Sarcopenic obesity and inflammation in the InCHIANTI study

Association between sarcopenic obesity, obesity, sarcopenia and quality of life in middle-aged and older Chinese: the Guangzhou Biobank Cohort Study

PURPOSE

Sarcopenic obesity (SO) is increasing globally, especially in aging populations. This study aims to analyze whether SO is more strongly associated with poorer quality of life (QoL) than obesity or sarcopenia alone.

METHODS

SO was defined as the coexistence of probable sarcopenia combined with obesity. Obesity was defined by body mass index and waist circumference, and probable sarcopenia was identified using the Asian Working Group for Sarcopenia criteria 2019. QoL was assessed using the Short-Form 12 Health Survey Version 2. Linear regression was used to analyze the association between SO with QoL composite and domain scores.

RESULTS

Of 6,332 participants aged 50 years or older, 21.9% had SO, 10.6% had obesity only, and 38.7% had probable sarcopenia only. Compared to participants without obesity or sarcopenia, those with SO showed a significant negative association with physical health-related QoL (all P < 0.05), which remained significant when obesity or sarcopenia alone was used as the reference. The adjusted beta (95% CI) for the Physical Component Summary, General Health, Physical Functioning, Role Physical, and Bodily Pain for the SO group was -1.23 (-1.68, -0.79), -0.86 (-1.51, -0.21), -1.28 (-1.77, -0.80), -0.51 (-0.95, -0.07), and -0.77 (-1.37, -0.18), respectively. Non-significant association of SO with the Mental Component Summary, Vitality, Role Limitation due to Emotional Problem, and Mental Health was found (all P > 0.05). The results were consistent across different SO criteria and by sex (P for sex-interaction from 0.21 to 0.99).

CONCLUSION

SO was associated with lower physical health-related QoL compared to obesity or sarcopenia alone, but non-significantly associated with mental health-related QoL.

Quantifying knee-adjacent subcutaneous fat in the entire OAI baseline dataset - Associations with cartilage MRI T2, thickness and pain, independent of BMI

OBJECTIVE

Knee-adjacent subcutaneous fat (kaSCF) has emerged as a potential biomarker and risk factor for osteoarthritis (OA) progression. This study aims to develop an artificial intelligence-based tool for the automatic segmentation of kaSCF thickness and evaluate the cross-sectional associations between kaSCF, cartilage thickness, magnetic resonance imaging-based cartilage T2 relaxation time, knee pain, and muscle strength independent of body mass index (BMI).

DESIGN

Baseline 3.0T MR images of the right knee from the entire Osteoarthritis Initiative cohort (n=4796) were used to quantify average values of kaSCF, cartilage thickness, and T2 using deep learning algorithms. Regression models (adjusted for age, gender, BMI, and race) were used to evaluate the associations between standardized kaSCF and outcomes of cartilage thickness, T2, pain, and knee extension strength.

RESULTS

Model prediction CVs for kaSCF thickness ranged from 3.57% to 9.87% across femoral and tibial regions. Greater average kaSCF was associated with thinner cartilage in men (std. β= -0.029, 95% CI: -0.050 to -0.007, p=0.010) and higher T2 in women (std. β=0.169, 95% CI: 0.072 to 0.265, p=0.001). Greater kaSCF was also associated with lower knee extension force (std. β= -15.36, 95% CI: -20.39 to -10.33, p<0.001) and higher odds of frequent knee pain (std. odds ratio=1.156, 95% CI: 1.046 to 1.278, p=0.005) across all participants.

CONCLUSIONS

Greater kaSCF was associated with thinner cartilage in men, higher T2 in women, reduced knee strength, and greater knee pain, independent of BMI. These findings suggest a potential role of kaSCF as a predictor for knee osteoarthrits-related structural, functional, and clinical outcomes independent of the effects of BMI.

Association of possible Sarcopenia, Sarcopenia and sarcopenic obesity with multimorbidity among middle-aged and older adults: findings from the China health and retirement longitudinal study

BACKGROUND AND OBJECTIVES

The association between possible sarcopenia, sarcopenia and sarcopenic obesity on multimorbidity risk remains poorly investigating. We aimed to evaluate the associations between possible sarcopenia, sarcopenia and sarcopenic obesity on multimorbidity prevalence and incidence among middle-aged and older Chinese population.

