Evaluation and improvement of current guidelines for treatment of obesity in older adults (WC2015-043 HZ)

Methods

Starting date: 27/10/2015

Question 1 and 2 (current dietetic approach and effectivity of the treatment of obese older adults in the Netherlands, and success and failure factors in this treatment) will be investigated using data of the ‘DIEET’ project: www.hva.nl/kik-dieet

In summary: within this prospective observational project 237 dieticans are observed during their first consults with their client. In total more than 600 observations are done. The factors of observation mainly cover factors in the preparation of the consult, the content of the consult, the knowledge of the dietician, dietary history of the client, dietetic diagnosis, treatment goals, advice, communication skills, anthropometric measurements and the location of dietetic practice. A follow-up will take place after 6, 9 and 12 months. The dietician will be asked for data on outcome measures such as body weight, waist circumference, BIA, laboratory values and medication and data on the progress of the treatment.

 

Question 3 (validity of predictive equations for resting energy expenditure in obese older adults)

In more than 200 obese older adults (55 years and over) the resting energy expenditure (indirect calorimetrie: Vmax ENCORE), length (stadiometer), body weight, fat free mass and fat mass (air displacement plethysmography, BodPod) are measured under standardized conditions in the Amsterdam Nutritional Assessment Centre Amsterdam (Amsterdam University of Applied Sciences). Based on these data published equations for estimating resting energy expenditure will be evaluated and a new equation will be developed and cross-validated.

 

Question 4 (relation amount and type of protein, amino acid composition, level of (resistance) training and 5-year change in muscle mass in obese older adults) will be investigated with the data of the American Health ABC study. The Health ABC study is an observational cohort study in which more than 3000 elderly are followed annually since 1997. Data include food intake (108-item FFQ), level of (resistance) training, lean mass and fat mass (DXA-scan) and thigh muscle area (CT-scan). The thigh muscle area is the primary outcome.

 

Question 5 (effect of resistance training and/or a high protein diet on preservation of fat free mass during weight loss in overweight older adults) will be investigated with data of the ‘WelPrex’ study. In this study we included 100 overweight adults (55-80y) in a RCT with a 2x2 factorial design. During a 10-wk weight loss program all subjects followed a hypocaloric diet (-600 kcal/d). Subjects were randomly allocated to either a high protein (1.3 g/kg body weight) or control diet (0.8 g/kg), with or without a resistance exercise program 3 times/wk. Primary outcome was change in FFM (air displacement plethysmography). Secondary outcomes were change in body weight, FM, physical performance, and quality of life. For more information, see trialregister (nr: 4556): http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4556

 

Question 6 (effect of protein supplementation combined with resistance training during 13 weeks of weight loss on preservation of muscle mass and insulin sensitivity in older obese diabetic adults)

For this question data of the ‘Probe’ project will be used. Inclusion of this project is ongoing. In total 120 obese diabetic older adults will be included in a double-blind randomized controlled trial. During a 13-wk weight loss program, all subjects will follow a hypocaloric diet (-600 kcal/d) and perform resistance training 3/wk. Subjects will be randomly allocated to a high whey protein–, leucine-, and vitamin D–enriched supplement including a mix of other micronutrients (150 kcal, 21 g protein; 10 x/wk, intervention group) or an isocaloric control. Primary outcome is change in appendicular muscle mass. Secondary outcomes are body composition, handgrip strength, and physical performance and insulin sensitivity (Oral Glucose Tolerance Test).

For more information on the Probe project, see trialregister (nr: 4497): http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4497