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The risk of eating disorders and bone health in young adults: the mediating role of body composition and fitness

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Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Purpose

To analyze the independent relationship between the risk of eating disorders and bone health and to examine whether this relationship is mediated by body composition and cardiorespiratory fitness (CRF).

Methods

In this cross-sectional study, bone-related variables, lean mass, fat mass (by DXA), risk of eating disorders (SCOFF questionnaire), height, weight, waist circumference and CRF were measured in 487 university students aged 18–30 years from the University of Castilla-La Mancha, Spain. ANCOVA models were estimated to test mean differences in bone mass categorized by body composition, CRF or risk of eating disorders. Subsequently, linear regression models were fitted according to Baron and Kenny’s procedures for mediation analysis.

Results

The marginal estimated mean ± SE values of total body bone mineral density for the categories “no risk of eating disorders” and “risk of eating disorders” were 1.239 ± 0.126 < 1.305 ± 0.089, P = 0.021. However, this relationship disappeared after adjustment for any of the parameters of body composition or CRF. Therefore, all body composition parameters (except for lean mass) and CRF turned out to be full mediators in the association between the risk of eating disorders and bone health in young adults.

Conclusions

Body composition and CRF mediate the association between the risk of eating disorders and bone health. These findings highlight the importance of maintaining a healthy weight and good CRF for the prevention of the development of eating disorders and for the maintenance of good bone health in young adults.

Level of Evidence

Level V, cross-sectional descriptive study.

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Abbreviations

BMD:

Bone mineral density

BMC:

Bone mineral content

BMI:

Body mass index

CRF:

Cardiorespiratory fitness

References

  1. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, DSM-5, 5th edn. American Psychiatric Publishing, Arlington, VA

  2. Jacobi C, Abascal L, Taylor CB (2004) Screening for eating disorders and high-risk behavior: caution. Int J Eat Disord 36(3):280–295. https://doi.org/10.1002/eat.20048

    Article  Google Scholar 

  3. Zeiler M, Waldherr K, Philipp J, Nitsch M, Dür W, Karwautz A et al (2016) Prevalence of eating disorder risk and associations with health-related quality of life : results from a large school-based population screening. Eur Eat Disord Rev 24(1):9–18. https://doi.org/10.1002/erv.2368

    Article  Google Scholar 

  4. Tavolacci MP, Richard L, Meyrignac G, Pierre D (2015) Eating disorders and associated health risks among university students. J Nutr Educ Behav 47(5):412–421. https://doi.org/10.1016/j.jneb.2015.06.009

    Article  PubMed  Google Scholar 

  5. Veses AM, Martínez-Gómez D, Gómez-Martínez S, Zapatera B, Veiga ÓL, Marcos A (2011) Association between excessive body fat and eating-disorder risk in adolescents: the AFINOS study. Med Clin (Barc) 136(14):620–622. https://doi.org/10.1016/j.medcli.2010.09.042

    Article  Google Scholar 

  6. Schorr M, Thomas JJ, Eddy KT, Dichtel LE, Lawson EA, Meenaghan E et al (2017) Bone density, body composition, and psychopathology of anorexia nervosa spectrum disorders in DSM-IV vs DSM-5. Int J Eat Disord 50(4):343–351. https://doi.org/10.1002/eat.22603

    Article  PubMed  Google Scholar 

  7. Robinson L, Aldridge V, Clark EM, Misra M, Micali N (2016) A systematic review and meta-analysis of the association between eating disorders and bone density. Osteoporos Int 27(6):1953–1966. https://doi.org/10.1007/s00198-015-3468-4

    Article  CAS  PubMed  Google Scholar 

  8. Goldschmidt AB, Aspen VP, Sinton MM, Tanofsky-Kraff M, Wilfley DE (2008) Disordered eating attitudes and behaviors in overweight youth. Obesity 16(2):257–264. https://doi.org/10.1038/oby.2007.48

    Article  PubMed  Google Scholar 

  9. Holland G, Tiggemann M (2016) A systematic review of the impact of the use of social networking sites on body image and disordered eating outcomes. Body Image 17:100–110. https://doi.org/10.1016/j.bodyim.2016.02.008

    Article  PubMed  Google Scholar 

  10. Baxter-Jones AD, Faulkner RA, Forwood MR, Mirwald RL, Bailey DA (2011) Bone mineral accrual from 8 to 30 years of age: an estimation of peak bone mass. J Bone Miner Res 26(8):1729–1739. https://doi.org/10.1002/jbmr.412

