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.

项目概要：肥胖对老年人身体机能的负面影响很大程度上是 尽管未被认识到，但美国有近 40% 的老年人肥胖，而且几乎所有人的体力都下降了 由于身体脂肪过多以及与年龄相关的肌肉质量/力量下降（肌肉减少症）而导致功能障碍。 在老年非裔美国人中尤其常见，他们因此面临更大的功能衰退和更高的发病率 与白人相比，肥胖治疗可以改善 2 型糖尿病的功能和肌肉健康，但会威胁长期健康。 由于肌肉质量的伴随损失而导致的长期功能结果不仅是一个问题。 除非采取有效的干预措施，否则它也可能导致糖耐量受损。 可以发现，为了规避这些挑战，老年人的身体因肌肉减少症和过度运动而受到限制 在不久的将来，肥胖可能会成为老年衰弱的最常见表型。 拟议的研究涉及晚年肥胖的各种重要后果，但其主要重点是 肥胖对老年人身体机能的不利影响是高风险人群 认识到老年人（尤其是非裔美国人）2 型糖尿病的患病率很高。 及其与肌肉质量差的联系，该干预措施将针对患有糖尿病前期的男性，并评估他们的情况 胰岛素敏感性的变化及其对干预措施的功能反应。 蛋白质，通过膳食平衡）减肥方案，之前已被证明可以改善身体机能 肥胖、虚弱的老年人将在功能受限的肥胖老年白人和黑人退伍军人中接受测试。 干预方案将根据文化量身定制，以满足目标人群的个人偏好， 旨在确保低收入参与者能够负担得起饮食计划中的健康食品。 共有 168 名年龄≥60 岁、轻度至中度功能障碍的肥胖（BMI ≥30 kg/m2）男性退伍军人 损伤（4 至 10 个单位的短期身体表现电池评分）和糖尿病前期，将被随机分组 接受更高蛋白质的减肥治疗或 RDA 水平的蛋白质控制减肥治疗 全部。 参与者接受个性化的卡路里处方，计算出每人体重减轻约 1-2 磅 周并参加每周的团体支持会议，旨在提高饮食对目标设定、自我调整的遵守情况 监测、压力管理和日常饮食日记；[他们还将参加每周一次的低影响会议； 运动课] 为高蛋白质组参与者提供冷藏/冷冻优质蛋白质。 足以为三分之二的人提供≥30克优质蛋白质的食物（瘦肉、低脂乳制品、鸡蛋） 每天进餐以帮助确保饮食依从性，将比较治疗反应的主要结果。 短物理性能电池的功能性能和重要的辅助测量，包括 肌肉质量、胰岛素敏感性、去脂体重、[体力活动、最近跌倒和对跌倒的恐惧]、 一项探索性目标检查了日常生活的工具性活动以及 0、3 和 6 个月时的生活质量。 治疗反应中种族差异的潜在调节因素并记录了最成功的治疗 这将是第一个关于均衡、高蛋白饮食的随机对照试验。 在糖尿病前期患者的代谢挑战（热量限制）期间，这是第一项针对种族的研究 肥胖老年男性对该方案的反应存在差异，研究结果将[通过以下方式完成 RR&D 的使命。 推进干预措施以改善老年退伍军人的身体功能]，产生有关 均衡、较高的蛋白质对肌肉质量和胰岛素敏感性的影响，并探讨种族差异 对肥胖干预措施的反应。