The implications of sarcopenia and sarcopenic obesity on cardiometabolic disease

Dynapenic abdominal obesity and incident functional disability: Results from a nationwide longitudinal study of middle-aged and older adults in China

BACKGROUND

There is little epidemiological evidence on the relationship of dynapenic abdominal obesity (DAO) and the development of functional disability, particularly in Asian populations. We aimed to investigate the association of DAO with new-onset functional disability in Chinese adults.

METHODS

A total of 7881 participants aged ≥45 years from China Health and Retirement Longitudinal Study (CHARLS) in 2011 and 2015 were included in the study. Dynapenia and abdominal obesity were respectively defined based on handgrip strength (<28 kg for male and <18 kg for female) and waist circumference (≥ 90 cm for male and ≥85 cm for female). The sample was divided into four groups: non-dynapenic/non-abdominal obesity (ND/NAO), non-dynapenic/abdominal obesity (ND/AO), dynapenic/non-abdominal obesity (D/NAO) and dynapenic/abdominal obesity (D/AO). Functional status was assessed by basic activities of daily living (BADL) or instrumental activities of daily living (IADL). Logistic regression model was used to explore the longitudinal association between dynapenic abdominal obesity and incident functional disability.

RESULTS

After a 4-year follow-up, 1153 (14.6 %) developed BADL disability and 1335 (16.9 %) developed IADL disability. The multivariable-adjusted odds ratios (95 % CIs) for the D/AO versus ND/NAO were 2.21 (1.61-3.03) for BADL disability, and 1.68 (1.23-2.30) for IADL disability. In addition, DAO was associated with an increased risk for functional dependency severity (odds ratio, 2.08 [95 % CI, 1.57-2.75]).

CONCLUSIONS

DAO was significantly associated with greater risk of functional disability among Chinese middle-aged and older adults. Our findings indicated that interventions targeted DAO might be effective in the primary prevention of functional disability.

Dynapenic abdominal obesity and the risk of depressive symptoms in middle-aged and older Chinese adults: Evidence from a national cohort study

BACKGROUND

Population-based evidence on the relationship between dynapenic abdominal obesity and depressive symptoms is rare. We aimed to prospectively investigate the relationship between dynapenic abdominal obesity and depressive symptoms among middle-aged and older Chinese adults.

METHODS

A total of 9322 participants free of depressive symptoms in the China Health and Retirement Longitudinal Study were included. The participants were divided into four groups: non-dynapenic/non-abdominal obesity (ND/NAO), non-dynapenic/abdominal obesity (ND/AO), dynapenic/non-abdominal obesity (D/NAO) and dynapenic/abdominal obesity (D/AO) according to the sex-specific grip strength (<28 kg for men and <18 kg for women) and waist circumference (≥85 cm for men and ≥80 cm for women) that in line with the Chinese criteria. Depressive symptoms was defined as a score of ≥12 for the 10-item Center for Epidemiological Studies Depression Scale. Logistic regression model was used to explore the association between dynapenic abdominal obesity and depressive symptoms.

RESULTS

After an approximately 3-year of follow-up, 1810 participants (19.4 %) developed depressive symptoms. The multivariable-adjusted odds ratio for the D/AO versus ND/NAO was 1.61 (95 % CI: 1.31-1.98) for depressive symptoms. In addition, this relationship was more profound in participants aged<60 years (OR = 2.27, 95 % CI: 1.60-3.22) than participants aged ≥60 (OR = 1.36, 95 % CI: 1.05-1.77; P-interaction = 0.04). However, dynapenic obesity (defined by body mass index) was not linked to depressive symptoms.

LIMITATIONS

Causal link and residual confounding were not addressed because of the observational study design.

CONCLUSIONS

Dynapenic abdominal obesity was associated with an increased risk of depressive symptoms, especially among those aged<60 years.

The association between weight-adjusted-waist index and sarcopenia in adults: a population-based study

This study aims to investigate the relationship between weight-adjusted-waist index (WWI), a new body index, and sarcopenia, while also assessing the potential of WWI as a tool for screening sarcopenic patients. The cross-sectional study involved adults who possessed complete data on WWI and appendicular skeletal muscle mass from the 1999-2006 and 2011-2018 National Health and Nutrition Examination Surveys. Weighted multivariate regression and logistic regression analyses were employed to explore the independent relationship between WWI and sarcopenia. The study included 26,782 participants. The results showed that WWI demonstrated a positive correlation with sarcopenia risk. In the fully adjusted model, with each 1 unit increase in WWI, the risk of developing sarcopenia rose 14.55 times higher among males (OR: 14.55, 95% CI 12.33, 17.15) and 2.86 times higher among females (OR: 2.86, 95% CI 2.59, 3.15). The optimal cutoff values of WWI for sarcopenia were 11.26 cm/√kg for males and 11.39 cm/√kg for females. Individuals with a higher WWI have an increased risk of developing sarcopenia, and a high WWI functions as a risk factor for sarcopenia. Assessing WWI could assist in identifying individuals at risk of sarcopenia.

Combined Nutrition with Exercise: Fueling the Fight Against Sarcopenia Through a Bibliometric Analysis and Review

Objective

This bibliometric analysis and review aimed to examine the current research status and trends in the combination of nutrition and exercise training for sarcopenia. Additionally, it sought to provide researchers with future research directions in this field.

Methods

Relevant publications were obtained from the Web of Science Core Collection (WoSCC) database, covering the period from January 1995 to October 2023. The collected publications were analyzed using CiteSpace, VOSviewer, Bibliometrix, and Review Manager.

Results

Out of the 2528 retrieved publications, the United States emerged as the leading contributor in terms of publication volume. The University of Texas System was identified as the most productive institution. Luc J C van Loon emerged as the most published author in this field. Analysis of keywords revealed recent hot topics and emerging areas of interest, such as "gut microbiota" and "mechanisms". Upon further evaluation, resistance training (RT) and protein supplementation were identified as the most commonly employed and effective methods.

Conclusion

RT and protein supplementation are widely recognized as effective strategies. Future research should focus on investigating the molecular aspects of sarcopenia. Moreover, the potential therapeutic role of gut microbiota in sarcopenia requires further comprehensive investigation in human subjects to establish its correlation.

Association between sarcopenia and risk of major adverse cardiac and cerebrovascular events-UK Biobank database

BACKGROUND

Few studies on the risk of incident major adverse cardiac and cerebrovascular events (MACCEs) in sarcopenia have been reported. The objective was to assess the association between presarcopenia and sarcopenia and a higher risk of MACCEs.

METHODS

This study on the UK Biobank prospective cohort, used data collected between 2006 and 2021. Community-dwelling Caucasian participants aged 37 to 73 years were included if values for Handgrip Strength (HGS) and Skeletal Muscle Index (SMI) were available and if no history of MACCEs was reported. Exposure was assessed using the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. Muscle strength was measured using HGS, and muscle mass using the SMI. Presarcopenia was defined through the two definitions available in the literature, as low HGS with normal SMI and as normal HGS with low SMI, whereas sarcopenia was defined as low HGS with low SMI. The main outcome was to determine whether presarcopenia and/or sarcopenia were predictors of MACCEs (composite events).

RESULTS

A total of 406,411 included participants (women: 55.7%) were included. At baseline, there were 18,257 (4.7%) presarcopenics-subgroup n°1 (low HGS only), 7940 (2.1%) presarcopenics-subgroup n°2 (low SMI only), and 1124 (0.3%) sarcopenics. Over a median follow-up of 12.1 years (IQR: [11.4; 12.8]), 28,300 participants (7.0%) were diagnosed with at least one event. Compared to NonSarc, presarcopenic (subgroups n°1 and n°2) and sarcopenic status were significantly associated with a higher risk of MACCEs (respectively fully adjusted HRs: HR = 1.25 [95% CI: 1.19; 1.31], HR = 1.33 [95% CI: 1.23; 1.45] and HR = 1.62 [95% CI: 1.34; 1.95]).

CONCLUSIONS

In a community-dwelling population, the risk of MACCEs was higher in both presarcopenic and sarcopenic participants.

Novel subgroups of obesity and their association with outcomes: a data-driven cluster analysis

BACKGROUND

Obesity is associated with various complications and decreased life expectancy, and substantial heterogeneity in complications and outcomes has been observed. However, the subgroups of obesity have not yet been clearly defined. This study aimed to identify the subgroups of obesity especially those for target of interventions by cluster analysis.

METHODS

In this study, an unsupervised, data-driven cluster analysis of 9,494 individuals with obesity (body mass index ≥ 35 kg/m2) was performed using the data of ICD-10, drug, and medical procedure from the healthcare claims database. The prevalence and clinical characteristics of the complications such as diabetes in each cluster were evaluated using the prescription records. Additionally, renal and life prognoses were compared among the clusters.

RESULTS

We identified seven clusters characterised by different combinations of complications and several complications were observed exclusively in each cluster. Notably, the poorest prognosis was observed in individuals who rarely visited a hospital after being diagnosed with obesity, followed by those with cardiovascular complications and diabetes.

CONCLUSIONS

In this study, we identified seven subgroups of individuals with obesity using population-based data-driven cluster analysis. We clearly demonstrated important target subgroups for intervention as well as a metabolically healthy obesity group.

The Relationship Between Sarcopenia And Proteinuria, What Do We Know?

Sarcopenia is one of the most common geriatric syndromes in the elderly. It is defined as a decrease in muscle mass and function, and it can lead to physical disability, falls, poor quality of life, impaired immune system, and death. It is known that, the frequency of sarcopenia increases in the kidney patient population compared to healthy individuals. Although it is known that kidney disease can lead to sarcopenia; our knowledge of whether sarcopenia causes kidney disease is limited. Prior studies have suggested that protein energy wasting may be a risk of de novo CKD. Proteinuria is an important manifestation of kidney disease and there is a relationship between sarcopenia and proteinuria in diabetes, geriatric population, kidney transplant, and nephrotic syndrome. Does proteinuria cause sarcopenia or vice versa? Are they both the results of common mechanisms? This issue is not clearly known. In this review, we examined the relationship between sarcopenia and proteinuria in the light of other studies.

