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

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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
2
. 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.
INTRODUCTION
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.
E-mail: david.t.thomas@uky.edu
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
604
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.
MATERIALS AND METHODS
Participants
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
2
, 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
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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
2
).
Fat mass index (FMI) was calculated from fat mass and height
measurements (FMI ¼fat mass [kg] 4height [m
2
]). 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.
RESULTS
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
2
),
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)
1
76.7 (7.3) 74.1 (6.9) 76.9 (6.9) 75.8 (6.8)
Body fat
Fat mass (kg)
2
32.5 (5.2) 28.7(5.3) 33.9 (4.4 ) 32.1 (4.8)
Fat mass index (fat kg/m
2
)
2
12.2 (2.0) 10.8 (2.0) 12.9 (1.6 ) 12.2 (1.7)
Trunk fat (g)
2
17.0 (3.6) 14.9 (3.7) 16.6 (2.7 ) 15.3 (2.5)
Fat-free mass (kg)
2
44.2 (3.7) 45.4 (3.8) 43.0 (4.3) 43.6 (4.3)
Waist circumference (cm)
2
87.9 (6.0) 83.9 (6.6) 84.0 (5.9) 81.9 (5.7)
Sagittal diameter (cm)
2
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
2
) 1.25 (0.06) 1.25 (0.06) 1.27 (0.08) 1.28 (0.08)
Lumbar spine BMD (g/cm
2
)
3
1.31 (0.14) 1.29 (0.12) 1.36 (0.15) 1.37 (0.14)
Total hip BMD (g/cm
2
) 1.05 (0.10) 1.05 (0.10) 1.08 (0.13) 1.09 (0.12)
1
Significantly decreased over time, p0.05 (repeated-measures analyses of variance [RMANOVA]).
2
Significantly changed over time, p0.005 (RMANOVA).
3
Significantly different by group, p0.01 (RMANOVA).
JOURNAL OF THE AMERICAN COLLEGE OF NUTRITION 607
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.
DISCUSSION
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)
1
1882 (324) 1458 (425) 1541 (273) 1835 (407) 1677 (319) 1565 (304)
Kilocalories per kilogram
1
24.6 (4.5) 19.6 (6) 21 (3.8) 24.1 (6.2) 22 (4.5) 21 (4.5)
Protein (g)
2
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 (%)
1
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)
1
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)
2
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)
3
554 (136) 463 (150) 445 (166) 543 (148) 1313 (289) 1311 (245)
1
Significantly different over time, p0.001 (repeated-measures analyses of variance [RMANOVA]).
2
Significantly different between groups, p0.05 (RMANOVA).
3
Significantly different over time and between groups, p0.001 (RMANOVA).
608 VOL. 29, NO. 6
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[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
group.
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
JOURNAL OF THE AMERICAN COLLEGE OF NUTRITION 609
Effects of Calcium and Exercise on Body Composition
loss observed in our women resulted in lower power to
determine significant differences.
CONCLUSION
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.
ACKNOWLEDGMENTS
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
assistance.
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JOURNAL OF THE AMERICAN COLLEGE OF NUTRITION 611
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). ...
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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). ...
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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.
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Testprotokolle, Testbeschreibungen unterschiedlichster Krafttests
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