title: Combined effects of interaction between physical activity and nutrition on bone health in children and adolescents: a systematic review.
abstract: BACKGROUND
  Osteoporosis is a major public health concern worldwide. Understanding the roles of diet and physical activity in ensuring adequate bone mass accrual during childhood and adolescence may help identify strategies to reduce the risk of osteoporotic fractures later in life.
  
  
  OBJECTIVE
  The present systematic review was conducted to provide an overview of the current knowledge of the combined effects of physical activity and diet on bone mass accrual in children and adolescents.
  
  
  METHODS
  Data were obtained via searches of the PubMed, EMBASE, SPORTDiscus, and ISI Web of Science databases.
  
  
  METHODS
  Studies published in English and Spanish between 1887 and August 2013 were eligible for inclusion. Two investigators evaluated the studies against the inclusion and exclusion criteria. A total of 14 studies (7 cross-sectional and 7 experimental) were included in the review.
  
  
  METHODS
  The Pedro score and the Black and Down's checklist were used to evaluate the methodological quality of the experimental and the cross-sectional studies, respectively. Study characteristics were summarized in accordance with the review's PICO criteria.
  
  
  RESULTS
  Significant exercise-by-calcium interaction was detected at several different bone sites.
  
  
  CONCLUSIONS
  Although the results of cross-sectional studies were inconsistent, the results of randomized controlled trials showed that exercise has the potential to improve bone health under conditions of adequate calcium intake.
authors.affiliation: C. Julián-Almárcegui, A. Gómez-Cabello, A. González-Agüero A, J.A. Casajús, and Germán Vicente-Rodríguez are with the GENUD "Growth, Exercise, NUtrition and Development" Research Group, University of Zaragoza, Zaragoza, Spain. C. Julián-Almárcegui and I. Huybrechts are with the Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. A. Gómez-Cabello is with the Centro Universitario de la Defensa, Zaragoza, Spain. I. Huybrechts is with the International Agency for Research on Cancer, Dietary Exposure Assessment Group, Lyon, France. A. González-Agüero is with the Department of Sport and Exercise Science, Aberystwyth University, Aberystwyth, United Kingdom. J.M. Kaufman is with the Department of Endocrinology, Ghent University Hospital, Ghent, Belgium. J.A. Casajús and Germán Vicente-Rodríguez are with the Department of Physiatry and Nursing, Faculty of Health and Sport Science (FCSD), University of Zaragoza, Zaragoza, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Julián-Almárcegui
authors.affiliation: C. Julián-Almárcegui, A. Gómez-Cabello, A. González-Agüero A, J.A. Casajús, and Germán Vicente-Rodríguez are with the GENUD "Growth, Exercise, NUtrition and Development" Research Group, University of Zaragoza, Zaragoza, Spain. C. Julián-Almárcegui and I. Huybrechts are with the Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. A. Gómez-Cabello is with the Centro Universitario de la Defensa, Zaragoza, Spain. I. Huybrechts is with the International Agency for Research on Cancer, Dietary Exposure Assessment Group, Lyon, France. A. González-Agüero is with the Department of Sport and Exercise Science, Aberystwyth University, Aberystwyth, United Kingdom. J.M. Kaufman is with the Department of Endocrinology, Ghent University Hospital, Ghent, Belgium. J.A. Casajús and Germán Vicente-Rodríguez are with the Department of Physiatry and Nursing, Faculty of Health and Sport Science (FCSD), University of Zaragoza, Zaragoza, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Gómez-Cabello
authors.affiliation: C. Julián-Almárcegui, A. Gómez-Cabello, A. González-Agüero A, J.A. Casajús, and Germán Vicente-Rodríguez are with the GENUD "Growth, Exercise, NUtrition and Development" Research Group, University of Zaragoza, Zaragoza, Spain. C. Julián-Almárcegui and I. Huybrechts are with the Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. A. Gómez-Cabello is with the Centro Universitario de la Defensa, Zaragoza, Spain. I. Huybrechts is with the International Agency for Research on Cancer, Dietary Exposure Assessment Group, Lyon, France. A. González-Agüero is with the Department of Sport and Exercise Science, Aberystwyth University, Aberystwyth, United Kingdom. J.M. Kaufman is with the Department of Endocrinology, Ghent University Hospital, Ghent, Belgium. J.A. Casajús and Germán Vicente-Rodríguez are with the Department of Physiatry and Nursing, Faculty of Health and Sport Science (FCSD), University of Zaragoza, Zaragoza, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Huybrechts
