Source: UNIVERSITY OF GEORGIA submitted to NRP
OBESITY, PHYSICAL ACTIVITY AND BONE STRENGTH IN CHILDREN AND ADULTS
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
COMPLETE
Funding Source
HATCH
Reporting Frequency
Annual
Accession No.
1009464
Grant No.
(N/A)
Cumulative Award Amt.
(N/A)
Proposal No.
(N/A)
Multistate No.
(N/A)
Project Start Date
May 5, 2016
Project End Date
Mar 30, 2021
Grant Year
(N/A)
Program Code
[(N/A)]- (N/A)
Recipient Organization
UNIVERSITY OF GEORGIA
200 D.W. BROOKS DR
ATHENS,GA 30602-5016
Performing Department
CFACS - Foods and Nutrition
Non Technical Summary
This project seeks to reduce the burdens of illness and disability in the processes of human growth and development. The research proposed has the following objectives, i.e., to determine:Exercise effects on musculoskeletal healthEffects of childhood artistic gymnastics activity on bone in menopausal womenEffects of a non-combative boxing intervention on cardiometabolic and musculoskeletal health in low-income youthBody composition effects on musculoskeletal healthEffects of obesity on bone health: a cross-sectional studyEffects of obesity on bone health: a 4-6 year prospective studyEffects of adenovirus 36 on musculoskeletal healthThere are two key strategies for preventing osteoporosis: 1) maximize bone strength in childhood and 2) slow the loss of bone in the adult years. This project will contribute significantly to our existing knowledge of exercise and body fatness with regard to bone health in both children and adults. Results from this work will help determine if follow-up studies are warranted to explore how these lifestyle modifications can improve bone health.Objective #1a. Determine the effects of childhood artistic gymnastics activity on bone in menopausal womenTheoretically, because bone loss occurs with aging, people who acquire maximal bone mass in their early years should be at a reduced risk of skeletal fracture later in life. One strategy to maximize bone acquisition is participation in weight-bearing sports, such as artistic gymnastics. Currently, however, participation in weight-bearing sports remains an unproven investment as an evidence-based means to prevent osteoporotic fractures. This research will provide further insight into the effects of past athletic participation on skeletal health. The proposed project's aim #1a is to determine whether former college gymnasts maintain higher bone density after a 34-year retirement from sport. We anticipate that the study findings will provide additional support to encourage weight-bearing sport activities during youth as a means to prevent osteoporosis and related fractures.Objective #1b. Determine the effects of a non-combative boxing intervention on cardiometabolic and musculoskeletal health in low-income youthThe purpose of the proposed study is to evaluate the effectiveness of the 12-week CORE (Confidence, Ownership, Responsibility, and Exercise) shadow boxing program on selected body composition, metabolic, and health outcomes among children with multiple weight-related health risks. The sample will consist of 9 to 15-year-old children and their parents/guardians. The treatment group will participate in the 12-week CORE program; whereas, the control group will receive no training, but will be offered the program on a delayed basis. The proposed project's aim #1b is to determine if participation in CORE improves cardiometabolic outcomes of its participants. It is hypothesized that participation in CORE will significantly reduce participants' body mass index (BMI), body fat %, and waist circumference, and increase fat-free soft tissue mass, and improve serum cholesterol, HDL/LDL ratio, triglycerides, and insulin resistance. This study is designed to be a 12-week intervention; however, we are interested in obtaining bone data to determine if the CORE program improves bone strength. Therefore, we plan to extend both the intervention and follow-up to 9 months to allow adequate time for changes in skeletal strength. This novel project will advance our knowledge about a physician referral based exercise program to improve musculoskeletal and cardiometabolic outcomes in youth. The findings could have public health significance if it can serve as a model program for replication in other communities.Objective #2a. Determine the effects of obesity on bone health: a cross-sectional study Substantial evidence supports the position that the rapid bone development that accompanies adolescent growth is compromised with obesity. If the trajectory of bone development is impaired in obese youth, this will have a profound influence on adult bone strength and fracture risk. Non-Hispanic white females, ages 18 to 19 years, were recruited for obese (≥32% body fat) or normal weight (≤30% body fat) groups in this study to assess radius and tibia trabecular bone microarchitecture and cortical bone architecture were via magnetic resonance imaging. The proposed project's aim #2a is to compare the trabecular bone microarchitecture and cortical bone architecture between obese and normal-weight late-adolescent females in a cross-sectional, case-control study. We hypothesize that excess adiposity will indicate weaker bone microarchitecture and negatively influence bone strength. This novel project will advance our knowledge about the increased risk for skeletal fracture in obese youth. The findings could have public health significance if obesity prevention practices result in a reduced risk for childhood fractures, and future osteoporotic fractures in adulthood.Objective #2b. Determine the effects of obesity on bone health: a 4-6 year prospective study Though a high body weight is thought to be protective against osteoporotic fractures, obese adults have increased risk of lower limb fractures, and obese children may have a higher incidence of forearm fractures. Weight loss is associated with significant decreases in aBMD, increased fracture risk in adults and inadequate bone gain in children. However, little is known about the effects of weight gain in young adulthood on bone geometry or bone strength, because studies to date have exclusively used aBMD or BMC as outcomes. There are no published studies to date that have examined prospective changes in structural properties of bone in young adult females with excess levels of adiposity. The proposed project's aim #2b is to examine 4- to 6-year changes in adiposity, bone density, geometry, and strength of the tibia and radius, as well as insulin resistance, in young adult males and females. If we provide evidence that obesity and insulin resistance during childhood lead to poorer bone quality, the need to intervene becomes increasingly important in order to reduce the risk for future osteoporotic fractures in adulthood.Objective #2c. Determine the effects of adenovirus 36 on musculoskeletal healthA contributing factor to suboptimal bone development in children may be infection with human adenovirus 36 (Ad36), a common upper respiratory illness transmitted through person-to-person contact that has been shown to be associated with lower bone strength in obese females. It is possible that inflammation may play a role in the Ad36-bone association because it has been implicated in the progression of both viral infection and osteoporosis. However, whether inflammation provides an important link between Ad36 infection and reduced bone strength in children is unknown. The proposed project's aim #2c is to determine if there are associations between Ad36 infection and bone strength and serum inflammatory-related markers in obese (≥30% body fat) females ages 9-12 years. We hypothesized that lower bone strength observed in those with Ad36 infection would be related to higher serum concentrations of inflammatory-related markers. Though several studies have investigated the association of Ad36 and adiposity in children, research related to Ad36 and bone is limited. This novel project could have public health significance given the parallels in the biology of these tissues. It may be that the proposed effects of Ad36 on adiposity development diminish bone development. Demonstration of adverse effects of adenovirus infection on bone health could have important public health significance, prompting development of vaccines and other treatment modalities.
Animal Health Component
100%
Research Effort Categories
Basic
(N/A)
Applied
100%
Developmental
(N/A)
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
72473101010100%
Knowledge Area
724 - Healthy Lifestyle;

Subject Of Investigation
7310 - Experimental design and statistical methods;

