Obesity rates have become unjustifiable with more than 40% of adult population staying overweight and more than 14% of children existing in the obesity zone. Inappropriate environmental, biological and psychological factors have resulted in a situation where obesity rates have tripled since 1975. We have moved past the fact that adult obesity rates are inappropriately high and now researchers are mainly focusing on childhood obesity rates. 10% of the global population is obese and almost 15% of kids between 2 and 5 years old are obese. We have multiple research on the effect of early life factors and its effect on childhood obesity. Its also known that maternal and paternal obesity increase the risk of obesity in the offspring and most excess weight in childhood are gained during the preschool years. Some of the evident examples come from some of the most developed nations-U.S. has 69% adults and 32% kids either in the obese or overweight range; Western Europe exbibits some of the highest obesity/overweight rates and data from the ‘National Child Measurement programme’ (NCMP) shows that more than one in five kids in England are now obese/overweight by the time they are enrolled in primary school and the rates increase further to one in three by the age of 6. To make things worse, 8% of infants and toddlers display weight ranges above 95th percentile in the U.S.A. This is indeed a nightmare as obesity/overweight that’s prevalent in these tender years is sure to linger past adolescence and well into adulthood.
Staying above recommended weight ranges since childhood puts the kid at a potential risk for comorbid conditions such as diabetes, cardiovascular problem and even cancer. We have a good number of research done on the risk factors of obesity during childhood years such as children’s eating habits, infant feeding practices and television viewing but what we need exactly is to understand the factors present in both parents and offspring that promote obesity across early life stages (right from preconception through prenatal period to infancy to the tender age of 2). Though researchers focus on risk of obesity through childhood and adolescent years we have evidence showing that the foundation for inappropriate weight gain is laid in early years of life by actions and interactions that can have biological and behavioural consequences. Such influences on obesity and risks for it are linked across generations-from parent to child. An understanding of various processes and sewing them together in the right order helps us focus on the generation link that’s evident.
The intrauterine environment shapes the trajectory of weight gain and after birth the teachings of parents and families combined with the socioeconomic environment has greater impact on the weight trajectories of infants and toddlers. Obesity rates of kids greatly vary depending on where they live.
Seeds of Obesity Sown Even Before Deciding to Plant
Preconception: The risk of obesity in the next generation starts even before conceiving. Until sometime back most studies focused on maternal influence of obesity on the offspring but recently even the paternal involvement in determining offspring’s health has now been taken into consideration.
The major factors affecting offspring include a mother’s birth weight, obesity and nutritional status throughout her life. Pre-pregnancy obesity rates have steadily increased since the last decade to the present one and statistics show that mothers who are overweight/obese before pregnancy are at an increased risk of having children who are large for gestational age at birth compared to their normal weight counterparts. A study by Whitaker et al. showed that maternal obesity during the first trimester of pregnancy doubled the risk of childhood obesity at 2 years of age. Fathers affect embryonic development through genetic and epigenetic mechanisms. Epigenetic changes affect the fetus’ metabolism which is primarily due to variations in the dad’s diet. This shows that paternal lifestyle behaviour definitely puts future kids at risk of obesity and obesity-related outcomes. These epigenetic changes could even be inherited by the developing sperm. All this clearly show one thing-the world that’s been monopolizing the attention to women who plan to conceive must also consider the health of men. A number of suggestions have been proposed for women in their reproductive years right from nutritional guidance to weight management. They are advised to take supplements that include multivitamins and folate to avoid deficiencies such as neural tube defects and likewise. A survey showed that 77% women opted for enrolling in a program that promoted effective lifestyle intervention before conceiving and this shows that women are on the right track. Men should also be encouraged to take care of their health. Actually, both men and women must be motivated to stay within normal weight ranges right from adolescence to help the future generation to stay at a minimal risk of obesity.
Prenatal influence: The environment affects us in many a way. Environmental exposure and timing of exposure to different factors within the environments produce interactions that are biologically seeded in the developing child. Epigenetic influence do exist and the gene sequence cannot be modified but we can indeed change the gene expression in response to environmental cues. For instance, changes to the placenta made as a result of maternal stressors or nutritional status prevails as the mediator between the developing child and the environment. This prevails as the trailer for the fetus before the main picture is shown (when the fetus then becomes a newborn). The fetus becomes adapted to epigenetic changes which then regulate behaviour, obesity and glucose tolerance. But when the fetus is small for gestational age during development or there was restricted intrauterine growth the growing newborn is at a greater risk of suffering during later stages in life.
