Calorie Restriction & Changes in Body Composition, Disease, Function, & QoL in Ol

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• 批准号: 7741538
• 负责人: Jamy D Ard
• 金额: $ 59.76万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-15 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7741538
• 关键词: Address; Adipose tissue; Adult; Affect; Age; Automobile Driving; Blood Glucose; Blood Pressure; Body Composition; Body Weight; Body Weight decreased; Body fat; Body mass index; Bone Density; C-reactive protein; Caloric Restriction; Caregivers; Categories; Chronic Disease; Clinical; Communities; Control Groups; Decision Making; Diabetes Mellitus; Diet; Dietary Intervention; Disease; Elderly; Exercise; Fatty acid glycerol esters; Growth; Guidelines; Hand; Health; Health Benefit; Healthcare Systems; Heart Diseases; Hypertension; Insulin; Interleukin-6; Intervention; Leg; Leptin; Life; Lipids; Maintenance; Muscle; Obesity; Obesity associated disease; Older Population; Outcome; Overweight; Performance; Population; Prevalence; Public Health; Quality of life; Randomized Controlled Clinical Trials; Randomized Controlled Trials; Recommendation; Reducing diet; Relative Risks; Research; Risk; Risk Factors; Skeletal Muscle; Testing; Tumor Necrosis Factor-alpha; Tumor Necrosis Factors; Upper arm; Visceral; Weight; Weight Gain; adiponectin; age effect; age group; age related; aged; base; bone mass; cardiovascular disorder risk; design; disorder risk; experience; fasting glucose; follow-up; functional decline; functional disability; functional status; grasp; health related quality of life; high risk; improved; mortality; muscle form; obesity management; older patient; primary outcome; prospective; public health relevance; response; secondary outcome; subcutaneous; weight maintenance; young adult

DESCRIPTION (provided by applicant): Older adults represent one of the fastest growing segments of the population, and by 2030, those aged 65 and older are expected to make up more than 20% of the US population. Parallel to this demographic shift, the US is experiencing an unprecedented increase in the number of people who are obese. This increase in obesity extends to those who are older as well, with over 37% of older adults expected to be obese by 2010. The cumulative effects of age- and obesity-related disease risk could create a tremendous problem for our already strained health care system. The risks of cardiometabolic diseases (e.g., diabetes, heart disease) and declines in functional status and quality of life for older adults will be extraordinarily high. One potential option to reduce these risks is to promote weight loss in older adults. However, this recommendation has limited evidence to support its benefit in this age group and may actually be harmful for older adults-weight loss can decrease lean muscle mass and bone mineral density, and higher body mass index has been associated with lower mortality in older adults. The key to understanding how to minimize risk with weight reducing diets in older adults may be in understanding how age-related changes in body composition, in addition to excess weight gain, affect cardiometabolic risk factors and functional status. Prior research suggests that visceral adipose tissue may be primarily responsible for driving obesity associated risk in older adults, leading to increased cardiometabolic disease risk and worsened functional status. If visceral fat is a key factor that increases risk in obese older adults, do weight reducing diets that decrease total fat mass as well as lean mass unnecessarily increase risk of an adverse outcome in the setting of ongoing age-related declines in skeletal muscle and bone mass? Ideally, older adults using a prescribed dietary intervention combined with exercise would be able to preferentially reduce visceral fat mass, while minimizing loss of lean muscle, to obtain maximum improvements in both cardiometabolic and functional health risk. We propose to conduct a randomized, controlled trial in 180 older adults with 1 year follow up to test the hypothesis that changes in diet composition alone or in combination with calorie restriction have a significant effect on visceral fat stores (primarily) in older adults and as a result have an impact on cardiometabolic and functional health risk factors and quality of life. Compared to an exercise only control group, we will assess the effects of weight maintenance and weight loss (10%) interventions on body composition (Specific Aim #1: total body fat, visceral fat, subcutaneous fat, muscle mass, intramyocellular lipid, bone density), cardiometabolic risk factors (Specific Aim #2: blood pressure, blood glucose, insulin, lipids, C-reactive protein, adiponectin, leptin, tumor necrosis factor-1, interleukin-6), functional status, and quality of life (Specific Aim #3: life space mobility, Short Physical Performance Battery, leg and hand grip strength, Short Form-36 Health Related Quality of Life, Impact of Weight on Quality of Life-Lite). PUBLIC HEALTH RELEVANCE: The significance of this project, including its relevance for public health, is the new evidence it will provide regarding whether changes in diet composition alone or in combination with calorie restriction benefits, without causing harm, obese older adults at high risk for cardiometabolic disease and functional impairment. Important results generated from this study can be used to inform both clinical decision-making and community-based public health initiatives designed to improve the quality of life of the increasing population of older adults who are living longer.

