Impact of a community-based exercise programme on physical fitness in middle-aged and older patients with type 2 diabetes

ObjectivesPhysical fitness is related to all-cause mortality, quality of life and risk of falls in patients with type 2 diabetes. This study aimed to analyse the impact of a long-term community-based combined exercise program (aerobic + resistance + agility/balance + flexibility) developed with minimum and low-cost material resources on physical fitness in middle-aged and older patients with type 2 diabetes.MethodsThis was a non-experimental pre-post evaluation study. Participants (N = 43; 62.92 ± 5.92 years old) were engaged in a community-based supervised exercise programme (consisting of combined aerobic, resistance, agility/balance and flexibility exercises; three sessions per week; 70 min per session) of 9 months’ duration. Aerobic fitness (6-Minute Walk Test), muscle strength (30-Second Chair Stand Test), agility/balance (Timed Up and Go Test) and flexibility (Chair Sit and Reach Test) were assessed before (baseline) and after the exercise intervention.ResultsSignificant improvements in the performance of the 6-Minute Walk Test (Δ = 8.20%, p < 0.001), 30-Second Chair Stand Test (Δ = 28.84%, p < 0.001), Timed Up and Go Test (Δ = 14.31%, p < 0.001), and Chair Sit and Reach Test (Δ = 102.90%, p < 0.001) were identified between baseline and end-exercise intervention time points.ConclusionsA long-term community-based combined exercise programme, developed with low-cost exercise strategies, produced significant benefits in physical fitness in middle-aged and older patients with type 2 diabetes. This supervised group exercise programme significantly improved aerobic fitness, muscle strength, agility/balance and flexibility, assessed with field tests in community settings.     

Effectiveness of a Diet and Resistance Exercise Intervention on Muscle Health in Older Adults: ProMuscle in Practice

ObjectivesClinical studies show that resistance exercise and a protein-rich diet can counteract the age-related decline of muscle mass, strength, and physical performance. The aim of the ProMuscle in Practice study was to test effectiveness of a resistance exercise and dietary protein intervention for older adults implemented in a real-life setting.DesignA randomized controlled multicenter intervention study.Setting and ParticipantsOne hundred sixty-eight community-dwelling older adults were included (age 75 ± 6 years). A 12-week intensive support intervention including progressive resistance exercise supervised by a physiotherapist and dietitian guidance on increasing protein intake was followed by a voluntary 12-week moderate support intervention to continue the adapted lifestyle pattern. The control group received no intervention.MethodsCompliance was measured through attendance lists and 3-day food records. Physical functioning, leg strength (3-repetition maximum, knee extension strength), lean body mass [(LBM) dual-energy X-ray absorptiometry], and quality of life (5-level EQ-5D) were measured at baseline, and after 12 and 24 weeks. Differences in change between groups were assessed with linear mixed model analysis.ResultsThe intervention group increased protein intake and attended 83.6% of the training sessions. Short Physical Performance Battery score slightly increased in intervention participants [from 10.1 (95% confidence interval 9.7–10.5) to 10.4 (10.0–10.8) at week 12 and 10.6 (10.2–10.9) at week 24], where control participants decreased (time × treatment interactions, P < .05). Improvements in intervention group compared with controls were also observed for Timed Up-and-Go, strength and LBM at both time points (time × treatment interactions, P < .05). No difference between groups was found for the 6-Minute Walking Test, activities of daily living, and quality of life.Conclusions and ImplicationsProMuscle in Practice was effective on improving muscle strength and LBM, with small changes in the composite function score in community-dwelling older adults in a real-life setting. Further research should explore feasibility of real-life implementation, as well as improving long-term compliance.     

