Changes in prevalence of obesity and high waist circumference over four years across European regions: the European male ageing study (EMAS)

Psychometric evaluation of three-factor eating questionnaire -R18 in aging Finnish men with increased risk for type 2 diabetes

BACKGROUND

Deeper comprehension of eating-related behaviour (how and why people eat) can reveal new aspects to support health and prevent type 2 diabetes (T2D). However, such research is largely missing in aging men.

AIM

The aim was to investigate suitability of the Three-Factor Eating Questionnaire-R18 (TFEQ-R18) in Finnish aging men which is widely used to examine factors: cognitive restraint (CR), uncontrolled eating (UE), and emotional eating (EE).

METHODS

Study population consisted of 420 men aged 50-75, who completed the TFEQ-R18 at the baseline of the T2D-GENE lifestyle intervention study. Inclusion criteria were impaired fasting glucose (IFG) and body mass index ≥25 kg/m2. Confirmatory factor analysis was used to study psychometrics (reliability, validity, and model fit) and factor structure of TFEQ-R18.

RESULTS

The items loaded to the three factors (CR, UE, EE) as in previous studies, except two items at CR factor and one at UE factor, which were therefore omitted. UE was also discovered split into two sub factors (named as 'craving' and 'loss-of-control'), UE being a higher-order (h) factor. The resultant revised version was named as Three-Factor Eating Questionnaire Revised to 15-items with higher-order factor (TFEQ-R15h).

CONCLUSION

The original 18-item version of the TFEQ was not optimal in the population consisting of Finnish aging men with elevated T2D risk. A modified 15-item version of the TFEQ could be used to describe EB in this population instead.

Finding a Link between Obesity and Senescence: A Systematic Review and Meta-Analysis

Background

Cell aging is associated with changes in telomeres due to DNA damage arising from chronic inflammation in obese patients. The aim of the systematic review and meta-analysis was to find the relationship between obesity and aging or senescence.

Methods

The systematic review was conducted through PRISMA guideline, beginning with literature search within 2012-2022 in several databases (PubMed, EBSCOHost, Science Direct, Scopus, and Cochrane) followed by screening process using predetermined PICO criteria. Original studies on the topic of obesity and senescence (aging), from preclinical studies to clinical research (cohort or cross-sectional studies) that were published within the last ten years. All studies were appraised using SYRCLE risk of bias tool for preclinical studies and Newcastle-Ottawa Scale (NOS) for cross-sectional and cohort studies. The data extraction on the studies' characteristic and outcome on aging or senescence were followed by quantitative analysis using MetaXL process on prevalence ratio and hazard ratio of obesity to comorbidities and mortality.

Results

Fifteen studies were enrolled. Obesity and white adipose tissue cause increased levels of pro-inflammatory and pro-senescence cytokine and macrophage whilst the aging process lowers metabolism with increased insulin resistance and linked to increased risk of obesity. Obesity occurs in 22% (95% CI 18%-26%) of elderly population with higher prevalence rate in the women population. Obesity is associated with significant increased risk of multimorbidity by 56% (OR = 1.58 [95% CI 1.48-1.96]).

Conclusion

The obesity and aging or senescence has reciprocal relationship between each other.

Assessing body mass index stages, individual diabetes and hypertension history effects on the risk of developing hypertension among Ghanaians: A cross-sectional study

Background and Aims

This study aimed to understand the relationship between body mass index (BMI), diabetes and hypertension history, and other risk of hypertension among Ghanaians.

Methods

The BMI data are categorized according to the World Health Organization (WHO) definition. The data were obtained from the WHO Study on global AGEing and adult health (WHO SAGE) Ghana Wave 2. Descriptive statistics were used to summarize the variables, and the association between these variables and hypertension was assessed using the χ². Multivariable logistic regression was used to examine the relationship between hypertension and different BMI levels and other variables.

