{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T10:15:36Z","timestamp":1788344136781,"version":"build-2803163510"},"reference-count":40,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T00:00:00Z","timestamp":1772928000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T00:00:00Z","timestamp":1772928000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J cachexia sarcopenia muscle"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Nutritional weight\u2010loss interventions are known to reduce bone mineral density (BMD), which can be prevented by adding (resistance) exercise training. However, this combined effect is not well studied in non\u2010obese adults. In addition, the association between biomarkers and metabolite\u2010based composite health markers with changes in BMD in such an intervention has not been studied as thoroughly.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The aims of the current study were to investigate the effect of a combined nutritional and activity lifestyle intervention on lumbar spine and total body BMD in healthy middle\u2010aged to older adults, and to relate these effects to a selection of immune\u2010metabolic biomarkers, muscle mass and fat mass measurements, and two composite metabolite\u2010based health scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this ancillary study of the single\u2010arm Growing Old TOgether (GOTO) trial (trial registration number GOTNL3301 [\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/onderzoekmetmensen.nl\/nl\/trial\/27183\">https:\/\/onderzoekmetmensen.nl\/nl\/trial\/27183<\/jats:ext-link>\n                      ], NL\u2010\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/trialsearch.who.int\/Trial2.aspx?TrialID=NL-OMON27183\">OMON27183<\/jats:ext-link>\n                      ), 134 participants (mean age 62.9\u2009years, 49% female) undertook a 13\u2010week lifestyle modification, incorporating 12.5% caloric restriction and 12.5% increase in physical activity. The impact on lumbar spine and total body BMD was evaluated using dual\u2010energy X\u2010ray absorptiometry (DEXA). The intervention effect on BMD was related to changes in immune\u2010metabolic biomarkers and two metabolite\u2010based immune\u2010metabolic health scores.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The trial significantly reduced bodyweight with 3.3 and 3.4\u2009kg, consisting of 1.4 and 1.1\u2009kg lean mass, in males (fdr &lt;\u20090.001) and females (fdr &lt;\u20090.001), respectively. Lean mass reduced by 1.4\u2009kg in males (fdr &lt;\u20090.001) and 1.1\u2009kg in females (fdr &lt;\u20090.001), whereas total body fat% reduced significantly with \u22121.5% (fdr &lt;\u20090.001) in males and \u22121.5% (fdr &lt;\u20090.001) in females. In males, lumbar spine BMD increased with 3.0% (fdr &lt;\u20090.001) and total body BMD with 0.7% (fdr\u2009=\u20090.002). In females, the lumbar spine BMD had a trend in the upwards direction (1.2%, fdr\u2009=\u20090.09) and the total body BMD remained stable (0.4%, fdr\u2009=\u20090.07). In males, the increase in lumbar spine BMD was significantly associated with decreased weight (fdr\u2009=\u20090.001) and with decreased body and trunk fat% (fdr\u2009=\u20090.001, fdr\u2009=\u20090.001) and improved immune\u2010metabolic health (fdr\u2009=\u20090.02). Males with higher BMD but a poor metabolite\u2010based health score at baseline had a stronger increase in lumbar spine BMD (fdr\u2009=\u20090.03).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A combined nutritional and activity lifestyle intervention significantly improved BMD of males with good bone health at baseline while at the same time improving metabolic health. Nutritional weight\u2010loss interventions may not harm BMD when combined with exercise.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jcsm.70226","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T06:39:12Z","timestamp":1773038352000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of a Combined Dietary and Physical Activity Intervention on Bone Density, Lean Mass and Fat Mass in Adults: The GOTO Trial"],"prefix":"10.1002","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2553-5346","authenticated-orcid":false,"given":"F.\u00a0A.","family":"Bogaards","sequence":"first","affiliation":[{"name":"Molecular Epidemiology Leiden University Medical Center  Leiden the Netherlands"},{"name":"Leiden Computational Biology Center  Leiden the Netherlands"},{"name":"Division of Human Nutrition and Health Wageningen University &amp; Research  Wageningen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inge","family":"Groenendijk","sequence":"additional","affiliation":[{"name":"Division of Human Nutrition and Health Wageningen University &amp; 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