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Prado CM, Batsis JA, Donini LM, Gonzalez MC, Siervo M. Sarcopenic obesity in older adults: a clinical overview. Nat Rev Endocrinol 2024; 20:261-277. [PMID: 38321142 DOI: 10.1038/s41574-023-00943-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 02/08/2024]
Abstract
Sarcopenic obesity is characterized by a concurrent decline in muscle mass and function, along with increased adipose tissue. Sarcopenic obesity is a growing concern in older adults owing to significant health consequences, including implications for mortality, comorbidities and risk of developing geriatric syndromes. A 2022 consensus statement established a new definition and diagnostic criteria for sarcopenic obesity. The pathophysiology of this condition involves a complex interplay between muscle, adipose tissue, hormonal changes, inflammation, oxidative stress and lifestyle factors, among others. Sarcopenic obesity is treated with a range of management approaches, such as lifestyle interventions, exercise, nutrition and medical therapies. Emerging therapies that were developed for treating other conditions may be relevant to sarcopenic obesity, including novel pharmacological agents and personalized approaches such as precision medicine. In this Review, we synthesize the current knowledge of the clinical importance of sarcopenic obesity, its assessment and diagnosis, along with current and emerging management strategies.
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Affiliation(s)
- Carla M Prado
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada.
| | - John A Batsis
- Division of Geriatric Medicine, School of Medicine, and Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lorenzo M Donini
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - M Cristina Gonzalez
- Postgraduate Program in Nutrition and Food, Pelotas, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Mario Siervo
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Curtin Dementia Centre of Excellence, enAble Institute, Curtin University, Perth, Western Australia, Australia
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Bradley M, Melchor J, Carr R, Karjoo S. Obesity and malnutrition in children and adults: A clinical review. OBESITY PILLARS (ONLINE) 2023; 8:100087. [PMID: 38125660 PMCID: PMC10728708 DOI: 10.1016/j.obpill.2023.100087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/05/2023] [Accepted: 09/05/2023] [Indexed: 12/23/2023]
Abstract
Background In the U.S., children and adults are consuming more low-nutrient foods with added sugar and excess fats as compared to healthy, high-quality calories and micronutrients. This diet is increasing the prevalence of malnutrition and nutritional deficiencies, despite high calorie intake. This is a review of the common micronutrient deficiencies, the risk factors for malnutrition, dietary plans, and the health consequences in children and adults with obesity in the U.S. Methods This clinical review of literature was performed on the MEDLINE (PubMed) search engine. A total of 1391 articles were identified and after review, a total of 130 were found to be most pertinent. Discussion The most common micronutrient deficiencies found in patients with obesity were vitamin A, thiamine (B1), folate (B9), cobalamin (B12), vitamin D, iron, calcium, and magnesium, especially prior and after bariatric surgery. Diets that produced the most weight reduction also further puts these individuals at risk for worsening malnutrition. Malnutrition and micronutrient deficiencies can worsen health outcomes if not properly managed. Conclusion Adequate screening and awareness of malnutrition can improve the health outcomes in patients with obesity. Physiologic changes in response to increased adiposity and inadequate intake increase this population's risk of adverse health effects. Malnutrition affects the individual and contributes to worse public health outcomes. The recommendations for screening for malnutrition are not exclusive to individuals undergoing bariatric procedures and can improve the health outcomes of any patient with obesity. However, clearly, improved nutritional status can assist with metabolism and prevent adverse nutritional outcomes post-bariatric surgery. Clinicians should advise on proper nutrition and be aware of diets that worsen deficiencies.
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Affiliation(s)
- Morgan Bradley
- Florida State University College of Medicine, 1115 W Call St, Tallahassee, FL, 32304, USA
| | - Julian Melchor
- Florida State University College of Medicine, 1115 W Call St, Tallahassee, FL, 32304, USA
| | - Rachel Carr
- Florida State University College of Medicine, 1115 W Call St, Tallahassee, FL, 32304, USA
| | - Sara Karjoo
- Florida State University College of Medicine, 1115 W Call St, Tallahassee, FL, 32304, USA
- Johns Hopkins All Children's Hospital, 601 5th St. S. Suite 605, St. Petersburg, FL, 33701, USA
- University of South Florida Morsani College of Medicine, 560 Channelside Drive MDD 54, Tampa, FL, 33602, USA
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Koutoukidis DA, Jebb SA, Foster C, Wheatstone P, Horne A, Hill TM, Taylor A, Realpe A, Achana F, Buczacki SJA. CARE: Protocol of a randomised trial evaluating the feasibility of preoperative intentional weight loss to support postoperative recovery in patients with excess weight and colorectal cancer. Colorectal Dis 2023; 25:1910-1920. [PMID: 37525408 DOI: 10.1111/codi.16687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/12/2023] [Accepted: 06/19/2023] [Indexed: 08/02/2023]
Abstract
AIM Excess weight increases the risk of morbidity following colorectal cancer surgery. Weight loss may improve morbidity, but it is uncertain whether patients can follow an intensive weight loss intervention while waiting for surgery and there are concerns about muscle mass loss. The aim of this trial is to assess the feasibility of intentional weight loss in this setting and determine progression to a definitive trial. METHODS CARE is a prospectively registered, multicentre, feasibility, parallel, randomised controlled trial with embedded evaluation and optimisation of the recruitment process. Participants with excess weight awaiting curative colorectal resection for cancer are randomised 1:1 to care as usual or a low-energy nutritionally-replete total diet replacement programme with weekly remote behavioural support by a dietitian. Progression criteria will be based on the recruitment, engagement, adherence, and retention rates. Data will be collected on the 30-day postoperative morbidity, the typical primary outcome of prehabilitation trials. Secondary outcomes will include, among others, length of hospital stay, health-related quality of life, and body composition. Qualitative interviews will be used to understand patients' experiences of and attitudes towards trial participation and intervention engagement and adherence. CONCLUSION CARE will evaluate the feasibility of intensive intentional weight loss as prehabilitation before colorectal cancer surgery. The results will determine the planning of a definitive trial.
