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Diet, Physical Activity and Bone Mineral Density of Post-Menopausal Saudi Women and Development of a Culturally Acceptable Food Product

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Diet, Physical Activity and Bone Mineral Density of Post-Menopausal Saudi Women and Development of a Culturally Acceptable Food Product DIET, PHYSICAL ACTIVITY AND BONE MINERAL DENSITY OF POST-MENOPAUSAL SAUDI WOMEN AND DEVELOPMENT OF A CULTURALLY ACCEPTABLE FOOD PRODUCT By ALAA SALEM ALHARBI Bachelor of Science in Nutrition & Food Science King Abdulaziz University, Jeddah, Saudi Arabia 2009 Master of Science in Nutrition & Food Management University of Central Oklahoma Edmond, Oklahoma 2014 Submitted to the Faculty of the Graduate College Oklahoma State University in partial fulfillment of the requirements for the Degree of DOCTOR OF PHILOSOPHY May, 2020 DIET, PHYSICAL ACTIVITY AND BONE MINERAL DENSITY OF POST-MENOPAUSAL SAUDI WOMEN AND DEVELOPMENT OF A CULTURALLY ACCEPTABLE FOOD PRODUCT Dissertation Approved: Dr. Barbara J. Stoecker Dissertation Adviser Dr. William McGlynn Dr. Ranjith Ramanathan Dr. Timothy Bowser ii ACKNOWLEDGEMENTS First and foremost, praises and sincere gratitude to Allah, the Omnipotent, who provide me with the supports, good health, and power to achieve success in the accomplishment of this dissertation. Through the Ph.D.'s journey, I have acquired a magnificent and immeasurable opportunity to obtain unlimited knowledge and education that will have an impact on my life and career in the future. My sincere thanks go to the Food Science Department for offering the chance for me to be a member of their community, to learn and gain valuable professional experience. I am extending my profound thanks and immeasurable appreciation to my supervisor whom I owe a magnificent debt for giving me the benefit of her rich knowledge, perceptive advice, and precious support. My profound gratitude to my committee members Dr. William McGlynn for his cooperation with me throughout my graduate study and Dr. Ranjith Ramanathan for his assistance in guiding me on the right path to complete the dissertation. I would like to thank Dr. Tim Bowser for his collaboration and precious support. Special appreciation goes to my loved parents, my father, Dr. Salem Alharbi, and my mother, Mrs. Salmah Alhazmi, for giving me the support and surround me with their love. Nothing can express my appreciation for their perseverance and efforts to help me make my dream reality. I want to express my thanks for my brothers Dr. Mohmmed, iii Raid, and Yaser, for making me believe in myself and my sisters Ashwag and Rawan for their persistence prayers and encouragement throughout my Ph.D. From my heart bottom, I owe my loving thanks to my husband Rakan for honoring my life by his pleasing existence and adding a lovely measure of his spirit to my presence. My children Badr, Kenan, and Ryan, who made my life brighter and making me smile even in hard times. Great appreciation to the Hospital of King AbdulAziz University for the great collaboration and easing any obstacles that might be experiencing during my collecting data. My appreciation and thanks go to the technical director of the radiology department Mr. Bandr Almutairi for his help and provision of the professional equipment needed throughout the collecting data. iv Acknowledgements reflect the views of the author and are not endorsed by committee members or Oklahoma State University Date of Degree: May, 2020 Title of Study: DIET, PHYSICAL ACTIVITY AND BONE MINERAL DENSITY OF POST-MENOPAUSAL SAUDI WOMEN AND DEVELOPMENT OF A CULTURALLY ACCEPTABLE FOOD PRODUCT Major Field: FOOD SCIENCE Abstract: This study seeks to determine whether higher dietary calcium and vitamin D intakes and increased physical activity are associated with improved bone mineral density (BMD) in Saudi post-menopausal females. A total of 150 women participated in the study. Physical activity questionnaires and three-day food records were used to assess participants’ daily routine activities and dietary habits. The levels of physical activity were also tracked over three days using a Letsfit watch, which counted each participant’s daily steps. BMD was evaluated using a DXA scan. The findings of the study revealed high osteopenia and osteoporosis prevalence among the participants, estimated at 43.3% and 23.3%, respectively. The study also showed low sunlight exposure and low dietary intake of vitamin D in the participants. There was a positive association between BMD and the number of previous pregnancies and a negative association with the number of years after menopause. There was an observed negative association between daily vitamin D consumption and BMD. However, the result showed no associations among calcium intake, physical activity and BMD. For centuries, cow’s milk was used as a source for calcium and vitamins. However, some people have lactose intolerance or an allergy to cow milk, and they