Abstract
BackgroundInsulin resistance and accumulation of visceral adipose tissue (VAT) and intermuscular adipose tissue (IMAT) place aging adults with obesity at high risk of cardio-metabolic disease. A very low carbohydrate diet (VLCD) may be a means of promoting fat loss from the visceral cavity and skeletal muscle, without compromising lean mass, and improve insulin sensitivity in aging adults with obesity.ObjectiveTo determine if a VLCD promotes a greater loss of fat (total, visceral and intermuscular), preserves lean mass, and improves insulin sensitivity compared to a standard CHO-based/low-fat diet (LFD) in older adults with obesity.DesignThirty-four men and women aged 60–75 years with obesity (body mass index [BMI] 30-40 kg/m2) were randomized to a diet prescription of either a VLCD (< 10:25:> 65% energy from CHO:protein:fat) or LFD diet (55:25:20) for 8 weeks. Body composition by dual-energy X-ray absorptiometry (DXA), fat distribution by magnetic resonance imaging (MRI), insulin sensitivity by euglycemic hyperinsulinemic clamp, and lipids by a fasting blood draw were assessed at baseline and after the intervention.ResultsParticipants lost an average of 9.7 and 2.0% in total fat following the VLCD and LFD, respectively (p < 0.01). The VLCD group experienced ~ 3-fold greater loss in VAT compared to the LFD group (− 22.8% vs − 1.0%, p < 0.001) and a greater decrease in thigh-IMAT (− 24.4% vs − 1.0%, p < 0.01). The VLCD group also had significantly greater thigh skeletal muscle (SM) at 8 weeks following adjustment for change in total fat mass. Finally, the VLCD had greater increases in insulin sensitivity and HDL-C and decreases in fasting insulin and triglycerides compared to the LFD group.ConclusionsWeight loss resulting from consumption of a diet lower in CHO and higher in fat may be beneficial for older adults with obesity by depleting adipose tissue depots most strongly implicated in poor metabolic and functional outcomes and by improving insulin sensitivity and the lipid profile.Trial registrationNCT02760641. Registered 03 May 2016 - Retrospectively registered.
Highlights
35% of adults in the U.S aged 65 and over have obesity, and the prevalence of chronic metabolic disease and impaired functional status among older adults with obesity is high [1, 2]
The very low carbohydrate diet (VLCD) group experienced ~ 3-fold greater loss in visceral adipose tissue (VAT) compared to the low-fat diet (LFD) group (− 22.8% vs − 1.0%, p < 0.001) and a greater decrease in thigh-intermuscular adipose tissue (IMAT) (− 24.4% vs − 1.0%, p < 0.01)
The VLCD had greater increases in insulin sensitivity and HDL-C and decreases in fasting insulin and triglycerides compared to the LFD group
Summary
35% of adults in the U.S aged 65 and over have obesity, and the prevalence of chronic metabolic disease and impaired functional status among older adults with obesity is high [1, 2]. VAT and IMAT increase with advancing age, and are linked to insulin resistance and promote a pro-inflammatory state [3,4,5,6] that may inhibit skeletal muscle synthesis, contributing to poorer metabolic and functional outcomes [7]. To reduce risk of metabolic disease in older adults with obesity, nonpharmacological interventions designed to deplete visceral and ectopic adiposity and improve insulin resistance are needed. Insulin resistance and accumulation of visceral adipose tissue (VAT) and intermuscular adipose tissue (IMAT) place aging adults with obesity at high risk of cardio-metabolic disease. A very low carbohydrate diet (VLCD) may be a means of promoting fat loss from the visceral cavity and skeletal muscle, without compromising lean mass, and improve insulin sensitivity in aging adults with obesity
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