    Article  PubMed  Google Scholar 

  11. Boot AM, de Ridder MA, van der Sluis IM, van Slobbe I, Krenning EP, Keizer-Schrama SM (2010) Peak bone mineral density, lean body mass and fractures. Bone 46(2):336–341. https://doi.org/10.1016/j.bone.2009.10.003

    Article  PubMed  Google Scholar 

  12. Bonjour JP, Chevalley T, Ferrari S, Rizzoli R (2009) The importance and relevance of peak bone mass in the prevalence of osteoporosis. Salud Publica Mex 51(Suppl 1):S5–S17. https://doi.org/10.1590/S0036-36342009000700004

    Article  PubMed  Google Scholar 

  13. Nieves JW, Ruffing JA, Zion M, Tendy S, Yavorek T, Lindsay R et al (2016) Eating disorders, menstrual dysfunction, weight change and DMPA use predict bone density change in college-aged women. Bone 84:113–119. https://doi.org/10.1016/j.bone.2015.12.054

    Article  PubMed  Google Scholar 

  14. Pocock NA, Eisman JA, Hopper JL, Yeates MG, Sambrook PN, Eberl S (1987) Genetic determinants of bone mass in adults. A twin study. J Clin Invest 80(3):706–710. https://doi.org/10.1172/JCI113125

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Seeman E, Hopper JL, Young NR, Formica C, Goss P, Tsalamandris C (1996) Do genetic factors explain associations between muscle strength, lean mass, and bone density? A twin study. Am J Physiol 270(2 Pt 1):E320–E327

    CAS  PubMed  Google Scholar 

  16. Wang MC, Bachrach LK, Van Loan M, Hudes M, Flegal KM, Crawford PB (2005) The relative contributions of lean tissue mass and fat mass to bone density in young women. Bone 37(4):474–481. https://doi.org/10.1016/j.bone.2005.04.038

    Article  CAS  PubMed  Google Scholar 

  17. Meyer HE, Willett WC, Flint AJ, Feskanich D (2016) Abdominal obesity and hip fracture: results from the Nurses’ Health Study and the Health Professionals Follow-up Study. Osteoporos Int 27(6):2127–2136. https://doi.org/10.1007/s00198-016-3508-8

    Article  CAS  PubMed  Google Scholar 

  18. Kim YM, Kim SH, Kim S, Yoo JS, Choe EY, Won YJ (2016) Variations in fat mass contribution to bone mineral density by gender, age, and body mass index: the Korea National Health and Nutrition Examination Survey (KNHANES) 2008–2011. Osteoporos Int 27(8):2543–2554. https://doi.org/10.1007/s00198-016-3566-y

    Article  CAS  PubMed  Google Scholar 

  19. Swenne I, Stridsberg M (2015) Bone metabolism in adolescent girls with eating disorders and weight loss: independent effects of weight change, insulin-like growth factor-1 and oestradiol. Eat Weight Disord 20(1):33–41. https://doi.org/10.1007/s40519-014-0149-9

    Article  PubMed  Google Scholar 

  20. Lawlor DA, Sattar N, Sayers A, Tobias JH (2012) The association of fasting insulin, glucose, and lipids with bone mass in adolescents: findings from a cross-sectional study. J Clin Endocrinol Metab 97(6):2068–2076. https://doi.org/10.1210/jc.2011-2721

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Torres-Costoso A, Gracia-Marco L, Sánchez-López M, Notario-Pacheco B, Arias-Palencia N, Martínez-Vizcaíno V (2015) Physical activity and bone health in schoolchildren: the mediating role of fitness and body fat. PLoS One 10(4):e0123797. https://doi.org/10.1371/journal.pone.0123797

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Gracia-Marco L, Vicente-Rodriguez G, Casajus JA, Molnar D, Castillo MJ, Moreno LA (2011) Effect of fitness and physical activity on bone mass in adolescents: the HELENA study. Eur J Appl Physiol 111:2671–2680. https://doi.org/10.1007/s00421-011-1897-0

    Article  CAS  PubMed  Google Scholar 

  23. Veses AM, Martínez-Gómez D, Gómez-Martínez S, Vicente-Rodriguez G, Castillo R et al (2014) Physical fitness, overweight and the risk of eating disorders in adolescents. The AVENA and AFINOS studies. Pediatr Obes 9(1):1–9. https://doi.org/10.1111/j.2047-6310.2012.00138

