Weight loss interventions have not been advocated for overweight/obese older adults due to potential loss of skeletal muscle and strength impacting on physical function with potential loss of independence. Carotenoids and polyphenols are inversely associated with sarcopenic symptomology. This paper reports the protocol of a study evaluating the efficacy of a high-protein, energy restricted diet rich in carotenoids and polyphenols on body composition, muscle strength, physical performance and quality of life in overweight and obese older adults.
This randomised controlled clinical trial will recruit community-dwelling, healthy overweight and obese older adults (≥60 years) for a 12-week weight loss intervention. Seventy-three participants will be recruited and randomized to an energy restricted (~30% restriction), isocaloric diet (30% protein; 30% carbohydrate; 40% fat) enriched with either: a) 375 g/d of high carotenoid vegetables, 300 g/d high carotenoid fruit, and 40-60 ml extra-virgin olive oil (EVOO); or b) 375 g/d of lower carotenoid vegetables, 300 g/d lower carotenoid fruit, and 40-60 ml Polyunsaturated fatty acid (PUFA) based oil. All participants will receive individual dietary counselling each fortnight for the duration of the study and will be asked to maintain their habitual level of physical activity throughout the study. The primary outcome will be appendicular skeletal muscle (ASM) assessed by dual energy X-ray absorptiometry (DXA). Secondary outcomes will include body weight, fat-free mass (FFM), fat mass (FM), muscle strength (Isometric hand-grip strength), physical performance (Short Physical Performance Battery), physical activity (International Physical Activity Questionnaire) and health related quality of life (SF-36). Outcomes will be measured at baseline and at week 12.
The results of this study will provide a novel insight relating to the potential influence of high carotenoid and polyphenol intakes on attenuation of ASM during dietary energy-restricted weight loss in overweight and obese older adults.
The trial was registered on the Australia New Zealand Clinical Trials Register (ACTRN12616001400459); Trial registration date: 10th October, 2016.
Fielding RA, Vellas B, Evans WJ, Bhasin S, Morley JE, Newman AB, Abellan van Kan G, Andrieu S, Bauer J, Breuille D. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. JAMA. 2011;12(4):249–56.
Cruz-Jentoft AJ, Landi F, Schneider SM, Zúñiga C, Arai H, Boirie Y, Chen L-K, Fielding RA, Martin FC, Michel J-P. Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the international sarcopenia initiative (EWGSOP and IWGS). Age Ageing. 2014;43(6):748–59. PubMedPubMedCentralCrossRef
Janssen I, Heymsfield SB, Wang Z, Ross R. Skeletal muscle mass and distribution in 468 men and women aged 18–88 yr. J Applied Physiol. 2000;89(1):81–8. CrossRef
Houston DK, Nicklas BJ, Zizza CA. Weighty concerns: the growing prevalence of obesity among older adults. JADA. 2009;109(11):1886–95. CrossRef
Ballor DL, Katch V, Becque M, Marks C. Resistance weight training during caloric restriction enhances lean body weight maintenance. Am J Clin Nutr. 1988;47(1):19–25. PubMed
Chomentowski P, Dubé JJ, Amati F, Stefanovic-Racic M, Zhu S, Toledo FG, Goodpaster BH. Moderate exercise attenuates the loss of skeletal muscle mass that occurs with intentional caloric restriction–induced weight loss in older, overweight to obese adults. J Gerontol A Biol Sci Med Sci. 2009;64(5):575–80. PubMedCrossRef
McDonald SR, Starr KNP, Mauceri L, Orenduff M, Granville E, Ocampo C, Payne ME, Pieper CF, Bales CW. Meal-based enhancement of protein quality and quantity during weight loss in obese older adults with mobility limitations: rationale and design for the MEASUR-UP trial. Contemporary Clinical Trials. 2015;40:112–23. PubMedCrossRef
Starr KNP, Orenduff MC, McDonald SR, Pieper CF, Mulder HC, Maloney K, Bales CW. Influence of daily and per meal protein intakes on function and body composition in frail, obese older adults undergoing weight reduction. FASEB J. 2016;30(1):411–9.
