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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 7  |  Issue : 1  |  Page : 82-88

Impact of vegetarian and nonvegetarian dietary habits and age on body composition and bone mineral density of office workers


1 Department of Nutrition and Biochemistry, Defence Institute of Physiology and Allied Sciences, Delhi, India
2 Defence Scientific Information and Documentation Centre, Delhi, India

Date of Submission15-Jan-2021
Date of Decision09-Mar-2021
Date of Acceptance16-Mar-2021
Date of Web Publication27-Jun-2022

Correspondence Address:
Dr. Som Nath Singh
Defence Institute of Physiology and Allied Sciences, Defence Research and Defence Organisation, Lucknow Road, Timarpur, Delhi - 110 054
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bjhs.bjhs_8_21

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  Abstract 


INTRODUCTION: Measurement of bone mineral density (BMD) is important for skeletal health. Several factors such as age, gender, dietary habits, exposure to sunlight, lifestyle, and bodyweight influence BMD directly or indirectly. People living in metropolitan cities are at risk of low BMD due to low Vitamin D status and less physical activity. This study aimed to evaluate BMD status of office workers and also establish a correlation between body composition and BMD with different age groups and dietary habits.
MATERIALS AND METHODS: The present study was carried out on 175 participants with 124 males and 51 females. Body composition was determined using bioelectrical impedance and BMD measurements were made using peripheral dual-energy X-ray absorptiometry.
RESULTS: A strong and positive correlation was observed between body composition and BMD. Fat-free mass (FFM) has a more significant correlation than fat Mass with BMD. Handgrip strength was significantly higher in the right forearm (RF) of nonvegetarians. When compared with the Indian reference range, 20% of males and 23.5% of females had low BMD at the measurement site, ultradistal forearm. Both male and female participants below 30 years of age had higher BMD compared to participants above 30 years of age.
CONCLUSION: It was observed that there were no statistically significant differences in BMD of vegetarians and nonvegetarians. It was also seen that the bone density decreases while the age increases. It may be due to inadequate nutrition, poor lifestyle, physical inactivity, and many more. Bone health is a major public concern and should be taken seriously where osteoporosis and fracture risks are considered.

Keywords: Age, body composition, bone mineral density, food habit, gender, office workers


How to cite this article:
Singh VV, Yadav A, Bansal A, Singh VK, Verma SK, Saxena S, Kirar V, Singh M, Kumar B, Singh SN. Impact of vegetarian and nonvegetarian dietary habits and age on body composition and bone mineral density of office workers. BLDE Univ J Health Sci 2022;7:82-8

How to cite this URL:
Singh VV, Yadav A, Bansal A, Singh VK, Verma SK, Saxena S, Kirar V, Singh M, Kumar B, Singh SN. Impact of vegetarian and nonvegetarian dietary habits and age on body composition and bone mineral density of office workers. BLDE Univ J Health Sci [serial online] 2022 [cited 2022 Aug 16];7:82-8. Available from: https://www.bldeujournalhs.in/text.asp?2022/7/1/82/348278




  Introduction Top


Maintenance of healthy body weight by using adequate dietary intake, physical activity, and lifestyle is the key of disease-free healthy life. A healthy diet must contain the proper amount of macro- and micronutrients required for energy and metabolic functions as well as prevention of various diseases. Analysis of body composition variables such as fat mass (FM), lean mass, bone mass, and body mass index (BMI) helps in monitoring health and fitness level. Body composition differs with age, sex, and ethnicity, which impart normal variability in bone structure and bone mineral density (BMD) between adults.[1] To ascertain the diet adequacy, monitoring of body composition and BMD is a noninvasive and reliable technique.

