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.
MULTIFILE
Background & aims: Individual energy requirements of overweight and obese adults can often not be measured by indirect calorimetry, mainly due to the time-consuming procedure and the high costs. To analyze which resting energy expenditure (REE) predictive equation is the best alternative for indirect calorimetry in Belgian normal weight to morbid obese women.Methods: Predictive equations were included when based on weight, height, gender, age, fat free mass and fat mass. REE was measured with indirect calorimetry. Accuracy of equations was evaluated by the percentage of subjects predicted within 10% of REE measured, the root mean squared prediction error (RMSE) and the mean percentage difference (bias) between predicted and measured REE.Results: Twenty-seven predictive equations (of which 9 based on FFM) were included. Validation was based on 536 F (18–71 year). Most accurate and precise for the Belgian women were the Huang, Siervo, Muller (FFM), Harris–Benedict (HB), and the Mifflin equation with 71%, 71%, 70%, 69%, and 68% accurate predictions, respectively; bias −1.7, −0.5, +1.1, +2.2, and −1.8%, RMSE 168, 170, 163, 167, and 173 kcal/d. The equations of HB and Mifflin are most widely used in clinical practice and both provide accurate predictions across a wide range of BMI groups. In an already overweight group the underpredicting Mifflin equation might be preferred. Above BMI 45 kg/m2, the Siervo equation performed best, while the FAO/WHO/UNU or Schofield equation should not be used in this extremely obese group.Conclusions: In Belgian women, the original Harris–Benedict or the Mifflin equation is a reliable tool to predict REE across a wide variety of body weight (BMI 18.5–50). Estimations for the BMI range between 30 and 40 kg/m2, however, should be improved.
As the population is aging rapidly, there is a strong increase in the number of individuals with chronic disease and physical limitations. The decrease in skeletal muscle mass and function (sarcopenia) and the increase in fat mass (obesity) are important contributors to the development of physical limitations, which aggravates the chronic diseases prognosis. The combination of the two conditions, which is referred to as sarcopenic obesity, amplifies the risk for these negative health outcomes, which demonstrates the importance of preventing or counteracting sarcopenic obesity. One of the main challenges is the preservation of the skeletal muscle mass and function, while simultaneously reducing the fat mass in this population. Exercise and nutrition are two key components in the development, as well as the prevention and treatment of sarcopenic obesity. The main aim of this narrative review is to summarize the different, both separate and combined, exercise and nutrition strategies so as to prevent and/or counteract sarcopenic obesity. This review therefore provides a current update of the various exercise and nutritional strategies to improve the contrasting body composition changes and physical functioning in sarcopenic obese individuals.