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Affiliation(s)
- Dimitrios A Koutoukidis
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Claire Foster
- Centre for Psychosocial Research in Cancer: CentRIC+ in Health Sciences, University of Southampton, Southampton, UK
| | | | - Alison Horne
- Surgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - T Martyn Hill
- Surgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Amy Taylor
- Surgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Alba Realpe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Felix Achana
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon J A Buczacki
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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Pepe RB, Lottenberg AM, Fujiwara CTH, Beyruti M, Cintra DE, Machado RM, Rodrigues A, Jensen NSO, Caldas APS, Fernandes AE, Rossoni C, Mattos F, Motarelli JHF, Bressan J, Saldanha J, Beda LMM, Lavrador MSF, Del Bosco M, Cruz P, Correia PE, Maximino P, Pereira S, Faria SL, Piovacari SMF. Position statement on nutrition therapy for overweight and obesity: nutrition department of the Brazilian association for the study of obesity and metabolic syndrome (ABESO-2022). Diabetol Metab Syndr 2023; 15:124. [PMID: 37296485 DOI: 10.1186/s13098-023-01037-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 03/23/2023] [Indexed: 06/12/2023] Open
Abstract
Obesity is a chronic disease resulting from multifactorial causes mainly related to lifestyle (sedentary lifestyle, inadequate eating habits) and to other conditions such as genetic, hereditary, psychological, cultural, and ethnic factors. The weight loss process is slow and complex, and involves lifestyle changes with an emphasis on nutritional therapy, physical activity practice, psychological interventions, and pharmacological or surgical treatment. Because the management of obesity is a long-term process, it is essential that the nutritional treatment contributes to the maintenance of the individual's global health. The main diet-related causes associated with excess weight are the high consumption of ultraprocessed foods, which are high in fats, sugars, and have high energy density; increased portion sizes; and low intake of fruits, vegetables, and grains. In addition, some situations negatively interfere with the weight loss process, such as fad diets that involve the belief in superfoods, the use of teas and phytotherapics, or even the avoidance of certain food groups, as has currently been the case for foods that are sources of carbohydrates. Individuals with obesity are often exposed to fad diets and, on a recurring basis, adhere to proposals with promises of quick solutions, which are not supported by the scientific literature. The adoption of a dietary pattern combining foods such as grains, lean meats, low-fat dairy, fruits, and vegetables, associated with an energy deficit, is the nutritional treatment recommended by the main international guidelines. Moreover, an emphasis on behavioral aspects including motivational interviewing and the encouragement for the individual to develop skills will contribute to achieve and maintain a healthy weight. Therefore, this Position Statement was prepared based on the analysis of the main randomized controlled studies and meta-analyses that tested different nutrition interventions for weight loss. Topics in the frontier of knowledge such as gut microbiota, inflammation, and nutritional genomics, as well as the processes involved in weight regain, were included in this document. This Position Statement was prepared by the Nutrition Department of the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), with the collaboration of dietitians from research and clinical fields with an emphasis on strategies for weight loss.
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Affiliation(s)
- Renata Bressan Pepe
- Grupo de Obesidade e Sindrome Metabolica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Ana Maria Lottenberg
- Laboratório de Lipides (LIM10), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
- Nutrition Department of the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), Rua Mato Grosso 306 - cj 1711, Sao Paulo, SP, 01239-040, Brazil.
| | - Clarissa Tamie Hiwatashi Fujiwara
- Grupo de Obesidade e Sindrome Metabolica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Mônica Beyruti
- Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), São Paulo, SP, Brazil
| | - Dennys Esper Cintra
- Centro de Estudos em Lipídios e Nutrigenômica - CELN - University of Campinas, Campinas, SP, Brazil
| | - Roberta Marcondes Machado
- Liga Acadêmica de Controle de Diabetes do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Alessandra Rodrigues
- Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), São Paulo, SP, Brazil
| | - Natália Sanchez Oliveira Jensen
- Liga Acadêmica de Controle de Diabetes do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | | | - Ariana Ester Fernandes
- Grupo de Obesidade e Sindrome Metabolica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Carina Rossoni
- Instituto de Saúde Ambiental, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Fernanda Mattos
- Programa de Obesidade e Cirurgia Bariátrica do Hospital Universitário Clementino Fraga Filho da UFRJ, Rio de Janeiro, RJ, Brazil
| | - João Henrique Fabiano Motarelli
- Núcleo de Estudos e Extensão em Comportamento Alimentar e Obesidade (NEPOCA) da Universidade de São Paulo - FMRP/USP, Ribeirão Preto, Brazil
| | - Josefina Bressan
- Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, MG, Brazil
| | | | - Lis Mie Masuzawa Beda
- Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), São Paulo, SP, Brazil
| | - Maria Sílvia Ferrari Lavrador
- Liga Acadêmica de Controle de Diabetes do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Mariana Del Bosco
- Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), São Paulo, SP, Brazil
| | - Patrícia Cruz
- Grupo de Obesidade e Sindrome Metabolica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | | | - Priscila Maximino
- Instituto PENSI - Fundação José Luiz Egydio Setúbal, Instituto Pensi, Fundação José Luiz Egydio Setúbal, Hospital Infantil Sabará, São Paulo, SP, Brazil
| | - Silvia Pereira
- Núcleo de Saúde Alimentar da Sociedade Brasileira de Cirurgia Bariátrica e Metabólica, São Paulo, Brazil
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Abstract
The obesity epidemic in aging populations poses significant public health concerns for greater morbidity and mortality risk. Age-related increased adiposity is multifactorial and often associated with reduced lean body mass. The criteria used to define obesity by body mass index in younger adults may not appropriately reflect age-related body composition changes. No consensus has been reached on the definition of sarcopenic obesity in older adults. Lifestyle interventions are generally recommended as initial therapy; however, these approaches have limitations in older adults. Similar benefits in older compared with younger adults are reported with pharmacotherapy, however, large randomized clinical trials in geriatric populations are lacking.
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Affiliation(s)
- Noemi Malandrino
- Division of Endocrinology, Diabetes & Metabolism, The Johns Hopkins University School of Medicine, The Johns Hopkins University, 1830 East Monument Street, Suite 333, Baltimore, MD 21287, USA
| | - Salman Z Bhat
- Division of Endocrinology, Diabetes & Metabolism, The Johns Hopkins University School of Medicine, The Johns Hopkins University, 1830 East Monument Street, Suite 333, Baltimore, MD 21287, USA
| | - Maha Alfaraidhy
- The Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - Rajvarun S Grewal
- California Health Sciences University - College of Osteopathic Medicine (CHSU-COM), 2500 Alluvial Avenue, Clovis, CA 93611, USA
| | - Rita Rastogi Kalyani
- Division of Endocrinology, Diabetes & Metabolism, The Johns Hopkins University School of Medicine, The Johns Hopkins University, 1830 East Monument Street, Suite 333, Baltimore, MD 21287, USA; Center on Aging and Health, The Johns Hopkins University, 2024 East Monument Street, Baltimore, MD 21205, USA.
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Zhang L, Zhu M, Liu X, Zhao Z, Han P, Lv L, Yang C, Han Y. Calorie-restricted diet mitigates weight gain and metabolic abnormalities in obese women with schizophrenia: a randomized controlled trial. Front Nutr 2023; 10:1038070. [PMID: 37215202 PMCID: PMC10198382 DOI: 10.3389/fnut.2023.1038070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 04/10/2023] [Indexed: 05/24/2023] Open
Abstract
Background Obesity is a prevalent health problem in patients with schizophrenia, and calorie restriction diet (CRD) achieved effective weight loss and metabolic improvement; however, these have not been rigorously evaluated in obese patients with schizophrenia. Objective To measure the effects of CRD on weight loss and metabolic status in hospitalized obese women with schizophrenia during a 4-week period. Methods Participants were randomly assigned to two groups in a 1:1 ratio. The intervention group (n = 47) was asked to follow a CRD and the control group (n = 48) a normal diet for 4 weeks. Outcomes of body weight, body composition, as well as metabolic parameters were measured at baseline and following the intervention period. Results Forty-five participants completed the 4-week research in both the intervention and control groups. Compared to the normal diet, adherence to the CRD significantly decreased body weight (2.38 ± 1.30 kg), body mass index (0.94 ± 0.52 kg/m2), waist circumference (4.34 ± 2.75 cm), hip circumference (3.37 ± 2.36 cm), mid-upper circumferences, triceps skin-fold thickness, fat mass and free fat mass with large effect sizes (p = <0.001, ηp2 range between 0.145 and 0.571), as well as total cholesterol (0.69 ± 0.70 mmol/L) with a medium effect size (p = 0.028, ηp2 = 0.054). There were no differences between the CRD and control groups in terms of pre-post changes in triglycerides, high- and low-density lipoprotein-cholesterols, as well as systolic and diastolic blood pressures (p > 0.05). Conclusion CRD is preventative of weight gain, but not apparent in intervention for metabolic status in hospitalized obese women with schizophrenia.Clinical trial registration: http://www.chictr.org.cn, ChiCTR-INR-16009185.