Bone is a dynamic tissue, which provides structural support to body, enables mobility, stores minerals, and produces red and white blood cells. It persistently undergoes changes in the form of bone resorption and formations, which is highly influenced by nutritional status, physical forces, and hormonal and metabolic factors.[2] BMD is the amount of minerals present in bone tissue and robust marker for the prognosis of osteoporosis and prediction of risk of bone fractures.[3] Osteoporosis is a stage where the bone becomes fragile and weak due to less mineral density that even mild tremors to body can lead to fracture. According to the International Osteoporosis Foundation, osteoporosis which is becoming a global epidemic will affect the risk of fractures to 1 in 3 women and 1 in 5 men who are above the age of 50 years.[4] India, with a rapidly growing population of over 1.2 billion people, making it the second-largest populated country in the world, currently has more than 100 million people who are over 50 years of age.[5]

About 50 million people in India have low bone mass and at risk of osteopenia and osteoporosis.[6] Bone health starts deteriorating silently and gradually with advancing age, many studies suggest that the age where peak bone mass varies is from 20 to 30 years. A high prevalence of osteoporosis was observed in the study upon 1600 elderly Indian subjects residing in Delhi having an age range above 50.[7] Measuring BMD or bone mineral content (BMC) is the easiest way of directly assessing bone strength in humans. Studies have explained BMD as the best predictor for fracture risk.[8]A reference standard for BMD was taken for ultradistal (UD) in forearm from a published report by the Indian Council of Medical Research in 2010 on the basis of a multicentric study.[9] Numerous responsible factors, namely age, gender, diet, exposure to sunlight, lifestyle, drugs, heredity, body weight, smoking, and alcohol consumption have been shown to influence BMD directly or indirectly.[10],[11] Our country is facing a dual burden of malnutrition as well as overnutrition-related rise in obesity, diabetes, cardiovascular respiratory dysfunction, and other degenerative disorders. People living in metropolitan cities are more vulnerable to low Vitamin D status due to indoor work, less physical activity, and very little exposure to sunlight. Beloyartseva et al. have observed that only 6% of 2119 Indian health care professionals were having sufficient vitamin D, which indicating that majority of urban Indian population is deficient in vitamin D.[12] Despite adequate sunlight, which is an utmost source of Vitamin D, Indians still encounter a high risk of Vitamin D deficiency in different subgroups of the Indian population, particularly in the urban areas when compared to the western Caucasians. Vitamin D deficiency is a prime factor causing low BMD and poor status of bone health in Indians, which can be improved by following a healthy lifestyle (diet, exercise, and sunlight exposure) to ameliorate bone health and its metabolism.[13] Various studies have shown that bone health declines due to paltry Vitamin D intake and lack of exercise.[12],[13],[14],[15] Vitamin D status on hospital staff showed the deficiency of Vitamin D in north Indians, possibly due to quality and quantity of sunlight exposure, dress patterns, skin pigmentation in Indians[14] and age; as elder people synthesize less Vitamin D in longer duration than younger adults.[15] Diet is considered to be one of the prime factors to maintain bone health, whereas a poor diet leads to loss of bone mineral. Indian diets lack in Vitamin D fortified foods, for example, cod liver oil, salmon, and mushrooms, which are the major sources of Vitamin D and consume mainly phytate rich cereals which lower Vitamin D absorption diet.[16] In a study among south Indian women, age ranged 30–60 years from low-socioeconomic income groups reported lower BMD at all skeletal sites with a high prevalence of osteopenia and osteoporosis, in which inadequate nutrition was an important determinant.[17] Similar findings were found in a study on healthy school children in India; where a higher prevalence of low BMD and Vitamin D deficiency was significantly higher in children belonging from low socioeconomic backgrounds suggest that adequate nutrition is a key to overcome hypovitaminosis D.[18] Food habits is also a point to consider, as many people are vegetarian which impacts on bone health and considered beneficial for bones is also a disputable matter.[19] A study conducted on the effect of BMD on vegetarian and nonvegetarian groups in Taiwan showed no significant differences between the two groups.[11] It is well established that senescence leads to a decrease in body composition as body slows down its metabolism process, which increases the risk of disorders in body. The bone formation decreases and resorption increases with the aging.[20] The importance of levels of hormones, nutrition, age and gender were considered to have a significant influence on BMD out of several factors.[19],[21] Age-related changes in body composition and bone density differs from other populations due to racial or cultural differences. In additions, lack of physical activity, unhealthy dietary habits and poor lifestyle had also made our population more prone to this silent progressive disease. Hence, it is essential to study the effect of food habits with different age groups on body composition and BMD in the Indian population. The objective of the present study was to observe and compare dietary habits in both the sexes with age, body composition, and BMD in office workers.


