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

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/m(2)): 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/cm(2), 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.