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Effects of Calcium and Resistance Exercise on Body Composition in Overweight Premenopausal Women


Abstract and Figures

To examine the combined treatment effect of a mild energy restriction, high dairy calcium intake, and resistance exercise on promoting favorable body composition changes in overweight women with a low dairy intake. Combined treatment strategies may produce synergistic effects on increasing fat loss and preserving bone in a population at risk for obesity and osteoporosis. Overweight, sedentary women consuming a diet low in dairy calcium (≤1 serving of dairy per day) were randomized either (1) to maintain a low-calcium diet (LOW; ≤ 500 mg; n = 15) or (2) to increase dairy calcium (HIGH; ≥1200 mg; n = 14) for 16 weeks. Both groups began resistance training 3 days per week and received dietary counseling to reduce energy intake by 250 kcal per day. Body composition was measured at the beginning and at the end of the study with dual energy x-ray absorptiometry. Two 24-hour dietary recalls were measured at baseline, midpoint, and end of study with Nutrition Data System for Research software. Participants were 36.8 ± 4.8 years of age, with an average body mass index of 29.1 ± 2.1 kg/m2. Fat mass decreased significantly over time (LOW = 3.8 ± 4.1 kg and HIGH = 1.8 ± 2.1 kg) but was not significantly different by group. Mean energy reduction from baseline was 382 kcal (LOW) and 214 kcal (HIGH; p = 0.14). When change in energy intake was included as a covariate, there was still no significant difference in fat loss between groups. Change in lumbar spine bone mineral density (LOW = -1.5% and HIGH = 0.8%) was significant between groups (p = 0.02). The prescribed mean calcium intake was achieved for each study group (LOW = 454 ± 143 mg and HIGH = 1312 ± 183 mg), with no significant changes in protein intake over time (LOW = 0.9 g/kg and HIGH = 1.0 g/kg, p = 0.08). These results suggest that increasing dairy calcium offers no added benefit in reducing body fat when combined with resistance training and energy restriction. However, increasing dairy calcium improves bone mineral density in premenopausal overweight women.
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Original Research
Effects of Calcium and Resistance Exercise on Body
Composition in Overweight Premenopausal Women
David T. Thomas, PhD, Laurie Wideman, PhD, Cheryl A. Lovelady, PhD
Division of Clinical Nutrition (D.T.T.) University of Kentucky, Lexington, Kentucky, Department of Nutrition (C.A.L.) and
Department of Kinesiology (L.W.), The University of North Carolina Greensboro, Greensboro, North Carolina
Key words: dairy, bone, fat mass, resistance training
Objective: To examine the combined treatment effect of a mild energy restriction, high dairy calcium intake,
and resistance exercise on promoting favorable body composition changes in overweight women with a low dairy
intake. Combined treatment strategies may produce synergistic effects on increasing fat loss and preserving bone
in a population at risk for obesity and osteoporosis.
Methods: Overweight, sedentary women consuming a diet low in dairy calcium (1 serving of dairy per day)
were randomized either (1) to maintain a low-calcium diet (LOW; 500 mg; n ¼15) or (2) to increase dairy
calcium (HIGH; 1200 mg; n ¼14) for 16 weeks. Both groups began resistance training 3 days per week and
received dietary counseling to reduce energy intake by 250 kcal per day. Body composition was measured at the
beginning and at the end of the study with dual energy x-ray absorptiometry. Two 24-hour dietary recalls were
measured at baseline, midpoint, and end of study with Nutrition Data System for Research software.
Results: Participants were 36.8 64.8 years of age, with an average body mass index of 29.1 62.1 kg/m
. Fat
mass decreased significantly over time (LOW ¼3.8 64.1 kg and HIGH¼1.8 62.1 kg) but was not significantly
different by group. Mean energy reduction from baseline was 382 kcal (LOW) and 214 kcal (HIGH; p¼0.14 ).
When change in energy intake was included as a covariate, there was still no significant difference in fat loss
between groups. Change in lumbar spine bone mineral density (LOW ¼1.5%and HIGH ¼0.8%) was
significant between groups (p¼0.02). The prescribed mean calcium intake was achieved for each study group
(LOW ¼454 6143 mg and HIGH ¼1312 6183 mg), with no significant changes in protein intake over time
(LOW ¼0.9 g/kg and HIGH ¼1.0 g/kg, p¼0.08).
Conclusion: These results suggest that increasing dairy calcium offers no added benefit in reducing body fat
when combined with resistance training and energy restriction. However, increasing dairy calcium improves bone
mineral density in premenopausal overweight women.
The National Center for Health Statistics reports that 61%
of United States women aged 30 to 44 years are overweight or
obese, with the age-specific prevalence steadily increasing to
71%of women by the eighth decade of life [1]. In addition to
the rise in female obesity rates, osteoporosis is also becoming
more prevalent. It is estimated that osteoporosis in women will
increase by 1.4 million by 2020 [2]. Since the rate of obesity
and reduction of bone mineral density (BMD) increases with
age, behavioral interventions designed to prevent their
progression are needed prior to the development of disease-
related comorbidities.
Studies have shown that modifiable behavioral factors such
as diet and exercise can make a significant contribution to
optimizing BMD [3]. Sufficient calcium intake is necessary for
optimal bone health and prevention of age-related bone loss
over time [4]. Exercise also plays a significant role in bone
health because of the mechanical stress it places on bones [5].
Recent reports also show an association between dairy
calcium intake and fat oxidation [6–11]. Trials by Zemel et al.
[12–14] have shown a significant reduction in fat mass with
increased intake of dairy products and concomitant energy
Address correspondence to: David T. Thomas, PhD, 900 South Limestone Street, CTW Building, Room 209B, University of Kentucky, Lexington, KY 40536-0200.
This study was partially supported by a grant from the Department of Women and Gender Studies at the University of North Carolina Greensboro.
Journal of the American College of Nutrition, Vol. 29, No. 6, 604–611 (2010)
Published by the American College of Nutrition
restriction. In addition, observational studies suggest an inverse
relationship between dietary calcium and body weight and
indices of adiposity [15,16]. However, not all studies support
this relationship [17–20].
Interventions combining resistance exercise and increased
dairy consumption on body composition in premenopausal
women are limited in number [5,21]. A recent 12-week weight
loss trial incorporating resistance training and aerobics [5]
compared 4 supplement groups: calcium supplementation
(calcium lactate or phosphate), skim milk, or placebo. The
sample included women who normally consumed approxi-
mately 750 mg of calcium per day. There was no greater fat
loss among women increasing their calcium intake compared
with placebo. In comparison, White et al. [21] studied the effect
of 3 supplemental yogurt servings per day in young women
during resistance training for 8 weeks. Participating women
reported a habitual calcium intake 800 mg per day. All
groups significantly decreased percentage body fat over time,
but only the yogurt group reported higher energy intake during
the intervention. Given these findings, the question still
remains as to whether these results would be similar in
sedentary, untrained, premenopausal women normally con-
suming a low-calcium diet (500 mg) participating in a longer
16-week progressive whole-body resistance training program.
Since weight is regarded as a modifiable risk factor for
osteoporosis [22], intervention studies should be designed to
counter diet-induced bone loss by minimizing energy restric-
tion and promoting exercise as the primary strategy for
healthful, bone-preserving, body composition change. Promot-
ing dairy consumption as a third element may further enhance
the body composition benefits of resistance training and energy
restriction by augmenting fat loss while preserving BMD.
