Diet Management

Enhancing Diet Management in Older Adults with Sarcopenic Obesity (SO) Through the EatWelLong App with Family Support: A Pilot RCT

在家庭支持下透過 EatWelLong 應用程式加強肌肉少症肥胖 (SO) 老年人的飲食管理：試點隨機對照試驗

PI: Justina LIU (Associate Professor, SN); Co-Is: Chunyi WEN (Associate Professor, BME); Kenneth Ka Hei LO (Assistant Professor, FSN); Jed Ray MONTAYRE (Associate Professor, SN)

Project Background

The EatWellLog App, developed by our team, offers personalized support and adapts to individual dietary habits. It uses motivational elements from Klasnja and Pratt's mHealth development framework1 to facilitate health behaviour change, addressing the challenges of adherence and the impracticality of prolonged in-person dietary consultations and monitoring with the goal of improving management of SO. In this proposal, we suggest a new feature that enables family involvement, supporting and motivating older adults through the App to sustainably improve their dietary health leading to the improvement of the SO status.

Problem Identification

SO, marked by diminished muscle mass and excess adiposity, affects 9.95% of older adults in Chinaand 11% globally², with rates climbing to over 23% in those aged 75+². SO significantly heightens the risk of physical disability, institutionalization, and mortality compared to sarcopenia or obesity alone³. Due to its profound impact and the limited research, it is critical to develop evidence-based strategies to combat this health issue.

Nutritional Interventions: Essential for managing sarcopenia due to inadequate protein intake and obesity from excessive caloric consumption⁴. Systematic reviews have demonstrated improvements in various SO metrics such as muscle strength, muscle mass, physical performance, and BMI through dietary interventions⁶. However, challenges in increasing muscle mass often persist, potentially due to low adherence to recommended protein levels.

Challenges of Solving the Existing Problem

Conventional in-person dietary interventions are often hindered by low compliance, high attrition, time and labour demends⁷, which compromise the viability of research findings leading to inconsistent treatment effects. Also, therapeutic effects often diminish after completing dietary programmes. Managing SO demands a balance of increased protein and reduced calories, with practical challenges in portion control and daily dietary integration, complicating SO dietary management4

Project Objective

1. Investigate the acceptability of the EatWelLog App (hereafter referred to as "the App") by survey and focus groups
2. Assess the feasibility of the App by evaluating recruitment rates, attrition rates, user adherence, and the incidence of adverse events and technical issues reported
3. Explore App usage patterns of participants and their family members by analysing data collected from the backend databases
4. Test the preliminary effects of an 8-week supervised dietary programme combined with the App in the experimental (EXPE) group, which includes family support via the App, versus the active control group (ACon) that uses the same dietary programme with the App but without family using the App. Both groups will be compared to a control (Con) group that receives only the supervised dietary programme without the App.

We have two hypotheses

1) the App is acceptable and feasible for use by older adults with SO and their families to improve management and adherence to specialized dietary regimens.

2) users of the App, whether with or without family support via the App, will exhibit significant improvements in SO status—measured by four SO diagnostic criteria: grip strength, muscle mass, physical performance, and body fat mass—as well as in secondary outcomes: nutritional self-efficacy, nutritional status, dietary quality, health-related quality of life (QoL), and adherence to diet regimens.

Research Design

The pilot RCT to test the above hypotheses will be a 3-armed, 1:1:1 ratio, assessor-blinded, parallelgroup comprising:

• An EXPE group receiving an 8-week supervised nutrition programme for SO, along with training to incorporate the App for daily diet management plus the support of family members via the App

• An ACon group receiving the identical 8-week supervised programme combined with the App but without family support via the App

• A Con group receiving the identical 8-week supervised programme without the App

Overview of Interventions (Appendix 1): All groups will separately receive an 8-week supervised dietary programme. The programme consists of personalized dietary modification programme designed for assisting older adults with SO to follow a special dietary regimen.

Additionally, both the EXPE and the ACon groups will be instructed to use the App for daily diet self-management but only the EXPEwith have an additional function in the App to engage family member to monitor and support participants to adherence to the recommended dietary regimen.

*The EatWelLog App: designed for older adults with SO, incorporates Klasnja and Pratt’s framework1 for developing m-Health to facilitate health behavioural change (Appendix 2). It supports users in managing their diet for gradual weight loss and muscle preservation, and adhering to the dietary regimen. Its key functions include Tracking Diet Information, Involving the Healthcare Team, Leveraging Social Influence, Accessible Health Information, and Utilizing Entertaining.

Benefits and Impacts

In short-term, older people with SO will benefit from improved body composition, physical performance, and overall health. Collaborative community centers for seniors can adopt the evidence-based intervention, utilizing m-health tools, to enhance the health of service users.

In mid-term, formal and informal caregivers will experience reduced burden, while the general public will gain knowledge on preventing and managing SO.

In long-term, public health policymakers can promote active and healthy aging by using m-health (gerontechnology), and healthcare and community resources will improve population health outcomes, leading to reduced financial burdens.

References

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2. Gao Q, Mei F, Shang Y, et al. Global prevalence of sarcopenic obesity in older adults: A systematic review and meta-analysis. Clin Nutr. Jul 2021;40(7):4633-4641. doi:10.1016/j.clnu.2021.06.009
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4. Trouwborst I, Verreijen A, Memelink R, et al. Exercise and Nutrition Strategies to Counteract Sarcopenic Obesity. Nutrients. May 12 2018;10(5)doi:10.3390/nu10050605
5. Katsanos CS, Kobayashi H, Sheffield-Moore M, Aarsland A, Wolfe RR. Aging is associated with diminished accretion of muscle proteins after the ingestion of a small bolus of essential amino acids. Am J Clin Nutr. Nov 2005;82(5):1065-73. doi:10.1093/ajcn/82.5.1065
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10. Kraus WE, Bhapkar M, Huffman KM, et al. 2 years of calorie restriction and cardiometabolic risk (CALERIE): exploratory outcomes of a multicentre, phase 2, randomised controlled trial. Lancet Diabetes Endocrinol. Sep 2019;7(9):673-683. doi:10.1016/s2213-8587(19)30151-2
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12. Bauer J, Biolo G, Cederholm T, et al. Evidence-Based Recommendations for Optimal Dietary Protein Intake in Older People: A Position Paper From the PROT-AGE Study Group. Journal of the American Medical Directors Association. 2013/08/01/ 2013;14(8):542-559. doi:https://doi.org/10.1016/j.jamda.2013.05.021