Effect of protein source during weight loss on body composition, cardiometabolic risk and physical performance in abdominally obese, older adults: a pilot feeding study

Effects of Plant-Based Protein Interventions, with and without an Exercise Component, on Body Composition, Strength and Physical Function in Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Maintaining muscle mass, strength, and function is crucial for our aging population. Exercise and dietary protein intake are recommended strategies; however, animal proteins have been the most studied. Plant-based protein sources have lower digestibility and incomplete amino acid profiles. However new innovative plant-based proteins and products may have overcome these issues. Therefore, this systematic review aimed to synthesize the current research and evaluate the effects of plant-based protein interventions compared to placebo on body composition, strength, and physical function in older adults (≥60 years old). The secondary aim was whether exercise improved the effectiveness of plant-based protein on these outcomes. Randomized controlled trials up to January 2023 were identified through Medline, EMBASE, CINAHL, and Cochrane Library databases. Studies contained a plant-protein intervention, and assessed body composition, strength, and/or physical function. Thirteen articles were included, all using soy protein (0.6-60 g daily), from 12 weeks to 1 year. Narrative summary reported positive effects on muscle mass over time, with no significant differences compared to controls (no intervention, exercise only, animal protein, or exercise + animal protein interventions). There was limited impact on strength and function. Meta-analysis showed that plant-protein interventions were comparable to controls, in all outcomes. In conclusion, plant-protein interventions improved muscle mass over time, and were comparable to other interventions, warranting further investigation as an anabolic stimulus in this vulnerable population.

Nutrition and exercise interventions to improve body composition for persons with overweight or obesity near retirement age: A systematic review and network meta-analysis of randomised controlled trials

The retirement phase is an opportunity to integrate healthy (nutrition/exercise) habits into daily life. We conducted this systematic review to assess which nutrition and exercise interventions most effectively improve body composition (fat/muscle mass), body mass index (BMI) and waist circumference (WC) in persons with obesity/overweight near retirement age (ages 55-70). We conducted a systematic review and network-meta-analysis (NMA) of randomised controlled trials, searching four databases from their inception up to 12 July 2022. The NMA was based on a random effects model, pooled mean differences, standardised mean differences, their 95% confidence intervals, and correlations with multi-arm studies. Subgroup and sensitivity analyses were also conducted. 92 studies were included, 66 of which with 4957 participants could be used for the NMA. Identified interventions were clustered into 12 groups: no intervention, energy restriction (i.e. 500-1000 kcal), energy restriction plus high protein (HP) intake (1.1-1.7 g/kg/body weight), intermittent fasting, mixed exercise (aerobic and resistance), resistance training (RT), aerobic training (AT), HP plus RT, energy restriction plus HP plus exercise, energy restriction plus RT, energy restriction plus AT, and energy restriction plus mixed exercise (ME). Intervention durations ranged from 8 weeks to 6 months. Body fat was reduced with energy restriction plus any exercise or plus HP intake. Energy restriction alone was less effective and tended to decrease muscle mass. Muscle mass was only significantly increased with ME. All other interventions including exercise effectively preserved muscle mass. A BMI and/or WC decrease was achieved with all interventions except AT/RT alone or RT plus HP. Overall, the most effective strategy for nearly all outcomes was combining energy restriction with RT or ME and HP. Healthcare professionals involved in the management of persons with obesity need to be aware that an energy-restricted diet alone may contribute to sarcopenic obesity in persons near retirement age. This network meta-analysis is registered at https://www.crd.york.ac.uk/prospero/as CRD42021276465.

Effect of flavonoids on skeletal muscle mass, strength and physical performance in middle-aged and older adults with or without Sarcopenia: A meta-analysis of randomized controlled trials

The role of flavonoids in regulating the synthesis and function of skeletal muscles is increasingly recognized. However, randomized controlled trials have yielded inconsistent results on the influence of flavonoids on human muscular parameters. Therefore, we performed a meta-analysis to evaluate the possible effects of flavonoids on sarcopenia-related parameters in middle-aged and elderly people. Eligible literature and randomized controlled trials reports have been extensively searched from PubMed, Cochrane Library, Web of Science, and EMBASE databases until April 2022. A total of 20 articles involving 796 participants were available for the meta-analysis. There were significant benefits for participants in appendicular muscle mass gain (SMD = 0.29; 95% CI: 0.07, 0.52; P = 0.01) and 6-min walk distance (SMD = 0.37; 95% CI: 0.01, 0.73; P = 0.05). A subgroup analysis indicated that flavonoid significantly improves appendicular muscle mass (SMD = 0.50; 95% CI: 0.21, 0.80; P < 0.01) and Timed-Up and Go test (SMD = −0.47; 95% CI: −0.85, −0.09; P = 0.02) in Sarcopenia population. Our results provide insight into the effects of flavonoids on skeletal muscle mass and gait speed for those without exercise. However, there was no significant improvement in the subjects' muscle strength.

Outcomes addressed in randomized controlled lifestyle intervention trials in community-dwelling older people with (sarcopenic) obesity-An evidence map

Obesity and sarcopenic obesity (SO) are characterized by excess body fat with or without low muscle mass affecting bio-psycho-social health, functioning, and subsequently quality of life in older adults. We mapped outcomes addressed in randomized controlled trials (RCTs) on lifestyle interventions in community-dwelling older people with (sarcopenic) obesity. Systematic searches in Medline, Embase, Cochrane Central, CINAHL, PsycInfo, Web of Science were conducted. Two reviewers independently performed screening and extracted data on outcomes, outcome domains, assessment methods, units, and measurement time. A bubble chart and heat maps were generated to visually display results. Fifty-four RCTs (7 in SO) reporting 464 outcomes in the outcome domains: physical function (n = 42), body composition/anthropometry (n = 120), biomarkers (n = 190), physiological (n = 30), psychological (n = 47), quality of life (n = 14), pain (n = 4), sleep (n = 2), medications (n = 3), and risk of adverse health events (n = 5) were included. Heterogeneity in terms of outcome definition, assessment methods, measurement units, and measurement times was found. Psychological and quality of life domains were investigated in a minority of studies. There is almost no information beyond 52 weeks. This evidence map is the first step of a harmonization process to improve comparability of RCTs in older people with (sarcopenic) obesity and facilitate the derivation of evidence-based clinical decisions.