METHODS

A total of 13,036 participants from the China Health and Retirement Longitudinal Study 2011 were included in cross-sectional analyses. 5771 participants were including in longitudinal analyses and were followed up in 2018. Sarcopenia status was defined according to the Asian Working Group for Sarcopenia 2019 (AWGS 2019) criteria. Obesity was defined according to body mass index.

RESULTS

In cross-sectional analyses, possible sarcopenia, sarcopenia and sarcopenic obesity were significantly associated with higher multimorbidity prevalence. During the 7 years of follow-up, 2295(39.77%) participants with new-onset multimorbidity were identified. Compared with participants without sarcopenia or obesity, a greater increase in the risk of multimorbidity incidence was found among participants with obesity only (OR = 1.39, 1.21-1.59), sarcopenia only (OR = 1.45, 1.35-1.58) and sarcopenic obesity (OR = 2.42, 2.03-2.89). Both pre-sarcopenia, sarcopenia and sarcopenic obesity were positively related to an increased number of morbidities.

CONCLUSION

Pre-sarcopenia, sarcopenia and sarcopenic obesity were associated with higher multimorbidity prevalence and incidence. Our findings provide important implications for screening and preventing possible sarcopenia, sarcopenia and obesity, which may be beneficial in reducing chronic disease burden.

Obesity and Metabolic Health in CKD

Obesity is a worldwide epidemic with a future projected growth of 40% over 10 years. Obesity increases the risk of diabetes, hypertension, and cardiovascular disease, and it also leads to higher risk of CKD, through both direct and indirect mechanisms. Although obesity is a feature of overnutrition and is associated with poor outcomes in the general population, obese individuals with CKD often display complex metabolic patterns such as sarcopenic obesity, and obesity can be associated with better survival in individuals with advanced CKD. Weight loss interventions are proven to improve glycemic control and cardiovascular risk factors, and successful weight loss is associated with improved albuminuria in patients with preexisting CKD. The long-term effects of weight loss interventions on kidney function and on survival in patients with CKD are less well studied, and hence, such interventions should be individualized.

Identification of Association Between Mitochondrial Dysfunction and Sarcopenia Using Summary-Data-Based Mendelian Randomization and Colocalization analyses

BACKGROUND

Mitochondrial dysfunction has been demonstrated to be an important hallmark of sarcopenia, yet its specific mechanism remains obscure. In this study, mitochondrial-related genes were used as instrumental variables to proxy for mitochondrial dysfunction, and summary data for sarcopenia-related traits were used as outcomes to examine their genetic association.

METHODS

A total of 1 136 mitochondrial-related genes from the human MitoCarta3.0 database were extracted. Genetic instruments for them were obtained from gene expression quantitative trait locus (eQTLs) study (n = 31 684). Aggregated data for sarcopenia-related traits including low hand grip strength (LHGS), appendiceal lean mass (ALM), and usual walking pace (UWP) were provided by large-scale genome-wide association studies (GWASs). We integrated eQTLs data with GWAS data to estimate genetic association between mitochondrial dysfunction and sarcopenia using summary-data-based Mendelian randomization (SMR) analysis. Additionally, we implemented colocalization analysis to strengthen their association. Finally, eQTLs data from skeletomuscular tissue (n = 706) was used to validate the primary findings.

RESULTS

By integrating the analysis results from the 3 sarcopenia-related traits, 2 mitochondrial genes genetically associated with sarcopenia were identified, namely UQCC1 (tier 2 evidence) and ETFDH (tier 3 evidence). Specifically, elevated expression levels of UQCC1 increased LHGS risk (OR = 1.114; 95% CI, 1.078-1.152; P-FDR = 1.70 × 10-7), which matched the negative association between it and UWP (Beta = -0.015; 95% CI, -0.021 to -0.010; P-FDR = 6.70 × 10-5). Furthermore, elevated expression levels of ETFDH were found to be associated with both lower ALM (Beta = 0.031; 95% CI, 0.020-0.042; P-FDR = 1.41 × 10-6) and UWP (Beta = 0.013; 95% CI, 0.006-0.021; P-FDR = 0.029). Of note, consistent results were replicated in specific skeletomuscular tissues, further suggesting our findings were robust.

CONCLUSIONS

Our analyses revealed the genetic association between 2 mitochondrial-related genes, ie, UQCC1 and ETFDH, and sarcopenia, highlighting the pivotal role of mitochondrial dysfunction driven by these genes in the pathogenesis of sarcopenia. Importantly, these candidate genes represent potential clinical drug targets for the treatment of sarcopenia.