Sexual Minority College Undergraduate Students Have Worse Health-Related Quality of Life,Diet Quality,and Weight Dissatisfaction Than Their Heterosexual Peers

ObjectiveAssess the health-related quality of life (HRQOL), diet quality (DQ), and weight dissatisfaction in sexual minority (SM) undergraduates.MethodsUndergraduates (n = 690) at 2 universities completed a survey assessing HRQOL, body mass index, DQ, and weight dissatisfaction. A multivariate analysis of covariance assessed HRQOL between SM and heterosexual students. Chi-square tests and independent t tests measured weight dissatisfaction and DQ. P < 0.05 was considered statistically significant.ResultsSignificant differences in HRQOL were observed (F[6,584] = 8.89; P < 0.001; Wilk's Λ = 0.916; partial η² = 0.084). Sexual minority students experienced more days per month feeling sad/blue/depressed (12.0 ± 9.7 vs 6.3 ± 7.8 days; P < 0.001) and worried/tense/anxious (18.1 ± 10.2 vs 10.9 ± 9.8 days; P < 0.001); and fewer days feeling healthy and full of energy (6.8 ± 6.5 vs 11.4 ± 8.7 days; P < 0.001). Sexual minority students consumed more sugar (14.4 ± 7.9 g vs 10.2 ± 7.1 g; P = 0.020), had higher body mass indexes (25.8 ± 6.1 vs 24.4 ± 4.8; P = 0.005), and were less satisfied with their weight (30.7% vs 44.0%; P = 0.001).Conclusions and ImplicationsSexual minority undergraduates experience similar health disparities as other SM populations and have indicators of poorer DQ.     

Response and Adherence of Nursing Home Residents to a Nutrition/Exercise Intervention

ObjectivesInterindividual response variability to nutrition and exercise interventions is extensive in older adults. A group of nursing home (NH) residents participated in a combined intervention. The objective of this post-hoc analysis was to identify factors associated with intervention response measured by change in physical function and body composition.DesignPost-hoc analyses in the Older Person's Exercise and Nutrition study, a 2-arm randomized trial. The primary outcomes were 30-second Chair Stand Test and composite scores combining physical function and fat-free mass. A secondary outcome was intervention adherence. A 12-week intervention of sit-to-stand exercises and protein-rich nutritional supplements did not improve chair-stand capacity vs control on intention-to-treat basis.Setting and ParticipantsResidents ≥75 years of age from dementia and somatic units in eight NHs in Sweden.MethodsLogistic regressions were performed to define factors associated with response (maintenance/improvement) or nonresponse (deterioration) in 30-second Chair Stand Test, and with intervention adherence. Linear regressions were performed to explore factors associated with response in composite scores.ResultsMean age of participants (n = 52 intervention, n = 49 control) was 85.8 years. Sarcopenia was occurring in 74%. Sarcopenia at baseline (P = .005) and high adherence to nutritional supplements (P = .002) increased the odds of response. Higher independence in daily activities increased the odds of adherence to sit-to-stand exercises (P = .027) and the combined intervention (P = .020). Allocation to the intervention group and higher self-perceived health were associated with higher composite scores.Conclusions and ImplicationsNH residents with baseline sarcopenia, better self-perceived health, and high adherence to nutritional supplements benefitted most from a combined nutrition and exercise intervention regarding chair-stand capacity and composite scores of function and fat-free mass. Adherence was related to higher grade of independence. Understanding factors associated with response and adherence to an intervention will help target susceptible residents in most need of support and to optimize the outcome.     

Effect of Sit-to-Stand Exercises Combined With Protein-Rich Oral Supplementation in Older Persons: The Older Person's Exercise and Nutrition Study

ObjectivesNursing home (NH) residents are often undernourished and physically inactive, which contributes to sarcopenia and frailty. The Older Person's Exercise and Nutrition Study aimed to investigate the effects of sit-to-stand exercises (STS) integrated into daily care, combined with a protein-rich oral nutritional supplement (ONS), on physical function, nutritional status, body composition, health-related quality of life, and resource use.DesignResidents in 8 NHs were randomized by NH units into an intervention group (IG) or a control group (CG) (n = 60/group). The IG was a combination of STS (4 times/day) and ONS (2 bottles/day providing 600 kcal and 36 g protein) for 12 weeks.Setting and ParticipantsThe participants resided in NH units (dementia and somatic care), were ≥75 years of age, and able to rise from a seated position.MethodsThe 30-second Chair Stand Test was the primary outcome. Secondary outcomes were balance, walking speed, dependence in activities of daily living, nutritional status and body composition, health-related quality of life, and resource use.ResultsAltogether, 102 residents (age 86 ± 5 years, 62% female) completed the study. No improvement in the physical function assessments was observed in the IG, whereas body weight increased significantly (2.05 ± 3.5 kg, P = .013) vs the CG. Twenty-one (of 52) participants with high adherence to the intervention (ie, at least 40% compliance to the combined intervention) increased their fat free mass (2.12 kg (0.13, 4.26 interquartile range), P = .007 vs CG). Logistic regression analyses indicated that the odds ratio for maintained/improved 30-second Chair Stand Test was 3.5 (confidence interval 1.1, 10.9, P = .034) among the participants with high adherence compared with the CG.Conclusions/ImplicationsTwelve-week intervention of daily STS combined with ONS in NH residents did not improve physical function, but increased body weight. Subgroup analyses indicated that high adherence to the combined intervention was associated with maintained or improved physical function and a gain of fat free mass.     