Results

Obesity class II individuals have about a 4-fold higher risk of developing hypertension compared to underweight individuals. Obesity class III, class I, and preobesity individuals have approximately a 3-fold higher risk. Normal weight is associated with increased hypertension risk. Both males and females show a significant increase in hypertension risk across all BMI categories. History of hypertension is linked to a 2.2-fold increased risk. Diabetes history is associated with hypertension when considering other factors. Elevated hypertension risk is observed among married, divorced, and widowed males then never married males. Only widowed females showed an increased risk. Older age significantly increases hypertension risk, particularly in females. Vegetable servings reduce hypertension risk, while fruit servings are associated with an increased risk. Vigorous exercise increases hypertension risk, particularly in females.

Conclusion

Regular check-ups are recommended for married, divorced, and widowed males, focusing on blood pressure (BP) levels. Regular exercise from young age helps lower BP in later years. Individuals with a history of hypertension should follow BP control measures. Encouraging the consumption of the right combination of vegetables and fruits can help lower BP. Female tobacco smoking should be strongly discouraged due to a 54% increased risk of developing hypertension.

The Burden of Modifiable Cardiovascular Risk Factors in a Population of Central Italy: A Pilot Study

BACKGROUND

By the mid-20th century, cardiovascular disease (CVD) had become an important cause of mortality and morbidity in developed countries. The aim was to set up a pilot study to screen citizens aged 45-59 in order to identify modifiable risk factors (RFs).

METHODS

Our study was conducted from February 2019 to February 2020 on citizens of a population of central Italy, aged 45-59, contacted by letter. The variables evaluated were lipid profile, glycemia, anthropometric parameters, lifestyle and utility of screening.

RESULTS

It is important to underline that from the comparison with Italian national data, our results showed that blood pressure and lipid profile had better values. On the contrary, there were some alarm bells: a high percentage (57%) of smokers (63.9 in men and 37.1 in women), a sedentary lifestyle (24.5%), and a significantly higher waist circumference than the reference cut-offs for both men and women. The organization of the screening was considered excellent by 56.3% of women and 48.4% of men, and good by 37.5% of women and 46.5% of men.

CONCLUSIONS

Our study provides a picture to stakeholders of the state of the health of citizens in the area under study, in the immediate pre-pandemic period; however, it is important to underline that their state of health may be modified after the pandemic period. Furthermore, cardiovascular (CV) screening was perceived by the citizens to be important for health care.

Steady increase of obesity prevalence in Austria: Analysis of three representative cross-sectional national health interview surveys from 2006 to 2019

BACKGROUND

Obesity is associated with adverse health consequences throughout life. Monitoring obesity trends is important to plan and implement public heath interventions adapted to specific target groups. We aimed to analyze the development of obesity prevalence in the Austrian population using data from the most recent representative Austrian Health Interview Surveys.

METHODS

The three cross-sectional Austrian health interview surveys from 2006/2007, 2014 and 2019 were used (n = 45,707). Data correction for self-reported body mass index (BMI) was applied. Sex, age, education level, employment status, country of birth, urbanization, and family status were used as sociodemographic factors. Logistic regression models were applied.

RESULTS

Prevalence of obesity increased in both sexes in the study period (men 13.7% to 20.0%, women 15.2% to 17.8%, p < 0.001). Adjusted odds ratios (95% confidence interval [CI]) for the increase in obesity prevalence was 1.47 (95% CI: 1.38-1.56). In men, obesity prevalence almost doubled from 2006/2007 to 2019 in subgroups of 15-29-year-olds (4.8% to 9.0%), unemployed (13.5% to 27.6%), men born in non-EU/non-EFTA countries (13.9% to 26.2%), and not being in a relationship (8.1% to 15.4%). In women, the largest increase was found in subgroups of 30-64-year-olds (15.8% to 18.7%), women born in non-EU/non-EFTA countries (19.9% to 22.8%) and in women living in the federal capital Vienna (16.5% to 19.9%).

