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Nutrition and Exercise Interventions to Improve Body Composition for Persons with Overweight or Obesity Near Retirement Age: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.
Eglseer, D, Traxler, M, Embacher, S, Reiter, L, Schoufour, JD, Weijs, PJM, Voortman, T, Boirie, Y, Cruz-Jentoft, A, Bauer, S
Advances in nutrition (Bethesda, Md.). 2023;14(3):516-538
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Obesity is characterised by excessive fat accumulation that often occurs during the process of aging. Aging is accompanied not only by a gradual increase in body fat stores but also a decrease in muscle mass, muscle function, and water retention. The aim of this study was to assess which nutrition and exercise interventions are most effective for improving the body composition (fat mass and muscle mass), body mass index, and waist circumference in persons with overweight or obesity near retirement age (55 to 70 years of age). This study was a systematic review and network meta-analysis (NMA) of randomised controlled trials of sixty-six studies. Results of the NMA showed that the most effective strategy to improve body composition, i.e., losing fat without increasing risk of sarcopenia in persons with obesity around retirement age, was combining energy restriction with resistance training or with mixed exercise (resistance combined with aerobic exercise) and/or high-protein intake. In fact, without training, an energy-restricted diet with or without added protein helped individuals lose fat mass but also tended to result in losses of muscle mass. Authors conclude that an energy-restricted diet alone probably contributes to the development of sarcopenic obesity in persons of retirement age. Thus, to simultaneously lose weight and maintain muscle mass, authors recommend a combination of energy restriction and resistance training.
Abstract
The retirement phase is an opportunity to integrate healthy (nutrition/exercise) habits into daily life. We conducted this systematic review to assess which nutrition and exercise interventions most effectively improve body composition (fat/muscle mass), body mass index (BMI), and waist circumference (WC) in persons with obesity/overweight near retirement age (ages 55-70 y). We conducted a systematic review and network meta-analysis (NMA) of randomized controlled trials, searching 4 databases from their inception up to July 12, 2022. The NMA was based on a random effects model, pooled mean differences, standardized mean differences, their 95% confidence intervals, and correlations with multi-arm studies. Subgroup and sensitivity analyses were also conducted. Ninety-two studies were included, 66 of which with 4957 participants could be used for the NMA. Identified interventions were clustered into 12 groups: no intervention, energy restriction (i.e., 500-1000 kcal), energy restriction plus high-protein intake (1.1-1.7 g/kg/body weight), intermittent fasting, mixed exercise (aerobic and resistance), resistance training, aerobic training, high protein plus resistance training, energy restriction plus high protein plus exercise, energy restriction plus resistance training, energy restriction plus aerobic training, and energy restriction plus mixed exercise. Intervention durations ranged from 8 wk to 6 mo. Body fat was reduced with energy restriction plus any exercise or plus high-protein intake. Energy restriction alone was less effective and tended to decrease muscle mass. Muscle mass was only significantly increased with mixed exercise. All other interventions including exercise effectively preserved muscle mass. A BMI and/or WC decrease was achieved with all interventions except aerobic training/resistance training alone or resistance training plus high protein. Overall, the most effective strategy for nearly all outcomes was combining energy restriction with resistance training or mixed exercise and high protein. Health care professionals involved in the management of persons with obesity need to be aware that an energy-restricted diet alone may contribute to sarcopenic obesity in persons near retirement age. This network meta-analysis is registered at https://www.crd.york.ac.uk/prospero/ as CRD42021276465.
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Comparison of the Effects of Intermittent Energy Restriction and Continuous Energy Restriction among Adults with Overweight or Obesity: An Overview of Systematic Reviews and Meta-Analyses.
