Enhanced Protein Intake During Obesity Reduction in Older Male Veterans: Differences in Physical Function and Muscle Quality Responses by Race

老年男性退伍军人在减少肥胖期间增加蛋白质摄入量：不同种族的身体功能和肌肉质量反应的差异

• 批准号: 10766672
• 负责人: CONNIE W BALES
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10766672
• 关键词: Acceleration; Accelerometer; Adherence; African American; African American population; Age; Black Populations; Body Composition; Body Weight decreased; Body fat; Body mass index; Caloric Restriction; Calories; Chills; Chronic; Consumption; Controlled Study; Dairy Products; Diabetes Mellitus; Diet; Elderly; Exercise; Face; Fatty acid glycerol esters; Female; Food; Frail Elderly; Freezing; Future; Goals; Health; Health Food; Healthcare; High Prevalence; Individual; Inferior; Intervention; Intervention Trial; Leptin; Link; Literature; Low income; Measures; Meat; Mediator; Metabolic; Mission; Monitor; Muscle; Musculoskeletal; Non-Insulin-Dependent Diabetes Mellitus; OGTT; Obesity; Outcome; Participant; Performance; Phenotype; Physical Function; Physical Performance; Physical activity; Physiological; Prediabetes syndrome; Prevalence; Productivity; Proteins; Publishing; Quality of life; Race; Randomized; Randomized, Controlled Trials; Recovery of Function; Reducing diet; Regimen; Research; Support Groups; Target Populations; Testing; Thinness; Veterans; Vulnerable Populations; Weight; Weight maintenance regimen; age-related muscle loss; aged; black men; black women; care burden; comparison control; design; diet compliance; dietary adherence; dietary control; effective intervention; egg; falls; fear of falling; frailty; functional decline; functional disability; functional improvement; functional outcomes; functional status; high risk; human old age (65+); impaired glucose tolerance; improved; innovation; instrumental activity of daily living; insulin sensitivity; lean body mass; loss of function; male; men; muscle form; novel; obesity treatment; older men; preference; preservation; primary outcome; protein intake; racial difference; reduced muscle mass; response; sarcopenia; secondary outcome; social; stress management; successful intervention; treatment response; trend; weight loss intervention

Project Summary: The negative impact of obesity on physical function in older adults is largely unrecognized, yet close to 40% of older adults in the U.S. are obese and almost all have reduced physical function due to excess body fat plus age-related decline in muscle mass/strength (sarcopenia). Obesity is especially common in older African Americans, who as a result face greater functional decline and higher rates of Type 2 diabetes than whites. Obesity treatment can improve function and muscle health but it threatens long term functional outcomes due to concomitant loss of lean mass. Lowering of muscle mass is a concern not only for future functional status but it could also lead to impaired glucose tolerance. Unless effective interventions can be found to circumvent these challenges, the older adult physically limited by sarcopenia and excessive adiposity is likely to become the most common phenotype of geriatric frailty in the near future. The proposed study concerns a variety of important consequences of late life obesity but its primary focus is on the detrimental influences of obesity on physical function in older individuals who are at very high risk for frailty. Recognizing the high prevalence of Type 2 diabetes in older individuals (especially African Americans) and its links with poor muscle quality, the intervention will target men with prediabetes and assess their changes in insulin sensitivity, as well as their functional responses, to the interventions. A novel (higher- protein, balanced by meal) weight loss regimen that has been previously shown to improve physical function in obese, frail older adults will be tested in obese older white and black Veterans with functional limitations. The intervention regimen will be culturally tailored to meet the individual preferences of the target population and adapted to make sure low-income participants are able to afford the healthy foods in their diet plan. A total of 168 obese (BMI ≥30 kg/m2) male Veterans aged ≥60 yrs, with mild to moderate functional impairments (Short Physical Performance Battery score of 4 to 10 units) and prediabetes, will be randomized to a higher-protein weight loss treatment or an RDA-level protein control weight loss treatment. All participants receive individualized calorie prescriptions calculated to achieve a weight loss of ~1-2 pounds per week and attend weekly group support sessions designed to enhance diet compliance with goal setting, self- monitoring, stress management, and daily diet journaling; [they will also attend a weekly low impact, chair exercise class]. Higher-protein group participants are provided a supply of chilled/frozen high quality protein foods (lean meats, low fat dairy products, eggs) sufficient to give ≥30 g high quality protein for two of three meals daily to help assure diet compliance. Treatment responses will be compared for the primary outcome of functional performance by Short Physical Performance Battery and important secondary measures, including muscle quality, insulin sensitivity, lean body mass, [physical activity, recent falls and fear of falling], instrumental activities of daily living, and quality of life at 0, 3 and 6 months. An exploratory aim examines potential mediators of racial differences in treatment responses and documents the most successful intervention strategies. This will be the first randomized controlled trial of a balanced, higher-protein diet during a metabolic challenge (caloric restriction) in those with prediabetes and the first study to look at racial differences in responses of obese older men to this regimen. Study findings will [fulfill the RR&D mission by advancing interventions to improve physical function in older Veterans], yield novel information about the impact of balanced, higher protein on muscle quality and insulin sensitivity, and explore racial differences in responses to obesity interventions.

