Journal of Nutrition in Gerontology and Geriatrics最新文献

Randomized, controlled trials (RCTs) show intentional weight loss improves body composition and physical function in older adults; however, the long-term benefits (and risks) are unknown. We conducted a pilot study to assess the feasibility of recalling prior RCT participants to examine the long-term effects of intentional weight loss on body composition and physical function. A weighted, random sample of 60 older adults who were randomized to caloric restriction plus exercise (CR + EX) or exercise (EX) only in 5 prior RCTs (mean age at randomization, 67.3 years; 69% women, 80% white) were invited to participate. Follow-up was obtained on 89% (42 clinic visits, 10 phone interviews, 1 death) an average of 3.5 years (range, 2.2-5.8 years) after RCT completion. Despite greater weight, fat and lean mass loss during the RCT (mean difference in change (95% CI): -4.19 (-7.52, -0.86), -2.75 (-5.10, -0.40), and -2.32 (-3.69, -0.95) kg, respectively) in those randomized to CR + EX, long-term changes in weight (2.05 (-2.35, 6.45) kg) and body composition (1.80 (-1.56, 5.17) and 0.03 (-2.20, 2.26) kg for fat and lean mass, respectively) from baseline and physical function at long-term follow-up (mean difference in 400-m walk and SPPB (95% CI): 23.2 (-19.3, 65.6) sec and -0.03 (-1.02, 0.96) points, respectively) were similar in CR + EX and EX only. Although improvements in weight and body composition following intentional weight loss may not be sustained long-term, physical function does not appear to be negatively impacted. A larger study is needed to confirm these results.

Bariatric surgery is the most effective approach to treating morbid obesity, resulting in decreased morbidity, mortality, and improved quality of life. Research on outcomes has generally been restricted to young and middle-aged adults, despite a growing epidemic of obesity in older adults. The use of bariatric surgery has been limited in older individuals, in part due to concerns that preexisting cognitive dysfunction increases the risk of poor post-surgical outcomes, including cognitive decline. The literature on the relationship between obesity and cognition in older adults is emerging, but fraught by several methodological limitations. While there is insufficient research to determine the nature of cognitive outcomes following bariatric surgery in older adults, the aim of this paper is to review the existing evidence and make the case for further study.

Both aging and obesity are associated with increased levels of pro-inflammatory metabolites, while weight reduction is associated with improvements in inflammatory status. However, few studies have explored the response of key inflammatory markers to the combined settings of weight reduction in an aging population. There are also few studies that have investigated the potential impact of diet composition on inflammatory marker responses. In the MEASUR-UP trial, we evaluated changes in baseline levels of inflammatory markers with post-study levels for a traditional weight loss control group versus a group with generous, balanced protein intake. In this 6-month randomized controlled trial (RCT), older (≥60 years) adults with obesity (BMI ≥30 kg/m²) and Short Physical Performance Battery (SPPB) score of 4-10 were randomly assigned to either a traditional weight loss regimen, (Control, n = 14) or one with higher protein intake (≥30 g) at each meal (Protein, n = 25). All participants were prescribed a hypo-caloric diet and attended weekly support and education groups and weigh-ins. Protein participants consumed ≥30 g of high-quality protein/meal, including lean and extra lean beef provided to them for two of the three meals per day. Protein intakes were 0.8 and 1.2 g/kg/day for Control and Protein, respectively. Adiponectin, leptin, C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1), IL-6, IL-8, serum amyloid A (SAA), vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), and glycated serum protein (GSP) levels were measured at 0 and 6-month time points. At the 6-month endpoint, there was significant weight loss and decrease in BMI in both the Control (-4.8 ± 8.2 kg; -2.3 ± 2.4 kg/m²; p = 0.05) and Protein (-8.7 ± 7.4 kg; -2.9 ± 2.3 kg/m²; p < 0.0001) groups. SPPB scores improved in both arms, with a superior functional response in Protein (p < 0.05). Body fat (%) at baseline was positively correlated with leptin, hs-CRP, VCAM-1, ICAM-1, and GSP. Several markers of inflammation responded to the Protein group: leptin (p < 0.001), hs-CRP (p < 0.01), and ICAM-1 (p < 0.01) were decreased and adiponectin increased (p < 0.01). There were no significant changes in any inflammatory markers in the Control arm. In the between group comparison, only adiponectin trended towards a group difference (more improvement in Protein; p < 0.07). Our findings in the MEASUR-UP trial show that a weight loss diet with enhanced protein intake is comparable to an adequate protein diet in terms of weight loss success and that it can lead to improvements in inflammatory status, specifically for adiponectin, leptin, hs-CRP, and ICAM-1. These findings are important given current recommendations for higher protein intakes in older adults and justify the additional study of the inflammatory impact of an enhanced protein diet. (ClinicalTrials.gov identifier: NCT01715753).

