减重及增加蛋白质摄入量对肥胖老年人炎症生物标志物的影响
Influence of Weight Reduction and Enhanced Protein Intake on Biomarkers of Inflammation in Older Adults with Obesity.
作者信息
Porter Starr Kathryn N, Orenduff Melissa, McDonald Shelley R, Mulder Hillary, Sloane Richard, Pieper Carl F, Bales Connie W
机构信息
a Center for the Study of Aging , Duke University Medical Center , Durham , NC , USA.
b Geriatric Research, Education, and Clinical Center , Durham VA Medical Center , Durham , NC , USA.
出版信息
J Nutr Gerontol Geriatr. 2019 Jan-Mar;38(1):33-49. doi: 10.1080/21551197.2018.1564200. Epub 2019 Feb 27.
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/m) 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/m; p = 0.05) and Protein (-8.7 ± 7.4 kg; -2.9 ± 2.3 kg/m; 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).
衰老和肥胖都与促炎代谢物水平升高有关,而体重减轻则与炎症状态的改善有关。然而,很少有研究探讨关键炎症标志物在老年人群体重减轻的综合情况下的反应。也很少有研究调查饮食组成对炎症标志物反应的潜在影响。在MEASUR-UP试验中,我们评估了传统体重减轻对照组与蛋白质摄入量充足且均衡的组在研究后炎症标志物基线水平的变化。在这项为期6个月的随机对照试验(RCT)中,年龄较大(≥60岁)、肥胖(BMI≥30 kg/m²)且短身体性能量表(SPPB)评分为4-10的成年人被随机分配到传统体重减轻方案组(对照组,n = 14)或每餐蛋白质摄入量较高(≥30 g)的组(蛋白质组,n = 25)。所有参与者都被规定了低热量饮食,并参加每周的支持和教育小组以及体重测量。蛋白质组参与者每餐摄入≥30 g优质蛋白质,包括每天三餐中的两餐提供的瘦牛肉和特瘦牛肉。对照组和蛋白质组的蛋白质摄入量分别为0.8和1.2 g/kg/天。在0个月和6个月时间点测量脂联素、瘦素、C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-1(IL-1)、IL-6、IL-8、血清淀粉样蛋白A(SAA)、血管细胞粘附分子-1(VCAM-1)、细胞间粘附分子-1(ICAM-1)和糖化血清蛋白(GSP)水平。在6个月的终点,对照组(-4.8±8.2 kg;-2.3±2.4 kg/m²;p = 0.05)和蛋白质组(-8.7±7.4 kg;-2.9±2.3 kg/m²;p < 0.0001)的体重均显著减轻,BMI下降。两组的SPPB评分均有所改善,蛋白质组的功能反应更佳(p < 0.05)。基线时的体脂百分比与瘦素、hs-CRP、VCAM-1、ICAM-1和GSP呈正相关。蛋白质组中几种炎症标志物有反应:瘦素(p < 0.001)、hs-CRP(p < 0.01)和ICAM-1(p < 0.01)下降,脂联素增加(p < 0.01)。对照组的任何炎症标志物均无显著变化。在组间比较中,只有脂联素存在组间差异趋势(蛋白质组改善更多;p < 0.07)。我们在MEASUR-UP试验中的发现表明,在减肥成功方面,蛋白质摄入量增加的减肥饮食与蛋白质摄入量充足的饮食相当,并且它可以改善炎症状态,特别是对于脂联素、瘦素、hs-CRP和ICAM-1。鉴于目前对老年人更高蛋白质摄入量的建议,这些发现很重要,并证明有必要进一步研究蛋白质增强饮食对炎症的影响。(ClinicalTrials.gov标识符:NCT01715753)
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