Ratio of Skeletal Muscle Mass to Visceral Fat Area Is a Useful Marker for Assessing Left Ventricular Diastolic Dysfunction among Koreans with Preserved Ejection Fraction: An Analysis of the Random Forest Model

Background

Although the presence of both obesity and reduced muscle mass presents a dual metabolic burden and additively has a negative effect on a variety of cardiometabolic parameters, data regarding the associations between their combined effects and left ventricular diastolic function are limited. This study investigated the association between the ratio of skeletal muscle mass to visceral fat area (SVR) and left ventricular diastolic dysfunction (LVDD) in patients with preserved ejection fraction using random forest machine learning.

Methods

In total, 1,070 participants with preserved left ventricular ejection fraction who underwent comprehensive health examinations, including transthoracic echocardiography and bioimpedance body composition analysis, were enrolled. SVR was calculated as an index of sarcopenic obesity by dividing the appendicular skeletal muscle mass by the visceral fat area.

Results

In the random forest model, age and SVR were the most powerful predictors of LVDD. Multivariate logistic regression analysis demonstrated that older age (adjusted odds ratio [OR], 1.11; 95% confidence interval [CI], 1.07 to 1.15) and lower SVR (adjusted OR, 0.08; 95% CI, 0.01 to 0.57) were independent risk factors for LVDD. SVR showed a significant improvement in predictive performance and fair predictability for LVDD, with the highest area under the curve noted in both men and women, with statistical significance. In non-obese and metabolically healthy individuals, the lowest SVR tertile was associated with a greater risk of LVDD compared to the highest SVR tertile.

Conclusion

Decreased muscle mass and increased visceral fat were significantly associated with LVDD compared to obesity, body fat composition, and body muscle composition indices.

Exerkines and Sarcopenia: Unveiling the Mechanism Behind Exercise-Induced Mitochondrial Homeostasis

Background/Objectives: Sarcopenia, characterized by the progressive loss of muscle mass and strength, is linked to physical disability, metabolic dysfunction, and an increased risk of mortality. Exercise therapy is currently acknowledged as a viable approach for addressing sarcopenia. Nevertheless, the molecular mechanisms behind exercise training or physical activity remain poorly understood. The disruption of mitochondrial homeostasis is implicated in the pathogenesis of sarcopenia. Exercise training effectively delays the onset of sarcopenia by significantly maintaining mitochondrial homeostasis, including promoting mitophagy, improving mitochondrial biogenesis, balancing mitochondrial dynamics, and maintaining mitochondrial redox. Exerkines (e.g., adipokines, myokines, hepatokines, and osteokines), signaling molecules released in response to exercise training, may potentially contribute to skeletal muscle metabolism through ameliorating mitochondrial homeostasis, reducing inflammation, and regulating protein synthesis as a defense against sarcopenia. Methods: In this review, we provide a detailed summary of exercise-induced exerkines and confer their benefit, with particular focus on their impact on mitochondrial homeostasis in the context of sarcopenia. Results: Exercise induces substantial adaptations in skeletal muscle, including increased muscle mass, improved muscle regeneration and hypertrophy, elevated hormone release, and enhanced mitochondrial function. An expanding body of research highlights that exerkines have the potential to regulate processes such as mitophagy, mitochondrial biogenesis, dynamics, autophagy, and redox balance. These mechanisms contribute to the maintenance of mitochondrial homeostasis, thereby supporting skeletal muscle metabolism and mitochondrial health. Conclusions: Through a comprehensive investigation of the molecular mechanisms within mitochondria, the context reveals new insights into the potential of exerkines as key exercise-protective sensors for combating sarcopenia.

A partial loss-of-function variant (Ile191Val) of the TAS1R2 glucose receptor is associated with enhanced responses to exercise training in older adults with obesity: A translational study

BACKGROUND

The TAS1R2 receptor, known for its role in taste perception, has also emerged as a key regulator of muscle physiology. Previous studies have shown that genetic ablation of TAS1R2 in mice enhances muscle fitness mimicking responses to endurance exercise training. However, the translational relevance of these findings to humans remains uncertain.

