.
26. Katsumata S, Tsuboi R, Uehara M, Suzuki K. Dietary iron deficiency decreases serum osteocalcin concentration and bonemineral density in rats. Biosci Biotechnol Biochem. 2006; 70(10):2547–2550.
27. Steingrimsdottir L, Gunnarsson O, Indridason OS, Franzson L, Sigurdsson G. Relationship between serum parathyroid hormone levels, vitamin D sufficiency, and calcium intake. JAMA. 2005; 294(18):2336–2341.
28. Tartibian B, Maleki BH, Kanaley J, Sadeghi K. Long-term aerobic exercise and omega-3 supplementation modulate osteoporosis through inflammatory mechanisms in post-menopausal women: a randomized, repeated measures study. Nutr Metab (Lond). 2011; 8:71.
29. Välimäki VV, Alfthan H, Lehmuskallio E, Löyttyniemi E, Sahi T, Suominen H, Välimäki MJ. Risk factors for clinical stress fractures in male military recruits: a prospective cohort study. Bone. 2005; 37(2):267–273.
30. Wayne PM, Kiel DP, Buring JE, Connors EM, Bonato P, Yeh GY, Cohen CJ, Mancinelli C, Davis RB. Impact of Tai Chi exercise on multiple fracture-related risk factors in postmenopausal osteopenic women: a pilot pragmatic, randomized trial. BMC Complement Altern Med. 2012; 12:7.
31. World Health Organization. The world health report. Geneva, Switzland: 1998.
32. Yeon JY, Sung CJ. A study on dietary mineral intakes, urinary mineral excretions, and bone mineral density in Koreanpostmenopausal women. Korean J Community Nutr. 2011; 16(5):569–579.
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