seek alternative products to avoid these health problems. The second part of this study aimed to develop a gluten, dairy, and soy-free product that would be culturally acceptable in the Middle East. The product developed was entirely plant-based, with the primary ingredients being almond (25%), dates (5%), and figs (5%). Laboratory analysis was performed of the developed almond milk product and an existing commercial product (Silk almond milk), evaluating their different compositional properties. The commercial almond milk displayed higher levels of moisture, calcium, vitamin D, ash, and pH. Levels of potassium, carbohydrates, fat, sugar, and protein were higher in the developed product. A comparison between the two products was made using sensory evaluation, with the descriptive sensory evaluation showing that consumer acceptance for the developed product was higher than for the existing commercial product. However, fortification of the developed almond milk product with calcium is recommended. v TABLE OF CONTENTS PART ONE: DIET, PHYSICAL ACTIVITY AND BONE MINERAL DENSITY OF POST-MENOPAUSAL SAUDI WOMEN ............................................................. 1 Chapter Page I. INTRODUCTION ...................................................................................................... 2 1.1 Background ........................................................................................................ 2 1.2 Prevalence of Osteoporosis ............................................................................... 4 1.3 Risk Factors ....................................................................................................... 5 1.4 BMD Measurements .......................................................................................... 7 1.5 Statement of the Research Problem ................................................................... 8 1.6 Goals and Specific Aims ................................................................................. 10 1.7 Purpose of the Study ........................................................................................ 10 II. REVIEW OF LITERATURE ................................................................................. 12 2.1 Calcium Intake and Osteoporosis .................................................................... 12 2.2 Vitamin D Intake and Osteoporosis ................................................................ 15 2.3 Physical Activity and Osteoporosis ................................................................. 18 2.4 Dual –Energy X-Ray Absorptiometry ............................................................. 22 III. METHODOLOGY ................................................................................................ 25 3.1 Data Collection and Confidentiality ................................................................ 25 3.2 Inclusion and Exclusion Criteria ..................................................................... 28 3.3 Dietary Measurements ..................................................................................... 29 3.4 Physical Activity Measurements ..................................................................... 29 3.5 Laboratory Analysis ........................................................................................ 30 3.6 Measurements of Bone Mineral Density ......................................................... 30 3.7 Statistical Analysis .......................................................................................... 31 vi Chapter Page IV. FINDINGS ............................................................................................................ 32 4.1 Characteristics of the Participants ................................................................... 32 4.2 Bone Mineral Density ...................................................................................... 34 4.3 Laboratory Biomarkers Related to Bone Health ............................................. 36 4.4 Physical Activity Estimates ............................................................................. 39 4.5 Dietary Intake of Calcium and Vitamin D ...................................................... 40 4.6 Association between T-score for Bone BMD and Other Variables ................ 42 V. DISCUSSION ......................................................................................................... 48 5.1 Bone Mineral Density ...................................................................................... 48 5.2 Risk Factors and BMD .................................................................................... 50 5.3 Laboratory Biomarkers Related to Bone Health ............................................. 52 5.4 Dietary Intake of Calcium and Vitamin D ...................................................... 54 5.5 Physical Activity Estimates ............................................................................
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