Bone Health Status and its Association with Body Composition, Physical Activity, and Calcium Intake Among Malaysian University Students in Bangi, Selangor, Malaysia
Keywords:
body composition, bone mineral density, calcium intake, physical activity, young adultsAbstract
External and internal factors, including body composition, active participation in physical activities, and adequate calcium intake (CI), have been suggested as important measures to optimize bone health, particularly among young adults, as peak bone mass accumulates during this stage of life. This cross-sectional study was conducted to investigate the relationship between body composition, physical activity levels (PAL), and CI with bone mineral density (BMD) in Malaysian university students. A total of 216 students from Universiti Kebangsaan Malaysia (72 each from Malay, Chinese, and Indian ethnicities) with a mean age of 22.1 ± 2.2 years were recruited. The assessment included body mass index (BMI), waist circumference (WC), body fat (BF), lean mass (LM), BMD, PAL, and CI. These were measured using a measuring tape, digital scale, quantitative ultrasound, the international physical activity questionnaire, and a 24-hr dietary recall alongside a food frequency questionnaire, respectively. The results showed that BMI, WC, BF, LM, BMD, PAL, and CI levels were 22.7 ± 4.5 kgm-2, 79.8 ± 12.3 cm, 23.2 ± 8.6%, 46.9 ± 11.4 kg, 0.29 ± 1.2, 2106.0 ± 1381.0 MET-min/week, and 335.4 ± 211.0 mg/day and 449.4 ± 284.6 mg/day, respectively. This means that the subjects had normal body composition, normal BMD levels, and moderate PAL. However, their calcium intake was generally low. The BMD mean of overweight subjects was significantly higher (f= 2.792, p=0.041) compared to the BMD of underweight subjects. A trend toward a significant increase of BMD (p=0.058) was also shown when PAL was increased. All parameters, except for body fats (r=-0.013, p=0.847) had a significantly weak correlation with BMD (r values: 0.143 to 0.198, p<0.05). The results of this study highlight the importance of maintaining body composition, living an active lifestyle, and optimizing CI levels for strong bones to prevent osteoporosis in old age.
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Abdulameer, S.A., Sahib, M.N. & Sulaiman, S.A.S. 2018. The prevalence of osteopenia and osteoporosis among Malaysian type 2 diabetic patients using quantitative ultrasound densitometer. The Open Rheumatology Journal, 12: 50-64. DOI: https://doi.org/10.2174/1874312901812010050
Alexiou, K.I., Roushias, A., Varitimidis, S.E. & Malizos, K.N. 2018. Quality of life and psychological consequences in elderly patients after a hip fracture: A review. Clinical Interventions in Aging, 13: 143-150. DOI: https://doi.org/10.2147/CIA.S150067
Baxter-Jones, A.D., Faulkner, R.A., Forwood, M.R., Mirwald, R.L. & Bailey, D.A. 2011. Bone mineral accrual from 8 to 30 years of age: an estimation of peak bone mass. Journal of Bone Mineral Research, 26(8): 1729-39. DOI: https://doi.org/10.1002/jbmr.412
Bierhals, I.O., dos Santos Vaz, J., Bielemann, R.M., de Mola, C.L., Barros, F.C., Goncalves, H., Wehrmeister, F.C. & Assuncao, M.C.F. 2019. Associations between body mass index, body composition and bone density in young adults: findings from a southern Brazilian cohort. BMC Musculoskeletal Disorders, 20: 322. DOI: https://doi.org/10.1186/s12891-019-2656-3