Causal influence of muscle weakness on cardiometabolic diseases and osteoporosis

The causal roles of muscle weakness in cardiometabolic diseases and osteoporosis remain elusive. This two-sample Mendelian randomization (MR) study aims to explore the causal roles of muscle weakness in the risk of cardiometabolic diseases and osteoporosis. 15 single nucleotide polymorphisms (SNPs, P < 5 × 10-8) associated with muscle weakness were used as instrumental variables. Genetic predisposition to muscle weakness led to increased risk of coronary artery disease (inverse variance weighted [IVW] analysis, beta-estimate: 0.095, 95% confidence interval [CI]: 0.023 to 0.166, standard error [SE]:0.036, P-value = 0.009) and reduced risk of heart failure (weight median analysis, beta-estimate: - 0.137, 95% CI - 0.264 to - 0.009, SE:0.065, P-value = 0.036). In addition, muscle weakness may reduce the estimated bone mineral density (eBMD, weight median analysis, beta-estimate: - 0.059, 95% CI - 0.110 to - 0.008, SE:0.026, P-value = 0.023). We found no MR associations between muscle weakness and atrial fibrillation, type 2 diabetes or fracture. This study provides robust evidence that muscle weakness is causally associated with the incidence of coronary artery disease and heart failure, which may provide new insight to prevent and treat these two cardiometabolic diseases.

Associations between body composition and cardiovascular disease risk in pre- and postmenopausal women

BACKGROUND

Menopause transition is a critical phase of women's life since body composition and cardiovascular risk factors begin to change during this period. This study investigated the associations between body composition and cardiovascular disease risk (CVDR) in pre (PrMW) and postmenopausal women (PMW).

METHODS

A community-based cross-sectional study involving 184 PrMW and 166 PMW, selected randomly from Bope-Poddala area in Galle, Sri Lanka was carried out. Total-body fat mass (TBFM, kg), total body skeletal muscle mass (TBSMM, kg), total body bone mineral density (TBBMD, g/cm2) and total body bone mineral content (TBBMC, g) were measured with total body DXA scanner and they were taken as indices of body composition. CVDR was evaluated using Framingham risk score (FRS%) and individual CVDR factors, such as systolic blood pressure (SBP, mmHg), diastolic blood pressure (DBP, mmHg), fasting blood sugar (FBS, mg/dl), total cholesterol, (TC, mg/dl), tryglycerides (TG, mg/dl), high-density lipoprotein (HDL, mg/dl) and low-density lipoprotein (LDL, mg/dl). Correlations between indices of body composition and CVDR factors were assessed with adjusted partial correlation (adjusted for socio-demographic and gynecologic status, age, daily calorie consumption and physical activity level).

RESULTS

Mean(SD) age of PrMW and PMW were 42.4(6.0) and 55.8(3.8) years respectively. TBFM correlated with SBP and DBP (r range; 0.15 to 0.21) and TBSMM correlated with SBP, DBP and HDL (r range; - 0.24 to 0.17) only in PrMW (p < 0.05). TBBMD correlated only with FBS in PMW (r; - 0.21, p = 0.01). TBBMC did not show correlations with CVDR factors (p > 0.05). Body composition indices did not show correlations with total CVDR estimated by FRS and in both groups of women (p > 0.05).

CONCLUSIONS

Both SBP and DBP are associated with FM and SMM in different ways among PrMW. This association, however, was not seen among PMW. FBS is associated with BMD only in PMW.

Association between sarcopenia-related traits and cardiovascular diseases: a bi-directional Mendelian randomization study

Background

The two geriatric diseases, sarcopenia and cardiovascular disease (CVD), often coexist, yet the causal relationship is unclear. However, few studies focus on the effect of muscle mass on CVD. This comprehensive study is dedicated to unearthing the potential connection between sarcopenia-related traits and CVD at the genetic level.

Method

A two-sample bi-directional Mendelian randomization (MR) study was conducted. In the first stage, we performed MR analysis regarding coronary heart disease (CHD), stroke, and myocardial infarction (MI) as exposure factors to reveal their effect on appendicular lean mass (ALM) and hand grip strength. In the second stage, we reverse the position of exposures and outcomes. The inverse variance weighted (IVW) method was used as the primary approach to reveal the potential causation between the exposure and outcome.

Results

The results of the IVW method revealed a negative causal effect of ALM on CHD (OR = 0.848, 95% CI = 0.804 to 0.894, p = 8.200E-10), stroke (OR = 0.931, 95% CI = 0.890 to 0.975, p = 2.220E-03), and MI (OR = 0.810, 95% CI = 0.694 to 0.901, p = 1.266E-13). Additionally, the left-hand grip strength is a significant protective factor for CHD (OR = 0.737, 95% CI = 0.601 to 0.904, p = 3.353E-03) and MI (OR = 0.631, 95% CI = 0.515 to 0.765, p = 2.575E-06), but is not causally linked to the stroke (OR = 0.971, 95% CI =0.829 to 1.139, p = 0.720). Meanwhile, the same conclusion about the effect of right-hand grip strength on CHD (OR = 0.681, 95% CI = 0.558 to 0.832, p = 1.702E-05), MI (OR = 0.634, 95% CI = 0.518 to 0.776, p = 9.069E-06), and stroke (OR = 1.041, 95% CI = 0.896 to 1.209, p = 0.604) was obtained. However, no significant causal effect of CVD (CHD, stroke, MI) on sarcopenia-related traits (ALM, handgrip strength) was found.

Conclusion

There is a unidirectional causal relationship between sarcopenia and CVD. The loss of muscle mass and strength has a significant causal role in promoting the occurrence and development of CVD, providing a reference for the prevention and treatment of comorbidities in older people.

The relationship between skeletal muscle mass and the KOSHA cardiovascular risk in obese male workers

Background

Efforts for the prevention and management of cardiovascular diseases (CVDs) in workers have been actively pursued. Obesity is one of the important risk factors related to CVDs. Obesity has various metabolic characteristics, and some individuals can be metabolically healthy. Body composition including skeletal muscle mass is known to have protective effect in obesity. The study aims to investigate the association between skeletal muscle mass and Korea Occupational Safety and Health Agency (KOSHA) CVD risk among obese male manufacturing workers in Korea and to identify appropriate indicators of skeletal muscle mass for predicting risk of CVDs.

Methods

The study was conducted on 2,007 obese male workers at a manufacturing industry aged more than 19 years. Skeletal muscle mass, skeletal muscle index (SMI), skeletal muscle mass percent (SMM%) and skeletal muscle to body fat ratio (MFR) were used to evaluate body composition and these indicators were divided into quartiles. The odds ratios (ORs) and 95% confidence intervals (CIs) for the KOSHA CVD risk groups according to quartiles of skeletal muscle mass indicators were estimated using ordinal logistic regression analysis.

Results

The OR for the KOSHA CVD risk groups in the highest quartile of SMI was 1.67 (95% CI: 1.42-1.92), while the ORs for the KOSHA CVD risk groups in the highest quartiles of SMM%, SMM/body mass index (BMI), and MFR were 0.47 (95% CI: 0.22-0.72), 0.51 (95% CI: 0.05-0.76), and 0.48 (95% CI: 0.23-0.74), respectively.

Conclusions

We found that high SMI increase the likelihood of high risk of CVDs, while high SMM%, SMM/BMI, and MFR lower the likelihood of high risk of CVDs. Accurate evaluation of skeletal muscle mass can help assess the cardiovascular risk in obese male workers.

Dietary behaviour change intervention for managing sarcopenic obesity among community-dwelling older people: a pilot randomised controlled trial

BACKGROUND

The effects of dietary intervention in managing sarcopenic obesity are controversial, and behavior change techniques are lacking in previous studies which are important for the success of dietary intervention. This study aimed to evaluate the feasibility and preliminary effects of a dietary behaviour change (DBC) intervention on managing sarcopenic obesity among community-dwelling older people in the community.

METHODS

A two-armed, RCT was conducted. Sixty community-dwelling older adults (≥ 60 years old) with sarcopenic obesity were randomised into either the experimental group (n = 30), receiving a 15-week dietary intervention combined with behaviour change techniques guided by the Health Action Process Approach model, or the control group (n = 30), receiving regular health talks. Individual semi-structured interviews were conducted with 21 experimental group participants to determine the barriers and facilitators of dietary behaviour changes after the intervention.

RESULTS

The feasibility of the DBC intervention was confirmed by an acceptable recruitment rate (57.14%) and a good retention rate (83.33%). Compared with the control group, the experimental group significantly reduced their body weight (p = 0.027, d = 1.22) and improved their dietary quality (p < 0.001, d = 1.31). A positive improvement in handgrip strength (from 15.37 ± 1.08 kg to 18.21 ± 1.68 kg), waist circumference (from 99.28 ± 1.32 cm to 98.42 ± 1.39 cm), and gait speed (from 0.91 ± 0.02 m/s to 0.99 ± 0.03 m/s) was observed only in the experimental group. However, the skeletal muscle mass index in the experimental group decreased. The interview indicated that behaviour change techniques enhanced the partcipants' compliance with their dietary regimen, while cultural contextual factors (e.g., family dining style) led to some barriers.

CONCLUSION

The DBC intervention could reduce body weight, and has positive trends in managing handgrip strength, gait speed, and waist circumference. Interestingly, the subtle difference between the two groups in the change of muscle mass index warrants futures investigation. This study demonstrated the potential for employing dietary behaviour change interventions in community healthcare.

TRIAL REGISTRATION

Registered retrospectively on ClinicalTrailas.gov (31/12/2020, NCT04690985).