CONCLUSION

Obesity prevalence in the Austrian population continues to rise significantly. We identified distinct subgroups with a fast-growing obesity prevalence in recent years, emphasizing the importance of regular long-term data collection as a basis for sustainable and target group-specific action planning.

Exercise associated or not to the intake of Eurycoma longifolia improves strength and cardiorespiratory fitness in men with androgen deficiency

This study aims to analyze the effects of a concurrent training (CT) associated with Eurycoma longifolia (EL) supplementation on the muscle strength, cardiorespiratory fitness, and symptomatology score of men with the androgen deficiency of aging male (ADAM). Forty-five subjects (47.6 ± 5.2 years) were included in the study. The randomized, double-blinded, placebo controlled clinical trial lasted for 6 months. Participants were randomized into four groups, control (C; n = 12); EL (n = 11); CT (n = 11); and CT + EL (n = 11). Along this period, the isokinetic peak torque of the knee extensors increased in the CT (14%) and CT + EL (17%) groups (p = 0.040; p = 0.006, respectively), while the isokinetic peak torque of knee flexion increased in the CT + EL group only (p < 0.05). For all participants, testosterone levels were correlated with isokinetic peak torque of knee extension (r = 0.517, p = 0.001) and flexion (r = 0.362, p = 0.028). Subjects of the CT (27.3%) and CT + EL (36.1%) groups decreased the symptomatology of ADAM (p = 0.005). This study demonstrated the benefits of CT and EL consumption as a non-pharmacological treatment for ADAM.

Prevalence of testosterone deficiency among aging men with and without morbidities

In this cross-sectional study 1852 men aged 40-70 years attending primary health care were invited to fill out the aging male symptoms (AMS) scale. Out of these, 1222 men were found positive for the AMS and agreed to provide blood samples for the general blood test, lipid profile, glucose levels, and assessment of both total and free testosterone (T) levels. Men were screened for the following morbidities and syndromes: dyslipidemia, arterial hypertension, obesity, type II diabetes, metabolic syndrome, and chronic obstructive pulmonary disease (COPD). Testosterone deficiency was diagnosed if total T ≤ 3.46 ng/mL or free T ≤ 72 pg/mL. Among all 1222 men with positive AMS, decreased blood testosterone levels were detected in 669 men (55%). A total of 402 men were found healthy and 820 men were detected with different morbidities. Out of 669 men with testosterone deficiency, only 2.8% had no co-morbidities and 97.2% were men with co-morbidities. Testosterone levels were found significantly higher among healthy men (median 4.7 ng/mL) as compared to the men with morbidities (median 2.55 ng/mL, p<.001), adjusted for age. Testosterone deficiency was detected in significantly lower proportion of 402 men without co-morbidities as compared to the 820 men with co-morbidities: in 19 men (4.7) and in 650 men (79.3%, p<.05), respectively.

Cardiometabolic Risk Factor in Obese and Normal Weight Individuals in Community Dwelling Men

The aim of this study was to investigate the cardiometabolic risk factors (CRFs) in community dwelling men based on a combination of body mass index (BMI) and waist circumference (WC). This cross-sectional study was based on 867 males between the ages of 20 and 71 years. Subjects were categorized into 4 groups by BMI and WC (Group 1, BMI < 25 kg/m2 and WC < 90 cm; Group 2, BMI < 25 kg/m2 and WC > 90 cm; Group 3, BMI > 25 kg/m2 and WC < 90 cm; and Group 4 BMI > 25 kg/m2 and WC > 90 cm). The proportion of subjects with a normal weight with high WC was 3.2%. Among normal weight men with the high range of WC, significantly high Odds ratios (ORs) and 95% CI were found for hypertriglyceridemia (3.8, 1.8-8.2) and high blood glucose (3.2, 1.5-6.9). The probability that the general obesity group (Group 3) had one CRF was around twice that of the reference group (Group 1) (1.9 to 2.1 times), but Group 2 had probability more than 4 times higher (4.3 to 4.6 times). In community dwelling adult men, normal weight with high waist circumference was associated with the highest cardiometabolic risk. In conclusion, follow-up screening of those with high WC may be necessary to detect and prevent cardiometabolic diseases, particularly for men with a normal weight.