Boudin, E., Fijalkowski, I., Hendrickx, G. & Van Hul, W. 2016. Genetic control of bone mass. Molecular and Cellular Endocrinology, 432: 3-13. DOI: https://doi.org/10.1016/j.mce.2015.12.021
Chan, C.Y., Subramaniam, S., Mohamed, N., Soelaiman, I-N., Muhammad, N., Fairus, A., Ng, P.Y., Jamil, N.A., Aziz, N.A. & Chin, K.Y. 2020. Determinants of bone health status in a multi-ethnic population in Klang Valley, Malaysia. International Journal of Environmental Research and Public Health, 17(2): 384. DOI: https://doi.org/10.3390/ijerph17020384
Chang, C.Y., Arasu, K., Wong, S.Y., Ong, S.H., Yang, W.Y., Chong, M.H.Z., Mavinkurve, M., Khoo, E.J., Chinna, K., Weaver, C.M. & Chee, W.S.S. 2021. Factors associated with bone health status of Malaysian pre-adolescent children in the PRE-BONE-Kids Study. BMC Pediatrics, 21: 382. DOI: https://doi.org/10.1186/s12887-021-02842-6
Chee, W.S.S., Suriah, A.R., Zaitun, Y., Chan, S.P., Yap, S.L. & Chan, Y.M. 2002. Dietary calcium intake in postmenopausal Malaysian women: comparison between the food frequency questionnaire and three-day food records. Asia Pacific Journal of Clinical Nutrition, 11: 142–146. DOI: https://doi.org/10.1046/j.1440-6047.2002.00276.x
Chin, K.Y., Kamaruddin, A.A.A., Low, N.Y. & Soelaiman, I.N. 2016. Effects of age, sex, and ethnicity on bone health status of the elderly in Kuala Lumpur, Malaysia. Clinical Interventions in Aging, 11: 767-773. DOI: https://doi.org/10.2147/CIA.S108772
Chin, K.Y., Low, N.Y., Dewiputri, W.I. & Ima-Nirwanaa, S. 2017. Factors associated with bone health in Malaysian middle-aged and elderly women assessed via quantitative ultrasound. International Journal of Environmental Research and Public Health, 14(7): 736. DOI: https://doi.org/10.3390/ijerph14070736
Chin, K.Y., Soelaiman, I.N., Mohamed, I.N., Ahmad, F., Mohd Ramli, E.S., Aminuddin, A. & Wan Ngah, W.Z. 2015. The association between bone health indicated by calcaneal quantitative ultrasound and metabolic syndrome in Malaysian men. Journal of Diabetes & Metabolic Disorders, 14: 9. DOI: https://doi.org/10.1186/s40200-015-0136-3
Chin, K.Y., Soelaiman, I.N., Mohamed, I.N., Mohamed, N., Shuid, A.N., Muhammad, N. & Wan Ngah, W.Z. 2013. Discrepancy between the quantitative ultrasound value of Malaysian men and the manufacturer’s reference and the impact on classification of bone health status. Journal of Clinical Densitometry, 16(2): 189–195. DOI: https://doi.org/10.1016/j.jocd.2012.03.004
Chiu, C.T., Lee, J.I., Lu, C.C., Huang, S.P., Chen, S.C. & Geng, J.H. 2024. The association between body mass index and osteoporosis in a Taiwanese population: a cross-sectional and longitudinal study. Scientific Reports, 14: 8509. DOI: https://doi.org/10.1038/s41598-024-59159-4
Chu, A.H. & Moy, F.M. 2015. Reliability and validity of the Malay International Physical Activity Questionnaire (IPAQ-M) among a Malay population in Malaysia. Asia Pacific Journal of Public Health, 27(2): 2381-2389. DOI: https://doi.org/10.1177/1010539512444120
Clemente, F.M., Ramirez-Campillo, R., Sarmento, H., Castillo, D., Raya-Gonzalez, J., Rosemann, T. & Knechtle, B. 2021. Effects of recreational small-sided soccer games on bone mineral density in untrained adults: A systematic review and meta-analysis. Healthcare (Basel), 9(4): 457. DOI: https://doi.org/10.3390/healthcare9040457
Daniel, W.W. & Cross, C.L. 2013. Biostatistics: A Foundation for Analysis in the Health Sciences. John Wiley & Sons, New York. 960 pp.
