Obesity Interventions for Older Adults: Diet as a Determinant of Physical Function
Obesity Interventions for Older Adults: Diet as a Determinant of Physical Function
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DOI：
10.1093/advances/nmx016
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发表时间：
2018-03-01
影响因子：
9.3
通讯作者：
Starr, Kathryn N. Porter
中科院分区：
文献类型：
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作者：
Bales, Connie W.;Starr, Kathryn N. Porter
在世界范围内，老年人群中肥胖的高流行率造成了一种新的虚弱表型：肥胖，功能虚弱的老年人。肥胖流行与全球老龄化的趋同无疑会增加这种担忧的流行程度。治疗的障碍包括，由于与年龄相关的生理变化，以及对具体标准和临界值缺乏共识，对应该引发干预的适当肥胖水平存在歧见。此外，由于担心对瘦体重、骨密度甚至死亡率的负面影响，对这一人群的肥胖干预受到限制。然而，最近报道的通过减少肥胖来恢复身体功能的方法已经显示出良好的短期疗效。由于这些干预措施中的大多数都将运动作为治疗的一部分，因此本综述特别关注目前对饮食干预对老年肥胖的离散影响的理解，这些影响涉及到测试的功能结果，包括短时间身体表现测试、身体表现测试和西安大略和麦克马斯特大学骨关节炎指数。文献显示，减肥饮食或运动养生对身体机能的好处大致相当，尽管这两种方式单独使用都不如两者结合使用有效。在减肥期间摄入蛋白质的3项研究中，只有1项显示蛋白质对功能有积极影响，但迄今为止的研究结果太有限，无法证明或否定蛋白质的益处。我们的结论是，尽管饮食和运动应该尽可能地结合起来，但进一步调查卡路里限制和/或营养改变所能提供的有益和可能的独特效果仍然很重要，特别是对肥胖和功能虚弱的老年人。
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.