Association between sarcopenia with incident cardio-cerebrovascular disease: A systematic review and meta-analysis

Sarcopenia is an age-associated skeletal muscle disease characterized by the progressive loss of muscle mass and function. The objective of this systematic review and meta-analysis was to evaluate the associations between sarcopenia and cardio-cerebrovascular disease (CCVD). A comprehensive search of the PubMed/Medline, Embase, Web of Science, Scopus, and Cochrane Library databases was conducted from their inception to April 1st, 2023. A total of eight cross-sectional studies involving 63,738,162 participants met the inclusion criteria. Pooled estimates of odds ratios (ORs) were calculated using random-effects models. The findings demonstrated a significant association between sarcopenia and an increased risk of CCVD (OR: 1.33, 95% CI: 1.18 - 1.50, I2 = 1%; p < 0.001). Subgroup analyses indicated that sarcopenia was associated with a 1.67-fold increase in the risk of stroke and a 1.31-fold increase in the risk of CVD. Four studies included in this review examined the association between sarcopenic obesity and the risk of CCVD, and the results revealed that sarcopenic obesity was associated with a higher risk of CCVD (OR: 1.64, 95% CI: 1.08 - 2.49, I2 = 69%; p < 0.001). Meta-regressions and sensitivity analyses consistently supported the robustness of the overall findings. In conclusion, sarcopenia and sarcopenic obesity are significantly associated with an elevated risk of developing CCVD. However, further prospective cohort studies are warranted to validate this relationship while controlling for confounding factors.

Correlation of Sarcopenic Obesity on Various Cardiometabolic Risk Factors and Fracture Risk in Mid-Aged Korean Women

OBJECTIVES

This study aimed to investigate the correlation of sarcopenic obesity with various cardiometabolic risk factors and fracture risk in middle-aged Korean women.

METHODS

In this cross-sectional study, the medical records of 1,775 women who had visited Pusan National University Hospital for routine health screenings from 2010 to 2016 were reviewed. The patients were divided into four groups as follows: group 1, nonsarcopenic, nonobese (NS-NO); group 2, nonsarcopenic, obese (NS-O); group 3, sarcopenic, nonobese (S-NO); and group 4, sarcopenic, obese (S-O). Each patient was assessed based on self-reported questionnaires and individual interviews with a healthcare provider. The Fracture Risk Assessment Tool (FRAX) was used to assess bone fracture risk.

RESULTS

Postmenopausal women accounted for 68.5% of the total patient population. The proportion of each group was as follows: NS-NO, 71.2%; NS-O, 17.9%; S-NO, 10.2%; and S-O, 0.7%. Statistical analysis of various parameters associated with metabolic and cardiovascular risks revealed that the S-O group had more patients with hypertension, diabetes, osteopenia, and metabolic syndrome. The FRAX scores were significantly higher in the S-O group than in other groups.

CONCLUSIONS

Middle-aged women with obesity and reduced muscle mass, known as sarcopenic obesity, are at increased risk of hypertension, diabetes, and metabolic syndrome. Furthermore, sarcopenic obesity, individual cardiometabolic risks, and menopause can increase the bone fracture risk.

Impact of Sarcopenic Obesity on Severe Postoperative Complications in Patients with Gastric Cancer Undergoing Gastrectomy

INTRODUCTION

Several studies have indicated that sarcopenia affects the short- and long-term outcomes of cancer patients, including those with gastric cancer. In recent years, sarcopenic obesity and its effects have been reported in cancer patients. This study aimed to evaluate the impact of sarcopenic obesity on postoperative complications in patients with gastric cancer undergoing gastrectomy.

METHODS

This single-center, retrospective study included 155 patients who underwent curative gastrectomy for gastric cancer from January 2015 to July 2021. Sarcopenia was defined by the psoas muscle index (<6.36 cm2/m2 in men and <3.92 cm2/m2 in women), which measures the iliopsoas muscle area at the lumbar L3 level using computed tomography. Obesity was defined by body mass index (≥25). Patients with both sarcopenia and obesity were defined as the sarcopenic obesity group and others as the non-sarcopenic obesity group. Severe postoperative complications were defined as Clavien-Dindo classification grade IIIa or higher.

RESULTS

Of the 155 patients, 26 (16.8%) had sarcopenic obesity. The incidence of severe postoperative complications was significantly higher in the sarcopenic obesity group (30.8% vs. 10.9%; p = 0.014). Multivariate analysis indicated that sarcopenic obesity was an independent risk factor for severe postoperative complications (odds ratio, 3.950; 95% confidence interval, 1.390-11.200; p = 0.010).

CONCLUSION

Sarcopenic obesity is an independent risk factor for severe postoperative complications.

CT analysis of thoracolumbar body composition for estimating whole-body composition

BACKGROUND

To evaluate the correlation between single- and multi-slice cross-sectional thoracolumbar and whole-body compositions.

METHODS

We retrospectively included patients who underwent whole-body PET-CT scans from January 2016 to December 2019 at multiple institutions. A priori-developed, deep learning-based commercially available 3D U-Net segmentation provided whole-body 3D reference volumes and 2D areas of muscle, visceral fat, and subcutaneous fat at the upper, middle, and lower endplate of the individual T1-L5 vertebrae. In the derivation set, we analyzed the Pearson correlation coefficients of single-slice and multi-slice averaged 2D areas (waist and T12-L1) with the reference values. We then built prediction models using the top three correlated levels and tested the models in the validation set.

RESULTS

The derivation and validation datasets included 203 (mean age 58.2 years; 101 men) and 239 patients (mean age 57.8 years; 80 men). The coefficients were distributed bimodally, with the first peak at T4 (coefficient, 0.78) and the second peak at L2-3 (coefficient 0.90). The top three correlations in the abdominal scan range were found for multi-slice waist averaging (0.92) and single-slice L3 and L2 (0.90, each), while those in the chest scan range were multi-slice T12-L1 averaging (0.89), single-slice L1 (0.89), and T12 (0.86). The model performance at the top three levels for estimating whole-body composition was similar in the derivation and validation datasets.

CONCLUSIONS

Single-slice L2-3 (abdominal CT range) and L1 (chest CT range) analysis best correlated with whole-body composition around 0.90 (coefficient). Multi-slice waist averaging provided a slightly higher correlation of 0.92.

Palmitic Acid Inhibits Myogenic Activity and Expression of Myosin Heavy Chain MHC IIb in Muscle Cells through Phosphorylation-Dependent MyoD Inactivation

Sarcopenia associated with aging and obesity is characterized by the atrophy of fast-twitch muscle fibers and an increase in intramuscular fat deposits. However, the mechanism of fast-twitch fiber-specific atrophy remains unclear. In this study, we aimed to assess the effect of palmitic acid (PA), the most common fatty acid component of human fat, on muscle fiber type, focusing on the expression of fiber-type-specific myosin heavy chain (MHC). Myotubes differentiated from C2C12 myoblasts were treated with PA. The PA treatment inhibited myotube formation and hypertrophy while reducing the gene expression of MHC IIb and IIx, specific isoforms of fast-twitch fibers. Consistent with this, a significant suppression of MHC IIb protein expression in PA-treated cells was observed. A reporter assay using plasmids containing the MHC IIb gene promoter revealed that the PA-induced reduction in MHC IIb gene expression was caused by the suppression of MyoD transcriptional activity through its phosphorylation. Treatment with a specific protein kinase C (PKC) inhibitor recovered the reduction in MHC IIb gene expression levels in PA-treated cells, suggesting the involvement of the PA-induced activation of PKC. Thus, PA selectively suppresses the mRNA and protein expression of fast-twitch MHC by modulating MyoD activity. This finding provides a potential pathogenic mechanism for age-related sarcopenia.

The effect of combining nutrient intake and physical activity levels on central obesity, sarcopenia, and sarcopenic obesity: a population-based cross-sectional study in South Korea

BACKGROUND

This study was conducted to investigate the effects of combining nutritional and physical activity (PA) factors on four different categories, according to the presence or absence of sarcopenia and central obesity.

METHODS

From the 2008-2011 Korea National Health and Nutrition Examination Survey, 2971 older adults aged ≥ 65 years were included and divided into four groups based on their sarcopenia and central obesity status: healthy control (39.3%), central obesity (28.9%), sarcopenia (27.4%), and sarcopenic obesity (4.4%). Central obesity was defined as a waist circumference of ≥ 90 cm in men and ≥ 85 cm in women. Sarcopenia was defined as an appendicular skeletal mass index of < 7.0 kg/m2 in men and < 5.4 kg/m2 in women, and sarcopenic obesity was defined as the coexistence of sarcopenia and central obesity.

RESULTS

Participants who consumed more energy and protein than the average requirement had a lower likelihood of having sarcopenia (odds ratio (OR): 0.601, 95% confidence interval (CI): 0.444-0.814) than those who did not consume enough nutrients. The likelihood of central obesity and sarcopenic obesity decreased in groups with recommended PA levels, regardless of whether energy intake met or did not meet the average requirement. Whether PA met or did not meet the recommended level, the likelihood of sarcopenia decreased in groups with energy intake that met the average requirement. However, when PA and energy requirements were met, there was a greater reduction in the likelihood of sarcopenia (OR: 0.436, 95% CI: 0.290-0.655).

CONCLUSION

These findings suggest that adequate energy intake that meets requirements is more likely to be effective as a major prevention and treatment goal for sarcopenia, whereas PA guidelines should be prioritized in the case of sarcopenic obesity.

Association between Sarcopenic Obesity Status and Nonalcoholic Fatty Liver Disease and Fibrosis

Background/Aims

There are no data regarding the association between sarcopenic obesity status and nonalcoholic fatty liver disease (NAFLD) and NAFLD-associated liver fibrosis. Therefore, we aimed to investigate the relationship between sarcopenic obesity status (sarcopenia only, obesity only, and sarcopenic obesity) and NAFLD and liver fibrosis in Korean adults.