Field Of Science
1010 - Nutrition and metabolism;
Goals / Objectives
The comprehensive goal of this research project, which involves both observational and intervention designs, is to identify lifestyle approaches that will not only improve health during childhood and adolescence; but, will also reduce the risk of chronic diseases in adulthood (i.e., osteoporosis, obesity and related metabolic health consequences). Further, results from the proposed project could ultimately have clinical applications for the treatment or management of such diseases. Outcomes from this research are intended to foster the development of collaborations with students, professionals, families, and communities in Georgia in order to promote and encourage healthy living.It is expected that our results from the proposed studies in children, young adults, and older adults will generate lifestyle interventions that will have noticeable and valuable community presence.The research proposed has the following objectives, i.e., to determine:Exercise effects on musculoskeletal healthEffects of childhood artistic gymnastics activity on bone in menopausal womenEffects of a non-combative boxing intervention on cardiometabolic and musculoskeletal health in low-income youthBody composition effects on musculoskeletal healthEffects of obesity on bone health: a cross-sectional studyEffects of obesity on bone health: a 4-6 year prospective studyEffects of adenovirus 36 on musculoskeletal healthObjective #1a. Determine the effects of childhood artistic gymnastics activity on bone in menopausal womenSpecific aim #1a of this project is to examine changes in 2-dimensional aBMD and related factors, such as body composition, physical activity and dietary intake, in the former female collegiate gymnasts and controls approximately 20 years after their first (baseline) visit to the laboratory. A secondary aim is to compare the geometric properties of bone at the tibia and radius using 3-dimensional imaging technology. We hypothesize that the higher aBMD observed in former artistic gymnasts compared with controls will be maintained at the 20-year follow-up as this cohort enters menopause. Moreover, we hypothesize that 3-dimensional bone strength measured cross-sectionally at the 20-year follow up only, will be higher in retired gymnasts vs. controls. Successful completion of the proposed project will provide evidence on whether bone gains, theoretically acquired from childhood artistic gymnastics training, are maintained approximately 34 years after cessation of the sport. We anticipate that the study findings will provide additional support to encourage participation in weight-bearing sport activities, such as artistic gymnastics, during youth as a means to prevent osteoporosis and related fractures later in life.Objective #1b. Determine the effects of a non-combative boxing intervention on cardiometabolic and musculoskeletal health in low-income youthSpecific aim #1b is to determine in a randomized trial if the CORE program improves cardiometabolic health outcomes, bone strength, and body composition in participants. We hypothesize that participants assigned to the CORE group will show improvements in cardiometabolic health and musculoskeletal health compared to participants assigned to the control group. It is expected that an exercise modification approach to combating obesity in youth will be one that has noticeable and valuable community presence. This program is intended to show effectiveness in the short-term, demonstrate sustainability within Athens-Clarke County, and be replicated in other communities, long after the program's initial phase is complete.Objective #2a. Determine the effects of obesity on bone health: a cross-sectional study Specific aim #2a is to utilize high-resolution MRI to compare radius and tibia trabecular bone microarchitecture and cortical bone architecture between obese and normal-weight non-Hispanic white late-adolescent females. Additionally, this study will take into consideration factors that likely contribute to obesity-related differences in skeletal outcomes (i.e., FFST mass and insulin resistance). We hypothesize that obese vs. normal weight females will have lower trabecular bone microarchitectural outcomes, and FFST mass and insulin resistance will be important contributors to this relationship.Objective #2b. Determine the effects of obesity on bone health: a 4-6 year prospective study Specific aim #2b is to determine if obesity and insulin resistance observed prospectively diminish bone mineralization and strength in youth. We hypothesize that chronic obesity (over 4-6 years) vs. normal weight status during pubertal growth will impede bone mineralization and strength. Our second hypothesis is that insulin resistance will be associated with reduced bone mineralization and strength.Objective #2c. Determine the effects of adenovirus 36 on musculoskeletal healthSpecific aim #2c is to determine associations of Ad36 infection, bone strength, and serum inflammatory-related markers in obese (≥30% body fat) 9 to 12 year-old females. We hypothesize that lower bone strength observed in those with Ad36 infection will be related to higher serum concentrations of inflammatory-related markers.
Project Methods
Data in Objective #1a were collected previously. Statistical analyses and manuscript preparation are proposed.Former collegiate gymnasts (n=18) and non-gymnast controls group-matched for age-, height-, and weight (n=15), were recruited in 1994. This was a pilot study designed to be hypothesis generating, and from which future studies could be powered. Procedures were completed in this cohort at baseline, time point 2 in 2002-2004 (16 gymnasts and 13 controls), and time point 3 (2013-2014; 17 gymnasts and 10 controls; current study). Testing for time point 3 consisted of anthropometric measurements, DXA, pQCT, physical activity and health history questionnaires. Statistical analyses will be performed using the Statistical Package for the Social Sciences (SPSS v23). Independent samples t-tests will be used to determine differences between groups at baseline, during time point 2 (2003), and at time point 3. A repeated-measures mixed model analysis will determine differences in aBMD and body composition within groups, over time and any interactions. Statistical significance will be set at P<.05.The intervention described in Objective #1b below is proposed.48 children (ages 9-15y) will be randomly assigned to the treatment (CORE program n=24) or control (n=24) conditions. The control will not participate in CORE, but will be offered participation following the study's completion. This is a pilot study designed to be hypothesis generating, and from which future studies can be powered. To be included, children must be diagnosed by their physician as overweight or obese. The treatment group will participate in the 12-week CORE program delivered by amateur and Olympic boxers. The design is a randomized controlled trial with a parallel group design. This study will be a 12-week intervention; however, we are interested in obtaining bone strength data, so we plan to extend the intervention to 9 months to allow adequate time for changes in skeletal strength. Participants will complete a general information/health questionnaire, sexual maturation self-assessment, and physical activity questionnaires. Fasting blood samples (30 ml) will be collected and stored at -70 °C until analyses for biomarkers of obesity and bone health-related factors. Body composition [total body fat mass, FFST and %body fat as well as total body and forearm bone area, bone mineral content and bone mineral density] will be measured using DXA. PQCT measurements will be taken of the nondominant radius. Diet will be assessed using the Automated Self-Administered 24-hour Recall (ASA24-2014) and ASA24-Kids-2014 online programs. Participants will wear an activity monitor for 7 days. Statistical analyses will be performed using SPSS (v23). Independent samples t-tests will be used to determine differences between the intervention and control groups at baseline and 13 weeks. A repeated-measures mixed model analysis will be performed to determine differences in our variables of interest within groups, over time and any interactions. Statistical significance will be set at P<.05.Data in Objective #2a were collected previously. Statistical analyses and manuscript preparation are proposed.The participants were normal weight (n=12) and obese (n=12) non-Hispanic white late-adolescent females (18-19yo). Sample size calculations using SPSS (Sample Power, v2.0) were estimated from pQCT- and MRI-derived adiposity and bone data previously collected in our laboratory. Based on these preliminary findings, we estimated that 7-12 subjects in each adiposity group would provide 80-85% power (α=5%) to detect an approximate 10% difference in trabecular outcomes at the tibia, thus we included 12 subjects per adiposity group. Participants in the obese group were required to have %body fat ≥32, BMI-for-age >90th percentile, and waist circumference-for-age ≥90th percentile. Normal weight was defined as %body fat <30, BMI-for-age between the 20th-79th percentiles, and waist circumference-for-age between the 25th-75th percentiles. Participants were matched for age (±6 months), height (±1 inch), oral contraceptive use (yes or no) and duration (±6 months). Data will be analyzed using SPSS (v23). Unadjusted between-group comparisons of radius and tibia trabecular and cortical bone outcomes will be performed using independent samples two-tailed t-tests. Adjusting for differences in FFST, analysis of covariance will be performed. Statistical significance will be set at P<.05.The prospective study described in Objective #2b below is proposed.We will perform a follow-up study in a cohort of children (N=160, 50% black, 50% female) who participated in a clinical trial from 2009-2010 (9-13yo). Participants will complete a sexual maturation self-assessment, a demographic, medical history and sun exposure questionnaire. Weight will be measured using an electronic scale. Height will be measured using a wall-mounted stadiometer. Waist circumference will be measured by measuring tape. Blood pressure measurements will be performed using the sphygmanometer and Littmann stethoscope. Fasting blood samples (30 ml) will be collected and stored at -80°C until analyses for biomarkers of obesity and bone health-related factors. Diet will be assessed using the 3-day diet record and the BEVQ-15 questionnaire. Physical activity will be assessed using the Youth Risk Behavior survey, the Adolescent Sedentary Activity questionnaire, the Past Physical Activity Questionnaire, and the Bone-Specific Physical Activity Questionnaire. Participants will wear tri-axial Actigraph GT3X+ accelerometers for 7 days. Body composition [total body fat mass, lean tissue, and % body fat as well as total body, lumbar spine, forearm and proximal femur bone area, bone mineral content, and bone mineral density] will be measured using DXA. Forearm strength will be performed using the handgrip dynamometer. PQCT measurements will be taken of the nondominant tibia and radius. Using an isokinetic dynamometer, 5 maximal knee extension and flexion contractions will be performed. Leg power testing will occur immediately after the Biodex muscular strength testing. A battery of tests will assess multiple components of physical function, including static and dynamic balance, joint mobility and stability. Using a GAITRite mat, walking speed, cadence, step time, step length, stride length, stance width, swing time, stance time, and double support time. Participants will walk three times over a 25ft course, with a 5ft lead-in and 20ft single pass over the Gait mat.Data in Objective #2c were collected previously. Statistical analyses and manuscript preparation are proposed.The study included data from a subsample of children (n=93) who were part of a multi-site vitamin D supplementation trial (Lewis, PI) conducted at The University of Georgia (UGA, Athens, Georgia), Purdue University (PU, West Lafayette, Indiana), and Indiana University (IU, Indianapolis, Indiana) from 2009-2010 (9-13yo, sexual maturation stage 2/3). The subjects in the subsample were chosen from the original baseline sample because they were female and classified as obese, and had body fat ≥30%. Analyses will be conducted using SPSS (v23). Analysis of variance will be used to compare age, sexual maturation stage, anthropometric, body composition, and inflammatory-related variables between the Ad36+ and Ad36- groups. ANOVA will also be used to compare cortical bone indices between groups, after adjusting for age and race. Group differences in categorical variables will be tested using chi-square tests. Statistical significance will be set at a P<.05.

