Mediterranean Diet, Weight Loss, and Cognition in Obese Older Adults

地中海饮食、减肥和肥胖老年人的认知

• 批准号: 9115315
• 负责人: Marian L. Fitzgibbon
• 金额: $ 80.6万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-01 至 2021-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9115315
• 关键词: Activities of Daily Living; Adherence; Adult; Affect; African American; Age; Aging; Alcohol consumption; Alzheimer' s Disease; American; Attention; Behavioral; Biological; Body Composition; Body Weight; Body Weight decreased; Body mass index; Caloric Restriction; Cardiovascular Diseases; Cause of Death; Cognition; Cognitive deficits; Dementia; Development; Diabetes Mellitus; Diet; Diet Habits; Diet Modification; Dietary Factors; Dietary Fats; Dietary Fiber; Dietary Practices; Dyslipidemias; Elderly; Energy Intake; Epidemiologic Studies; Ethnic Origin; Exhibits; Fabaceae; Fasting; Food; Glucose; High Prevalence; Hispanics; Hyperlipidemia; Hypertension; Impaired cognition; Impairment; Individual; Inflammation; Insulin; Insulin Resistance; Intake; Intervention; Life Style; Link; Lipids; Maintenance; Mediating; Mediator of activation protein; Mediterranean Diet; Memory; Metabolic; Neurocognition; Not Hispanic or Latino; Nuts; Obesity; Observational Study; Oxidative Stress; Participant; Pattern; Pharmacological Treatment; Physical activity; Population; Prevalence; Quality of life; Race; Randomized; Randomized Clinical Trials; Reporting; Risk; Risk Factors; Sampling; Saturated Fatty Acids; Self Efficacy; Social support; Socioeconomic Status; Symptoms; Systemic blood pressure; Testing; United States; Unsaturated Fatty Acids; Weight; Weight maintenance regimen; Work; adiponectin; aged; arm; blood lipid; blood pressure reduction; cardiovascular disorder risk; cognitive function; dietary antioxidant; disability; ethnic diversity; executive function; follow-up; food consumption; fruits and vegetables; glucose metabolism; improved; innovation; intrinsic motivation; lifestyle intervention; physical inactivity; polyphenol; post intervention; prevent; psychosocial; public health priorities; public health relevance; randomized trial; weight loss intervention

 DESCRIPTION (provided by applicant): Obesity is a leading cause of death and disability in the United States (US), affecting as many as 80 million Americans. It is well-established that obesity contributes to a number of risk factors for metabolic abnormalities and cardiovascular disease (CVD), including hypertension, diabetes, and hyperlipidemia. In addition, there is growing evidence that obesity is associated with cognitive deficits in multiple domains, even in otherwise healthy older adults. With the rapidly aging US population and the high prevalence of obesity among older adults, innovative strategies to prevent cognitive decline in this population are needed. Dietary patterns are central to the development and maintenance of obesity and evidence suggests that dietary factors also may affect cognition. Epidemiologic studies have shown that adherence to a Mediterranean Diet (MedDiet) is associated with less cognitive decline and reduced risk for dementia. Weight loss through caloric restriction also has been shown to improve cognitive function in obese adults. The identification of effective lifestyle interventions for diet/weight management to improve cognition among obese older adults is a public health priority. However, to our knowledge, no randomized clinical trials (RCTs) have examined the effect of the MedDiet, with and without caloric restriction, to promote weight loss on cognitive functioning in obese older adults. We propose a three-arm RCT in which 180 obese (body mass index [BMI] >30 and < 50 kg/m2) older adults, aged 55 years and older, will be randomized to an 8-month intervention consisting of: 1) MedDiet Alone, without caloric restriction/weight loss (MedDiet-A); 2) MedDiet lifestyle intervention with caloric restriction/weight loss (MedDiet-WL); or 3) typical diet control (TDC) without caloric restriction/weight loss. We will test the following hypotheses: 1) participants randomized to MedDiet-A and MedDiet-WL will achieve greater improvements in cognition compared to participants randomized to TDC; 2) participants randomized to MedDiet-WL will exhibit greater improvements in cognition compared to participants randomized to MedDiet-A; 3) participants randomized to MedDiet-A and MedDiet-WL will show greater improvements in CVD/metabolic risk factors, systemic inflammation, oxidative stress (OxStress), and body weight/composition compared to participants in TDC; 4) participants randomized to MedDiet-WL will exhibit greater improvements in CVD/metabolic risk factors, systemic inflammation, OxStress, and body weight/composition compared to MedDiet-A. We also we examine potential moderators of treatment (e.g., ethnicity and baseline cognitive function) and explore mediators by which neurocognition is improved by diet, including changes in CVD/metabolic risk factors, physical activity, systemic inflammation, and OxStress. We also will determine the extent to which changes in dietary habits, weight, and cognitive functioning are maintained over a 6-month follow-up period.

 肥胖是美国（US）死亡和残疾的主要原因，影响多达8000万美国人。众所周知，肥胖导致代谢异常和心血管疾病（CVD）的许多风险因素，包括高血压、糖尿病和高脂血症。此外，越来越多的证据表明，肥胖与多个领域的认知缺陷有关，即使在其他健康的老年人中也是如此。随着美国人口的迅速老龄化和老年人肥胖的高患病率，需要创新策略来预防这一人群的认知能力下降。饮食模式对肥胖的发展和维持至关重要，有证据表明饮食因素也可能影响认知。流行病学研究表明，坚持地中海饮食（MedDiet）与认知能力下降和痴呆症风险降低有关。通过热量限制减肥也被证明可以改善肥胖成年人的认知功能。确定有效的生活方式干预饮食/体重管理，以改善肥胖老年人的认知是公共卫生的优先事项。然而，据我们所知，没有随机临床试验（RCT）研究了MedDiet的效果，有和没有热量限制，以促进肥胖老年人的认知功能的体重减轻。我们提出了一个三臂随机对照试验，其中180名肥胖（体重指数[BMI] >30且< 50 kg/m2）年龄在55岁及以上的老年人将被随机分配至8个月的干预，包括：1）单独的MedDiet，无热量限制/体重减轻（MedDiet-A）; 2）具有热量限制/体重减轻的MedDiet生活方式干预（MedDiet-WL）;或3）没有热量限制/体重减轻的典型饮食控制（TDC）。我们将检验以下假设：1）与随机分配到TDC的参与者相比，随机分配到MedDiet-A和MedDiet-WL的参与者将在认知方面实现更大的改善; 2）与随机分配到MedDiet-A的参与者相比，随机分配到MedDiet-WL的参与者将在认知方面表现出更大的改善; 3）随机分配到MedDiet-A和MedDiet-WL的参与者将显示CVD/代谢风险因素，全身炎症，氧化应激的更大改善（OxStress）和体重/组成; 4）与MedDiet-A相比，随机分配至MedDiet-WL的参与者将表现出CVD/代谢风险因素、全身性炎症、OxStress和体重/组成的更大改善。我们还检查了治疗的潜在调节剂（例如，种族和基线认知功能），并探索通过饮食改善神经认知的介质，包括CVD/代谢风险因素、体力活动、全身炎症和OxStress的变化。我们还将确定饮食习惯、体重和认知功能的变化在6个月的随访期内保持的程度。