描述（由申请人提供）：老年人是人口中增长最快的部分之一，到2030年，年龄在65岁及以上的人将占美国人口的20％以上。与这种人口转变的同时，美国正在经历肥胖的人数的前所未有的增加。肥胖症的这种增加也扩展到年龄较大的人，预计到2010年，预计有超过37％的老年人会肥胖。与年龄和肥胖相关的疾病风险的累积影响可能会给我们已经紧张的医疗保健系统带来一个巨大的问题。心脏代谢疾病（例如糖尿病，心脏病）的风险和老年人的功能状况和生活质量的下降将非常高。降低这些风险的一种潜在选择是促进老年人的体重减轻。但是，该建议的证据有限，可以支持其在该年龄段的好处，实际上可能对老年人损失有害，可以降低瘦肌肉质量和骨矿物质密度，而较高的体重指数与老年人的死亡率较低有关。了解如何通过减轻体重来减少老年人饮食的风险的关键可能是了解与年龄相关的身体成分变化，除了体重增加过多外，还会影响心脏代谢风险因素和功能状况。先前的研究表明，内脏脂肪组织可能主要负责驱动老年人肥胖与肥胖相关的风险，从而导致心脏代谢疾病的风险增加和功能状况恶化。如果内脏脂肪是增加肥胖老年人风险的关键因素，那么在减少总脂肪质量的饮食中，体重是否会在骨骼肌和骨骼肿块中持续下降的情况下不必要地增加瘦肉质量的不良预后风险？理想情况下，使用规定的饮食干预与运动结合的老年人将能够优先减少内脏脂肪量，同时最大程度地减少瘦肌肉的损失，从而获得心脏代谢和功能健康风险的最大改善。我们建议在180名老年人中进行一项随访的随机对照试验，并随访1年，以测试以下假设：饮食组成或与卡路里限制结合的变化对内脏脂肪储存（主要是）老年人对饮食脂肪储存产生了重大影响，因此对心脏代谢和功能健康风险因素和生命的质量产生了影响。 Compared to an exercise only control group, we will assess the effects of weight maintenance and weight loss (10%) interventions on body composition (Specific Aim #1: total body fat, visceral fat, subcutaneous fat, muscle mass, intramyocellular lipid, bone density), cardiometabolic risk factors (Specific Aim #2: blood pressure, blood glucose, insulin, lipids, C-reactive protein, adiponectin,瘦素，肿瘤坏死因子-1，白介素6），功能状态和生活质量（特定目的＃3：寿命流动性，短体性能，腿部和手抓手力，短-36与健康相关的生活质量，体重对生活质量质量的影响）。公共卫生相关性：该项目的重要性，包括其与公共卫生的相关性，是关于单独饮食组成的变化或与卡路里限制益处结合的新证据，而不会造成损害，肥胖的老年人肥胖的老年人对心脏代谢疾病和功能障碍的风险很高。这项研究产生的重要结果可用于为临床决策和基于社区的公共卫生计划提供信息，旨在改善寿命越来越长的老年人人口增长的生活质量。