Progress 05/05/16 to 03/30/21

Outputs
Target Audience: Nothing Reported Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? Nothing Reported How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? PI is retired

Publications


    Progress 10/01/20 to 03/30/21

    Outputs
    Target Audience: Nothing Reported Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? Nothing Reported How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

    Impacts
    What was accomplished under these goals? PI is retired

    Publications


      Progress 10/01/19 to 09/30/20

      Outputs
      Target Audience: Nothing Reported Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? Nothing Reported How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

      Impacts
      What was accomplished under these goals? PI is retired

      Publications


        Progress 10/01/18 to 09/30/19

        Outputs
        Target Audience: Nothing Reported Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? Nothing Reported How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

        Impacts
        What was accomplished under these goals? PI is retired

        Publications


          Progress 10/01/17 to 09/30/18

          Outputs
          Target Audience:We include both males and females in our studies. There is a strong rationale for studying females since a potential benefit of our interventions may be a reduced risk of osteoporotic fractures; however, males are also included in the study populations because males are also at risk for osteoporosis. According to the National Osteoporosis Foundation, 50% of females and 20% of males will experience an osteoporotic fracture, and men vs. women have a higher risk for mortality following a hip fracture. Minorities were included in the recruitment of our study populations. Participant ethnicity (Hispanic or Latino/Non-Hispanic or Latino) and race (American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or other Pacific Islander, White, or any combination of the above) were obtained via self-report by the parent during screening, using the National Institutes of Health Policy and Guidelines on the Inclusion of Women and Minorities as Subjects in Clinical Research. Since musculoskeletal health and vitamin D metabolism differences exist between blacks and whites, the risk for suffering from osteoporosis and related fractures may vary as well, and could provide important health information, such as differences in treatment options. For example, blacks compared to whites have higher bone mass, but are still at risk for osteoporotic fractures and are more likely to have complications and premature death resulting from hip fractures. Recruitment of our participants has been from local pediatrician offices (flyers), elementary schools (flyers; Parent-Teacher Association Newsletters), and from announcements (flyers, newspapers, postcards, television, radio) in the University community. We have been successful in retaining children in our studies. The region in which our studies are conducted is represented by a large percentage of non-Hispanic blacks and less by Hispanic and Asian populations. The general racial demographic of Clarke Co., is 69.6% white, 25.6% black and 4.9% other (Georgia County Guide, Center for Agribusiness and Economic Development, The University of Georgia, Athens, GA). Our study samples are representative of the local population. The participants in our studies learn about their bone health, diet and physical activity patterns. The data collected provide important information about growing children and their potential to be healthy teens and adults. In addition, each subject gains individual health knowledge that may improve his/her quality of life and possibly detect a health problem. The parents of our participants value the health information, as it provides an excellent baseline to follow growth, maturation and health status of their child. Following the completion of testing, educational symposia are held inviting respective participants and their parents to receive individual and group results. Parents who are not able to attend the meetings receive all information in the mail with careful explanations of data for their own child, as well as group data. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?In 2017 and 2018, three graduate (Winston, Coheley, and Rollins) and two undergraduate (Roof and Sreenivasan) students contributed to the funded project.We have maintained collaborations with Drs. Connie Weaver, Kathleen Hill Gallant and George McCabe and post-doctoral fellow, Christian Wright (Purdue University), Munro Peacock and Stuart Warden (Indiana School of Medicine), Michael Kimlin (Queensland University of Technology) from the GAPI vitamin D supplementation grant, and Assaf Oshri, Sami Yli-Piipari, Alison Berg, Jon Udwadia, Diane Hartzel, Patrick O'Connnor, and Kirk Kealey (University of Georgia). These collaborations have provided both training and professional development. In addition, we have developed new collaborative efforts with Nitin Shivappa and James Hebert (University of South Carolina). How have the results been disseminated to communities of interest?Our results have been disseminated to communities of interest in the form of: 1) presentations at professional meetings occurring locally and on a national/international scale, at local community events, and at UGA departmental seminars and faculty meetings; 2) publications in professional journals that are disseminated to professionals; and 3) a handout that UGA Extension Agents can use to disseminate information about our research throughout the state (this one-page handout was developed to reach members of communities who are not usually aware of these research activities for the purpose of enhancing public understanding and increasing interest in learning). What do you plan to do during the next reporting period to accomplish the goals?In order to accomplish the goals, a key objective during the next reporting period is to complete the editing process and submit the works we currently have in preparation for submission. For those manuscripts in review at the moment, we aim to respond to reviewer comments (if favorable) and resubmit without too much delay to increase the chances of publication. A second objective is to prepare manuscripts for submission that are based on the abstracts presented this year. We will also continue to generate preliminary data in order to prepare proposals to submit to federal agencies, as well as industry, to fund the next phase of this project.

