Effect of Weight Change Following Intentional Weight Loss on Bone Health in Older Adults with Obesity.
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ABSTRACT:
SUBMITTER: Kammire DE
PROVIDER: S-EPMC6832808 | biostudies-literature | 2019 Nov
REPOSITORIES: biostudies-literature
Publications
Effect of Weight Change Following Intentional Weight Loss on Bone Health in Older Adults with Obesity.
Kammire Daniel E DE Walkup Michael P MP Ambrosius Walter T WT Lenchik Leon L Shapses Sue A SA Nicklas Barbara J BJ Houston Denise K DK Marsh Anthony P AP Rejeski W Jack WJ Beavers Kristen M KM
Obesity (Silver Spring, Md.) 20190904 11
<h4>Objective</h4>This study aimed to examine change in bone mineral density (BMD) and trabecular bone score among older adult weight regainers (WR) and weight maintainers (WM).<h4>Methods</h4>Observational data come from 77 older adults (mean age: 67 [SD 5] years; 69% women; 70% white) with obesity (mean BMI: 33.6 [SD 3.7] kg/m<sup>2</sup> ) who lost weight during an 18-month weight loss intervention. Total body mass and body composition, along with regional (total hip, femoral neck, lumbar sp ...[more]
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Project description:BACKGROUND:Observational research has identified several mortality biomarkers; however, their responsiveness to change is unknown. We tested whether the Healthy Aging Index (HAI) and other mortality biomarkers were responsive to intentional weight loss (WL), which is associated with lower mortality risk in recent meta-analyses. METHODS:Older adults (70.3 ± 3.7 years) with obesity were randomized into a 6-month WL (n = 47) or weight stability (WS: ±5% baseline weight; n = 48) program. Baseline and 6-month HAI score (0-10) was calculated from component sum (each 0-2: systolic blood pressure, forced vital capacity [FVC], creatinine, fasting blood glucose [FBG], Montreal Cognitive Assessment), and gait speed, grip strength, Digit Symbol Substitution Test, FEV1, Interleukin-6, C-Reactive Protein, and Cystatin-C were assessed at baseline and 6 months. RESULTS:Mean baseline HAI was 3.2 ± 1.6. By 6 months, WL participants lost 8.87 (95% CI: -10.40, -7.34) kg, whereas WS participants remained weight stable. WL group reduced HAI score (WL: -0.75 [95% CI: -1.11, -0.39] vs WS: -0.22 [95% CI: -0.60, 0.15]; p = .04), and components changing the most were FBG (WL: -3.89 [95% CI: -7.78, 0.00] mg/dL vs WS: 1.45 [95% CI: -2.61, 5.50] mg/dL; p = .047) and FVC (WL: 0.11 [95% CI: -0.01, 0.23] L vs WS: -0.05 [95% CI: -0.17, 0.08] L; p = .06). Among other biomarkers, only Cystatin-C significantly changed (WL: -2.53 [95% CI: -4.38, -0.68] ng/mL vs WS: 0.07 [95% CI: -1.85, 1.98] ng/mL; p = .04). Combining treatment groups, 1 kg WL was associated with a 0.07 (95% CI: 0.03, 0.12) HAI reduction (p < .01). CONCLUSION:Intentional WL via caloric restriction reduced HAI score by 0.53 points, largely attributable to metabolic and pulmonary improvements.
| S-EPMC7179512 | biostudies-literature
Project description:OBJECTIVE:To examine the long-term effects of exercise modality during weight loss on body composition and associations between body composition and physical function changes. METHODS:Two hundred forty-nine older adults (66.9?±?4.7 years, 71% women, 32% African American, BMI: 34.4?±?3.7 kg/m2 ) were randomized to weight loss (WL; n?=?82), WL plus aerobic training (WL?+?AT; n?=?86), or WL plus resistance training (WL?+?RT; n?=?81) for 18 months. Dual-energy x-ray absorptiometry-acquired body composition, 400-m walk time, and knee extensor strength were measured at baseline and at 6 and 18 months. RESULTS:Total body mass loss was enhanced when WL was combined with exercise (WL: -5.7?±?0.7 kg, WL?+?AT: -8.5?±?0.7 kg, WL?+?RT: -8.7?±?0.7 kg; P?<?0.01). Total body fat mass loss was significantly greater in WL?+?AT (-6.8?±?0.6 kg, -16.4%) and WL?+?RT (-7.8?±?0.5 kg, -19.0%) than WL (-4.8?±?0.6 kg, -10.9%); both P?<?0.01. Lean mass loss was greatest in WL?+?AT (-1.6?±?0.3 kg, -3.1%) compared with WL?+?RT (-0.8?±?0.3 kg, -1.5%) or WL (-1.0?±?0.3 kg; -2.0%); both P???0.02. Change in 400-m walk time was associated with change in fat mass (?/SD?=?+6.1 s; P?<?0.01), while change in knee extensor strength was associated with change in lean mass (?/SD?=?+1.6?Nm; P?<?0.01). CONCLUSIONS:WL?+?RT results in less lean mass lost than WL?+?AT; WL plus exercise yields greater fat mass loss than WL alone.
