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| ID | Type | Description | Link |
|---|---|---|---|
| NCBA | Other Grant/Funding Number | National Cattleman's Beef Association |
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The prevalence of obesity continues to increase at an alarming rate for all sectors of the population in the US. Obesity in the older adult cohort is of great concern as it is associated with reductions in mobility, declines in physical performance and increased risk for physical disability. With regard to body composition, a) fat mass has been determined to be a stronger predictor of mobility limitations than low muscle mass in older individuals and alternatively, b) leg lean mass has also been cited as a primary determinant of lower extremity physical function.
Obesity is related to increased levels of fatigue and lack of motivation and mental energy. Fatigue can be categorized as both a subjective perception and a performance decrement. Fatigue can be defined as a perceived lack of physical or mental energy while fatigability is another construct categorized by the degree of fatigue associated with activity in any dimension (i.e. physical, mental, emotional, and/or social).
The impact of a higher protein diet on muscle quality, muscle fatigability, perceptions of fatigue and systemic inflammation in older adults has not been well documented. The utility of a higher protein weight loss diet combined with resistance exercise training to augment fat mass loss, attenuate lean mass loss and improve muscle quality and physical function could potentially be of high value to overweight older women. The potential further benefits of this regimen to enhance mental energy and other aspects of psycho-social well-being are unknown.
The aims of the present study include assessing the effects of the proposed diet and exercise intervention on 1) body composition, 2) strength and muscle quality, and 3) energy and fatigue symptoms.
Our target population includes 75 overweight or obese (BMI >/= 25kg/m^2) women between the ages of 65 and 80.
This study will use a parallel-arm design. After blocking on age and BMI, 75 overweight or obese (BMI ≥ 25 kg/m2) older females (65 - 80 y old) will be randomized into three groups; PRO or CARB diet combined with exercise (PRO+EX;n=25, CARB+EX; n=25) or PRO (n=25) without exercise for 6 months. All groups will have the goal of losing ~10% of initial body weight. We anticipate an adherence rate of 80% (n = 20 in each group remaining). At the initiation of the study, all subjects will be weight stable (within 2 kg) for past 6 mos and sedentary (defined as < 1h/wk or less than 2 exercise sessions per week in the last 6 months). Eligible participants will be planning to live in the community for the duration of the study. Exclusion criteria will include any chronic disease/condition that would not permit exercise or dietary restriction or alter interpretation of data. All subjects will require personal physician clearance prior to enrollment. Main outcome variables of interest are whole body composition, regional body composition, muscle strength endurance and quality, physical function, fatigue and biomarkers related to fatigue.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Protein + Exercise | Experimental | PRO diet recommendations will include high quality proteins with an emphasis on lean meats, with protein being targeted for every meal and snack. PRO will provide dietary protein (1.6 g.kg-1.d-1; ~30% of energy intake) with a ratio of carbohydrate/protein of <1.5 and dietary lipids at ~ 30% energy intake. Energy deficit will be determined by reducing estimated daily energy needs by ~500 kcal/d. The prescribed diet will include a minimum of one serving of beef per day, which is approximately 3 to 3.5 ounces or ~100 grams. The exercise program will require attendance of 3 nonconsecutive days per week. A program that combines flexibility and balance activities, weight bearing endurance exercise (walking) and resistance training to preserve lean mass will be prescribed. Each session will last ~75 min with a 35 min warm-up/aerobic exercise of mild to moderate intensity, ~30 min of resistance training, and finally, a ~10 min of balance and flexibility exercises during the cool-down period. |
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| Protein | Experimental | PRO diet recommendations will include high quality proteins with an emphasis on lean meats, with protein being targeted for every meal and snack. PRO will provide dietary protein (1.6 g.kg-1.d-1; ~30% of energy intake) with a ratio of carbohydrate/protein of <1.5 and dietary lipids at ~ 30% energy intake. Energy deficit will be determined by reducing estimated daily energy needs by ~500 kcal/d. The prescribed diet will include a minimum of one serving of beef per day, which is approximately 3 to 3.5 ounces or ~100 grams. |
