Risk factors for low bone mineral density in pediatric inflammatory bowel disease: the positive role of physical activity

Nobile, Stefano; Grand, Richard J.; Pappa, Helen

doi:10.1097/meg.0000000000001076

Cited by 23 publications

(25 citation statements)

References 28 publications

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“…The low BMD measurements and the correlations with the anthropometric parameters reported herein are concordant with previous studies . These findings might be attributed to a more severe disease, which causes undernutrition, weight loss and stunted growth, and ultimately results in low BMD …”

Section: Discussionsupporting

confidence: 92%

Longitudinal changes in bone mineral density in children with inflammatory bowel diseases

et al. 2019

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Decreased bone mineral density (BMD) is an important extraintestinal complication of paediatric inflammatory bowel disease (IBD). 1 Almost 50% of children and adolescents with IBD have a BMD zscore of <−1 and about 25% have a BMD z-score <−2. 2 Children with IBD may have an increased risk for fractures during childhood, especially vertebral fractures. 3 Peak bone mass is reached by the third decade of life. Thus, children with IBD are at risk of failing to reach their optimal peak bone mass, and of having a higher incidence of fractures later, during adulthood. 4 A number of factors contribute to impaired BMD in IBD patients.These include: inflammatory cytokines, 5 glucocorticoid treatment, 6 malnutrition, 7 low calcium intake, vitamin D deficiency, 6 decreased Abbreviations: BMD, bone mineral density; DXA, dual-energy X-ray absorptiometry; IBD, inflammatory bowel disease; SDS, standard deviation score; TBLH, total body less head. Abstract Aim: Children with inflammatory bowel disease (IBD) are prone to low bone mineral density (BMD). Our aim was to assess longitudinal changes in BMD in this population. Methods: A retrospective longitudinal study of children with IBD, treated at two tertiary centres in Israel, who underwent two BMD measurements by dual-energy X-ray absorptiometry (DXA). Changes in lumbar spine BMD (∆L1-4 z-scores) were examined for correlations with clinical characteristics. Results: The cohort included 41 patients (age at diagnosis 12.1 ± 3.5 years, 23 females).The mean interval between the scans was 3.4 ± 2.0 years. There was a trend towards improvement in L1-4 z-scores (−1.64 ± 1.02 vs −1.45 ± 0.83, P = .12). ∆L1-4 z-scores correlated positively with ∆weight-standard deviation scores (SDS), ∆height-SDS and ∆BMI-SDS, and with age at the second scan (R = .55, P < .01; R = .42, P < .01; R = .42, P = .01; R = .35, P = .02, respectively); and negatively with L1-4 z-scores at the first scan (R = −.63, P < .01). Stepwise linear regression analysis identified the first scan L1-4 z-scores and ∆weight-SDS as independent predictors of ∆L1-4 z-scores. An L1-4 z-score ≤−2 at the first DXA scan was associated with significant improvement at the second scan.Conclusion: Improvement in BMD was more pronounced in children who gained weight or whose BMD was low at the first scan. K E Y W O R D S bone, bone mineral density, Crohn's disease, dual-energy X-ray absorptiometry, ulcerative colitis | 1027 LEVY-SHRAGA Et AL. activity, hypogonadism, decreased skeletal muscle mass 1 and possibly dysbiotic intestinal microbial flora. 8Only limited longitudinal data are available regarding changes in BMD in the course of IBD. Some studies in paediatric 9,10 and adult patients 11,12 found no significant changes in BMD z-scores during follow-up, despite clinical disease remission. However, others reported improvement with time. 13,14 The aim of our study was to examine longitudinal changes in BMD of children and adolescents with IBD, and associations of such changes with anthropometric parameters and disease activity.

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Section: Discussionsupporting

confidence: 92%

Longitudinal changes in bone mineral density in children with inflammatory bowel diseases

et al. 2019

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“…The exact mechanisms underlying the altered body composition seen in patients with IBD are unclear. Implicated factors include: (i) Inflammation per se, given that skeletal muscle depletion has been shown to be reversed after treatment with either anti-TNF-a [40] or colectomy [41]; (ii) physical inactivity and sedentary life-style in childhood, which have been shown to play important roles in the development of both skeletal muscle [42] and bone [43]; (iii) malnutrition, possibly caused by malabsorption, low dietary intake and/or higher energy expenditure [44]; and (iv) treatment with corticosteroids, for which common side-effects are low BMD and increased fat mass [45].…”

Section: Discussionmentioning

confidence: 99%

Altered body composition profiles in young adults with childhood-onset inflammatory bowel disease

