The risk of eating disorders and bone health in young adults: the mediating role of body composition and fitness

  • Miriam Garrido-Miguel
  • Ana Torres-Costoso
  • María Martínez-Andrés
  • Blanca Notario-Pacheco
  • Ana Díez-Fernández
  • Celia Álvarez-Bueno
  • Jorge Cañete García-Prieto
  • Vicente Martínez-VizcaínoEmail author
Original Article



To analyze the independent relationship between the risk of eating disorders and bone health and to examine whether this relationship is mediated by body composition and cardiorespiratory fitness (CRF).


In this cross-sectional study, bone-related variables, lean mass, fat mass (by DXA), risk of eating disorders (SCOFF questionnaire), height, weight, waist circumference and CRF were measured in 487 university students aged 18–30 years from the University of Castilla-La Mancha, Spain. ANCOVA models were estimated to test mean differences in bone mass categorized by body composition, CRF or risk of eating disorders. Subsequently, linear regression models were fitted according to Baron and Kenny’s procedures for mediation analysis.


The marginal estimated mean ± SE values of total body bone mineral density for the categories “no risk of eating disorders” and “risk of eating disorders” were 1.239 ± 0.126 < 1.305 ± 0.089, P = 0.021. However, this relationship disappeared after adjustment for any of the parameters of body composition or CRF. Therefore, all body composition parameters (except for lean mass) and CRF turned out to be full mediators in the association between the risk of eating disorders and bone health in young adults.


Body composition and CRF mediate the association between the risk of eating disorders and bone health. These findings highlight the importance of maintaining a healthy weight and good CRF for the prevention of the development of eating disorders and for the maintenance of good bone health in young adults.

Level of Evidence

Level V, cross-sectional descriptive study.


Eating disorders Bone health Body composition Body Mass Index Waist circumference College students Cardiorespiratory fitness 



Bone mineral density


Bone mineral content


Body mass index


Cardiorespiratory fitness



We thank all of the people that have participated in this research. MGM, ATC and VMV are the principal researchers and contributed equally to conceiving the study design, conducting the statistical analysis, and editing the manuscript. MMA, BNP, ADF, CAB, JCGP contributed to drafting the manuscript. All authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest to declare.

Ethics approval and consent to participate

Ethical clearance for the study was obtained from the Clinical Research Ethics Committee of the Virgen de la Luz Hospital in Cuenca, Universidad Castilla-La Mancha, Spain. Written informed consent was obtained from all individual participants. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


This work was supported by the Fundación para la Investigación Sanitaria en Castilla-La Mancha (FISCAM) (Ref.-AN/2008/31). Additional funding was obtained from the Instituto de Salud Carlos III, Red de Investigación en Actividades Preventivas y de Promoción de Salud (Ref.- RD06/0018/0038). CAB and MGM are supported by grants from the Spanish Ministry of Education, Culture and Sport (FPU13/03137 and FPU15/03847, respectively).

Supplementary material

40519_2017_458_MOESM1_ESM.docx (315 kb)
Supplementary material 1 (DOCX 314 KB)
40519_2017_458_MOESM2_ESM.docx (29 kb)
Supplementary material 2 (DOCX 29 KB)


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2017

Authors and Affiliations

  • Miriam Garrido-Miguel
    • 1
  • Ana Torres-Costoso
    • 2
  • María Martínez-Andrés
    • 1
  • Blanca Notario-Pacheco
    • 1
  • Ana Díez-Fernández
    • 1
  • Celia Álvarez-Bueno
    • 1
  • Jorge Cañete García-Prieto
    • 1
  • Vicente Martínez-Vizcaíno
    • 1
    • 3
    Email author
  1. 1.Health and Social Research CenterUniversidad de Castilla-La ManchaCuencaSpain
  2. 2.Facultad de Enfermería y FisioterapiaUniversidad de Castilla-La ManchaToledoSpain
  3. 3.Facultad de Ciencias de la SaludUniversidad Autónoma de ChileTalcaChile

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