          Impacts
          What was accomplished under these goals? The comprehensive goal of this research project, which involves both observational and intervention designs, is to identify lifestyle approaches that will not only improve health during childhood and adolescence; but, will also reduce the risk of chronic diseases in adulthood (i.e., osteoporosis, obesity and related metabolic health consequences). Further, results from the proposed project could ultimately have clinical applications for the treatment or management of such diseases. Outcomes from this research are intended to foster the development of collaborations with students, professionals, families, and communities in Georgia in order to promote and encourage healthy living.It is expected that our results from the proposed studies in children, young adults, and older adults will generate lifestyle interventions that will have noticeable and valuable community presence. In #1a, a manuscript has been completed and is pending submssion. We found that former gymnasts vs controls maintained significantly higher lumbar spine aBMD over 20 years, but not at the proximal femur aBMD. Cross-sectional measures of cortical bone geometry at the 20 year follow-up indicate significantly stronger bones in former artistic gymnasts compared to controls. In #1b, a manuscript on the pilot study was published in 2018 (Yli-Piipari et al). This was a case series study with pre- and post-test analyses in a convenience sample of high-risk pediatric primary care patients (n = 22; 6 girls, 16 boys; M age = 11.73 ± 1.39 years) and their guardians in the Southeast United States. They participated in twice per week 60 min (total of 24 h) of moderate-to-vigorous intensity boxing exercise training, 12 h of nutrition education for guardians, and a 30-min pediatrician appointment. A significant reduction was observed in waist circumference t(17) = -2.57, p = 0.020, d = 0.64; BMI% t(15) = -2.53, p = 0.023, d = 0.20; fasting glucose t(15) = -6.43, p < 0.001, d = 1.67; and amotivation (-) t(17) = -2.29, p = 0.036, d = 0.64; whereas a significant increase was identified in moderate t(10) = 4.01, p = 0.002, d = 1.23 and vigorous t(10) = 3.41, p = 0.007, d = 1.07 intensity PA; intrinsic motivation t(17) = 2.71, p = 0.015, d = 0.38; and introjected regulation t(17) = 2.74, p = 0.014, d = 0.64. The data suggest that participation in the CORE training program improves cardiometabolic health outcomes and pschological health in Hispanic children and adolescents. In order to confirm these results, a study design using a control, non-intervention group, will need to be employed. In #2a, Higgins et al (published in 2018) studied healthy young adults (n = 142, 19.7 ± 0.7 yr old, 52.8% female) who were assessed via peripheral quantitative computed tomography at the midtibia for cortical bone status and muscle cross-sectional area (MCSA). Results showed that MCSA, knee extension peak torque, and peak anaerobic power from vertical jump were independent predictors of select cortical structural outcomes (cortical thickness and area, periosteal and endosteal circumference, and estimated strength) accounting for up to 78.4% of the variance explained (all P < 0.05). However, cortical volumetric bone mineral density was unrelated to any measure or surrogate of muscle force capacity. The study cooncluded that MCSA is a strong independent predictor of cortical bone structure; however, both laboratory- and field-based measures of peak torque and/or peak anaerobic power are promising alternatives, explaining similar and sometimes greater variance than MCSA. In Wright et al. (published in 2018), participants were randomly assigned to receive 0, 400, 1,000, 2,000 or 4,000 IU/d vitamin 47 D3 for 12 weeks during winter. We examined the associations between changes in vitamin D metabolites and changes in muscle mass, strength, and composition after 12 weeks of vitamin D3 supplementation. Serum 25(OH)D and 1,25(OH)2 D, but not iPTH, increased over time, as did fat mass, FFST, forearm and calf MCSA, forearm IMAT, and handgrip strength (p < 0.05). Vitamin D metabolites were not associated with muscle strength at baseline nor after the 12-week intervention. Changes in serum 25(OH)D correlated with decreases in forearm IMAT, whereas changes in serum iPTH predicted increases in forearm and calf MCSA and IMAT (p < 0.05). Overall, increases in 25(OH)D did not influence muscle mass or strength in vitamin D-sufficient children and adolescents; however, the role of iPTH on muscle composition in this population is unknown and warrants further investigation. In #2b, we showed previously that insulin resistance had a significant and negative influence on the lean mass-dependent relationships between IGF-I and bone mass in 147 black and white boys and girls. We have a paper in review (Kindler et al) that shows that pentasodine, an advanced glycation endproduct, is associated with insulin resistance and cortical bone geometry in healthy children. In #2c, we showed previously in a cohort of adolescents within a normal range of body mass index-for-age percentiles, that Ad36 infection does not appear to influence cortical bone strength.