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Affiliation(s)
- Lei Zhang
- Department of Clinical Nutrition, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Mingwen Zhu
- Department of Clinical Nutrition, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Xiangqun Liu
- Department of Clinical Nutrition, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Zhijun Zhao
- Department of Clinical Nutrition, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Ping Han
- Department of Nutrition and Food Hygiene, School of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Luxian Lv
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
- Henan Key Lab of Biological Psychiatry of Xinxiang Medical University, Xinxiang, Henan, China
| | - Chun Yang
- Department of Nutrition and Food Hygiene, School of Public Health, Capital Medical University, Beijing, China
| | - Yong Han
- Henan Key Lab of Biological Psychiatry of Xinxiang Medical University, Xinxiang, Henan, China
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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.
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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.
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Hsieh KL, Neiberg RH, Beavers KM, Rejeski WJ, Messier SP, Nicklas BJ, Beavers DP. Effect of Baseline BMI and IL-6 Subgroup Membership on Gait Speed Response to Caloric Restriction in Older Adults with Obesity. J Nutr Health Aging 2023; 27:285-290. [PMID: 37170436 PMCID: PMC10804887 DOI: 10.1007/s12603-023-1909-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Prior work shows caloric restriction (CR) can improve physical function among older adults living with obesity. However, the contribution of starting weight and inflammatory burden to CR-associated functional improvements is unclear. The primary purpose of this study was to determine if CR-associated gait speed change varied by body mass index (BMI) and plasma interleukin 6 (IL-6) at baseline and secondarily to determine the contribution of BMI change and IL-6 change to gait speed change. DESIGN, SETTING, PARTICIPANTS Data from eight randomized control trials were pooled, with 1184 participants randomized to CR (n=661) and No CR (n=523) conditions. All studies assessed outcomes before and five or six months after assignment to CR or No CR. MEASUREMENTS BMI and IL-6 were assessed at baseline using standard procedures. Gait speed was assessed with the six-minute walk test or 400m walk test. Baseline BMI/IL-6 subgroups were constructed using BMI≥35 kg/m2 and IL-6>2.5 pg/mL thresholds. Participants with BMI≥35 kg/m2 were grouped into class 2+ obesity and BMI<35 kg/m2 into class 1- obesity; IL-6>2.5 pg/mL were grouped into high IL-6, and <2.5 pg/mL as low IL-6 (class 2+ obesity/high IL-6: n=288, class 2+ obesity/low IL-6: n=143, class 1- obesity/high IL-6: n=354, or class 1- obesity/low IL-6: n=399). All analyses used adjusted general linear models. RESULTS Gait speed significantly improved with CR versus non-CR [mean difference: +0.02 m/s (95% CI: 0.01, 0.04)]. CR assignment significantly interacted with BMI/IL-6 subgroup membership (p=0.03). Greatest gait speed improvement was observed in the class 2+ obesity/high IL-6 subgroup [+0.07 m/s (0.03, 0.10)]. No other subgroups observed significant gait speed change. For each unit decrease in BMI, gait speed change increased by +0.02 m/s (p<0.001; R2=0.26), while log IL-6 change did not significantly affect gait speed change [+0.01 m/s (p=0.20)]. CONCLUSIONS Only the class 2+ obesity/high IL-6 subgroup significantly improved gait speed in response to CR. Improvement in gait speed in this subgroup was driven by a larger decrease in BMI, but not IL-6, in response to CR. Individuals with class 2+ obesity and high IL-6 are most likely to show improved gait speed in response to CR, with improvement predominantly driven by reductions in BMI.
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Affiliation(s)
- K L Hsieh
- Katherine L. Hsieh, Department of Physical Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, USA, Phone: 336-758-3106,
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Using a Very Low Energy Diet to Achieve Substantial Preconception Weight Loss in Women with Obesity: A Review of the Safety and Efficacy. Nutrients 2022; 14:nu14204423. [PMID: 36297107 PMCID: PMC9608905 DOI: 10.3390/nu14204423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 09/29/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022] Open
Abstract
Obesity in women of reproductive age is common. Emerging evidence suggests that maternal obesity not only increases the risk of adverse pregnancy outcomes but also has an enduring impact on the metabolic health of the offspring. Given this, management of obesity prior to pregnancy is critically important. Almost all international guidelines suggest that women with obesity should aim to achieve weight loss prior to pregnancy. However, current pre-conception weight loss therapies are sub-optimal. Lifestyle modification typically results in modest weight loss. This may assist fertility but does not alter pregnancy outcomes. Bariatric surgery results in substantial weight loss, which improves pregnancy outcomes for the mother but may be harmful to the offspring. Alternative approaches to the management of obesity in women planning pregnancy are needed. Very low energy diets (VLEDs) have been proposed as a possible tool to assist women with obesity achieve weight loss prior to conception. While VLEDs can induce substantial and rapid weight loss, there are concerns about the impact of rapid weight loss on maternal nutrition prior to pregnancy and about inadvertent exposure of the early fetus to ketosis. The purpose of this review is to examine the existing literature regarding the safety and efficacy of a preconception VLED program as a tool to achieve substantial weight loss in women with obesity.
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Galicia Ernst I, Torbahn G, Schwingshackl L, Knüttel H, Kob R, Kemmler W, Sieber CC, Batsis JA, Villareal DT, Stroebele-Benschop N, Visser M, Volkert D, Kiesswetter E, Schoene D. Outcomes addressed in randomized controlled lifestyle intervention trials in community-dwelling older people with (sarcopenic) obesity-An evidence map. Obes Rev 2022; 23:e13497. [PMID: 35891613 DOI: 10.1111/obr.13497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 12/24/2022]
Abstract
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.
