老年人局部身体成分变化对身体功能的影响：一项试点随机对照试验
Effects of Changes in Regional Body Composition on Physical Function in Older Adults: A Pilot Randomized Controlled Trial.
作者信息
Santanasto A J, Newman A B, Strotmeyer E S, Boudreau R M, Goodpaster B H, Glynn N W
机构信息
Nancy W. Glynn, PhD, 130 DeSoto Street, A531 Crabtree Hall Pittsburgh, PA 15261, 412.383.1309 (phone), 412.624.7397 (fax),
出版信息
J Nutr Health Aging. 2015 Nov;19(9):913-21. doi: 10.1007/s12603-015-0523-y.
BACKGROUND/OBJECTIVE: Obesity exacerbates age-related physical disability; however, observational studies show that any weight loss in old age is associated with greater risk of mortality. Conversely, randomized controlled trials in older adults show that weight loss is beneficial. The discrepancy may be due to weight loss intention and differential changes to regional body composition. The purpose of this research was to evaluate the independent role of regional body composition remodeling in improving physical function.
DESIGN
Pilot Randomized Controlled Trial.
SETTING
Community based research center.
PARTICIPANTS
Thirty-six community dwelling, overweight to moderately obese (BMI 28.0-39.9 kg/m2) older adults (age 70.6±6.1 yrs).
INTERVENTION
Physical activity plus weight loss (PA+WL, n=21) or PA plus successful aging (SA) education. PA consisted primary of treadmill walking supplemented with lower extremity resistance and balance training. The WL program was based on the Diabetes Prevention Project and aimed at achieving a 7% weight loss by cutting calories, specifically those from fat.
MEASUREMENTS
At baseline, 6- and 12-months, body composition was measured using computerized tomography and dual x-ray absorptiometry. Abdominal visceral (VAT) and thigh intermuscular (IMAT) adipose tissue were quantified. Physical function was assessed using the short physical performance battery (SPPB).
RESULTS
Separate multivariable linear regression models with both groups combined demonstrated that decreases in IMAT and VAT were significantly associated with improvements in SPPB (P<0.05) independent of change in total fat mass. PA+WL improved SPPB scores from baseline (0.8±1.4, P<0.05), whereas PA+SA did not; however no intergroup difference was detected. Of note, these effects were mainly achieved during the intensive intervention phase.
CONCLUSION
Decreases in IMAT and VAT are important mechanisms underlying improved function following intentional weight loss plus physical activity.
背景/目的：肥胖会加剧与年龄相关的身体残疾；然而，观察性研究表明，老年人的任何体重减轻都与更高的死亡风险相关。相反，针对老年人的随机对照试验表明体重减轻是有益的。这种差异可能是由于减肥意愿以及身体成分区域的不同变化。本研究的目的是评估身体成分区域重塑在改善身体功能方面的独立作用。
设计
试点随机对照试验。
地点
社区研究中心。
参与者
36名居住在社区的超重至中度肥胖（BMI 28.0 - 39.9 kg/m²）的老年人（年龄70.6±6.1岁）。
干预措施
体育活动加体重减轻（PA + WL，n = 21）或体育活动加成功老龄化（SA）教育。体育活动主要包括在跑步机上行走，并辅以下肢阻力和平衡训练。体重减轻计划基于糖尿病预防项目，旨在通过减少卡路里摄入，特别是来自脂肪的卡路里，实现7%的体重减轻。
测量指标
在基线、6个月和12个月时，使用计算机断层扫描和双能X线吸收法测量身体成分。对腹部内脏脂肪（VAT）和大腿肌间脂肪（IMAT）进行量化。使用简短身体功能测试量表（SPPB）评估身体功能。
结果
将两组合并的单独多变量线性回归模型表明，IMAT和VAT的减少与SPPB的改善显著相关（P < 0.05），与总脂肪量的变化无关。PA + WL组的SPPB评分较基线有所改善（0.8±1.4，P < 0.05），而PA + SA组则没有；然而，未检测到组间差异。值得注意的是，这些效果主要在强化干预阶段实现。
结论
IMAT和VAT的减少是有意减肥加体育活动后功能改善的重要潜在机制。
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