Elhakeem, A., Heron, J., Tobias, J.H. & Lawlor, D.A. 2020. Physical activity throughout adolescence and peak hip strength in young adults. JAMA Network Open, 3(8): e2013463. DOI: https://doi.org/10.1001/jamanetworkopen.2020.13463
El Miedany, Y., El Gaafary, M., Mahran, S. Gadallah, N., Abdel Azim, A., Hassan, W., Abu-Zaid, M.H., Shalaby, R.H., Alhamed Tabra, S.A. & Elwakil, W. 2024. The inter-relationship of the triad: osteoporosis, fracture risk, and obesity—a longitudinal multicenter analysis by the Egyptian Academy of Bone Health. Egyptian Rheumatology Rehabilitation, 51: 7. DOI: https://doi.org/10.1186/s43166-024-00241-0
Gandham, A., Mesinovic, J., Cervo, M.M., Glavas, C., Jansons, P., Ng, C.A., Rodriguez, J.P., Zengin, A., Bonham, M.P., Ebeling, P.R. & Scott, D. 2023. Associations of body mass index, body fat percentage and sarcopenia components with bone health estimated by second-generation high-resolution peripheral quantitative computed tomography in older adults with obesity. Experimental Gerontology, 179: 112227. DOI: https://doi.org/10.1016/j.exger.2023.112227
Guo, M., Lei, Y., Liu, X., Li, X., Xu, Y. & Zheng, D. 2023. The relationship between weight-adjusted-waist index and total bone mineral density in adults aged 20-59. Frontiers in Endocrinology (Lausanne), 14: 1281396. DOI: https://doi.org/10.3389/fendo.2023.1281396
Hong, A.R. & Kim, S.W. 2018. Effects of resistance exercise on bone health. Endocrinology and Metabolism (Seoul), 33(4): 435-444. DOI: https://doi.org/10.3803/EnM.2018.33.4.435
Jamil, N.A., Jia Ling, C., Md Ibrahim, H.I., Hamzaid, N.H. & Kok Yong, C. 2020. Nutritional and bone health status in young men with mild-to-moderate intellectual disability and without intellectual disability residing in community setting in Malaysia. Journal of Applied Research in Intellectual Disabilities, 33(3): 632-639. DOI: https://doi.org/10.1111/jar.12708
Kim, D.H., Lim, H., Chang, S., Kim, J.N., Roh, Y.K. & Choi, M.K. 2019. Association between body fat and bone mineral density in normal-weight middle-aged Koreans. Korean Journal of Family Medicine, 40(2):100-105. DOI: https://doi.org/10.4082/kjfm.17.0082
Koo, H.C., Lim, G.L., Kaur, S., Chan, K.Q., Chan, K.E., Chung, C., Wong, M. & Danaselvam, U. 2021. Bone health and its positive relationship with body composition in Malaysian schoolchildren: findings from a cross-sectional study. Children (Basel), 8(7): 569. DOI: https://doi.org/10.3390/children8070569
Kyle, U.G., Bosaeus, I., De Lorenzo, A., Deurenberg, P., Elia, M., Manuel Gόmez, J., Lilienthal Heitmann, B., Kent-Smith, L., Melchior, J.C., Pirlich, M., Scharfetter, H., Schols, A.M.W.J. & Pichard, C. 2004. Bioelectrical impedance analysis—Part II: utilization in clinical practice. Clinical Nutrition, 23(6): 1430-1453. DOI: https://doi.org/10.1016/j.clnu.2004.09.012
Lewis, R., Laing, E. & Weaver, C. 2018. Adolescence and acquisition of peak bone mass. In: Vitamin D. Volume 1: Biochemistry, Physiology and Diagnostics. Feldman, D. (Ed). Academic Press, Massachusetts, USA. pp. 731-748. DOI: https://doi.org/10.1016/B978-0-12-809965-0.00041-0
Li, L., Chen, X., Lv, S., Dong, M., Zhang, L., Tu, J., Yang, J., Zhang, L., Song, Y., Zu, L. & Zou, J. 2014. Influence of exercise on bone remodelling-related hormones and cytokines in ovariectomized rats: A model of postmenopausal osteoporosis. Plos One, 9(11): e112845. DOI: https://doi.org/10.1371/journal.pone.0112845
Lim, H.P., Nur Shahira, N. & Daud, N.M. 2022. Ethnic difference in bone health status and its association with calcium intake, physical activity and bone mass index among Malaysian older adults from Bangi and Kajang, Selangor, Malaysia. Malaysian Applied Biology Journal, 51(3): 147-157. DOI: https://doi.org/10.55230/mabjournal.v51i3.2410