High-Intensity Interval and Resistance Training Improve Health Outcomes in Older Adults With Coronary Disease

ObjectiveBoth high-intensity interval training (HIIT) and resistance exercises (R) are used in cardiac rehabilitation in patients with coronary artery disease (CAD). However, the combined effect of an HIIT + R exercise program in older adults with CAD is not well investigated. The study's purpose was to assess the changes in anthropometric parameters, physical activity, functional capacity, physiological parameters, and quality of life (QoL) in this population following a combined HIIT + R program.DesignThe study was a 2-group (n = 45 each) randomized controlled single-blinded trial.Setting and ParticipantsThe study was done at a treatment clinic of a tertiary hospital. The mean age of participants was 69.23 ± 4.9 years. The HIIT + R group performed 8 sessions (1/wk) of HIIT + R training. The 30 minutes of the active exercise phase consisted of ten 3-minute bouts. Each bout comprised of 1 minute of high-intensity treadmill walking at 85% to 90% maximum heart rate (MHR), followed by a low-intensity walking at 60%-70% MHR, followed by low-to moderate-intensity resistance training. The Usual Care group underwent conventional medical treatment.MeasuresAnthropometric measurements [weight, body mass index (BMI), waist circumference, body fat percentage, lean body mass], physical activity (International Physical Activity Questionnaire), functional capacity (Incremental Shuttle Walking Test), physiologic measurements (blood pressure, heart rate), and QoL (36-Item Short Form Health Survey) were measured pre- and postintervention.ResultsSignificant group and time interaction were found for the participants in the HIIT + R Group for BMI (P = .001), body fat percentage (P = .001), waist circumference (P < .001), physical activity (P < .001), functional capacity (P < .001), and QoL (P = .001) compared with the UC Group. Significant improvement in systolic blood pressure (P = .001) was seen in the HIIT + R group.Conclusions and ImplicationsA combined HIIT + R training protocol in older adults with CAD can be useful in producing desired health outcomes. Further evaluation of longer duration exercise programs with more frequent dosing needs to be evaluated for their benefits and sustainability.     

Vitamin D status and its association with adiposity and oxidative stress in schoolchildren

ObjectiveThe aim of this study was to evaluate serum 25-hydroxyvitamin D [25(OH)D] level and its association with adiposity, inflammation, and oxidative stress in schoolchildren.MethodsA total of 1488 schoolchildren ages 7 to 11 y were recruited in Harbin, China (latitude: 44°04′N–46°40′N) in May. Serum 25(OH)D, which is an indicator of vitamin D status, was determined. Anthropometric data were collected following general physical examinations. Serum lipids, glucose metabolism indices, inflammatory molecules, and oxidative stress markers were determined. Dietary intake and physical activity also were assessed.ResultsThe median serum 25(OH)D concentration was 18.4 ng/mL. Of the 1488 schoolchildren included, 839 (56.4%) had vitamin D deficiency [25(OH)D < 20 ng/mL]. Children in the vitamin D deficiency group had significantly higher body weight (34.1 ± 3.8 versus 31.5 ± 3.3 kg; P < 0.001), body mass index (18.4 ± 2.2 versus 16.8 ± 1.7 kg/m²; P < 0.001), waist circumference (60.1 ± 8.5 versus 57.2 ± 7.7 cm; P < 0.001), percentage of body fat (20.2% ± 2.6% versus 19.1% ± 2.4%; P < 0.001), and significantly lower concentrations of serum superoxide dismutase (95.38 ± 12.22 versus 127.62 ± 15.98 U/mL; P < 0.001) compared with those in the vitamin D sufficiency group. After adjusting for sex, age, body mass index, and percentage of body fat, a positive association between serum 25(OH)D and superoxide dismutase was found (β = 0.230; P < 0.001).ConclusionsVitamin D deficiency is common in Harbin schoolchildren. Serum 25(OH)D is closely associated with adiposity and superoxide dismutase in schoolchildren, suggesting that vitamin D deficiency potentially increases the risk for diseases caused by higher adiposity and oxidative stress.     