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Affiliation(s)
- Isabel Galicia Ernst
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Gabriel Torbahn
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.,Department of Pediatrics, Paracelsus Medical University, Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität Nürnberg, Nuremberg, Germany
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Helge Knüttel
- University Library, University of Regensburg, Regensburg, Germany
| | - Robert Kob
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Wolfgang Kemmler
- Institute of Medical Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.,Department of Medicine, Kantonsspital Winterthur, Winterthur, Switzerland
| | - John A Batsis
- Division of Geriatric Medicine, School of Medicine and Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dennis T Villareal
- Division of Endocrinology, Diabetes and Metabolism, Baylor College of Medicine, Houston, Texas, USA
| | - Nanette Stroebele-Benschop
- Department of Nutritional Psychology, Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Eva Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.,Institute for Evidence in Medicine, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Daniel Schoene
- Institute of Medical Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Institute for Exercise and Public Health, University of Leipzig, Leipzig, Germany
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11
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Bennell KL, Jones SE, Hinman RS, McManus F, Lamb KE, Quicke JG, Sumithran P, Prendergast J, George ES, Holden MA, Foster NE, Allison K. Effectiveness of a telehealth physiotherapist-delivered intensive dietary weight loss program combined with exercise in people with knee osteoarthritis and overweight or obesity: study protocol for the POWER randomized controlled trial. BMC Musculoskelet Disord 2022; 23:733. [PMID: 35907828 PMCID: PMC9338658 DOI: 10.1186/s12891-022-05685-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obesity is associated with knee osteoarthritis (OA). Weight loss, alongside exercise, is a recommended treatment for individuals with knee OA and overweight/obesity. However, many patients cannot access weight loss specialists such as dietitians. Innovative care models expanding roles of other clinicians may increase access to weight loss support for people with knee OA. Physiotherapists may be well placed to deliver such support. This two-group parallel, superiority randomized controlled trial aims to compare a physiotherapist-delivered diet and exercise program to an exercise program alone, over 6 months. The primary hypothesis is that the physiotherapist-delivered diet plus exercise program will lead to greater weight loss than the exercise program. METHODS 88 participants with painful knee OA and body mass index (BMI) > 27 kg/m2 will be recruited from the community. Following baseline assessment, participants will be randomised to either exercise alone or diet plus exercise groups. Participants in the exercise group will have 6 consultations (20-30 min) via videoconference with a physiotherapist over 6 months for a strengthening exercise program, physical activity plan and educational/exercise resources. Participants in the diet plus exercise group will have 6 consultations (50-75 min) via videoconference with a physiotherapist prescribing a ketogenic very low-calorie diet with meal replacements and educational resources to support weight loss and healthy eating, plus the intervention of the exercise only group. Outcomes are measured at baseline and 6 months. The primary outcome is percentage change in body weight measured by a blinded assessor. Secondary outcomes include self-reported knee pain, physical function, global change in knee problems, quality of life, physical activity levels, and internalised weight stigma, as well as BMI, waist circumference, waist-to-hip ratio, physical performance measures and quadriceps strength, measured by a blinded assessor. Additional measures include adherence, adverse events, fidelity and process measures. DISCUSSION This trial will determine whether a physiotherapist-delivered diet plus exercise program is more effective for weight loss than an exercise only program. Findings will inform the development and implementation of innovative health service models addressing weight management and exercise for patients with knee OA and overweight/obesity. TRIAL REGISTRATION NIH US National Library of Medicine, Clinicaltrials.gov NCT04733053 (Feb 1 2021).
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Affiliation(s)
- Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Australia.
| | - Sarah E Jones
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Fiona McManus
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Karen E Lamb
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.,Methods and Implementation Support for Clinical Health research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Jonathan G Quicke
- School of Medicine, Keele University, Keele, UK.,Chartered Society of Physiotherapy, Chancery Exchange, London, UK
| | - Priya Sumithran
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | | | - Elena S George
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | | | - Nadine E Foster
- School of Medicine, Keele University, Keele, UK.,STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Brisbane, Australia
| | - Kim Allison
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
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12
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Hall M, Hinman RS, Knox G, Spiers L, Sumithran P, Murphy NJ, McManus F, Lamb KE, Cicuittini F, Hunter DJ, Messier SP, Bennell KL. Effects of adding a diet intervention to exercise on hip osteoarthritis pain: protocol for the ECHO randomized controlled trial. BMC Musculoskelet Disord 2022; 23:215. [PMID: 35248012 PMCID: PMC8898434 DOI: 10.1186/s12891-022-05128-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Hip osteoarthritis (OA) is a leading cause of musculoskeletal pain. Exercise is a core recommended treatment. Despite some clinical guidelines also recommending weight loss for hip OA, there is no evidence from randomised controlled trials (RCT) to substantiate these recommendations. This superiority, 2-group, parallel RCT will compare a combined diet and exercise program to an exercise only program, over 6 months. Methods One hundred people with symptomatic and radiographic hip OA will be recruited from the community. Following baseline assessment, participants will be randomly allocated to either, i) diet and exercise or; ii) exercise only. Participants in the diet and exercise group will have six consultations with a dietitian and five consultations with a physiotherapist via videoconferencing over 6 months. The exercise only group will have five consultations with a physiotherapist via videoconferencing over 6 months. The exercise program for both groups will include prescription of strengthening exercise and a physical activity plan, advice about OA management and additional educational resources. The diet intervention includes prescription of a ketogenic very low-calorie diet with meal replacements and educational resources to support weight loss and healthy eating. Primary outcome is self-reported hip pain via an 11-point numeric rating scale (0 = ‘no pain’ and 10 = ‘worst pain possible’) at 6 months. Secondary outcomes include self-reported body weight (at 0, 6 and 12 months) and body mass index (at 0, 6 and 12 months), visceral fat (measured using dual energy x-ray absorptiometry at 0 and 6 months), pain, physical function, quality of life (all measured using subscales of the Hip Osteoarthritis Outcome Scale at 0, 6 and 12 months), and change in pain and physical activity (measured using 7-point global rating of change Likert scale at 6 and 12 months). Additional measures include adherence, adverse events and cost-effectiveness. Discussion This study will determine whether a diet intervention in addition to exercise provides greater hip pain-relief, compared to exercise alone. Findings will assist clinicians in providing evidence-based advice regarding the effect of a dietary intervention on hip OA pain. Trial registration ClinicalTrials.gov . Identifier: NCT04825483. Registered 31st March 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05128-9.
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13
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Safdar B. Influence of Sex and Gender on Lifestyle Interventions for Cardiovascular Disease. Clin Ther 2021; 44:8-10. [PMID: 34973826 DOI: 10.1016/j.clinthera.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/10/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Basmah Safdar
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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14
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Dewansingh P, Reckman GAR, Mijlius CF, Krijnen WP, van der Schans CP, Jager-Wittenaar H, van den Heuvel EGHM. Protein, Calcium, Vitamin D Intake and 25(OH)D Status in Normal Weight, Overweight, and Obese Older Adults: A Systematic Review and Meta-Analysis. Front Nutr 2021; 8:718658. [PMID: 34568405 PMCID: PMC8461258 DOI: 10.3389/fnut.2021.718658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/16/2021] [Indexed: 12/18/2022] Open
Abstract
The aging process is often accompanied by increase in body weight. Older adults with overweight or obesity might have an overconsumption in energy that is accompanied by inadequate intake of protein, vitamin D, and calcium. It is unclear if intake of protein and vitamin D and calcium is sufficient in older adults with overweight/obesity, and whether it differs from older adults with normal weight, since a recent overview of the literature review is lacking. Therefore, we systematically analyzed the current evidence on differences in nutrient intake/status of protein, vitamin D and calcium between older adults with different body mass index (BMI) categories. Randomized controlled trials and prospective cohort studies were identified from PubMed and EMBASE. Studies reporting nutrient intake/status in older adults aged ≥50 years with overweight/obesity and studies comparing between overweight/obesity and normal weight were included. Nutrient intake/status baseline values were reviewed and when possible calculated for one BMI category (single-group meta-analysis), or compared between BMI categories (meta-analysis). Nutrient intake/status was compared with international recommendations. Mean protein (N = 8) and calcium intake (N = 5) was 0.98 gram/kilogram body weight/day (g/kg/d) [95% Confidence Interval (CI) 0.89-1.08] and 965 mg [95% CI: 704-1225] in overweight/obese. Vitamin D intake was insufficient in all BMI categories (N = 5). The pooled mean for vitamin D intake was 6 ug [95% CI 4-9]. For 25(OH)D, the pooled mean was 54 nmol/L [95% CI 45-62], 52 nmol/L [95% CI 46-58], and 48 nmol/l [95% CI 33-62] in normal (N = 7), combined overweight and obese (N = 12), and obese older adults (N = 4), respectively. In conclusion, older adults with overweight and obesity have a borderline sufficient protein and sufficient calcium intake, but insufficient vitamin D intake. The 25(OH)D concentration is deficient for the obese older adults.