项目摘要：肥胖对老年人身体机能的负面影响在很大程度上是 未被认可，但在美国的老年人中有接近40％ 由于超过体内脂肪加肌肉质量/强度（肌肉减少症）的年龄相关的功能。肥胖是 在非洲裔美国人中尤其常见，因此，他们的功能下降和更高的速度面临 2型糖尿病比白人。肥胖治疗可以改善功能和肌肉健康，但威胁很长 术语功能结果是由于瘦质量损失而引起的。降低肌肉质量不仅是一个问题 对于未来的功能状态，但也可能导致葡萄糖耐受性受损。除非有效干预 可以发现可以避免这些挑战，老年人在身体上受到肌肉减少症的限制和多余的 在不久的将来，肥胖可能成为老年脆弱的最常见表型。 拟议的研究涉及晚期肥胖的各种重要后果，但其主要重点是 肥胖对身体机能的不利影响，在年龄较大的年龄较高的人中 脆弱。认识到老年人（尤其是非洲裔美国人）中2型糖尿病的高患病率 及其与肌肉质量差的联系，干预措施将针对糖尿病前期的男性 胰岛素敏感性及其功能反应的变化对干预措施。小说（更高 - 蛋白质，通过进餐平衡）减肥方案，以前已证明可以改善 肥胖，脆弱的老年人将在具有功能限制的肥胖白人和黑人退伍军人中进行测试。这 干预方案将根据文化量身定制，以满足目标人群的个体偏好和 适应以确保低收入参与者能够在饮食计划中负担健康食品。 总共168个肥胖（BMI≥30kg/m2）男性退伍军人，年龄≥60岁，功能轻至中度 损伤（物理性能短的电池得分为4至10个单位）和糖尿病前期，将被随机分配 进行较高的蛋白质减肥治疗或RDA级蛋白质控制减肥治疗。全部 参与者收到的个性化卡路里处方是为了实现约1-2磅的体重减轻 一周并参加每周的小组支持会议，旨在提高饮食依从性，以设定目标 监测，压力管理和日常饮食期刊； [他们还将参加每周的低影响力，主席 运动课]。为较高的蛋白质组参与者提供冷水/冷冻高品质蛋白质的供应 食物（瘦肉，低脂乳制品，鸡蛋）足以使三个中的两个具有≥30克高质量的蛋白质 每天用餐以确保饮食合规性。将比较治疗反应的主要结果 通过短体性能电池和重要的二级措施的功能性能，包括 肌肉质量，胰岛素敏感性，瘦体重，[身体活动，最近跌倒和跌倒的恐惧]， 日常生活的工具活动和0、3和6个月的生活质量。探索性目标检查 种族差异在治疗反应和记录中的潜在介体是最成功的 干预策略。这将是第一个平衡，高蛋白饮食的随机对照试验 在糖尿病前期的代谢挑战（热量限制）中，以及首次研究种族的研究 肥胖老年人对该方案的反应差异。研究结果将[履行RR＆D任务 推进干预措施以改善老年退伍军人的身体机能]，产生有关 平衡，较高蛋白质对肌肉质量和胰岛素敏感性的影响，并探索种族差异 对肥胖干预的反应。