Association between sleep quality and physical functioning in adults with Down syndrome: A brief report

BackgroundSleep quality is associated with physical functioning in adults, but this has not been examined in those with Down syndrome (DS). High body mass index (BMI) and accelerated aging, both common in adults with DS, may alter the relationship between sleep quality and physical functioning in this population.ObjectiveTo examine sleep quality indicators and its association with physical functioning in adults with DS, and whether associations are altered by BMI and age.MethodsParticipants were 15 adults with DS (8 women; age 29 ± 14 years). We evaluated sleep quality over seven days with wrist-worn accelerometers and physical functioning with the timed-up-and-go (TUG) and 6-min walk (6 MW) tests. We examined the associations between sleep quality and physical functioning variables using Spearman's rho.ResultsSleep quality indicators were: total sleep time 407 ± 54 min; latency 26.8 ± 21 min; efficiency 73.9 ± 12 %; wake after sleep onset 122.8 ± 65.2 min; number of awakenings 21.0 ± 6.2; and average length of awakenings 6.1 ± 3 min. Total sleep time and average length of awakenings were significantly associated with 6 MW distances (rho = 0.58 and ?0.69; p < 0.05, respectively). After controlling for age and BMI, 6 MW distance was significantly associated with total sleep time, latency, efficiency, and average length of awakenings (rho = 0.56, ?0.73, 0.60, and ?0.87; p < 0.05, respectively). TUG was significantly associated with total time in bed (rho = 0.71); p < 0.05).ConclusionsSleep quality indicators are associated with walking performance in adults with DS. Age and BMI strengthen the relationship between sleep quality and physical functioning.     

Four-Month Course of Soluble Milk Proteins Interacts With Exercise to Improve Muscle Strength and Delay Fatigue in Elderly Participants

BackgroundThe benefit of protein supplementation on the adaptive response of muscle to exercise training in older people is controversial.ObjectiveTo investigate the independent and combined effects of a multicomponent exercise program with and without a milk-based nutritional supplement on muscle strength and mass, lower-extremity fatigue, and metabolic markers.DesignA sample of 48 healthy sedentary men aged 60.8 ± 0.4 years were randomly assigned to a 16-week multicomponent exercise training program with a milk-based supplement containing, besides proteins [total milk proteins 4 or 10 g/day or soluble milk proteins rich in leucine (PRO) 10 g/day], carbohydrates and fat. Body composition, muscle mass and strength, and time to task failure, an index of muscle fatigue, were measured. Blood lipid, fibrinogen, creatine phosphokinase, glucose, insulin, C-reactive protein, interleukin-6, tumor necrosis factor-α soluble receptors, and endothelial markers were assessed.ResultsBody fat mass was reduced after the 4-month training program in groups receiving 10 g/day of protein supplementation (P < .01). The training program sustained with the daily 10 g/day PRO was associated with a significant increase in dominant fat free mass (+5.4%, P < .01) and in appendicular muscle mass (+4.5%, P < .01). Blood cholesterol was decreased in the trained group receiving 10 g/day PRO. The index of insulin resistance (homeostasis model assessment–insulin resistance) and blood creatine phosphokinase were reduced in the groups receiving 10 g/day PRO, irrespective of exercise. The inflammatory and endothelial markers were not different between the groups. Training caused a significant improvement (+10.6% to 19.4%, P < .01) in the maximal oxygen uptake. Increased maximum voluntary contraction force was seen in the trained groups receiving 10 g/day of proteins (about 3%, P < .05). Time to task failure was improved in the trained participants receiving a 10 g/day supplementation with PRO (P < .01).ConclusionsSoluble milk proteins rich in leucine improved time to muscle failure and increase in skeletal muscle mass and strength after prolonged multicomponent exercise training in healthy older men.     