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Affiliation(s)
- Priya Dewansingh
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Gerlof A. R. Reckman
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, Netherlands
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Caspar F. Mijlius
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, Netherlands
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Wim P. Krijnen
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, Netherlands
- Faculty of Mathematics and Natural Sciences, University of Groningen, Groningen, Netherlands
| | - Cees P. van der Schans
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, Netherlands
- Faculty of Medical Sciences, University Medical Center Groningen, Groningen, Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Department of Health Psychology Research, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Harriët Jager-Wittenaar
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, Netherlands
- Department of Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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15
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Price SAL, Sumithran P, Nankervis AJ, Permezel M, Prendergast LA, Proietto J. Impact of preconception weight loss on fasting glucose and pregnancy outcomes in women with obesity: A randomized trial. Obesity (Silver Spring) 2021; 29:1445-1457. [PMID: 34431233 DOI: 10.1002/oby.23200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/04/2021] [Accepted: 04/13/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study examined the effectiveness of a nonsurgical, preconception weight loss intervention on pregnancy outcomes in women with obesity. METHODS This was a two-arm, parallel-group randomized controlled trial. A total of 164 women with BMI 30 to 55 kg/m2 who were aged 18 to 38 years and planning pregnancy were randomized to a 12-week standard dietary intervention (SDI; n = 79) or a modified very low-energy diet (VLED; n = 85). Participants were observed for ≤48 weeks while trying for pregnancy and then during pregnancy. The primary outcome was maternal fasting plasma glucose at 26 to 28 weeks' gestation. Exploratory outcomes were individual and composite obesity-related adverse pregnancy outcomes. RESULTS Weight loss was greater in the VLED group (SDI 3.2 [0.6] kg vs. VLED 13.0 [0.5] kg, p < 0.01). In completers who had a singleton live birth (SDI 22/79 vs. VLED 35/85, p = 0.10), there was no difference in fasting glucose at 26 to 28 weeks' gestation (SDI 4.8[0.2] mmol/L vs. VLED 4.6 [0.1] mmol/L, p = 0.42). However, the composite of adverse pregnancy outcomes was significantly lower in the VLED group (p < 0.001). CONCLUSIONS Substantial prepregnancy weight loss in women with obesity does not alter fasting glucose at 26 to 28 weeks' gestation but does reduce a composite of adverse pregnancy outcomes. A better understanding of metabolic changes in pregnancy after preconception weight loss may assist in improving maternal and neonatal health outcomes.
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Affiliation(s)
- Sarah A L Price
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg Heights, Victoria, Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Priya Sumithran
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg Heights, Victoria, Australia
- Department of Endocrinology (Austin Health), Heidelberg Heights, Victoria, Australia
| | - Alison J Nankervis
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Michael Permezel
- Department of Obstetrics and Gynaecology, Mercy Hospital, Heidelberg, Victoria, Australia
| | - Luke A Prendergast
- Department of Mathematics and Statistics, La Trobe University, Bundoora, Victoria, Australia
| | - Joseph Proietto
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg Heights, Victoria, Australia
- Department of Endocrinology (Austin Health), Heidelberg Heights, Victoria, Australia
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16
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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.
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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
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17
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Al-Nimr RI, Wright KCS, Aquila CL, Petersen CL, Gooding TL, Batsis JA. Intensive nutrition counseling as part of a multi-component weight loss intervention improves diet quality and anthropometrics in older adults with obesity. Clin Nutr ESPEN 2020; 40:293-299. [PMID: 33183553 DOI: 10.1016/j.clnesp.2020.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/01/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Obesity significantly impacts older adults. Intensive nutrition counseling can aid in weight reduction and improve diet quality, but data are sparse in this population. The objective of this intervention is to determine how intensive nutrition counseling affects diet quality and anthropometric measures during a multi-component weight loss intervention in rural older adults with obesity. METHODS A series of 12-week, single-arm feasibility pilots were conducted in fall 2017 and winter/spring 2018 in a community aging center in rural Northern New England. Adults were eligible if ≥ 65 years old with a Body Mass Index (BMI) ≥30 kg/m2. Exclusion criteria included dementia/cognitive impairment, uncontrolled psychiatric illness, weight-loss surgery, weight loss >5% in previous 6-months, life-threatening illness, palliative/hospice services, current participation in another weight-loss study/program, obesogenic medications, or presence of major chronic conditions. Participants received once-weekly nutrition counseling by a registered dietitian nutritionist (RDN), and twice-weekly exercise sessions by a physical therapist (PT). Primary outcomes were diet quality changes measured by total Rapid Eating and Activity Assessment for Patients-Short Version (REAP-S) and Automated Self-Administered 24-h dietary recall (ASA-24). Secondary outcome measures were changes in weight (kilograms) and waist circumference (centimeters). McNemar test was conducted for all paired categorical data while paired t-tests were conducted for all paired continuous data. All analyses were conducted in R; p-value<0.05 was significant. RESULTS Total n = 23. Mean age was 72.2 (5.8) years (73.9% female); mean BMI was 35.9 ± 5.0 kg/m2. At 12 weeks, diet quality significantly improved. REAP-S scores increased by 3.53 ± 3.13 points (p < 0.001). Kilocalories, grams fat, grams saturated fat, milligrams sodium, grams added sugar, and grams alcohol via ASA-24 significantly decreased (all p < 0.05). Significant reductions in weight (-5.22 ± 3.13 kg) and waist circumference (-6.88 ± 5.67 cm) were observed (both p < 0.001). CONCLUSION Intensive nutrition counseling significantly enhances diet quality and reduces weight and waist circumference in rural older adults with obesity.
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Affiliation(s)
- Rima Itani Al-Nimr
- The Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road Hanover, NH, 03755, USA; Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive Lebanon, NH, 03766, USA.
| | - K C S Wright
- Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive Lebanon, NH, 03766, USA; Wildberrycommunications.com, 1106 Lakeshore Drive, New London, NH, 03257, USA.
| | - Christina L Aquila
- Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive Lebanon, NH, 03766, USA.
| | - Curtis L Petersen
- The Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road Hanover, NH, 03755, USA; The Dartmouth Institute for Health Policy,1 Medical Center Drive, Lebanon, NH, 03766, USA.
| | - Tyler L Gooding
- Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive Lebanon, NH, 03766, USA.
| | - John A Batsis
- The Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road Hanover, NH, 03755, USA; Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive Lebanon, NH, 03766, USA; The Dartmouth Institute for Health Policy,1 Medical Center Drive, Lebanon, NH, 03766, USA; Division of Geriatric Medicine, Center for Aging and Health, Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, HC, 27517, USA.
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18
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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.
