1
|
Eglseer D, Traxler M, Embacher S, Reiter L, Schoufour JD, Weijs PJ, Voortman T, Boirie Y, Cruz-Jentoft A, Bauer S. 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. Adv Nutr 2023; 14:516-538. [PMID: 37028708 DOI: 10.1016/j.advnut.2023.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/16/2023] [Accepted: 04/03/2023] [Indexed: 04/09/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Doris Eglseer
- Medical University of Graz, Institute of Nursing Science, Universitätsplatz 4, 8010 Graz, Austria.
| | - Mariella Traxler
- Medical University of Graz, Institute of Nursing Science, Universitätsplatz 4, 8010 Graz, Austria.
| | - Stefan Embacher
- Medical University of Graz, Institute for Medical Informatics, Statistics and Documentation, Auenbruggerplatz 2, 8036 Graz.
| | - Lea Reiter
- Medical University of Graz, Institute of Nursing Science, Universitätsplatz 4, 8010 Graz, Austria
| | - Josje D Schoufour
- Faculty of Sports and Nutrition, Centre of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Dr. Meurerhuis, Dokter Meurerlaan 8, 1067 SM Amsterdam, the Netherlands.
| | - Peter Jm Weijs
- Faculty of Sports and Nutrition, Centre of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Dr. Meurerhuis, Dokter Meurerlaan 8, 1067 SM Amsterdam, the Netherlands; Department of Nutrition and Dietetics, Amsterdam University Medical Centers, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands.
| | - Trudy Voortman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, P.O. Box 176700 AA Wageningen, The Netherlands; Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.
| | - Yves Boirie
- University Clermont Auvergne, Human Nutrition Unit, INRA, CRNH Auvergne, CHU Clermont-Ferrand, Clinical Nutrition Department, 63000, Clermont-Ferrand, France.
| | - Alfonso Cruz-Jentoft
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Spain, Ctra. Colmenar Viejo, 28034 Madrid.
| | - Silvia Bauer
- Medical University of Graz, Institute of Nursing Science, Universitätsplatz 4, 8010 Graz, Austria.
| |
Collapse
|
2
|
Buch A, Marcus Y, Shefer G, Zimmet P, Stern N. Approach to Obesity in the Older Population. J Clin Endocrinol Metab 2021; 106:2788-2805. [PMID: 34406394 DOI: 10.1210/clinem/dgab359] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Indexed: 12/14/2022]
Abstract
Until recently, weight loss in older obese people was feared because of ensuing muscle loss and frailty. Facing overall increasing longevity, high rates of obesity in older individuals (age ≥ 65 years) and a growing recognition of the health and functional cost of the number of obesity years, abetted by evidence that intentional weight loss in older obese people is safe, this approach is gradually, but not unanimously, being replaced by more active principles. Lifestyle interventions that include reduced but sufficient energy intake, age-adequate protein and micronutrient intake, coupled with aerobic and resistance exercise tailored to personal limitations, can induce weight loss with improvement in frailty indices. Sustained weight loss at this age can prevent or ameliorate diabetes. More active steps are controversial. The use of weight loss medications, particularly glucagon-like peptide-1 analogs (liraglutide as the first example), provides an additional treatment tier. Its safety and cardiovascular health benefits have been convincingly shown in older obese patients with type 2 diabetes mellitus. In our opinion, this option should not be denied to obese individuals with prediabetes or other obesity-related comorbidities based on age. Finally, many reports now provide evidence that bariatric surgery can be safely performed in older people as the last treatment tier. Risk-benefit issues should be considered with extreme care and disclosed to candidates. The selection process requires good presurgical functional status, individualized consideration of the sequels of obesity, and reliance on centers that are highly experienced in the surgical procedure as well as short-term and long-term subsequent comprehensive care and support.
Collapse
Affiliation(s)
- Assaf Buch
- The Sagol Center for Epigenetics of Aging and Metabolism, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
- The Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Yonit Marcus
- The Sagol Center for Epigenetics of Aging and Metabolism, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
- The Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Gabi Shefer
- The Sagol Center for Epigenetics of Aging and Metabolism, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
- The Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Paul Zimmet
- The Sagol Center for Epigenetics of Aging and Metabolism, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria 3004, Australia
| | - Naftali Stern
- The Sagol Center for Epigenetics of Aging and Metabolism, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
- The Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| |
Collapse
|
3
|
Quillen EE, Beavers DP, O’Brien Cox A, Furdui CM, Lee J, Miller RM, Wu H, Beavers KM. Use of Metabolomic Profiling to Understand Variability in Adiposity Changes Following an Intentional Weight Loss Intervention in Older Adults. Nutrients 2020; 12:E3188. [PMID: 33086512 PMCID: PMC7603124 DOI: 10.3390/nu12103188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/11/2020] [Accepted: 10/13/2020] [Indexed: 11/18/2022] Open
Abstract
Inter-individual response to dietary interventions remains a major challenge to successful weight loss among older adults. This study applied metabolomics technology to identify small molecule signatures associated with a loss of fat mass and overall weight in a cohort of older adults on a nutritionally complete, high-protein diet. A total of 102 unique metabolites were measured using liquid chromatography-mass spectrometry (LC-MS) for 38 adults aged 65-80 years randomized to dietary intervention and 36 controls. Metabolite values were analyzed in both baseline plasma samples and samples collected following the six-month dietary intervention to consider both metabolites that could predict the response to diet and those that changed in response to diet or weight loss.Eight metabolites changed over the intervention at a nominally significant level: D-pantothenic acid, L-methionine, nicotinate, aniline, melatonin, deoxycarnitine, 6-deoxy-L-galactose, and 10-hydroxydecanoate. Within the intervention group, there was broad variation in the achieved weight-loss and dual-energy x-ray absorptiometry (DXA)-defined changes in total fat and visceral adipose tissue (VAT) mass. Change in the VAT mass was significantly associated with the baseline abundance of α-aminoadipate (p = 0.0007) and an additional mass spectrometry peak that may represent D-fructose, myo-inositol, mannose, α-D-glucose, allose, D-galactose, D-tagatose, or L-sorbose (p = 0.0001). This hypothesis-generating study reflects the potential of metabolomic biomarkers for the development of personalized dietary interventions.