When metabolic pathways, hormonal signalling and glucose metabolisms change by a greater margin during pregnancy it increases the risk of larger birth size and higher percentage of body fat at birth. The gut bacteria also play a critical role as researchers have come up with differences in the microbiome of overweight individuals compared to normal-weight people. The same is also seen in pregnant women and hence, might be transferred to the child too (as the child gets the microbiome composition from mother during birth through the birth canal and it’s also affected by the mode of delivery) thereby resulting in intergenerational transfer of obesity.
Maternal Lifestyle: Time and again gynaecologists insist on a healthy maternal weight gain and lifestyle behaviours to deliver a healthy offspring. Eating, physical activity and smoking levels during pregnancy have a strong impact on the risk of obesity for the fetus developing inside the mother’s womb. Besides preconception obesity gestational weight gain (GWG) changes the pregnant woman’s metabolism leading to higher risk for dyslipidaemia, glucose intolerance and insulin resistance. Such GWG leads to a greater percentage of offspring born with higher birth weight, increased body fat during the neonatal period and greater adiposity all though childhood and adulthood as well. All this is due to increased nutrition transfer from overnourished mothers to the developing fetus.
Moms pass on food likes and dislikes to the developing fetus. The food that she consumes, her tastes and smelling traits that are present during fetal development strongly influence a child’s preferences for food and flavour. Now we can understand why our little ones love sweets, hate certain vegetables and relish certain foods more than others. Performing physical activity regularly during pregnancy helps the woman deliver infants that are smaller than the ones born to women who don’t exercise. Different studies come up with different results and hence reviews are inconclusive. Another important factor affecting fetal weight is smoking status of the pregnant woman. Smoking, both maternal and paternal, during the prenatal period is strongly linked to obesity development in the offspring during childhood and adulthood.
Numerous systemic reviews and meta-analysis of data show that maternal pre-pregnancy weight gain is linked to an increased risk of overweight/obesity in the offspring, children born to moms after weight loss were only at a 35% risk of overweight/obesity compared to 60% risk in kids born to moms who remained obese, according to a study. A recent systemic review showed that 19 of 21 studies supported increased risk of childhood overweight in kids when moms experienced GWG. Kids of women who gained excessive weight during pregnancy were at a 4-times higher risk of being overweight at age 3 compared to kids whose mothers gained inadequate weight according to a study by Oken et al. A population-based cohort study proved that compared to infants of women who gained 8-10 kg of weight during pregnancy those of women who gained more than 23 kg were about 2.5 kg heavier at birth.
Factors Affecting Obesity Risk Up to 2 Years of Age: Infant birth weight is a strong determining factor of obesity/overweight risk in the child. Kids born either too small or big for gestational age are at an increased risk of overweight, obesity, metabolic disorders and cardiovascular diseases. The birth weight of the child is determined by the maternal weight at conception and GWG. As in adults, infants too should gain a definite weight in a definite period and accelerated weight gain occurring during the first 4 months of life are related to obesity at 7 years of age and a 60% increase in risk if weight gain happens within the first 2 years of life. but the reason behind rapid weight gain during this period is due to genetic factors, epigenetic processes, differences in placental leptin levels and the infant’s gut microbiome composition.
Infant-feeding habits: Kids depend on their parents for making the right decisions up to a certain age and food habits are one of those. What and how much food parents feed their infants directly affect the weight gain and obesity risks of child during later stages in life. There are not any recommended dietary guidelines for kids younger than 2 years of age to help parents and caregivers choose the right portions and foods to feed the kids. Infants are blessed with the knowledge to know how much to eat, when to eat and when they are full. They self-regulate their needs even while breastfeeding choosing how much to drink how often. That’s why infants fed on formula by parents gain more weight maybe due to the amount and pattern of feeding and so do infants who start weaning early in life. The child’s ability to self-regulate narrows down when it is dominated more and more by parental intervention.
Sometimes, parents feeding practices also depend on the child’s food choices which is affected greatly by its exposure to sweet and sour taste during prenatal exposure to the mother’s diet but they can be modified by repeated exposure to certain foods by the parents. Some parents also use feeding as a mechanism to soothe infants and such practices lead to unintentional weight gain in kids. Our lifestyle and sedentary behaviour also hold greater influence on obesity risks. The present world encourages the use of car seats and strollers that make the children idle, exposure to television starts right from their 3rd month sometimes and many suffer from lack of sleep due to increased screen time. A prospective cohort study on more than 900 infants showed that those who slept for less than 12 hours doubled their odds of becoming overweight by age 3 compared to others. An infant’s birth weight and rapid weight gain during the first months of life are clear cut indicators of future obesity risk. Hence, it does show that the way parents and caretakers feed infants and the steps that they take to engage children do affect the risk of long-term weight gain in these little ones.
