Weight loss, exercise, or both and physical function in obese older adults

BACKGROUND: Obesity exacerbates the age-related decline in physical function and causes frailty in older adults; however, the appropriate treatment for obese older adults is controversial. METHODS: In this 1-year, randomized, controlled trial, we evaluated the independent and combined effects of weight loss and exercise in 107 adults who were 65 years of age or older and obese. Participants were randomly assigned to a control group, a weightmanagement (diet) group, an exercise group, or a weight-management-plus-exercise (diet–exercise) group. The primary outcome was the change in score on the modified Physical Performance Test. Secondary outcomes included other measures of frailty, body composition, bone mineral density, specific physical functions, and quality of life. RESULTS: A total of 93 participants (87%) completed the study. In the intention-to-treat analysis, the score on the Physical Performance Test, in which higher scores indicate better physical status, increased more in the diet–exercise group than in the diet group or the exercise group (increases from baseline of 21% vs. 12% and 15%, respectively); the scores in all three of those groups increased more than the scores in the control group (in which the score increased by 1%) (P<0.001 for the between-group differences). Moreover, the peak oxygen consumption improved more in the diet–exercise group than in the diet group or the exercise group (increases of 17% vs. 10% and 8%, respectively; P<0.001); the score on the Functional Status Questionnaire, in which higher scores indicate better physical function, increased more in the diet–exercise group than in the diet group (increase of 10% vs. 4%, P<0.001). Body weight decreased by 10% in the diet group and by 9% in the diet–exercise group, but did not decrease in the exercise group or the control group (P<0.001). Lean body mass and bone mineral density at the hip decreased less in the diet–exercise group than in the diet group (reductions of 3% and 1%, respectively, in the diet–exercise group vs. reductions of 5% and 3%, respectively, in the diet group; P<0.05 for both comparisons). Strength, balance, and gait improved consistently in the diet–exercise group (P<0.05 for all comparisons). Adverse events included a small number of exercise-associated musculoskeletal injuries. CONCLUSIONS: These findings suggest that a combination of weight loss and exercise provides greater improvement in physical function than either intervention alone

Effect of aerobic or resistance exercise, or both, on intermuscular and visceral fat and physical and metabolic function in older adults with obesity while dieting

BACKGROUND: Obesity exacerbates age-related effects on body composition and physical and metabolic function. Which exercise mode is most effective in mitigating these deleterious changes in dieting older adults with obesity is unknown. METHODS: In a randomized controlled trial, we performed a head-to-head comparison of aerobic (AEX), resistance (REX), or combination (COMB) exercise during matched ~10% weight loss in 160 obese older adults. Prespecified analyses compared 6-month changes in intermuscular adipose tissue (IMAT) and visceral adipose tissue (VAT) assessed using MRI, insulin sensitivity index (ISI) by oral glucose tolerance test, physical function using Modified Physical Performance Test (PPT), VO2peak, gait speed, and knee strength by dynamometry. RESULTS: IMAT and VAT decreased more in COMB than AEX and REX groups (IMAT; -41% vs -28% and -23% and VAT: -36% vs -19% and -21%; p = .003 to .01); IMAT and VAT decreased in all groups more than control (between-group p \u3c .001). ISI increased more in COMB than AEX and REX groups (86% vs 50% and 39%; p = .005 to .03). PPT improved more in COMB than AEX and REX groups, while VO2peak improved more in COMB and AEX than REX group (all p \u3c .05). Knee strength improved more in COMB and REX than AEX group (all p \u3c .05). Changes in IMAT and VAT correlated with PPT (r = -0.28 and -0.39), VO2peak (r = -0.49 and -0.52), gait speed (r = -0.25 and -0.36), and ISI (r = -0.49 and -0.52; all p \u3c .05). CONCLUSIONS: Weight loss plus combination aerobic and resistance exercise was most effective in improving ectopic fat deposition and physical and metabolic function in older adults with obesity

Evaluation of the seasonal formation of subsurface negative preformed nitrate anomalies in the subtropical North Pacific and North Atlantic