METHODS

We explored responses to endurance exercise training in mice and humans with genetic deficiency of TAS1R2. First, we assessed the effects of muscle-specific deletion of TAS1R2 in mice (mKO) or wild type controls (mWT) following 4 weeks of voluntary wheel running (VWR). Next, we investigated the effects of the TAS1R2-Ile191Val (rs35874116) partial loss-of-function variant on responses to a 6-month diet-induced weight loss with exercise training (WLEX), weight loss alone (WL), or education control (CON) interventions in older individuals with obesity. Participants were retrospectively genotyped for the TAS1R2-Ile191Val polymorphism and classified as conventional function (Ile/Ile) or partial loss-of-function (Val carriers: Ile/Val and Val/Val). Body composition, cardiorespiratory fitness, and skeletal muscle mitochondrial function were assessed before and after the intervention.

RESULTS

In response to VWR, mKO mice demonstrated enhanced running endurance and mitochondrial protein content. Similarly, TAS1R2 Val carriers exhibited distinctive improvements in body composition, including increased muscle mass, along with enhanced cardiorespiratory fitness and mitochondrial function in skeletal muscle following the WLEX intervention compared to Ile/Ile counterparts. Notably, every Val carrier demonstrated substantial responses to exercise training and weight loss, surpassing all Ile/Ile participants in overall performance metrics.

CONCLUSIONS

Our findings suggest that TAS1R2 partial loss-of-function confers beneficial effects on muscle function and metabolism in humans in response to exercise training, akin to observations in TAS1R2 muscle-deficient mice. Targeting TAS1R2 may help enhancing exercise training adaptations in individuals with compromised exercise tolerance or metabolic disorders, presenting a potential avenue for personalized exercise interventions.

Malnutrition in patients with obesity: An overview perspective

Malnutrition in patients with obesity presents a complex and often overlooked clinical challenge. Although obesity is traditionally associated with overnutrition and excessive caloric intake, it can also coincide with varying degrees of malnutrition. The etiopathogenesis of obesity is multifaceted and may arise from several factors such as poor diet quality, nutrient deficiencies despite excess calorie consumption, genetics, and metabolic abnormalities affecting nutrient absorption and utilization. Moreover, a chronic low-grade inflammatory state resulting from excess adipose tissue, commonly observed in obesity, can further exacerbate malnutrition by altering nutrient metabolism and increasing metabolic demands. The dual burden of obesity and malnutrition poses significant risks, including immune dysfunction, delayed wound healing, anemia, metabolic disturbances, and deficiencies in micronutrients such as vitamin D, iron, magnesium, and zinc, among others. Malnutrition is often neglected or not given enough attention in individuals with obesity undergoing rapid weight loss through aggressive caloric restriction, pharmacological therapies, and/or surgical interventions. These factors often exacerbate vulnerability to nutrition deficiencies. We advocate for healthcare practitioners to prioritize nutrition assessment and initiate medical intervention strategies tailored to address both excessive caloric intake and insufficient consumption of essential nutrients. Raising awareness among healthcare professionals and the general population about the critical role of adequate nutrition in caring for patients with obesity is vital for mitigating the adverse health effects associated with malnutrition in this population.

Association of interleukin-6 with sarcopenia and its components in older adults: a systematic review and meta-analysis of cross-sectional studies

BACKGROUND

Observational studies have documented increased serum IL-6 levels in elderly individuals afflicted with sarcopenia. Nevertheless, the relationship between serum IL-6 concentrations and sarcopenia prevalence in the aging population is yet to be defined.

METHODS

We executed a systematic review and meta-analysis of cross-sectional studies that scrutinized serum IL-6 levels in older adults with and without sarcopenia. Relevant studies were sourced from PubMed, Scopus, Embase, Cochrane Library, and Web of Science from inception until 10 September 2023. The standard mean differences (SMDs) in serum IL-6 levels between studies were synthesized using a random-effects model. To examine the influence of demographic and clinical factors on these outcomes, we performed subgroup analyses and meta-regression, focusing on variables such as sex, age, and body mass index (BMI). We also assessed the relationship between serum IL-6 levels and the defining components of sarcopenia: muscle mass, muscle strength, and physical performance. We used Fisher's Z transformation to standardize the interpretation of effect sizes from these relationships. The transformed values were then converted to summary correlation coefficients (r) for a clear and unified summary of the results.