authors.affiliation: C. Julián-Almárcegui, A. Gómez-Cabello, A. González-Agüero A, J.A. Casajús, and Germán Vicente-Rodríguez are with the GENUD "Growth, Exercise, NUtrition and Development" Research Group, University of Zaragoza, Zaragoza, Spain. C. Julián-Almárcegui and I. Huybrechts are with the Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. A. Gómez-Cabello is with the Centro Universitario de la Defensa, Zaragoza, Spain. I. Huybrechts is with the International Agency for Research on Cancer, Dietary Exposure Assessment Group, Lyon, France. A. González-Agüero is with the Department of Sport and Exercise Science, Aberystwyth University, Aberystwyth, United Kingdom. J.M. Kaufman is with the Department of Endocrinology, Ghent University Hospital, Ghent, Belgium. J.A. Casajús and Germán Vicente-Rodríguez are with the Department of Physiatry and Nursing, Faculty of Health and Sport Science (FCSD), University of Zaragoza, Zaragoza, Spain.
authors.forename: A
authors.initials: A
authors.lastname: González-Agüero
authors.affiliation: C. Julián-Almárcegui, A. Gómez-Cabello, A. González-Agüero A, J.A. Casajús, and Germán Vicente-Rodríguez are with the GENUD "Growth, Exercise, NUtrition and Development" Research Group, University of Zaragoza, Zaragoza, Spain. C. Julián-Almárcegui and I. Huybrechts are with the Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. A. Gómez-Cabello is with the Centro Universitario de la Defensa, Zaragoza, Spain. I. Huybrechts is with the International Agency for Research on Cancer, Dietary Exposure Assessment Group, Lyon, France. A. González-Agüero is with the Department of Sport and Exercise Science, Aberystwyth University, Aberystwyth, United Kingdom. J.M. Kaufman is with the Department of Endocrinology, Ghent University Hospital, Ghent, Belgium. J.A. Casajús and Germán Vicente-Rodríguez are with the Department of Physiatry and Nursing, Faculty of Health and Sport Science (FCSD), University of Zaragoza, Zaragoza, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Kaufman
authors.affiliation: C. Julián-Almárcegui, A. Gómez-Cabello, A. González-Agüero A, J.A. Casajús, and Germán Vicente-Rodríguez are with the GENUD "Growth, Exercise, NUtrition and Development" Research Group, University of Zaragoza, Zaragoza, Spain. C. Julián-Almárcegui and I. Huybrechts are with the Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. A. Gómez-Cabello is with the Centro Universitario de la Defensa, Zaragoza, Spain. I. Huybrechts is with the International Agency for Research on Cancer, Dietary Exposure Assessment Group, Lyon, France. A. González-Agüero is with the Department of Sport and Exercise Science, Aberystwyth University, Aberystwyth, United Kingdom. J.M. Kaufman is with the Department of Endocrinology, Ghent University Hospital, Ghent, Belgium. J.A. Casajús and Germán Vicente-Rodríguez are with the Department of Physiatry and Nursing, Faculty of Health and Sport Science (FCSD), University of Zaragoza, Zaragoza, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: Casajús
authors.affiliation: C. Julián-Almárcegui, A. Gómez-Cabello, A. González-Agüero A, J.A. Casajús, and Germán Vicente-Rodríguez are with the GENUD "Growth, Exercise, NUtrition and Development" Research Group, University of Zaragoza, Zaragoza, Spain. C. Julián-Almárcegui and I. Huybrechts are with the Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. A. Gómez-Cabello is with the Centro Universitario de la Defensa, Zaragoza, Spain. I. Huybrechts is with the International Agency for Research on Cancer, Dietary Exposure Assessment Group, Lyon, France. A. González-Agüero is with the Department of Sport and Exercise Science, Aberystwyth University, Aberystwyth, United Kingdom. J.M. Kaufman is with the Department of Endocrinology, Ghent University Hospital, Ghent, Belgium. J.A. Casajús and Germán Vicente-Rodríguez are with the Department of Physiatry and Nursing, Faculty of Health and Sport Science (FCSD), University of Zaragoza, Zaragoza, Spain. gervicen@unizar.es.
authors.forename: G
authors.initials: G
authors.lastname: Vicente-Rodríguez
mesh_terms: D000293:Adolescent; D015519:Bone Density / Q000502:physiology*; D002136:Calcium, Dietary; D002648:Child; D003430:Cross-Sectional Studies; D004032:Diet; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D009752:Nutritional Status / Q000502:physiology*
chemical_list: D002136:Calcium, Dietary
keywords: adolescents; bone mass; calcium intake; children; diet; exercise; growth; weight-bearing exercise