    Article  CAS  PubMed  Google Scholar 

  24. Baron RM, Kenny DA (1986) The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 51(6):1173–1182

    Article  CAS  Google Scholar 

  25. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: executive summary (1998) Expert panel on the identification, evaluation, and treatment of overweight in adults. Am J Clin Nutr 68(4):899–917

    Article  Google Scholar 

  26. Garcia-Campayo J, Sanz-Carrillo C, Ibañez JA, Lou S, Solano V, Alda M (2005) Validation of the Spanish version of the SCOFF questionnaire for the screening of eating disorders in primary care. J Psychosom Res 59(2):51–55. https://doi.org/10.1016/j.jpsychores.2004.06.005

    Article  PubMed  Google Scholar 

  27. Botella J, Sepúlveda AR, Huang H, Gambara H (2013) A meta-analysis of the diagnostic accuracy of the SCOFF. Span J Psychol 16:E92. https://doi.org/10.1017/sjp.2013.92

    Article  PubMed  Google Scholar 

  28. Ruiz JR, Castro-Piñero J, España-Romero V, Artero EG, Ortega FB, Cuenca MM et al (2011) Field-based fitness assessment in young people: the ALPHA health-related fitness test battery for children and adolescents. Br J Sports Med 45(6):518–524. https://doi.org/10.1136/bjsm.2010.075341

    Article  PubMed  Google Scholar 

  29. Preacher KJ, Hayes AF (2008) Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods 40(3):879–891

    Article  Google Scholar 

  30. Sobel ME (1982) Asymptotic confidence intervals for indirect effects in structural equation models. Sociol Methodol 13(1982):290–312

    Article  Google Scholar 

  31. Loth K, Wall M, Larson N, Neumark-Sztainer D (2015) Disordered eating and psychological well-being in overweight and nonoverweight adolescents: secular trends from 1999 to 2010. Int J Eat Disord 48(3):323–327. https://doi.org/10.1002/eat.22382

    Article  PubMed  PubMed Central  Google Scholar 

  32. Mond JM, Hay PJ, Rodgers B, Owen C (2009) Comparing the health burden of eating-disordered behavior and overweight in women. J Womens Health (Larchmt) 18(7):1081–1089. https://doi.org/10.1089/jwh.2008.1174

    Article  Google Scholar 

  33. Doyle AC, le Grange D, Goldschmidt A, Wilfley DE (2007) Psychosocial and physical impairment in overweight adolescents at high risk for eating disorders. Obesity (Silver Spring) 15(1):145–154. https://doi.org/10.1038/oby.2007.515

    Article  Google Scholar 

  34. Claus L, Braet C, Decaluwé V (2006) Dieting history in obese youngsters with and without disordered eating. Int J Eat Disord 39(8):721–728. https://doi.org/10.1002/eat.20295

    Article  PubMed  Google Scholar 

  35. Xu X, Mellor D, Kiehne M, Ricciardelli LA, McCabe MP, Xu Y (2010) Body dissatisfaction, engagement in body change behaviors and sociocultural influences on body image among Chinese adolescents. Body Image 7(2):156–164. https://doi.org/10.1016/j.bodyim.2009.11.003

    Article  PubMed  Google Scholar 

  36. Goldschmidt AB, Wall MM, Loth KA, Neumark-Sztainer D (2015) Risk factors for disordered eating in overweight adolescents and young adults. J Pediatr Psychol 40(10):1048–1055. https://doi.org/10.1093/jpepsy/jsv053

    Article  PubMed  PubMed Central  Google Scholar 

  37. Babio N, Canals J, Pietrobelli A, Pérez S, Arija V (2009) A two-phase population study: relationships between overweight, body composition and risk of eating disorders. Nutr Hosp 24(4):485–491

    CAS  PubMed  Google Scholar 

  38. Hu WW, Zhang H, Wang C, Gu JM, Yue H, Ke YH et al (2012) Lean mass predicts hip geometry and bone mineral density in Chinese men and women and age comparisons of body composition. J Clin Densitom 15(4):434–442. https://doi.org/10.1016/j.jocd.2012.02.004

    Article  PubMed  Google Scholar 

  39. Wetzsteon RJ, Zemel BS, Shults J, Howard KM, Kibe LW, Leonard MB (2011) Mechanical loads and cortical bone geometry in healthy children and young adults. Bone 48(5):1103–1108. https://doi.org/10.1016/j.bone.2011.01.005

    Article  PubMed  PubMed Central  Google Scholar 

  40. Frost HM (2003) Bone’s mechanostat: a 2003 update. Anat Rec A Discov Mol Cell Evol Biol 275(2):1081–1101. https://doi.org/10.1002/ar.a.10119