Cardiac troponin T and autoimmunity in skeletal muscle aging

Age-related muscle mass and strength decline (sarcopenia) impairs the performance of daily living activities and can lead to mobility disability/limitation in older adults. Biological pathways in muscle that lead to mobility problems have not been fully elucidated. Immunoglobulin G (IgG) infiltration in muscle is a known marker of increased fiber membrane permeability and damage vulnerability, but whether this translates to impaired function is unknown. Here, we report that IgG1 and IgG4 are abundantly present in the skeletal muscle (vastus lateralis) of ~ 50% (11 out of 23) of older adults (&gt; 65 years) examined. Skeletal muscle IgG1 was inversely correlated with physical performance (400 m walk time: r = 0.74, p = 0.005; SPPB score: r =  - 0.73, p = 0.006) and muscle strength (r =  - 0.6, p = 0.05). In a murine model, IgG was found to be higher in both muscle and blood of older, versus younger, C57BL/6 mice. Older mice with a higher level of muscle IgG had lower motor activity. IgG in mouse muscle co-localized with cardiac troponin T (cTnT) and markers of complement activation and apoptosis/necroptosis. Skeletal muscle-inducible cTnT knockin mice also showed elevated IgG in muscle and an accelerated muscle degeneration and motor activity decline with age. Most importantly, anti-cTnT autoantibodies were detected in the blood of cTnT knockin mice, old mice, and older humans. Our findings suggest a novel cTnT-mediated autoimmune response may be an indicator of sarcopenia.

Soy Food Intake Associated with Obesity and Hypertension in Children and Adolescents in Guangzhou, Southern China

The associations between soy food intake and cardio-metabolic risk factors in children remain unclear due to limited evidence. We aim to explore soy food intake and its association with the risks of obesity and hypertension in Chinese children and adolescents. A total of 10,536 children and adolescents aged 7–18 years (5125 boys and 5411 girls) were enrolled in a cross-sectional study in Guangzhou City, southern China. Data on demographic characteristics and dietary consumption were collected using self-reported questionnaires, and anthropometric characteristics were measured. Obesity, abdominal obesity, and hypertension were defined using Chinese criteria for children and adolescents. A multiple logistic regression model was applied to estimate the association between soy food intake and obesity and hypertension. Roughly 39.5% of the participants consumed soy food more than three times per week. The mean amounts of liquid and solid soy food intake were 0.35 ± 0.54 cups/day and 0.46 ± 0.63 servings/day, respectively. The adjusted odds ratios (OR) of hypertension among those with high liquid soy food intake and a high frequency of all soy food intake (more than three times/week) were 0.79 (95% confidence interval (CI), 0.67–0.94), and 0.83 (95% CI, 0.70–0.97) compared to those with no intake. Additionally, the adjusted OR of obesity among those with high solid soy food intake and a high frequency of all soy food intake were 1.34 (95% CI, 1.09–1.63) and 1.30 (95% CI, 1.07–1.58), respectively. In conclusion, 39.5% of southern Chinese children and adolescents had high soy food intake (more than three times/week), which was significantly associated with a lower prevalence of hypertension and a greater prevalence of obesity.

Incorporating Nutrition, Vests, Education, and Strength Training (INVEST) in Bone Health: Trial Design and Methods

BACKGROUND

Achievement of 5-10% weight loss (WL) among older adults living with obesity considerably improves prognosis of health-related outcomes; however, concomitant declines in bone mineral density (BMD) limit overall benefit by increasing fracture risk. Declines in mechanical loading contribute to WL-associated BMD loss, with pilot data signaling the addition of external weight replacement (via weighted vest use) during intentional WL mitigates bone loss at weight bearing sites to a similar degree as resistance exercise training (RT). Definitive data in support of weighted vest use as a potential strategy to mitigate WL-associated bone loss in this population are needed.

METHODS

In the Incorporating Nutrition, Vests, Education, and Strength Training (INVEST) in Bone Health trial (NCT04076618), 192 older adults (60-85 years) who are overweight (BMI ≥ 27 kg/m²) with at least one obesity-related risk factor or obese (BMI = 30-40 kg/m²) will be randomly assigned to participate in one of three 12-month intervention groups: WL alone, WL + weighted vest use (WL + VEST), or WL + RT. The primary aim is to determine the effects of WL + VEST compared to WL alone and WL + RT on indicators of bone health and subsequent fracture risk.

DISCUSSION

Determining effective, translatable strategies that minimize bone loss during intentional WL among older adults holds public health potential. The INVEST in Bone Health trial offers an innovative approach for increasing mechanical stress during intentional WL in the absence of RT. If successful, findings from this study will provide evidence in support of a scalable solution to minimize bone loss during intentional WL among older adults with obesity.

Impact of Protein Intake during Weight Loss on Preservation of Fat-Free Mass, Resting Energy Expenditure, and Physical Function in Overweight Postmenopausal Women: A Randomized Controlled Trial

INTRODUCTION

Weight loss in old age increases the risk of sarcopenia caused by the age-related reduction of fat-free mass (FFM). Due to the strong correlation between FFM and resting energy expenditure (REE), the maintenance of this must also be considered. Besides, the physical function (PF) must be maintained.

OBJECTIVE

The impact of protein intake on changes in FFM, REE, and PF during weight loss in overweight postmenopausal women was investigated.

METHODS

Fifty-four postmenopausal women (BMI 30.9 ± 3.4; age 59 ± 7 years) were randomized into 2 groups receiving energy-restricted diets with either 0.8 g (normal protein; NP) or 1.5 g protein/kg body weight (high protein; HP) for 12 weeks, followed by a 6-month follow-up phase with an ad libitum food intake. FFM, REE, and PF (strength, endurance, and balance) were measured at baseline, after weight loss, and after follow-up.

RESULTS

Forty-six women completed the weight loss intervention and 29 were followed up. The weight loss was -4.6 ± 3.6 kg (HP) and -5.2 ± 3.4 kg (NP; both p < 0.001) and the weight regain during follow-up was 1.3 ± 2.8 kg (HP; p = 0.03) and 0.4 ± 2.5 kg (NP; p = 0.39), with no differences between groups. Similar decreases in FFM (-0.9 ± 1.1 [HP] vs. -1.0 ± 1.3 kg [NP]) and REE (-862 ± 569 [HP] vs. -1,000 ± 561 kJ [NP]; both p < 0.001) were observed in both groups. During follow-up, no changes in FFM were detected in either group, whereas in the NP group the REE increased again (+138 ± 296; p = 0.02). The main determinants of FFM loss were the energy deficit and the speed of weight loss. In the NP group, the Short Physical Performance Battery score improved with weight loss (+0.6 ± 0.8; p < 0.001) and handgrip strength decreased (-1.7 ± 3.4 kg; p < 0.001), whereas no changes were observed in the HP group.

CONCLUSIONS

An HP weight-loss diet without exercise had no impact on preservation of FFM and REE but may help to maintain muscle strength in postmenopausal women.

Is soy protein effective in reducing cholesterol and improving bone health?

