Herrmann Diana, Pohlabeln Hermann, Gianfagna Francesco, Konstabel Kenn, Lissner Lauren, Mårild Staffan, Molnar Dénes, Moreno Luis A, Siani Alfonso, Sioen Isabelle, Veidebaum Toomas, Ahrens Wolfgang
Department of Epidemiological Methods and Etiologic Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359 Bremen, Germany.
Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359 Bremen, Germany.
Bone. 2015 Sep;78:142-9. doi: 10.1016/j.bone.2015.04.043. Epub 2015 May 4.
Physical activity (PA) and micronutrients such as calcium (Ca), vitamin D (25OHD), and phosphate (PO) are important determinants of skeletal development. This case-control study examined the association of these nutritional biomarkers and different PA behaviours, such as habitual PA, weight-bearing exercise (WBE) and sedentary time (SED) with bone stiffness (SI) in 1819 2-9-year-old children from the IDEFICS study (2007-2008). SI was measured on the calcaneus using quantitative ultrasound. Serum and urine Ca and PO and serum 25OHD were determined. Children's sports activities were reported by parents using a standardised questionnaire. A subsample of 1089 children had accelerometer-based PA data (counts per minute, cpm). Moderate-to-vigorous PA (MVPA) and SED were estimated. Children with poor SI (below the 15th age-/sex-/height-specific percentile) were defined as cases (N=603). Randomly selected controls (N=1216) were matched by age, sex, and country. Odds ratios (OR) for poor SI were calculated by conditional logistic regression for all biomarkers and PA behaviour variables separately and combined (expressed as tertiles and dichotomised variables, respectively). ORs were adjusted for fat-free mass, dairy product consumption, and daylight duration. We observed increased ORs for no sports (OR=1.39, p<0.05), PA levels below 524 cpm (OR=1.85, p<0.05) and MVPA below 4.2% a day (OR=1.69, p<0.05) compared to WBE, high PA levels (<688 cpm) and high MVPA (6.7%), respectively. SED was not associated with SI. ORs were moderately elevated for low serum Ca and 25OHD. However, biomarkers were not statistically significantly associated with SI and did not modify the association between PA behaviours and SI. Although nutritional biomarkers appear to play a minor role compared to the osteogenic effect of PA and WBE, it is noteworthy that the highest risk for poor SI was observed for no sports or low MVPA combined with lower serum Ca (<2.5 mmol/l) or lower 25OHD (<43.0 nmol/l).
身体活动（PA）以及钙（Ca）、维生素D（25OHD）和磷酸盐（PO）等微量营养素是骨骼发育的重要决定因素。这项病例对照研究在来自IDEFICS研究（2007 - 2008年）的1819名2至9岁儿童中，考察了这些营养生物标志物以及不同的PA行为，如习惯性PA、负重运动（WBE）和久坐时间（SED）与骨硬度（SI）之间的关联。使用定量超声在跟骨上测量SI。测定血清和尿液中的Ca和PO以及血清25OHD。家长通过标准化问卷报告儿童的体育活动情况。1089名儿童的子样本有基于加速度计的PA数据（每分钟计数，cpm）。估算了中度至剧烈PA（MVPA）和SED。SI较差（低于年龄/性别/身高特异性第15百分位数）的儿童被定义为病例（N = 603）。随机选择的对照组（N = 1216）按年龄、性别和国家进行匹配。分别对所有生物标志物和PA行为变量单独及联合计算（分别表示为三分位数和二分变量）SI较差的比值比（OR），通过条件逻辑回归计算。OR针对去脂体重、乳制品消费和日照时长进行了调整。与WBE、高PA水平（>688 cpm）和高MVPA（6.7%）相比，我们观察到不运动（OR = 1.39，p < 0.05）、PA水平低于524 cpm（OR = 1.85，p < 0.05）以及MVPA低于每日4.2%（OR = 1.69，p < 0.05）时OR升高。SED与SI无关联。低血清Ca和25OHD时OR适度升高。然而，生物标志物与SI无统计学显著关联，且未改变PA行为与SI之间的关联。尽管与PA和WBE的成骨作用相比，营养生物标志物似乎作用较小，但值得注意的是，不运动或低MVPA与较低血清Ca（<2.5 mmol/l）或较低25OHD（<43.0 nmol/l）相结合时，观察到SI较差的风险最高。