Therefore, when offering a combination of resistance training
and mild energy restriction in untrained, overweight women
with low habitual calcium intake, the primary aims of this study
were (1) to investigate if fat reduction is augmented by high
dairy calcium and (2) to evaluate if BMD is preserved by high
dairy calcium.
Women were recruited using advertisements distributed at a
local university campus and in the nearby community of a
southeastern city. Potential volunteers were asked questions
regarding dietary intake of dairy products, exercise, and
medical history, and they completed a validated screening
form designed to assess pre-exercise health status [23].
Inclusion criteria were (1) usual dairy intakes of less than or
equal to 1 serving per day, (2) 29 to 45 years of age, (3) body
mass index (BMI) of 25 to 30 kg/m
, and (4) no resistance
training in the previous 3 months.
Women who were pregnant or lactating, consumed calcium
supplements, consumed more than 1 serving per day of dairy
products, reported an aversion to dairy products, or who
reported previous history of orthopedic injury, gastrointestinal
disease, endocrine disorders, or any other medical condition
that could compromise the safety of participation were
excluded. Women who were on medications that could
confound study results were also excluded, including steroids,
diuretics, calcium channel blockers, insulin or antidiabetic
agents, synthetic thyroid hormones, and over-the-counter
weight loss supplements. The study was approved by the
university Institutional Review Board, and all eligible partic-
ipants gave informed written consent prior to engaging in
baseline measures. All institutional and governmental regula-
tions concerning the use of human volunteers were followed
during this research. Participants were not given any financial
compensation for participating in the study. Study incentives
included free exercise training, dietary counseling, and
discussion of personal results at study conclusion.
Study Design
This study was a 16-week randomized intervention trial.
After baseline measurements of diet, muscular strength, weight,
and body composition, participants were randomized to either a
continuation of their low-calcium diet (500 mg/d; LOW) or a
high-dairy–based calcium diet (1200 mg/d; HIGH) group.
Random numbers that corresponded to each of the study
groups were generated by statistical software and individually
placed in sealed envelopes for group assignment. Participants
assigned to LOW were asked to maintain their typical low-
calcium intake, whereas HIGH participants were instructed to
increase their dietary calcium by increasing their dairy intake.
Measurements of diet, strength, and anthropometrics were
reassessed at study midpoint and endpoint.
All volunteers participated in 3 days per week whole-body
resistance training for 16 weeks and were asked to refrain from
engaging in additional exercise or using dietary supplements
throughout the 16-week intervention. The primary goals of this
intervention were to reduce fat mass while maximizing the
conservation of BMD. Therefore, a modest weight loss of
approximately 0.25 kg/wk was our goal and was attempted
with a prescribed daily energy deficit limited to 250 kcal.
Participant weight was documented weekly and used as a tool
to assess diet adherence. In addition to monitoring body weight
changes, participants met with the study dietitian 3 times per
week prior to the exercise sessions to discuss dietary adherence
and address diet-related questions.
Anthropometric Measurements
Average height from 2 measurements was taken without
shoes on a stadiometer (Accustat Genentech, San Francisco,
CA) at baseline. Body weight was measured weekly on a
stationary balance beam scale in light exercise clothing without
Effects of Calcium and Exercise on Body Composition
shoes. Typical clothing consisted of exercise shorts and shirts
and remained similar throughout the study. Total and regional
body composition at baseline and endpoint were assessed by
dual energy x-ray absorptiometry (DXA; Lunar-Prodigy
Advance Plus, General Electric). DXA measures included total
body mass (kg), fat mass (kg), trunk fat (g), and BMD (g/cm
Fat mass index (FMI) was calculated from fat mass and height
measurements (FMI ¼fat mass [kg] 4height [m
]). FMI is a
better indicator of fat mass changes over time than percentage
body fat [24]. Waist circumference (Gulick II tape measure)
and sagittal diameter (Rosscraft Campbell Caliper 20) were
measured to assess changes in central adiposity over time.
Waist circumferences were measured at the narrowest part of
the waist per American College of Sports Medicine (ACSM)
guidelines [23] at all 3 study time points.
Exercise Intervention
Resistance training occurred 3 times per week for the entire
16-week study protocol. Participants chose to train on a
Monday-Wednesday-Friday or Tuesday-Thursday-Saturday
schedule. The resistance exercises for each training session
included dumbbell chops (for total body warm-up and core
stimulation), followed by dumbbell squats, dumbbell bench
press, dumbbell rows, and dumbbell dead lift. Participants
completed all training sessions in the Human Performance Lab
under the close supervision of trained research personnel.
Participants began the program with 2 weeks of exercise
familiarization followed by 14 weeks of progressive overload
training. During the familiarization period, participants com-
pleted all exercises with 2 sets of 10 repetitions at 60%–70%of
their baseline 1 repetition max (1-RM). Training progression
from weeks 3 to 16 was governed by baseline and midpoint
strength assessment, ability to perform goal range of 8–12
repetitions per set, and ability to maintain proper exercise form
throughout each exercise set. Starting at week 3, training
advanced to 3 sets per exercise, and participants gradually
progressed to training loads of 80%–100%of baseline 1-RM.
For the second half of the intervention (weeks 9–16),
participants continued to perform 3 sets per exercise within
the repetition range noted above and gradually progressed to
training at loads of 80%–100%of midpoint 1-RM.
Strength Assessment
Strength was assessed with 1-RM testing for all lifts at
baseline, midpoint, and at the end of 16 weeks [25]. Lifts
included dumbbell bench press, squats, dead lift, and rows.
Participants began with a warm-up of 5 to 10 repetitions at
40%–60%of the participant’s perceived capacity for 1 lift.
After a short rest period of 2 minutes, 3 to 5 repetitions were
completed at 60%–80%of the participant’s perceived capacity
for the same lift. Finally, successive 1-RM attempts were
performed until failure with the goal of determining the true 1-
RM within 3 to 5 trials. Verbal encouragement was given at
each attempt to maximize performance.
Diet Intervention
After randomization to either low-calcium (500 mg/d) or
high-calcium (1200 mg/d) diets, participants received
individualized counseling from a registered dietitian (RD)
and were instructed on the use of an exchange system diet to
guide prescriptions for energy and daily calcium intake. The
prescribed diet was based on the American Diabetes Associ-
ation exchange system [26] and provided approximately 15%
of total energy intake from protein, 55%to 60%from
carbohydrate, and 25%to 30%from fat. Diets were
individualized and designed by the study RD during initial
counseling sessions to promote a modest energy reduction
(250 kcal) from baseline energy needs. The primary method
for accomplishing this deficit was encouraging participants to
reduce their sugar and fat intake while attempting to increase
nutritious food variety and appeal.
Participants in the high–dairy calcium group received a
high-calcium food list and were given examples on how to
incorporate these foods into their daily exchange plan to
maintain their daily dietary intake goal of 1200 mg. The
primary strategy for increasing calcium intake was through
encouraging the consumption of at least 3 servings of low-fat
dairy foods per day. Participants in the low-calcium group were
instructed not to consume any dairy products or calcium
supplements and to avoid any food with greater than 15%of
daily calcium value per serving, and they were taught to avoid
naturally occurring nondairy calcium sources. Participants in
both groups received daily vitamin D supplements (400 IU) to
prevent insufficient dietary intake.