Hyperlipidemia associated with cardiovascular health, and bone loss with regard to osteoporosis contribute to increased morbidity and mortality and are influenced by diet. Soy protein has been shown to reduce cholesterol levels, and its isoflavones may improve bone health. The objective of this study was to determine the effects of soy protein on lipid profiles and biomarkers of bone metabolism and inflammation. Ninety men and women (aged 27-87) were randomly assigned to consume 40 g of soy or casein protein daily for three months. Both soy and casein consumption significantly reduced bone alkaline phosphatase (P = 0.011) and body fat % (P < 0.001), tended to decrease tartrate-resistant acid phosphatase (P = 0.066), and significantly increased serum insulin-like growth factor-I (IGF-1) (P < 0.001), yet soy increased IGF-1 to a greater extent (P = 0.01) than casein. Neither treatment affected total cholesterol, HDL cholesterol, LDL cholesterol, or C-reactive protein. These results demonstrate that daily supplementation of soy and casein protein may have positive effects on indices of bone metabolism and body composition, with soy protein being more effective at increasing IGF-1, an anabolic factor, which may be due to soy isoflavones' role in upregulating Runx2 gene expression, while having little effect on lipid profiles and markers of inflammation.

Dietary weight-loss interventions for the management of obesity in older adults

The obesity epidemic has reached old age in most industrialized countries, but trials elucidating the benefits and risks of weight reduction in older adults above 70 years of age with obesity remain scarce. While some findings demonstrate a reduced risk of mortality and other negative health outcomes in older individuals with overweight and mild obesity (i.e. body mass index (BMI) < 35 kg/m²), other recent research indicates that voluntary weight loss can positively affect diverse health outcomes in older individuals with overweight and obesity (BMI > 27 kg/m²), especially when combined with exercise. However, in this age group weight reduction is usually associated with a reduction of muscle mass and bone mineral density. Since uncertainty persists as to which level overweight or obesity might be tolerable (or even beneficial) for older persons, current recommendations are to consider weight reducing diets only for older persons that are obese (BMI ≥ 30 kg/m²) and have weight-related health problems. Precise treatment modalities (e.g. appropriate level of caloric restriction and indicated dietary composition, such as specific dietary patterns or optimal protein content) as well as the most effective and safest way of adding exercise are still under research. Moreover, the long-term effects of weight-reducing interventions in older individuals remain to be clarified, and dietary concepts that work for older adults who are unable or unwilling to exercise are required. In conclusion, further research is needed to elucidate which interventions are effective in reducing obesity-related health risks in older adults without causing relevant harm in this vulnerable population.

Effects of a lifestyle intervention on body composition in prostate cancer patients on androgen deprivation therapy

Background

Exercise and dietary (EX+D) interventions could represent an optimal treatment for attenuating or reversing adverse effects of androgen deprivation therapy (ADT) in prostate cancer (PCa) patients. The Individualized Diet and Exercise Adherence-Pilot (IDEA-P) trial compared the effects of an EX+D intervention relative to standard-of-care (SC) treatment among PCa patients undergoing ADT. The present study evaluated the effects of the EX+D intervention on body composition (BC) obtained via dual-energy X-ray absorptiometry (DXA) in a subsample of IDEA-P patients. A secondary objective was to explore the association of adiposity and lean mass with mobility performance and strength.

Methods

Complete DXA data were acquired from a subsample of 22 PCa patients (EX+D: n = 13; SC: n = 9) at baseline and 3 month follow-up. Intention-to-treat analysis included data from 30 participants (M age = 66.28; SD = 7.79) with baseline DXA assessments.

Results

Intention-to-treat analysis revealed EX+D resulted in significant improvements in fat mass (P = 0.022), per cent fat mass (P = 0.028), trunk fat mass (P = 0.017), fat mass/lean mass (P = 0.040), and per cent lean mass (P = 0.026) vs. SC. EX+D also resulted in more favourable changes in appendicular lean mass/body mass (d = 0.59). Select BC outcomes were also significantly correlated with mobility performance and strength (P < 0.05) at 3 month follow-up.

Conclusions

Findings suggest the EX+D intervention resulted in superior preservation of lean tissue and improvement in adiposity relative to SC treatment. Results underscore the utility of implementing EX+D interventions for preserving muscle mass and reducing adiposity in PCa patients undergoing ADT.

Soy Products Ameliorate Obesity-Related Anthropometric Indicators in Overweight or Obese Asian and Non-Menopausal Women: A Meta-Analysis of Randomized Controlled Trials

Background: The effect of soy products on the weight of overweight or obese people is controversial, so we aimed to conduct a systematic review and a meta-analysis of published randomized controlled trials to analyze whether supplementation with soy products can help them to lose weight. Methods: The relevant data before January 2019 in PubMed, Embase and Cochrane Library were searched. A random-effect model was adopted to calculate the weighted average difference of net changes of body weight, body mass index (BMI), body fat percentage, fat mass, waist circumference, etc. Results: A total of 22 trials (870 overweight or obese participants) were reflected in the present meta-analysis. Analysis showed that soy products significantly reduced body weight, BMI, body fat percent and waist circumference in overweight or obese Asian populations (−0.37 kg, P = 0.010; −0.27 kg/m², P = 0.042; −0.36%, P = 0.032; −0.35 cm, P = 0.049) and more significant effects were observed in non-menopausal women reduced body weight (−0.59 kg, P = 0.041), BMI (−0.59, P = 0.041) and waist circumference (−0.59 cm, P = 0.041) in overweight or obese populations. Conclusion: This meta-analysis showed that soy products have weight loss effects, mainly due to soy protein, isoflavone and soy fiber.

The effect of whey protein on the components of metabolic syndrome in overweight and obese individuals; a systematic review and meta-analysis

BACKGROUND

The risk of developing chronic diseases such as diabetes, cardiovascular disease, dyslipidemia, and stroke is increased following an outbreak of metabolic syndrome. Whey protein can play a major role in preventing metabolic syndrome.

OBJECTIVE

This study was conducted to systematically evaluate the effect of whey protein on the components of metabolic syndrome in overweight and obesity patients.

METHODS

This systematic review and meta-analysis was conducted on RCTs (PROSPERO registration number: CDR42019114794). Published articles of controlled trials between 1 January 2000 to 30 May 2019 indexed in PubMed, Scopus, Web of Science and Cochrane Library were reviewed. Keywords were Whey Protein, Metabolic Syndrome, HDL Lipoprotein, Blood Pressure, Triglyceride, Fasting Blood Glucose, Waist Circumference, Overweight and Obesity or a combination of them in the title/abstracts. The mean difference was extracted for each study. All analyses performed using STATA version 11.

RESULTS

There were 2344 individuals reviewed in this systematic review of 37 published articles.