Methods

In total, 2,191 subjects completed a health checkup program, including abdominal ultrasonography and FibroScan. Subjects were classified into the following four categories: optimal body composition (nonobese and nonsarcopenic), sarcopenia only (nonobese), obesity only (nonsarcopenic), and sarcopenic obesity. Sarcopenic obesity was stratified by the skeletal muscle mass index and body fat using bioelectrical impedance analysis. NAFLD was diagnosed by ultrasonography, and liver fibrosis was assessed using transient elastography in subjects with NAFLD.

Results

The prevalence of NAFLD and liver fibrosis significantly increased according to the sarcopenic obesity status. In the logistic regression analysis, after adjusting for multiple risk factors, the odds ratio (OR) for the risk of NAFLD was largest in the sarcopenic obesity group (OR, 3.68; 95% confidence interval [CI], 2.94 to 4.60), followed by the obesity only (OR, 2.25; 95% CI, 1.67 to 3.03) and sarcopenia only (OR, 1.92; 95% CI, 1.30 to 2.84) groups, when compared with the optimal group. Additionally, liver fibrosis was independently associated with sarcopenic obesity status (OR 4.69, 95% CI 1.95 to 11.29; OR 4.17, 95% CI 1.56 to 11.17; OR 3.80, 95% CI 0.86 to 16.75, respectively).

Conclusions

These results demonstrated that sarcopenic obesity was independently associated with NAFLD and liver fibrosis and increased the risk of NAFLD and liver fibrosis more than obesity or sarcopenia alone.

Dynapenic Abdominal Obesity as a Risk Factor for Metabolic Syndrome in Individual 50 Years of Age or Older: English Longitudinal Study of Ageing

OBJECTIVES

To analyse whether dynapenic abdominal obesity is a risk factor for Metabolic syndrome (MetS) and its components in individuals 50 years of age or older.

DESIGN

A longitudinal study was conducted with an eight-year follow-up.

SETTING

Representative sample of community-dwelling participants of the English Longitudinal Study of Ageing (ELSA).

PARTICIPANTS

3,952 individuals free of MetS at baseline.

MEASUREMENTS

Dynapenic abdominal obesity was defined based on waist circumference (> 102 cm for men and > 88 cm for women) and grip strength (< 26 kg for men and < 16 kg for women). The participants were classified as non-abdominally obese/non-dynapenic (NAO/ND - reference group), abdominally obese/non-dynapenic (AO/ND), non-abdominally obese/dynapenic (NAO/D) and abdominally obese/dynapenic (AO/D). The outcome was the incidence of MetS based on the presence of three or more of the following criteria: hypertriglyceridemia, hyperglycaemia, low HDL cholesterol, arterial hypertension or body mass index ≥ 30 kg/m2 throughout eight-year follow-up. Additionally, the incidence of each component of MetS was also analyzed. Poisson regression models were run and controlled for sociodemographic, behavioural and clinical variables.

RESULTS

The mean age of the participants was 65 years and 55% were women. The prevalence of AO/ND, NAO/D and AO/D were 35.3, 4.3 and 2.2%, respectively. At the end of follow-up 558 incident cases of MetS were recorded. The adjusted model demonstrated that although abdominal obesity was a risk factor for MetS (IRR: 2.26; 95% CI: 1.87 - 2.73), the IRR was greater in AO/D individuals (IRR: 3.34; 95% CI: 2.03 - 5.50) compared with ND/NAO group. Furthermore, ND/AO was a risk factor for incidence of hypertriglyceridemia (IRR: 1.27; 95% CI: 1.06 - 1.52), hyperglycaemia (IRR: 1.41; 95% CI: 1.18 - 1.69), low HDL cholesterol (IRR: 1.70; 95% CI: 1.32 - 2.19) and BMI ≥ 30 kg/m2 (IRR: 2.58; 95% CI: 2.04 - 3.26) while D/AO was a risk factor for hyperglycaemia (IRR: 1.78; 95% CI: 1.02 - 3.10), low HDL cholesterol (IRR: 2.36; 95% CI: 1.10 - 5.08), and BMI ≥ 30 kg/m2 (IRR: 2.79; 95% CI: 1.38 - 5.62).

CONCLUSIONS

Dynapenic abdominal obesity increases the risk of MetS, with a higher IRR compared to obesity alone. The understanding of this synergic action could guide specific clinical strategies, enabling the prevention of metabolic changes that can lead to cardiovascular disease, disability and death.

Association Between Skeletal Muscle Mass and Cardiovascular Risk Factors in Occupational Sedentary Population: A Cross-sectional Study

OBJECTIVE

The aims of this study were to determine the association of skeletal muscle mass with three cardiovascular risk factors and explore a simple and clinically feasible indicator for identifying high-risk groups of cardiovascular diseases in occupational sedentary population.

METHODS

We recruited 7316 occupational sedentary participants older than 18 years from the Health Management Center of Tianjin Union Medical Center. Age-adjusted logistic regression was used to analyze the association between skeletal muscle mass index (SMI) and cardiovascular risk factors.

RESULTS

There were significant positive associations between SMI, especially arm SMI, and cardiovascular risk factors in both male and female subjects (odds ratio, 1.28 to 5.02; P < 0.001).

CONCLUSIONS

Our findings suggest that measurements of skeletal muscle mass, particularly in the arms, may help identify individuals at high risk for cardiovascular disease in an occupationally sedentary population.

Associations of Body-Roundness Index and Sarcopenia with Cardiovascular Disease among Middle-Aged and Older Adults: Findings from CHARLS

OBJECTIVES

Sarcopenia and obesity may contribute to chronic disease. However, little is known about the association between sarcopenia, body roundness index (BRI), and cardiovascular disease (CVD). The aim of this study was to investigate the association of sarcopenia and BRI with CVD in middle-aged and older Chinese population.

DESIGN

Cohort study with an 8-year follow-up.

SETTING AND PARTICIPANTS

Data were derived from 4 waves of the China Health and Retirement Longitudinal Study, and 6152 participants aged 45 or above were included in the study.

METHODS

Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria. CVD was defined as the presence of physician-diagnosed heart disease, diabetes and/or stroke. The associations of BRI and sarcopenia with CVD risk were explored using Cox proportional hazards regression models.

RESULTS

The mean age of the participants was 58.3 (8.9) years, and 2936 (47.7%) were males. During the 8 years follow-up, 2385 cases (38.8%) with incident CVD were identified. Longitudinal results demonstrated that compared to neither sarcopenia or high BRI, both sarcopenia and high BRI (HR: 1.49, 95%CI: 1.08, 2.07) were associated with higher risk of CVD. In the subgroup analysis, individuals with both sarcopenia and high BRI were more likely to have new onset stroke (HR: 1.93, 95%CI: 1.12, 3.32) and increased risk of multimorbidity (HR: 2.15, 95% CI: 1.14, 4.04).

CONCLUSIONS

Coexistence of sarcopenia and high BRI was associated with higher risk of CVD. Early identification and intervention for sarcopenia and BRI not only allows the implementation of therapeutic strategies, but also provides an opportunity to mitigate the risk of developing CVD.

The Implication of Nutrition on the Prevention and Improvement of Age-Related Sarcopenic Obesity: A Systematic Review

OBJECTIVES

Nutrition plays a pivotal role in the initiation and progression of sarcopenic obesity, making it a critical focus for preventing and treating this condition. However, the specific dietary components that effectively combat sarcopenic obesity remain poorly understood. The objective of this systematic review was to examine the potential nutritional and dietary factors that may play a role in the development of sarcopenic obesity in the elderly population.

METHODS

To identify relevant studies investigating the association/effects of dietary pattern/single foods/nutrients or supplements with sarcopenic obesity-related outcomes, a comprehensive literature search was conducted until April 2023. The search encompassed multiple databases including PubMed, Scopus, EMBASE, and Google Scholar. Two researchers performed rigorous assessments that included screening titles and abstracts, reviewing full-text studies, extracting data, and evaluating the quality of the studies. The Newcastle-Ottawa Scale was used for observational studies, while the Jadad-Oxford Scale was employed for clinical trials.

RESULTS

Twenty-three studies (14 observational studies and 9 trials) with 37078 participants, published between 2012 and 2022, were eligible for the systematic review. Of the 14 observational articles, two focused on dietary patterns and 12 on food/calorie/macro- and micronutrient intake. The nutritional interventions included the intake of supplements (i.e., protein, amino acids, tea catechin, and vitamin D) and dietary management (calorie restriction, very low-calorie ketogenic diet, and high-protein diet). Appropriate dietary factors, such as appropriate intake of calories, macronutrients, micronutrients, antioxidant nutrients, vegetables, fruits, and overall dietary quality, have been shown to be effective in preventing and treating sarcopenic obesity-related parameters. A combined approach of hypocaloric diet and high protein intake may be necessary for managing both obesity and sarcopenia in older individuals.

CONCLUSION

Studies suggest that dietary factors, such as overall dietary quality, appropriate intake of calories and protein, consumption of antioxidant nutrients, vegetables, fruits, and protein, may be linked to sarcopenic obesity.

Association between Lower-to-Upper Ratio of Appendicular Skeletal Muscle and Metabolic Syndrome

(1) Background: Metabolic syndrome (MetS) is a cluster-based disorder comprising several pre-disease or pre-clinical statuses for diabetes, hypertension, dyslipidemia, cardiovascular risk, and mortality. Appendicular skeletal muscle (ASM), or lean mass, is considered the main site of insulin-mediated glucose utilization. Therefore, we aimed to reveal the association between lower appendicular skeletal muscle mass to upper appendicular skeletal muscle mass ratio (LUR) and risk for MetS. (2) Methods: We analyzed the 2008–2011 Korean National Health Examination and Nutrition Survey (KNHANES) data. Quintiles of lower ASM to upper ASM ratio (LUR) were categorized as follows: Q1: ≤2.65, Q2: 2.66–2.80, Q3: 2.81–2.94, Q4: 2.95–3.11, and Q5: ≥3.12 in men and Q1: ≤3.00, Q2: 3.01–3.18, Q3: 3.19–3.36, Q4: 3.37–3.60, and Q5: ≥3.61 in women. Multivariate logistic regression models were used after setting MetS and the LUR quintiles as the independent and dependent variables and adjusting for covariates. (3) Result: In men, MetS in accordance with the LUR quintiles exhibits a reverse J-curve. All groups from Q2 to Q5 had a lower odds ratio (OR) (95% CI) for MetS compared to the Q1 group. The lowest OR (95% CI) of 0.85 (0.80–0.91) was observed in Q4. However, in women, the figure shows a sine curve. Compared to the Q1 group, the Q2 and Q3 groups had a higher OR, while the Q4 and Q5 groups presented a lower OR. Among them, the OR (95% CI) in the Q4 group was lowest, at 0.83 (0.76–0.91). (4) Conclusions: While total appendicular skeletal muscle mass is important to prevent MetS, it is necessary to maintain an optimal ratio of muscle mass between the upper and lower appendicular skeletal muscle mass.