Backx E, Tieland M, Borgonjen-van den Berg K, Claessen P, van Loon L, de Groot L. Protein intake and lean body mass preservation during energy intake restriction in overweight older adults. IJO. 2016;40(2):299–304.
Verreijen AM, Verlaan S, Engberink MF, Swinkels S, de Vogel-van den Bosch J, Weijs PJ. A high whey protein–, leucine-, and vitamin D–enriched supplement preserves muscle mass during intentional weight loss in obese older adults: a double-blind randomized controlled trial. Am J Clin Nutr. 2015;101(2):279–86. PubMedCrossRef
Beavers KM, Gordon M, Easter L, Beavers D, Hairston K, Nicklas B, Vitolins M. Effect of protein source during weight loss on body composition, cardiometabolic risk and physical performance in abdominally obese, older adults: a pilot feeding study. J Nutr Health Aging. 2015;19(1):87–95. PubMedPubMedCentralCrossRef
Coker RH, Miller S, Schutzler S, Deutz N, Wolfe RR. Whey protein and essential amino acids promote the reduction of adipose tissue and increased muscle protein synthesis during caloric restriction-induced weight loss in elderly, obese individuals. Nutr J. 2012; https://doi.org/10.1186/1475-2891-11-105.
Breen L, Phillips SM. Skeletal muscle protein metabolism in the elderly: interventions to counteract the'anabolic resistance’ of ageing. Nutr Metab. 2011; https://doi.org/10.1186/1743-7075-8-68.
Welle S, Thornton C, Jozefowicz R, Statt M. Myofibrillar protein synthesis in young and old men. Am J Physiol Endocrinol Metab. 1993;264(5):693–8. CrossRef
Proctor D, Balagopal P, Nair KS. Age-related sarcopenia in humans is associated with reduced synthetic rates of specific muscle proteins. J Nutr. 1998;128(2):351–5.
Cuthbertson D, Smith K, Babraj J, Leese G, Waddell T, Atherton P, Wackerhage H, Taylor PM, Rennie MJ. Anabolic signaling deficits underlie amino acid resistance of wasting, aging muscle. FASEB J. 2005;19(3):422–4. PubMed
Bauer J, Biolo G, Cederholm T, Cesari M, Cruz-Jentoft AJ, Morley JE, Phillips S, Sieber C, Stehle P, Teta D. Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE study group. JAMA. 2013;14(8):542–59.
Urpi-Sarda M, Andres-Lacueva C, Rabassa M, Ruggiero C, Zamora-Ros R, Bandinelli S, Ferrucci L, Cherubini A. The relationship between urinary total polyphenols and the frailty phenotype in a community-dwelling older population: the InCHIANTI study. J Gerontol A Biol Sci Med Sci. 2015;70(9):1141–7. PubMedPubMedCentralCrossRef
Rabassa M, Zamora-Ros R, Andres-Lacueva C, Urpi-Sarda M, Bandinelli S, Ferrucci L, Cherubini A. Association between both total baseline urinary and dietary polyphenols and substantial physical performance decline risk in older adults: a 9-year follow-up of the InCHIANTI study. J Nutr Health Aging. 2016;20(5):478–84. PubMedPubMedCentralCrossRef
Talegawkar SA, Bandinelli S, Bandeen-Roche K, Chen P, Milaneschi Y, Tanaka T, Semba RD, Guralnik JM, Ferrucci L. A higher adherence to a Mediterranean-style diet is inversely associated with the development of frailty in community-dwelling elderly men and women. J Nutr. 2012;142(12):2161–6. PubMedPubMedCentralCrossRef
León-Muñoz LM, García-Esquinas E, López-García E, Banegas JR, Rodríguez-Artalejo F. Major dietary patterns and risk of frailty in older adults: a prospective cohort study. BMC Med. 2015; https://doi.org/10.1186/s12916-014-0255-6.