CONCLUSION

According to the results, whey supplementation significantly reduced the SBP, DBP, HDL, waist circumference, TG and FBS in intervention groups in comparing to control groups.

Feasibility of Weighted Vest Use during a Dietary Weight Loss Intervention and Effects on Body Composition and Physical Function in Older Adults

BACKGROUND

While intentional weight loss in older adults with obesity yields clinically important health benefits there is a need to minimize the negative effects of weight loss on concomitant loss of muscle mass and strength. Data show wearing weighted vests during exercise improves lean mass and lower extremity strength, however the efficacy of wearing a weighted vest during a period of weight loss to mitigate muscle and strength loss is not known.

OBJECTIVES

This study examined the feasibility of daily weighted vest use during a dietary weight loss intervention, and examined effects of vest use on body composition and physical function in well-functioning older adults with obesity.

DESIGN

Randomized, controlled pilot study.

SETTING

Wake Forest Baptist Medical Center in Winston-Salem, NC.

PARTICIPANTS

37 older (age=65-79 yrs), obese (BMI=30-40 kg/ m2) sedentary men and women.

INTERVENTIONS

22-week behavioral diet intervention (targeting 10% weight loss, 1100-1300 kcals/day) with (Diet+Vest; n=20) or without (Diet; n=17) weighted vest use (goal of 10 hours/ day with weight added weekly according to individual loss of body mass).

MEASUREMENTS

Body composition by dual-energy x-ray absorptiometry and measures of physical function, mobility, and muscle strength/power.

RESULTS

Average weighted vest use was 6.7±2.2 hours/day and the vest-wear goal of 10 hrs/day was achieved for 67±22% of total intervention days. Five participants reported adverse events from wearing the vest (all back pain or soreness). Both groups lost a similar amount of weight (Diet= -11.2±4.4 kg; Diet+Vest = -11.0±6.3 kg; p<0.001), with no differences between groups (p=0.25). Fat mass, lean mass, and % body fat decreased significantly (p<0.0001), with no differences between groups. Compared to Diet+Vest, the Diet intervention resulted in greater decreases in leg power (p<0.02), with no other between group differences in physical function.

CONCLUSION

This pilot study showed that vest use during dietary weight loss is feasible and safe in well-functioning older adults with obesity. Larger studies are needed to definitively determine whether external replacement of lost weight during caloric restriction may preserve lower extremity muscle strength and power.

Effects of isolated soy protein and strength exercise training on exercise performance and biochemical profile in postpartum mice

OBJECTIVE

Postpartum women are at an increased risk for obesity and metabolic diseases because of excessive weight gain during pregnancy and weight retention after delivery. Maintenance of good nutrition and regular physical activity is used as a therapeutic approach for promotion of health and well-being in postpartum women. The aim of this study is to assess the independent and additive effects of isolated soy protein (ISP) and strength exercise training (ET) on weight management, exercise performance and health maintenance in postpartum mice.

DESIGN AND METHODS

Thirty-two postpartum mice (ICR, 14-weeks old) were divided into four groups (n = 8 per group): Group 1 mice were the sedentary control with vehicle (SC), Group 2 mice were the sedentary control with ISP supplementation (8.95 g·kg^-1, SC + ISP), Group 3 mice received vehicle with exercise training (ET) and Group 4 mice received isolated soy protein with exercise training (ISP + ET). Animals in the ET and ISP + ET groups underwent strength exercise training for 6 weeks, 5 days a week. Exercise performance was evaluated by forelimb grip strength and exhaustive swimming time, as well as by changes in body composition and biochemical parameters at the end of the experiment.

RESULTS

Combined intervention of ISP and ET increased lean muscle mass and prevented body weight and fat elevation. The grip strength and exhaustive swimming time of the ISP + ET group were significantly higher than the other groups. The ISP + ET group showed significantly decreased serum levels of lactate, ammonia and creatinine phosphate kinase (CPK), and increased glucose level after the 15-min swimming test. The serum levels of aspartate transaminase (AST), triglyceride (TG) and creatinine after sacrifice were significantly decreased in the ET + ISP group. ISP combined with ET promoted fat oxidation in brown adipose tissue (BAT) as evidenced from the increased utilization of plasma and BAT tissue triglyceride.

CONCLUSIONS

We suggest that long-term supplementation with ISP can have a wide spectrum of bioactivities on health promotion, performance improvement and fitness. ISP with ET conferred better energy utilization, improved biochemical profiles and may be an effective ergogenic aid in strength training.

Treatment of obesity in older persons-A systematic review

The study aims to systematically review the available evidence regarding weight loss interventions (lifestyle, surgical, and pharmacological) for obesity in adults aged over 60 years. A search of prospective, randomized studies took place in January 2018, on Medline (Web of Science) and PubMed databases. Search terms included the following: elderly, obese, hypocaloric, pharmacotherapy, and bariatric surgery. Abstracts were screened for eligibility. A total of 256 publications regarding lifestyle interventions were identified; of these, 69 studies were eligible. As no eligible studies were identified for pharmacotherapy or bariatric surgery, the search was broadened to include non- randomized studies. Four pharmacotherapy and 66 surgery studies were included. Lifestyle intervention had similar weight loss efficacy in older compared with younger people, with positive effects on a number of relevant outcomes, including physical function and cardiovascular parameters. There was little data regarding obesity pharmacotherapy in older persons. The available data for bariatric surgery indicate comparable weight loss and resolution of type 2 diabetes, with similar or slightly higher complication rates in older compared with younger people. Older age alone should not be considered a contraindication to intensive lifestyle or surgical intervention for obesity. There are insufficient data to guide clinical decisions regarding obesity pharmacotherapy in older people.

Effects of a Hypocaloric, Nutritionally Complete, Higher Protein Meal Plan on Regional Body Fat and Cardiometabolic Biomarkers in Older Adults with Obesity

BACKGROUND

Whether improvements in cardiometabolic health following weight loss (WL) are associated with changes in regional body fat distribution (gluteal vs. -android) is not well documented.

METHODS

Older (age: 70 ± 4 years; mean ± SD) adults with obesity were randomized to a 6-month WL program (WL; n = 47), accomplished using a hypocaloric, nutritionally complete, higher protein -(targeting ≥1.0 g/kg/day) meal plan, or a weight stability (WS; n = 49) program. Android, gynoid, visceral, and subcutaneous abdominal fat masses (via dual energy X-ray absorptiometry ) and fasting glucose and lipid profiles were assessed at baseline and 6 months.