Summertime mixed-layer drawdown of dissolved inorganic carbon in the absence of measurable nutrients in the ocean's subtropical gyres and non-Redfieldian oxygen&thinsp;:&thinsp;nitrate relationships in the underlying subsurface waters are two biogeochemical phenomena that have thus far eluded complete description. Many processes are thought to contribute to one or both, including lateral nutrient transport, carbon overconsumption or non-Redfield C : N : P organic matter cycling, heterotrophic nutrient uptake, and the actions of vertically migrating phytoplankton. To obtain insight into the likely magnitude of potential contributing mechanisms that can remove nitrate from the nutricline while supporting dissolved inorganic carbon (DIC) drawdown tens of meters higher in the water column, we investigated the seasonal formation rates for negative preformed nitrate (preNO3) anomalies (oxygen consumption without stoichiometric nitrate release) in the subsurface and positive preformed nitrate anomalies (oxygen production without stoichiometric nitrate drawdown) in the euphotic zone at the subtropical ocean time series stations ALOHA (A Long-Term Oligotrophic Habitat Assessment) in the North Pacific and BATS (Bermuda Atlantic Time-series Study) in the North Atlantic. Non-Redfield −O2 : N stoichiometry for dissolved organic matter (DOM) remineralization accounts for up to  ∼ 15&thinsp;mmol&thinsp;N&thinsp;m−2&thinsp;yr−1 of negative preNO3 anomaly formation at both stations. We present a new formulation for calculating preNO3 (residual preNO3) that includes components resulting from non-Redfield DOM cycling. Residual negative preNO3 anomalies in excess of that which can be accounted for by non-Redfield DOM cycling are found to accumulate at a rate of  ∼ 32–46&thinsp;mmol&thinsp;N&thinsp;m−2&thinsp;yr−1 at Station ALOHA and  ∼ 46–87&thinsp;mmol&thinsp;N&thinsp;m−2&thinsp;yr−1 at the BATS station. These negative anomaly formation rates are in approximate balance with residual positive preNO3 anomaly formation rates from the euphotic zone located immediately above the nutricline in the water column. We evaluate three mechanisms to explain these anomalies, calculating that transparent exopolymer particle (TEP) cycling and heterotrophic nitrate uptake can contribute to the formation of both residual preNO3 anomalies. However, a significant fraction, estimated at  ∼ 50&thinsp;%–95&thinsp;%, is unexplained by the sum of these processes. Vertically migrating phytoplankton possess the necessary distribution, nutrient acquisition strategy, and biogeochemical signature to simultaneously remove nitrate at depth and transport it above the nutricline. Reported transport rates by known migrators equal or exceed the residual preNO3 anomaly formation rates and potentially explain both the negative and positive residual preNO3 anomalies as well as the mixed-layer DIC drawdown at the stations ALOHA and BATS within the limits of scarce detailed abundance profiles. However, the three processes examined are not independent and mutually exclusive. The model Rhizosolenia mat system (and perhaps other migrators) produces TEPs, suggesting that migration could provide accelerated vertical transport of TEPs and provide labile carbon for heterotrophic nitrate uptake. These results based on geochemical distributions suggest that, in the absence of additional mechanisms and rates, phytoplankton vertical migrators, although rare and easily overlooked, play a larger role in subtropical ocean nutrient cycling and the biological pump than generally recognized.</p

Effect of Weight Loss, Exercise, or Both on Undercarboxylated Osteocalcin and Insulin Secretion in Frail, Obese Older Adults

Background. Obesity exacerbates age-related decline in glucometabolic control. Undercarboxylated osteocalcin (UcOC) regulates pancreatic insulin secretion. The long-term effect of lifestyle interventions on UcOC and insulin secretion has not been investigated. Methods. One hundred seven frail, obese older adults were randomized into the control (N=27), diet (N=26), exercise (N=26), and diet-exercise (N=28) groups for 1 year. Main outcomes included changes in UcOC and disposition index (DI). Results. UcOC increased in the diet group (36 ± 11.6%) but not in the other groups (P<0.05 between groups). Although similar increases in DI occurred in the diet-exercise and diet groups at 6 months, DI increased more in the diet-exercise group (92.4 ± 11.4%) than in the diet group (61.9 ± 15.3%) at 12 months (P<0.05). UcOC and body composition changes predicted DI variation in the diet group only (R2=0.712), while adipocytokines and physical function changes contributed to DI variation in both the diet (∆R2=0.140 and 0.107) and diet-exercise (∆R2=0.427 and 0.243) groups (P<0.05 for all). Conclusions. Diet, but not exercise or both, increases UcOC, whereas both diet and diet-exercise increase DI. UcOC accounts for DI variation only during active weight loss, while adipocytokines and physical function contribute to diet-exercise-induced DI variation, highlighting different mechanisms for lifestyle-induced improvements in insulin secretion. This trial was registered with ClinicalTrials.gov number NCT00146107

What weight changes really happened during COVID-19 among older adults?