Collapse
Affiliation(s)
- Ellen E. Quillen
- Internal Medicine, Section on Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; (E.E.Q.); (C.M.F.); (J.L.); (H.W.)
| | - Daniel P. Beavers
- Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA;
| | - Anderson O’Brien Cox
- Proteomics and Metabolomics Shared Resource, Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA;
| | - Cristina M. Furdui
- Internal Medicine, Section on Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; (E.E.Q.); (C.M.F.); (J.L.); (H.W.)
- Proteomics and Metabolomics Shared Resource, Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA;
| | - Jingyun Lee
- Internal Medicine, Section on Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; (E.E.Q.); (C.M.F.); (J.L.); (H.W.)
- Proteomics and Metabolomics Shared Resource, Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA;
| | - Ryan M. Miller
- Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA;
| | - Hanzhi Wu
- Internal Medicine, Section on Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; (E.E.Q.); (C.M.F.); (J.L.); (H.W.)
- Proteomics and Metabolomics Shared Resource, Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA;
| | - Kristen M. Beavers
- Health and Exercise Science, Wake Forest University, Winston-Salem, NC 27109, USA
| |
Collapse
|
4
|
Abstract
Dietary proteins have been used for years to treat obesity. Body weight loss is beneficial when it concerns fat mass, but loss of fat free mass - especially muscle might be detrimental. This occurs because protein breakdown predominates over synthesis, thus administering anabolic dietary compounds like proteins might counter fat free mass loss while allowing for fat mass loss.Indeed, varying the quantity of proteins will decrease muscle anabolic response and increase hyperphagia in rodents fed a low protein diet; but it will favor lean mass maintenance and promote satiety, in certain age groups of humans fed a high protein diet. Beyond protein quantity, protein source is an important metabolic regulator: whey protein and plant based diets exercize favorable effects on the risk of developing obesity, body composition, metabolic parameters or fat free mass preservation of obese patients. Specific amino-acids like branched chain amino acids (BCAA), methionine, tryptophan and its metabolites, and glutamate can also positively influence parameters and complications of obesity especially in rodent models, with less studies translating this in humans.Tuning the quality and quantity of proteins or even specific amino-acids can thus be seen as a potential therapeutic intervention on the body composition, metabolic syndrome parameters and appetite regulation of obese patients. Since these effects vary across age groups and much of the data comes from murine models, long-term prospective studies modulating proteins and amino acids in the human diet are needed.
Collapse
Affiliation(s)
- Mathilde Simonson
- UNH, Unité de Nutrition Humaine, CHU Clermont-Ferrand, Service de Nutrition Clinique, CRNH Auvergne, INRA, Université Clermont Auvergne, 63000, Clermont-Ferrand, France
| | - Yves Boirie
- UNH, Unité de Nutrition Humaine, CHU Clermont-Ferrand, Service de Nutrition Clinique, CRNH Auvergne, INRA, Université Clermont Auvergne, 63000, Clermont-Ferrand, France.
| | - Christelle Guillet
- UNH, Unité de Nutrition Humaine, CHU Clermont-Ferrand, Service de Nutrition Clinique, CRNH Auvergne, INRA, Université Clermont Auvergne, 63000, Clermont-Ferrand, France
| |
Collapse
|
5
|
Goisser S, Kiesswetter E, Schoene D, Torbahn G, Bauer JM. Dietary weight-loss interventions for the management of obesity in older adults. Rev Endocr Metab Disord 2020; 21:355-368. [PMID: 32829454 DOI: 10.1007/s11154-020-09577-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
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.
Collapse
Affiliation(s)
- Sabine Goisser
- Centre for Geriatric Medicine, Heidelberg University Hospital, Heidelberg, Germany.
- Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany.
| | - Eva Kiesswetter
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Daniel Schoene
- Institute of Medical Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Department of Geriatric Rehabilitation, Robert-Bosch Hospital, Stuttgart, Germany
| | - Gabriel Torbahn
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Jürgen M Bauer
- Centre for Geriatric Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany
| |
Collapse
|
6
|
Diaz JT, Foegeding EA, Lila MA. Formulation of protein–polyphenol particles for applications in food systems. Food Funct 2020; 11:5091-5104. [DOI: 10.1039/d0fo00186d] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Consumers are demanding healthy nutritious foods rich in protein (both plant and animal) and biologically-active phytochemicals from plants, which can help the body to sustain a stronger immune system and fight against oxidative stress.
Collapse
Affiliation(s)
- Joscelin T. Diaz
- Plants for Human Health Institute
- Food Bioprocessing & Nutrition Sciences
- North Carolina State University
- North Carolina Research Campus
- Kannapolis
| | - E. Allen Foegeding
- Food Bioprocessing & Nutrition Sciences
- North Carolina State University
- Raleigh
- USA
| | - Mary Ann Lila
- Plants for Human Health Institute
- Food Bioprocessing & Nutrition Sciences
- North Carolina State University
- North Carolina Research Campus
- Kannapolis
| |
Collapse
|