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

Concept of an Intervention for Sustainable Weight Loss in Postmenopausal Women with Overweight-Secondary Analysis of a Randomized Dietary Intervention Study

INTRODUCTION

The approach of an individual diet has great potential for sustainable weight reduction. Social support, participation and empowerment are also key factors for high motivation and compliance. So, the impact of an individual diet in combination with group sessions on weight loss in postmenopausal women with overweight was investigated.

METHODS

In this reanalysis of a controlled intervention study, postmenopausal women (n = 54; BMI 30.9 ± 3.4 kg/m²; 59 ± 7 years) were recruited receiving an energy restricted diet for 12 weeks, followed by a six-month follow-up phase. The women received 51 individual meal plans based on their habits and were trained in four group sessions.

RESULTS

Forty-six women completed the intervention phase, and 29 completed the follow-up. Average weight loss was -5.8 ± 3.0 kg (p < 0.001) after 12 weeks and was still significant at follow-up (-4.9 ± 5.4 kg, p < 0.001). Also, decreases in fat-free mass (-1.1 ± 1.2 kg, p < 0.001) and resting energy expenditure (-1096 ± 439 kJ/24 h, p < 0.001) were observed.

CONCLUSIONS

The individual nutrition approach with a focus on nutritype in combination with group sessions was effective for long-lasting weight loss in postmenopausal women. An important factor is close individual and group support.

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

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

The role of diet in managing menopausal symptoms: A narrative review

Menopause is a natural stage that occurs when women stop menstruating, during which many women experience physical and psychological symptoms that can affect their quality of life and ability to work. Dietary modifications and food supplements may be explored by some women as alternatives to hormone replacement therapy, although existing reviews and expert position statements have given this limited consideration. This narrative review summarises the current evidence for dietary patterns, and botanical and food supplements, in the management of common menopausal symptoms, including vasomotor symptoms (VMS; hot flushes; night sweats), changes in bodyweight and composition, psychological symptoms (depression; anxiety; cognitive changes), sleep disturbances, joint pain, skin changes and urogenital symptoms. Soy isoflavones may reduce the frequency and/or severity of VMS, although results are inconsistent, and it is unclear whether dietary and supplemental sources have comparable effects. Adopting a healthier dietary pattern may support a healthy bodyweight and benefit VMS. However, evidence suggesting dietary patterns may benefit depression, anxiety, and cognition remains largely observational. While some botanicals, such as black cohosh and St John's Wort, have been reported in some studies to alleviate symptoms (such as VMS and depression), these are not currently recommended due to uncertainty about the appropriate dose and preparation, and potential safety concerns. Evidence for other symptoms is currently too limited to draw conclusions. While further trials at different menopausal stages are needed, adopting a healthier dietary pattern in accordance with dietary guidelines is likely to help support women's health before, during and after the menopausal transition.

Sarcopenia in Menopausal Women: Current Perspectives

Menopause is associated with hormonal changes, which could accelerate or lead to sarcopenia. Functional impairment and physical disability are the major consequences of sarcopenia. In order to hamper these negative health outcomes, it appears necessary to prevent and even treat sarcopenia, through healthy lifestyle changes including diet and regular physical activity or through hormonal replacement therapy when appropriate. Therefore, the purpose of this narrative review will be 1) to present the prevalence of sarcopenia in postmenopausal women; 2) to address the risk factors related to sarcopenia in this specific population; and 3) to discuss how to manage sarcopenia among postmenopausal women.

Perspective: Time-Restricted Eating-Integrating the What with the When

Time-restricted eating (TRE) is a popular dietary strategy that emphasizes the timing of meals in alignment with diurnal circadian rhythms, permitting ad libitum energy intake during a restricted (∼8-10 h) eating window each day. Unlike energy-restricted diets or intermittent fasting interventions that focus on weight loss, many of the health-related benefits of TRE are independent of reductions in body weight. However, TRE research to date has largely ignored what food is consumed (i.e., macronutrient composition and energy density), overlooking a plethora of past epidemiological and interventional dietary research. To determine some of the potential mechanisms underpinning the benefits of TRE on metabolic health, future studies need to increase the rigor of dietary data collected, assessed, and reported to ensure a consistent and standardized approach in TRE research. This Perspective article provides an overview of studies investigating TRE interventions in humans and considers dietary intake (both what and when food is eaten) and their impact on selected health outcomes (i.e., weight loss, glycemic control). Integrating existing dietary knowledge about what food is eaten with our recent understanding on when food should be consumed is essential to optimize the impact of dietary strategies aimed at improving metabolic health outcomes.

A protein-supplemented very-low-calorie diet does not mitigate reductions in lean mass and resting metabolic rate in subjects with overweight or obesity: A randomized controlled trial

BACKGROUND & AIMS

The European Food Safety Authority recently recommended an increase in the protein content of total diet replacement (TDR) products from 50 to 75 g/day. The rationale was to minimize reductions in lean mass (LM) and resting metabolic rate (RMR) that occur with weight loss, and thereby facilitate maintenance of lost weight. We sought to directly compare the efficacy of TDR regimens with the new vs the current protein requirement.

METHODS

We randomized 108 adults with overweight or obesity (body mass index 28-40 kg/m²) to very-low-calorie diets (VLCD) with either 52 or 77 g/day protein for 8 weeks (total energy intake of 600 or 700 kcal/day, respectively). LM was determined by dual energy X-ray absorptiometry and RMR by indirect calorimetry.

RESULTS

Attrition rate was 22% in both groups. Both VLCDs decreased body weight, fat mass, LM, and RMR (all P < 0.05). Significant time-by-group interactions were detected for weight and fat mass (both P < 0.05), with corresponding reductions being smaller in the higher-protein than the standard-protein VLCD, likely because of the added calories. On the other hand, reductions in LM (6% from baseline) and RMR (9-10% from baseline) did not differ between groups (P = 0.155 and P = 0.389, respectively), and the contribution of LM to total weight loss was identical (27 ± 2% of lost weight, P = 0.973).

CONCLUSIONS

Our results indicate that the proposed increase in the protein content of TDR products does not attenuate reductions in LM and RMR in individuals with overweight and obesity who are treated with <800 kcal/day VLCDs for 2 months.

CLINICAL TRIAL REGISTRY

ClinicalTrials.gov # NCT04156165.