In recent years, more attention has been focused on interventions targeting parents and modifiable risk factors that prevent obesity and promote healthy growth in the first 1000 days of life. Lifestyle and nutrition practices followed through life-before conception, time spent in utero and the following months after birth greatly affect the child’s weight at birth, during childhood and well into adulthood. Women who take care before conceiving, while pregnant and even after childbirth have greater chances of giving birth to and nurturing kids who are at a minimum risk of obesity in life. Nutritional interventions by parents, the steps they take to ensure kids’ exposure to healthy food and their participation in physical activity plans with the children do indeed help in making the kids as healthy as possible. It would be beneficial for both the kid and the mother when the woman strives for a healthy weight before pregnancy, abstains from smoking, strives for a normal weight gain during pregnancy, breastfeeds unless there is some health issue linked and takes care that infants get the desired sleep time during the first few years of life.
Preventing Obesity Across Generations: Evidence for Early Life Intervention: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5305001/
Prevention of Overweight & Obesity in Early Life: https://www.cambridge.org/core/journals/proceedings-of-the-nutrition-society/article/prevention-of-overweight-and-obesity-in-early-life/F9BB50517A0A0F9D4F542276A30926D5/core-reader
The Effect of Early Life Factors & Early Interventions on Childhood Overweight & Obesity: https://www.cambridge.org/core/journals/proceedings-of-the-nutrition-society/article/prevention-of-overweight-and-obesity-in-early-life/F9BB50517A0A0F9D4F542276A30926D5/core-reader
Preventing Childhood Obesity: Early Life Messages & Epidemiology: https://onlinelibrary.wiley.com/doi/full/10.1111/nbu.12277
Prenatal & Early Life Influences: https://www.hsph.harvard.edu/obesity-prevention-source/obesity-causes/prenatal-postnatal-obesity/
Despite our food being an enriching source of nutrients and full of goodness we don’t make utmost use of this naturally available health source but try to achieve the same through other means such as supplements and likewise. Fruits, vegetables and whole grains-authentic nutrient source-have been taken for granted and now, we are victims of serious nutrient deficiencies and health-related problems. Due to continuous breaching of these nutrient sources we have landed ourselves in a state where supplementation has become indispensable for a majority of individuals.
A majority of the population are regular consumers of multivitamin supplements on a daily basis. Vitamin D and vitamin B deficiencies are on a rise for which supplements have once again become mandatory otherwise this can result in serious health consequences. Another group of supplements that’s especially crucial for vegetarians and vegans are fish oil supplements that have been steadily used for lowering blood triglyceride levels in all individuals including athletes. So, what’s so special about these supplements that makes it a favourite of athletes too? The very fact that they contain omega-3 fatty acids which cannot be produced by our body but must be added via the food that we consume. Omega-3 fatty acids have been proposed for protecting the heart, improving mental life, easing inflammation and lengthening life and deficiencies have created innumerable problems right from arthritis and mood disorders to cancers, cardiovascular diseases and more. The most recent fascination on omega-3 supplementation is the fact that these have been proudly presented as an ergogenic aid for athletes for improved athletic performance.
Omega-3 Fatty Acids
Sharks, swordfish, tilefish and albacore tuna are rich sources of omega-3 fatty acids but they come with a statutory warning that these might be loaded with toxic substances. Hence, controlling the consumption of these fish is always recommended to avoid effects due to mercury overload and so. Fish oils are made from the tissues of oily fish and are overloaded with eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), both of which are forms of omega-3 fatty acids. Omega-3s are polyunsaturated fatty acids (PUFAs) which exert anti-inflammatory properties. Interestingly, though fish is the best source for omega-3 they too don’t produce it but acquire it by consuming microalgae or fish that’s enriched in omega-3 fatty acids. Sometimes called as vitamin F due to its presence in ‘fatty fish’ sea creatures such as krill, algae, microalgae and crustaceans are also excellent sources of n-3 PUFAs. Alpha-linolenic fatty acid (ALA) is also a form of omega-3 but primarily found in soybeans, pumpkin seeds, perilla seed oil, walnuts, flaxseed and canola. But sadly, ALA from food sources must be converted into DHA and EPA before reaping benefits. DHA and EPA have even been named as ‘brain food’ because of their prime participation in cognitive health.
So, fish oil supplements are indeed helpful in preventing illnesses and promoting health but they are not a one-stop solution for all the problems and illnesses as advertised by marketing individuals. With this in mind, let’s look at where we stand with respect to fish oil supplementation and athletic performance.
