Sports Medicine ( IF 9.3 ) Pub Date : 2024-08-13 , DOI: 10.1007/s40279-024-02087-0 Eimear Dolan 1, 2 , Alina Dumas 1, 2 , Gabriel Perri Esteves 1, 2 , Leticia Lopes Takarabe 1, 2 , Luisa Alves Mendonça Perfeito 1, 2 , Karen M Keane 3 , Bruno Gualano 1, 2 , George A Kelley 4 , Louise Burke 5 , Craig Sale 6 , Paul A Swinton 7
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Background
Although nutrition and exercise both influence bone metabolism, little is currently known about their interaction, or whether nutritional intervention can modulate the bone biomarker response to acute exercise. Improved understanding of the relationships between nutrition, exercise and bone metabolism may have substantial potential to inform nutritional interventions to protect the bone health of exercising individuals, and to elucidate mechanisms by which exercise and nutrition influence bone.
Objective
The aim was to synthesise available evidence related to the influence of nutrition on the response of the bone biomarkers procollagen type 1 N-terminal propeptide (P1NP) and C-terminal telopeptide of type 1 collagen (CTX-1) to acute exercise, using a systematic review and meta-analytic approach.
Methods
Studies evaluating the influence of nutritional status or intervention on the bone biomarker response to an acute exercise bout were included and separated into four categories: (1) feeding status and energy availability, (2) macronutrients, (3) micronutrients and (4) other. Studies conducted on healthy human populations of any age or training status were included. Meta-analysis was conducted when data from at least five studies with independent datasets were available. In the case of insufficient data to warrant meta-analysis, results from individual studies were narratively synthesised and standardised mean effect sizes visually represented.
Results
Twenty-two articles were included. Of these, three investigated feeding status or energy availability, eight macronutrients, eight micronutrients (all calcium) and six other interventions including dairy products or collagen supplementation. Three studies had more than one intervention and were included in all relevant outcomes. The largest and most commonly reported effects were for the bone resorption marker CTX-1. Meta-analysis indicated that calcium intake, whether provided via supplements, diet or infusion, reduced exercise-induced increases in CTX-1 (effect size − 1.1; 95% credible interval [CrI] − 2.2 to − 0.05), with substantially larger effects observed in studies that delivered calcium via direct infusion versus in supplements or foods. Narrative synthesis suggests that carbohydrate supplementation may support bone during acute exercise, via reducing exercise-induced increases in CTX-1. Conversely, a low-carbohydrate/high-fat diet appears to induce the opposite effect, as evidenced by an increased exercise associated CTX-1 response, and reduced P1NP response. Low energy availability may amplify the CTX-1 response to exercise, but it is unclear whether this is directly attributable to energy availability or to the lack of specific nutrients, such as carbohydrate.
Conclusion
Nutritional intervention can modulate the acute bone biomarker response to exercise, which primarily manifests as an increase in bone resorption. Ensuring adequate attention to nutritional factors may be important to protect bone health of exercising individuals, with energy, carbohydrate and calcium availability particularly important to consider. Although a wide breadth of data were available for this evidence synthesis, there was substantial heterogeneity in relation to design and intervention characteristics. Direct and indirect replication is required to confirm key findings and to generate better estimates of true effect sizes.
中文翻译：
营养干预对急性运动发作的 P1NP 和 CTX-1 反应的影响：荟萃分析的系统评价
背景
尽管营养和运动都会影响骨代谢，但目前对它们的相互作用或营养干预是否可以调节骨骼生物标志物对急性运动的反应知之甚少。提高对营养、运动和骨骼代谢之间关系的理解可能具有巨大的潜力，可以为营养干预提供信息，以保护锻炼个体的骨骼健康，并阐明运动和营养影响骨骼的机制。
目的
目的是使用系统评价和荟萃分析方法，综合与营养对骨生物标志物前胶原 1 型 N 末端前肽 （P1NP） 和 1 型胶原蛋白的 C 末端肽 （CTX-1） 对急性运动的反应影响相关的现有证据。
方法
评估营养状况或干预对骨骼生物标志物对急性运动反应影响的研究被纳入其中，并分为四类：（1） 喂养状况和能量可用性，（2） 宏量营养素，（3） 微量营养素和 （4） 其他。纳入了对任何年龄或训练状态的健康人群进行的研究。当至少有 5 项具有独立数据集的研究的数据可用时，进行 meta 分析。在数据不足以保证进行meta分析的情况下，对单个研究的结果进行叙述性综合，并直观地表示标准化的平均效应量。
结果
包括 22 篇文章。其中，3 项调查了喂养状况或能量可用性，8 项宏量营养素，8 项微量营养素（全部钙）和 6 项其他干预措施，包括乳制品或胶原蛋白补充剂。3项研究有不止一种干预措施，并被纳入所有相关结局。最大和最常报道的影响是骨吸收标志物 CTX-1。荟萃分析表明，钙摄入量，无论是通过补充剂、饮食还是输液提供，都减少了运动诱导的 CTX-1 增加（效应量 - 1.1;95% 可信区间 [CrI] - 2.2 至 -0.05），在通过直接输注提供钙的研究中观察到的效果比在补充剂或食物中观察到的效果要大得多。叙述性综合表明，碳水化合物补充剂可能通过减少运动诱导的 CTX-1 增加，在急性运动期间支持骨骼。相反，低碳水化合物/高脂肪饮食似乎会引起相反的效果，运动相关的 CTX-1 反应增加和 P1NP 反应减少就证明了这一点。低能量可用性可能会放大 CTX-1 对运动的反应，但目前尚不清楚这是直接归因于能量可用性还是缺乏特定营养素，例如碳水化合物。
结论
营养干预可以调节急性骨生物标志物对运动的反应，主要表现为骨吸收增加。确保对营养因素的充分关注对于保护锻炼者的骨骼健康可能很重要，其中能量、碳水化合物和钙的可用性尤为重要。尽管本证据综合有广泛的数据可用，但在设计和干预特征方面存在很大的异质性。需要直接和间接复制来确认关键发现并生成对真实效应大小的更好估计。
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