| S-EPMC5678994 | biostudies-literature
Project description:BackgroundDespite the reported benefits, weight loss is not always advised for older adults because some observational studies have associated weight loss with increased mortality. However, the distinction between intentional and unintentional weight loss is difficult to make in an observational context, so the effect of intentional weight loss on mortality may be clarified in the setting of a randomized controlled trial.ObjectiveThe objective was to determine the effect of intentional weight loss on all-cause mortality by using follow-up data from a randomized trial completed in 1995 that included a weight-loss arm.DesignThe Trial of Nonpharmacologic Intervention in the Elderly (TONE) used a 2 × 2 factorial design to determine the effect of dietary weight loss, sodium restriction, or both on blood pressure control in 585 overweight or obese older adults being treated for hypertension (mean ± SD age: 66 ± 4 y; 53% female). All-cause mortality was ascertained by using the Social Security Index and National Death Index through 2006.ResultsThe mortality rate of those who were randomly assigned to the weight-loss intervention (n = 291; mean weight loss: 4.4 kg) did not differ significantly from that of those who were not randomly assigned to this group (n = 294; mean weight loss: 0.8 kg). The adjusted HR was 0.82 (95% CI: 0.55, 1.22).ConclusionsIntentional dietary weight loss was not significantly associated with increased all-cause mortality over 12 y of follow-up in older overweight or obese adults. Additional studies are needed to confirm and extend our findings to older age groups. This trial is registered at clinicaltrials.gov as NCT00000535.
| S-EPMC3155925 | biostudies-literature
Project description:Abstract Randomized controlled trial results in obese older adults consistently associate intentional weight loss of 5–10% with clinically meaningful improvement in gait speed, on average. Consideration of individual differences in response, however, has been largely ignored. The purpose of this study is to describe the inter-individual variability in gait speed response to intentional weight loss in overweight and obese older adults. Participants from the Intensive Diet and Exercise for Arthritis trial (NCT00381290), randomized to a caloric restriction intervention targeting 10% weight loss over 18 months were included, with fast-paced 6-minute walk assessed at baseline and 6 months. Of 112 participants (BMI: 33.6?±?3.7?kg/m2; age: 66.7?±?5.9 years), 79 experienced at least 5% weight loss at 6 months and increased gait speed by 0.05?±?0.10 m/s (p<0.001). Individual changes, however, varied from -0.27 to 0.29 m/s, with 24% (n=19) experiencing no improvement (i.e. change?0.0 m/s). At ?10% achieved weight loss at 6 months, mean gait speed increased by 0.06?±?0.10 m/s (range: -0.16 to 0.29 m/s) and the subset of non-responders increased to 29% (n=14/48). When considering gender, age, race, baseline BMI and baseline gait speed, change in gait speed was negatively associated with both baseline gait speed and African-American race (both p<0.05). Data suggest large variation in the magnitude of gait speed change for a given amount of weight loss and highlight a subset of participants likely to experience no improvement. Better understanding of the characteristics influencing weight loss-associated functional change is necessary to optimize individualized weight management strategies for this population.
| S-EPMC6248507 | biostudies-literature
Project description:BackgroundEpidemiologic studies regarding weight loss and subsequent cancer risk are sparse. The study aim was to evaluate the association between weight change by intentionality and obesity-related cancer incidence in the Women's Health Initiative Observational Study. Eleven cancers were considered obesity related: breast, ovary, endometrium, colon and rectum, esophagus, kidney, liver, multiple myeloma, pancreas, stomach, and thyroid.MethodsPostmenopausal women (n = 58 667) aged 50-79 years had body weight and waist circumference (WC) measured at baseline and year 3. Weight or WC change was categorized as stable (change < ±5%), loss (≥5%), and gain (≥5%). Self-report at year 3 characterized weight loss as intentional or unintentional. During the subsequent 12 years (mean) of follow-up, 6033 incident obesity-related cancers were identified. Relationships were evaluated using multivariable Cox proportional hazards regression models.ResultsCompared to women with stable weight, women with intentional weight loss had lower obesity-related cancer risk (hazard ratio [HR] = 0.88, 95% confidence interval [CI] = 0.80 to 0.98). A similar result was observed for intentional WC reduction (HR = 0.88, 95% CI = 0.80 to 0.96). Among all cancers, intentional weight loss was most strongly associated with endometrial cancer (HR = 0.61, 95% CI = 0.42 to 0.88). Intentional WC loss was also associated with lower colorectal cancer risk (HR = 0.79, 95% CI = 0.63 to 0.99). Unintentional weight loss or weight gain was not associated with overall obesity-related cancer risk.ConclusionIntentional weight or WC loss in postmenopausal women was associated with lower risk of obesity-related cancer. These findings suggest that postmenopausal women who intentionally lose weight can reduce their obesity-related cancer risk.