          Publications

          • Type: Book Chapters Status: Published Year Published: 2018 Citation: Laing E.M. and Lewis R.D. New concepts in vitamin D requirements for children and adolescents: a controversy revisited. (2018) In: Giustina and Bilezikian (Eds.) Frontiers in Hormone Research: Vitamin D in clinical medicine, Vol 50, pp 42-65, Switzerland, Karger.
          • Type: Journal Articles Status: Other Year Published: 2018 Citation: Working Paper: Kindler J.M., Verroken C, Pollock N.K., Ross H., Laing E.M., Lewis RD. Bone Mass is Lower in Obese Versus Normal-Weight Late-Adolescent Females.
          • Type: Journal Articles Status: Other Year Published: 2018 Citation: Working Paper: Laing E.M., Pollock N.K., Ferira A.J., Taylor R.G., Bernard P.J., & Lewis R.D. Breastfeeding Duration is a Positive Independent Predictor of Trabecular and Cortical Bone Parameters at Age 21 Years.
          • Type: Journal Articles Status: Published Year Published: 2018 Citation: Coheley L.M., Kindler J.M., Laing E.M., Oshri A., Hausman D.B., McCabe G.P., Martin B.R., Hill Gallant K.M., Warden S.J., Weaver C.M., Peacock M., Lewis R.D. Whole egg consumption and cortical bone in healthy children. 2018, Osteoporosis International, Aug;29(8):1783-1791.
          • Type: Journal Articles Status: Published Year Published: 2018 Citation: Yli-Piipari, S., Berg, A., Laing, E.M., Hartzell, D.L., Parris, K.O., Udwadia, J., and Lewis, R.D. A 12-Week Lifestyle Program to Improve Cardiometabolic, Behavioral, and Psychological Health in Hispanic Children and Adolescents. 2018 Journal of Alternative and Complementary Medicine, Feb;24(2):132-138.
          • Type: Journal Articles Status: Published Year Published: 2018 Citation: Kindler J.M., Pollock N.K., Ross H.L., Modlesky C.M., Singh, H., Laing E.M., Lewis R.D. Obese versus normal-weight late-adolescent females have inferior trabecular bone microarchitecture: a pilot case-control study. 2017 Calcified Tissue International, 101(5):479-488.
          • Type: Journal Articles Status: Published Year Published: 2018 Citation: Wright C.S., Laing E.M., Pollock N.K., Hausman D.B., Weaver C.M., Martin B.R., McCabe G.P., Peacock M., Warden S.J., Hill Gallant K.M., Lewis R.D. Serum 25-hydroxyvitamin D and intact parathyroid hormone influence muscle outcomes in children and adolescents. J Bone Miner Res. 2018 J Bone Miner Res, 33(11):1940-1947.
          • Type: Theses/Dissertations Status: Published Year Published: 2018 Citation: Emily Rollins, M.S. student, University of Georgia, Chair: R. Lewis, 2018 VITAMIN D SUPPLEMENTATION AND INSULIN-LIKE GROWTH FACTOR I IN ADOLESCENTS
          • Type: Book Chapters Status: Accepted Year Published: 2018 Citation: Higgins S., Belcher S. L. and Lewis R.D. Sedentary Behaviors in Children and Adolescents: What is the Influence on Bone Strength. Nutritional Influences on Bone Health, 10th International Symposium on Nutritional Aspects of Osteoporosis. Switzerland, Springer International Publishing, In Press.
          • Type: Journal Articles Status: Under Review Year Published: 2018 Citation: Van Loan M.D., Peerson J.M., D. Alekel D. L., Steinberg F. M., Lewis R.D. Phenotypic Characteristics as Predictors of 2-Year Change in Bone Mineral Density in Postmenopausal Women Not on Hormone Therapy: Results from Two Randomized Trials. Osteoporosis International, In Review.
          • Type: Journal Articles Status: Under Review Year Published: 2018 Citation: Kindler JM, Laing EM, Liu W, Dain JA, Lewis RD. Pentasodine, an Advanced Glycation Endproduct, is Associated with Insulin Resistance and Cortical Bone Geometry in Healthy Children, Journal of Bone and Mineral Research, In Review.
          • Type: Journal Articles Status: Under Review Year Published: 2018 Citation: Coheley LM, Shivappa N, Hebert J, Lewis RD. Dietary inflammatory index and cortical bone outcomes in healthy adolescent children, Osteoporosis International, In Review.
          • Type: Journal Articles Status: Published Year Published: 2018 Citation: Hohos N. Smith AK, Kilaru V, Park HJ, Hausman DB, Bailey LB, Lewis RD, Meagher RB.CD4+ AND CD8+ T Cell-Specific DNA Cytosine Methylation Differences Associated with Obesity. Obesity (Silver Spring). 2018 Aug;26(8):1312-1321.
          • Type: Conference Papers and Presentations Status: Accepted Year Published: 2018 Citation: Coheley L.M., Laing E.M., Oshri A., OConnor P.J., Kealey K., Lewis R.D. Egg consumption, skeletal health, and cognition in adolescents. 2018 UGA Graduate School Symposium, Athens, GA (Submitted: March 2018).
          • Type: Conference Papers and Presentations Status: Accepted Year Published: 2018 Citation: Higgins S., Kindler J.M., Mahar T.F., Coheley L.M., Laing E.M., Schmidt M.D., Evans E.M., Lewis, R.D. Sedentary Behavior and Cortical Bone in Healthy Adolescents and Young Adults: An Isotemporal Substitution Analysis. 2018 Georgia Clinical & Translational Science Conference, Brasleton, GA.
          • Type: Conference Papers and Presentations Status: Accepted Year Published: 2018 Citation: Berg A.C., Yli-Piipari S.R., Selph E.L., Lewis R.D., Laing E.M., Hollingsworth T.L., Parris K., Hartzell D.L., Improving Weight Management Behaviors among Guardians of Overweight and Obese Hispanic Adolescents: An evaluation of the CORE nutrition education program. 2018 Society for Nutrition Education and Behavior (Submitted: January 2018).
          • Type: Journal Articles Status: Published Year Published: 2018 Citation: Higgins S., Sokolowski CM, Vishwanathan M, Anderson JG, Schmidt MD, Lewis RD, Evans EM. Predicting Diaphyseal Cortical Bone Status Using Measures of Muscle Force Capacity. Med Sci Sports Exerc. 2018 Jul;50(7):1433-1441.
          • Type: Conference Papers and Presentations Status: Accepted Year Published: 2018 Citation: Coheley L.M., Shivappa N., Hebert JR., Laing E.M., Lewis R.D. Dietary Inflammatory Index and Cortical Bone Outcomes in Healthy Adolescent Children. 2018 J Bone Miner Res. (Submitted: June 2018).


          Progress 10/01/16 to 09/30/17

          Outputs
          Target Audience: We include both males and females in our studies. There is a strong rationale for studying females since a potential benefit of our interventions may be a reduced risk of osteoporotic fractures; however, males are also included in the study populations because males are also at risk for osteoporosis. According to the National Osteoporosis Foundation, 50% of females and 20% of males will experience an osteoporotic fracture, and men vs. women have a higher risk for mortality following a hip fracture. Minorities were included in the recruitment of our study populations. Participant ethnicity (Hispanic or Latino/Non-Hispanic or Latino) and race (American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or other Pacific Islander, White, or any combination of the above) were obtained via self-report by the parent during screening, using the National Institutes of Health Policy and Guidelines on the Inclusion of Women and Minorities as Subjects in Clinical Research. Since musculoskeletal health and vitamin D metabolism differences exist between blacks and whites, the risk for suffering from osteoporosis and related fractures may vary as well, and could provide important health information, such as differences in treatment options. For example, blacks compared to whites have higher bone mass, but are still at risk for osteoporotic fractures and are more likely to have complications and premature death resulting from hip fractures. Recruitment of our participants has been from local pediatrician offices (flyers), elementary schools (flyers; Parent-Teacher Association Newsletters), and from announcements (flyers, newspapers, postcards, television, radio) in the University community. We have been successful in retaining children in our studies. The region in which our studies are conducted is represented by a large percentage of non-Hispanic blacks and less by Hispanic and Asian populations. The general racial demographic of Clarke Co., is 69.6% white, 25.6% black and 4.9% other (Georgia County Guide, Center for Agribusiness and Economic Development, The University of Georgia, Athens, GA). Our study samples are representative of the local population. The participants in our studies learn about their bone health, diet and physical activity patterns. The data collected provide important information about growing children and their potential to be healthy teens and adults. In addition, each subject gains individual health knowledge that may improve his/her quality of life and possibly detect a health problem. The parents of our participants value the health information, as it provides an excellent baseline to follow growth, maturation and health status of their child. Following the completion of testing, educational symposia are held inviting respective participants and their parents to receive individual and group results. Parents who are not able to attend the meetings receive all information in the mail with careful explanations of data for their own child, as well as group data. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?In 2016, five graduate students and one undergraduate student have contributed to the funded projects; graduate students, Lauren Coheley, Staci Belcher, Emily Rollins, Hannah Winston, Simon Higgins, and Joseph Kindler, and undergraduate student Madison Spek. We have maintained multidisciplinary collaborations with Drs. Connie Weaver, Berdine Martin, Kathleen Hill Gallant, and George McCabe and post-doctoral fellow, Christian Wright (Purdue University), Munro Peacock and Stuart Warden (Indiana School of Medicine), and Michael Kimlin (Queensland University of Technology). We have also strengthened our partnerships with Drs. Ralph Tripp, Stephen Tompkins, Mary Anne Della-Fera, and Ellen Evans (University of Georgia), as well as Mark Hamrick, KeHong Ding, Carlos Isales, and Norman Pollock (Augusta University). In addition, we developed new collaborative efforts with Patrick O'Connor, Assaf Oshri, Sami Yli-Piipari, Alison Berg, Jon Udwadia, and Diane Hartzel (University of Georgia). These collaborations have provided both training and professional development opportunities. How have the results been disseminated to communities of interest?Our results have been disseminated to communities of interest in the form of: 1) presentations at professional meetings occurring locally and on a national/international scale, at local community events, and at UGA departmental seminars and faculty meetings; 2) publications in professional journals that are disseminated to professionals; and 3) a handout that UGA Extension Agents can use to disseminate information about our research throughout the state (this one-page handout was developed to reach members of communities who are not usually aware of these research activities for the purpose of enhancing public understanding and increasing interest in learning). What do you plan to do during the next reporting period to accomplish the goals?In order to accomplish the goals, a key objective during the next reporting period is to complete the editing process and submit the works we currently have in preparation for submission. For those manuscripts in review at the moment, we aim to respond to reviewer comments (if favorable) and resubmit without too much delay to increase the chances of publication. A second objective is to prepare manuscripts for submission that are based on the abstracts presented this year. We will also continue to generate preliminary data in order to prepare proposals to submit to federal agencies, as well as industry, to fund the next phase of this project.

