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

项目总结/摘要 肥胖加剧了与年龄相关的功能下降，是行动能力障碍的一个强有力的决定因素， 与较差的临床结局和生活质量相关。鉴于超过三分之一的老年人肥胖， 以及与年龄相关的残疾的公共卫生负担，确定有效的治疗方法， 老年人的功能和健康下降是迫切需要的。我们小组和其他人的临床试验表明 饮食引起的减肥干预，特别是当与运动相结合时， 在短期内（在体重减轻的状态下）， 老年人然而，在这一人群中有意减肥的总体安全性和长期益处 仍然存在争议，减肥往往不推荐，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，大多数人都没有成功。 长期保持减肥效果。因此，无论是身体和代谢功能的改善， 在老年人中，其他健康参数在有意减肥后会随着时间的推移而持续存在，特别是如果 体重反弹，未知。拟议研究的总体目标是确定短期内 有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。我们将确定随机化的影响， 饮食诱导的体重减轻对身体功能（主要结局）、身体成分、骨矿物质密度和 心血管风险因素（次要目标）干预后至少3年，最多10年 建成我们的一般假设是，随机减肥将导致改善的长期 与随机化至无体重减轻相比的身体和代谢功能。我们将利用我们的 独家访问五项NIH支持的随机对照试验，这些试验招募了超重或肥胖（BMI≥27 kg/m2）老年人（随机分组时的平均年龄为67.3岁），并将其随机分组为减肥加运动组 （n=458）或单独运动（n=396）在维克森林从2005年至2014年，其中汇集将提供 足够的样本量，以明确评估既往治疗的长期功能和健康后果 故意减肥。我们还将探讨随机减肥对减肥质量的长期影响。 生活（SF-36）、肥胖和体重减轻相关的医学事件（例如，膝关节置换术、骨折、MI）， 住院和死亡率;并评估当前行为的作用（例如，饮食摄入量、体力活动） 对维持减肥、身体机能、身体成分和心血管危险因素的影响。的 拟议的研究将是第一个随机，对照设计，以检查长期影响的故意 在老年人的体重减轻，并建立在我们的老龄化中心的合作研究重点在老年肥胖症 治疗，以回答有关长期疗效和安全性的令人信服的临床重要问题 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.