General vs health-specific consideration of immediate and future consequences to explain eating and exercise behavior in a Norwegian student population: A randomized survey experiment

Over several decades, the consideration of future consequences (CFC) construct has been used to explain and predict health behaviors. However, the reported associations between CFC and health behaviors are relatively weak, leading to the low explanatory power of the models. Recent research suggests that CFC can be a domain-specific construct. In this study, we explored the psychometric properties of the Norwegian CFC-general and CFC-health questionnaires in terms of factor structure and discriminant and convergent validity and tested the association between the general and domain-specific CFC and exercise and eating behaviors. In a randomized survey experiment, 1,001 university students were assigned to either a CFC-general or a CFC-health questionnaire. In the tested models, two dimensions of CFC, consideration of immediate consequences (CFC-I) and consideration of future consequences (CFC-F), were independent variables. The exercise and eating behaviors, measured both as self-evaluated behaviors and self-reported frequency measures, were dependent variables. The results showed that in both CFC-general and CFC-health, CFC-I and CFC-F are distinct dimensions that differentially explain variance in health behaviors. A domain-specific CFC-health explained a significantly higher amount of variance in self-reported eating and exercising behaviors than a general CFC. Self-evaluated health behaviors were better explained by CFC than self-reported behavioral frequencies. Practical implications of the findings and avenues for future research are discussed.

Lycopene in tomatoes and tomato products

This article focused on the content of lycopene in fresh and dried tomatoes and tomato pomace, as well as in tomato paste at different harvest times (harvest 1 – August and harvest 2 – September). The lycopene content of tomatoes and tomato products was evaluated by using high-performance liquid chromatography (HPLC). The results showed that the highest content of lycopene was estimated in the tomato paste independent of the time of harvest (211.73 mg/100 g dm in August and 184.29 mg/100 g dm in September) and the lowest content in fresh pomace (20.45 and 16.11 mg/100 g dm in August and September, respectively). Good sources of lycopene are tomato by-products, in particularly dried tomato pomace (25.11 mg/100 g dm – harvest 1 and 19.30 mg/100 g dm – harvest 2). This study showed that tomato waste can be considered as a promising source of lycopene for the production of functional foods.

Regional and Social Disparities for Obesity among Austrian Adults: Representative Long-term Trends from 1973-2014

STUDY AIM

To present regional long-term trends for the prevalence of obesity (BMI ≥ 30 kg/m²) among Austrian adults in Western, Central and Eastern Austria. Furthermore, the educational inequality regarding obesity was analysed in these regions in Austria for the investigation period.

METHODS

Self-reported data from six nationally representative, cross-sectional surveys (n=194,030) conducted between 1973 and 2014 were analysed. Absolute changes (AC) and Etiologic fractions (EF) were calculated to measure trends. The extent of social inequality was presented by the relative index of inequality (RII) based on the educational level.

RESULTS

Since 1973, a clear east to west gradient for obesity among adults in Austria has been observed. In 2014, the age-standardized prevalence was highest among Eastern Austrian adults (women: 16.9%; men: 18.2%). A constant increase in obesity among men has been visible since 1983. Since 2007, the values for women have stabilized, while the prevalence of obesity among female Austrians in Western and Central Austria decreased. Considering the AC for the prevalence of obesity from 1983 on, the highest increase was found among women (+2.60%) and men (+1.56%) in Eastern Austria. The outcomes regarding social inequality are instable on a regional level, with the highest RII observed in 2014 for Central Austria.

CONCLUSION

These study findings reveal significant regional differences in the prevalence of obesity in Austria and confirm the existence of an current east-west gradient in Austria for obesity. Considering the latest trends, especially men represent a risk group for obesity in the 3 regions.