Energy intake requirements were estimated using the Food
and Nutrition Board’s equation for determining energy needs in
overweight and obese adult women [27]. Adjustment of total
energy expenditure (TEE) for physical activity levels (PAL)
were accomplished by multiplying the TEE by the appropriate
PAL coefficient determined by assessing usual activity level
(sedentary ¼1.0 or low active¼1.16). This energy estimate was
added to the energy intake determined by the baseline dietary
recall information. The 2 estimates were averaged, resulting in
the energy required for weight maintenance. The energy
prescription was determined by subtracting 250 kcal to promote
a 0.25-kg weight loss per week. During the course of the 16-
week trial, if weight loss was not progressing as planned, the
study RD immediately assessed diet adherence and subsequent-
ly decided if additional food exchanges needed to be subtracted
from the diet plan to create a greater energy intake deficit.
Diet Assessment
Participants reported their dietary intake during a phone
interview by staff trained in the use of nutrition research
606 VOL. 29, NO. 6
Effects of Calcium and Exercise on Body Composition
software. The Nutrition Data System for Research (NDS
version 2008, Minneapolis, MN) nutrition software system was
used to collect and assess dietary intake. This system uses the
multiple-pass method to help improve the validity of dietary
data [28,29]. The multiple-pass method is a standardized recall
strategy that refers to the number of times a participant’s food
intake is reviewed during the interview in efforts to improve
accuracy. Two random weekday 24-hour dietary recalls
occurred within a 7-day period at baseline, midpoint, and at
the end of the study.
Statistical Analysis
Sample size was determined using the difference in loss of
fat mass reported by Zemel et al. [12] (high-calcium group ¼
4.43 60.47 kg, low-calcium group ¼2.75 60.73 kg). A final
sample size of 26 (13 per group) was estimated to provide
significant power (80%) to detect a 1.68-kg difference in fat
loss between groups. Data were analyzed using the Statistical
Package for the Social Sciences (SPSS) software for Windows
(version 15.0, SPSS Inc, Chicago, IL, 2007). Differences
between groups in baseline characteristics were determined
with the Student ttest. Differences in body composition,
weight, anthropometrics, diet, and strength over time and by
group were determined by repeated-measures analyses of
variance (RMANOVA). Since energy intake affects fat loss,
post hoc analysis was done, entering change in energy intake as
a covariate in the RMANOVA of fat loss between groups. A
post hoc analysis was also conducted with race (black versus
nonblack) as a covariate when assessing changes in BMD. Data
are reported as means and standard deviations.
Thirty-five participants met all eligibility requirements and
were invited to the laboratory for baseline measures. After
randomization, 6 participants withdrew from the study because
to pregnancy (n ¼1, HIGH) and personal reasons (n ¼2, LOW;
n¼3, HIGH). A total of 29 participants completed the 16-week
intervention. Baseline characteristics were not different be-
tween dropouts and those who completed the study. There were
no significant differences in baseline age, weight, height, or
BMI between groups (Table 1).
Body Composition
Changes in weight and body composition by group are
outlined in Table 2. Mean weight loss over the 16-week
protocol was 2.7 64.5 kg (LOW) and 1.1 62.5 kg (HIGH),
which was significant over time but not between groups. While
both groups significantly decreased their fat mass over time
(LOW ¼3.8 64.1 kg versus HIGH ¼1.8 62.1 kg), there were
no observed group differences. When change in energy intake
Table 1. Baseline Characteristics of Participants by Group
Low Calcium
(n ¼15)
High Calcium
(n ¼14)
Age (y), mean (SD) 37.1 (5.4) 36.4 (4.3)
Weight (kg), mean (SD) 76.7 (7.3) 76.9 (6.9)
Height (cm), mean (SD) 163.4 (5.9) 162.2 (5.6)
Body mass index (kg/m
mean (SD)
28.9 (2.3) 29.3 (1.9)
Race (n)
Black 7 11
White 5 3
Asian 2 0
Latina 1 0
Table 2. Mean (SD) Body Composition Measurements at Baseline and Endpoint by Group
Low Calcium (n ¼15) High Calcium (n ¼14)
Baseline Endpoint Baseline Endpoint
Body weight (kg)
76.7 (7.3) 74.1 (6.9) 76.9 (6.9) 75.8 (6.8)
Body fat
Fat mass (kg)
32.5 (5.2) 28.7(5.3) 33.9 (4.4 ) 32.1 (4.8)
Fat mass index (fat kg/m
12.2 (2.0) 10.8 (2.0) 12.9 (1.6 ) 12.2 (1.7)
Trunk fat (g)
17.0 (3.6) 14.9 (3.7) 16.6 (2.7 ) 15.3 (2.5)
Fat-free mass (kg)
44.2 (3.7) 45.4 (3.8) 43.0 (4.3) 43.6 (4.3)
Waist circumference (cm)
87.9 (6.0) 83.9 (6.6) 84.0 (5.9) 81.9 (5.7)
Sagittal diameter (cm)
26.6 (2.2) 25.4 (2.2) 25.5 (2.2) 24.4 (2.2)
Bone mineral density (BMD)
Total body BMD (g/cm
) 1.25 (0.06) 1.25 (0.06) 1.27 (0.08) 1.28 (0.08)
Lumbar spine BMD (g/cm
1.31 (0.14) 1.29 (0.12) 1.36 (0.15) 1.37 (0.14)
Total hip BMD (g/cm
) 1.05 (0.10) 1.05 (0.10) 1.08 (0.13) 1.09 (0.12)
Significantly decreased over time, p0.05 (repeated-measures analyses of variance [RMANOVA]).
Significantly changed over time, p0.005 (RMANOVA).
Significantly different by group, p0.01 (RMANOVA).
Effects of Calcium and Exercise on Body Composition
was included as a covariate, there was still no significant
difference in fat loss between groups.
Trunk fat decreased significantly over time, with no
differences between groups (LOW ¼2.1 62.5 kg versus
HIGH ¼1.2 61.4 kg). Waist circumference decreased
significantly over time, without group differences. Participants
in the LOW group lost 3.97 65.3 cm in waist circumference
compared with participants in the HIGH group, who lost 2.1 6
2.3 cm. Women with a waist circumference greater than 88 cm
at baseline (n ¼11), which is considered at risk for the
development of chronic disease per ACSM guidelines [23], lost
5.3 cm in waist circumference compared with 1.7 cm in women
with lower baseline measures (n ¼18; p¼0.02). Mean sagittal
diameter reduction was significant over time (LOW ¼1.2 6
1.4 cm versus HIGH ¼1.1 60.8 cm) but not between groups.
Women in the HIGH group gained 0.8%in their lumbar
spine BMD, which was significantly different from the loss of
1.5%in the LOW group (p¼0.02). There were no differences
in total body or hip BMD over time or between groups. In post
hoc analysis, after controlling for race, there was still a
significant difference between groups (p¼0.002) in lumbar
spine but not in total body or hip BMD. Only 2 women (13%)
in the LOW group increased their lumbar spine BMD,
compared with 9 (64%) in the HIGH group.
Dietary Changes
The dietary intake of groups over the course of the study is
outlined in Table 3. Energy intake, protein intake per kilogram
body weight, and calcium intake were not significantly
different at baseline. The HIGH group achieved their goal
calcium intake, as evidenced by a mean intake (average of
midpoint and endpoint) of 1312 mg, whereas the LOW group
reported a mean intake of 454 mg. Energy intake significantly
decreased over time in both groups (p0.05). The mean
energy intake reduction from baseline was 382 kcal (LOW)
and 214 kcal (HIGH; p¼0.14). The mean study protein intake
was 67 g (LOW) and 78 g (HIGH; p¼0.01), with protein per
kilogram body weight remaining constant (0.9 60.1 g/kg
LOW versus 1.0 60.2 g/kg HIGH; p¼0.08) throughout the
study. Carbohydrate intake was significantly (p¼0.02)
different between groups, with an average of all 3 time points
of 205 g (LOW) and 219 g (HIGH). No time (p0.09) or
group (p0.39) differences were observed in caffeine,
alcohol, or fiber intake. Dietary vitamin D intake was not
significant between groups (p¼0.06 ). Adherence with vitamin
D supplementation was estimated at .90%based on self-
reported weekly assessment.