| S-EPMC6795232 | biostudies-literature
Project description:Background:To examine the effects of daily weighted vest use during a dietary weight loss intervention, on (a) hip and spine bone mineral density (aBMD), and (b) biomarkers of bone turnover, in older adults with obesity. Methods:37 older (70.1 ± 3.0 years) adults with obesity (BMI=35.3 ± 2.9) underwent a 22 week dietary weight loss intervention (1100-1300 kcal/day) with (Diet+Vest; n=20) or without (Diet; n=17) weighted vest use (goal: 10+ h/day; weight added incrementally based on amount of weight lost). Total body weight; DXA-acquired aBMD of the total hip, femoral neck and lumbar spine; and biomarkers of bone turnover (OC, BALP, P1NP, CTX) were measured at baseline and follow up. General linear models, adjusted for baseline values of the outcome and gender, were used to examine intervention effects. Results:Average weight loss was significant in both groups (-11.2 ± 4.4 kg and -11.0 ± 6.3 kg, Diet+Vest and Diet groups, respectively), with no difference between groups (p=0.91). Average weighted vest use was 6.7 ± 2.2 h/day. No significant changes in aBMD or biomarkers were observed, although trends were noted for total hip aBMD and BALP. Loss in total hip aBMD was greater in the Diet group compared with Diet+Vest (?: -18.7 [29.3, -8.1] mg/cm2 versus -6.1 [-15.7, 3.5] mg/cm2; p=0.08). BALP increased in the Diet+Vest group by 3.8% (?: 0.59 [-0.33, 1.50] ?g/L) and decreased by -4.6% in the Diet group (?: -0.70 [-1.70, 0.31] ?g/L, p=0.07). Conclusion:Weighted vest use during weight loss may attenuate loss of hip aBMD and increase bone formation in older adults with obesity. Further study is warranted.
| S-EPMC5788462 | biostudies-literature
Project description:Background:To examine the effect of exercise modality during weight loss on hip and spine bone mineral density (BMD) in overweight and obese, older adults. Methods:This analysis compared data from two 5-month, randomized controlled trials of caloric restriction (CR; inducing 5-10% weight loss) with either resistance training (RT) or aerobic training (AT) in overweight and obese, older adults. Participants in the RT + CR study underwent 3 days/week of 8 upper/lower body exercises (3 sets, 10 repetitions at 70% 1 RM) and participants in the AT+CR study underwent 4 days/week of treadmill walking (30 min at 65-70% heart rate reserve). BMD at the total hip, femoral neck, and lumbar spine was assessed via dual-energy X-ray absorptiometry at baseline and 5 months. Results:A total of 123 adults (69.4 ± 3.5 years, 67% female, 81% Caucasian) participated in the RT+CR (n = 60) and AT+CR (n = 63) interventions. Average weight loss was 5.7% (95% CI: 4.6-6.7%) and 8.2% (95% CI: 7.2-9.3%) in RT+CR and AT+CR groups, respectively. After adjustment for age, gender, race, baseline BMI and BMD, and weight change, differential treatment effects were observed for total hip and femoral neck (both p < .05), but not lumbar spine. Total hip (1.83 [-3.90, 7.55] mg/cm2) and femoral neck (9.14 [-0.70, 18.98] mg/cm2) BMD was unchanged in RT+CR participants, and modestly decreased in AT+CR participants (total hip: -7.01 [-12.73, -1.29] mg/cm2; femoral neck: -5.36 [-14.92, 4.20] mg/cm2). Conclusions:Results suggest performing resistance, rather than aerobic, training during CR may attenuate loss of hip and femoral neck BMD in overweight and obese older adults. Findings warrant replication from a long-term, adequately powered, RCT.
