title: Effects of Calorie Restriction in Obese Older Adults: The CROSSROADS Randomized Controlled Trial.
abstract: BACKGROUND
  We lack a comprehensive assessment of the risks and benefits of calorie restriction in older adults at high risk for cardiometabolic disease. Calorie restriction may reduce visceral adipose tissue (VAT) but also have negative effects on lean mass and quality of life.
  
  
  METHODS
  We conducted a 52-week, randomized controlled trial involving 164 older adults with obesity taking at least one medication for hyperlipidemia, hypertension, or diabetes. Interventions included an exercise intervention alone (Exercise), or with diet modification and body weight maintenance (Maintenance), or with diet modification and energy restriction (Weight Loss). The primary outcome was change in VAT at 12 months. Secondary outcomes included cardiometabolic risk factors, functional status, and quality of life.
  
  
  RESULTS
  A total of 148 participants had measured weight at 12 months. Despite loss of -1.6% ± 0.3% body fat and 4.1% ± 0.7% initial body weight, Weight Loss did not have statistically greater loss of VAT (-192.6 ± 185.2 cm3) or lean mass (-0.4 ± 0.3 kg) compared with Exercise (VAT = -21.9 ± 173.7 cm3; lean mass = 0.3 ± 0.3 kg). Quality of life improved in all groups with no differences between groups. No significant changes in physical function were observed. Weight Loss had significantly greater improvements in blood glucose (-8.3 ± 3.6 mg/dL, p < .05) and HDL-cholesterol (5.3 ± 1.9, p < .01) compared with Exercise. There were no group differences in the frequency of adverse events.
  
  
  CONCLUSIONS
  While moderate calorie restriction did not significantly decrease VAT in older adults at high risk for cardiometabolic disease, it did reduce total body fat and cardiometabolic risk factors without significantly more adverse events and lean mass loss.
authors.affiliation: Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
authors.forename: Jamy D
authors.initials: JD
authors.lastname: Ard
authors.affiliation: Department of Nutrition Sciences, University of Alabama at Birmingham.
authors.forename: Barbara
authors.initials: B
authors.lastname: Gower
authors.affiliation: Department of Nutrition Sciences, University of Alabama at Birmingham.|Department of Human Studies, University of Alabama at Birmingham.
authors.forename: Gary
authors.initials: G
authors.lastname: Hunter
authors.affiliation: Division of Geriatrics, Department of Medicine, University of California, San Francisco.
authors.forename: Christine S
authors.initials: CS
authors.lastname: Ritchie
authors.affiliation: Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: David L
authors.initials: DL
authors.lastname: Roth
authors.affiliation: Department of Nutrition Sciences, University of Alabama at Birmingham.
authors.forename: Amy
authors.initials: A
authors.lastname: Goss
authors.affiliation: Department of Occupational Therapy, University of Alabama at Birmingham.
authors.forename: Brooks C
authors.initials: BC
authors.lastname: Wingo
authors.affiliation: Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham.
authors.forename: Eric V
authors.initials: EV
authors.lastname: Bodner
authors.affiliation: Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham.
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Brown
authors.affiliation: Department of Nutrition Sciences, University of Alabama at Birmingham.|Department of Human Studies, University of Alabama at Birmingham.
authors.forename: David
authors.initials: D
authors.lastname: Bryan
authors.affiliation: Department of Food Science, Nutrition, and Health Promotion, Mississippi State University, Starkville.
authors.forename: David R
authors.initials: DR
authors.lastname: Buys
authors.affiliation: Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham.
authors.forename: Marilyn C
authors.initials: MC
authors.lastname: Haas
authors.affiliation: Institute for Community Health Promotion, Brown University, Providence, Rhode Island.
authors.forename: Akilah Dulin
authors.initials: AD
authors.lastname: Keita
authors.affiliation: Department of Sociology, University of Alabama at Birmingham.
authors.forename: Lee Anne
authors.initials: LA
authors.lastname: Flagg
authors.affiliation: Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham.
authors.forename: Courtney P
authors.initials: CP
authors.lastname: Williams
authors.affiliation: Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham.
authors.forename: Julie L
authors.initials: JL
authors.lastname: Locher
mesh_terms: D000368:Aged; D015992:Body Mass Index; D031204:Caloric Restriction / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009765:Obesity / Q000178:diet therapy*; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology*
keywords: Weight reduction; cardiometabolic risk; physical function; quality of life; visceral adipose tissue