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| Carbohydrate + Exercise | Experimental | Diet will provide dietary protein at 0.8 g.kg-1.d-1 (~ 18% of energy intake) with a ratio of carbohydrates/protein > 3.5 and dietary lipids at ~30% energy intake. Again, energy deficit will be determined by reducing estimated daily energy needs by ~500 kcal/d. The exercise program will require attendance of 3 nonconsecutive days per week. A program that combines flexibility and balance activities, weight bearing endurance exercise (walking) and resistance training to preserve lean mass will be prescribed. Each session will last ~75 min with a 35 min warm-up/aerobic exercise of mild to moderate intensity, ~30 min of resistance training, and finally, a ~10 min of balance and flexibility exercises during the cool-down period. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Exercise | Behavioral | PRO+EX and CARB+EX groups will be prescribed an exercise program with required attendance of 3 nonconsecutive days per week. Exercise sessions will be supervised and conducted by trained graduate students in the Department of Kinesiology. Based on recommended practice, a program that combines flexibility and balance activities, weight bearing endurance exercise (walking) and resistance training to preserve lean mass will be prescribed. Each session will last ~75 min with a 35 min warm-up/aerobic exercise of mild to moderate intensity, ~30 min of resistance training, and finally, a ~10 min of balance and flexibility exercises during the cool-down period. Endurance training activities will vary but will all be weight-bearing. |
| Measure | Description | Time Frame |
|---|---|---|
| Change from Baseline in Body Composition at 3 Months and 6 Months | Abdominal visceral and subcutaneous adiposity and muscle area and adipose infiltration of muscle will be measured using proton-weighted MR imaging. Subjects will be positioned feet first and supine in a 3.0 Tesla whole body imager (Signa, General Electric, Milwaukee, WI, USA). Imaging of the abdominal region and the thigh will be performed with two separate imaging sequences. The following pulse sequence parameters will be used: Fast Spin Echo-XL, TR/TE = 700/8.12 ms; Slice Thickness = 10mm; NEX = 3; Gap thickness = 5mm; ETL = 3; FA = 90; Number of slices = 18; Acquisition Matrix = 320 x 224 (Reconstructed = 512 x 512); FOV = 20cm; Voxel Size = .39 x .39 x 10 mm. Following high resolution T1 imaging, the images will be analyzed to determine the relative amount of fat in images using a modified Dixon method. Whole body fat mass, lean mass and bone mass will also be assessed with DXA scanning. | Baseline (Week 0), Midpoint (Week 12), Post-Intervention (Week 24) |
| Change from Baseline in Strength & Muscle Quality at 3 Months and 6 Months | Using an isokinetic dynamometer (Biodex System Pro 4, Biodex Medical Systems, INC., New York) with the participant positioned according to manufacturer guidelines, four maximal knee extension and knee flexion contractions will be performed and measured at 0, 60 and 180 deg/sec with the testing order (left, right) and velocity (fast, slow, zero) randomized. The isometric (0 deg/sec) effort will be held for 4-seconds. A set of 25 consecutive maximal repetitions at 180 deg/sec will be used to assess muscular endurance. | Baseline (Week 0), Midpoint (Week 12), Post-Intervention (Week 24) |
| Change from Baseline in Energy & Fatigue Symptoms/Psychological Function at 3 Months and 6 Months | Subjects will take the following battery of psychological questionnaires at three timepoints: Profile of Mood States, Self-Motivation Inventory, Labeled Magnitude Scale, Affect Grid, SF-36, Pittsburgh Sleep Quality Index, Center for Epidemiological Studies Depression Scale, Perceived Stress Scale, WEL Self-Efficacy Questionnaire, Three Factor Eating Questionnaire, Mini-Mental Status, and the Trails B. |
| Measure | Description | Time Frame |
|---|---|---|
| Physical Functional Performance | A battery of tests will assess multiple components of physical function, including static and dynamic balance, agility, muscular strength and power, and aerobic capacity. | Baseline (Week 0), Midpoint (Week 12), Post-Intervention (Week 24) |
| Biomarkers Related to Fatigue |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Ellen M Evans, PhD | University of Georgia | Principal Investigator |
| Rachelle M Acitelli, MS | University of Georgia | Study Director |
| Chad R Straight, MS | University of Georgia | Study Director |
| Alison C Berg, MS, RD | University of Georgia | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Georgia | Athens | Georgia | 30606 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 36410339 | Derived | Williams ER, Straight CR, Wilson HK, Lynall RC, Gregory CM, Evans EM. Weight Loss and Exercise Effects on Rate of Torque Development and Physical Function in Overweight Older Women. J Aging Phys Act. 2022 Nov 21;31(3):458-464. doi: 10.1123/japa.2022-0032. Print 2023 Jun 1. | |