Effect of Whey Protein Supplementation in Postmenopausal Women: A Systematic Review and Meta-Analysis

(1) Background: Whey protein (WP) in combination with resistance training (RT) is beneficial in improving sarcopenic obesity and its damaging effects in older adults, while the difference between men and women should be considered while interpreting results. This review aims to investigate WP's efficacy on postmenopausal women with or without RT; (2) Material and Methods: We searched electronic databases including PubMed, EMBASE, and the Cochrane Library from inception to August 2021 for randomized controlled trials that included comparison groups to evaluate WP's efficacy in women aged 55 years and above. The outcomes included body composition, muscular strength, functional capacity, and dietary intake. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were used to estimate the effect of WP. We also performed subgroup analysis with or without RT; (3) Results: We included 14 studies in the systematic review and 10 studies in the meta-analysis. Subgroup analyses showed RT was a major confounder for muscle strength, lean mass, and dietary protein intake (PI). In the RT subgroup, WP supplementation had a significant positive effect on biceps curl strength (BC) (SMD: 0.6805, 95% CI: 0.176, 1.185, I²: 0%), and lower limb lean-mass (LLLM) (SMD: 1.103, 95% CI: 0.632, 1.574, I²: 14%). In the subgroup without RT, a significant negative effect on PI (SMD: -0.4225, 95% CI: -0.774, -0.071, I²: 47%) was observed, while no significant effect on muscle strength or lean mass was revealed. WP supplementation did not show a significantly different effect on fat mass or body weight loss in both the subgroups; (4) Conclusions: In postmenopausal women, WP supplementation only in combination with RT enhances BC and LLLM compared to placebo controls. Without RT, WP has no significant benefit on muscle strength or lean mass.

SARC-F Is a Predictor of Longer LOS and Hospital Readmission in Hospitalized Patients after a Cardiovascular Event

It is already established that sarcopenia is associated with adverse outcomes; however, few studies have focused on patients who have suffered an acute cardiovascular event. The use of SARC-F, a 5-item sarcopenia screening questionnaire, in these patients remains to be investigated. We aimed to investigate whether SARC-F can predict adverse outcomes in patients admitted to a hospital with a suspected infarction. This is a 1-year prospective cohort study. During hospitalization, patients completed the SARC-F questionnaire (scores ≥ 4 considered positive for the risk of sarcopenia). Length of hospital stay (LOS), new hospital admission, myocardial infarction, and cardiovascular mortality were collected via medical records and phone interviews. In total, 180 patients were evaluated. The median age was 60.6 years; 72.3% of the participants were men, and half of the sample had comorbidities. The median SARC-F score was 1.0 (interquartile range, 0–3.0), and 21.1% of the participants screened positive. Risk of sarcopenia was independently associated with longer LOS (odds ratio, 2.34; 95% CI, 1.09–5.04; p = 0.030) and hospital readmission (odds ratio, 3.73; 95% CI, 1.60–8.69; p = 0.002). One-fifth of post-acute cardiovascular event patients in this cohort screened positive for sarcopenia using the SARC-F screening questionnaire. Positive scores were associated with a longer LOS and hospital readmission.

The Potential of the Mediterranean Diet to Improve Mitochondrial Function in Experimental Models of Obesity and Metabolic Syndrome

The abnormal expansion of body fat paves the way for several metabolic abnormalities including overweight, obesity, and diabetes, which ultimately cluster under the umbrella of metabolic syndrome (MetS). Patients with MetS are at an increased risk of cardiovascular disease, morbidity, and mortality. The coexistence of distinct metabolic abnormalities is associated with the release of pro-inflammatory adipocytokines, as components of low-to-medium grade systemic inflammation and increased oxidative stress. Adopting healthy lifestyles, by using appropriate dietary regimens, contributes to the prevention and treatment of MetS. Metabolic abnormalities can influence the function and energetic capacity of mitochondria, as observed in many obesity-related cardio-metabolic disorders. There are preclinical studies both in cellular and animal models, as well as clinical studies, dealing with distinct nutrients of the Mediterranean diet (MD) and dysfunctional mitochondria in obesity and MetS. The term “Mitochondria nutrients” has been adopted in recent years, and it depicts the adequate nutrients to keep proper mitochondrial function. Different experimental models show that components of the MD, including polyphenols, plant-derived compounds, and polyunsaturated fatty acids, can improve mitochondrial metabolism, biogenesis, and antioxidant capacity. Such effects are valuable to counteract the mitochondrial dysfunction associated with obesity-related abnormalities and can represent the beneficial feature of polyphenols-enriched olive oil, vegetables, nuts, fish, and plant-based foods, as the main components of the MD. Thus, developing mitochondria-targeting nutrients and natural agents for MetS treatment and/or prevention is a logical strategy to decrease the burden of disease and medications at a later stage. In this comprehensive review, we discuss the effects of the MD and its bioactive components on improving mitochondrial structure and activity.

Implication of diet and exercise on the management of age‐related sarcopenic obesity in Asians

The incidence of sarcopenic obesity among adults aged ≥65 years is rising worldwide. Sarcopenic obesity is a high‐risk geriatric syndrome defined as a gain in the amount of adipose tissue along with the age‐related loss of muscle mass and strength or physical performance. Sarcopenic obesity is associated with increased risks of falls, physical limitations, cardiovascular diseases, metabolic diseases, and/or mortality. Thus, the identification of preventive and treatment strategies against sarcopenic obesity is important for healthy aging. Diet and exercise are the reasons for the development of sarcopenic obesity and are key targets in its prevention and treatment. Regarding weight reduction alone, it is most effective to maintain a negative energy balance with dietary calorie restriction and aerobic exercise. However, it is important to preserve skeletal muscle mass while reducing fat mass. Resistance exercise and appropriate protein supply are the main ways of preserving skeletal muscle mass, as well as muscle function. Therefore, in order to improve sarcopenic obesity, a complex treatment strategy is needed to limit energy ingestion with proper nutrition and to increase multimodal exercises. In this review, we focus on recently updated interventions for diet and exercise and potential future management strategies for Asian individuals with aging‐related sarcopenic obesity. Geriatr Gerontol Int 2022; 22: 695–704.

'Obesities': Position statement on a complex disease entity with multifaceted drivers

Academic medicine fosters research that moves from discovery to translation, at the same time as promoting education of the next generation of professionals. In the field of obesity, the supposed integration of knowledge, discovery and translation research to clinical care is being particularly hampered. The classification of obesity based on the body mass index does not account for several subtypes of obesity. The lack of a universally shared definition of "obesities" makes it impossible to establish the real burden of the different obesity phenotypes. The individual's genotype, adipotype, enterotype and microbiota interplays with macronutrient intake, appetite, metabolism and thermogenesis. Further investigations based on the concept of differently diagnosed "obesities" are required.

Visceral Adipose Tissue Influence on Health Problem Development and Its Relationship with Serum Biochemical Parameters in Middle-Aged and Older Adults: A Literature Review

Background

The amount of visceral adipose tissue (VAT) tends to increase with age and is associated with several health problems, such as cardiometabolic diseases, increased infections, and overall mortality.

Objectives

This review provides a general assessment of how visceral adiposity correlates with the development of health problems and changes in serum biochemical parameters in middle-aged and older adults.

Methods

We searched specific terms in the Virtual Health Library (VHL) databases for VAT articles published in the English language between 2009 and 2019 related to older adults.

Results

The search found twenty-three publications in this period, of which nine were excluded. The publications had a population aged between 42 and 83 years and correlated the VAT area ratio with several comorbidities (such as pancreatitis, depression, cancer, and coronary heart disease) and serum biochemical parameters.

Conclusion

Further research on the association between visceral obesity and the emergence of health problems and the relationship between VAT and changes in serum biochemical parameters in older individuals should deepen the understanding of this connection and develop preventive actions.

The Prevalence of Metabolic Dysfunction-Associated Fatty Liver Disease and Its Association with Physical Function and Prognosis in Patients with Acute Coronary Syndrome

It is believed that patients with acute coronary syndrome (ACS) are at an increased risk of nonalcoholic fatty liver disease (NAFLD), which can lead to sarcopenia and physical dysfunction. However, the relationship between metabolic dysfunction-associated fatty liver disease (MAFLD) and physical dysfunction and prognosis remains unclear. We investigated the prevalence of MAFLD in patients with ACS to assess the relationship between MAFLD and muscle strength, walking speed, and 6-min walking distance (6 MWD). We reviewed patients with ACS who were assessed for hepatic steatosis using the fatty liver index, and the results were further assessed to determine the presence of MAFLD. Among 479 enrolled hospitalized patients, MAFLD was identified in 234 (48.9%) patients. Multiple regression analysis revealed that MAFLD was independently associated with lower leg strength, gait speed, and 6 MWD (leg strength, p = 0.020; gait speed, p = 0.003 and 6 MWD, p = 0.011). Furthermore, in multivariate Poisson regression models after adjustment for clinical confounding factors, combined MAFLD and reduced physical functions were significantly associated with a higher incidence of clinical events. MAFLD is common in hospitalized patients with ACS and is associated with impaired physical function. Also, the coexistence of MAFLD and lower physical function predict the incidence of clinical events in patients with ACS.