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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
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Sivakumar J, Chong L, Ward S, Sutherland TR, Read M, Hii MW. Body Composition Changes Following a Very-Low-Calorie Pre-Operative Diet in Patients Undergoing Bariatric Surgery. Obes Surg 2020; 30:119-126. [PMID: 31529393 DOI: 10.1007/s11695-019-04174-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Fatty liver in obese patients increases the technical difficulty of bariatric surgery. Pre-operative weight loss with a very-low-calorie diet (VLCD) is commonly used to facilitate surgery. Few studies have quantified the systemic effect of rapid pre-operative weight loss on body composition. The objective of this study is to evaluate body composition changes in bariatric surgery patients undergoing a VLCD. METHODS Body composition assessments were performed between August 2017 and January 2019 using dual-energy X-ray absorptiometry immediately before and after a 2-week VLCD at St Vincent's Hospital Melbourne. Data collected prospectively pre- and post-VLCD included total body weight, excess body weight, body mass index (BMI), lean body mass (LBM), fat mass (FM) and bone mineral content (BMC). The pre- and post-operative results were compared. RESULTS Forty-four patients completed both the 2-week VLCD and body composition assessments. Following a 2-week VLCD, patients lost a mean of 4.5 kg (range - 0.3 to 9.5) in a total body weight and 8.8% (range - 0.9 to 17.1) of excess body weight, with a mean reduction in body mass index of 1.6 kg/m2 (range - 0.2 to 3.1). Loss of LBM was 2.8 kg and was significantly greater than loss of FM, 1.7 kg (p < 0.05). BMC changes were insignificant. CONCLUSION A VLCD is an effective tool for pre-operative weight reduction. In this cohort, a large amount of the total weight loss was attributed to a loss of lean body mass. The impact of significant lean body mass loss and its relationship to short- and long-term health outcomes warrants further assessment.
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Affiliation(s)
- Jonathan Sivakumar
- Department of Hepatobiliary and Upper GI Surgery, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.
| | - Lynn Chong
- Department of Hepatobiliary and Upper GI Surgery, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Salena Ward
- Department of Hepatobiliary and Upper GI Surgery, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Tom R Sutherland
- Department of Radiology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Matthew Read
- Department of Hepatobiliary and Upper GI Surgery, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Michael W Hii
- Department of Hepatobiliary and Upper GI Surgery, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.,Department of Surgery, St Vincent's Hospital Melbourne, University of Melbourne, Melbourne, VIC, Australia
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20
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Seimon RV, Wild-Taylor AL, McClintock S, Harper C, Gibson AA, Johnson NA, Fernando HA, Markovic TP, Center JR, Franklin J, Liu PY, Grieve SM, Lagopoulos J, Caterson ID, Byrne NM, Sainsbury A. 3-Year effect of weight loss via severe versus moderate energy restriction on body composition among postmenopausal women with obesity - the TEMPO Diet Trial. Heliyon 2020; 6:e04007. [PMID: 32613096 PMCID: PMC7322133 DOI: 10.1016/j.heliyon.2020.e04007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/06/2020] [Accepted: 05/13/2020] [Indexed: 12/15/2022] Open
Abstract
We have previously shown that a severely energy-restricted diet leads to greater loss of weight, fat, lean mass and bone mineral density (BMD) at 12 months in postmenopausal women with obesity than a moderately energy-restricted diet. We now aim to evaluate whether these effects are sustained longer term (ie, at 36 months). 101 postmenopausal women were randomized to either 12 months of moderate (25 to 35%) energy restriction with a food-based diet (moderate intervention), or 4 months of severe (65 to 75%) energy restriction with a total meal replacement diet followed by moderate energy restriction for 8 months (severe intervention). Body weight and composition were measured at 0, 24 and 36 months. Participants in the severe intervention lost ~1.5 to 1.7 times as much weight, waist circumference, whole-body fat mass and visceral adipose tissue compared to those in the moderate intervention, and were 2.6 times more likely (42% versus 16%) to have lost 10% or more of their initial body weight at 36 months (P < 0.01 for all). However, those in the severe versus moderate intervention lost ~1.4 times as much whole-body lean mass (P < 0.01), albeit this was proportional to total weight lost and there was no greater loss of handgrip strength, and they also lost ~2 times as much total hip BMD between 0 and 36 months (P < 0.05), with this bone loss occurring in the first 12 months. Thus, severe energy restriction is more effective than moderate energy restriction for reducing weight and adiposity in postmenopausal women in the long term (3 years), but attention to BMD loss in the first year is required. Trial registration Australian New Zealand Clinical Trials Registry Reference Number: 12612000651886, anzctr.org.au.
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Affiliation(s)
- Radhika V. Seimon
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Corresponding author.
| | - Anthony L. Wild-Taylor
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sally McClintock
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Claudia Harper
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Alice A. Gibson
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Nathan A. Johnson
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
| | - Hamish A. Fernando
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Tania P. Markovic
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Jacqueline R. Center
- Bone Biology Program, Garvan Institute of Medical Research, St Vincent's Hospital Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Janet Franklin
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Peter Y. Liu
- Division of Endocrinology, Department of Medicine, Harbor-University of California Los Angeles Medical Center and Los Angeles BioMedical Research Institute, Los Angeles
| | - Stuart M. Grieve
- Imaging and Phenotyping Laboratory, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Jim Lagopoulos
- Sunshine Coast Mind and Neuroscience–Thompson Institute, University of the Sunshine Coast, Queensland, Australia
| | - Ian D. Caterson
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Nuala M. Byrne
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Amanda Sainsbury
- School of Human Sciences, Faculty of Science, The University of Western Australia, Crawley, Western Australia, Australia
- Corresponding author.
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21
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Yan S, Wang C, Zhao H, Pan Y, Wang H, Guo Y, Yao N, Li B, Cui W. Effects of fasting intervention regulating anthropometric and metabolic parameters in subjects with overweight or obesity: a systematic review and meta-analysis. Food Funct 2020; 11:3781-3799. [DOI: 10.1039/d0fo00287a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Previous studies have shown that fasting produces a potential effect in the prevention and treatment of many diseases.
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Affiliation(s)
- Shoumeng Yan
- Department of Epidemiology and Biostatistics
- School of Public Health
- Jilin University
- Changchun
- P. R. China
| | - Changcong Wang
- Department of Epidemiology and Biostatistics
- School of Public Health
- Jilin University
- Changchun
- P. R. China
| | - Hantong Zhao
- Department of Epidemiology and Biostatistics
- School of Public Health
- Jilin University
- Changchun
- P. R. China
| | - Yingan Pan
- Department of Epidemiology and Biostatistics
- School of Public Health
- Jilin University
- Changchun
- P. R. China
| | - Han Wang
- Department of Epidemiology and Biostatistics
- School of Public Health
- Jilin University
- Changchun
- P. R. China
| | - Yinpei Guo
- Department of Epidemiology and Biostatistics
- School of Public Health
- Jilin University
- Changchun
- P. R. China
| | - Nan Yao
- Department of Epidemiology and Biostatistics
- School of Public Health
- Jilin University
- Changchun
- P. R. China
| | - Bo Li
- Department of Epidemiology and Biostatistics
- School of Public Health
- Jilin University
- Changchun
- P. R. China
| | - Weiwei Cui
- Department of Nutrition and Food Hygiene
- School of Public Health
- Jilin University
- Changchun
- P. R. China
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22
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Zhou T, Qi L. Vitamin D, genetics, and bone mineral density during weight loss. Curr Opin Clin Nutr Metab Care 2019; 22:465-471. [PMID: 31577641 DOI: 10.1097/mco.0000000000000599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The current review is to summarize the recent progress in the research of the relation between vitamin D and bone mineral density (BMD) during weight-loss interventions, and describe how genetic factors interact with weight-loss interventions on changes in bone health. RECENT FINDINGS Obesity has shown to be a protective factor for bone health, whereas the relation between weight loss and BMD has yet to be well established. Although beneficial on a variety of metabolic outcomes, weight-loss interventions, such as dietary modifications and surgical treatment, showed adverse effects on bone health in some studies. Despite the biological plausibility for a role of vitamin D in promoting bone health, current evidence does not consistently support the connection between changes in circulating vitamin D levels and BMD during weight loss, partly because of insufficient vitamin D levels during weight loss. Genome-wide association studies have identified genetic variants related to the blood levels of vitamin D; and emerging evidence suggests that dietary intakes may modify the relationship between genetically determined circulating vitamin D levels and change in BMD in response to weight-loss diets. SUMMARY The relations of changes in circulating vitamin D levels with bone health during weight-loss interventions remain to be established, and the role of genetic factors would be considered in future investigations.
