Anna E Bragg1, Kristi M Crowe-White2, Amy C Ellis1, Matthew Studer3, Frank Phillips3, Steven Samsel3, Jason Parton3, Julie L Locher4, Jamy D Ard5. 1. Department of Human Nutrition, The University of Alabama, Tuscaloosa. 2. Department of Human Nutrition, The University of Alabama, Tuscaloosa. Electronic address: kcrowe@ches.ua.edu. 3. Institute of Business Analytics, The University of Alabama, Tuscaloosa. 4. Institute of Business Analytics, The University of Alabama at Birmingham. 5. Department of Epidemiology and Prevention, The Wake Forest University School of Medicine, Winston-Salem, NC.
Abstract
BACKGROUND: Obesity imposes risk to cardiometabolic health; however, intentional weight loss among older adults with obesity remains controversial. OBJECTIVE: 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. DESIGN: 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 AND SETTING: 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). MAIN OUTCOME MEASURES: To evaluate effects of exercise plus weight maintenance and exercise plus intentional weight loss on changes in cardiometabolic risk. STATISTICAL ANALYSES PERFORMED: Generalized estimating equations were used to assess changes in risk with ethnicity, biological sex, and age as covariates. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND: Obesity imposes risk to cardiometabolic health; however, intentional weight loss among older adults with obesity remains controversial. OBJECTIVE: 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. DESIGN: 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 AND SETTING: 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). MAIN OUTCOME MEASURES: To evaluate effects of exercise plus weight maintenance and exercise plus intentional weight loss on changes in cardiometabolic risk. STATISTICAL ANALYSES PERFORMED: Generalized estimating equations were used to assess changes in risk with ethnicity, biological sex, and age as covariates. RESULTS: 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. CONCLUSIONS: 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.
Authors: Paul K Whelton; Robert M Carey; Wilbert S Aronow; Donald E Casey; Karen J Collins; Cheryl Dennison Himmelfarb; Sondra M DePalma; Samuel Gidding; Kenneth A Jamerson; Daniel W Jones; Eric J MacLaughlin; Paul Muntner; Bruce Ovbiagele; Sidney C Smith; Crystal C Spencer; Randall S Stafford; Sandra J Taler; Randal J Thomas; Kim A Williams; Jeff D Williamson; Jackson T Wright Journal: Hypertension Date: 2017-11-13 Impact factor: 9.897
Authors: Gregory A Roth; Catherine O Johnson; Kalkidan Hassen Abate; Foad Abd-Allah; Muktar Ahmed; Khurshid Alam; Tahiya Alam; Nelson Alvis-Guzman; Hossein Ansari; Johan Ärnlöv; Tesfay Mehari Atey; Ashish Awasthi; Tadesse Awoke; Aleksandra Barac; Till Bärnighausen; Neeraj Bedi; Derrick Bennett; Isabela Bensenor; Sibhatu Biadgilign; Carlos Castañeda-Orjuela; Ferrán Catalá-López; Kairat Davletov; Samath Dharmaratne; Eric L Ding; Manisha Dubey; Emerito Jose Aquino Faraon; Talha Farid; Maryam S Farvid; Valery Feigin; João Fernandes; Joseph Frostad; Alemseged Gebru; Johanna M Geleijnse; Philimon Nyakauru Gona; Max Griswold; Gessessew Bugssa Hailu; Graeme J Hankey; Hamid Yimam Hassen; Rasmus Havmoeller; Simon Hay; Susan R Heckbert; Caleb Mackay Salpeter Irvine; Spencer Lewis James; Dube Jara; Amir Kasaeian; Abdur Rahman Khan; Sahil Khera; Abdullah T Khoja; Jagdish Khubchandani; Daniel Kim; Dhaval Kolte; Dharmesh Lal; Anders Larsson; Shai Linn; Paulo A Lotufo; Hassan Magdy Abd El Razek; Mohsen Mazidi; Toni Meier; Walter Mendoza; George A Mensah; Atte Meretoja; Haftay Berhane Mezgebe; Erkin Mirrakhimov; Shafiu Mohammed; Andrew Edward Moran; Grant Nguyen; Minh Nguyen; Kanyin Liane Ong; Mayowa Owolabi; Martin Pletcher; Farshad Pourmalek; Caroline A Purcell; Mostafa Qorbani; Mahfuzar Rahman; Rajesh Kumar Rai; Usha Ram; Marissa Bettay Reitsma; Andre M N Renzaho; Maria Jesus Rios-Blancas; Saeid Safiri; Joshua A Salomon; Benn Sartorius; Sadaf Ghajarieh Sepanlou; Masood Ali Shaikh; Diego Silva; Saverio Stranges; Rafael Tabarés-Seisdedos; Niguse Tadele Atnafu; J S Thakur; Roman Topor-Madry; Thomas Truelsen; E Murat Tuzcu; Stefanos Tyrovolas; Kingsley Nnanna Ukwaja; Tommi Vasankari; Vasiliy Vlassov; Stein Emil Vollset; Tolassa Wakayo; Robert Weintraub; Charles Wolfe; Abdulhalik Workicho; Gelin Xu; Simon Yadgir; Yuichiro Yano; Paul Yip; Naohiro Yonemoto; Mustafa Younis; Chuanhua Yu; Zoubida Zaidi; Maysaa El Sayed Zaki; Ben Zipkin; Ashkan Afshin; Emmanuela Gakidou; Stephen S Lim; Ali H Mokdad; Mohsen Naghavi; Theo Vos; Christopher J L Murray Journal: JAMA Cardiol Date: 2018-05-01 Impact factor: 14.676