Fish Oil Supplements & Athletic Performance
Athletes need greater sustenance capacity and energy for maximized performance. Because of this, we have seen that most of them use dietary supplements to increase metabolic capability, delay fatigue, improve muscle hypertrophy and shorted recovery period. Any athletic performance requires a strict exercising routine that exerts physiological stress on the body. The body tries to counter this by going for a joint response by the cardiovascular, pulmonary and nervous system as this increases blood flow and oxygen supply to skeletal muscles. There is a tremendous change in blood flow during rest and exercise-while muscles receive 20% of total blood flow during rest, they receive more than 80% during exercise. In such scenarios ergogenic aids are of utmost use as they aid in improving exercise efficiency and also enhance recovery. Omega-3 are considered as an ergogenic aid here as they are helpful in restricting exercise-induced inflammation and enhancing health of muscle and energy availability.
Intense exercise can lead to oxidative stress and reactive oxygen species (ROS) production occurs due to muscle contraction. This is greater than antioxidant capacity of the muscles and might lead to fatigue development in athletes. There are various experimental studies showing that dietary intake of PUFAs could optimize immune and inflammatory response. The consumption of omega-3 decreases interleukin IL-1 and IL-6 prevents inflammation. Daily prescription of 4 g of n-3 PUFA on young and old subjects for 8 weeks showed significant increase in muscle protein synthesis; another study that administered the supplement for six months showed improved muscle mass and strength in elderly adults. Seven days of 3 g/day of PUFA supplementation decreased post-exercise muscle damage and soreness in individuals who performed eccentric biceps curls. Chronic supplementation of n-3 PUFAs improves neuromuscular activity in animal studies and they are indeed an excellent supplementation for athletes given the fact that they are helpful in recovery during training or competition. A study was conducted on 20 international rugby players for 5 weeks of pre-season training. These players were made to consume a protein-based supplement consisting of n-3 PUFA twice a day or a protein-based placebo to check on muscle soreness, countermovement jump performance and psychological well-being. All the players filled a questionnaire assessing their fatigue, sleep, stress and mood levels every day during the training period. Results showed that PUFA supplement improved better maintenance of explosive power in the rugby players during pre-season training.
Exercise provides a platform for infectious agents to enter the body and cause diseases due to alterations in immune functions (this is the work of pro-inflammatory cytokine production, decreased neutrophil function and NK cell cytotoxicity). Studies show that n-3 PUFA supplementation decreased IL-6 production in athletes. A study focused on the immune functionality of fish oil supplementation on athletes who underwent endurance training-16 male subjects underwent a six-week double blind placebo supplementation trial involving two groups (fish oil or placebo oil). Each of them visited the research team twice-during the first visit they underwent a maximal exercise test and during the second they performed 1-h of endurance exercise on a cycle ergometer. Results showed that fish oil supplements reduce increase in peripheral blood mononuclear cell production. Immune levels are suppressed after performing high-intensity exercises and such decline in immunity levels increases the risk for upper respiratory tract infections. There are several studies that support the fact that n-3 PUFA supplementation can combat such infection risk.
A study defined asthma in elite athletes as ‘sport asthma’ that’s nothing but respiratory symptoms and bronchial hyperresponsiveness without allergic features. Some athletes, such as those involved in sports such as skiing and long-distance running/cycling that require intense breathing. Likewise, swimmers too face this issue due to inhalation of chlorine derivatives in the swimming pool. Eskimos exhibit low asthma rates as they consume more of omega-3 fatty fish. Studies show that n-3 PUFA intake reduces asthma rates because of its anti-inflammatory mechanism: Supplying asthmatic patients with 3.2 g of EPA and 2.0 g of DHA daily for 3 weeks reduces eicosanoids and pro-inflammatory cytokines concentration. Yet another study that supplied the same supplement combination and an anti-LT medication showed that both the supplement and the medication were independently effective in attenuating airway inflammation and bronchoconstriction. Exercise-induced bronchoconstriction improved when individuals were supplied with n-3 PUFAs.
Effects on Joint Pain
Joint pain is a common complaint for athletes especially those participating in sport with joint torsional movement such as football, volleyball and tennis or increased articular impact loading such as football, running and basketball. There is an increased chance of developing osteoarthritis in athletes when they are involved in playing a sport that has rapid acceleration/deceleration or causes high impact on joints continuously. Joint pain is the result of infiltration of inflammatory cells and n-3 PUFAs could help preserve joint health. A New Zealand study reported reduced inflammation in animal and human trials with 89% decrease in pain symptoms and 91% increase in quality of life.