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Affiliation(s)
- Tao Zhou
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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23
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Haywood CJ, Prendergast LA, Lim R, Lappas M, Lim WK, Proietto J. Obesity in older adults: Effect of degree of weight loss on cardiovascular markers and medications. Clin Obes 2019; 9:e12316. [PMID: 31207126 DOI: 10.1111/cob.12316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/12/2019] [Accepted: 04/25/2019] [Indexed: 01/28/2023]
Abstract
Obesity worsens the age-related tendency towards cardiovascular disease and diabetes. Older adults are vulnerable to medication adverse effects. Intentional weight loss in older adults with obesity has been shown to improve cardiovascular and glycaemic markers. The effect of rapid weight loss induced by very-low-calorie diets (VLCDs) on these markers has not been evaluated in this group. In this 12-week study, participants were randomized to one of healthy eating, hypocaloric diet or VLCD, all combined with three times weekly exercise (Ex/HE, Ex/Diet, Ex/VLCD, respectively). The effects of these interventions on weight, blood pressure, lipids, glucose and HbA1c , inflammatory markers and cardiovascular and diabetes medication changes were measured. Weight loss was 3.7%, 5.1% and 11.1% in Ex/HE, Ex/Diet and Ex/VLCD, respectively. There were significant improvements in HbA1c in all groups, but by the greatest degree in Ex/VLCD (0.18 ± 0.07%, 0.18 ± 0.06% and 0.59 ± 0.13%, respectively). Similar patterns were seen in total cholesterol (0.13 ± 0.15, 0.21 ± 0.11 and 0.53 ± 0.13 mmol/L, respectively, P = .047), triglycerides (0.35 ± 0.13, 0.20 ± 0.10 and 0.51 ± 0.09 mmol/L, respectively, P = .011) and systolic blood pressure (9 ± 2, 2 ± 3 and 14 ± 3 mmHg respectively, P = .025). There were no between-group differences in fasting glucose, high-density lipoprotein (HDL) cholesterol, LDL-C and inflammatory markers. Reductions in anti-hypertensive or diabetes medication were made in 4/29, 7/36 and 16/37 participants in Ex/HE, Ex/Diet and Ex/VLCD, respectively (P = .017). Significant weight loss achieved with a VLCD gave rise to improvements in multiple cardiovascular risk markers, despite reduction in medication. Weight loss is an under-utilized method of cardiovascular risk management in this group.
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Affiliation(s)
- Cilla J Haywood
- Department of Medicine (Austin Health), University of Melbourne, Melbourne, Victoria, Australia
- Department of Aged Care, Austin Health, Melbourne, Victoria, Australia
- Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia
| | - Luke A Prendergast
- Mathematics and Statistics, LaTrobe University, Melbourne, Victoria, Australia
| | - Ratana Lim
- Obstetrics, Nutrition and Endocrinology Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Martha Lappas
- Obstetrics, Nutrition and Endocrinology Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Wen Kwang Lim
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Melbourne, Victoria, Australia
- Department of Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Joseph Proietto
- Department of Medicine (Austin Health), University of Melbourne, Melbourne, Victoria, Australia
- Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia
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24
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Papageorgiou M, Kerschan-Schindl K, Sathyapalan T, Pietschmann P. Is Weight Loss Harmful for Skeletal Health in Obese Older Adults? Gerontology 2019; 66:2-14. [DOI: 10.1159/000500779] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/06/2019] [Indexed: 11/19/2022] Open
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25
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Comparative Effects of Medical Versus Surgical Weight Loss on Body Composition: a Pilot Randomized Trial. Obes Surg 2019; 29:2503-2510. [PMID: 30997619 DOI: 10.1007/s11695-019-03879-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Bariatric surgery leads to more rapid and greater weight loss (WL) compared to medical weight loss (MWL), but the differences in body composition (BC) changes for these modalities remain unclear. Due to the known health risks associated with central adiposity, we compared the changes in regional distribution of fat mass (FM) and lean mass (LM) after surgical versus MWL. METHODS In this 1:1:1 randomized trial among 15 persons with type 2 diabetes and body mass index (BMI) 30-39.9 kg/m2, we compared changes in BC, by dual-energy X-ray absorptiometry and abdominal computerized tomography, at time of 10%WL or 9 months after intervention (whichever came first). Participants underwent MWL, adjustable gastric banding (AGB), or Roux-en-Y gastric bypass (RYGB). Non-parametric tests evaluated BC differences (FM, LM, and visceral adipose tissue [VAT]) within and across all three arms and between pair-wise comparisons. RESULTS Twelve female participants (75% African American) completed the study. Patient age, BMI, and baseline anthropometric characteristics were similar across study arms. AGB lost more LM (MWL - 5.2%, AGB - 10.3%, p = 0.021) and VAT (MWL + 10.9%, AGB - 28.0%, p = 0.049) than MWL. RYGB tended to lose more VAT (MWL +10.9%, RYGB - 20.2%, p = 0.077) than MWL. AGB tended to lose more LM than RYGB (AGB - 12.38%, RYGB - 7.29%, p = 0.15). CONCLUSIONS At similar WL, AGB lost more LM and VAT than MWL; RYGB similarly lost more VAT. Given the metabolic benefits of reducing VAT and retaining LM, larger studies should confirm the changes in BC after surgical versus medical WL. CLINICAL TRIAL REGISTRATION NCTDK089557 - ClinicalTrials.gov.
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26
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Haywood C, Sumithran P. Treatment of obesity in older persons-A systematic review. Obes Rev 2019; 20:588-598. [PMID: 30645010 DOI: 10.1111/obr.12815] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 11/05/2018] [Indexed: 02/06/2023]
Abstract
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.
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Affiliation(s)
- Cilla Haywood
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Victoria, Australia.,Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia.,Department of Aged Care, Austin Health, Heidelberg, Victoria, Australia
| | - Priya Sumithran
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Victoria, Australia.,Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
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27
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Al-Nimr RI. Optimal Protein Intake during Weight Loss Interventions in Older Adults with Obesity. J Nutr Gerontol Geriatr 2019; 38:50-68. [PMID: 30806592 DOI: 10.1080/21551197.2018.1544533] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Obesity rates in people 60 years and older are increasing. While obesity is linked with detrimental health risks, weight loss in this population has previously been considered controversial due to potential worsening of age-related sarcopenia. Protein intake during energy restriction has been linked to lean body mass preservation. No formal guidelines for optimal protein intake during structured weight loss interventions exist for this population, but it appears that the current Recommended Dietary Allowance of 0.8 grams per kilogram of body weight per day may be inadequate. The purpose of this review is to discuss optimal protein intake during structured weight loss interventions in persons 60 years and older with obesity and to present a framework for guidelines to be used by health professionals focusing on weight loss interventions in older adults. Goals for the amount, source, and timing of protein intake, from both food and supplements, are presented and discussed.
