| Author: | Yin, Yueheng |
| Title: | Dietary behaviour change intervention for managing sarcopenic obesity among community-dwelling older people : a pilot randomised controlled trial |
| Advisors: | Liu, Justina (SN) Välimäki, Maritta (SN) |
| Degree: | Ph.D. |
| Year: | 2022 |
| Subject: | Obesity Older people -- Health and hygiene -- China Reducing diets Hong Kong Polytechnic University -- Dissertations |
| Department: | School of Nursing |
| Pages: | xx, 205 pages : color illustrations |
| Language: | English |
| Abstract: | Background Sarcopenic obesity, a combined condition of muscle loss and fat accumulation, could cause morbidity, falls, metabolic problems, or even mortality. Plenty of interventional studies have been conducted assessing sarcopenic obesity management primarily through exercise and supplements. While exercise is not suitable for all older people, especially for those with physical limitations, and supplements may cause side effects. Comparatively, changing dietary behaviour could help older people develop a healthy dietary habits and have long-term effects on managing sarcopenic obesity. The present study aimed to develop a dietary behaviour change intervention and to evaluate the feasibility and preliminary effects of the intervention on managing sarcopenic obesity among older people in the community. Methods This study followed the Medical Research Council 2008 guideline to develop and evaluate the intervention protocol. The intervention was developed based on an evidence-based literature review and the Delphi method, by which the intervention components, including the intervention duration, the dose of calorie and protein intake, and intervention guidebook, were identified. A pilot randomised controlled trial nested with a qualitative interview was conducted to evaluate the feasibility and preliminary effects of the intervention. This pilot study was a two-armed single-blind trial, which was conducted in three community health centres in Nanjing, China. Sixty participants aged 60 years old or above were allocated to two groups in a 1:1 ratio by block randomisation. The experimental group received a 15-week dietary behaviour change (DBC) intervention (12% caloric reduction/day + 1.2-1.5 g/kg body weight/day intake of protein), which included 6 face-to-face sessions and weekly telephone calls. Behaviour change techniques were utilised during the intervention, which included establishing risk perception, outcome expectancies, coping planning, and actions to enhance self-efficacy. The purposive sampling method was used to identify twenty-one participants from the experimental group with various levels of compliance to food diary taken, who were invited to individual semi-structured interviews after the intervention to explore their perceptions about the intervention process. The control group received regular social interaction at a similar frequency and timing to the experimental group. The feasibility assessment covered the following elements: recruitment, safety, and acceptability of the intervention components. The preliminary effects of the intervention were assessed at baseline (T0) and post-intervention (T1) by evaluating the following outcomes: body composition, handgrip strength, physical performance, nutrition self-efficacy, dietary quality, nutritional status and health status. The data analysis followed the intention-to-treat principle. Descriptive statistics, Chi-square test, Mann Whitney U test, independent t-test, generalised estimating equation, missing completely at random analysis, and content analysis were used to analyse the data. Results The feasibility of the DBC intervention was confirmed by the recruitment rate (57.14%), the response rate of the measurement tool (100%), and the retention rate (83.33%). No adverse events were reported. The percent of people who attended face-to-face sessions at least five times was 73.33%, the adherence rate of people taking food diary rated as moderate or above was 26.66%. The compliance rate to adequate protein intake was 66.67%, and calorie intake for male participants decreased from 1715±284 kcal/day to 1571±267 kcal/day, for female participants decreased from 1696±231 kcal/day to 1451±195 kcal/day. Four themes were synthesised from the qualitative interviews after the intervention: overall perceptions of intervention, barriers in participating in the intervention, facilitators for implementing the intervention, and suggestions for the future program. The participants felt the design of the DBC intervention was acceptable and helpful for them, and they presented desires for learning nutritional knowledge. Compared with the control group, participants in the experimental group significantly reduced the body weight (Wald χ2=4.90, p=0.027, d=1.22) and improved the dietary quality (Wald χ2=12.66, p<0.001, d=1.31). However, the skeletal muscle mass (Wald χ2=5.62, p=0.018, d=0.84) and the fat free mass (Wald χ2=7.49, p=0.006, d=1.11) of participants in the experimental group were also reduced significantly. The handgrip strength (increased from 15.37± 1.08 kg to 18.21± 1.68 kg) and 6-m gait speed (increased from 0.91±0.02 m/s to 0.99±0.03 m/s) in the experimental group showed a trend of increase from baseline to post-intervention. Conclusions The dietary behavioural change to increase protein intake and reduce calorie intake can be achieved by older people under the dietary intervention, which has incorporated the behaviour change techniques. The 15-week DBC intervention could significantly decrease the body weight, and presented a trend to increase the handgrip strength and gait speed, but the skeletal muscle mass was decreased simultaneously. Cautions are needed for the generalisation of this study's findings because the insufficient statistic power caused by the small sample size. Significance This study combined behaviour change techniques with dietary interventions, which is novel in the research area related to sarcopenic obesity, which addressed the limitations of previous studies in managing sarcopenic obesity. The qualitative results of this study provided us with a better understanding of current older people's needs and concerns in dietary behaviour change. This study indicated the pressing needs to provide professional nutrition knowledge addressing muscle function to community-dwelling older people. This study also demonstrated the potential for employing dietary behaviour change intervention in community healthcare. |
| Rights: | All rights reserved |
| Access: | open access |
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