Effects of maternal over- and undernutrition on intestinal morphology,enzyme activity,and gene expression of nutrient transporters in newborn and weaned pigs

ObjectivesIt has been suggested that maternal nutrition during gestation is involved in the offspring's intestinal development. The aim of this study was to evaluate the effects of maternal nutrition on digestive and absorptive function of offspring at both birth and weaning with pig as model.MethodsEighteen primiparous Landrace × Yorkshire gilts (ages 253 ± 9 d; body weight 148.6 ± 6.9 kg) were allocated to a normal nutrition (control) group as recommended by the National Research Council (NRC; 1998), an undernutrition (UN) group (75% of NRC recommendations), and an overnutrition (ON) group (150% of NRC recommendations); the nutritional treatments were introduced from day 1 of gestation to farrowing.ResultsBy comparison, the small intestine weight (+33%; P < 0.01) and the ratio of small intestine weight to length (+25%; P < 0.05) for the ON group were higher than those for the control group. Meanwhile, the maternal ON treatment had significant effect on the activity of brush border lactase in the jejunum (+125%; P < 0.05) at birth. Expression of mRNA for SGLT1, GLUT2, PEPT1, and GLP2R were significantly increased (+1.7∼9.6-fold; P < 0.05) in jejunum of newborn or weaned piglets from the ON group; whereas maternal UN significantly affected small intestine weight (–28%; P < 0.01), length, and the ratio of weight to length (–11% and –19%; P < 0.05, respectively), and villus height (–29% and –22%; P < 0.05, respectively) in jejunum and ileum. Furthermore, maternal UN enhanced the activity of brush border lactase in the jejunum of newborn piglets (P < 0.05).ConclusionsMaternal ON enhanced intestinal function via up-regulating digestive enzyme activities and gene expression of transporters in both newborn and weaning piglets. Maternal UN impaired fetal intestinal development that could be partially compensated during the neonatal period.     

Serum 25-hydroxyvitamin D levels among Mexican children ages 2 y to 12 y: A national survey

ObjectiveThe aim of this study was to assess the vitamin D status in preschool and school-age children in Mexico.Methods25-hydroxyvitamin D (25-OH-D) serum concentrations were measured using a direct enzyme-linked immunosorbent assay commercial kit in a nationally representative sample of 1025 Mexican children ages 2 y to 12 y who participated in the 2006 Mexican National Health and Nutrition Survey.ResultsMean serum 25-OH-D concentration was 94.6 ± 47 nmol/L. Concentrations were lower in preschool children (2–5 y; 78.3 ± 37 nmol/L) than in school-aged children (6–12 y; 105.8 ± 51 nmol/L; P < 0.001). Children living in urban areas had lower levels (89.8 ± 36 nmol/L) than children from rural areas (108.1 ± 75 nmol/L; P < 0.05). Twenty-four percent of preschool children had vitamin D deficiency (25-OH-D < 50 nmol/L) compared with 10% of school-aged children (P < 0.05). Thirty percent of preschool children had vitamin D insufficiency (25-OH-D 50–74.9 nmol/L) compared with 18% of school-aged children (P < 0.05). In urban areas, 18% of children had vitamin D deficiency and 25% had insufficiency compared with 10% and 16% of children in rural areas, respectively (P < 0.05). Prevalence of severe vitamin D deficiency (25-OH-D < 20 nmol/L) was extremely low (0.3%).ConclusionsVitamin D deficiency and insufficiency are important public health problems in Mexican children.     

Reliability and Validity of Digital Images to Assess Child Dietary Intake in a Quick-Service Restaurant Setting

