Students' Scientific Center, Tehran University of Medical Sciences, Tehran, Iran.
Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
Crit Rev Food Sci Nutr. 2021;61(4):553-565. doi: 10.1080/10408398.2020.1739620. Epub 2020 Mar 17.
A major therapeutic goal in weight management should be total body fat reduction whereas as preserving lean body mass and bone mass density. It is uncertain if an exercise program reduces the adverse effects of calorie restriction-induced weight loss in adults. The aim of the present study was to evaluate the differences in bone mass between adults who enrolled in a calorie restriction or an exercise-calorie restriction induced weight loss program. Both PubMed and Scopus libraries were searched up to February 2020. Systematic reviews and a meta-analysis were carried out of randomized clinical trials (published to February 2020) on differences in bone mineral density and content (BMD and BMC) of adults who lost weight by calorie restriction alone (CR) or exercise-calorie restriction (CR-E). The study quality was calculated using the Cochrane scoring system. Retrieved data were pooled when weight mean differences (WMDs) were computed between two groups for BMD and BMC at various sites of the body. Thirteen studies, with a total of 852 participants were included. Available evidence found significantly higher BMD at the hip (WMD: 0.03 g/cm, 95%CI: 0.01 to 0.04, p < 0.001) and femoral neck WMD: 0.03 g/cm, 95%CI: 0.01 to 0.05, p < 0.001) and total body BMC (WMD: 0.13 kg/cm, 95%CI: -0.10 to 0.36, p < 0.001) in the CR-E compared to the CR weight loss group. In contrast, all changes in total body BMD (WMD: 0.00 g/cm, 95%CI: -0.01 to 0.02, p = 0.57) and lumbar spine BMD (WMD: 0.00 g/cm, 95%CI: -0.01 to 0.01, p = 0.89) were not statistically significant. Little evidence was available for different sexes separately. Most individuals were postmenopausal females and no subgroup analysis could be conducted based on menopausal status. This study suggests that physical training can preserve and even significantly increase the bone mass of the hip and femoral neck during weight reduction. Of note, various exercise modalities affected BMD at different sites. Similar results were not found for lumbar spine and total body BMD.
在体重管理中，一个主要的治疗目标应该是减少总体脂肪量，同时保留瘦体重和骨密度。目前尚不确定运动方案是否可以减轻因热量限制引起的体重减轻对成年人的不良影响。本研究的目的是评估参加热量限制或运动-热量限制诱导体重减轻计划的成年人之间的骨量差异。检索了截至 2020 年 2 月的 PubMed 和 Scopus 数据库。对单独通过热量限制（CR）或运动-热量限制（CR-E）减轻体重的成年人的骨矿物质密度和含量（BMD 和 BMC）差异的随机临床试验进行了系统评价和荟萃分析（截至 2020 年 2 月发表）。使用 Cochrane 评分系统计算研究质量。当计算两组之间的体重平均差异（WMD）时，对身体各部位的 BMD 和 BMC 进行汇总。共纳入 13 项研究，共 852 名参与者。现有证据发现，髋部（WMD：0.03g/cm，95%CI：0.01 至 0.04，p<0.001）和股骨颈（WMD：0.03g/cm，95%CI：0.01 至 0.05，p<0.001）的 BMD 以及总身体 BMC（WMD：0.13kg/cm，95%CI：-0.10 至 0.36，p<0.001）在 CR-E 组中显著高于 CR 体重减轻组。相比之下，全身 BMD 的所有变化（WMD：0.00g/cm，95%CI：-0.01 至 0.02，p=0.57）和腰椎 BMD（WMD：0.00g/cm，95%CI：-0.01 至 0.01，p=0.89）均无统计学意义。分别针对不同性别提供的证据很少。大多数人是绝经后女性，由于没有基于绝经状态的亚组分析，因此无法进行亚组分析。本研究表明，体育锻炼可以在减肥过程中保持甚至显著增加髋部和股骨颈的骨量。值得注意的是，各种运动方式对不同部位的 BMD 有不同的影响。腰椎和全身 BMD 未发现类似结果。