Strength Change
Total workload (load 3repetitions) significantly increased
over time in both groups ( p0.0001) without group
differences. Measures of strength (1-RM) were similar between
groups at baseline. Strength increases in both groups were
significant in the bench press, squat, dead lift, and dumbbell
row exercises (p0.001) with no group differences (data not
shown). Exercise adherence in the LOW group was 93.2%
versus 91.4%in the HIGH group.
High dairy calcium intake did not enhance fat loss when
added to a structured resistance exercise and modest energy
reduction program but did increase lumbar BMD in overweight
women. The fat loss finding is similar to others who increased
calcium intake but did not implement an exercise program.
Shapses et al. [19] found no effect on fat loss with calcium
supplementation during energy restriction, and Gunther et al.
Table 3. Dietary Intake at Baseline, Midpoint, and Endpoint by Group
Low Calcium (n ¼15) High Calcium (n ¼14)
Baseline Midpoint Endpoint Baseline Midpoint Endpoint
Energy (kcal)
1882 (324) 1458 (425) 1541 (273) 1835 (407) 1677 (319) 1565 (304)
Kilocalories per kilogram
24.6 (4.5) 19.6 (6) 21 (3.8) 24.1 (6.2) 22 (4.5) 21 (4.5)
Protein (g)
73.6 (19.4) 60.8 (12.6) 73.0 (10.7) 66.6 (19.5) 77.1 (17.7) 78.8 (16.2)
Protein (%)
15.6 (3.7) 17.7 (3.9) 19.9 (4.4) 14.7 (3.5) 19.9 (6.0) 21.0 (5.4)
Protein per kilogram 1 (0.3) 0.8 (0.2) 1 (0.1) 0.9 (0.3) 1 (0.3) 1.1 (0.3)
Fat (g)
72.7 (24.8) 41.4 (18.3) 47.1 (13.1) 72.7 (19.1) 50.2 (17.3) 49.6 (20.9)
Total carbohydrate (g)
237 (41.5) 197 (27.7) 214 (44.9) 228 (67.3) 234 (43.4 ) 204 (53.8)
Caffeine (mg) 133 (192) 114 (229) 105 (170) 89 (82) 49 (72) 58 (64)
Fiber (g) 19.4 (7.4) 22.3 (5.4) 19.5 (6.0) 13.8 (4.9) 15.7 (3.4) 14.0 (4.8)
Vitamin D (mg) 2.8 (3.0) 2.7 (2.6) 2.4 (2.5) 3.7 (3.5) 7.2 (3.1) 7.5 (3.2)
Alcohol (g) 2 (5.6) 0.01 (0.0) 0.12 (0.2) 3.6 (7.2) 1.9 (7.1) 1.6 (6.0)
Calcium (mg)
554 (136) 463 (150) 445 (166) 543 (148) 1313 (289) 1311 (245)
Significantly different over time, p0.001 (repeated-measures analyses of variance [RMANOVA]).
Significantly different between groups, p0.05 (RMANOVA).
Significantly different over time and between groups, p0.001 (RMANOVA).
608 VOL. 29, NO. 6
Effects of Calcium and Exercise on Body Composition
[30] found no benefit of increasing dairy intake without energy
restriction on body weight or fat mass. In previous trials, it is
possible that confounding factors in study design such as the
use of calcium supplements instead of dairy-based dietary
calcium [18,19] and high baseline calcium intake .500 mg/d
[19,20] may have prevented the ability to observe a group
response. It is important to note that usual calcium intake of
participants in the current trial was 549 mg. This intake was
much lower than average intakes of 700–800 mg/d in women
aged 12 through 59 years in NHANES III. Energy intake did
not differ significantly between groups, but the LOW group
reported a larger, almost twofold, energy deficit from baseline
to endpoint compared with the HIGH group. However, in post
hoc analysis of adding the change in energy intake as a
covariate, there was still no significant difference of fat loss
between groups (p¼0.15). The variability in energy intake was
too large to determine a significant difference between groups.
Other clinical trials have prescribed larger energy deficits of
at least 500 kcal [12–14,18–20,31] and resulted in much larger
weight loss. Some of these trials [12–14] have observed a
positive effect of dairy on weight loss, while others [18–20,31]
suggested that the addition of dairy or calcium supplements did
not enhance weight loss. Our data show no added benefit of a
high–dairy calcium diet on weight loss during resistance
training with a smaller energy deficit.
The results of the change in body composition between
LOW and HIGH groups are similar to a recent 8-week
resistance training study by White et al. [21]. They reported
differences between high dairy calcium and low calcium
groups in weight and body composition [21]. It is important to
note that they did not include an intervention to restrict energy
intake and studied mostly normal weight, young women.
However, body composition changes over time expressed by
increased fat-free mass and decreased fat mass were consistent
with our results and suggest a strong influence of resistance
training on promoting positive body composition changes.
Much of the fat lost was in the trunk region, an area strongly
implicated in the development of metabolic syndrome. It was
also observed that participants with the largest waist circum-
ference at baseline (88 cm) lost more waist circumference
than participants with a smaller waist circumference at baseline
(,88 cm). The magnitude of fat loss generated by this
intervention is comparable to other studies that report an
association with fat mass reduction and calcium intake [5,21].
This 4-month intervention resulted in a 1.5%loss in lumbar
BMD in the LOW group, compared with an 0.8%increase in
lumbar BMD in the HIGH group. These are significant findings
due to the short time frame of the intervention and that this
population was not within a stage of life that is associated with
a large amount of bone turnover (pregnancy, lactation, and
menopause). Typically, longer trials are needed to observe
appreciable differences in BMD caused by weight-bearing
exercise. Singh et al. [32] showed that resistance training over 9
months without dietary intervention did not lead to significant
changes in total body or regional BMD in premenopausal
women. Their exercise group reported a nonsignificant 2.2%
increase in spinal BMD compared with no observed changes in
the control. Even though both groups in the current study were
resistance training, only 2 women (13%) in the LOW group
increased their BMD, compared with 9 (64%) in the HIGH
When examining BMD change across groups, the variations
in calcium and energy restriction are also noteworthy. Other
trials [19,30] allowed for a 200–400 mg/d difference between
control and intervention groups in comparison to 600–700 mg/
d in this study. Furthermore, the presence of a mild energy
intake restriction in the current study may have contributed to
the loss of BMD in the LOW group, an effect that was
potentially negated by the group receiving high dairy calcium
treatment. This preservation effect is supported by Shapses et
al. [19], who studied obese premenopausal women during
moderate weight loss and reported that a daily calcium
supplement produced a small increase in lumbar BMD by
1.7%. The findings in this study suggest that suboptimal dairy
calcium coupled with small energy restrictions may potentiate
greater bone losses when calcium intake is less than 600 mg/d.
The results also suggest the importance of increasing dairy
calcium intake in the presence of a similar energy restriction
and exercise program employed in this study. This strategy
may improve BMD in women reporting low calcium intakes,
even at this stage of life.
Strengths of this study include participant commitment, as
evidenced by high exercise adherence (90%), high total work
(load 3repetitions) during supervised training sessions, and
significant body composition changes by exercising 25–30
minutes 3 times per week while making small dietary changes.