Lu, J., Shin, Y., Yen, M.S. & Sun, S.S. 2016. Peak bone mass and patterns of change in total bone mineral density and bone mineral contents from childhood into young adulthood. Journal of Clinical Densitometry, 19(2):180-91. DOI: https://doi.org/10.1016/j.jocd.2014.08.001
Lloyd, J.T., Alley, D.E., Hawkes, W.G., Hochberg, M.C., Waldstein, S.R. & Orwig, D.L. 2014. Body mass index is positively associated with bone mineral density in US older adults. Archives of Osteoporosis, 9: 175 DOI: https://doi.org/10.1007/s11657-014-0175-2
Ma, M., Feng, Z., Liu, X., Jia, G., Geng, B. & Xia, Y. 2021. The saturation effect of body mass index on bone mineral density for people over 50 years old: A cross-sectional study of the US population. Frontiers in Nutrition, 8: 2021. DOI: https://doi.org/10.3389/fnut.2021.763677
Ma, G., Xu, B., Zhang, D. Zhu, L., Zhang, Y., Yang, B., Qin, X., Yin, H. & Wei, X. 2024. Association between weight-adjusted waist index and bone mineral density in adolescents. Scientific Reports, 14: 16509. DOI: https://doi.org/10.1038/s41598-024-66565-1
Massini, D.A., Nedog, F.H., de Oliveira, T.P., Almeida, T.A.F., Santana, C.A.A., Neiva, C.M., Macedo, A.G., Castro, E.A., Espada, M.C., Santos, F.J. & Pessôa Filho, D.M. 2022. The Effect of resistance training on bone mineral density in older adults: A systematic review and meta-analysis. Healthcare (Basel), 10(6):1129. DOI: https://doi.org/10.3390/healthcare10061129
Mathieu, M., Guillot, P., Riaudel, T., Boureau, A.S., Chapelet, G., Brouessard, C., de Decker, L. & Berrut, G. 2021. Association between bone mineral density and fat mass independent of lean mass and physical activity in women aged 75 or older. Nutrients, 13(6):1994. DOI: https://doi.org/10.3390/nu13061994
Multani, N., Kaur, H. & Chahal, A. 2011. Impact of sporting activities on bone mineral density. Journal of Exercise Science and Physiotherapy, 7(2): 103-109. DOI: https://doi.org/10.18376//2011/v7i2/67615
Nguyen, H.G., Pham, M.T., Ho-Pham, L.T. & Nguyen, T.V. 2020. Lean mass and peak bone mineral density. Osteoporosis and Sarcopenia, 6(4):212-216. DOI: https://doi.org/10.1016/j.afos.2020.10.001
NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. 2001. Osteoporosis prevention, diagnosis, and therapy. The Journal of the American Medical Association, 285: 785-795. DOI: https://doi.org/10.1001/jama.285.6.785
Nurumal, M.S., Md. Isa, M.L., Nik Mohd Hatta, N.N.K., Daud, A., Ibrahim, M., Sharifudin, M.A. & Deraman, S. 2019. Bone health status among postmenopausal women in Malaysia. International Journal of Women’s Health and Reproduction Sciences, 7(2): 169-173. DOI: https://doi.org/10.15296/ijwhr.2019.28
Oliveira, T.P., Espada, M.C., Massini, D.A., Robalo, R.A.M., Almeida, T.A.F., Hernández-Beltrán, V., Gamonales, J.M., Castro, E.A. & Filho, D.M.P. 2023. Effects of exercise and sports intervention and the involvement level on the mineral health of different bone sites in the leg, hip, and spine: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 15: 6537. DOI: https://doi.org/10.3390/ijerph20156537
Okada, E., Nakade, M., Hanzawa, F., Murakawi, K., Matsumoto, M., Sasaki, S. & Takimoto, H. 2023. National nutrition surveys applying dietary records or 24-h dietary recalls with questionnaires: a scoping review. Nutrients, 15(22): 4739. DOI: https://doi.org/10.3390/nu15224739
Patel, H., Woods, L., Teesdale-Spittle, P. & Dennison, E. 2020. A cross-sectional study of the relationship between recreational sporting activity and calcaneal bone density in adolescents and young adults. The Physician and Sports Medicine, 50(3): 218-226. DOI: https://doi.org/10.1080/00913847.2021.1903819
Perna, S., Gasperri, C., Allehdan, S., Riva, A., Petrangolini, G., Ferraris, C., Guido, D., Alalwan, T. A. & Rondanelli, M. 2023. Discovering the physio-pathological mechanisms of interaction between bone mineral density, muscle mass, and visceral adipose tissue in female older adults through structural equation modelling. Journal of Clinical Medicine, 12(6): 2269.