Studies & their Supporting Evidences for Fish Oil Supplementation
Nieman et al. supplied 23 cyclists with 6 weeks of fish oil supplementation to check their effect on exercise performance, inflammation and immune measures. Results showed that the supplement increased blood levels of EPA and DHA but had no impact on exercise performance, inflammation and immune response. Poprzecki et al. showed that supplementing men with omega-3 for 6 weeks increased antioxidant activity. Omega-3 supplementation improves muscle flexibility in endurance athletes and in younger adult athletes it contributes to lower peak heart rate, reduces resting heart rate variability and oxygen consumption required while exercising. But there are several other studies showing not much improvements in markers of inflammation, performance and immunity. Another study on young men and women performing endurance exercise showed that supplementing with krill oil did not impact immune function nor affect markers of exercise performance.
Though fish oil supplements decrease triglyceride levels in athletes and nonathletes we need more concrete studies to show that they are an effective ergogenic aid for exercise performance. For those consuming fish, it is advantageous as it increases fish oil intake but too much of it is also hazardous to health. Get in touch with your physician for the recommended dosages of the supplements.
Omega-3 Polyunsaturated Fatty Acids: Benefits & Endpoints in Sport: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357022/
Omega-3 Fatty Acid Supplementation: Helpful for Exercise? https://www.uws.edu/omega-3-fatty-acid-supplementation-helpful-for-exercise/
Fish Oil Supplementation & Athletic Performance: https://journals.lww.com/acsm-healthfitness/Fulltext/2012/09000/Fish_Oil_Supplementation_and_Athletic_Performance.9.aspx?WT.mc_id=HPxADx20100319xMP
Fish Oil: Friend or Foe? https://www.health.harvard.edu/blog/fish-oil-friend-or-foe-201307126467
Osteoporosis is a concern for each of us as there are millions of individuals around the world suffering from this debilitating condition. As the world’s ageing population seems to increase the prevalence of osteoporosis and osteopenia also increases characterized by decreased bone mass and increased fragility risk. According to the Osteoporosis Consensus Development osteoporosis is a metabolic bone disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. When the condition is not prevented it progresses until the bone is fractured (mostly includes regions of the hip, wrist and lumbar spine). Menopause brings about numerous hormonal changes in women and they can lose around 20% of bone mass in the initial 5-7 years which finally can result in osteoporosis. Its been shown that 50% of women and 25% of men over the age of 50 will suffer from fracture due to osteoporosis in their lifetime.
Bone is a living tissue that constantly breaks down and rebuilds but with the advent of diseases such as osteoporosis there is more breakdown than building up. But this is not irreversible and exercising helps in rebuilding bones and reducing the likelihood of fracture. Exercising has been recommended as an inexpensive and safe intervention technique for preserving musculoskeletal health but all types of exercises don’t have the same beneficial effect on bone mineral density (BMD). According to the World Health Organization (WHO) osteoporosis and osteopenia are defined as the lowest BMD T-score of ≤-2.5 and -2.5 to 1.0 measured at the lumbar hip or spine. Present guidelines include resistance training and weight-bearing exercises for preventing bone loss and preserving bone mass in patients with osteoporosis.
Strength training helps to maintain or rather improve BMD, promote increased levels of bone formation markers (such as type 1 collagen amino-terminal propeptide (P1NP)) and decrease levels of bone resorption markers (such as type 1 collagen C breakdown products (CTX)) in the blood. We have reports on a positive association between maximal muscle strength measured as 1-repetition maximum (1RM) and bone mass. We have strength training programs that focus on 1RM improvements to be helpful in improving BMD and bone mineral content (BMC), especially in postmenopausal women.
A study focused on 1-year and 4-year results from the Bone Estrogen Strength Training (BEST) Study was the most extensive study in United States that began in 1995 focusing mainly on how strength training combined with calcium intake impacts BMD in two groups of postmenopausal women. Anyone whether or not they were undergoing hormone replacement therapy (HRT) were allowed to participate in the study which meant a total of 266 women aged 45-65 years completed the first year of study. Sedentary (<120 minutes of exercise per week) postmenopausal women were selected and were randomly assigned to either control or exercise group and all participants took 800mg of calcium citrate supplements daily. Each of the participants’ dietary intake through the first year was assessed using 8 randomized days of dietary recall (DR) collected at baseline, 6 months and 12 months of study. While those in the control group continued with their sedentary lifestyle those in the exercise group performed weight bearing and resistance exercises 30 days per week on non-consecutive days. These exercise sessions lasted for 60-75 minutes and included weight-bearing activities for warm up, strength training and cardio weight bearing circuit of moderate impact activities at 70-80% of maximum heart rate such as stair climbing on step boxes wearing weight-bearing vests and small muscle exercises including stretching and balancing ones. All types of exercises and its duration was regularly monitored and the data entered by BEST trainers.