          Impacts
          What was accomplished under these goals? In #1a, a manuscript has been completed and is ready for submssion. We found that former gymnasts vs controls maintained significantly higher lumbar spine aBMD over 20 years, but not at the proximal femur aBMD. After examining the individual data carefully, it appears the greater decline in aBMD at the proximal femur in fomer gymnasts vs controls over 20 years is not an artifact of subject retention or lack of participation (i.e., former gymnasts with high aBMD at 10 years do not participate at the 20 year timepoint). Cross-sectional measures of cortical bone geometry at the 20 year follow-up indicate significantly stronger bones in former artistic gymnasts compared to controls. In #1b, a manuscript on the pilot study was published. The pilot data suggests that participation in the CORE training program improves cardiometabolic health outcomes and pschological health in Hispanic children and adolescents. However, in order to confirm these results, a study design using a control, non-intervention group, will need to be employed. In #2b, we showed thatinsulin resistance had a significant and negative influence on the lean mass-dependent relationships between IGF-I and bone mass in 147 black and white boys and girls. Furthermore, we observed, in a cohort of 315 black and white boys and girls, thatchildren with higher insulin resistance had lower cortical bone size and estimated bending strength. In addition, insulin resistance moderated the relationship between IGF-I and lean mass as well as cortical bone size and strength. Our data are the first to implicate a suppression of IGF-I-dependent lean mass accretion as a contributor to the smaller cortical bone in children with insulin resistance. As such, insulin resistance-related deficits in cortical bone size and subsequent bending strength, which might involve IGF-I, could help explain the greater propensity for skeletal fracture in obese youth. In #2c: Additional analysis were performed on adata set including black and white boys and girls, 9-13 years of age, which provided insight into the effects of Ad36 infection on adolescent musculoskeletal development over the couse of five years. There were no significant baseline group differences in age, height, weight, SMR, sex, race, dietary variables or any musculoskeletal endpoints. Overweight/obesity prevalence was 38.9% and 42.9% in the Ad36(+) and Ad36(-) groups, respectively (p=.734). Change in height (p=0.001), total body bone area (p=0.021), tibia MCSA (p=.016), periosteal circumference (p=.021), and total area (p=.035) were significantly lower in the Ad36(+) versus Ad36(-) children. After correcting for change in limb length, changes in tibia cortical bone endpoints did not differ between AD36(-) and AD36(+) groups. Our data indicate that, over five years of growth, infection with Ad36 does not significantly alter body composition. Cortical bone at the tibia was affected by seropositivity, though the observed significant changes wereexplained by changes in limb length. In a cohort of adolescents within a normal range of body mass index-for-age percentiles, Ad36 infection does not appear to influence cortical bone strength. Ad36 infection may impact longitudinal growth, but more careful control of maturational status during this rapid growth would help ascertain that notion.

          Publications

          • Type: Book Chapters Status: Awaiting Publication Year Published: 2017 Citation: Lewis R.D., Laing E.M., Weaver C.M. Chapter 41: Adolescence and Acquisition of Peak Bone Mass. In: Feldman D., Pike J.W., & Adams J.S. (Eds.) Vitamin D, Volume 1: Biochemistry, Physiology And Diagnostics, Fourth Edition, San Diego, CA: Elsevier, Inc. Pages 731753. (published online in 2017)
          • Type: Journal Articles Status: Other Year Published: 2017 Citation: Wright C., Laing E., Pollock N., Hausman D., Weaver C., Martin B., McCabe G., Peacock M., Warden S., Hill Gallant K., Lewis R. Vitamin D supplementation, muscle mass, strength, and composition in early pubertal adolescents (in review, 2017).
          • Type: Journal Articles Status: Published Year Published: 2017 Citation: Lobene A.J., Kindler J.M., Jenkins N.T., Pollock N.K., Laing E.M., Grider A. Lewis R.D. Zinc supplementation does not alter indicators of insulin secretion and sensitivity in black and white female adolescents, 2017 J Nutr, 147(7):1296-1300
          • Type: Journal Articles Status: Other Year Published: 2017 Citation: Coheley L.M., Kindler J.M., Laing E.M., Oshri A., Hausman D.B., McCabe G.P., Martin B.R., Hill Gallant K.M., Warden S.J., Weaver C.M., Peacock M., Lewis R.D. Egg consumption and cortical bone outcomes in healthy black and white children. 2018, Osteo Int. https://doi.org/10.1007/s00198-018-4538-1.
          • Type: Conference Papers and Presentations Status: Accepted Year Published: 2017 Citation: Higgins S., Kindler J.M., Mahar T.F., Coheley L.M., Laing E.M., Schmidt M.D., Evans E.M., Lewis, R.D. Sedentary Behavior and Cortical Bone in Healthy Adolescents and Young Adults: An Isotemporal Substitution Analysis. 2017 10th International Symposium on Nutritional Aspects of Osteoporosis, Hong Kong (Submitted: July 2017).
          • Type: Journal Articles Status: Published Year Published: 2017 Citation: Kindler J.M., Pollock N.K., Laing E.M., Oshri A., Jenkins N.T., Isales C.M., Hamrick M.W., Ding K.H., Hausman D.B., McCabe G.P., Martin B.R., Hill Gallant K.M., Warden S.J., Weaver C.M., Peacock M., Lewis R.D. Insulin resistance and the IGF-I-cortical bone in children ages 9-13 years. 2017 J Bone Miner Res, 32(7):1537-1545.
          • Type: Theses/Dissertations Status: Submitted Year Published: 2017 Citation: Joseph Kindler, Ph.D. student, University of Georgia, Chair: Richard Lewis, 2017 INSULIN RESISTANCE, INSULIN-LIKE GROWTH FACTOR 1, AND PEDIATRIC MUSCULOSKELETAL DEVELOPMENT
          • Type: Conference Papers and Presentations Status: Accepted Year Published: 2017 Citation: Kindler, J., Laing, E. M., & Lewis, R. (2017). Pentosidine, an Advanced Glycation Endproduct, Is a Negative Predictor of Skeletal Endpoints in Children. Journal of the Federation of American Societies for Experimental Biology
          • Type: Journal Articles Status: Accepted Year Published: 2018 Citation: Yli-Piipari, S., Berg, A., Laing, E.M, Hartzell, D.L., Parris, K. O., Udwadia, J., Lewis, R.D. A Twelve-Week Lifestyle Program to Improve Cardiometabolic, Behavioral, and Psychological Health in Hispanic Children and Adolescents. J. Alt. Compl. Med. V24, (2):132-138 Feb 2018
          • Type: Theses/Dissertations Status: Submitted Year Published: 2017 Citation: Staci Belcher, M.S. student, University of Georgia, Chair: Richard Lewis, 2017 INFLUENCE OF AD36 SEROPOSITIVITY ON ADOLESCENT MUSCULOSKELETAL DEVELOPMENT: A 5-YEAR PROSPECTIVE STUDY
          • Type: Theses/Dissertations Status: Submitted Year Published: 2017 Citation: Simon Higgins, University of Georgia, Committee Member: Richard Lewis, 2017 Higgins, S, Assessing the Relationship Among Physical Activity, Muscle Force Capacity, and Cortical Diaphyseal Bone Status: The Muscle-Bone Unit in Young Adults
          • Type: Book Chapters Status: Published Year Published: 2017 Citation: Laing, E. M., & Lewis, R. D. (2018). New concepts in vitamin D requirements for children and adolescents: a controversy revisited. In A. Giustina, & J. P. Bilezikian (Eds.), Frontiers in Hormone Research: Novel aspects of vitamin D in clinical medicine. Switzerland: Karger
          • Type: Journal Articles Status: Published Year Published: 2017 Citation: Kindler, J. M., Pollock, N. K., Ross, H. L., Modlesky, C. M., Singh, H., Laing, E. M., & Lewis, R. D. (2017). Obese Versus Normal-Weight Late-Adolescent Females have Inferior Trabecular Bone Microarchitecture: A Pilot Case-Control Study. CALCIFIED TISSUE INTERNATIONAL, 101(5), 479-488. doi:10.1007/s00223-017-0303-2
          • Type: Conference Papers and Presentations Status: Accepted Year Published: 2017 Citation: Belcher, S., Laing, E. E., Tripp, R., & Lewis, R. (2017). Cortical Bone Development is Lower in Ad36 Seropositive Versus Seronegative Adolescents: A 5-Year Prospective Study. Journal of the Federation of American Societies for Experimental Biology