Prevalence and associated risk of advanced colorectal neoplasia in adults with sarcopenia

BACKGROUND/AIMS

Although several studies have shown that sarcopenia is associated with poor outcomes in colorectal cancer patients, the impact of sarcopenia on the development of colorectal neoplasia remains unclear. We aimed to evaluate the prevalence and association of colorectal neoplasia, especially advanced colorectal neoplasia, in adults with sarcopenia.

METHODS

We retrospectively analyzed the data for 10,676 adults who underwent firsttime colonoscopy and bioelectrical impedance analysis (BIA) on the same day in a health screening program at a single center. Sarcopenia was diagnosed using established BIA-based criteria as adjusted appendicular skeletal muscle mass (ASM) divided by body mass index (BMI) (ASM/BMI), height (ASM/height2), or weight (ASM/weight). Prevalence of overall and advanced colorectal neoplasia and their association with sarcopenia, as established by the aforementioned diagnostic criteria, were evaluated.

RESULTS

Among 10,676 subjects, 583 were diagnosed with sarcopenia using ASM/ BMI. Subjects with sarcopenia had a higher prevalence of colorectal neoplasia than those without. In the multivariate analysis after adjusting for confounding factors, sarcopenia was an independent risk factor for any colorectal neoplasia (odds ratio [OR], 1.31; 95% confidence interval [CI], 1.09 to 1.56) and advanced colorectal neoplasia (OR, 1.97; 95% CI, 1.27 to 3.06). The association between sarcopenia and advanced colorectal neoplasia remained significant for all sarcopenia measures including ASM/height2 (OR, 2.19; 95% CI, 1.24 to 3.85) and ASM/weight (OR, 2.41; 95% CI, 1.54 to 3.77).

CONCLUSION

Prevalence of overall and advanced colorectal neoplasia was higher in subjects with sarcopenia than in those without. Sarcopenia was a significant risk factor for colorectal neoplasia, especially for advanced colorectal neoplasia.

Short-Term Changes on Body Composition After Sleeve Gastrectomy and One Anastomosis Gastric Bypass

Introduction: Changes in body composition after different bariatric surgeries have been studied extensively, but most of them have emphasized on Roux-en-Y gastric bypass. Only a few studies have assessed the effects of sleeve gastrectomy (SG). Also, the effect of one anastomosis gastric bypass (OAGB) on body composition is not fully apprehended. Furthermore, there is no agreement on how much fat-free mass (FFM) loss is tolerable in weight loss interventions. Therefore, we decided to assess the reduction in fat mass (FM) and FFM at 1, 3, 6, and 12 months after two types of bariatric surgery in a single center. Methods: In the current retrospective cross-sectional study, the patients' hospital records were analyzed. We included patients who had SG or OAGB and a complete 1-year follow-up record. We recorded demographic data as well as weight, body mass index (BMI), FM, and FFM before and at 1, 3, 6, and 12 months after surgery in a predesigned checklist. Results: We analyzed 311 patients (43 males and 268 females) in the SG (N = 192, 61.7%) and OAGB (N = 119, 38.3%) groups. Both the SG and OAGB groups demonstrated a statistically significant reduction in weight, BMI, FM, and FFM indices at 12 months after the intervention (P < .001). Moreover, no statistically significant difference was observed between the SG and OAGB groups regarding the mean of all body composition indices at 3, 6, and 12 months after the intervention. Conclusion: We found that SG and OAGB effectively decreased weight and body composition indices, comprising FM and FFM, with no significant difference between each other.

Importance of TP53 codon 72 and intron 3 duplication 16 bp polymorphisms and their haplotypes in susceptibility to sarcopenia in Iranian older adults

Background

Sarcopenia is described as age-related progressive skeletal muscle failure that results in marked reduction in the patient’s independence and life quality. In this study, we explored the association of TP53 exon 4 Arg72pro (rs1042522) and Intron 3 16-bp Del/Ins (rs17878362) polymorphisms and their haplotypes with sarcopenia, anthropometric, body composition and biochemical parameters.

Methods

A total of 254 older individuals (65 sarcopenic and 189 healthy) were recruited in this research and genotyped by PCR–RFLP. Linear regression was applied to find the correlation between TP53 polymorphism, and biochemical and anthropometric parameters. The correlation between TP53 polymorphism and haplotypes and the risk of sarcopenia was investigated by logistic regression.

Results

Arg/Pro genotype carriers was at a lower (ORadj = 0.175, 95% CI = 0.068 – 0.447; P < 0.001) risk of sarcopenia compared to the Arg/Arg group. In haplotypes analysis, Arg-Ins (ORadj: 0.484, 95% CI = 0.231 – 1.011, P = 0.043) and Pro-Ins (ORadj: 0.473, 95% CI = 0.210 – 1.068, P = 0.022) haplotypes showed decreased risk of developing sarcopenia. Moreover, in the case of codon 72 polymorphism, skeletal muscle mass, appendicular lean mass (ALM), skeletal muscle mass index (SMI), hand grip strength and Triglycerides, for Intron 3 16-bp Del/Ins polymorphism, albumin, calcium, cholesterol, and LDL were different, and for the haplotypes, skeletal muscle mass, SMI, ALM, HDL and triglycerides were significantly different between groups.

Conclusions

We suggested that the Arg/Pro genotype of the codon 72 polymorphism in exon 4 of TP53, and Arginine-Insertion and Proline-Insertion haplotypes might decrease the risk of sarcopenia in Iranian older adults.

Sarcopenia Is a Cause and Consequence of Metabolic Dysregulation in Aging Humans: Effects of Gut Dysbiosis, Glucose Dysregulation, Diet and Lifestyle

Skeletal muscle mass plays a critical role in a healthy lifespan by helping to regulate glucose homeostasis. As seen in sarcopenia, decreased skeletal muscle mass impairs glucose homeostasis, but it may also be caused by glucose dysregulation. Gut microbiota modulates lipopolysaccharide (LPS) production, short-chain fatty acids (SCFA), and various metabolites that affect the host metabolism, including skeletal muscle tissues, and may have a role in the sarcopenia etiology. Here, we aimed to review the relationship between skeletal muscle mass, glucose homeostasis, and gut microbiota, and the effect of consuming probiotics and prebiotics on the development and pathological consequences of sarcopenia in the aging human population. This review includes discussions about the effects of glucose metabolism and gut microbiota on skeletal muscle mass and sarcopenia and the interaction of dietary intake, physical activity, and gut microbiome to influence sarcopenia through modulating the gut–muscle axis. Emerging evidence suggests that the microbiome can regulate both skeletal muscle mass and function, in part through modulating the metabolisms of short-chain fatty acids and branch-chain amino acids that might act directly on muscle in humans or indirectly through the brain and liver. Dietary factors such as fats, proteins, and indigestible carbohydrates and lifestyle interventions such as exercise, smoking, and alcohol intake can both help and hinder the putative gut–muscle axis. The evidence presented in this review suggests that loss of muscle mass and function are not an inevitable consequence of the aging process, and that dietary and lifestyle interventions may prevent or delay sarcopenia.

Relationship Between Sarcopenia and Cardiovascular Diseases in the Elderly: An Overview

With the advent of population aging, aging-related diseases have become a challenge for governments worldwide. Sarcopenia has defined as a clinical syndrome associated with age-related loss such as skeletal muscle mass, strength, function, and physical performance. It is commonly seen in elderly patients with chronic diseases. Changes in lean mass are common critical determinants in the pathophysiology and progression of cardiovascular diseases (CVDs). Sarcopenia may be one of the most important causes of poor physical function and decreased cardiopulmonary function in elderly patients with CVDs. Sarcopenia may induce CVDs through common pathogenic pathways such as malnutrition, physical inactivity, insulin resistance, inflammation; these mechanisms interact. In this study, we aimed to investigate the relationship between sarcopenia and CVDs in the elderly. Further research is urgently needed to understand better the relationship, pathophysiology, clinical presentation, diagnostic criteria, and mechanisms of sarcopenia and CVDs, which may shed light on potential interventions to improve clinical outcomes and provide greater insight into the disorders above.

Sarcopenia and coronary heart disease synergistically increase the risk of new onset depressive symptoms in older adults

Background

Coronary heart disease (CHD), sarcopenia and depression are common disorders that markedly impair quality of life and impose a huge financial burden on society. They are also frequently comorbid, exacerbating condition and worsening prognosis. This study aimed to investigate the additive effects of CHD and sarcopenia on the risk of new onset depressive symptoms in older adults.

Methods

The prospective cohort study comprised 897 Chinese community-dwelling participants who were aged 60 years and older (386 men; mean age 66.9 ± 5.9 years) without depressive symptoms at baseline, recruited from Chadian of Tianjin, China. Sarcopenia was defined according to the Asian Working Group for Sarcopenia (AWGS) criteria. CHD was identified via medical records or new diagnosed by at least two physicians. Depressive symptoms were assessed using the Geriatric Depression Scale (GDS) ≥11. Longitudinal data on new onset depressive symptoms were collected up to 12 months after baseline.

Results

We found that 103 (11.5%) of the 897 participants without depressive symptoms at baseline had developed depressive symptoms. Participants were classified into mutually exclusive groups based on sarcopenia status and CHD: normal, CHD alone, sarcopenia alone, and co-occurring groups. A logistic regression showed that the CHD alone [odd ratios (OR) = 1.78, 95% confidence interval (CI) = 1.05–3.02], sarcopenia alone (OR = 2.79, 95% CI = 1.26–6.22), and co-occurring (OR = 7.19, 95% CI = 2.75–18.81) had higher risk of depressive symptoms than the normal group after adjusting for the covariates.

