Effect of a hypocaloric, nutritionally complete, higher-protein meal plan on bone density and quality in older adults with obesity: a randomized trial

Abstract

Background Dietary protein and micronutrients are important to the maintenance of bone health and may be an effective countermeasure to weight-loss–associated bone loss. Objectives We aimed to determine the effect of a 6-mo hypocaloric, nutritionally complete, higher-protein meal plan on change in bone density and quality as compared with weight stability in older adults using a randomized post-test design. We hypothesized that participants randomly assigned to this meal plan would maintain similar bone density and quality to weight-stable controls, despite significant reductions in body mass. Methods Ninety-six older adults (aged 70.3 ± 3.7 y, 74% women, 27% African American) with obesity [body mass index (kg/m2): 35.4 ± 3.3] were randomly assigned to a 6-mo hypocaloric, nutritionally complete, higher-protein meal plan targeting ≥1.0 g protein · kg body weight–1 · d–1 [weight-loss (WL) group; n = 47] or to a weight-stability (WS) group targeting 0.8 g protein · kg body weight–1 · d–1, the current Recommended Dietary Allowance (n = 49). The primary outcome was total hip bone mineral density (BMD), with femoral neck BMD, lumbar spine BMD, and lumbar spine trabecular bone score (TBS) as secondary outcomes, all assessed at baseline and 3 and 6 mo with dual-energy X-ray absorptiometry. Results Baseline total hip, femoral neck, and lumbar spine BMDs were 1.016 ± 0.160, 0.941 ± 0.142, and 1.287 ± 0.246 g/cm2, respectively; lumbar TBS was 1.398 ± 0.109. Despite significant weight loss achieved in the WL group (6.6 ± 0.4 kg; 8.6% ± 0.4% of baseline weight), 6-mo regional BMD estimates were similar to those in the WS group (all P > 0.05). Lumbar spine TBS significantly increased at 6 mo in the WL group (mean: 1.421; 95% CI: 1.401, 1.441) compared with the WS group (1.390: 95% CI: 1.370, 1.409; P = 0.02). Conclusions Older adults following a hypocaloric, nutritionally complete, higher-protein meal plan maintained similar bone density and quality to weight-stable controls. Our data suggest that adherence to this diet does not produce loss of hip and spine bone density in older adults and may improve bone quality. This trial was registered at clinicaltrials.gov as NCT02730988.

Menopause-Associated Lipid Metabolic Disorders and Foods Beneficial for Postmenopausal Women

“…According to the North American reference standards for nutrients, macronutrient portions should consist of approximately 10%-35% protein-derived energy, 45%-65% carbohydrate-derived energy, and 20%-35% fat-derived energy [97]. The requirements of several key nutrients, such as protein, vitamin D, vitamin B-12, fiber, and fluid, must be met in a hypocaloric diet for older obese adults [98]. The 2013 American Heart Association (AHA)/American College of Cardiology (ACC) Guideline for Obesity prescribed the following methods to reduce food and calorie intake for weight loss: (a) 1200-1500 kcal/day for women (kilocalorie levels are usually adjusted for the individual's body weight), (b) a 500 kcal/day or 750 kcal/day energy deficit, (c) one of the evidence-based diets that restricts certain food types (such as high-carbohydrate foods, low-fiber foods, or high-fat foods) to create an energy deficit and reduce food intake.…”

Protein, amino acids and obesity treatment

“…Moreover, the android to gynoid fat mass ratio improved, in association with subsequent lipid and glucose plasmatic profiles [ 17 ]. Finally, the hypocaloric, nutritionally complete, high protein diet helped to maintain bone density and quality during weight loss [ 18 ]. In a recent meta-analysis, Hsu et al also found that very low calorie, high protein diets improve body composition compared to very low calorie, normal protein diets, preserving skeletal muscle mass and decreasing fat mass [ 19 ].…”

Low Energy Availability with and without a High-Protein Diet Suppresses Bone Formation and Increases Bone Resorption in Men: A Randomized Controlled Pilot Study

“…Increased dietary protein preserves lean mass, which is positively associated with bone mineral density [ 12 ]. Indeed, a high-protein diet has been shown to preserve lean mass and bone mineral density similar to an energy balance control during a six-month weight loss intervention [ 13 ]. Maintenance of lean mass and bone mineral density during periods of low energy availability in athletes may improve performance capacity and reduced risk for future injury, or even osteoporosis later in life [ 14 , 15 ].…”