Sigurdsson

Schmidt

Mellström

et al. 2020

Scandinavian Journal of Gastroenterology

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Background: Patients with inflammatory bowel disease (IBD) often develop alterations in body composition in terms of their proportions of lean mass and fat mass, as well as reduced bone mineral density (BMD). However, there are limited data on the skeletal muscle index (SMI) and percentage fat (fat %) for young adults with childhood-onset IBD. Our aim was to investigate the body compositions of these patients, with the focus on SMI and fat %. Methods: Body composition was estimated by dual x-ray absorptiometry for 94 young adults with childhood-onset IBD aged 18-27 years, 65 of whom had ulcerative colitis. The Z-scores for SMI, fat %, and BMD were calculated using the normative data from 1,289 individuals with corresponding age. Based on the SMI and fat % Z-scores, each patient was classified as having a body composition profile that was: (i) normal; (ii) obese (fat % Z-score >1); (iii) myopenic (SMI Z-score < À1); or (iv) myopenic-obese. Results: A higher proportion of young adults with childhood-onset IBD had a body composition profile classified as myopenic (24%) or myopenic-obese (9%), as compared to the controls (myopenic [16%, p ¼ .016]; myopenic-obese [2%, p ¼ .002]). Patients with the myopenic or myopenic-obese profile had significantly lower total body BMD Z-scores (À1.3 ± 0.7 and À1.4 ± 0.9, respectively) than patients with the normal profile (À0.2 ± 1.1; p < .001 and p ¼ .004, respectively). Diagnosis of IBD in childhood represented an additional risk for low BMD, regardless of SMI Z-score. Conclusion: Young adults with childhood-onset IBD have a high risk for having altered body composition traits.

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“…However, the welldocumented benefits of exercise are instituted across various other sites and systems of the body, which may indirectly result in improving primary and secondary disease symptoms through other pathways not accounted for in this experiment. For example, PA as a primary intervention has been associated with improved quality of life in IBD patients (63) and inversely correlated with loss of bone mass density, a common risk factor in this population (64,65).…”

Section: Wheel Running In Muc2 -/Mice Does Not Reduce the Severity Ofmentioning

confidence: 99%

“…The human intestinal tract is continuously exposed to the trillions of microbes residing 61 within the mucosal layer of the lumen. Under homeostatic conditions, these microbes are 62 tolerated by the host as they provide essential functions such as digestion of complex 63 carbohydrates, protection against enteric pathogens, and production of beneficial short-chain 64 fatty acids (SCFA), to name a few. Separating the luminal microbes from intestinal epithelial 65 cells (IEC) is a mucus bilayer largely composed of the highly glycosylated protein MUC2.…”

Section: Introductionmentioning

confidence: 99%

Physical activity shapes the intestinal microbiome and immunity of healthy mice but has no protective effects against colitis in MUC2^-/- mice

Estaki

Morck

Quin

et al. 2020

Preprint

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The interactions among humans, their environment, and the trillions of microbes residing within the human intestinal tract form a tripartite relationship that is fundamental to the overall health of the host. Disruptions in the delicate balance between the intestinal microbiota and their host immunity are implicated in various chronic diseases including inflammatory bowel disease (IBD). There is no known cure for IBD, therefore, novel therapeutics targeting prevention and symptoms management are of great interest. Recently, physical activity in healthy mice was shown to be protective against chemically-induced colitis, however the benefits of physical activity during or following disease onset is not known. In this study, we examine whether voluntary wheel running is protective against primary disease symptoms in a mucin 2 deficient (Muc2-/-) life-long model of murine colitis. We show that 6 weeks of wheel running in healthy C57BL/6 mice leads to distinct changes in fecal bacteriome, increased butyrate production, and modulation in colonic gene expression of various cytokines, suggesting an overall primed anti-inflammatory state. However, these physical activity-derived benefits are not present in Muc2-/- mice harboring a dysfunctional mucosal layer from birth, ultimately showing no improvements in clinical signs. We extrapolate from our findings that while physical activity in healthy individuals may be an important preventative measure against IBD, for those with a compromised intestinal mucosa, a commonality in IBD patients, these benefits are lost.

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Risk factors for low bone mineral density in pediatric inflammatory bowel disease: the positive role of physical activity

Abstract: This study provides further insight into risk factors for low BMD in pediatric IBD. Novel findings were the association between low BMD and fractures, and the positive relationship between BMD and physical activity.

Cited by 23 publications

References 28 publications

Longitudinal changes in bone mineral density in children with inflammatory bowel diseases

Longitudinal changes in bone mineral density in children with inflammatory bowel diseases

Altered body composition profiles in young adults with childhood-onset inflammatory bowel disease

Physical activity shapes the intestinal microbiome and immunity of healthy mice but has no protective effects against colitis in MUC2^-/- mice

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Risk factors for low bone mineral density in pediatric inflammatory bowel disease: the positive role of physical activity

Abstract: This study provides further insight into risk factors for low BMD in pediatric IBD. Novel findings were the association between low BMD and fractures, and the positive relationship between BMD and physical activity.

Cited by 23 publications

References 28 publications

Longitudinal changes in bone mineral density in children with inflammatory bowel diseases

Longitudinal changes in bone mineral density in children with inflammatory bowel diseases

Altered body composition profiles in young adults with childhood-onset inflammatory bowel disease

Physical activity shapes the intestinal microbiome and immunity of healthy mice but has no protective effects against colitis in MUC2-/- mice

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Resources

About

Physical activity shapes the intestinal microbiome and immunity of healthy mice but has no protective effects against colitis in MUC2^-/- mice