Aging and the Male Reproductive System

This narrative review presents an overview of current knowledge on fertility and reproductive hormone changes in aging men, the factors driving and modulating these changes, their clinical consequences, and the benefits and risks of testosterone (T) therapy. Aging is accompanied by moderate decline of gamete quality and fertility. Population mean levels show a mild total T decline, an SHBG increase, a steeper free T decline, and a moderate LH increase with important contribution of comorbidities (e.g., obesity) to these changes. Sexual symptoms and lower hematocrit are associated with low T and are partly responsive to T therapy. The relationship of serum T with body composition and metabolic health is bidirectional; limited beneficial effects of T therapy on body composition have only marginal effects on metabolic health and physical function. Skeletal changes are associated primarily with estradiol and SHBG. Cognitive decline is not consistently linked to low T and is not improved by T therapy. Although limited evidence links moderate androgen decline with depressive symptoms, T therapy has small beneficial effects on mood, depressive symptoms, and vitality in elderly patients with low T. Suboptimal T (and/or DHT) has been associated with increased risk of stroke, but not of ischemic heart disease, whereas an association with mortality probably reflects that low T is a marker of poor health. Globally, neither severity of clinical consequences attributable to low T nor the nature and magnitude of beneficial treatment effects justify the concept of some broadly applied "T replacement therapy" in older men with low T. Moreover, long-term safety of T therapy is not established.

Long-term trends (1973-14) for obesity and educational inequalities among Austrian adults: men in the fast lane

BACKGROUND

The examination of obesity trends is important to plan public health interventions specific to target-groups. We investigated long-term trends of obesity for the Austrian adult population between 1973 and 2014 according to their sex, age and education and the magnitude of educational-inequalities.

METHODS

Data were derived from six national, representative, cross-sectional interview surveys (N = 194 030). Data correction factors for self-reported body mass index (BMI) were applied. Obesity was defined as BMI ≥ 30 kg/m2. Absolute changes (ACs) and aetiologic fractions (AFs) were calculated to identify trends in the obesity prevalence. To measure the extent of social inequality, the relative index of inequality was computed based on educational levels.

RESULTS

In 2014, the age-adjusted prevalence of obesity was 14.6% (95%CI: 14.0-15.3) for women and 16.8% (95%CI: 16.1-17.9) for men. Obesity was most prevalent among subjects aged 55-74 years and those with low educational status. The AC in the obesity prevalence during the study period was highest for men aged 75 years and older with high/middle educational levels (16.2%) and also high for subjects aged 55 years and older with low educational levels. The greatest dynamics for obesity were observed among the oldest men with high/middle educational levels. Educational inequalities for obesity were higher among women, but only increased among men.

CONCLUSIONS

Since 1973, the prevalence for obesity was observed to be higher for men than women in Austria for the first time. Men showed the greatest increase in prevalence and risk for obesity during the study period. Further studies are needed to determine the drivers behind these trends.

Changes in distributions of waist circumference, waist-to-hip ratio and waist-to-height ratio over an 18-year period among Chinese adults: a longitudinal study using quantile regression

BACKGROUND

Little is known about the long-term shifts in distributions of three abdominal-obesity-related indicators, waist circumference (WC), waist-to-hip ratio (WHpR) and waist-to-height ratio (WHtR) among Chinese adults. Traditional mean regression models used in the previous analyses were limited in their ability to capture cross-distribution among effects. The current study aims to describe the shift in distribution of WC, WHpR, and WHtR over a period of 18 years (1993-2011) in China, and to reveal quantile-specific associations of the three indicators with key covariates.

METHODS

Longitudinal data from seven waves of the China Health and Nutrition Surveys (CHNS) in 1993, 1997, 2000, 2004, 2006, 2009 and 2011 were analyzed. The LMS method was used to illustrate the gender-specific quantile curves of WC, WHtR and WHpR over age. Separate gender-stratified longitudinal quantile regressions were employed to investigate the effect of important factors on the trends of the three indicators.