BackgroundDevelopment of methods to accurately measure dietary intake in free-living situations—restaurants or otherwise—is critically needed to understand overall dietary patterns.ObjectiveThis study aimed to develop and test reliability and validity of digital images (DI) for measuring children’s dietary intake in quick-service restaurants (QSRs), validating against weighed plate waste (PW) and bomb calorimetry (BC).DesignIn 2016, cross-sectional data were collected at two time points within a randomized controlled trial assessing children’s leftovers in QSRs from parents of 4- to 12-year-old children.Participants/settingParents (n = 640; mean age = 35.9 y; 70.8% female) consented and agreed to provide their child’s PW for digital imaging, across 11 QSRs in Massachusetts in areas with low socioeconomic status and ethnically diverse populations.Outcome measuresOutcome measures were interrater reliability for DIs, correspondence between methods for energy consumed and left over, and correspondence between methods across varying quantities of PW.Analyses performedIntraclass correlations, percent agreement, Spearman correlations, Wilcoxon signed rank tests, and Bland-Altman plots were used.ResultsInterrater reliability ratings for DIs had substantial intraclass correlations (ICC = 0.94) but not acceptable exact percent agreement (80.2%); DI and PW energy consumed were significantly correlated (r = 0.96, P < 0.001); DI slightly underestimated energy consumed compared with PW (Mdiff = ?1.61 kcals, P < 0.001). Bland-Altman plots showed high DI–PW correspondence across various energy amounts and revealed few outliers. Energy left over by BC was highly correlated with DI (r = 0.87, P < 0.001) and PW (r = 0.90, P < 0.001); and mean differences were not significantly different from DI (Mdiff = 9.77 kcal, P = 0.06) or PW (Mdiff = ?2.84 kcal, P = 0.20).ConclusionsCorrespondence was high between PW and DI assessments of energy consumed, and high with BC energy left over. Results demonstrate reliability and practical validity of digital images for assessing child meal consumption in QSR settings.     

Changes in Cardiometabolic Risk Among Older Adults with Obesity: An Ancillary Analysis of a Randomized Controlled Trial Investigating Exercise Plus Weight Maintenance and Exercise Plus Intentional Weight Loss by Caloric Restriction

BackgroundObesity imposes risk to cardiometabolic health; however, intentional weight loss among older adults with obesity remains controversial.ObjectiveTo 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.DesignUsing 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 settingParticipants (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 measuresTo evaluate effects of exercise plus weight maintenance and exercise plus intentional weight loss on changes in cardiometabolic risk.Statistical analyses performedGeneralized estimating equations were used to assess changes in risk with ethnicity, biological sex, and age as covariates.ResultsGroup-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.ConclusionsAmong 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.     

Intranasal Oxytocin Improves Lean Muscle Mass and Lowers LDL Cholesterol in Older Adults with Sarcopenic Obesity: A Pilot Randomized Controlled Trial

ObjectivesObesity is associated with sarcopenia in older adults, and weight loss can lead to further muscle mass loss. Oxytocin decreases with age, and animal studies suggest that oxytocin administration has trophic effects on skeletal muscle cells and reduces adiposity. We conducted a clinical trial to examine the safety and preliminary efficacy of intranasal oxytocin for older adults with sarcopenic obesity.DesignA double-blind, placebo-controlled randomized controlled trial of intranasal oxytocin (24 IU 4 times per day) for 8 weeks.Setting and ParticipantsTwenty-one older (67.5 ± 5.4 years), obese (30–43 kg/m²), sedentary (<2 strenuous exercise per week) adults with slow gait speed (<1 m/s, proxy measure of sarcopenia) were recruited.MeasuresGeneralized estimating equations were used to evaluate the effect of oxytocin on safety/tolerability of oxytocin administration and whole body muscle and fat mass.ResultsAt baseline, body mass index (BMI) was 36.8 ± 3.6 kg/m², fat mass 46.09 ± 6.99 kg, lean mass 50.98 ± 11.77 kg, fasting plasma glucose (FPG) 92.0 ± 8.9 mg/dL, hemoglobin A1c (HbA1c) 5.7% ± 0.4%, low density lipoprotein (LDL) 111.3 ± 41.5 mg/dL, high-density lipoprotein (HDL) 47.85 ± 10.96 mg/dL, and triglycerides 140.55 ± 83.50 mg/dL. Oxytocin administration was well tolerated without any significant adverse events. Oxytocin led to a significant increase of 2.25 kg in whole body lean mass compared with placebo (P < .01) with a trend toward decreasing fat mass, and a significantly reduced plasma LDL cholesterol by −19.3 mg/dL (P = .023) compared against placebo. There were no significant changes in BMI, appetite scores, glycemia, plasma HDL, triglycerides, or depressive symptoms.Conclusions and ImplicationsThis proof-of-concept study indicates that oxytocin may be useful for the treatment of sarcopenic obesity in older adults. Oxytocin administration may also provide additional cardiovascular benefits.     