Conclusions

CHD and sarcopenia synergistically increase the risk of new onset depressive symptoms in older adults. Thus, older adults may require early detection, and appropriate interventions should be implemented.

Effects of GLP-1 receptor agonists on myokine levels and pro-inflammatory cytokines in patients with type 2 diabetes mellitus

BACKGROUND AND AIMS

To evaluate the change in circulating serum irisin and interleukin-6 (IL-6), in patients with type 2 diabetes mellitus (T2DM) after 6 and 12 months of GLP-1 treatment.

METHODS AND RESULTS

Eighty-five patients with T2DM inadequately controlled with insulin or other hypoglycaemic drugs were added to dulaglutide (N° = 44) and liraglutide (N° = 41) treatment. After 6 months of GLP-1 analogues a significant decrease in BMI (p < 0.001), waist circumference (WC) (p < 0.001), fasting blood glucose (p < 0.001), HbA1c (p < 0.001), total cholesterol (p < 0.001), LDL-cholesterol (p = 0.003), triglycerides (p = 0.017), IL-6 (p = 0.045) and a significant increase in serum irisin (p < 0.001) were observed compared to baseline. After 12 months of treatment no significant differences were found compared to the levels at 6 months. The change in irisin from baseline (Δ_irisin) was significantly related to the changes in total-cholesterol (Δ_total-cholesterol) (r = -0.293; p = 0.020), while the change in IL-6 (Δ_IL-6) was significantly related to the changes in WC (Δ_WC) (r = 0.347; p = 0.006).

CONCLUSIONS

Additive treatment with GLP1-analogues results in an increase in serum circulating irisin levels and a decrease in IL-6. The post-treatment change in irisin was correlated with a decrease in total cholesterol, while the change in IL-6 was correlated with a decrease in WC.

Impact of sarcopenic obesity on long-term clinical outcomes after ST-segment elevation myocardial infarction

BACKGROUND AND AIMS

Both low appendicular skeletal muscle index (ASMI) and specific abdominal fat composition [i.e., increased visceral to subcutaneous (V/S) fat ratio] have been associated with cardiovascular events. However, the combined impact of these 2 components on long-term outcomes remains unclear, especially in patients with ST-segment elevation myocardial infarction (STEMI).

METHODS

In 303 patients with STEMI, ASMI and V/S fat ratio were assessed using dual-energy X-ray absorptiometry and abdominal computed tomography. Based on the criteria of the Asian Working Group for Sarcopenia and median of V/S fat ratio, sarcopenic obesity (SO) pattern was defined as low ASMI with high V/S fat ratio. The primary endpoint was composite outcomes of all-cause death, myocardial infarction, ischemic stroke, hospitalization for heart failure and unplanned revascularization.

RESULTS

During a median follow-up of 3.9 years, primary endpoint occurred in 67 patients. Patients with an SO pattern showed significantly lower event-free survival rate compared with those without (p=0.006 by log-rank). Notably, when stratified by median age (67 years), this trend was particularly prominent in the younger-age group (p <0.001), but not significant in the older-age group (p=0.38). In the younger-age group, the multivariate analysis revealed that patients with SO pattern had a 2.97 (1.10-7.53) fold higher risk for primary endpoints compared with those without.

CONCLUSIONS

Low ASMI with high V/S fat ratio, or so-called sarcopenic obesity, was associated with poor prognosis after STEMI, particularly in younger-age patients. The combined assessment of skeletal muscle with abdominal fat distribution may help stratify the risk among patients with STEMI, rather than each component alone.

Association of Appendicular Skeletal Muscle Mass and Central Obesity Parameters with Lipid Profiles in Older Women

BACKGROUND: Metabolic syndrome is a common condition found in the elderly. The association between body compositions with the lipid profiles in the elderly as cardiovascular risk factors was still unclear. AIM: This study aimed to evaluate the association appendicular skeletal muscle mass (ASMM) and central obesity parameters with lipid profile in older women. METHODS: This was a cross-sectional study conducted at the Geriatric Outpatient Clinic, Hasan Sadikin General Hospital, Bandung, from January 2019 to February 2020. We collected patients’ medical records and analyzed the correlation between ASMM and central obesity parameters including truncal fat mass (TrFM) with lipid profile. RESULTS: A total of 61 subjects were included in the inclusion criteria in this study. The mean of body mass index (BMI) was 25.8 ± 4.5 with a normal BMI percentage of 44.2% and obesity of 16.4%. The mean of abdominal and calf circumference was 89 ±10 cm and 35 ± 4 cm, respectively. The mean of ASMM was 8.27 ± 1.29 kg/m2 and TrFM was 10.98 ± 3.92 kg/m2. We found a negative correlation between ASMM and high-density lipoprotein (HDL) (r = –0.297, p = 0.01). TrFM was correlated with triglycerides (TG) (r = 0.339, p = 0.004). There was no significant relationship between calf circumference and abdominal circumference to lipid profile parameters. CONCLUSION: ASMM is negatively correlated with HDL, meanwhile, TrFM had a positive correlation with TG in older women as alertness of cardiovascular risk.

Dynapenic abdominal obesity in hospitalized elderly patients with acute myocardial infarction

Obesity and dynapenia are cardiovascular risk factors. When present together, it is called dynapenic abdominal obesity and can potentiate adverse outcomes. This study aims to estimate the prevalence of dynapenic abdominal obesity and its relationship with prognostic markers in patients with acute myocardial infarction (AMI). This is a hybrid study with a longitudinal component plus a cross-sectional component at baseline involving elderly patients admitted to a reference hospital in cardiology due to AMI in the Brazilian Northeast from May to October 2015. We analyzed patients' admission data and evaluated some prognostic markers up to two years after admission. We established abdominal obesity by measuring waist circumference (>102 cm for men and >88 cm for women) and dynapenia by handgrip strength (<27 kg/F for men and <16 kg/F for women). We considered the prognostic markers troponin and creatinine kinase - MB (CKMB), AMI classification according to ST segment elevation, TIMI score, need for coronary angioplasty or coronary artery bypass surgery, complications during hospitalization and within two years after admission, and re-admission to the same service. We evaluated 92 patients with a mean age of 71.4 ± 7.5 years. The prevalence of abdominal obesity and dynapenia was 56.5% and 44.6%, respectively. The coexistence of the two conditions occurred in 25.0% of the patients, being higher among women (p < 0.001). When comparing the dynapenic abdominal obese groups with the group of patients who had one of the two isolated conditions we observed that, for a same mean age and clinical characteristics, patients with only one of the conditions had a higher CKMB (p = 0.046) and troponin median (p = 0.032). The presence of dynapenia in the groups of abdominal obese and non-abdominal obese individuals is not associated with risk marker parameters (p > 0.05). High prevalence of abdominal obesity and dynapenia occurred among patients with AMI and in a quarter of these both conditions coexisted. Dynapenic abdominal obesitydoes not increase the risk of adverse outcomes and isolated dynapenia is not a marker of a poor prognosis.

Proteomic profiling of low muscle and high fat mass: a machine learning approach in the KORA S4/FF4 study

BACKGROUND

The coexistence of low muscle mass and high fat mass, two interrelated conditions strongly associated with declining health status, has been characterized by only a few protein biomarkers. High-throughput proteomics enable concurrent measurement of numerous proteins, facilitating the discovery of potentially new biomarkers.

METHODS

Data derived from the prospective population-based Cooperative Health Research in the Region of Augsburg S4/FF4 cohort study (median follow-up time: 13.5 years) included 1478 participants (756 men and 722 women) aged 55-74 years in the cross-sectional and 608 participants (315 men and 293 women) in the longitudinal analysis. Appendicular skeletal muscle mass (ASMM) and body fat mass index (BFMI) were determined through bioelectrical impedance analysis at baseline and follow-up. At baseline, 233 plasma proteins were measured using proximity extension assay. We implemented boosting with stability selection to enable false positives-controlled variable selection to identify new protein biomarkers of low muscle mass, high fat mass, and their combination. We evaluated prediction models developed based on group least absolute shrinkage and selection operator (lasso) with 100× bootstrapping by cross-validated area under the curve (AUC) to investigate if proteins increase the prediction accuracy on top of classical risk factors.

RESULTS

In the cross-sectional analysis, we identified kallikrein-6, C-C motif chemokine 28 (CCL28), and tissue factor pathway inhibitor as previously unknown biomarkers for muscle mass [association with low ASMM: odds ratio (OR) per 1-SD increase in log2 normalized protein expression values (95% confidence interval (CI)): 1.63 (1.37-1.95), 1.31 (1.14-1.51), 1.24 (1.06-1.45), respectively] and serine protease 27 for fat mass [association with high BFMI: OR (95% CI): 0.73 (0.61-0.86)]. CCL28 and metalloproteinase inhibitor 4 (TIMP4) constituted new biomarkers for the combination of low muscle and high fat mass [association with low ASMM combined with high BFMI: OR (95% CI): 1.32 (1.08-1.61), 1.28 (1.03-1.59), respectively]. Including protein biomarkers selected in ≥90% of group lasso bootstrap iterations on top of classical risk factors improved the performance of models predicting low ASMM, high BFMI, and their combination [delta AUC (95% CI): 0.16 (0.13-0.20), 0.22 (0.18-0.25), 0.12 (0.08-0.17), respectively]. In the longitudinal analysis, N-terminal prohormone brain natriuretic peptide (NT-proBNP) was the only protein selected for loss in ASMM and loss in ASMM combined with gain in BFMI over 14 years [OR (95% CI): 1.40 (1.10-1.77), 1.60 (1.15-2.24), respectively].

CONCLUSIONS

Proteomic profiling revealed CCL28 and TIMP4 as new biomarkers of low muscle mass combined with high fat mass and NT-proBNP as a key biomarker of loss in muscle mass combined with gain in fat mass. Proteomics enable us to accelerate biomarker discoveries in muscle research.