To our knowledge, there are no studies that match both the
demographic (diverse racial group of women) and intervention
characteristics (energy restriction, dairy supplementation, and
resistance training) of this current trial.
A limitation of this trial is the possibility of underreporting
dietary intake, as suggested by the low reported energy intake
compared with weight loss outcomes. Dietary underreporting
has been observed in women more than men, and there appears
to be an inverse relationship in the magnitude of underreporting
and BMI in women [33]. In addition, a study comparing
telephone-administered multiple-pass dietary recall methods
with doubly labeled water [34] found a 16%rate of
underreporting among women with similar characteristics of
participants in this trial. Another limitation of this study is
sample size; for this trial, we conducted an a priori calculation
of sample size. Based on the variability in fat loss reported by
Zemel et al. [12] (4.43 60.47 kg vs 2.75 60.73 kg), 26
participants were determined as our sample size goal to detect a
difference of 1.68 kg in fat loss between groups at 80%power
with a significance of p,0.05. The large variability in weight
Effects of Calcium and Exercise on Body Composition
loss observed in our women resulted in lower power to
determine significant differences.
Fat loss and strength gains over time were primarily related
to the resistance exercise stimulus and energy reduction and
were not enhanced by increasing dairy calcium intake. While
there may be other benefits to increasing calcium intake (e.g.,
BMD), high dairy calcium diets do not appear to enhance fat
mass reduction when combined with 16 weeks of resistance
training in this population of women. Since excess weight and
truncal fat are associated with the risk for developing metabolic
syndrome [35], this type of program may be a factor in
preventing or delaying its onset. This is evident by the
significant trunk fat reductions experienced in this trial despite
relatively small dietary changes and resistance exercise lasting
only 25 minutes, 3 times per week. In addition, dietary calcium
of 1200 mg per day was sufficient to support the anabolic
effects of resistance training resulting in an increase in lumbar
BMD, while ,500 mg per day was not adequate as it resulted
in a loss in lumbar BMD. Results from this study are promising
because bone accretion is not thought to be possible at this age
of life, particularly during weight loss. Therefore, the
convenient and time-efficient nature of this diet and exercise
program may be relevant in improving the health of women at
risk for bone loss, weight gain, and metabolic syndrome.
We thank the undergraduate and graduate students who
assisted in data collection. We also thank Paula Cooney for her
technical assistance with DXA measures. We would also like to
acknowledge the Department of Women and Gender Studies at
the University of North Carolina Greensboro for financial
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Received May 4, 2010; revision accepted December 2, 2010.
Effects of Calcium and Exercise on Body Composition
... Relevant original studies published to 22 March 2016 (first search conducted on 2 June 2014 and updated on 22 March 2016) were identified by a comprehensive systematic search of scientific journal databases (MEDLINE on Web of Science, EMBASE, Pubmed, Cochrane Central and World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and scanning reference lists of included reports, key meta-analyses and reviews. Two search themes were specified based on the dairy intervention and outcome variables using relevant medical subject heading (MeSH) terms and key words. ...
... The correlation coefficient calculated was only applied to studies of ď9 months duration, because fully reported data was not available for studies of longer duration. SDs were imputed for three studies [20][21][22]. Study authors were contacted for missing data or when results were presented in graphs. When no response was received results presented in graphs were estimated by UN-SCAN-IT software for windows (version 7, Silk Scientific Inc., Orem, UT, USA) or the data was not included in the meta-analysis. ...
... Daily intake of protein and calcium at baseline are summarized in Table S1. Few studies reported dairy intake at baseline, but based on inclusion criteria of ď1 serving/day or reported baseline calcium intake <600 mg/day, low dairy intake at baseline was presumed for 11 studies [12,22,41,44,45,47,52,[54][55][56][57] while high intakes of >1 serving/day were assumed for other studies because of high baseline calcium intakes reported (>600 mg/day) [20,39,43,50,53]. Several studies, however, did not report dietary intake at baseline (Table S1). ...
Full-text available
Background/aims: A meta-analysis of randomized controlled trials (RCTs) was performed to investigate the effects of dairy food or supplements during energy restriction on body weight and composition in 18-50-year-old. Methods: RCTs ≥ 4 weeks comparing the effect of dairy consumption (whole food or supplements) with control diets lower in dairy during energy restriction on body weight, fat and lean mass were identified by searching MEDLINE, EMBASE, Pubmed, Cochrane Central and World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) until March 2016. Reports were identified and critically appraised in duplicate. Data were pooled using random-effects meta-analysis. Chi²- and I²-statistics indicated heterogeneity. Dose effect was assessed using meta-regression analysis. GRADE guidelines were used to rate the quality (QR) of the evidence considering risk of bias, inconsistency, indirectness, imprecision, publication bias and effect estimates. Results: 27 RCTs were reviewed. Participants consumed between 2 and 4 standard servings/day of dairy food or 20-84 g/day of whey protein compared to low dairy control diets, over a median of 16 weeks. A greater reduction in body weight (-1.16 kg [-1.66, -0.66 kg], p < 0.001, I² = 11%, QR = high, n = 644) and body fat mass (-1.49 kg [-2.06, -0.92 kg], p < 0.001, I² = 21%, n = 521, QR = high) were found in studies largely including women (90% women). These effects were absent in studies that imposed resistance training (QR = low-moderate). Dairy intake resulted in smaller loss of lean mass (all trials pooled: 0.36 kg [0.01, 0.71 kg], p = 0.04, I² = 64%, n = 651, QR = moderate). No between study dose-response effects were seen. Conclusions: Increased dairy intake as part of energy restricted diets resulted in greater loss in bodyweight and fat mass while attenuating lean mass loss in 18-50-year-old adults. Further research in males is needed to investigate sex effects.
... After screening the titles and abstracts, 50 and 69 articles, respectively, remained for the full text evaluation (Supplemental Figure 1(A,B)). In the end, after excluding studies at 1 to 17 years old due to the small number of articles ( 2 articles for each obesity index), 13 study arms from 10 articles about calcium supplements (Yanovski et al. 2009;Reid et al. 2010;Shalileh et al. 2010;Zhou et al. 2010;Palacios et al. 2011;Smilowitz et al. 2011;Jones et al. 2013;Torres and Sanjuliani 2013;Zhu et al. 2013;Subih et al. 2018) and 16 study arms from 14 articles about dairy products (Kukuljan et al. 2009;Wennersberg et al. 2009;Angeles-Agdeppa et al. 2010;Thomas et al. 2010;Gilbert et al. 2011;Josse et al. 2011;Palacios et al. 2011;Rosado et al. 2011;Smilowitz et al. 2011;Stancliffe et al. 2011;Van Loan et al. 2011;Jones et al. 2013;Tanaka et al. 2014;Bendtsen et al. 2018) were included in the meta-analysis. ...
... The interventions were mostly done by comparing low-dairy diets as a control group with adequate-dairy diets as the experimental group. The criteria for low-dairy varied from none to habitual intake; none (Rosado et al. 2011), lower than 0.5 serving per day (serving/d) (Stancliffe et al. 2011), about 1 serving/d (Josse et al. 2011;Smilowitz et al. 2011;Van Loan et al. 2011;Jones et al. 2013;Bendtsen et al. 2018), 2 serving/d (Angeles-Agdeppa et al. 2010; Gilbert et al. 2011), and habitual intake (Kukuljan et al. 2009;Wennersberg et al. 2009;Thomas et al. 2010;Palacios et al. 2011;Tanaka et al. 2014). It was based on one serving amount for each dairy product (200-250 ml for milk, 170-180 g for yogurt, and 30-60 g for cheese). ...