  Materials and Methods Top


Study participants

The study was conducted at Defence Scientific Information and Documentation Centre (DESIDOC) during month of June 2018. A total of 175 employees comprising 124 males and 51 females volunteered for this study. Further, participants were categorized on the basis of age groups: below 30 (age range: 20–30 years) and above 30 years (age range: 31–50 years) and food habit: vegetarian and nonvegetarians. Each participant was briefly explained about the purpose of the study and an informed consent form was signed by each of the participant. Institutional ethical committee approval (IEC/DIPAS/C-1/2) was granted under an ongoing project as per the updated version of the Declaration of Helsinki.[22]

Experimental details

Demographic profile and body composition measurement

Age and dietary habits were recorded during interaction with participants. Height was determined by making a person to stand without shoes on a plane surface parallel to the floor by Martin Anthropometer (make: Seritex GPM Model 101). Measuring body composition by bioelectrical impedance is a reliable and quick method of measurement of body water and fat content. Before measurement, all metallic items such as rings and chain etc., were removed and with minimal clothes, participants stood barefoot on Tanita body fat analyzer (Model: BC420 MA) consisting of four electrodes for bioelectric impedance measurement. Subjects were advised to avoid exercise and taking food at least 4 h prior to measurement. Blood pressure (BP) (systolic and diastolic) and heart rate were measured using digital BP apparatus (make: Omron model M1). Participants were instructed to sit and remain calm for a while before measuring to ensure normal conditions and avoid fluctuations. BP was measured thrice for each volunteer and the mean value of reading was taken.

Handgrip test

A passive handgrip test for muscular strength was carried out using Grip Strength Dynamometer (TKK 5001, Grip A, Takei Scientific Instruments Co. Ltd., least count: 0.5 kg). Subjects were explained the technique before conducting the measurement and encouraged to press the dynamometer by their right hand and left hand with full grip strength and readings were recorded.

Bone mineral density measurement

Dual-energy X-ray absorptiometry (DEXA) is considered as a gold standard for measurement of BMD. It is a quick and noninvasive technique that requires less radiation exposure which uses two levels of X-ray photon energy to measure the amount of minerals in bone. Peripheral DEXA (make: EXA 3000, Ostoesys) was used to measure bone density of forearm at Ultra Distal and calcaneus region. Low bone density with increased bone turnover and fracture risk can easily be seen in the distal region.[23] Furthermore, calcaneus is rich in the trabecular bone which is weight-bearing. It is considered more effective than other sites for measurement of bones such as the radius, metacarpal bones, or fingers for detecting the effect of body composition,[10] so these two sites of measurement may help in primary screening of subjects having low bone density. The BMD was measured at four different points, i.e., RF, left forearm (LF), right calcaneus (RC), and left calcaneus (LC). The densitometer was standardized by phantom before measurement. Participants were briefed about this measurement technique and the necessary precautions were taken during the time of measurement. The actual sites of measurement were at UD, a portion in the forearm and measurement of calcaneus located within the foot, the calcaneus is also known as heel bone, as shown in [Figure 1].
Figure 1: (a) Site of measurement of ultra-distal (UD) portion in forearm, (b) Site of measurement of Calcaneus, (c) A specimen of report generated by bone densitometer

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Statistical analysis

All values were presented as mean ± standard deviation. Data were checked for normality, and then, comparative analysis was performed using a multivariate Analysis of Variance (MANOVA) followed by Bonferroni post hoc analysis, using the Statistical Package for the Social Sciences for Windows V16.0 (SPSS, Nikiski, AK 99635, USA). Pearson correlation was used to examine the relationships between variables. All statistical differences were considered significant at P ≤ 0.05.


