{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T04:31:20Z","timestamp":1777523480789,"version":"3.51.4"},"reference-count":76,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2020,9,25]],"date-time":"2020-09-25T00:00:00Z","timestamp":1600992000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Factors associated with bone mineral density (BMD) are poorly known in severely obese individuals i.e., a body mass index (BMI) &gt; 35 kg\/m2. The objectives of this study were to describe the bone health profile of severely obese Brazilian women, to identify the health risk and health protective factors for BMD in this group and to assess whether these factors vary according to three different bone sites. BMD was assessed using dual-energy X-ray absorptiometry (DXA). This study analyzed baseline data from 104 women who had an average BMI of 43.7 \u00b1 4.5 kg\/m2 and presented the following BMD status: 1.283 \u00b1 0.094 g\/cm2 for total body, 1.062 \u00b1 0.159 g\/cm2 for vertebral column and 1.195 \u00b1 0.134 g\/cm2 for hip. They took part in the \u201cEffect of nutritional intervention and olive oil in severe obesity\u201d randomized clinical trial (DieTBra Trial). The risk factors negatively associated with lower BMD were age \u226550 years for the three bone sites i.e., total body, vertebral column and hip. Smoking for total body BMD (p = 0.045); BMI \u2265 50kg\/m2 for vertebral column and hip; menopause for hip; high C-reactive protein (CRP) levels (p = 0.049), insufficient zinc (p = 0.010) and previous fracture for vertebral column (p = 0.007). The protective factors positively associated with BMD were physical activity (\u2265150 min\/week (p = 0.001)) for hip; type 2 diabetes mellitus (DM2) (p &lt; 0.0001) total body and adequate vitamin D levels from food consumption (p = 0.039) for vertebral column. A BMI \u2265 50 kg\/m2 was a risk factor for lower BMD. The findings showed that protective and risk factors varied by bone site. The original study is registered with ClinicalTrials.gov. (protocol number: NCT02463435).<\/jats:p>","DOI":"10.3390\/ijerph17197017","type":"journal-article","created":{"date-parts":[[2020,9,25]],"date-time":"2020-09-25T08:57:32Z","timestamp":1601024252000},"page":"7017","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Bone Mineral Density in Severely Obese Women: Health Risk and Health Protective Risk Factors in Three Different Bone Sites"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1246-5572","authenticated-orcid":false,"given":"Camila","family":"Kellen de Souza Cardoso","sequence":"first","affiliation":[{"name":"Postgraduate Program in Health Sciences, Pontifical Catholic University of Goias, Goi\u00e2nia 74605-020, Goi\u00e1s, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1950-0817","authenticated-orcid":false,"given":"Maria do Ros\u00e1rio","family":"Gondim Peixoto","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Nutrition and Health, Faculty of Nutrition, Federal University of Goias, Goi\u00e2nia 74605-220, Goi\u00e1s, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0447-898X","authenticated-orcid":false,"given":"Ana Paula","family":"dos Santos Rodrigues","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goias, Goi\u00e2nia 74605-220, Goi\u00e1s, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9902-8227","authenticated-orcid":false,"given":"Carolina","family":"Rodrigues Mendon\u00e7a","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goias, Goi\u00e2nia 74605-220, Goi\u00e1s, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4099-4762","authenticated-orcid":false,"given":"Cesar","family":"de Oliveira","sequence":"additional","affiliation":[{"name":"Department of Epidemiology &amp; Public Health, Institute of Epidemiology &amp; Health Care, University College London, London WC1E 6BT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8839-4520","authenticated-orcid":false,"given":"Erika","family":"Aparecida Silveira","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goias, Goi\u00e2nia 74605-220, Goi\u00e1s, Brazil"},{"name":"Department of Epidemiology &amp; Public Health, Institute of Epidemiology &amp; Health Care, University College London, London WC1E 6BT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,9,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1016\/S0140-6736(16)30054-X","article-title":"Trends in adult body-mass index in 200 countries from 1975 to 2014: A pooled analysis of 1698 population-based measurement studies with 19\u00b72 million participants","volume":"387","author":"Collaboration","year":"2016","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Palermo, A., Tuccinardi, D., Defeudis, G., Watanabe, M., D\u2019Onofrio, L., Pantano, A.L., Napoli, N., Pozzilli, P., and Manfrini, S. 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