Chae Kacey, Bettencourt Amie F, Houston Denise K, Simonsick Eleanor M, Ferrucci Luigi, Kalyani Rita R, Schoenborn Nancy, Clark Jeanne M, Gudzune Kimberly A
Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
J Gerontol A Biol Sci Med Sci. 2025 Jun 10;80(7). doi: 10.1093/gerona/glaf103.
Intentional weight loss improves physical function among older adults with obesity, despite the associated lean mass loss. However, prior studies have not assessed the impacts of weight loss on physical function and body composition among older adults with type 2 diabetes mellitus and obesity, a population at high risk for sarcopenia and functional decline. Our objective was to examine differences in body composition changes by physical function status among middle-aged and older adults with type 2 diabetes mellitus and overweight/obesity participating in an intensive weight-loss intervention of diet and exercise over 12 months.
We conducted a secondary analysis of 12-month data from the Look AHEAD dual-energy X-ray absorptiometry substudy among participants randomized to intervention (n = 603). Independent variables included dual-energy X-ray absorptiometry-derived percent change in appendicular lean mass and fat mass. The dependent variable was SF-36 physical function subscale change categorized as worsened (decrease ≥ 5), stable (change ± 4), or improved (increase ≥ 5). We examined the associations using ANOVA.
Overall, participants had a mean age of 58.3 (SD 6.7) and 63% were women-8% had worsened, 69% stable, and 22% improved physical function. Differences in mean percent appendicular lean mass change between physical function groups were nonsignificant (worsened -3.7%; stable -4.8%; improved -5.6%; p = .05). Mean percent fat mass change was significantly different across physical function groups (worsened -9.3%; stable -14.6%; improved -17.9%; p < .01).
Lean mass loss associated with lifestyle weight-loss intervention does not negatively affect physical function, rather the intervention appears to improve physical function by reducing adiposity among adults with type 2 diabetes mellitus and overweight/obesity.
尽管有意减肥会导致瘦体重减少，但它能改善肥胖老年人的身体功能。然而，先前的研究尚未评估减肥对患有2型糖尿病和肥胖症的老年人身体功能和身体成分的影响，这一人群存在肌肉减少症和功能衰退的高风险。我们的目的是研究在参加为期12个月的饮食和运动强化减肥干预的2型糖尿病和超重/肥胖的中老年人中，身体功能状态对身体成分变化的影响差异。
我们对来自“展望”（Look AHEAD）双能X线吸收法亚研究的12个月数据进行了二次分析，该研究中的参与者被随机分配至干预组（n = 603）。自变量包括双能X线吸收法得出的四肢瘦体重和脂肪量的百分比变化。因变量是SF-36身体功能分量表变化，分为恶化（下降≥5）、稳定（变化±4）或改善（增加≥5）。我们使用方差分析来研究这些关联。
总体而言，参与者的平均年龄为58.3岁（标准差6.7），63%为女性。8%的参与者身体功能恶化，69%稳定，22%改善。身体功能组之间四肢瘦体重平均百分比变化的差异无统计学意义（恶化-3.7%；稳定-4.8%；改善-5.6%；p = 0.05）。不同身体功能组的脂肪量平均百分比变化存在显著差异（恶化-9.3%；稳定-14.6%；改善-17.9%；p < 0.01）。
与生活方式减肥干预相关的瘦体重减少不会对身体功能产生负面影响，相反，该干预似乎通过减少2型糖尿病和超重/肥胖成年人的肥胖来改善身体功能。