High-protein diet promotes a moderate postpartum weight loss in a prospective cohort of Brazilian women

ObjectiveWhether a high-protein (HP) diet promotes body weight loss (BWL) when compared with a low-protein (LP) diet is still unclear. Therefore, we evaluated the effects of an HP diet on BWL during postpartum.MethodsA food-frequency questionnaire with 81 items was applied at 6 mo after delivery to evaluate the diet of 430 postpartum women aged 18–45 y. Body weight was measured approximately at 0.5, 2, 6, and 9 mo after delivery. Body weight loss was modeled by comparing an HP diet (≥1.2 g · kg^?1 · d^?1) with an LP diet (<1.2 g · kg^?1 · d^?1) using mixed-effects linear regression models adjusted for energy intake, percentage of body fat at baseline, stature, age, race, smoking, and schooling.ResultsUsual energy intake was higher in the HP than in the LP diet group (2623 versus 1791 kcal, P < 0.0001). Daily mean protein intakes were 1.54 ± 0.32 g · kg^?1 · d^?1 for the HP group and 0.83 ± 0.20 g · kg^?1 · d^?1 for the LP group. A multivariate model showed that women in the HP group lost 316 ± 0.062 g of body weight more per month (P < 0.01) when compared with the LP group.ConclusionA reported higher protein intake may improve moderate postpartum body weight loss. Further studies should evaluate the long-term consequences of an HP diet postpartum.     

Leptin,adiponectin, and short-term and long-term weight loss after a lifestyle intervention in obese children

ObjectiveIn overweight children, high leptin levels are independently associated with higher risk for cardiovascular disease, whereas adiponectin seems to be protective against type 2 diabetes and atherosclerosis. The study examines the predictive value of leptin for weight loss after a 4- to 6-wk inpatient therapy and again after 1 y; as well as the association among weight loss, leptin, and adiponectin levels and changes in cardiometabolic risk factors after therapy.MethodsBody mass index (BMI), blood pressure, Tanner stage, and cardiometabolic risk factors were studied in 402 children (59.2% females, 13.9 ± 2.3 y, BMI 33.8 ± 5.7 kg/m²) before and after a 4-to 6-wk inpatient intervention (exercise, diet, and behavioral therapy) and BMI 1 y later (n = 206).ResultsBMI was reduced from 33.8 ± 5.7 to 30.5 ± 5.1 kg/m² (P < 0.001) during the lifestyle intervention and remained unchanged after 1 y. Baseline BMI was positively associated with leptin (r = 0.60; P < 0.001) and cardiometabolic risk factors (blood pressure, high-density lipoprotein [HDL] cholesterol, triglycerides). Baseline leptin was associated with BMI and triglycerides (r = 0.39; P < 0.001), baseline adiponectin with HDL-cholesterol (r = 0.40; P < 0.001). Baseline BMI explained 40.7% of the variance in weight loss during therapy. The combination of BMI, sex, and leptin explained 50.4% of the variance. Neither BMI nor leptin predicted weight changes over the long term.ConclusionsOverweight children maintained a substantial amount of weight loss after participation in a short-term inpatient lifestyle intervention. Baseline BMI was positively associated with weight reduction during the intervention, whereas baseline leptin had only a minor predictive value.     

Feasibility and effects of a group-based resistance and aerobic exercise program for individuals with severe schizophrenia: A multidisciplinary approach