Differences among Three Skeletal Muscle Mass Indices in Predicting Non-Alcoholic Fatty Liver Disease: Korean Nationwide Population-Based Study

Recent studies have investigated the relationship between sarcopenia and non-alcoholic fatty liver disease (NAFLD); however, there is no unified definition of sarcopenia. Thus, we aimed to investigate the differences among three skeletal muscle mass indices (SMI) in predicting NAFLD. This study included 8133 adults from the 2008–2010 Korea National Health and Nutrition Survey. SMI was calculated as appendicular skeletal muscle mass divided by height-square (hSMI), weight (wSMI), or body mass index (bSMI). The presence of NAFLD was defined by using the NAFLD-liver fat score. On the receiver operating characteristic curve analysis, the predictive power of wSMI for NAFLD was significantly higher than those of hSMI and bSMI in men (wSMI vs. hSMI, p = 0.003; wSMI vs. bSMI, p < 0.001). In women, the predictive power of hSMI was only significantly higher than that of bSMI (p = 0.023), and other predictive powers were not significantly different. In addition, hSMI was correlated with insulin resistance and NAFLD-liver fat score in the opposite direction to wSMI and bSMI in both men and women. Among the three definitions of SMI, wSMI showed the highest diagnostic performance for predicting NAFLD in men, suggesting the importance of defining sarcopenia for its association with specific diseases.

Relationship between Serum Alkaline Phosphatase and Low Muscle Mass Index Among Korean Adults: A Nationwide Population-Based Study

Sarcopenia has attracted interest due to its impact on various health problems. Chronic inflammation is an important contributor to sarcopenia. Thus, we aimed to investigate the association between serum alkaline phosphatase (ALP), which is a novel inflammatory marker, and muscle mass. This study included 15,579 adults from the 2008–2011 Korea National Health and Nutrition Survey. Low skeletal muscle mass index (LSMI) was defined as body mass index-adjusted appendicular skeletal muscle mass less than 0.789 for men and 0.512 for women. Multiple logistic regression revealed that the highest ALP tertile was significantly associated with LSMI compared with the lowest ALP tertile in both men [Odds ratio (OR): 1.41; 95% confidence interval (CI): 1.04–1.91] and women (OR: 1.45; 95% CI: 1.00–2.10) after adjusting for other confounders. On the receiver operating characteristic curve analysis, the predictive power was significantly higher for ALP levels than for white blood cell count in women (p < 0.001), whereas the difference was not significant in men (p = 0.515). Our findings suggest the potential use of serum ALP as an inflammatory marker and a predictor of sarcopenia.

Associations between inflammatory markers and muscle strength in older adults according to the presence or absence of obesity

BACKGROUND

We investigated the association between inflammatory markers and muscle strength in older adults according to the presence or absence of obesity. Dynapenia is the age-related decline in muscle strength and results in negative outcomes to older adults. Accordingly, obesity is more prevalent throughout aging and is associated with comorbidities, such as type 2 diabetes, dyslipidemia and cardiovascular diseases. Both dynapenia and obesity are strongly linked to chronic inflammation, sharing common signaling pathways.

METHODS

We recruited 247 older adults aged 60 or older and collected sociodemographic, anthropometric and metabolic data. Dynapenia was diagnosed according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. Circulating inflammatory cytokines were measured in plasma using a multiplex panel kit. Anthropometric, sociodemographic, lipid profile, and fasting blood glucose were also assessed.

RESULTS

Dynapenic participants were predominantly males (74.4%), had insufficiently active lifestyle and higher IL-10 plasma levels (0.95 pg/mL; 0.40-2.12). The prevalence of obesity was higher among non-dynapenic participants (45.3%; 95% CI, 37.7-53). In dynapenic older adults, obesity was predominant in males (53.6%) and subjects with normal muscle strength had higher serum levels of TNF-β (0.63 pg/mL; 0.30-1.30) and lower hand-grip strength (24 kg; 20.00-28.00). Using a multivariate quantile regression analysis, we found a strong and negative association between IL-10 and muscle strength.

CONCLUSIONS

This study can help to understand the association of inflammation, obesity and muscle strength to promote interventions in order to avoid or delay the negative outcomes associated with dynapenia and sarcopenia in older adults.

Plasma C-Terminal Agrin Fragment as an Early Biomarker for Sarcopenia: Results from the Genofit Study

Barriers associated with direct muscle quantification have prevented a consistent implementation of therapeutic measures for sarcopenia. Recently, the relevance of circulating C-terminal agrin fragment (CAF) as an accessible screening method alternative for sarcopenia has gained credence. Accordingly, this study aimed to verify the pertinence of plasma CAF as a biomarker for sarcopenia. Three hundred healthy adults aged between 50 and 83 years took part in this study. Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People criteria. Body composition was assessed using dual-energy x-ray absorptiometry, while muscle strength was examined using hand dynamometry. Plasma CAF concentrations were determined using a commercially available ELISA kit. CAF concentrations were significantly associated with appendicular lean mass (ALM), but not grip strength (p = .028, p = .575, respectively). Plasma CAF concentrations were significantly elevated in sarcopenic individuals compared to nonsarcopenic (p < .001). Overall, individuals with low grip strength or low ALM displayed significantly higher CAF levels compared to healthy controls, after adjusting for age and body mass index (p = .027, p = .003, respectively). In males, those with low grip strength or low ALM had significantly elevated CAF levels (p = .039, p = .027, respectively), while in females, only those with low ALM had significantly raised CAF concentrations, compared to healthy controls (p = .035). Our findings illuminate the potential relevance of CAF as an accessible biomarker for skeletal muscle health. CAF determination may enhance clinical practice by facilitating more widespread treatment strategies for sarcopenia. Nevertheless, future research is needed to confirm the diagnostic pertinence of CAF concentrations in screening for sarcopenia.

Skeletal Muscle Proteomic Profile Revealed Gender-Related Metabolic Responses in a Diet-Induced Obesity Animal Model

Obesity is a chronic, complex pathology associated with a risk of developing secondary pathologies, including cardiovascular diseases, cancer, type 2 diabetes (T2DM) and musculoskeletal disorders. Since skeletal muscle accounts for more than 70% of total glucose disposal, metabolic alterations are strictly associated with the onset of insulin resistance and T2DM. The present study relies on the proteomic analysis of gastrocnemius muscle from 15 male and 15 female C56BL/J mice fed for 14 weeks with standard, 45% or 60% high-fat diets (HFD) adopting a label-free LC–MS/MS approach followed by bioinformatic pathway analysis. Results indicate changes in males due to HFD, with increased muscular stiffness (Col1a1, Col1a2, Actb), fiber-type switch from slow/oxidative to fast/glycolytic (decreased Myh7, Myl2, Myl3 and increased Myh2, Mylpf, Mybpc2, Myl1), increased oxidative stress and mitochondrial dysfunction (decreased respiratory chain complex I and V and increased complex III subunits). At variance, females show few alterations and activation of compensatory mechanisms to counteract the increase of fatty acids. Bioinformatics analysis allows identifying upstream molecules involved in regulating pathways identified at variance in our analysis (Ppargc1a, Pparg, Cpt1b, Clpp, Tp53, Kdm5a, Hif1a). These findings underline the presence of a gender-specific response to be considered when approaching obesity and related comorbidities.

The Role of Sarcopenic Obesity in Cancer and Cardiovascular Disease: A Synthesis of the Evidence on Pathophysiological Aspects and Clinical Implications

Obesity is globally a serious public health concern and is associated with a high risk of cardiovascular disease (CVD) and various types of cancers. It is important to evaluate various types of obesity, such as visceral and sarcopenic obesity. The evidence on the associated risk of CVD, cancer and sarcopenic obesity, including pathophysiological aspects, occurrence, clinical implications and survival, needs further investigation. Sarcopenic obesity is a relatively new term. It is a clinical condition that primarily affects older adults. There are several endocrine-hormonal, metabolic and lifestyle aspects involved in the occurrence of sarcopenic obesity that affect pathophysiological aspects that, in turn, contribute to CVD and neoplasms. However, there is no available evidence on the role of sarcopenic obesity in the occurrence of CVD and cancer and its pathophysiological interplay. Therefore, this review aims to describe the pathophysiological aspects and the clinical and epidemiological evidence on the role of sarcopenic obesity related to the occurrence and mortality risk of various types of cancer and cardiovascular disease. This literature review highlights the need for further research on sarcopenic obesity to demonstrate the interrelation of these various associations.

Short-Term Changes on Body Composition and Bone Mass After One-Anastomosis Gastric Bypass: a Prospective Observational Study

PURPOSE

Bariatric surgery generates a large weight loss. It is considered a successful surgery when 50% of the excess weight loss is reached. However, this measure does not include some variables that may have a direct impact on a patient's health, such as fat-free mass (FFM) or bone mass. Therefore, the aim of this study is to evaluate body composition and bone mass in patients undergoing one-anastomosis gastric bypass (OAGB).

METHODS

A prospective observational study was performed in patients undergoing OAGB. Body composition and bone mass were evaluated by bioelectrical impedance analysis at baseline (1 day prior to surgery), at 6 and 12 months after surgery.

RESULTS

A total of 94 patients (67% females and 33% males) were included in the study. The excess BMI loss at 6 and 12 months after surgery was 97.9 ± 20.1% and 110.2 ± 30.5% respectively. The FFM showed a reduction of 6.6 ± 4.8 kg (p < 0.01) 6 months after surgery and of 7.9 ± 4.9 kg (p < 0.01) at 12 months, meaning a decrease of 10.5 ± 7.3% and a 12.9 ± 6.6% respectively. The bone mass decrease was 10.1 ± 6.9% (p < 0.01) and 12.9 ± 6.5% (p < 0.01) at 12 months after OAGB.

CONCLUSIONS

OAGB obtains a relevant weight loss in patients with morbid obesity, mainly, due to fat mass reductions. However, this procedure also provokes FFM and bone mass decreases, especially in females, but not significantly greater than other restrictive or mixed procedures.