  Results Top


Out of total 175 adults, 71% (n = 124) of males and 29% (n = 51) of females participated in this study. Their demographic, body composition, pulse rate, blood pressure and hand-grip strength profiling are presented in [Table 1]. The average age and height of male were 36.8 ± 11.2 and 168.2 ± 6.4, whereas 32.8 ± 12.4 and 154.8 ± 6.7 in female, respectively.
Table 1: Body composition and demographic profile of study volunteers

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According to food habit, 50.8% of males and 60.8% of females were vegetarian, whereas 49.2% of males and 39.2% of females were consuming nonvegetarian foods. Considering age-wise (below and above 30 years) distribution of volunteer, it was observed that 36% of males and 64.7% of females were below 30 years, while 63.7% of males and 35.3% of females were above 30 years of age. According to the ICMR, the Indian reference standards of forearm at UD site for male and female were 0.465 ± 0.054 and 0.408 ± 0.048, respectively.[9] The mean values and standard deviation of BMD at different measuring sites of each group are depicted in [Table 2]. The reference values of Indians at UD site in hand are available for comparison; therefore, the average of BMD from both arms was taken. When compared with the Indian reference range, 20% of males and 23.5% of females were found to have lower BMD. In case of male participants with an age more than 30 years, 20 out of 79 showed low BMD, whereas only 5 out of 45 male participants below the age of 30 had lower BMD. Similarly, in case of females, lower BMD was noted in 18% and 33.3% in age groups below 30 and more than 30 years, respectively, as depicted in [Table 3]. Handgrip strength was significantly higher in RF of nonvegetarian when compared to RF of vegetarian participants [Table 1].
Table 2: Bone mineral density of the participants

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Table 3: Distribution of participants on the basis of low bone mineral density

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A Pearson correlation was run to determine the relation between body composition and BMD and a strong and positive correlation was found between them shown in [Table 4]. FM was positively correlated with RC_BMD (r = 0.185) and LC_BMD (r = 0.177) except RF_BMD (r = −0.024) and LF_BMD (r = −0.086) which was negatively correlated. FFM was strongly correlated with all four measurement sites of BMD, i.e., RF_BMD (r = 0.350), RC_BMD (r = 0.517), LF_BMD (r = 0.325), and LC_BMD (r = 0.466). Similarly, bone mass was strongly correlated with RF_BMD (r = 0.314), RC_BMD (r = 0.528), LF_BMD (r = 0.261), and LC_BMD (r = 0.475). A medium correlation was found with BMI at RF_BMD (r = 0.179) and strongly correlated with RC_BMD (r = 0.357) and LC_BMD (r = 0.328); in LF_BMD, no positive correlation was found (r = 0.105).
Table 4: Correlation shown between body composition and bone mineral density parameters

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MANOVA test was adopted to know the impact of independent variables that may influence BMD and body composition. There was a significant impact of gender on FM (F = 24.406, P = 0.000), FFM (F = 238.096, P = 0.000), BM (F = 119.385, P = 0.000), RF (F = 38.238, P = 0.000), RC (F = 16.399, P = 0.000), LF (F = 39.169, P = 0.000), and LC (F = 16.154, P = 0.000). We also found a significant effect of food habit on FFM (F = 7.041, P = 0.009), BM (F = 11.349, P = 0.001), and BMD of RF (F = 3.936, P = 0.049). There was also a significant effect of age group on FM (F = 0.41, P = 0.000), FFM (F = 6.408, P = 0.012), BM (F = 13.077, P = 0.000), BMI (F = 41.579, P = 0.000), and RC (F = 5.782, P = 0.017). We found a significant effect on gender × age interaction on FM (F = 6.230, P = 0.014) and gender × food habit interaction on bone mass (F = 8.114, P = 0.005). There was no significant impact of food habit × age interaction and gender × age × food habit interaction was observed on BMD and body composition parameters.


