强化营养咨询作为多组分减肥干预的一部分，可改善肥胖老年患者的饮食质量和人体测量学指标。
Intensive nutrition counseling as part of a multi-component weight loss intervention improves diet quality and anthropometrics in older adults with obesity.
机构信息
The Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road Hanover, NH, 03755, USA; Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive Lebanon, NH, 03766, USA.
Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive Lebanon, NH, 03766, USA; Wildberrycommunications.com, 1106 Lakeshore Drive, New London, NH, 03257, USA.
出版信息
Clin Nutr ESPEN. 2020 Dec;40:293-299. doi: 10.1016/j.clnesp.2020.09.002. Epub 2020 Sep 19.
BACKGROUND AND AIMS
Obesity significantly impacts older adults. Intensive nutrition counseling can aid in weight reduction and improve diet quality, but data are sparse in this population. The objective of this intervention is to determine how intensive nutrition counseling affects diet quality and anthropometric measures during a multi-component weight loss intervention in rural older adults with obesity.
METHODS
A series of 12-week, single-arm feasibility pilots were conducted in fall 2017 and winter/spring 2018 in a community aging center in rural Northern New England. Adults were eligible if ≥ 65 years old with a Body Mass Index (BMI) ≥30 kg/m. Exclusion criteria included dementia/cognitive impairment, uncontrolled psychiatric illness, weight-loss surgery, weight loss >5% in previous 6-months, life-threatening illness, palliative/hospice services, current participation in another weight-loss study/program, obesogenic medications, or presence of major chronic conditions. Participants received once-weekly nutrition counseling by a registered dietitian nutritionist (RDN), and twice-weekly exercise sessions by a physical therapist (PT). Primary outcomes were diet quality changes measured by total Rapid Eating and Activity Assessment for Patients-Short Version (REAP-S) and Automated Self-Administered 24-h dietary recall (ASA-24). Secondary outcome measures were changes in weight (kilograms) and waist circumference (centimeters). McNemar test was conducted for all paired categorical data while paired t-tests were conducted for all paired continuous data. All analyses were conducted in R; p-value<0.05 was significant.
RESULTS
Total n = 23. Mean age was 72.2 (5.8) years (73.9% female); mean BMI was 35.9 ± 5.0 kg/m. At 12 weeks, diet quality significantly improved. REAP-S scores increased by 3.53 ± 3.13 points (p < 0.001). Kilocalories, grams fat, grams saturated fat, milligrams sodium, grams added sugar, and grams alcohol via ASA-24 significantly decreased (all p < 0.05). Significant reductions in weight (-5.22 ± 3.13 kg) and waist circumference (-6.88 ± 5.67 cm) were observed (both p < 0.001).
CONCLUSION
Intensive nutrition counseling significantly enhances diet quality and reduces weight and waist circumference in rural older adults with obesity.
背景与目的
肥胖对老年人影响显著。强化营养咨询可帮助减轻体重和改善饮食质量，但此类人群的数据较为缺乏。本干预研究的目的是确定在针对农村肥胖老年人群的多组分减重干预中，强化营养咨询对饮食质量和人体测量指标的影响。
方法
2017 年秋季和 2018 年冬季/春季，在新英格兰北部农村地区的社区老龄化中心进行了一系列为期 12 周的单臂可行性试验。符合条件的参与者为年龄≥65 岁，体重指数（BMI）≥30kg/m。排除标准包括痴呆/认知障碍、未控制的精神疾病、减重手术、过去 6 个月内体重减轻>5%、危及生命的疾病、姑息治疗/临终关怀服务、当前参与另一项减重研究/计划、促肥胖药物、或存在主要慢性疾病。参与者每周接受一次由注册营养师进行的营养咨询，以及每周两次由物理治疗师进行的锻炼课程。主要结局指标是通过总快速饮食和活动评估患者简短版（REAP-S）和自动自我管理 24 小时膳食回忆（ASA-24）测量的饮食质量变化。次要结局指标为体重（千克）和腰围（厘米）的变化。对所有配对分类数据采用 McNemar 检验，对所有配对连续数据采用配对 t 检验。所有分析均在 R 中进行；p 值<0.05 为差异有统计学意义。
结果
共纳入 23 名参与者，平均年龄为 72.2（5.8）岁（73.9%为女性），平均 BMI 为 35.9±5.0kg/m。12 周时，饮食质量显著改善。REAP-S 评分增加了 3.53±3.13 分（p<0.001）。通过 ASA-24 测量的热量、脂肪克数、饱和脂肪克数、钠毫克数、添加糖克数和酒精克数均显著减少（均 p<0.05）。体重（-5.22±3.13kg）和腰围（-6.88±5.67cm）显著降低（均 p<0.001）。
结论
强化营养咨询可显著改善农村肥胖老年人群的饮食质量，并减轻体重和腰围。
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