The participants performed strength training exercises using free weights and machines focusing on major muscle groups. 8 different exercises were performed that included seated leg press, weighted march, lat pull down, seated row, back extension, one-arm military press, squats and rotary torso machine. All the subjects completed two sets of 6-8 repetitions at 70% (twice a week) and 80% (once per week) of the one-repetition maximum.
Results were positive for those who exercised as exercise group participants witnessed improved BMD compared to the control group. In those who used HRT, the use of calcium, HRT supplements and exercising increased hip, neck and femoral BMD by 1-2% while the use of supplements with no exercise performance had a non-significant effect on BMD. In those participants who did not undergo HRT, the performance of regular exercise improved BMD by almost 1% whereas abstinence from exercising decreased their BMD to a great extent. The study clearly proves increased advantage for those women who use HRT.
Besides BMD, BEST intervention also had positive effects on soft tissue composition-inclusion of all body components except bone. DXA measurements showed that women who exercised regularly displayed whole body and regional (arms and legs) lean soft tissue (LST). Though there was no improvement in LST in those who used HRT the use of HRT did prevent loss of LST in those women who did not exercise. There was significant fat mass loss in those women who used HRT and also exercised. Nutrition intake also had a significant effect on BMD-a greater intake of calcium, iron, zinc, magnesium, phosphorus and vitamin D was significantly linked to better BMD at the end of the first year of study. At baseline, a subsample of 242 women who completed DRs having dietary iron intake levels greater than 20 mg/day was linked to greater BMD at several bone sites when the participant’s daily calcium intake was from 800-1200 mg/day only. At the end of the first year of study 228 women had complete DR data. Among the 228 women, those who took HRT and consumed lowest amount of calcium showed increase in BMD as iron intake levels increased from 7 mg/day to 32 mg/day. In those who did not take HRT there was BMD increase only in those who took highest calcium intake with no changes due to iron intake levels.
The study showed that when women lifted more weights, they experienced greatest improvements in BMD, more specifically at the hips. Bone loss is not a short-term effect but something that takes place for many years after menopause and performing exercise meanwhile can definitely curb this effect. There are many studies dealing with the effects of exercise only on short-term advantages-one that happens within 1-2 years of exercising. The BEST study focused on long-term results and found that two sets of exercise was sufficient to increase BMD and the initiate to lift weights was necessary to further improve BMD levels. To help participants continue with the BEST exercise program the duration of exercising was reduced to 45 minutes and 6 strength training exercises that excluded rotary torso machine and weighted march. Some of them were also involved in doing yoga, spinning and Pilates to break the monotony and bring in variety to their exercising schedule.
It was only 167 women who completed 4 years of participation in the BEST study. At the end of the first year all of them were encouraged to exercise on their own and also have yearly DXA assessments conducted by the study group. At the end of the second year, supervision was reduced in the facilities, in the other years trainers were there in the facility only once a month. After 4 years the participants’ exercise frequency varied from 0-94% of the various exercises mentioned above. those participants who were actively engaged in exercising maintained or improved BMD at the hip and lumbar spine (LS). Those who showed maximum exercising efficiency experienced greatest BMD improvements at all bone sites than those who exercised less often. But it was observed that greatest increase in LST and BMD occurred in the first year of the BEST study regardless of HRT use. While LST increased during first year the effect was lost for years 2-4 yet the overall gain remained well above normal ranges. It was the LS BMD that continued to improve consistently for 4 years of participation in the BEST study program.
Those women who completed 4 years of the study taking 800 mg/day of calcium supplements but who were not on HRT showed maximized improvements in BMD than those taking less calcium supplements. Those women not on HRT and following BEST exercise schedule need at least 1700mg/day (this is 500 mg more than recommended DRI values for women aged 50+) of calcium supplements to preserve BMD. This shows that calcium too apart from exercising plays a pivotal role in determining BMD in individuals.
At the end of the 4-year period it was noticed that women who attended maximum exercise sessions and lifted greatest amount of weights showed greatest gains in LS BMD compared to those women who attended minimum exercise sessions and lifted least amount of weights. At the end of 4 years training, there was a 2.5% difference in LS BMD between those women who lifted greatest amount of weight and those who lifted least. Those who lift the greatest weights reaped maximum BMD benefits. This study thus shows that physicians and health experts can use the BEST exercise program for improved bone density.