RESULTS

The WL group lost more body weight (WL: -8.6% vs. WS: -1.7%, p < 0.01), resulting in a reduction in fat mass at each region only following WL (all p < 0.05). The decline in the ratio of android/gynoid fat mass also was significant only following WL, resulting in greater declines than WS (mean [95% CI]; WL: -0.026 [-0.040 to -0.011] vs. WS: 0.003 [-0.012 to 0.019] g, p < 0.01). The change in the ratio of visceral/subcutaneous abdominal fat mass was not significant in either group and did not differ between groups (WL: 0.65 [-0.38 to 1.68] vs. WS: 0.05 [-1.00 to 1.10] g, p = 0.42). In general, the improvements in glucose and lipid profiles were associated with declines in fat mass at the gynoid and android regions (r's = 0.20-0.42, all p < 0.05), particularly the visceral depot but not the ratios.

CONCLUSION

WL achieved via a hypocaloric, nutritionally complete, higher protein meal plan is effective in reducing body fat in the android, gynoid, and visceral depots, which relate to cardiometabolic improvements.

Randomized controlled trial assessing two commercial weight loss programs in adults with overweight or obesity

OBJECTIVE

Lifestyle interventions remain the cornerstone for obesity treatment. Commercial programs offer one weight loss approach, yet the efficacy of few such programs have been rigorously investigated. The purpose of this study was to evaluate the efficacy of two commercial weight-loss programs, both utilizing pre-portioned meal replacements (MRs) and different levels of behavioural support, compared to a self-directed control diet in adults with overweight and obesity.

METHODS

In this 16-week study, participants were randomized to the low-calorie OPTAVIA® 5&1 Plan® with telephone coaching (OPT), the reduced-calorie Medifast® 4&2&1 self-guided plan (MED), or a self-directed, reduced-calorie control diet. Differences in weight, body composition (DXA) and body circumferences, all measured monthly, were assessed by analysis of covariance with sex and baseline measures as covariates.

RESULTS

Of 198 participants randomized (80.8% female, BMI 34.2 kg/m2, 45.7 years), 92.3% completed the study. The OPT and MED groups had significantly greater reductions in body weight (-5.7% and - 5.0%, respectively, p < 0.0001), fat and abdominal fat mass (p < 0.0001) and waist and hip circumferences (p ≤ 0.003) than control at 16 weeks. Weight change was correlated with MR usage and completion of coaching support calls.

CONCLUSIONS

Both structured commercial programs were more efficacious than a self-directed, reduced-calorie diet for weight loss and other anthropometric measures. Evidence-based commercial programs can be an important tool to help adults with overweight and obesity lose clinically relevant amounts of weight.

Compensation in response to energy deficits induced by exercise or diet

Obesity is an extremely resilient condition. Weight loss is most challenging, and weight recidivism is rampant. There is accumulating evidence highlighting that energy deficits meant to produce increased mobilization of energy stores trigger a number of somewhat persistent adaptations that together increase the drive to eat and decrease energy output. These adaptations ostensibly enable a context where the likelihood of energy compensation is heightened. In fact, energy compensation is present for both diet and exercise induced energy deficits although at different magnitudes. For the most part, the energy compensation in response to exercise induced energy deficits seems to be larger. Interestingly, energy compensation appears to be greater for longer interventions, an effect independent of whether the energy deficit is induced through diet or exercise. The latter suggests that the increased drive to eat and the reduced energy expenditure that accompany weight loss might be successfully fought off initially. However, with time there seems to be increasing erosion of the behaviours that initially opposed adaptations to weight loss and increased energy compensation progressively sets in. Under such conditions, it would seem prudent to propose weight loss targets that align with a level of behaviour modifications that can be sustained indefinitely.

Central Obesity and Visceral Adipose Tissue Are Not Associated With Incident Atherosclerotic Cardiovascular Disease Events in Older Men

Background Visceral adipose tissue ( VAT ) and other measures of central obesity predict incident atherosclerotic cardiovascular disease ( ASCVD ) events in middle-aged individuals, but these associations are less certain in older individuals age 70 years and older. Our objective was to estimate the associations of VAT and the android-gynoid fat mass ratio, another measure of central obesity, with incident ASCVD events among a large cohort of older men. Methods and Results Two thousand eight hundred ninety-nine men (mean [ SD ] age 76.3 [5.5] years) enrolled in the Outcomes of Sleep Disorders in Older Men study had rigorous adjudication of incident ASCVD events (myocardial infarction, coronary heart disease death, or fatal or nonfatal stroke). We used proportional hazards models to estimate the hazard ratios for incident ASCVD per SD increase of VAT or android-gynoid fat mass ratio (measured at baseline with dual-energy absorptiometry), adjusted for age, race, education, systolic blood pressure, smoking status, oxidized low-density lipoprotein level, treatment for hypertension, statin use, aspirin use, presence of diabetes mellitus, and study enrollment site. Over a mean ( SD ) follow-up period of 7.9 (3.4) years, 424 men (14.6%) had an incident ASCVD event. Neither VAT nor android-gynoid fat mass ratio were associated with incident ASCVD events, either unadjusted or after multivariable-adjustment (hazard ratios [95% confidence interval ] per SD increase 1.02 [0.92-1.13] and 1.05 [0.95-1.17], respectively). Conclusions Central adipose tissue, as measured by VAT or android-gynoid fat mass ratio, was not associated with incident ASCVD events in this study of older men.

Effects of consuming a high-protein diet with or without soy protein during weight loss and maintenance: a non-inferiority, randomized clinical efficacy trial

OBJECTIVE

This 12-month randomized, non-inferiority clinical trial sought to determine the impact of consuming soy protein as part of an energy-restricted, high-protein diet on weight loss, body composition and cardiometabolic health.

METHODS

Seventy-one adults (58 female) with overweight or obesity (body mass index: 32.9 ± 3.6 kg m-2) were randomly assigned to consume three servings of soy (S) or non-soy (NS) protein foods per day for 12 months. All participants completed a group-based behavioural weight loss program lasting 4 months (M4), and follow-up assessments were completed at month 12 (M12).

RESULTS

Body weight was reduced in both groups at M4 (S: -7.0% ± 5.2%, NS: -7.1% ± 5.7%) and M12 (S: 3.6% ± 5.1%, NS: -4.8% ± 7.3%). Body weight reductions (mean difference [90% confidence interval]) were not different between S and NS at either time point (M4: -0.16% [-1.4, 3.6], P = 0.90; M12: 1.1% [-1.4, 3.6], P = 0.44). Differences in body fat mass loss were not different between S and NS at M4 (0.29 ± 0.84 kg, P = 0.73) or M12 (0.78 ± 1.5 kg, P = 0.59). Weight loss-induced improvements in cholesterol, triglycerides and blood pressure did not differ between S and NS.