RNI (Recommended Nutrient Intakes for Malaysia). 2017. A report of technical working group on nutritional guidelines. National Coordinating Committee on Food and Nutrition. Kementerian Kesihatan Malaysia [WWW Document]. URL http://nutrition.moh.gov.my/wp-content/uploads/2017/05/FA-Buku-RNI.pdf (accessed 6.5.24).
Rockville. 2004. Bone health and osteoporosis: A report of surgeon general. Office of the Surgeon General (US) [WWW Document]. URL http://www.ncbi.nlm.nih.gov/books/NBK45513/ (accessed 7.19.24).
Rosengren, B.E., Bergman, E., Karlsson, J., Ahlborg, H., Jehpsson, L. & Karlsson, M.K. 2022. Downturn in childhood bone mass: a cross-sectional study over four decades. Journal of Bone and Mineral Research Plus, 6(1): e10564. DOI: https://doi.org/10.1002/jbm4.10564
Salari, N., Ghasemi, H., Mohammadi, L., Behzadi, M.H., Rabieenia, E., Shohaimi, S. & Mohammadi, M. 2021. The global prevalence of osteoporosis in the world: a comprehensive systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research, 16: 609. DOI: https://doi.org/10.1186/s13018-021-02772-0
Sien, Y.P. 2014. Bone health status among thalassemia children. International Journal of Public Health Research, 4(1): 399-404.
Simões, D., Craveiro, V., Santos, M.P., Camões, M., Pires, B. & Ramos, E. 2021. The effect of impact exercise on bone mineral density: A longitudinal study on non-athlete adolescents. Bone, 153: 116151. DOI: https://doi.org/10.1016/j.bone.2021.116151
Simone, P., Gasparri, C., Allehdan, S., Riva, A., Petrangolini, G., Ferraris, C., Guido, D., Alalwan, T.A. & Rondanelli, M. 2023. Discovering the physio-pathological mechanisms of interaction between bone mineral density, muscle mass, and visceral adipose tissue in female older adults through structural equation modeling. Journal of Clinical Medicine, 12(6): 2269. DOI: https://doi.org/10.3390/jcm12062269
Song, J., Zhang, R., Lv, L., Liang, J., Wang, W., Liu, R. & Dang, X. 2020. The relationship between body mass index and bone mineral density, A Mendelian randomization study. Calcified Tissue International, 107: 440-445. DOI: https://doi.org/10.1007/s00223-020-00736-w
Stanghelle, B., Bentzen, H., Giangregorio, L., Pripp, A.H. & Bergland, A. 2019. Associations between health-related quality of life, physical function and pain in older women with osteoporosis and vertebral fracture. BMC Geriatrics, 19: 298. DOI: https://doi.org/10.1186/s12877-019-1268-y
Tai, V., Leung, W., Grey, A., Reid, I.R. & Bolland, M.J. 2015. Calcium intake and bone mineral density: a systematic review and meta-analysis. British Medical Journal, 351: h4183. DOI: https://doi.org/10.1136/bmj.h4183
Tajaldeen, A., Alghamdi, S.S., Aljondi, R., Awan, Z., Helmi, N., Lingawi, K., Mujalad, A. & Alzahrani, W. 2022. Associations between body mass index, body composition and bone density in young adults: Findings from Saudi cohort. Journal of Radiation Research and Applied Sciences, 15(Issue 1): 268-274. DOI: https://doi.org/10.1016/j.jrras.2022.03.010
Tuzun, S., Eskiyurt, N., Akarirmak, U., Saridogan, M., Senocak, M., Johansson, H. & Kanis, J.A. 2012. Incidence of hip fracture and prevalence of osteoporosis in Turkey: the FRACTURK study. Osteoporosis International, 23(3): 949-55. DOI: https://doi.org/10.1007/s00198-011-1655-5
Weaver, C.M., Gordon, C.M., Janz, K.F., Kalkwarf, H.J., Lappe, J.M., Lewis, R., O’Karma, M., Wallace, T.C. & Zemel, B.S. 2016. The National Osteoporosis Foundation’s position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. Osteoporosis International, 27(4): 1281-1386. DOI: https://doi.org/10.1007/s00198-015-3440-3
WHO (World Health Organization). 2004. Expert consultation appropriate body mass index for Asian populations and its implications for policy and intervention strategies. Lancet, 363(9403): 157–163. DOI: https://doi.org/10.1016/S0140-6736(03)15268-3
WHO (World Health Organization). 2011. Waist circumference and waist-hip ratio. Report of a WHO Expert Consultation 38 [WWW Document]. URL https://www.who.int/nutrition/publications/obesity/WHO_report_waistcircumference_and_waisthip_ratio/en/ (accessed 8.20.24).