This meta-analysis was performed to investigate whether calcium supplements and dairy products change obesity indices including fat mass. Original articles published in English between July 2009 and August 2019 were identified. Ten and 14 randomised controlled trials (RCTs) with ≥ 12 weeks interventions of calcium supplements and dairy products among overweight or obese adults aged ≥18 were critically reviewed. Mean difference (MD) or standardised mean difference (SMD) with 95% confidence interval (CI) were obtained using a random effect meta-analysis. Dairy products significantly changed fat mass (SMD, 95% CI; −0.40 [−0.77, −0.02]) and BMI (MD, 95% CI: −0.46 kg/m2 [−0.67, −0.26]), and calcium supplements also showed changes in fat mass (SMD, 95% CI; −0.15 [−0.28, −0.02]). However, in the analysis of RCTs with low risk of bias scores, the significant changes remained only in the dairy-products intervention. Our findings suggest that dairy products without distinction of fat percentage may help reduce fat mass and BMI, but calcium supplements may not.
... meat, fish, egg, dairy, vegetable) constituted the majority of total protein intake within the 34 publications (87%). Other publications emphasized the consumption of specific protein-containing foods, where the majority of dietary protein came from dairy sources (42,44,47,57,67,68,79,81), meat sources (57), or supplements (27,52) (Supplemental Figure 2). Data on dietary calcium and vitamin D intakes were not available for all studies (calcium, n = 26; vitamin D, n = 15); however, average intakes were 1.01 ± 0.39 g/d and 9.0 ± 17.2 μg/d, respectively. ...
... Risk-of-bias assessment is described in Table 1. Eleven articles displayed a low risk of selection and performance bias due to clear reporting of the randomization method, allocation concealment, and blinding techniques (44,45,53,55,59,61,64,67,69,71,73). However, the vast majority failed to fully report on such details and thus showed an unclear risk of selection or performance bias (n = 20) (13, 17, 24, 25, 27, 38, 41, 46-48, 52, 54, 56, 57, 60, 63, 66, 68, 70, 72). ...
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Research supports the hypothesis that higher total protein intake during weight loss promotes retention of lean soft tissue, but the effect of dietary protein quantity on bone mass, a lean hard tissue, is inconsistent. The purpose of this systematic review and meta-analysis was to assess the effect of dietary protein quantity [higher protein (HP): ≥25% of energy from protein or ≥1.0 g · kg body wt-1 · d-1; normal protein (NP): <25% of energy from protein or <1.0 g · kg body wt-1 · d-1] on changes in bone mineral density (BMD) and content (BMC; total body, lumbar spine, total hip, femoral neck) following a prescribed energy restriction. We hypothesized that an HP diet would attenuate the loss of BMD/BMC following weight loss in comparison to an NP diet. Two researchers systematically and independently screened 2366 publications from PubMed, Cochrane, Scopus, CINAHL, and Web of Science Core Collection and extracted data from 34 qualified publications. Inclusion criteria included the following: 1) healthy subjects ≥19 y; 2) a prescribed energy restriction; 3) measurements of total protein intake, BMD, and BMC; and 4) an intervention duration of ≥3 mo. Data from 10 of the 34 publications with 2 groups of different total protein intakes were extracted and used to conduct a random-effects model meta-analysis. A majority of publications (59%) showed a decrease in bone quantity following active weight loss, regardless of total protein intake. Statistically, the loss of total BMD (P = 0.016; weighted mean difference: +0.006 g/cm2; 95% CI: 0, 0.011 g/cm2) and lumbar spine BMD (P = 0.019; weighted mean difference: +0.017 g/cm2; 95% CI: 0.001, 0.033 g/cm2) was attenuated with an HP versus an NP weight-loss diet. However, the clinical significance is questionable given the modest weighted mean difference and study duration. Higher total protein intake does not exacerbate but may attenuate the loss of bone quantity following weight loss.
... It should be noted that Pilates training does not require a high physical fitness and emphasizes muscles' ability to maintain body balance (18). Performing Pilates requires no special skills and equipment; it is applicable to mattresses and for people with a normal fitness level (19,20). Thus, this study aimed to examine the effect of Pilates training on body composition, lipid profile, and serum 25-hydroxy vitamin D levels in inactive overweight women. ...
Full-text available
Background: The increasing prevalence of overweight and related diseases has gained more scientific attention. Overweight and obesity are known as a threat to health, and low serum 25-hydroxy vitamin D levels is associated with obesity. Objectives: Therefore, we examined the effect of Pilates training on body composition, lipid profile, and serum 25-hydroxy vitamin D levels in inactive overweight women. Methods: In this clinical study, 28 overweight women were randomly divided into a training group (n = 14) and a control group (n = 14). Pilates training was performed three 60-min sessions during 12 weeks. In two stages, blood samples were collected 48 hours before and after the last protocol exercise training session. During the 12 weeks, the control group had no exercise training. For analyzing within- and between-group changes, paired t-test and ANCOVA with the significant level of P < 0.05 were used, respectively. Results: After 12 weeks of Pilates training in the training group compared to the control group, there was a significant decrease in the body mass index (P = 0.005), cholesterol (P = 0.001) and triglyceride (P = 0.001) values, and serum 25-hydroxy vitamin D levels (P = 0.005), while high-density lipoprotein (P = 0.028) increased significantly. However, no significant change was observed in low-density lipoprotein levels (P = 0.435). Conclusions: According to the results, it can be indicated that 12 weeks of Pilates training have improved serum 25-hydroxy vitamin D levels, changed anthropometry, and lipid profile in inactive overweight women.
... Although those on the low-calcium diet had greater LBM and fat loss, those on the high-calcium diet that exceeded dietary calcium experienced a slower rate of fat loss [19]. ...
... Yoghurt has also been shown to augment general and central fat loss in obese subjects on a balanced, energy deficit diet [2090 kJ (500 kcal)/d] for 12 weeks compared with the usual low Ca diet (81% augmentation in trunk fat loss by yoghurt intake, P < 0.001) (Zemel et al., 2005a). Similar results for yoghurt on fat loss were observed by Thomas et al. (2010) when the intervention was combined with resistance training and modest energy restriction, although the difference did not reach statistical significance. ...
The prevalence of obesity has reached epidemic proportions globally, and the trend is especially alarming in children and adolescents. Dairy products provide a range of nutrients that are important to health but contribute to overconsumed nutrients such as fat and saturated fat. Data from existing reviews on the role of dairy products in the development of obesity in childhood and adulthood are inconsistent. This chapter reviews the totality of evidence and the justification for the current approach of limiting dairy in the diet to reduce or prevent obesity or weight gain. The majority of data available from longitudinal and intervention studies in adults provide evidence of neutral associations between intakes of milk and other dairy products, and body weight and adiposity measures. Similar results were found for children and adolescents, while there is limited data for older adults. Although the mechanisms have not been clearly elucidated, they include effects on energy and fat balance, fatty acid absorption, appetite, and the metabolic activity of gut microbiota. In conclusion, although inconsistencies exist, there is little evidence to support the justification for limiting dairy in the diet on the grounds that they may promote obesity.