PurposePeople with schizophrenia/schizoaffective disorders have a higher risk of morbidity and premature mortality compared to the general population in part due to sedentary lifestyles. The aim of this pilot study was to investigate the feasibility and effects of aerobic (AT) and resistance training (RT) on individuals with schizophrenia/schizoaffective disorders.MethodsEight males and five females (mean age 44.6 ± 3 years) were randomized to either twice weekly exercise (n = 7) or usual care (control) (n = 6). Functional exercise capacity (six minute walk distance (6MWD)), muscular strength, anthropometric measures, and domains of mental health were measured at baseline and after 12 weeks. Data are presented as means ± SEM.ResultsThe exercise group demonstrated a 27.7 ± 22.3 m increase in 6MWD while the control group showed a decrease of 28.3 ± 26.6 m (between-group difference, p = 0.1). There was a significant strength increase for exercise (28.3 ± 8.8%, p = 0.01) but not for control (12.5 ± 8.5%, p = 0.2). The exercise group had a significant improvement in total Mental Health Inventory (MHI) score (p < 0.03) with no change for control. Gain in 6MWD was directly associated with improvement in total MHI score (r = 0.8, p = 0.009) as was reduction in depressive symptoms (r = ?0.9, p < 0.001) among all participants. Attendance at exercise sessions averaged 72 ± 4.4% with no dropouts. Reduction in depressive symptoms correlated with greater adherence to exercise (r = ?0.93, p = 0.02).ConclusionsA 12-week community-based AT and RT program results in significant improvements in overall mental health, muscular strength and a trend for improvement in functional exercise capacity. Among all participants, improvement in functional exercise capacity was associated with improvement in overall mental health as well as a reduction in depressive symptoms. Reduction in depressive symptoms was associated with greater adherence to exercise. A group exercise program for individuals with schizophrenia/schizoaffective disorder is feasible when implemented by a multidisciplinary team.     

SGA Scores Have Poor Correlation With Serum Albumin in Obese Hemodialysis Patients: A Secondary Analysis

ObjectiveThe objective of this study was to determine the relationship between serum albumin and the Subjective Global Assessment (SGA) in a sample of obese hemodialysis (HD) patients.Design and MethodStudy subjects (N = 253) included patients who were categorized into well-nourished (68%, SGA score 6-7) and malnourished (score 1-5) groups, and, on the basis of the body mass index (BMI), into obese (BMI > 30 kg/m²; 35%) and nonobese (BMI < 30 kg/m²). The mean baseline data (±standard deviation) were as follows: age, 63.5 ± 14.3 years; BMI, 29 ± 8 kg/m²; and serum albumin, 3.8 ± 0.4 mg/dL (bromocresol green). The secondary analysis of data from the SGA Validation Project and Nutrition Algorithm Preliminary Report determined the relationship between the 7-point SGA and serum albumin concentrations in a sample of obese HD patients. Data were analyzed at Case Western Reserve University from a total of 253 HD patients.Main Outcome MeasureThe SGA scores in the BMI groups were compared with serum albumin as an objective measure of nutrition and inflammation risk.ResultsBy using analysis of variance, the obese and nonobese populations showed statistically significant differences in SGA scores (obese: P < .3468, nonobese: P < .0080) and serum albumin values (obese, P < .0943; nonobese, P < .0183) between well-nourished and malnourished groups. A multivariable nominal logistic fit was used to predict SGA group with age and gender as covariates. Serum albumin values (P < .0057) and BMI values greater than 30 (P < .0090) predicted SGA group.ConclusionThe secondary analysis showed that SGA does not correlate well with serum albumin; thus, it may not be a valid nutrition assessment tool among obese HD patients.     

Temporal Relationship Between Depressive Symptoms and Cognition in Mid and Late Life: A Longitudinal Cohort Study

ObjectivesTo examine the bidirectional temporal relationship between depressive symptoms and cognition in relation to risk, reaction, and prodrome.DesignCross-lag analysis of longitudinal data collected online at baseline and 12-month follow-up.Setting and ParticipantsA United Kingdom population cohort of 11,855 participants aged 50 years and over.MeasuresPatient Health Questionnaire-9 (depressive symptoms), cognitive measures: Paired Associate Learning, Verbal Reasoning, Spatial Working Memory, and Digit Span.ResultsDepressive symptoms predicted a decline in paired associates learning [β = −.020, P = .013, (95% confidence interval [CI], ‒.036, −.004)] and verbal reasoning [β = −.014, P = .016, (95% CI ‒.025, −.003)] but not vice versa. Depressive symptoms predicted [β = −.043, P < .001, (95% CI ‒.060, −.026); β = −.029, P < .001, (95% CI ‒.043, −.015)] and were predicted by [β = −.030, P = < .001, (95% CI ‒.047, −.014); β = −.025, P = .003, (95% CI ‒.041, −.009)], a decline in spatial working memory and verbal digit span, respectively.Conclusions and ImplicationsDepressive symptoms may be either a risk factor or prodrome for cognitive decline. In addition, a decline in attention predicts depressive symptoms. Clinical implications and implications for further research are discussed.