Wlodarek, D., Glabska, D., Kolota, A., Adamczyk, P., Czekajlo, A., Grzeszczak, W, Drozdzowska, B. & Pluskiewicz, W. 2014. Calcium intake and osteoporosis: the influence of calcium intake from dairy products on hip bone mineral density and fracture incidence – a population-based study in women over 55 years of age. Public Health Nutrition, 17(2), 383-389. DOI: https://doi.org/10.1017/S1368980012005307
Xue, S., Kemal, O., Lu, M., Lix, L.M., Leslie, W.D. & Yang, S. 2020. Age at attainment of peak bone mineral density and its associated factors: The National Health and Nutrition Examination Survey 2005–2014. Bone, 131: 115163. DOI: https://doi.org/10.1016/j.bone.2019.115163
Yahya, N.F.S., Daud, N.M., Makbul, I.A.A. & Aziz, Q.A.S.A. 2021. Association of calcium intake, lactose intolerance and physical activity with bone health assessed via quantitative ultrasound among young adults of a Malaysian university. Achieve of Osteoporosis, 16(1): 14. DOI: https://doi.org/10.1007/s11657-020-00874-6
Yahya, N.F.S., Makbul, I.A.A., Daud, N.M. & Abdul Aziz, Q.A.S. 2018. Relationship between body mass index, calcium intake and vitamin D status with bone mineral density among young adults: a preliminary investigation. Pakistan Journal of Nutrition, 17(4): 156-162. DOI: https://doi.org/10.3923/pjn.2018.156.162
Yoon, H., Sung, E., Kang, JH, Kim, C. H., Shin, H., Yoo, E., Kim, M. & Shin, S. 2023. Association between body fat and bone mineral density in Korean adults: a cohort study. Scientific Reports, 13: 17462. DOI: https://doi.org/10.1038/s41598-023-44537-1
Zhao, D., Fang, Z., Feng, Q., Li, X., Li, Y., Zhang, X., Wei, J., Feng, T., Luo, Y., Ma, S., Qin, G., Zhang, Q., Li, B. & Wang, J. 2023. Relationship between waist circumference, waist-height ratio, body fat percentage, visceral fat and bone mineral density in middle-aged and elderly Zhuang of China. Journal of Biosciences and Medicines, 11: 4. DOI: https://doi.org/10.4236/jbm.2023.114023
Zhu, K., Hunter, M., James, A., Lim, E.M. & Walsh, J.P. 2023. Relationships between longitudinal changes in body composition and bone mineral density in middle-to-older aged Australians. Osteoporosis International, 34(9):1601-1611. DOI: https://doi.org/10.1007/s00198-023-06773-z
Zhu, X. & Zheng, H. 2021. Factors influencing peak bone mass gain. Frontiers of Medicine, 15(1): 53-69. DOI: https://doi.org/10.1007/s11684-020-0748-y
Zulfarina, M.S., Sharif, R., Syarifah-Noratiqah, S.B., Sharkawi, A.M., Aqilah, S.M.Z., Mokhtar, S.A., Nazrun, S.A. & Isa, N.M. 2018. Modifiable factors associated with bone health in Malaysian adolescents utilizing calcaneus quantitative ultrasound. PloS One, 13(8): e0202321. DOI: https://doi.org/10.1371/journal.pone.0202321
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