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Backgrand and Objective: Low levels of 25-Hydroxyvitamin D are associated with obesity and anthropometricindices. Therefore,the aim of this study was to determine the effect of aerobic interval exercise training on serum levels of 25-OH Vitamin D and anthropometric indices in obesity and overweight women. Subjects and Methods: In this research semi-experimental study, 20 obese and overweight women aged between 30 to 50 years. and mean BMI of 31.71 ± 2.59 Kg / m2 referring to the Ahvaz Jundishapur University Clinic were selected purposefully. and randomly They were divided into intervention and control groups. The training program consisted of 30-45 minutes of aerobic interval exercise with intensity of 50-70% and 40-4540% of maximum heart rate, respectively, 2 minutes of exercise and 2 minutes of active rest, 3 sessions/ week for 8 weeks. Anthropometric and serum level of 25-hydroxyvitamin D were measured before and after intervention in both groups. Data analysis was performed using independent and dependent t test at a significant level (P ≤0.05) Results: After eight weeks of of aerobic interval exercise training, a significant increase was observed in levels serum 25-hydroxyvitamin D (P=0.002). Which was associated with a significant decrease in body fat percentage, waist to hip ratio and body mass index in overweight and obese women (P <0.05). Conclusion: Eight weeks of aerobic interval exercise training can improve body composition and increase serum 25-hydroxyvitamin D levels in overweight and obesity women.
Scope: Effects of dairy consumption on body weight and body composition have been inconsistently observed in randomized control trials (RCTs). Our meta-analysis aimed to systematically evaluate the effects of dairy consumption on body weight and body composition among the adults. Methods and results: We conducted a comprehensive search of the Cochrane Library, PubMed and Embase databases of the relevant studies from 1966 to Mar 2017 regarding dairy consumption on body weight and body composition including of body fat, lean mass and waist circumference (WC). The summary results were pooled by using a random-effects meta-analysis. 37 RCTs with 184,802 participants were included in this meta-analysis. High dairy intervention increased body weight (0.01, 95% CI: -0.25, 0.26, I(2) = 78.3%) and lean mass (0.37, 95% CI: 0.11, 0.62, I(2) = 83.4%); decreased body fat (-0.23, 95% CI: -0.48, 0.02, I(2) = 78.2%) and WC (-1.37, 95% CI: -2.28, -0.46, I(2) = 98.9%) overall. In the subgroup analysis, consumption of dairy products increased body weight (0.36, 95% CI: 0.01, 0.70, I(2) = 83.1%) among participants without energy restriction. Dairy consumption decreased body weight (-0.64, 95% CI: -1.05, -0.24, I(2) = 60.2%), body fat (-0.56, 95%CI: -0.95, -0.17, I(2) = 66.6%) and waist circumference (-2.18, 95%CI: -4.30, -0.06, I(2) = 99.0%) among the adults with energy restriction. Conclusions: This meta-analysis suggests a beneficial effect of energy-restricted dairy consumption on body weight and body composition. However, high dairy consumption in the absence of caloric restriction may increase body weight. This article is protected by copyright. All rights reserved.
Background: Whether calcium supplementation can reduce body weight and prevent obesity remains unclear because of inconsistent reports. Objective: We performed a meta-analysis to investigate the correlations between calcium supplementation and changes in body weight on the basis of age, sex, body mass index (BMI) of the subjects, and length of calcium intervention. Design: PubMed, EMBASE, Web of Knowledge, and China National Knowledge Infrastructure databases were systematically searched to select relevant studies that were published from January 1994 to March 2016. Both randomized controlled trials and longitudinal studies of calcium supplementation were included, and random- or fixed-effects models in a software program were used for the data analysis. Results: Thirty-three studies involving a total of 4733 participants were included in this meta-analysis. No significant differences in weight changes were shown between calcium intervention and control groups (mean: -0.01 kg; 95% CI -0.02, 0.00 kg; P = 0.12). However, negative correlations between calcium supplementation and weight changes were shown in children and adolescents (mean: -0.26 kg; 95% CI: -0.41, -0.11 kg; P < 0.001) and in adult men and either premenopausal or old (>60 y of age) women (mean: -0.91 kg; 95% CI: -1.38, -0.44 kg; P < 0.001) but not in postmenopausal women (mean: -0.14 kg; 95% CI: -0.54, 0.26 kg; P = 0.50). When BMI was considered, a negative correlation between calcium supplementation and weight changes was observed in subjects with normal BMI (mean: -0.53 kg; 95% CI: -0.89, -0.16 kg; P = 0.005) but not in overweight or obese subjects (mean: -0.35 kg; 95% CI: -0.81, 0.11 kg; P = 0.14). Compared with the control groups, no differences in weight changes were shown in the calcium-intervention groups when the lengths of calcium interventions were <6 mo (mean: -0.09 kg; 95% CI: -0.45, 0.26 kg; P = 0.60) or ≥6 mo (mean: -0.01 kg; 95% CI: -0.02, 0.01 kg; P = 0.46). Conclusion: Increasing calcium intake through calcium supplements can reduce body weight in subjects who have a normal BMI or in children and adolescents, adult men, or premenopausal women.
There is a pandemic of lifestyle-related diseases. In both developed and lesser developed countries of the world, an inadequacy of calcium intake and low vitamin D status is common. In this chapter, we explore a mechanistic framework that links calcium and vitamin D status to chronic conditions including obesity, systemic inflammation, endothelial dysfunction, dyslipidemia and cardiovascular disease, and type 2 diabetes mellitus. We also update the available clinical evidence, mainly from randomized controlled trials, to provide a synthesis of evidence in favor or against these hypotheses. There is consistent data to support calcium increasing whole body fat oxidation and increasing fecal fat excretion, while there is good cellular evidence for vitamin D reducing inflammation. Clinical trials support a marginal reduction in circulating lipids and some meta-analysis support an increase in insulin sensitivity following vitamin D. However, these mechanistic pathways and intermediate biomarkers of disease do not consistently transcribe into measurable health outcomes. Cementing the benefits of calcium and vitamin D for extraskeletal health needs a reexamination of the target 25(OH)D level to be achieved and the minimum duration of future trials.
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Expressing fat-free mass (FFM) and body fat mass (BFM) as percentages of body weight or by weight is unsatisfactory. For example, tall patients with protein-energy malnutrition (PEM) can exhibit values for FFM and BFM similar to those of shorter well-nourished individuals. To obviate such difficulties, we propose use of height-normalized indices, namely, a FFM index [FFM (kg)/height (m)2, or FFMI] and a BFM index [BFM (kg)/height (m)2, or BFMI]. We calculated these indices in a reference population of 124 healthy young men and in 32 nonobese young men (from the Minnesota Study) before, during, and after experimental semistarvation. When values for FFMI and BFMI falling below the reference cohort’s 5th percentile cutoff point were used as a criterion for PEM, these indices, together with basal oxygen-consumption rate, diagnosed PEM in 27 of the 32 Minnesota Study subjects after 12 wk of semi-starvation. These findings indicate that FFMI and BFMI may be useful in nutritional assessment.
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Some studies have shown an inverse relation between calcium intake and body weight or fat mass. We aimed to investigate the relations of dairy consumption and calcium intake with 6-y changes in body weight and waist circumference (WC). Multivariate analysis of variance according to dairy consumption or calcium intake quartile was presented, stratified by sex and body weight status at baseline, in 2267 middle-aged French adults. The associations between dairy products and anthropometric changes differed according to sex and overweight status at baseline. In overweight men only, 6-y changes in weight and WC were inversely associated with the consumption of dairy products-especially that of milk (P = 0.02 for both weight and WC changes) and yogurt (P = 0.01 and 0.03 for weight and WC changes, respectively). No relation was observed with cheese and calcium intake. Positive relations were found between milk consumption and WC change in overweight women and between yogurt consumption and weight change in normal-weight women. Multivariate analyses showed a trend toward increases in weight with high dairy calcium intakes in normal-weight women. The relation of dairy products and calcium intake with changes in weight and WC may differ according to sex, initial body-weight status, and type of dairy products. The negative association between dairy products and anthropometric changes observed in overweight men was not explained by dairy calcium intakes, which suggests that other components of dairy products or specific dietary patterns associated with dairy consumption may help to explain the observed associations.