CONCLUSION

These results indicate that soy-based protein foods can be effectively incorporated into an energy-restricted, high-protein diet for improving body weight, body composition and cardiometabolic health.

Associations of recent weight loss with health care costs and utilization among older women

The association of weight loss with health care costs among older women is uncertain. Our study aim was to examine the association of objectively measured weight change with subsequent total health care (THC) costs and other health care utilization among older women. Our study population included 2,083 women (mean age 80.2 years) enrolled in the Study of Osteoporotic Fractures and U.S. Medicare Fee for Service. Weight loss and gain were defined, respectively, as ≥5% decrease and ≥5% increase in body weight, and weight maintenance as <5% change in body weight over a period of 4.5 years. THC costs, outpatient costs, hospitalizations, and skilled nursing facility [SNF] utilization were estimated from Medicare claims for 1 year after the period during which weight change was measured. The associations of weight change with THC and outpatient costs were estimated using generalized linear models with gamma variance and log link functions, and with hospitalizations and SNF utilization using logistic models. Adjusted for age and current body mass index (BMI), weight loss compared with weight maintenance was associated with a 35% increase in THC costs ($2148 [95% CI, 745 to 3552], 2014 U.S. dollars), a 15% increase in outpatient costs ($329 [95% C.I. −1 to 660]), and odds ratios of 1.42 (95% CI, 1.14 to 1.76) for ≥1 hospital stay and 1.45 (95% CI, 1.03 to 2.03) for ≥1 SNF stay. These associations did not vary by BMI category. After additional adjustment for multi-morbidity and functional status, associations of weight loss with all four outcomes were no longer significant. In conclusion, ≥5% weight loss among older women is not associated with increased THC and outpatient costs, hospitalization, and SNF utilization, irrespective of BMI category after accounting for multi-morbidity and impaired functional status that accompany weight loss.

A randomised controlled intervention study investigating the efficacy of carotenoid-rich fruits and vegetables and extra-virgin olive oil on attenuating sarcopenic symptomology in overweight and obese older adults during energy intake restriction: protocol paper

Background

Weight loss interventions have not been advocated for overweight/obese older adults due to potential loss of skeletal muscle and strength impacting on physical function with potential loss of independence. Carotenoids and polyphenols are inversely associated with sarcopenic symptomology. This paper reports the protocol of a study evaluating the efficacy of a high-protein, energy restricted diet rich in carotenoids and polyphenols on body composition, muscle strength, physical performance and quality of life in overweight and obese older adults.

Methods

This randomised controlled clinical trial will recruit community-dwelling, healthy overweight and obese older adults (≥60 years) for a 12-week weight loss intervention. Seventy-three participants will be recruited and randomized to an energy restricted (~30% restriction), isocaloric diet (30% protein; 30% carbohydrate; 40% fat) enriched with either: a) 375 g/d of high carotenoid vegetables, 300 g/d high carotenoid fruit, and 40-60 ml extra-virgin olive oil (EVOO); or b) 375 g/d of lower carotenoid vegetables, 300 g/d lower carotenoid fruit, and 40-60 ml Polyunsaturated fatty acid (PUFA) based oil. All participants will receive individual dietary counselling each fortnight for the duration of the study and will be asked to maintain their habitual level of physical activity throughout the study. The primary outcome will be appendicular skeletal muscle (ASM) assessed by dual energy X-ray absorptiometry (DXA). Secondary outcomes will include body weight, fat-free mass (FFM), fat mass (FM), muscle strength (Isometric hand-grip strength), physical performance (Short Physical Performance Battery), physical activity (International Physical Activity Questionnaire) and health related quality of life (SF-36). Outcomes will be measured at baseline and at week 12.

Discussion

The results of this study will provide a novel insight relating to the potential influence of high carotenoid and polyphenol intakes on attenuation of ASM during dietary energy-restricted weight loss in overweight and obese older adults.

Trial registration

The trial was registered on the Australia New Zealand Clinical Trials Register (ACTRN12616001400459); Trial registration date: 10th October, 2016.

Chronic dietary supplementation with soy protein improves muscle function in rats

Athletes as well as elderly or hospitalized patients use dietary protein supplementation to maintain or grow skeletal muscle. It is recognized that high quality protein is needed for muscle accretion, and can be obtained from both animal and plant-based sources. There is interest to understand whether these sources differ in their ability to maintain or stimulate muscle growth and function. In this study, baseline muscle performance was assessed in 50 adult Sprague-Dawley rats after which they were assigned to one of five semi-purified “Western” diets (n = 10/group) differing only in protein source, namely 19 kcal% protein from either milk protein isolate (MPI), whey protein isolate (WPI), soy protein isolate (SPI), soy protein concentrate (SPC) or enzyme-treated soy protein (SPE). The diets were fed for 8 weeks at which point muscle performance testing was repeated and tissues were collected for analysis. There was no significant difference in food consumption or body weights over time between the diet groups nor were there differences in terminal organ and muscle weights or in serum lipids, creatinine or myostatin. Compared with MPI-fed rats, rats fed WPI and SPC displayed a greater maximum rate of contraction using the in vivo measure of muscle performance (p<0.05) with increases ranging from 13.3–27.5% and 22.8–29.5%, respectively at 60, 80, 100 and 150 Hz. When the maximum force was normalized to body weight, SPC-fed rats displayed increased force compared to MPI (p<0.05), whereas when normalized to gastrocnemius weight, WPI-fed rats displayed increased force compared to MPI (p<0.05). There was no difference between groups using in situ muscle performance. In conclusion, soy protein consumption, in high-fat diet, resulted in muscle function comparable to whey protein and improved compared to milk protein. The benefits seen with soy or whey protein were independent of changes in muscle mass or fiber cross-sectional area.

Cardiac troponin T and fast skeletal muscle denervation in ageing

BACKGROUND

Ageing skeletal muscle undergoes chronic denervation, and the neuromuscular junction (NMJ), the key structure that connects motor neuron nerves with muscle cells, shows increased defects with ageing. Previous studies in various species have shown that with ageing, type II fast-twitch skeletal muscle fibres show more atrophy and NMJ deterioration than type I slow-twitch fibres. However, how this process is regulated is largely unknown. A better understanding of the mechanisms regulating skeletal muscle fibre-type specific denervation at the NMJ could be critical to identifying novel treatments for sarcopenia. Cardiac troponin T (cTnT), the heart muscle-specific isoform of TnT, is a key component of the mechanisms of muscle contraction. It is expressed in skeletal muscle during early development, after acute sciatic nerve denervation, in various neuromuscular diseases and possibly in ageing muscle. Yet the subcellular localization and function of cTnT in skeletal muscle is largely unknown.