Strength Training Effect on Postmenopausal Women
We have one study reporting that power training focusing on high-speed contractions was more effective than conventional strength training for reducing bone loss while another study showed that neuromuscular performance (this makes rate of force development (RFD) capacity more important for skeletal adaptations) determined bone strength in postmenopausal women. Maximal strength training (MST) is characterized by high loads and fewer repetitions and till date there are no studies that have applied interventions combining heavy loads with high concentric acceleration as in MST promoting both 1RM and RFD improvements. The study below focused on the effect of squat exercise on MST on 1RM, RFD and bone-related parameters in patients with osteoporosis and osteopenia. 21 participants all of whom were at least 2 years postmenopausal, <75 years and having a BMD score between -1.5 and -4.0 at the lumbar spine, hip or neck were randomly assigned to either the training group (TG, n=10) or control group (CG, n=11). Participants in the training group followed a training program that comprised of MST for 12 weeks with 3 exercise sessions per week amounting to 36 sessions totally. The training sessions consisted of one exercise which used the lower extremities in a squat exercise machine-it started with a warm up including 2 sets of 8-12 repetitions at approximately 50% of the participant’s training load followed by 4 sets of 3-5 repetitions at 85-90% of 1 RM. The training load was increased by 2.5 kg if the participants could perform >5 repetitions.
Each of the participant’s vitamin D levels were measured and treadmill tests were performed to define aerobic capacity among participants. The research team was left with 16 participants with 8 of them in each group completing the study. Results showed that:
We have studies showing that performing resistance exercises (REs) 2-3 times per week for a year maintained or increased BMD at the lumbar spine and hip in postmenopausal women. Combining RE and weight-bearing aerobic exercises improves musculoskeletal outcomes including BMD, muscle mass and strength in older men as well as women. Another study with an 18-month RE and weight-bearing impact activity showed significant increase in bone strength and BMD in middle-aged men and women. A systemic review and meta-analysis on the effects of exercising on postmenopausal women suggested that exercise decreased bone mass loss.
Performing exercises to build and maintain muscle mass and strength leads to stronger bones which in turn help in minimizing risk of fractures due to osteoporosis.
Preventing Osteoporosis the Bone Estrogen Strength Training Way: https://journals.lww.com/acsm-healthfitness/Fulltext/2007/01000/Preventing_Osteoporosis_the_Bone_Estrogen_Strength.8.aspx?WT.mc_id=HPxADx20100319xMP
Maximal Strength Training in Postmenopausal Women with Osteoporosis or Osteopenia: https://journals.lww.com/nsca-jscr/Fulltext/2013/10000/Maximal_Strength_Training_in_Postmenopausal_Women.32.aspx
Effects of Resistance Exercise on Bone Health: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6279907/pdf/enm-33-435.pdf
Nutrient insufficiency is omnipresent. There are not many who have a healthy stock of all the required nutrients in the body and those suffering from deficiencies mostly rely on supplements to fulfil their needs. Physicians generally recommend patients to eat a well-balanced diet that’s replete with nutrients and even suggest a list of fruits, vegetables and other foods that are enriched with the nutrients missing in their body. But mankind has always been lazy to incorporate ideological ways depending mostly on shortcuts to fulfil most of their requirements. Even supplements came into existence only due to our inadept handling of our food habits.
Fruits and vegetables have always been our holy grail to health. We also depend on other foods such as dairy, fats, whole grains, nuts, seeds and legumes to fulfil all our nutrient needs. The list seems to be in total contrast of the junk food list that makes our mouth water even when we are simply reading it. So, how do legumes and pulses fare in our list of daily food recommendations?
Make Some Room for Legumes in Your Diet
Legumes in general, especially soybeans, are extremely rich in iron and ferritin content. They constitute a major portion of the diet for a large section of the human population and germination enhances the iron bioavailability of soybean. Iron is available as heme and non-heme iron in animal- and plant-based products respectively. While heme iron is easier to absorb non-heme iron is less readily absorbed by the body. Soybeans are a potent non-heme iron source that’s been increasingly consumed these days for its potent iron composition.
Women in general suffer from anaemia problems and they mostly blame it on their menstruation cycle for this as they lose ample blood every month. Otherwise too the human population is not a big fan of iron adequacy as most people including infants, kids and the elderly suffer from iron deficiency. Suggesting such people to eat pomegranates, dates or beetroot is not something new but again have we ever followed any of the nutritional guidance given by others? Definitely not.