RESULTS

A total of 11,923 participants aged 18-65 years with 49,507 observations were included in the analysis. The density curves of WC, WHtR and WHpR shifted to right and became wider. The three outcomes all increased with age and increased more at upper percentiles. From the multivariate quantile regression, physical activity was negatively associated in both genders; smoking only had a negative effect on male indicators. Education and drinking behavior both had opposite effects on the three indicators between men and women. Marital status and income were positively associated with the shifts in WC, WHtR and WHpR in male and female WC, while urbanicity index had a positive effect on three outcomes in men but inconsistent effect among female outcomes.

CONCLUSIONS

The abdominal-obesity related indicators of the Chinese adults experienced rapid growth according to our population-based, age- and gender-specific analyses. Over the 18-year study period, major increases in WC, WHtR and WHpR were observed among Chinese adults. Specifically, these increases were greater at upper percentiles and in men. Age, physical activity, energy intake, drinking, smoking, education, income and urbanicity index were associated with elevated abdominal obesity indicators, and the effects differed among percentiles and between genders.

Body Mass Index is Strongly Associated with Hypertension: Results from the Longevity Check-up 7+ Study

The present study was undertaken to provide a better insight into the relationship between different levels of body mass index (BMI) and changing risk for hypertension, using an unselected sample of participants assessed during the Longevity Check-up 7+ (Lookup7+) project. Lookup7+ is an ongoing cross-sectional survey started in June 2015 and conducted in unconventional settings (i.e., exhibitions, malls, and health promotion campaigns) across Italy. Candidate participants are eligible for enrolment if they are at least 18 years of age and provide written informed consent. Specific health metrics are assessed through a brief questionnaire and direct measurement of standing height, body weight, blood glucose, total blood cholesterol, and blood pressure. The present analyses were conducted in 7907 community-living adults. According to the BMI cutoffs recommended by the World Health Organization, overweight status was observed among 2896 (38%) participants; the obesity status was identified in 1135 participants (15%), with 893 (11.8%) participants in class I, 186 (2.5%) in class II, and 56 (0.7%) in class III. Among enrollees with a normal BMI, the prevalence of hypertension was 45% compared with 67% among overweight participants, 79% in obesity class I and II, and up to 87% among participants with obesity class III (p for trend < 0.001). After adjusting for age, significantly different distributions of systolic and diastolic blood pressure across BMI levels were consistent. Overall, the average systolic blood pressure and diastolic blood pressure increased significantly and linearly across BMI levels. In conclusion, we found a gradient of increasing blood pressure with higher levels of BMI. The fact that this gradient is present even in the fully adjusted analyses suggests that BMI may cause a direct effect on blood pressure, independent of other clinical risk factors.

Associations among health behaviors, body mass index, hypertension, and diabetes mellitus: A path analysis

Hypertension (HTN) and type 2 diabetes are common diseases; however, the effects of health behavior and body mass index (BMI) on their incidence and relationship are unclear. The purpose of this study was to investigate the associations among health behaviors, BMI, HTN, and type 2 diabetes.This study was a secondary data analysis using Korean Longitudinal Study of Aging data between 2010 and 2014 (third and fifth). The sample consisted of 3481 people aged 45 years or older. Path analysis was conducted using the generalized structural equation modeling of STATA 13.1 that enabled analyzing the types of binary variables and logit links.There were 129 underweight, 1714 normal, and 1638 overweight and obese individuals. In underweight and normal groups who had regular meals (B = 0.670, P < .001), BMI was higher. However, for those who were older (B = -0.041, P < .001) and female (B = -0.229, P = .021), BMI was lower. The incidence of HTN increased with age (B = 0.038, P = .001). In addition, the incidence of type 2 diabetes increased with age (B = 0.051, P = .005) and smoking (B = 1.539, P = .001). However, the incidence of type 2 diabetes was lower (B = -1.077, P = .036) for those who had regular meals. In the normal and overweight groups, BMI decreased with age (B = -0.033, P < .001). The incidence of HTN increased with age (B = 0.042, P < .001) and BMI (B = 0.145, P < .001). Moreover, the incidence of type 2 diabetes increased with age (B = 0.046, P < .001), smoking (B = 0.682, P = .020), and higher BMI (B = 0.151, P = .001).In the underweight and normal group, health behaviors were related to BMI. In the normal and overweight group, health behaviors were not related to BMI, but high BMI was related to the incidence of HTN and type 2 diabetes. Smoking has a direct effect on the incidence of type 2 diabetes. Thus, the importance of maintaining an ideal BMI and smoking cessation are highlighted.