METHODS

Studies were carried out on isolated skeletal muscles from mice, vervet monkeys, and humans. Immunoblotting, immunoprecipitation, and mass spectrometry were used to analyse protein expression, real-time reverse transcription polymerase chain reaction was used to measure gene expression, immunofluorescence staining was performed for subcellular distribution assay of proteins, and electromyographic recording was used to analyse neurotransmission at the NMJ.

RESULTS

Levels of cTnT expression in skeletal muscle increased with ageing in mice. In addition, cTnT was highly enriched at the NMJ region-but mainly in the fast-twitch, not the slow-twitch, muscle of old mice. We further found that the protein kinase A (PKA) RIα subunit was largely removed from, while PKA RIIα and RIIβ are enriched at, the NMJ-again, preferentially in fast-twitch but not slow-twitch muscle in old mice. Knocking down cTnT in fast skeletal muscle of old mice: (i) increased PKA RIα and reduced PKA RIIα at the NMJ; (ii) decreased the levels of gene expression of muscle denervation markers; and (iii) enhanced neurotransmission efficiency at NMJ.

CONCLUSIONS

Cardiac troponin T at the NMJ region contributes to NMJ functional decline with ageing mainly in the fast-twitch skeletal muscle through interfering with PKA signalling. This knowledge could inform useful targets for prevention and therapy of age-related decline in muscle function.

Effect of Soy and Soy Isoflavones on Obesity-Related Anthropometric Measures: A Systematic Review and Meta-analysis of Randomized Controlled Clinical Trials

Soy may be a suitable food for anti-obesity efforts because of its high protein and isoflavone content. We conducted this meta-analysis to evaluate potential effects of soy and soy isoflavones on weight, waist circumference, and fat mass. PubMed, MEDLINE, Scopus, EMBASE, and Cochrane databases were searched. Twenty-four trials with soy and 17 trials with isoflavones passed the eligibility stage. According to the results, soy showed no overall statistically significant effect on weight, waist circumference, or fat mass, but a significant increasing effect on weight was observed in some circumstances: for instance, in obese subjects [mean difference (MD): 0.80 kg; 95% CI: 0.15, 1.45 kg; P = 0.02], with ingestions of ≥40 g soy protein/d (MD: 0.94 kg; 95% CI: 0.11, 1.77 kg; P = 0.03), with short-term applications (1-3 mo) (MD: 0.45 kg; 95% CI: 0.05, 0.86 kg; P = 0.03), and when soy was compared with meat (MD: 0.36 kg; 95% CI: 0.09, 0.64 kg; P = 0.03) and whey protein (MD: 1.53 kg; 95% CI: 0.10, 2.96 kg; P = 0.04). In contrast to the effects of soy on weight, soy significantly decreased waist circumference in older ages (MD: -0.36 cm; 95% CI: -0.71, -0.01 cm; P = 0.04), in women (MD: -0.32 cm; 95% CI: -0.57, -0.08 cm; P = 0.01), and at doses of <40 g soy protein/d (MD: -0.31 cm; 95% CI: -0.57, -0.05 cm; P = 0.02). Isoflavone studies, conducted only in women, showed that isoflavones may reduce body mass index (BMI; in kg/m2) (MD: -0.26; 95% CI: -0.55, 0.04; P = 0.085), especially in dosages <100 mg/d (MD: -0.48; 95% CI: -0.90, -0.06; P = 0.02) and in intervention periods of 2-6 mo (MD: -0.28; 95% CI: -0.56, 0.00; P = 0.053), but no effect was observed in higher doses or longer intervention periods. Also, a trend for reduced BMI after consumption of isoflavones was observed in Caucasians (MD: -0.35; 95% CI: -0.74, 0.04; P = 0.08). Overall, results showed that, although soy is the major source of isoflavones, soy and isoflavones may have different impacts on weight status.

Beyond the Cholesterol-Lowering Effect of Soy Protein: A Review of the Effects of Dietary Soy and Its Constituents on Risk Factors for Cardiovascular Disease

The hypocholesterolemic effect of soy is well-documented and this has led to the regulatory approval of a health claim relating soy protein to a reduced risk of cardiovascular disease (CVD). However, soybeans contain additional components, such as isoflavones, lecithins, saponins and fiber that may improve cardiovascular health through independent mechanisms. This review summarizes the evidence on the cardiovascular benefits of non-protein soy components in relation to known CVD risk factors such as hypertension, hyperglycemia, inflammation, and obesity beyond cholesterol lowering. Overall, the available evidence suggests non-protein soy constituents improve markers of cardiovascular health; however, additional carefully designed studies are required to independently elucidate these effects. Further, work is also needed to clarify the role of isoflavone-metabolizing phenotype and gut microbiota composition on biological effect.

Comparison of Intermittent Fasting Versus Caloric Restriction in Obese Subjects: A Two Year Follow-Up

OBJECTIVE

Caloric restriction (CR) is proven to be effective in increasing life span and it is well known that, nutritional habits, sleeping pattern and meal frequency have profound effects on human health. In Ramadan some Muslims fast during the day-light hours for a month, providing us a unique model of intermittent fasting (IF) in humans. In the present study, we have investigated the effects of IF versus CR on the same non-diabetic obese subjects who were followed for two years according to the growth hormone (GH)/Insulin like growth factor (IGF)-1 axis and insulin resistance.

DESIGN

Single-arm Interventional Human Study.

PARTICIPANTS

23 female subjects (Body Mass Index (BMI) 29-39, aged between 28-42years).

SETTING

Follow-up is designed as 12 months of CR, after which there was a month of IF and 11 months of CR again, to be totally 24 months. Subjects' daily diets were aligned as low calorie diet during CR and during the IF period, the same subjects fasted for 15 hours in a day for a month and there was no daily calorie restriction. Nutritional pattern was changed as 1 meal in the evening and a late supper before sleeping and no eating and drinking during the day light hours in the IF model. Subjects made brisk walking twice a day during the whole follow-up including both CR and IF periods. BMI, Blood glucose, insulin, TSH, GH, HbA1c, IGF-1, Homa-IR and urinary acetoacetate levels were monitored once in three months and twice in the fasting month.

MEASUREMENTS AND RESULTS

While subjects lost 1250 ± 372g monthly during the CR, in the IF period, weight loss was decreased to 473 ± 146 g. BMI of all subjects decreased gradually and as the BMI decreased, glucose, HbA1c, insulin, Homa-IR and TSH levels were decreased. GH levels were at baseline at the beginning, increased in the first six months and stayed steady during the CR and IF period than began decreasing after the IF period, while IGF-I increased gradually during the CR period and beginning with the 7th day of IF period, it decreased and kept on decreasing till the end of the follow-up. Urinary acetoacetate levels were higher during the IF period suggesting a constant lipid catabolism.

