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Leanne M. Redman, PhD; Jennifer Rood, PhD; Stephen D. Anton, PhD; Catherine Champagne, PhD; Steven R. Smith, MD; Eric Ravussin, PhD; for the Pennington Comprehensive Assessment of Long-Term Effects of Reducing Intake of Energy (CALERIE) Research Team

Arch Intern Med. 2008;168(17):1859-1866.

Background  Calorie restriction (CR) is promoted to increase longevity, yet this regimen could lead to bone loss and fracture and therefore affect quality of life.

Methods  Forty-six individuals were randomized to 4 groups for 6 months: (1) healthy diet (control group); (2) 25% CR from baseline energy requirements (CR group); (3) 25% energy deficit by a combination of CR and increased aerobic exercise (CR + EX group); and (4) low-calorie diet (890 kcal/d; goal, 15% weight loss) followed by weight maintenance (LCD group). Bone mineral density (total body and hip by dual-energy x-ray absorptiometry) and serum bone markers (bone-specific alkaline phosphatase, osteocalcin, cross-linked C-telopeptide of type I collagen, and cross-linked N-telopeptide of type I collagen) were measured at baseline and after 6 months.

Results  Mean ± SE body weight was reduced by –1.0% ± 1.1% (control), –10.4% ± 0.9% (CR), –10.0% ± 0.8% (CR + EX), and –13.9% ± 0.7% (LCD). Compared with the control group, none of the groups showed any change in bone mineral density for total body or hip. Bone resorption by serum cross-linked C-telopeptide of type I collagen was increased in all 3 intervention groups, with the largest change observed in the LCD group (CR, 23% ± 10%; CR + EX, 22% ± 9%; and LCD, 74% ± 16% vs control, 4% ± 10%). Serum levels of cross-linked N-telopeptide of type I collagen were also increased in the LCD group. With regard to bone formation, bone alkaline phosphatase levels were decreased in the CR group (–23% ± 10%) but were unchanged in the CR + EX, LCD, and control groups.

Conclusions  Moderate CR, with or without exercise, that preserves calcium intake for 6 months leads to large changes in body composition without significant bone loss in young adults. Longer studies with assessments of bone architecture are needed to confirm that CR nutrient-dense diets have no deleterious effect on bone health.

Trial Registration  clinicaltrials.gov Identifier: NCT00099151

Author Affiliations: Pennington Biomedical Research Center, Baton Rouge, Louisiana.

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