Long-term function and health effects of intentional weight loss in obese elders

项目摘要/摘要 肥胖会加剧与年龄相关的功能下降，是行动不便的一个重要决定因素，而且 与较差的临床结果和生活质量有关。鉴于超过三分之一的老年人肥胖 以及年龄相关残疾的公共卫生负担，确定预防肥胖相关的有效疗法 老年人的功能和健康水平下降是当务之急。我们小组和其他人的临床试验表明 饮食诱导的减肥干预，特别是当与运动相结合时，可以改善身体 肥胖者短期(减重状态)的组成和生理代谢功能 上了年纪的人。然而，在这一人群中，有意减肥的总体安全性和长期好处 仍然存在争议，减肥通常不被推荐，因为不确定是否有好处 超过风险(例如，肌肉质量和骨骼的损失)。此外，大多数人在以下方面不成功 长期保持减肥效果。因此，身体和代谢功能的改善以及 其他健康参数在有意减肥后的老年人中随着时间的推移而持续存在，特别是在 体重回升的发生，是未知的。拟议研究的总体目标是确定短期内 故意减肥对身体和代谢功能的好处是持续的，并检查潜在的 老年人减肥的长期益处和风险。我们将确定随机化对 饮食诱导的体重减轻对身体功能(主要结果)、身体成分、骨密度和 干预后心血管危险因素(次级目标)最少3年，最长10年 完成了。我们的一般假设是，随机减肥将导致长期改善 身体和代谢功能与随机化相比，没有减肥。我们将利用我们的 获得由美国国立卫生研究院支持的五项随机对照试验的独特途径，这些试验纳入了超重或肥胖(体重指数≥27 Kg/m2)老年人(随机分组的平均年龄为67.3岁)，并将他们随机分为减肥加锻炼组 (n=458)或在维克森林(n=396)单独锻炼(n=396)，这些活动的汇集将提供 足够的样本量来明确评估之前的长期功能和健康后果 故意减肥。我们还将探讨随机化减肥对质量的长期影响 生命(SF-36)，与肥胖和减肥相关的医疗事件(例如，膝关节置换、骨折、MI)， 住院和死亡率；并评估当前行为(例如，饮食摄入量、体力活动)的作用 关于减肥维持、身体机能、身体成分和心血管危险因素。这个 拟议的研究将是第一个随机对照设计，以检验意向性药物的长期影响。 老年人的体重减轻，并建立在我们老龄化中心对老年性肥胖的合作研究重点上 治疗以回答有关长期有效性和安全性的令人信服和临床重要的问题 以有效和具有成本效益的方式对老年人进行减肥干预。

Project Summary/Abstract Obesity exacerbates age-related declines in function, is a strong determinant of mobility disability, and is associated with poorer clinical outcomes and quality of life. Given that over one-third of older adults are obese and the public health burden of age-related disability, identifying effective therapies that prevent obesity-related declines in function and health in older adults are urgently needed. Clinical trials by our group and others show that diet-induced weight loss interventions, particularly when combined with exercise, improve body composition and physical and metabolic function over the short-term (in the weight-reduced state) in obese older adults. However, the overall safety and long-term benefits of intentional weight loss in this population remain controversial and weight loss is often not recommended because of uncertainty of whether the benefits outweigh the risks (e.g., loss of muscle mass and bone). Furthermore, most individuals are not successful at long-term maintenance of weight loss. Thus, whether improvements in physical and metabolic function and other health parameters persist over time among older adults following intentional weight loss, particularly if weight regain occurs, is unknown. The overall goals of the proposed study are to determine if the short-term benefits of intentional weight loss on physical and metabolic function are sustained and to examine potential long-term benefits and risks of weight loss in older adults. We will determine the effects of randomization to diet-induced weight loss on physical function (primary outcome), body composition, bone mineral density, and cardiovascular risk factors (secondary aims) a minimum of 3 and a maximum of 10 years after intervention completion. Our general hypothesis is that randomization to weight loss will result in improved long-term physical and metabolic function compared to randomization to no weight loss. We will take advantage of our unique access to five NIH-supported randomized, controlled trials that enrolled overweight or obese (BMI≥27 kg/m2) older adults (mean age at randomization, 67.3 years) and randomized them to weight loss plus exercise (n=458) or exercise alone (n=396) at Wake Forest from 2005 to 2014, the pooling of which will provide sufficient sample size to definitively evaluate the long-term functional and health consequences of prior intentional weight loss. We will also explore the long-term effects of randomization to weight loss on quality of life (SF-36), obesity- and weight loss-related medical events (e.g., knee replacements, fractures, MI), hospitalizations, and mortality; and assess the role of current behaviors (e.g., dietary intake, physical activity) on weight loss maintenance, physical function, body composition, and cardiovascular risk factors. The proposed study will be the first randomized, controlled design to examine the long-term effects of intentional weight loss in older adults and builds on our Aging Center's collaborative research focus in geriatric obesity treatment to answer compelling and clinically important questions regarding the long-term efficacy and safety of weight loss interventions in older adults in an efficient and cost-effective manner.