    Article  PubMed  Google Scholar 

  41. Reid IR (2002) Relationships among body mass, its components, and bone. Bone 31(5):547–555

    Article  CAS  Google Scholar 

  42. Reid IR (2008) Relationships between fat and bone. Osteoporos Int 19(5):595–606. https://doi.org/10.1007/s00198-007-0492-z

    Article  CAS  PubMed  Google Scholar 

  43. Vicente-Rodriguez G, Ara I, Perez-Gomez J, Serrano-Sanchez JA, Dorado C, Calbet JA (2004) High femoral bone mineral density accretion in prepubertal soccer players. Med Sci Sports Exerc 36:1789–1795

    Article  Google Scholar 

  44. Ortega FB, Ruiz JR, Castillo MJ, Sjöström M (2008) Physical fitness in childhood and adolescence: a powerful marker of health. Int J Obes (Lond) 32:1–11

    Article  CAS  Google Scholar 

  45. Nickols-Richardson S, Beiseigel JM (2006) Eating restraint is negatively associated with biomarkers of bone turnover but not measurements of bone mineral density in young women. J Am Diet Assoc 106(7):1095–1101. https://doi.org/10.1016/j.jada.2006.04.018

    Article  PubMed  Google Scholar 

  46. Mitchell JE, Crow S (2006) Medical complications of anorexia nervosa and bulimia nervosa. Curr Opin Psychiatry 19(4):438–443. https://doi.org/10.1097/01.yco.0000228768.79097.3e

    Article  PubMed  Google Scholar 

  47. Soyka LA, Grinspoon S, Levitsky LL, Herzog DB, Klibanski A (1999) The effects of anorexia nervosa on bone metabolism in female adolescents. J Clin Endocrinol Metab 84(12):4489–4496. doi:https://doi.org/10.1210/jcem.84.12.6207

    Article  CAS  PubMed  Google Scholar 

  48. Van Loan MD, Keim NL (2000) Influence of cognitive eating restraint on total body measurements of bone mineral density and bone mineral content in premenopausal women aged 18–45 y: a cross-sectional study. Am J Clin Nutr 72(3):837–843

    Article  Google Scholar 

  49. Schvey NA, Tanofsky-Kraff M, Yanoff LB, Checchi JM, Shomaker LB, Brady S et al (2009) Disordered-eating attitudes in relation to bone mineral density and markers of bone turnover in overweight adolescents. J Adolesc Heal 45(1):33–39. https://doi.org/10.1016/j.jadohealth.2008.12.020

    Article  Google Scholar 

  50. Bolton JG, Patel S, Lacey JH, White S (2005) A prospective study of changes in bone turnover and bone density associated with regaining weight in women with anorexia nervosa. Osteoporos Int 16(12):1955–1962. https://doi.org/10.1007/s00198-005-1972-7

    Article  PubMed  Google Scholar 

  51. Maricic M, Chen Z (2000) Bone densitometry. Clin Lab Med 20(3):469–488

    Article  CAS  Google Scholar 

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Acknowledgements

We thank all of the people that have participated in this research. MGM, ATC and VMV are the principal researchers and contributed equally to conceiving the study design, conducting the statistical analysis, and editing the manuscript. MMA, BNP, ADF, CAB, JCGP contributed to drafting the manuscript. All authors read and approved the final manuscript.

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Correspondence to Vicente Martínez-Vizcaíno.

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The authors have no conflict of interest to declare.

Ethics approval and consent to participate

Ethical clearance for the study was obtained from the Clinical Research Ethics Committee of the Virgen de la Luz Hospital in Cuenca, Universidad Castilla-La Mancha, Spain. Written informed consent was obtained from all individual participants. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Funding

This work was supported by the Fundación para la Investigación Sanitaria en Castilla-La Mancha (FISCAM) (Ref.-AN/2008/31). Additional funding was obtained from the Instituto de Salud Carlos III, Red de Investigación en Actividades Preventivas y de Promoción de Salud (Ref.- RD06/0018/0038). CAB and MGM are supported by grants from the Spanish Ministry of Education, Culture and Sport (FPU13/03137 and FPU15/03847, respectively).

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Garrido-Miguel, M., Torres-Costoso, A., Martínez-Andrés, M. et al. The risk of eating disorders and bone health in young adults: the mediating role of body composition and fitness. Eat Weight Disord 24, 1145–1154 (2019). https://doi.org/10.1007/s40519-017-0458-x

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