Meta-analysis on the Effect of Fortified Soybeans on Infants
Malnutrition and stunting are common problems in infants worldwide and China is no exception. Its been shown that infant malnutrition-related to stunting and anaemia are two of the commonest problems reported in infants and young children (IYC) in poor rural regions of China. Such unmatched nutrition levels elevate the risk of infectious diseases, cognitive disorder and chronic diseases as they grow. Statistics by the National Nutrition Survey show that anaemia rates in 0- to 6-, 6- to 12-, and 12- to 24-month-old IYC was 23.4%, 28.5% and 15.7% respectively with rates exceeding 40% in 6- to 24-month-old IYC in some regions of the country.
Its saddening to see that some newborn babies suffer from such complications soon after birth. At the same time, we need to come up with effective solutions to end this problem. Complementary food feeding is the best way to tackle stunting and anaemia in YIC. WHO reviewed the effects of micronutrient powder (MNP) on IYC revealing that MNP did improve haemoglobin concentration but did not do anything with regard to stunting.
Ying Yang Bao (YYB) is a soybean powder product enriched with vitamins and minerals often used as an MNP in China. It is commonly used as a complementary food containing protein and fat largely provided to infants in poor, rural regions of China. We have a number of studies probing into the effect of YYB on reducing infant malnutrition-related stunting and anaemia but results are contradictory. So, a group of researchers were determined to find the exact effect of the supplement on rural infants. They searched databases such as Central and Medline using several text terms such as Ying Yang Bao, anaemia, complementary food supplement, growth, development and so on to identify potential research materials.
Different eligibility criteria were imposed, randomized and quasi randomized trials were included and all the participants were healthy boy and girl IYC anywhere between 6 and 24 months without any health problem at the time of intervention. The researchers defined anaemia as haemoglobin values lower than 110g/L and stunting as having a z score <-2.0 for height for age. Underweight is defined as having a z score <-2.0 for weight for height.
The database came up with 17340 publications from which only 22 articles were selected after imposing all the eligibility criteria. Again, 5 studies were excluded due to incomplete information available and the remaining 17 studies were included in the meta-analysis. All the studies included YYB durations between 3 and 18 months, sample size was between 76 and 2183, 8 of them were parallel control trials and 16 were before-after control trials.
YYB vs No-intervention Studies
There were 6 studies having 9 subgroups involved in this specific study containing a total of 4929 participants. YYB supplementation resulted in increased haemoglobin concentration when compared to the control group and the changes were significant across subgroups.
This included 10 studies with 15 subgroups with a total sample size of 15897 (8269 participants before and 7628 participants after study). Significant increase in haemoglobin concentration over baseline was visible in the studies after YYB supplementation. All the studies had a follow-up period either above or below 12 months and across these periods too the results remained significant.
YYB vs No-intervention Studies
This included 7 studies with 12 subgroups with a total sample size of 11027 and YYB supplementation decreased anaemia rates across the intervention group in all the study participants in comparison to the control group.
13 studies with 20 subgroups were included here with a sample size of 26496. Subgroup analysis showed that anaemia rate was lower after YYB intervention compared to baseline and the results remained the same even after excluding two studies after they displayed low quality.
YYB vs No-intervention Studies
Four trials were included and they showed 47% reduction in stunting after the kids were fed with YYB.
12 subgroups were included here with 7536 participants before and 7895 participants after the study. While stunting effects were significantly decreased after providing YYB supplementation there was no effect of the supplement found in the subgroup under 12 months.
YYB vs No-intervention Studies
Two trials with a sample size of 885 were included here where underweight prevalence decreased by as much as 46% compared to the no intervention group.
This analysis included 10 trials with a sample size of 7599 participants (3996 of them before study). Feeding the participants with YYB decreased underweight rates as much as by 51% and the results remained the same even after excluding 2 studies due to some reasons.
YYB vs No-intervention Studies
Two trials with a sample size of 885 were included here but the supplement had no effect on wasting prevalence rates.
7 trials with a sample size of 5376 (2835 before and 2523 after) were included here and YYB supplementation showed significant decrease in wasting prevalence compared to baseline. Results showed no differences even after excluding a study.
YYB is an effective means to reduce anaemia, stunting and underweight in IYC. A study conducted in Guatemala in kids 2 years and above showed that consuming a supplement with high protein and energy content helped the kids score more in reading, math and other cognitive skills compared to those who did not consume such nutrients. Pollitt et al. conducted a follow-up study on kids aged under 18 months and found that after their 8th birthday these children showed better memory capability that those in the control group. This clearly shows that giving food supplements during appropriate periods of the kid’s growth and development has a long-term impact on their intelligence.
Supplementing Fortified Soybean Powder Reduced Anaemia in Infants & Young Children Aged 6-24 Months: https://www.sciencedirect.com/science/article/pii/S0271531718307553
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