  Discussion Top


Bones have an important role in framing our body, protecting vital organs, and anchoring muscle. They are weight bearing organ act as dynamic tissue and reservoir of minerals and trace elements and performs homeostatic functions and mechanical work.[24] Our study revealed no statistically significant differences in BMD between both the types of dietary habit. We found no statistically significant difference in BMD with vegetarian and nonvegetarian diet-consuming habit except in RF; for that, the possible reason for this can be gender, as male and female population were mixed in vegetarian and nonvegetarian food habit and the difference in the reference range in BMD values of male and female can result in a significant change in RF, whereas no statistically significant difference was observed when gender and food habit interaction was done. Bone density in respect to food habits shows very contrasting results, as some reports explained that there was no statistically significant difference between vegetarian and nonvegetarian diets with respect to bone density, while some reported that vegetarian diet has low bone density than nonvegetarian diet. A meta-analysis study has reported that vegetarians and vegans have low BMD at the femoral neck (FN) and lumbar spine (LS) than omnivores and there is a higher fracture risk in vegans as compared to omnivores.[25] In a study, there was no significant change observed in bone density in 27 vegetarian and 37 nonvegetarian diet-consuming premenopausal women.[26] A similar effect was experienced in a study of vegetarian and omnivores postmenopausal women.[27] Although one study reported the effect in BMD of elderly Chinese women, vegetarian had less bone density than nonvegetarians at some skeletal sites.[28] A study conducted in Taiwan summarized that postmenopausal women consuming vegetarian diet were at higher risk of bone loss.[29] The possible cause of low BMD in vegetarians was maybe due to differences in dietary intake, especially calcium and protein, and time duration of monitoring dietary habits strictly. Studies have also reported that physical activity, sun exposure, role of hormones, alcohol and cigarette consumption, and protein and calcium intake play vital role in regulating bone remodeling.[10],[30] The amount of adequate Vitamin D absorption and its synthesis is responsible for bone health in individuals. A study on healthy persons in Delhi concluded that the major reasons for Vitamin D deficiency were due to skin pigmentation and insufficient sunlight exposure which results in a high risk of bone mineral imbalance.[31] Handgrip strength is a musculoskeletal health marker which is an easy and noninvasive technique. In our study, nonvegetarians had greater muscle strength than vegetarian in RF. Similar results were found in a study on 641 vegetarians and 424 nonvegetarian Indian women, in which nonvegetarian had greater handgrip strength.[32]

The role of FFM and FM on BMD is very inconsistent, as many researchers have reported that FFM has a greater impact on BMD than FM or body weight,[33],[38] while some reported that FM has a greater role in BMD. A study reported that the FFM was found maximum in age range of 35-44 years and 45-54 years in male and female respectively, after that it starts declining, whereas FM increased gradually in both sexes between 15 and 98 years of age and greater weight was due to FM.[34] Our study revealed that FFM has a more significant correlation than FM on BMD, with this context that bone mass adjusts its toughness first and foremost to dynamic load which comes from muscular force rather than static force, i.e., bodyweight. FFM contributes more to muscle mass rather than FM, so they are more likely to exert a stronger impact on BMD.[35],[36] Ferretti et al have conducted a study on 700 children and 600 adults, during which they have observed that total bone mineral content was closely associated with lean mass across various age groups.[37] In contrast, some studies showed FM as a vital parameter in the judgment of BMD. In a review study on postmenopausal women, the effect of weight on bone density was because of both lean tissues mass and FM, but FM was a more stronger and consistent predictor of bone density.[39] Several believable mechanisms have been suggested regarding the positive association between FM and BMD, one among those is that FM contributes to higher gravitational mechanical load on bone, which helps in the increase of BMD.[40] Body weight also impacts bone density and fracture risk as obese people are likely to have a low risk of osteoporosis than underweight one, and FM is a major contributor to this relationship as hormones such as adiponectin, insulin, leptin, estrogens, and androgens all are responsible for this connection.[41]


  Conclusion Top


In this study, vegetarian and nonvegetarian diet-consuming participants had shown no significant differences in BMD. We also observed that the bone density decreases while the age increases. It may be due to inadequate nutrition, poor lifestyle, physical inactivity, and many more. Bone health is a major public concern and should be taken seriously where osteoporosis and fracture risks are considered. This study supported earlier reports that FFM plays a greater role in bone density than FM. Adequate dietary calcium, synthesis of Vitamin D through sun exposure in body, and beneficial exercise are the needs of the day. Therefore, creating public awareness is considered necessary. Early prediction of low bone health can help people in reduction of fracture risks. However, more studies are needed to be carried out for better understanding and establishing a stronger relationship between individual dietary components on BMD with a larger sample size.

Acknowledgments

Investigators express heartfelt thanks to all participants who were involved in this study And also express special thanks to Director, DESIDOC, for permitting logistic support to the study team in collecting data.

Financial support and sponsorship

The authors are thankful to DRDO, Ministry of Defence for providing funding.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
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