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

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• 批准号: 7940811
• 负责人: Jamy D Ard
• 金额: $ 58.08万
• 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/7940811
• 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; Communities; Control Groups; 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; Overweight; Performance; Population; Prevalence; Public Health; Quality of life; Randomized Controlled Trials; Recommendation; Reducing diet; Relative Risks; Research; Risk; Risk Factors; Skeletal Muscle; Testing; Tumor Necrosis Factor-alpha; Tumor Necrosis Factors; Visceral; Weight; Weight Gain; adiponectin; adverse outcome; age effect; age group; age related; aged; arm; base; bone mass; cardiovascular disorder risk; clinical decision-making; 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; randomized trial; 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）：老年人是人口增长最快的群体之一，到 2030 年，65 岁及以上的老年人预计将占美国人口的 20% 以上。与这种人口结构变化并行的是，美国肥胖人数正在经历前所未有的增加。肥胖症的增加也波及到了老年人，预计到 2010 年，超过 37% 的老年人将患有肥胖症。年龄和肥胖相关疾病风险的累积影响可能会给我们本已紧张的医疗保健带来巨大问题系统。老年人患心脏代谢疾病（例如糖尿病、心脏病）以及功能状态和生活质量下降的风险将非常高。降低这些风险的一种潜在选择是促进老年人减肥。然而，这一建议支持其对这个年龄段有益的证据有限，实际上可能对老年人有害——减肥会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较低的死亡率相关。了解如何最大限度地降低老年人减肥饮食风险的关键可能是了解除了体重过度增加之外，与年龄相关的身体成分变化如何影响心脏代谢危险因素和功能状态。先前的研究表明，内脏脂肪组织可能是导致老年人肥胖相关风险的主要原因，导致心脏代谢疾病风险增加和功能状态恶化。如果内脏脂肪是增加肥胖老年人风险的关键因素，那么在骨骼肌和骨骼持续与年龄相关的下降的情况下，减少总脂肪量和去脂量的减肥饮食是否会不必要地增加不良结果的风险大量的？理想情况下，老年人使用规定的饮食干预结合运动将能够优先减少内脏脂肪量，同时最大限度地减少瘦肌肉的损失，从而最大限度地改善心脏代谢和功能健康风险。我们建议对 180 名老年人进行一项随机对照试验，并进行 1 年随访，以检验以下假设：单独改变饮食结构或与热量限制相结合对老年人的内脏脂肪储存（主要）有显着影响，并且结果对心脏代谢和功能健康风险因素以及生活质量产生影响。与仅运动对照组相比，我们将评估体重维持和减肥 (10%) 干预措施对身体成分的影响（具体目标#1：全身脂肪、内脏脂肪、皮下脂肪、肌肉质量、肌细胞内脂质、骨骼）密度）、心脏代谢危险因素（具体目标#2：血压、血糖、胰岛素、血脂、C 反应蛋白、脂联素、瘦素、肿瘤坏死因子-1、 interleukin-6)、功能状态和生活质量（具体目标#3：生活空间流动性、短期身体表现电池、腿部和手部握力、Short Form-36 健康相关生活质量、体重对生活质量的影响-精简版）。公共健康相关性：该项目的重要性（包括其与公共健康的相关性）在于，它将提供新的证据，证明单独改变饮食结构或与限制热量相结合是否有益于肥胖老年人的健康风险，而不会造成伤害。心脏代谢疾病和功能障碍。这项研究产生的重要结果可用于为临床决策和社区公共卫生举措提供信息，这些举措旨在改善日益增长的长寿老年人口的生活质量。