          Progress 05/05/16 to 09/30/16

          Outputs
          Target Audience:We included both males and females in our studies. There is a strong rationale for studying females since a potential benefit of our interventions may be a reduced risk of osteoporotic fractures; however, males are also included in the study populations because males are also at risk for osteoporosis. According to the National Osteoporosis Foundation, 50% of females and 20% of males will experience an osteoporotic fracture, and men vs. women have a higher risk for mortality following a hip fracture. Minorities were included in the recruitment of our study populations. Participant ethnicity (Hispanic or Latino/Non-Hispanic or Latino) and race (American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or other Pacific Islander, White, or any combination of the above) were obtained via self-report by the parent during screening, using the National Institutes of Health Policy and Guidelines on the Inclusion of Women and Minorities as Subjects in Clinical Research. Since musculoskeletal health and vitamin D metabolism differences exist between blacks and whites, the risk for suffering from osteoporosis and related fractures may vary as well, and could provide important health information, such as differences in treatment options. For example, blacks compared to whites have higher bone mass, but are still at risk for osteoporotic fractures and are more likely to have complications and premature death resulting from hip fractures. Recruitment of our participants has been from local pediatrician offices (flyers), elementary schools (flyers; Parent-Teacher Association Newsletters), and from announcements (flyers, newspapers, postcards, television, radio) in the University community. We have been successful in retaining both children and adults in our studies. The region in which our studies are conducted is represented by a large percentage of non-Hispanic blacks and less by Hispanic and Asian populations. Our study samples are representative of the local population. The participants in our studies learn about their bone health, diet and physical activity patterns. The data collected provide important information about growing children and their potential to be healthy teens and adults. In addition, each subject gains individual health knowledge that may improve his/her quality of life and possibly detect a health problem. The parents of our participants value the health information, as it provides an excellent baseline to follow growth, maturation and health status of their child. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?In 2016, four graduate and two undergraduate students have contributed to the funded project.Graduate students, Lauren Coheley, Staci Belcher, Simon Higgins, and Joseph Kindler, along with undergraduate students, Kayla Patel and Derek Coger. We have maintained multidisciplinary collaborations with Drs. Connie Weaver, Berdine Martin, Kathleen Hill Gallant, and George McCabe and post-doctoral fellow, Christian Wright (Purdue University), Munro Peacock and Stuart Warden (Indiana School of Medicine), and Michael Kimlin (Queensland University of Technology). We have also strengthened our partnerships with Drs. Ralph Tripp, Stephen Tompkins, Mary Anne Della-Fera, and Ellen Evans (University of Georgia), as well as Mark Hamrick, KeHong Ding, Carlos Isales, and Norman Pollock (Augusta University). In addition, we have developed new collaborative efforts with Assaf Oshri, Sami Yli-Piipari, Alison Berg, Jon Udwadia, and Diane Hartzel (University of Georgia). These collaborations have provided both training and professional development. How have the results been disseminated to communities of interest?Our results have been disseminated to communities of interest in the form of: 1) presentations at professional meetings occurring locally and on a national/international scale, at local community events, and at UGA departmental seminars and faculty meetings; 2) publications in professional journals that are disseminated to professionals; and 3) a handout that UGA Extension Agents can use to disseminate information about our research throughout the state (this one-page handout was developed to reach members of communities who are not usually aware of these research activities for the purpose of enhancing public understanding and increasing interest in learning). What do you plan to do during the next reporting period to accomplish the goals?In order to accomplish the goals, a key objective during the next reporting period is to complete the editing process and submit the works we currently have in preparation for submission. For those manuscripts in review at the moment, we aim to respond to reviewer comments (if favorable) and resubmit without too much delay to increase the chances of publication. A second objective is to prepare manuscripts for submission that are based on the abstracts presented this year. We will also continue to generate preliminary data in order to prepare proposals to submit to federal agencies, as well as industry, to fund the next phase of this project.

          Impacts
          What was accomplished under these goals? There are two key strategies for preventing osteoporosis: 1) maximize bone strength in childhood when bone is forming, and 2) slow the loss of bone in the adult years. This project has contributed significantly to our knowledge of exercise, zinc, vitamin D, soy, and body fatness with regard to child and adult bone health. This project has also evaluated the impact of racial differences among these variables. In #1a, we showed beneficial effects of past athletic participation in childhood on bone mass in menopausal years. We assessed 20-yr changes in body composition and aBMD of the total body (TB) and regional skeletal sites (lumbar spine, femoral neck and proximal femur) using dual-energy X-ray absorptiometry (DXA), as well as cross-sectional differences in trabecular and cortical volumetric bone mineral density and geometry at the radius and tibia using peripheral quantitative computed tomography (pQCT). At the 20-yr follow-up, gymnasts (GYM) vs. controls (CON) had lower body fat [(BF%) P=.01], and higher TB aBMD [P=.02]. Unlike the other time points, at 20 yrs, there were no aBMD differences between groups at any skeletal site. Both groups were losing aBMD at all sites (all P<.03), but no group x time interactions occurred. At 20 yrs, GYM vs. CON had greater pQCT measures of bone strength index (BSI) and strength-strain index (SSI) at both the radius (P<.01) and the tibia (P<.04). In #1b, we aimed to examine the effectiveness of a 12-week CORE lifestyle intervention on cardio-metabolic, behavioral, and psychological health outcomes among Hispanic children and adolescents. A sample comprised 22 10- to 15-year-olds referred to the CORE program by a physician due to their elevated body mass index. Paired t-test analyses showed that the intervention with exercise and nutrition education components (2x60mins) was successful (p < .05; Cohen's d > .40) in reducing participants': fasting glucose; body mass index; and waist circumference; and increasing moderate and vigorous physical activity behavior; intrinsic exercise motivation and introjected regulation; and reducing amotivation toward exercise. In #2a, we showed no differences in cortical bone macroarchitecture between obese adolescents and their normal-weight (n=12/group) counterparts despite the obese being nearly 30 kg heavier and having 10 kg more FFST than the normal-weight group. Trabecular and cortical regions of the metaphysis and diaphysis at the radius and tibia were examined via magnetic resonance imaging. Obese compared to normal-weight had lower trabecular thickness at the proximal tibia (p=.03). At the distal radius, bone volume to total volume fraction and trabecular thickness were lower (both p<.03), and trabecular separation higher (p=.02), in obese vs. normal-weight. Most of these between-group trabecular bone microarchitectural differences were attenuated following adjustment for insulin resistance.

