摘要
Background:Weight-loss-induced fat loss improves cardiometabolic health in individuals with overweight and obesity;however,weight loss can also result in bone loss and increased fracture risk.Weight-loss-induced bone loss may be attenuated with exercise.Our aim was to compare changes in bone mineral density(BMD)in adults with overweight and obesity who undertook diet-induced weight loss alone or in combination with exercise.Methods:We included randomized controlled trials(RCTs)in adults with overweight or obesity(aged-18 years;body mass index-25 kg/m^(2))that prescribed diet-induced weight loss alone or in combination with supervised exercise,and measured any bone structural parameters.Risk of bias was assessed using the Cochrane Risk of Bias tool.Random-effects meta-analyses determined mean changes and net mean differences(95%confidence intervals(95%CIs))in the percentage of areal BMD(aBMD)change between groups.Results:We included 9 RCTs.Diet-induced weight loss led to significant losses in femoral neck aBMD(mean change:-1.73%(95%CI:-2.39%to-1.07%),p<0.001)and total hip aBMD(-2.19%(95%CI:-3.84%to-0.54%),p=0.009).Femoral neck aBMD losses were significantly greater in the diet-induced weight loss group compared to the exercise plus diet-induced weight loss group(net difference:-0.88%(95%CI:-1.73%to-0.03%));however,there were no differences in aBMD changes at any other skeletal site:total hip(-1.96%(95%CI:-4.59%to 0.68%))and lumbar spine(-0.48%(95%CI:-1.81%to 0.86%)).aBMD changes did not differ significantly according to exercise modality(resistance exercise,aerobic exercise,or a combination of the two)during diet-induced weight loss.Conclusion:Diet-induced weight loss led to greater femoral neck bone loss compared to diet-induced weight loss plus exercise.Bone loss at the total hip and lumbar spine was not attenuated by exercise during diet-induced weight loss.The lack of consistent skeletal benefits may be due to the insufficient duration and/or training intensities of most exercise interventions.Additional RCTs
基金
JM is supported by a Research Training Program Scholarship
DS is supported by an Australian National Health and Medical Research Council(NHMRC)RD Wright Biomedical Career Development Fellowship(GNT1123014)
an NHMRC Investigator Grant(GNT1174886).