Acid-base safety during the course of a very low-calorie-ketogenic diet

BACKGROUND AND AIMS

Very low-calorie ketogenic (VLCK) diets have been consistently shown to be an effective obesity treatment, but the current evidence for its acid-base safety is limited. The aim of the current work was to evaluate the acid-base status of obese patients during the course of a VLCK diet.

METHOD

Twenty obese participants undertook a VLCK diet for 4 months. Anthropometric and biochemical parameters, and venous blood gases were obtained on four subsequent visits: visit C-1 (baseline); visit C-2, (1-2 months); maximum ketosis; visit C-3 (2-3 months), ketosis declining; and visit C-4 at 4 months, no ketosis. Results were compared with 51 patients that had an episode of diabetic ketoacidosis as well as with a group that underwent a similar VLCK diet in real life conditions of treatment.

RESULTS

Visit C1 blood pH (7.37 ± 0.03); plasma bicarbonate (24.7 ± 2.5 mmol/l); plasma glucose (96.0 ± 11.7 mg/l) as well as anion gap or osmolarity were not statistically modified at four months after a total weight reduction of 20.7 kg in average and were within the normal range throughout the study. Even at the point of maximum ketosis all variables measured were always far from the cut-off points established to diabetic ketoacidosis.

CONCLUSION

During the course of a VLCK diet there were no clinically or statistically significant changes in glucose, blood pH, anion gap and plasma bicarbonate. Hence the VLCK diet can be considered as a safe nutritional intervention for the treatment of obesity in terms of acid-base equilibrium.

Cushing's syndrome: a model for sarcopenic obesity

PURPOSE

Obesity and its metabolic impairments are discussed as major risk factors for sarcopenia leading to sarcopenic obesity. Cushing's syndrome is known to be associated with obesity and muscle atrophy. We compared Cushing's syndrome with matched obese controls regarding body composition, physical performance, and biochemical markers to test the hypothesis that Cushing's syndrome could be a model for sarcopenic obesity.

METHODS

By propensity score matching, 47 controls were selected by body mass index and gender as obese controls. Fat mass and muscle mass were measured by bioelectrical impedance analysis. Muscle function was assessed by chair rising test and hand grip strength. Biochemical markers of glucose and lipid metabolism and inflammation (hsCRP) were measured in peripheral blood.

RESULTS

Muscle mass did not differ between Cushing's syndrome and obese controls. However, Cushing's syndrome patients showed significantly greater chair rising time (9.5 s vs. 7.3 s, p = 0.008) and significantly lower hand grip strength (32.1 kg vs. 36.8 kg, p = 0.003). Cushing's syndrome patients with impaired fasting glucose have shown the highest limitations in hand grip strength and chair rising time.

CONCLUSIONS

Similar to published data in ageing medicine, Cushing's syndrome patients show loss of muscle function that cannot be explained by loss of muscle mass. Impaired muscle quality due to fat infiltration may be the reason. This is supported by the observation that Cushing's syndrome patients with impaired glucose metabolism show strongest deterioration of muscle function. Research in sarcopenic obesity in elderly is hampered by confounding comorbidities and polypharmacy. As Cushing's syndrome patients are frequently free of comorbidities and as Cushing's syndrome is potentially curable we suggest Cushing's syndrome as a clinical model for further research in sarcopenic obesity.