CONCLUSION

Our results suggest that, CR affects metabolic parameters positively which will help especially pre-diabetic and insulin resistant patients without any pharmacological approach. In addition IF without calorie restriction can enhance health and cellular resistance to disease without losing weight and those effects may be attributed to different signalling pathways and circulating ketones during IF. Changes observed during IF are probably due to the changes in eating and sleeping pattern and thus changes in metabolic rhythm.

Effect of diet-induced weight loss on muscle strength in adults with overweight or obesity - a systematic review and meta-analysis of clinical trials

We conducted a systematic review and meta-analysis to identify how diet-induced weight loss in adults with overweight or obesity impacts on muscle strength. Twenty-seven publications, including 33 interventions, most of which were 8-24 weeks in duration, were included. Meta-analysis of seven interventions measuring knee extensor strength by isokinetic dynamometry in 108 participants found a significant decrease following diet-induced weight loss (-9.0 [95% confidence interval: -13.8, -4.1] N/m, P < 0.001), representing a 7.5% decrease from baseline values. Meta-analysis of handgrip strength from 10 interventions in 231 participants showed a non-significant decrease (-1.7 [-3.6, 0.1] kg, P = 0.070), with significant heterogeneity (I(2)  = 83.9%, P < 0.001). This heterogeneity may have been due to diet type, because there was a significant decrease in handgrip strength in seven interventions in 169 participants involving moderate energy restriction (-2.4 [-4.8, -0.0] kg, P = 0.046), representing a 4.6% decrease from baseline values, but not in three interventions in 62 participants involving very-low-energy diet (-0.4 [-2.0, 1.2] kg, P = 0.610). Because of variability in methodology and muscles tested, no other data could be meta-analyzed, and qualitative assessment of the remaining interventions revealed mixed results. Despite varying methodologies, diets and small sample sizes, these findings suggest a potential adverse effect of diet-induced weight loss on muscle strength. While these findings should not act as a deterrent against weight loss, due to the known health benefits of losing excess weight, they call for strategies to combat strength loss - such as weight training and other exercises - during diet-induced weight loss. © 2016 World Obesity.

Effects of Nutritional Supplements on Muscle Mass and Activities of Daily Living in Elderly Rehabilitation Patients with Decreased Muscle Mass: A Randomized Controlled Trial

OBJECTIVE

To investigate the effects of nutritional intervention with resistance training on skeletal muscle mass in elderly patients with disabilities in a convalescent rehabilitation setting.

DESIGN

A randomized controlled trial. (UMIN Clinical Trials Registry ID: UMIN000006238).

SETTING

A rehabilitation hospital.

PARTICIPANTS

39 elderly patients with decreased skeletal muscle mass in an inpatient convalescence rehabilitation unit.

INTERVENTIONS

A combination of resistance training plus nutritional supplementation (R/N group) or resistance training alone (R group). The training and supplementation were conducted essentially from the patient's admission to discharge (2-6 months).

OUTCOME MEASURES

The patients were evaluated at the time of admission and at the end of the intervention for skeletal muscle mass (calf circumference [CC] as a primary outcome, and arm circumference [AC]), hand grip strength (HG), Mini-Nutritional Assessment-Short Form (MNA®-SF) score, serum albumin level (Alb), body mass index (BMI), and activities of daily living (ADL) as represented by the Barthel Index (BI) score.

RESULTS

Significant treatment effects were seen for CC, AC, BI, Alb in the R/N group compared to the R group. A mean treatment effect of 3.2 (95%CI: 2.0-4.4) was seen in CC, 1.4 (95%CI: 0.8-2.1) was seen in AC, 11.2 (95%CI: 0.5-21.8) was seen in BI, 0.3 (95%CI: 0.1-0.5) was seen in Alb.

CONCLUSION

The results of this study suggest that nutritional intervention added to resistance training during convalescent rehabilitation may improve skeletal muscle mass and activities of daily living.

Effectiveness of a Medifast meal replacement program on weight, body composition and cardiometabolic risk factors in overweight and obese adults: a multicenter systematic retrospective chart review study

BACKGROUND

Recent medical guidelines emphasize the importance of actively treating overweight and obesity with diet and lifestyle intervention to achieve ≥ 5% weight loss in a 6-month period. Commercial programs offer one approach provided there is evidence of their efficacy and safety. This study was conducted to evaluate the effectiveness of the Medifast® 4 & 2 & 1 Plan™ on weight loss, body composition and cardiometabolic risk factors in overweight and obese adults.

METHODS

A systematic retrospective chart review of 310 overweight and obese clients following the Medifast 4 & 2 & 1 Plan at one of 21 Medifast Weight Control Centers® was conducted. Data were recorded electronically and key data points were independently verified. The primary endpoint was change from baseline body weight at 12 weeks. Within group paired t-tests were used to examine changes from baseline in a completers population. Differences between gender and age subgroups were examined using bivariate t-tests and mixed model regression analyses.

RESULTS

For the primary endpoint at 12 weeks, body weight among completers (n = 185) was reduced by a mean of 10.9 ± 5.6 kg (-10.1%, p < 0.0001), and at 24 weeks (n = 81) mean weight was reduced by 16.0 ± 7.9 kg (-14.3%). At 12 and 24 weeks, 85% and 96% of those remaining on the plan, respectively, had lost ≥ 5% of their baseline body weight. Lean mass was preserved to within 5% of baseline throughout the 24 weeks, and fat mass represented ≥ 80% of the body weight lost from 12 weeks onward. Men, women, seniors (≥ 65 years), and non-seniors (<65 years) all had significant weight reductions with preservation of lean mass. Significant improvements in blood pressure, pulse and waist-to-hip ratio were observed. Mean weight regain among the subset who entered a formal maintenance phase was <2% during an average follow-up of 34 weeks. The meal plan was well tolerated, and program adherence was >85%.

CONCLUSIONS

The 4 & 2 & 1 Plan used at Medifast Weight Control Centers was effective for weight loss, preservation of lean mass and improvement in cardiometabolic risk factors. The plan was generally well tolerated in a broad population of overweight and obese adults. #NCT02150837.

Excessive Body Weight in Older Adults

The health challenges prompted by obesity in the older adult population are poorly recognized and understudied. A defined treatment of geriatric obesity is difficult to establish, as it must take into account biological heterogeneity, age-related comorbidities, and functional limitations (sarcopenia/dynapenia). This retrospective article highlights the current understanding of the optimal body mass index (BMI) in later life, addressing appropriate recommendations based on BMI category, age, and health history. The findings of randomized control trials of weight loss/maintenance interventions help one to move closer to evidence-based and appropriately individualized recommendations for body weight management in older adults.