Wang, J, Wang, F, Chen, H, Liu, L, Zhang, S, Luo, W, Wang, G, Hu, X
Nutrients. 2022;14(11)
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Obesity is the leading cause of cardiovascular disease, diabetes, hypertension, hyperlipidaemia, and some forms of cancer. 38% of people worldwide are overweight, and 20% are obese. To combat obesity and associated comorbidities, calorie restriction (CR) is found to be a cost-effective non-pharmacological intervention. Intermittent energy restriction (IER) and continuous energy restriction (CER) are two forms of CR characterised by notable calorie restriction and normal energy intake phases. Forms of IER included in this research are the 5:2 diet, alternate-day fasting (ADF), and time-restricted feeding (TRF). For weight loss, CER limits calorie intake by 15-40%. A total of eleven randomised controlled studies were included in this systematic review and meta-analysis to compare the effectiveness of IER protocols with CER in reducing weight, BMI and waist circumferences in overweight or obese individuals. Improvements in anthropometric parameters were not different between IER and CER. A long-term robust study is necessary to evaluate the effects of IER and CER on improving anthropometric and metabolic parameters due to the limitations and heterogeneity of current research evidence. Nevertheless, healthcare professionals can use the results of this study to understand the role of IER and CER in weight loss and their clinical relevance for improving overall health and lifespan.
Abstract
There is considerable heterogeneity across the evidence regarding the effects of intermittent energy restriction and continuous energy restriction among adults with overweight or obesity which presents difficulties for healthcare decision-makers and individuals. This overview of systematic reviews aimed to evaluate and synthesize the existing evidence regarding the comparison of the two interventions. We conducted a search strategy in eight databases from the databases' inception to December 2021. The quality of 12 systematic reviews was assessed with A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE). One review was rated as high quality, 1 as moderate, 4 as low, and 6 as critically low. A meta-analysis of the original studies was conducted for comparison of primary intermittent energy restriction protocols with continuous energy restriction. Intermittent energy restriction did not seem to be more effective in weight loss compared with continuous energy restriction. The advantages of intermittent energy restriction in reducing BMI and waist circumference and improvement of body composition were not determined due to insufficient evidence. The evidence quality of systematic reviews and original trials remains to be improved in future studies.
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The Effectiveness of Intermittent Fasting to Reduce Body Mass Index and Glucose Metabolism: A Systematic Review and Meta-Analysis.
Cho, Y, Hong, N, Kim, KW, Cho, SJ, Lee, M, Lee, YH, Lee, YH, Kang, ES, Cha, BS, Lee, BW
Journal of clinical medicine. 2019;8(10)
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Calorie restriction (CR) is known to reduce body weight and to improve various cardiovascular risk factors. Due to the many difficulties in sustaining daily CR, intermittent fasting (IF) has been proposed as an alternative strategy for achieving and maintaining weight reduction. The aim of this study was to investigate the effectiveness of IF on weight loss and glucose metabolism by analysing the effect size of previous studies among the general population without diabetes mellitus. A total of 12 studies were included in this study. The total number of participants was 545 (261 in the intervention group and 284 in the control group). Study analysis indicates an improvement in glycaemic control and insulin resistance through IF diet as compared with a non-fasting control group. Lean mass was relatively conserved in the IF diet group however, no significant weight reduction was identified. Authors conclude that IF diet may improve fat distribution in the general population without chronic metabolic disease.
Abstract
The effects of an intermittent fasting diet (IFD) in the general population are still controversial. In this study, we aimed to systematically evaluate the effectiveness of an IFD to reduce body mass index and glucose metabolism in the general population without diabetes mellitus. Cochrane, PubMed, and Embase databases were searched to identify randomized controlled trials and controlled clinical trials that compared an IFD with a regular diet or a continuous calorie restriction diet. The effectiveness of an IFD was estimated by the weighted mean difference (WMD) for several variables associated with glucometabolic parameters including body mass index (BMI) and fasting glucose. The pooled mean differences of outcomes were calculated using a random effects model. From 2814 studies identified through a literature search, we finally selected 12 articles (545 participants). Compared with a control diet, an IFD was associated with a significant decline in BMI (WMD, -0.75 kg/m2; 95% CI, -1.44 to -0.06), fasting glucose level (WMD, -4.16 mg/dL; 95% CI, -6.92 to -1.40), and homeostatic model assessment of insulin resistance (WMD, -0.54; 95% CI, -1.05 to -0.03). Fat mass (WMD, -0.98 kg; 95% CI, -2.32 to 0.36) tended to decrease in the IFD group with a significant increase in adiponectin (WMD, 1008.9 ng/mL; 95% CI, 140.5 to 1877.3) and a decrease in leptin (WMD, -0.51 ng/mL; 95% CI, -0.77 to -0.24) levels. An IFD may provide a significant metabolic benefit by improving glycemic control, insulin resistance, and adipokine concentration with a reduction of BMI in adults.