Moderate‐to‐Vigorous Physical Activity Is Associated With Higher Bone Mineral Density in Children With Inflammatory Bowel Disease

Abstract

Objectives: Decreased mineral bone density (BMD) and reduced lean body mass (LBM) are common amongst children with inflammatory bowel disease (IBD). The aim of our cross-sectional, observational study was to evaluate the relationship between BMD, body composition and physical activity (PA) in children with IBD in remission. Methods: Total body less head (TLBH) dual energy X-ray absorptiometry (DXA) was used to measure BMD, fat mass (FM) and lean body mass (LBM). Triaxial accelerometer for five consecutive days was used to objectivize PA. Results: Forty pediatric IBD patients in clinical remission (24 boys; age 15.3 AE 0.4 years; Crohn disease [CD], n ¼ 20, ulcerative colitis [UC], n ¼ 18, inflammatory bowel disease-unclassified [IBD-U], n ¼ 2) were recruited. Mean BMD was 0.940 g/cm 2 and mean BMD z score was À0.42 AE 0.14. Patients with CD had significantly lower BMD than UC counterparts (P < 0.001). Average time spent in PA was 247.24 AE 16.71 min/day with 45.73 AE 8.22 min/day spent in moderate-to-vigorous PA (MVPA). We observed a significant positive correlation between the time spent in MVPA and BMD z score (P ¼ 0.003) and LBM z score (P ¼ 0.026). Multivariate analysis confirmed that the positive correlation of MVPA and BMD z score. There was no significant correlation between daily protein intake and BMD. Cumulative glucocorticoid dose negatively correlated with LBM z score (P ¼ 0.003), but not with BMD z score (P ¼ 0.069). Conclusions: This study points to a strong positive relationship between MVPA, LBM and BMD. Longitudinal studies are required in order to elucidate the modifiable processes that determine body health and favorable body composition.

Diet, Sun, Physical Activity and Vitamin D Status in Children with Inflammatory Bowel Disease

“…Daily physical activity positively affects respiratory and circulatory capacity, muscle strength, stimulates normal growth and bone strength, and has a positive effect on cognitive function and psychosocial factors. Low physical activity is a risk factor for cardiovascular disease, diabetes or osteoporosis [ 55 , 56 , 57 ]. In the analysis, 81.59% of children with CD and 81.24% of UC declared physical activity daily or several times a week for at least 30 min throughout the year compared to 94.15% of children in the comparative group.…”

Metabolic Bone Disorders in Children with Inflammatory Bowel Diseases

“…However, studies indicate that there are more cytokines that may affect bone health, such as IL-11, IL-17, IL-18, IL-23, TNF-B, epidermal growth factor (EGF), and prostaglandin E2 (PGE2) [ 9 , 10 ]. Inflammation also indirectly leads to a reduction in physical activity (the impact of which on bone tissue is confirmed by many studies; [ 11 , 12 , 13 ]), but also loss of appetite, malabsorption disorders, and increased energy demand, which in the case of children and their growing period may be responsible for significant consequences, leading to nutritional and vitamin deficiencies. These deficits, in turn, may already be a direct cause of metabolic bone disorders.…”

“…Low bone density at diagnosis was correlated with growth impairment and low BMI [ 14 ]. Moreover, BMD values were lower in the lumbar spine than in total body excluding the head, as well at diagnosis or at the end of follow-up [ 13 ]. In this study also, almost 20% of patients had a low BMD at the beginning and at the end of the study.…”

“…There are many publications indicating the positive effect of physical activity on bone density [ 11 , 12 , 13 ]. In a recent study, a survey was conducted within young adults diagnosed with IBD during childhood.…”

“…One cross-sectional, observational study, conducted in the pediatric IBD population, found a strong positive relationship between moderate-to-vigorous physical activity, lean body mass, and BMD [ 13 ]. However, there was no significant correlation determined between daily protein intake and BMD.…”