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Affiliation(s)
- Rima Itani Al-Nimr
- a The Geisel School of Medicine at Dartmouth , Hanover , NH , USA.,b Department of Medicine , Dartmouth-Hitchcock Medical Center , Lebanon , NH , USA
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28
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Abstract
PURPOSE OF REVIEW Obesity rates worldwide continue to increase and will disproportionately affect older adults because of population aging. This review highlights recent progress pertaining to therapeutic approaches to obesity in older adults. RECENT FINDINGS Caloric restriction alone improves physical function and quality of life in older adults with obesity but is associated with loss of lean mass and increases fracture risk. Adding progressive resistance training to caloric restriction attenuates loss of muscle and bone mass and increasing protein intake enhances this effect. Adding aerobic endurance training to caloric restriction further improves cardiorespiratory fitness but adding both aerobic endurance training and resistance training to caloric restriction results in the greatest improvement in overall physical function while still preserving lean mass. Future promising therapeutic interventions include testosterone, myostatin inhibitors, and bariatric surgery, but there are few studies specific to obese older adults. SUMMARY The optimal approach toward obesity in older persons is lifestyle intervention incorporating caloric restriction and exercise consisting of aerobic endurance training and resistance training. Maintenance of adequate protein intake, calcium, and vitamin D is advisable. There is insufficient evidence specific to obese older adults to recommend testosterone or bariatric surgery at this time. Myostatin inhibitors may become a future treatment, and clinical trials are ongoing.
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Affiliation(s)
- Bryan C. Jiang
- Center for Translational Research in Inflammatory Diseases (CTRID), Michael E DeBakey VA Medical Center, Houston, TX, 77030
- Department of Medicine – Endocrinology, Diabetes, and Metabolism, Baylor College of Medicine, Houston, TX, 77030
| | - Dennis T. Villareal
- Center for Translational Research in Inflammatory Diseases (CTRID), Michael E DeBakey VA Medical Center, Houston, TX, 77030
- Department of Medicine – Endocrinology, Diabetes, and Metabolism, Baylor College of Medicine, Houston, TX, 77030
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29
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Gargallo-Vaamonde J, Perdomo CM, de la Higuera M, Frühbeck G, Salvador J. Is pharmacotherapy enough for urgent weight loss in severely obese patients? Expert Opin Pharmacother 2018; 20:367-371. [PMID: 30576254 DOI: 10.1080/14656566.2018.1559818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Carolina M Perdomo
- a Department of Endocrinology & Nutrition , Clínica Universidad de Navarra , Pamplona , Spain
| | - Magdalena de la Higuera
- a Department of Endocrinology & Nutrition , Clínica Universidad de Navarra , Pamplona , Spain
| | - Gema Frühbeck
- a Department of Endocrinology & Nutrition , Clínica Universidad de Navarra , Pamplona , Spain.,b Metabolic Research Laboratory , University of Navarra, IdiSNA , Pamplona , Spain.,c CIBEROBN, Instituto de Salud Carlos III , Madrid , Spain
| | - Javier Salvador
- a Department of Endocrinology & Nutrition , Clínica Universidad de Navarra , Pamplona , Spain.,c CIBEROBN, Instituto de Salud Carlos III , Madrid , Spain
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30
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Abstract
The prevalence of obesity in combination with sarcopenia (the age-related loss of muscle mass and strength or physical function) is increasing in adults aged 65 years and older. A major subset of adults over the age of 65 is now classified as having sarcopenic obesity, a high-risk geriatric syndrome predominantly observed in an ageing population that is at risk of synergistic complications from both sarcopenia and obesity. This Review discusses pathways and mechanisms leading to muscle impairment in older adults with obesity. We explore sex-specific hormonal changes, inflammatory pathways and myocellular mechanisms leading to the development of sarcopenic obesity. We discuss the evolution, controversies and challenges in defining sarcopenic obesity and present current body composition modalities used to assess this condition. Epidemiological surveys form the basis of defining its prevalence and consequences beyond comorbidity and mortality. Current treatment strategies, and the evidence supporting them, are outlined, with a focus on calorie restriction, protein supplementation and aerobic and resistance exercises. We also describe weight loss-induced complications in patients with sarcopenic obesity that are relevant to clinical management. Finally, we review novel and potential future therapies including testosterone, selective androgen receptor modulators, myostatin inhibitors, ghrelin analogues, vitamin K and mesenchymal stem cell therapy.
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Affiliation(s)
- John A Batsis
- Sections of General Internal Medicine and Weight and Wellness, and the Dartmouth Centers for Health and Aging, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
- Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, The Health Promotion Research Center and the Norris Cotton Cancer Center, Dartmouth College, Hanover, NH, USA.
| | - Dennis T Villareal
- Division of Endocrinology, Diabetes and Metabolism, Baylor College of Medicine, Houston, TX, USA
- Center for Translational Research on Inflammatory Diseases, Michael E DeBakey VA Medical Center, Houston, TX, USA
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31
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Bales CW, Porter Starr KN. Obesity Interventions for Older Adults: Diet as a Determinant of Physical Function. Adv Nutr 2018; 9:151-159. [PMID: 29659687 PMCID: PMC5916429 DOI: 10.1093/advances/nmx016] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Throughout the world, a high prevalence of obesity in older populations has created a new phenotype of frailty: the obese, functionally frail older adult. The convergence of the obesity epidemic with global graying will undoubtedly increase the prevalence of this concern. Barriers to treatment include ambiguities about the appropriate level of obesity that should trigger an intervention, due to age-related physiologic changes and a lack of consensus on specific criteria and cutoffs. Moreover, obesity interventions for this population have been limited by concerns about negative effects on lean mass, bone mineral density, and even mortality. However, newly reported approaches for restoring physical function by obesity reduction have shown good short-term efficacy. Because the majority of these interventions have used exercise as part of the treatment, this review focuses specifically on current understanding of the discrete effects of dietary interventions for geriatric obesity with regards to functional outcomes on tests including the Short Physical Performance Battery, the Physical Performance Test, and the Western Ontario and McMaster Universities Osteoarthritis Index. The literature showed roughly equal benefits to function from a weight reduction diet or exercise regimen, although neither modality was as efficacious alone as the 2 combined. Only 1 of 3 studies of protein intake during weight loss showed a positive effect of protein on function, but findings to date are too limited to prove or disprove a protein benefit. We conclude that although diet and exercise should be combined whenever possible, it remains important to further investigate the beneficial and likely unique effects that calorie restriction and/or nutrient modification can provide, particularly for obese and functionally frail older populations.
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Affiliation(s)
- Connie W Bales
- Center for the Study of Aging, Duke University Medical Center, Durham, NC
- Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, Durham, NC
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Kathryn N Porter Starr
- Center for the Study of Aging, Duke University Medical Center, Durham, NC
- Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, Durham, NC
- Department of Medicine, Duke University Medical Center, Durham, NC
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32
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Abstract
The ketogenic diet (KD), a well-established treatment for childhood epilepsy, is gradually gaining acceptance as a therapeutic modality for obesity and type 2 diabetes. The perception of ketone bodies as an unhealthy or “sinful” entity has led to concerns and doubts regarding the efficacy and safety of KD in physicians. This article describes the mechanism of action of KD and shares a pragmatic approach to its usage. It highlights the importance of predietary counseling, screening for indications/contraindications, and clinico-nutritional monitoring during therapy. Robust indications for KD are mentioned, to help place KD’s utility in the management of obesity and type 2 diabetes.
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