| 32520876 | Derived | Evans EM, Straight CR, Reed RA, Berg AC, Rowe DA, Johnson MA. Exercise and Protein Effects on Strength and Function with Weight Loss in Older Women. Med Sci Sports Exerc. 2021 Jan;53(1):183-191. doi: 10.1249/MSS.0000000000002429. |
| Label | URL |
|---|---|
| National Cattleman's Beef Association | View source |
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| ID | Term |
|---|---|
| D009765 | Obesity |
| D005221 | Fatigue |
| D015431 | Weight Loss |
| ID | Term |
|---|---|
| D050177 | Overweight |
| D044343 | Overnutrition |
| D009748 | Nutrition Disorders |
| D009750 | Nutritional and Metabolic Diseases |
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| ID | Term |
|---|---|
| D015444 | Exercise |
| ID | Term |
|---|---|
| D009043 | Motor Activity |
| D009068 | Movement |
| D009142 | Musculoskeletal Physiological Phenomena |
| D055687 | Musculoskeletal and Neural Physiological Phenomena |
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| Higher Protein Diet | Behavioral | PRO diet recommendations will include high quality proteins with an emphasis on lean meats with protein being targeted for every meal and snack. PRO will provide dietary protein (1.6 g.kg-1.d-1; ~30% of energy intake) with a ratio of carbohydrate/protein of <1.5 and dietary lipids at ~ 30% energy intake. Energy deficit will be determined by reducing estimated daily energy needs by ~500 kcal/d. Regarding beef intake specifically, the prescribed diet will include a minimum of one serving of beef per day, which is approximately 3 to 3.5 ounces or ~100 grams. This amount of lean cooked beef provides an average of ~25-30 grams of protein per day (www.beefnutrition.org/leanbeef.aspx). Our dietary prescription to the PRO groups that they add 3 ounces (and perhaps up to 3.5 ounces pending body size) of lean beef daily will provide an additional 25-30 grams of protein. This diet will also include 5 servings/day of vegetables and 2-3 servings/day of fruit. |
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| Conventional Carbohydrate Diet | Behavioral | For the CARB group, the diet will provide dietary protein at 0.8 g.kg-1.d-1 (~ 18% of energy intake) with a ratio of carbohydrates/protein > 3.5 and dietary lipids at ~ 30% energy intake. Through nutrition education and counseling we will ensure that the CARB group meets the RDA for protein for women of 46 grams per day from a variety of plant and animal sources. Again, energy deficit will be determined by reducing estimated daily energy needs by ~500 kcal/d. Additional recommendations will include 5 servings/day of vegetables and 2-3 servings/day of fruit. Beef intake will be discouraged in the CARB group. |
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| Baseline (Week 0), Midpoint (Week 12), Post-Intervention (Week 24) |
Fasting blood samples will be obtained and assayed for markers of systemic inflammation [C-reactive protein (CRP) and IL-6] and indicators of anemia (ferritin and vitamin B12) using commercially available ELISA kits samples run in triplicate. Timing for blood sampling for the inflammatory markers will occur greater than 24 but not less than 48 hours post-exercise in the morning after an overnight fast. With the training occurring 3 times per week generally in the morning, this means that if a person exercises on a Monday, their draw will occur on Wednesday prior to that exercise session. This timing also has maximal translational value in that it provides a "snap shot" of our lifestyle intervention. Participants will be queried regarding any acute illnesses during the 48-hours prior to the blood draw and again one week following this laboratory visit to ensure inflammatory status was not falsely elevated. |
| Baseline (Week 0), Post-Intervention (Week 24) |
| Physical Activity | Physical activity will be quantified using the Physical Activity Scale for the Elderly (PASE) which estimates the total level of household, occupational and leisure-time physical activities. Accelerometers (ActiGraph single-axis model, Health One Technology) will also be used to provide an objective measure of physical activity. | Baseline (Week 0), Midpoint (Week 12), Post-Intervention (Week 24) |
| Acceptability | We will use Nominal Group Technique (NGT) as our focus group technique to qualitatively evaluate the interventions. Essentially 2 small groups (10-15 each) within each treatment group will be brought together to generate barriers and facilitations to the program, share ideas and opinions, have a group discussion and then vote and rank major barriers and facilitations to the program. Notably our facilitator will tap both the exercise and diet aspects of our intervention. | Post-Intervention (Week 24) |
| UGA Department of Kinesiology | View source |
| D001835 |
| Body Weight |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D001836 | Body Weight Changes |