          Publications

          • Type: Journal Articles Status: Published Year Published: 2016 Citation: Weaver C.M., Gordon C., Janz K., Kalkwarf H., Lappe J., Lewis R.D., O'karma M., Wallace T.C., Zemel B. The National Osteoporosis Foundation's Position Statement on Peak Bone Mass Development and Lifestyle Factors: A Systematic Review and Implementation Recommendations. 2016 Osteoporosis International, 27(4):1281-386.
          • Type: Journal Articles Status: Published Year Published: 2016 Citation: Kindler J.M., Pollock N.K., Laing E.M., Jenkins N.T., Oshri A., Isales C., Hamrick M.W., Lewis R.D. Insulin resistance negatively influences the muscle-dependent IGF-I-bone mass relationship in pre-menarcheal girls. 2016 J Clin Endocrinol Metab, 101(1):199-205.
          • Type: Journal Articles Status: Published Year Published: 2016 Citation: Gordon J.D., Hausman D.B., Bailey L.B., Lewis R.D., Laing E.M., Park H.J. (2016). Impact of gluten-containing foods on folate intake of women of childbearing age. The Digest. 51(1), 2-7.
          • Type: Conference Papers and Presentations Status: Submitted Year Published: 2016 Citation: Coger D., Kindler J.M., Laing E.M., Lewis R.D. The Relationship between Insulin Resistance and Distal Radius Cortical Bone Geometry. 2016 Peach State LSAMP (Louis Stokes Alliance for Minority Participation) Conference (Submitted: September 2016).
          • Type: Conference Papers and Presentations Status: Submitted Year Published: 2016 Citation: Yli-Piipari S.R., Berg A.C., Udwadia J., Laing E.M., Lewis R.D., Hartzel D. A 12-Week Lifestyle Intervention to Improve Cardio-Metabolic, Behavioral, and Psychological Health in Hispanic Children and Adolescents. 2017 American Educational Research Association (Submitted: July 2016).
          • Type: Conference Papers and Presentations Status: Published Year Published: 2016 Citation: Coheley L.M., Patel K., de La Serre C., Laing E.M., Kindler J.M., Lewis R.D. Maternal Obesity and Trabecular Bone Microarchitecture in C57BL Mice. 2016 J Bone Miner Res. (Submitted as Late-Breaking: June 2016).
          • Type: Conference Papers and Presentations Status: Published Year Published: 2016 Citation: Plenary Poster: Kindler J.M., Laing E.M., Lewis R.D. Kindler The Muscle-Dependent Link Between IGF-I and Cortical Bone is Suppressed in Children with Insulin Resistance 2016 J Bone Miner Res.
          • Type: Conference Papers and Presentations Status: Published Year Published: 2016 Citation: Higgins S., Kindler J.M., Mahar T.F., Hathaway E.D., Laing E.M., Schmidt M.D., Evans E.M., Lewis R.D. Sedentary time and diaphyseal cortical bone outcomes in American adolescents. 2016 J Bone Miner Res.
          • Type: Theses/Dissertations Status: Published Year Published: 2016 Citation: Andrea Lobene, University of Georgia, Chair: Richard Lewis, 2016 Lobene A.J., Zinc Supplementation, Beta Cell Function, Insulin Secretion, and Insulin Resistance in Black and White Female Adolescents.
          • Type: Conference Papers and Presentations Status: Published Year Published: 2016 Citation: Kindler J.M., Laing E.M., Lewis R.D. IGF-I-Dependent Musculoskeletal Development is Blunted in Adolescents with Insulin Resistance: A 5-Year Prospective Study. 2016 J Bone Miner Res.
          • Type: Journal Articles Status: Other Year Published: 2016 Citation: Wright C., Laing E., Williams J., Pollock N., Hausman D., Weaver C., Martin B., McCabe G., Peacock M., Warden S., Hill K., Lewis R. Vitamin D supplementation and muscle responses in early pubertal adolescents (Other: working paper, 2016).
          • Type: Journal Articles Status: Other Year Published: 2016 Citation: Kort L.J., Laing E.M., Pollock N.K., Lewis R.D. Former Collegiate Gymnasts Maintain Higher Bone Mineral Density After A 34-Year Retirement: A Twenty-year Follow-up. (Other: working paper, 2016).
          • Type: Book Chapters Status: Awaiting Publication Year Published: 2016 Citation: Lewis R.D., Kindler J.M., Laing E.M. Chapter 3: Obesity, Insulin Resistance and Pediatric Bone (2016) In: Weaver C.M., et al. (Eds.) Nutritional Influences on Bone Health, London, Springer-Verlag. In Press and available via eBbook.
          • Type: Journal Articles Status: Other Year Published: 2016 Citation: Berger P.K., Laing E.M., Pollock N.K., Baxter-Jones A.D.G., Daly R.M., Erlandson M.C., Lewis, R.D. From beam to bone: the effects of artistic gymnastics on skeletal health. Medicine and Science in Sports and Exercise, In Preparation for Resubmission.
          • Type: Journal Articles Status: Under Review Year Published: 2016 Citation: Kindler J.M., Pollock N.K., Laing E.M., Oshri A., Jenkins N.T., Isales C.M., Hamrick M.W., Ding K.H., Hausman D.B., McCabe G.P., Martin B.R., Hill-Gallant K.M., Warden S.J., Weaver C.M., Peacock M., Lewis R.D. The IGF-I-cortical bone relationship is moderated in children who are insulin resistant. J Bone Miner Res, In Review.
          • Type: Journal Articles Status: Under Review Year Published: 2016 Citation: Giudici K.V., Martin B.R., Laing E.M., McCabe G.P., McCabe L.D., Hausman D.B., Martini L.A., Lewis R.D., Weaver C.M., Peacock M., Hill Gallant K.M. Osteocalcin, leptin and energy metabolism in American children. Hormone Research in Pediatrics, In Review.
          • Type: Journal Articles Status: Under Review Year Published: 2016 Citation: Kindler J.M., Ross H.L., Modlesky C.M., Laing E.M., Pollock N.K., Baile C.A., Harshvardhan, S., Lewis R.D. Trabecular Bone Microarchitecture is Compromised in Obese Late Adolescent Females. Bone, In Review.
          • Type: Journal Articles Status: Published Year Published: 2016 Citation: Higgins S., Straight C.R., Lewis, R.D. The Effects of Pre-Exercise Caffeinated-Coffee Ingestion on Endurance Performance: An Evidence-Based Review. 2016 Int J Sport Nutr Exerc Metab. Jun;26(3):221-39.
          • Type: Journal Articles Status: Published Year Published: 2016 Citation: Ferira A.J., Laing E.M., Hausman D.B., Hall D.B., McCabe G.P., Martin B.R., Hill K.M., Warden S.J., Weaver C.M., Peacock M., Lewis R.D. Vitamin D Supplementation Effects on Insulin Sensitivity in White and Black Children. 2016 J Clin Endocrinol Metab, 101(4):1710-8.