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The US Department of Agriculture Automated Multiple-Pass Method (AMPM) is used for collecting 24-h dietary recalls in What We Eat In America, the dietary interview component of the National Health and Nutrition Examination Survey. Because the data have important program and policy applications, it is essential that the validity of the method be tested. The accuracy of the AMPM was evaluated by comparing reported energy intake (EI) with total energy expenditure (TEE) by using the doubly labeled water (DLW) technique. The 524 volunteers, aged 30-69 y, included an equal number of men and women recruited from the Washington, DC, area. Each subject was dosed with DLW on the first day of the 2-wk study period; three 24-h recalls were collected during the 2-wk period by using the AMPM. The first recall was conducted in person, and subsequent recalls were over the telephone. Overall, the subjects underreported EI by 11% compared with TEE. Normal-weight subjects [body mass index (in kg/m(2)) < 25] underreported EI by <3%. By using a linear mixed model, 95% CIs were determined for the ratio of EI to TEE. Approximately 78% of men and 74% of women were classified as acceptable energy reporters (within 95% CI of EI:TEE). Both the percentage by which energy was underreported and the percentage of subjects classified as low energy reporters (<95% CI of EI:TEE) were highest for subjects classified as obese (body mass index > 30). Although the AMPM accurately reported EIs in normal-weight subjects, research is warranted to enhance its accuracy in overweight and obese persons.
Background: Previous results suggested that increased intake of dairy calcium is associated with reduced weight and fat mass. Objective: The purpose of this study was to determine whether long-term increases in consumption of dairy calcium alter body weight and fat mass in young, healthy women. Design: We used a randomized, 1-y intervention for dairy calcium. Subjects were 155 young (aged 18–30 y), healthy, normal-weight women with intake of dietary calcium < 800 mg/d and energy intake ≤ 2200 kcal/d. Women were randomly assigned to 1 of 3 groups: 1) control: continue established dietary intake; 2) medium dairy: substitute dairy products to achieve intake of calcium of ≈1000–1100 mg/d and maintain isocaloric intake; 3) high dairy: substitute dairy products to achieve intake of calcium of 1300–1400 mg/d and maintain isocaloric intake. The main outcome measures were 1-y changes in body weight (in kg) and fat mass (in kg). One hundred thirty-five women completed the trial. Results: Mean intakes of calcium during the intervention were 742.4 ± 321.5, 1026.4 ± 311.3, and 1131.29 ± 337.2 mg/d for the control, medium-dairy, and high-dairy groups, respectively (P < 0.0001). No significant differences were observed in the mean 1-y change in body weight between the control, medium-dairy, and high-dairy groups (0.8 ± 2.8, 0.7 ± 3.0, and 1.5 ± 4.1 kg, respectively; P = 0.45). No significant differences were observed in the mean 1-y change in fat mass between the control, medium-dairy, and high-dairy groups (−0.5 ± 2.5, 0.3 ± 2.7, and 0.5 ± 3.5 kg, respectively; P = 0.26). Conclusion: Increased intake of dairy products does not alter body weight or fat mass in young, healthy women over 1 y.
Testprotokolle, Testbeschreibungen unterschiedlichster Krafttests
The metabolic syndrome is a cluster of symptoms associated with insulin resistance and known to precede the onset of type 2 diabetes. Overweight and obesity contribute significantly to the development of the metabolic syndrome. In fact, weight loss has a huge impact in decreasing the symptoms associated with the metabolic syndrome. Several studies have demonstrated that just by losing 7% to 10% of initial body weight is sufficient to have improvement in waist circumference, dyslipidemias (elevated triglycerides and low high-density-lipoprotein cholesterol), trunk fat, and plasma glucose. This paper underlines the importance of weight loss and type of diet in reversing the symptoms of the metabolic syndrome
Resistance training is an effective method to decrease body fat (BF) and increase fat-free mass (FFM) and fat oxidation (FO). Dairy foods containing calcium and vitamin D might enhance these benefits. This study investigated the combined effects of habitual yogurt consumption and resistance training on body composition and metabolism. Untrained women (N = 35) participated in an 8-wk resistance-training program. The yogurt group (Y) consumed 3 servings of yogurt containing vitamin D per day, and the control groups maintained their baseline low-dairy-calcium diet. Postexercise, Y consumed 1 of the 3 servings/d fat-free yogurt, the protein group consumed an isocaloric product without calcium or vitamin D, and the carbohydrate group consumed an isocaloric product without protein. Strength, body composition, fasted resting metabolic rate (RMR) and FO, and serum 25-hydroxyvitamin D were measured before and after training. Calories (kcal x kg-1 x d-1) and protein (g x kg-1 x d-1) significantly increased from baseline for Y. FFM increased (main effect p = .002) and %BF decreased (main effect .02) for all groups with training, but Group x Time interactions were not observed. RMR and FO did not change with training for any group. Habitual consumption of yogurt during resistance training did not augment changes in body composition compared with a low-dairy diet. Y decreased %BF as a result of training, however, even with increased calorie consumption.
To assess the effect of 9 months of strength training on total body and regional bone mineral density (BMD, g/cm(2)) in 58 premenopausal women aged 30-50 years. Participants were randomized to either twice weekly supervised strength training for 15 weeks followed by 24 weeks of unsupervised training (treatment group) or control group. Height, weight, maximal muscular strength, nutrient intake and physical activity were assessed. Total body dual energy X-ray absorptiometry (DXA, Lunar Prodigy) scans were taken and analyzed for body composition (lean and fat mass), and BMD for total body and its sub-regions (spine, hip, arms and legs). All measurements were performed at baseline, 15 and 39 weeks. Analysis of covariance was used to assess group differences in BMD change adjusted for baseline BMD, weight, energy and calcium intake. At baseline, the two groups had similar BMD and body size characteristics ( P<0.05 for all), except that the treatment group had lower body weight (-7.1 kg), and higher energy (+259 kJ/d) and calcium (+232 mg/d) intake at baseline. Adjusted % change in BMD over 15 weeks (0.5% vs. 0.4%) or 39 weeks (0.9% vs. 1.2%) did not differ significantly between the exercise and control groups, respectively. The exercise group increased BMD at the spine and legs (1-2.2%), while there was no change in the controls, but differences between groups were not significant. Strength training over 9 months did not lead to significantly greater change in total body or regional BMD in premenopausal women.
At a given age, bone mass is determined by the amount of bone accumulated at the end of skeletal growth (the so-called peak bone mass), and by the amount of bone lost subsequently. Nutritional intake is an environmental factor that influences both bone capital accumulation, which is fully achieved by the end of the second decade of life, and bone loss, which occurs during the second half of existence. Nutrients may act directly by modifying bone turnover, or indirectly via changes in calciotropic hormone secretion. The study of the association between nutrition and a bone phenotypic expression may provide inconsistent results, in part because of the low accuracy and reproducibility of the various tools used to assess dietary intakes. Sufficient dietary calcium and protein are necessary for bone health during growth as well as in the elderly.