Worldwide, the coronavirus disease 19 (COVID-19) pandemic disrupted life for individuals of all ages, but it had a particularly negative impact on older adults aged 65 and older. As a result of the illness, older adults faced a higher degree of medical complications, hospitalizations, cognitive dysfunction, and weakness. Socio-environmental factors including physical distancing, quarantines, and stay-at-home orders prevented individuals in their ability to conduct usual daily activities. These all further exacerbated the development of existing and new mental health manifestations

Dehydroepiandrosterone (DHEA) replacement decreases insulin resistance and lowers inflammatory cytokines in aging humans

Plasma dehydroepiandrosterone (DHEA) decreases ~80% between ages 25 and 75 yr. In a preliminary study, we found that 6 mo of DHEA replacement improved insulin action in elderly individuals. The purpose of the present larger, randomized double-blind study was to determine whether a longer period of DHEA replacement improves glucose tolerance. Fifty-seven men and 68 women aged 65 to 75 yr were randomly assigned to 50 mg DHEA or placebo once daily. Year one was a randomized, double blind trial. Year 2 was an open label continuation. DHEA replacement improved glucose tolerance in participants who had abnormal GT initially, reduced plasma triglycerides, and the inflammatory cytokines IL6 and TNFα

Long-term moderate calorie restriction inhibits inflammation without impairing cell-mediated immunity: A randomized controlled trial in non-obese humans

Calorie restriction (CR) inhibits inflammation and slows aging in many animal species, but in rodents housed in pathogen-free facilities, CR impairs immunity against certain pathogens. However, little is known about the effects of long-term moderate CR on immune function in humans. In this multi-center, randomized clinical trial to determine CR's effect on inflammation and cell-mediated immunity, 218 healthy non-obese adults (20-50 y), were assigned 25% CR (n=143) or an ad-libitum (AL) diet (n=75), and outcomes tested at baseline, 12, and 24 months of CR. CR induced a 10.4% weight loss over the 2-y period. Relative to AL group, CR reduced circulating inflammatory markers, including total WBC and lymphocyte counts, ICAM-1 and leptin. Serum CRP and TNF-α concentrations were about 40% and 50% lower in CR group, respectively. CR had no effect on the delayed-type hypersensitivity skin response or antibody response to vaccines, nor did it cause difference in clinically significant infections. In conclusion, long-term moderate CR without malnutrition induces a significant and persistent inhibition of inflammation without impairing key in vivo indicators of cell-mediated immunity. Given the established role of these pro-inflammatory molecules in the pathogenesis of multiple chronic diseases, these CR-induced adaptations suggest a shift toward a healthy phenotype

Caloric restriction but not exercise-induced reductions in fat mass decrease plasma triiodothyronine concentrations: a randomized controlled trial

Caloric restriction (CR) decreases circulating triiodothyronine (T(3)) concentration. However, it is not known if this effect is due to body fat mass reductions or due to CR, per se. The purpose of this study was to test the hypothesis that plasma T(3) concentration decreases with CR-induced reductions in fat mass but not in response to similar decreases in fat mass that are induced by exercise. Sedentary, nonobese 50- to 60-year-old men and women with no clinical evidence of cardiovascular or metabolic disease and not taking thyroid medications were randomly assigned to 12 months of caloric restriction (n = 18) or exercise-induced weight loss (n = 17) or to a control group (n = 9). Body weight and composition and plasma concentrations of the thyroid hormones T(3), thyrotropin (TSH), thyroxine (T(4)), and free thyroxine (FT(4)) were measured at baseline and 12 months. Fat mass changed significantly in the CR (−6.3 ± 1.0 kg) and exercise (−5.5 ± 1.0 kg) groups but not in the control group (−0.6 ± 1.4 kg). The changes were not significantly different between the CR and exercise groups. Plasma T(3) concentration decreased in the CR group (−9.8 ± 2.0 ng/dL, p < 0.0001) but not in the exercise (−3.8 ± 2.1 ng/dL, p = 0.07) or control (− 1.3 ± 2.8 ng/dL, p = 0.65) groups. TSH, T(4), and FT(4) did not change in any of the study groups. Twelve months of CR decreased circulating T(3) concentrations in middle-aged adults. This effect does not appear to be attributable to changes in body fat mass because a comparable decrease in T(3) concentration was not observed in response to an exercise-induced fat mass reduction