Tyrovolas S, Haro J-M, Mariolis A, Piscopo S, Valacchi G, Bountziouka V, Anastasiou F, Zeimbekis A, Tyrovola D, Foscolou A. Skeletal muscle mass and body fat in relation to successful ageing of older adults: the multi-national MEDIS study. Arch Gerontol Geriat. 2016;66:95–101. CrossRef
Winter JE, MacInnis RJ, Wattanapenpaiboon N, Nowson CA. BMI and all-cause mortality in older adults: a meta-analysis. Am J Clin Nutr. 2014; https://doi.org/10.3945/ajcn.113.068122.
Kim J, Wang Z, Heymsfield SB, Baumgartner RN, Gallagher D. Total-body skeletal muscle mass: estimation by a new dual-energy X-ray absorptiometry method. Am J Clin Nutr. 2002;76(2):378–83. PubMed
Schaubert K, Bohannon R. Reliability and validity of three strength measures obtained from community-dwelling elderly persons. J Strength Cond Res. 2005;19(3):717–20. PubMed
Guralnik J, Simonsick E, Ferrucci L, Glynn R, Berkman L, Blazer D, Scherr P, Wallace R. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49:85–94. CrossRef
Guralnik JM, Ferrucci L, Pieper CF, Leveille SG, Markides KS, Ostir GV, Studenski S, Berkman LF, Wallace RB. Lower extremity function and subsequent disability consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci. 2000;55(4):221–31. CrossRef
Jancey J, Lee A, Howat P, Clarke A, Wang K, Shilton T. Reducing attrition in physical activity programs for older adults. J Ageing Phys Activity. 2007;15(2):152–65. CrossRef
Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;195:3508–1381.
Fernández-Ballart JD, Piñol JL, Zazpe I, Corella D, Carrasco P, Toledo E, Perez-Bauer M, Martínez-González MÁ, Salas-Salvadó J, Martín-Moreno JM. Relative validity of a semi-quantitative food-frequency questionnaire in an elderly Mediterranean population of Spain. BJN. 2010;103(12):1808–16. CrossRef
Martínez-González MA, García-Arellano A, Toledo E, Salas-Salvado J, Buil-Cosiales P, Corella D, Covas MI, Schröder H, Arós F, Gómez-Gracia E. A 14-item Mediterranean diet assessment tool and obesity indexes among high-risk subjects: the PREDIMED trial. PLoS One. 2012; https://doi.org/10.1371/journal.pone.0043134.
Mifflin MD, St Jeor ST, Hill LA, Scott BJ, Daugherty SA, Koh Y. A new predictive equation for resting energy expenditure in healthy individuals. Am J Clin Nutr. 1990;51(2):241–7. PubMed
Muscaritoli M, Anker SD, Argilés J, Aversa Z, Bauer JM, Biolo G, Boirie Y, Bosaeus I, Cederholm T, Costelli P, et al. Consensus definition of sarcopenia, cachexia and pre-cachexia: joint document elaborated by Special Interest Groups (SIG) “cachexia-anorexia in chronic wasting diseases” and “nutrition in geriatrics”. Clin Nutr. 2010;29(2):154–9. PubMedCrossRef
Bulotta S, Celano M, Lepore SM, Montalcini T, Pujia A, Russo D. Beneficial effects of the olive oil phenolic components oleuropein and hydroxytyrosol: focus on protection against cardiovascular and metabolic diseases. J Transl Med. 2014. doi: https://doi.org/10.1186/s12967-014-0219-9.
Liu RH. Health-promoting components of fruits and vegetables in the diet. Advances in nutrition: an international review. Journal. 2013;4(3):384–92.
- A randomised controlled intervention study investigating the efficacy of carotenoid-rich fruits and vegetables and extra-virgin olive oil on attenuating sarcopenic symptomology in overweight and obese older adults during energy intake restriction: protocol paper
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II