Department of Human Nutrition, The University of Alabama, Tuscaloosa.
Department of Human Nutrition, The University of Alabama, Tuscaloosa.
J Acad Nutr Diet. 2022 Feb;122(2):354-362. doi: 10.1016/j.jand.2021.07.009. Epub 2021 Sep 1.
Obesity imposes risk to cardiometabolic health; however, intentional weight loss among older adults with obesity remains controversial.
To explore the influence of exercise plus weight maintenance and exercise plus intentional weight loss by caloric restriction on changes in cardiometabolic risk among older adults with obesity assessed by four risk-scoring tools.
Using longitudinal data from the Calorie Restriction and Changes in Body Composition, Disease, Function, and Quality of Life in Older Adults study (CROSSROADS) (ClinicalTrials.gov identifier: NCT00955903; May 2009 to October 2014), scores were calculated using baseline and 12-month data according to criteria from the International Diabetes Federation, National Cholesterol Education Program's Adult Treatment Panel, Framingham Risk Score, and Cardiometabolic Disease Staging.
Participants (39% men, 23% African American, aged 70.2 ± 4.7 years) were randomized to exercise (n = 48), exercise plus nutrient-dense weight maintenance diet (n = 44), or exercise plus weight loss by moderate caloric restriction (n = 42).
To evaluate effects of exercise plus weight maintenance and exercise plus intentional weight loss on changes in cardiometabolic risk.
Generalized estimating equations were used to assess changes in risk with ethnicity, biological sex, and age as covariates.
Group-time interaction was only significant for Framingham and Cardiometabolic Disease Staging (P = 0.005 and 0.041, respectively). Upon post hoc analysis, significant within-group improvements in Framingham scores were observed for exercise plus weight maintenance (P < 0.001; r = -1.682) and exercise plus weight loss (P = 0.020; r = -0.881). In analysis of between-group differences in Framingham scores, significant decreases were observed in the exercise plus weight maintenance group (P = 0.001; r = -1.723) compared with the exercise group. For Cardiometabolic Disease Staging, the exercise plus weight loss group had significant within-group improvements (P = 0.023; r = -0.102). For between-group differences in Cardiometabolic Disease Staging, the exercise plus weight loss group showed significant risk reduction (P = 0.012; r = -0.142) compared with the exercise group.
Among risk scores evaluated, Framingham and Cardiometabolic Disease Staging showed significantly greater sensitivity to change in cardiometabolic risk. Older adults with obesity can significantly lower cardiometabolic risk through exercise plus weight maintenance or exercise plus weight loss by moderate caloric restriction.
肥胖对心脏代谢健康构成风险；然而，对于肥胖的老年人来说，有意图的体重减轻仍然存在争议。
通过使用热量限制来探索运动加体重维持和运动加有意的体重减轻对通过四种风险评分工具评估的肥胖老年人心脏代谢风险变化的影响。
使用来自热量限制和身体成分、疾病、功能和生活质量变化的老年人研究（CROSSROADS）（ClinicalTrials.gov 标识符：NCT00955903；2009 年 5 月至 2014 年 10 月）的纵向数据，根据国际糖尿病联合会、国家胆固醇教育计划成人治疗专家组、弗雷明汉风险评分和心脏代谢疾病分期的标准，使用基线和 12 个月的数据计算分数。
参与者（39%为男性，23%为非裔美国人，年龄 70.2±4.7 岁）被随机分配到运动组（n=48）、运动加营养丰富的体重维持饮食组（n=44）或运动加中等热量限制的体重减轻组（n=42）。
评估运动加体重维持和运动加有意的体重减轻对心脏代谢风险变化的影响。
使用广义估计方程评估风险随种族、生物性别和年龄的变化。
仅在 Framingham 和心脏代谢疾病分期方面观察到组间时间交互作用具有统计学意义（P=0.005 和 0.041）。在事后分析中，观察到运动加体重维持组（P<0.001；r=-1.682）和运动加体重减轻组（P=0.020；r=-0.881）的 Framingham 评分显著的组内改善。在Framingham 评分的组间差异分析中，与运动组相比，运动加体重维持组的 Framingham 评分显著下降（P=0.001；r=-1.723）。对于心脏代谢疾病分期，运动加体重减轻组的组内改善具有统计学意义（P=0.023；r=-0.102）。在心脏代谢疾病分期的组间差异中，与运动组相比，运动加体重减轻组的风险显著降低（P=0.012；r=-0.142）。
在评估的风险评分中，Framingham 和心脏代谢疾病分期对心脏代谢风险变化的敏感性显著更高。肥胖的老年人可以通过运动加体重维持或运动加中等热量限制的体重减轻显著降低心脏代谢风险。