Obesity in older adults is a growing public health problem, yet the appropriate treatment remains controversial partly due to evidence that weight loss reduces bone mass and may increase fracture risk. The purpose of this review is to summarize the research to date on the effects of diet-induced weight loss on bone health in obese (body mass index 30 kg/m² and above) older (aged 65 years or older) adults. Observational studies have shown that weight loss in this population decreases total hip bone mineral density and increases the risk of frailty fractures (composite of proximal femur, pelvis, and proximal humerus fractures). Randomized controlled trials have largely confirmed these earlier observations but have also shown that exercise, particularly progressive resistance training, can attenuate or even alleviate this bone loss. Further research incorporating outcomes concerning bone quality and mass are needed to identify the optimal exercise and nutritional regimens to counteract the bone loss.

The current study evaluated whether there were racial/ethnic differences in the association between childhood adverse experience (ACEs), perceived racial discrimination (PRD), and body mass index (BMI) in a sample of middle age and older adults. We used data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (N = 11,404; ≥55 years) that included ACE and past year experiences with PRD. Generalized linear models were stratified by race/ethnicity (non-Hispanic White (NHW; n = 7337), non-Hispanic Black (NHB; n = 1960), and Hispanic (n = 1249)). The prevalence of ACE and PRD was significantly greater in NHB (63.6 and 29.8%, respectively) and Hispanic (61.2 and 15.9%, respectively), relative to NHW (53.1 and 4.6%, respectively). Across race/ethnicity, exposure to ACE's was associated with significantly greater odds of reporting PRD. Surprisingly, among Hispanics, exposure to ACE's was generally associated with lower BMI; however, this association was moderated by PRD in that BMI was highest among those with no ACE's and PRD, and lowest among those without ACE's or PRD. Similar, but not significant, trends were found for NHW's and NHB's. Our findings highlight the importance of screening for psychosocial adversity across the life course as risks factors for high BMI among middle age and older adults, particularly among Hispanics.

Obesity rates in people 60 years and older are increasing. While obesity is linked with detrimental health risks, weight loss in this population has previously been considered controversial due to potential worsening of age-related sarcopenia. Protein intake during energy restriction has been linked to lean body mass preservation. No formal guidelines for optimal protein intake during structured weight loss interventions exist for this population, but it appears that the current Recommended Dietary Allowance of 0.8 grams per kilogram of body weight per day may be inadequate. The purpose of this review is to discuss optimal protein intake during structured weight loss interventions in persons 60 years and older with obesity and to present a framework for guidelines to be used by health professionals focusing on weight loss interventions in older adults. Goals for the amount, source, and timing of protein intake, from both food and supplements, are presented and discussed.

The older adult population in Canada is growing, creating a greater demand for long-term care (LTC) facilities. Seniors living in LTC are more vulnerable to malnutrition, making it important to implement nutrition screening tools on a routine basis. The purpose of this study was to explore the practices of Registered Dietitians (RDs) related to nutritional screening, nutritional assessment, and follow-ups conducted within LTC facilities. This study also explored possible barriers hindering the application of these practices. Nine RDs from two health regions in Southern Saskatchewan completed a phone interview to address nutrition care practices/policies and barriers in LTC facilities. Results showed a considerable amount of variability in nutrition care practices for screening and assessment with lack of time identified as the greatest barrier. These findings highlight the importance of having consistent policies and a sufficient amount of RDs available in LTC facilities to provide the expected level of nutrition care for residents.

Malnutrition in older adults residing in long-term care facilities continues to be a problem in the United States. Existing research has identified a list of possible contributing factors, including staffing problems. Few studies on food and nutrition care have attempted to gain the perspectives of nursing or dietary aides (henceforth, aides), the frontline staff who work most closely with the residents of long-term care facilities. The current study takes a qualitative approach grounded in a theoretical perspective based on Total Quality Management (TQM) to increase understanding of the interpersonal and management practices that affect resident wellbeing, health, and nutrition. Four focus groups (n = 24) were conducted with aides working in long-term care facilities. Aides expressed emotional closeness with residents and provided detailed knowledge about food and nutrition care. They reported both compassion fatigue and satisfaction. An element of dissatisfaction related to aide relationships with management and other employees who did not actively solicit their perspectives and knowledge on resident feeding. The knowledge and experience of aides could be better utilized by shifting management strategies to focus on employee empowerment and training. Principles of TQM could be applied to improve food and nutrition care in long-term care facilities.

Older adult (OA) dietary practices may be placing them at nutritional risk. This cross-sectional study examined the dietary intake frequencies (DIF) and nutritional risk (NR) using the Dietary Screening Tool (DST) of OA attending community-based nutrition education and physical activity programs. Most were white females aged 60-80 years. The majority (80.1%) were classified as "at NR" or "at possible NR." Participants had "low" lean protein, dairy, and processed meat DIF and "moderate" whole fruit and juice, total and whole grains, vegetables and added fats, sugars, and sweets DIF. State influenced whole fruit and juice (p ≤ .001) and vegetable (p = .021) DIF, age influenced processed meat DIF (p = .001), and gender influenced NR (p = .006), vegetable (p = .022), and processed meat (p = .033) DIF. Results indicate that OA participating in lifestyle interventions are at NR. When developing future nutrition education programs, educators should consider sociodemographic factors to promote dairy and protein-rich foods to OA at NR.