Bone Mineral Density Positively Associated With Physical Activity Among Children With IBD

Close up action of boys soccer teams, aged 12-14, playing a football match
Investigators assessed the relationship between physical activity, body mass index, and body composition among pediatric patients with inflammatory bowel disease.

Among children with inflammatory bowel disease (IBD), moderate to vigorous physical activity was positively associated with lean body mass (LBM) and improved bone mineral density (BMD). These findings were published in Journal of Pediatric Gastroenterology and Nutrition.

Children (N=40) with IBD were recruited at the Children’s Hospital Zagreb in Croatia between 2019 and 2020. The study participants were assessed for body composition, they kept a food diary for 3 days, and wore a triaxial accelerometer on 5 consecutive days to quantify physical activity.

The study participants were mostly boys (n=24) aged mean 15.28±0.42 years; 50% had Crohn disease (CD), 45% ulcerative colitis (UC), 5% had unclassified IBD, and 35% had undergone surgical treatment for their IBD.

BMD was 0.940 g/cm2 and the Z score was -0.42±0.14. Decreased BMD (Z-score <-1) was observed among 20% of the patients. Compared with UC, patients with CD had significantly lower BMD (P <.001).

Patients with CD were associated with increased fat mass (P =.001) and fat mass Z-scores (P =.024), as well as decreased lean mass (P =.001).

The accelerometer assessment indicated that patients with CD had less total physical activity (P =.014) and light physical activity time (P =.006), as well as more sedentary time (P =.014) vs patients with UC. This group of patients had low physical activity overall, with only 15% meeting the World Health Organization’s recommendations of 60 minutes of moderate to vigorous daily physical activity.

Daily protein, vitamin D, calcium, and phosphorus intake were not significantly related to BMD or LBM.

In a univariate analysis, BMD (standardized coefficient, 0.5; P =.003), LBM (standardized coefficient, 0.38; P =.026), and BMI (standardized coefficient, 0.36; P =.037) Z-scores were significantly associated with moderate to vigorous physical activity. In the multivariate analysis, only BMD Z-scores (standardized coefficient, 0.53; P =.043) remained significantly associated with moderate to vigorous physical activity.

This study was limited by its small sample size and lack of long-term dietary or physical activity monitoring.

This study found a positive association between moderate to vigorous physical activity and body composition among children with IBD. Additional longitudinal study is needed to evaluate optimal dietary and exercise regimes for this patient population.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Trivić I, Sila S, Batoš AT, Mišak Z, Kolaček S, Hojsak I. Moderate-to-vigorous physical activity is associated with higher bone mineral density in children with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2022;74(1):54-59. doi:10.1097/MPG.0000000000003258