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Weight loss, exercise or both and cardiometabolic risk factors in obese older adults: results of a randomized controlled trial

Abstract

Background:

Obesity exacerbates the age-related decline in insulin sensitivity and is associated with risk for cardiometabolic syndrome in older adults; however, the appropriate treatment for obese older adults is controversial.

Objective:

To determine the independent and combined effects of weight loss and exercise on cardiometabolic risk factors in obese older adults.

Design:

One-hundred and seven obese (body mass index (BMI)30 kg m−2) older (65 years) adults with physical frailty were randomized to control group, diet group, exercise group and diet–exercise group for 1 year. Outcomes for this study included changes in insulin sensitivity index (ISI), glucose tolerance, central obesity, adipocytokines and cardiometabolic syndrome.

Results:

Although similar increases in ISI occurred in the diet–exercise and diet groups at 6 months, the ISI improved more in the diet–exercise than in the diet group at 12 months (2.4 vs 1.2; between-group difference, 1.2; 95% confidence interval, 0.2–2.1); no changes in ISI occurred in both exercise and control groups. The diet–exercise and diet groups had similar improvements in insulin area under the curve (AUC) (−2.9 and −2.9 × 103 mg min dl−1), glucose AUC (−1.4 and −2.2 × 103mg min dl−1), visceral fat (−787 and −561 cm3), tumor necrosis factor (−17.0 and −12.8 pg ml−1), adiponectin (5.0 and 4.0 ng ml−1), waist circumference (−8.2 and −8.4 cm), triglyceride (−30.7 and −24.3 g dl−1) and systolic/diastolic blood pressure (−15.9 and −13.1/−4.9 and −6.7 mm Hg), while no changes in these parameters occurred in both exercise and control groups. The cardiometabolic syndrome prevalence decreased by 40% in the diet–exercise and by 15% in the diet group. Body weight decreased similarly in the diet–exercise and diet groups (−8.6 and −9.7 kg) but not in the exercise and control groups.

Conclusions:

In frail, obese older adults, lifestyle interventions associated with weight loss improve insulin sensitivity and other cardiometabolic risk factors, but continued improvement in insulin sensitivity is only achieved when exercise training is added to weight loss.

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Acknowledgements

We thank the participants for their cooperation and the staff of the Clinical and Translational Sciences for their skilled assistance in the performance of this study. This study was supported by grants RO1-AG025501, RO1-AG031176, and P30-DK56341 (Clinical Nutrition Research Unit), UL1-RR024992 (Clinical and Translational Science Award), DK20579 (Diabetes Research and Training Center) from the National Institutes of Health and resources at the New Mexico VA Health Care System.

Author Contributions

Study design: DTV, DRS. Acquisition of data: KS, NN, RA-V, DRS, DTV. Study conduct: DTV, KS, RA-V, NN, DRS. Data analysis and interpretation: DTV, MB, KS, RA-V, NN, DRS, CQ. Drafting of the manuscript: DTV, MB, RA-V, CQ. Critical revision of the manuscript for important intellectual content: DTV, MB, RA-V, NN, DRS, KS, CQ. Statistical analysis: CQ. Primary responsibility for final content: DTV and CQ.

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Correspondence to D T Villareal.

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Bouchonville, M., Armamento-Villareal, R., Shah, K. et al. Weight loss, exercise or both and cardiometabolic risk factors in obese older adults: results of a randomized controlled trial. Int J Obes 38, 423–431 (2014). https://doi.org/10.1038/ijo.2013.122

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  • DOI: https://doi.org/10.1038/ijo.2013.122

Keywords

  • aging
  • cardiometabolic risks
  • lifestyle

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