| S-EPMC5861903 | biostudies-other
Project description:To assess the extent to which initial, intentional weight loss-associated improvements in glucose tolerance and insulin action are diminished with weight regain.138 overweight and obese (BMI: 32.4±3.9kg/m(2)), adults (59.0±9.7 years), with pre-diabetes were followed through a 6-month weight loss intervention and subsequent 18-month weight maintenance period, or usual care control condition. Longitudinal change in weight (baseline, 6, 24 months) was used to classify individuals into weight pattern categories (Loser/Maintainer (LM), n= 50; Loser/Regainer (LR), n=51; and Weight Stable (WS), n=37). Fasting plasma glucose (FPG), insulin, and insulin resistance (HOMA-IR) were measured at baseline, 6, 12, 18 and 24 months and model adjusted changes, by weight pattern category, were assessed.LMs and LRs lost 8.3±4.7kg (8.7±4.5%) and 9.6±4.7kg (10.2±4.7%) during the first 6 months, respectively. LM continued to lose 1.1±3.4kg over the next 18 months (9.9±6.5% reduction from baseline; p<0.05), while LRs regained 6.5±3.7kg (3.3±5.3% reduction from baseline; p<0.05). Weight change was directly associated with change in all DM risk factors (all p<0.01). Notably, despite an absolute reduction in body weight (from baseline to 24 months) achieved in the LR group, 24-month changes in FPG, insulin, and HOMA-IR did not differ between WS and LR groups. Conversely, LM saw sustained improvements in all measured DM risk factors.Significant weight loss followed by weight loss maintenance is associated with sustained improvements in FPG, insulin, and HOMA-IR; conversely, even partial weight regain is associated with regression of initial improvements in these risk factors towards baseline values.
| S-EPMC4385513 | biostudies-literature
Project description:The objective of this study was to determine the ability of either aerobic or resistance training to counter weight-loss-associated bone loss in older adults. There were 187 older adults (67 years, 70% women, 64% white) with obesity (BMI = 34.5 ± 3.7 kg/m2 ) and cardiovascular disease and/or metabolic syndrome who were randomized to participate in an 18-month, community-based trial, with a follow-up assessment at 30 months. Intervention arms included: weight loss alone (WL; 7% to 10% baseline weight), WL plus aerobic training (WL + AT), and WL plus resistance training (WL + RT), as well as DXA-acquired total hip, femoral neck, and lumbar spine areal bone mineral density (aBMD), and trabecular bone score (TBS). Biomarkers of bone turnover (procollagen type 1 N-terminal propeptide, C-terminal telopeptide of type 1 collagen) were measured at baseline, 6, 18, and 30 (aBMD and TBS only) months. CT-acquired hip and spine volumetric BMD (vBMD), cortical thickness, and bone strength were measured in a subset at baseline (n = 55) and 18 months. Total hip aBMD was reduced by 2% in all groups at 18 months, with a primary analysis showing no significant treatment effects for any DXA, biomarker, or CT outcome. After adjustment for WL and follow-up at 30 months, secondary analyses revealed that total hip [-0.018 (-0.023 to -0.012) g/cm2 versus -0.025 (-0.031 to -0.019) g/cm2 ; p = 0.05] and femoral neck [-0.01 (-0.009 to 0.008) g/cm2 versus -0.011 (-0.020 to -0.002) g/cm2 ; p = 0.06] aBMD estimates were modestly attenuated in the WL + RT group compared with the WL group. Additionally, lumbar spine aBMD was increased in the WL [0.015 (0.007 to 0.024) g/cm2 ] and the WL + RT [0.009 (0.000 to 0.017) g/cm2 ] groups compared with the WL + AT [-0.003 (-0.012 to 0.005)g/cm2 ] group; both p ≤ 0.01. Community-based exercise does not prevent bone loss during active WL in older adults; however, adding RT may help minimize long-term hip bone loss. © 2018 American Society for Bone and Mineral Research.
| S-EPMC6545884 | biostudies-literature
Project description:Background:Among older, overweight, and obese adults with either cardiovascular disease or the metabolic syndrome, reduced mobility and loss of leg strength are important risk factors for morbidity, disability, and mortality. It is unclear whether community-based approaches to weight loss may be an effective solution to this public health challenge. Methods:An 18-month three-site, randomized controlled trial conducted by YMCA staff, with blinded assessors, enrolled 249 older, overweight, and obese adults with either cardiovascular disease or metabolic syndrome with randomization to three interventions: weight loss alone (WL), weight loss + aerobic training (WL + AT), and weight loss + resistance training (WT + RT). The dual primary outcomes were 400-m walk time in seconds and knee extensor strength in Newton meters. Results:All groups lost weight from baseline: average baseline adjusted change of -6.1% (95% confidence interval [CI]: -7.5 to -4.7) for WL only, -8.6% (95% CI: -10.0 to -7.2) for WL + AT, and -9.7% (95% CI: -11.1 to -8.4) for WL + RT. Combined, the two physical activity + WL training groups had greater improvement in walk time than WL alone (mean difference 16.9 seconds [95% CI: 9.7 to 24.0], p < .0001). Baseline adjusted change in knee extensor strength was no greater with WL + RT than WL + AT (mean difference -3.6 Nm [95% CI: -7.5 to 0.3], p = .07). Conclusions:At risk, older, overweight and obese adults can achieve clinically significant reductions in body weight with community-based weight loss programs. The change in percent weight loss and improvements in mobility are significantly enhanced when either RT or AT is combined with dietary WL.
| S-EPMC5861918 | biostudies-literature