RESULTS

We included twenty-one cross-sectional studies involving 3,902 participants. Meta-analysis revealed significantly elevated serum IL-6 levels in older adults with sarcopenia compared with those without sarcopenia (SMD = 0.31; 95% CI 0.18, 0.44). The difference was highly pronounced in the subgroups of male and those with female percentage below 50% or a mean BMI below 24 kg/m2. Serum IL-6 levels were inversely correlated with muscle mass (summary r = -0.18; 95% CI -0.30, -0.06), but not with handgrip strength (summary r = -0.10; 95%CI: -0.25, 0.05) or gait speed (summary r = -0.09; 95%CI: -0.24, 0.07).

CONCLUSIONS

This meta-analysis establishes a link between increased serum IL-6 levels and sarcopenia in the elderly, particularly in relation to decreased muscle mass.

Association between inflammatory markers, body composition and frailty in home-dwelling elderly: an 8-year follow-up study

Frailty has been linked to inflammation and changes in body composition, but the findings are inconsistent. To explore this, we used the Frailty Index (FI) definition to (1) investigate the association between levels of inflammatory markers (baseline) and change in FI score after 8 years of follow-up and (2) investigate the longitudinal associations between inflammatory markers, body composition, and frailty. Home-dwelling elderly (≥ 70 years) were invited to participate in the study and re-invited to a follow-up visit 8 years later. This study includes a total of 133 participants. The inflammatory markers included were high-sensitive C-reactive protein (hs-CRP), interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α), and glycoprotein acetyls (Gp-acetyls). We used the body composition markers fat mass, fat-free mass, and waist circumference. The FI score consisted of 38 variables. Additional clinical assessments such as blood pressure and body mass index (BMI), as well as information about daily medications, were collected at both visits. Linear regression model and Spearman's rank correlation were used to investigate associations. We showed that the FI score increased after 8 years, and participants with higher hs-CRP levels at baseline had the largest change in the FI score. Changes in fat mass were significantly correlated with changes in hs-CRP and IL-6, and changes in waist circumference were significantly correlated with changes in TNF-α. The use of drugs increased during the 8 years of follow-up, which may have attenuated the associations between inflammation and frailty. However, elevated concentrations of hs-CRP in the elderly may be associated with an increased risk of frailty in subsequent years.

Sarcobesity: New paradigms for healthy aging related to taurine supplementation, gut microbiota and exercise

Enigmatic sarcopenic obesity is still a challenge for science and adds to the global public health burden. The progressive accumulation of body fat combined with a dysfunctional skeletal muscle structure and composition, oxidative stress, mitochondrial dysfunction, and anabolic resistance, among other aggravating factors, together represent the seriousness and complexity of treating the metabolic disorder of sarcobesity in aging. For this reason, further studies are needed that encourage the support of therapeutic management. It is along these lines that we direct the reader to therapeutic approaches that demonstrate important, but still obscure, outcomes in the physiological conditions of sarcobesity, such as the role of taurine in modulating inflammatory and antioxidant mechanisms in muscle and adipose tissue, as well as the management of gut microbiota, able to systemically re-establish the structure and function of the gut-muscle axis, in addition to the merits of physical exercise as an instrument to improve muscular health and lifestyle quality.

Application of a new definition of sarcopenic obesity in middle-aged and older adults and association with cognitive function: Findings from the National Health and Nutrition Examination Survey 1999-2002

BACKGROUND & AIMS

The role of sarcopenic obesity (SO) in impaired cognitive function has been investigated in several observational studies, but results have been mixed. This study applied the proposed European Society for Clinical Nutrition and Metabolism (ESPEN)-European Association for the Study of Obesity (EASO) definition of SO to a representative population aged ≥50 years to identify the association between SO and cognitive function.

METHODS

Data from the National Health and Nutrition Examination Survey 1999-2002 waves were used. At the screening phase, body mass index or waist circumference were used to evaluate obesity; sarcopenia was identified using the SARC-F questionnaire. At the diagnostic phase I and II, sarcopenia was assessed using knee extensor isometric strength and appendicular lean mass, and fat mass percent was used to assess obesity. Cognitive function in older participants (60-85 years) was assessed using the Digit Symbol Substitution Test. A self-reported memory question was used in middle-aged individuals (50-59 years).

RESULTS

The sample included 2356 participants (men, 44.7%). The prevalence of SO was 32.3%, 21.2% and 15.0% at the screening, diagnosis I, and diagnosis II, respectively. Significant associations between SO and cognitive impairment were observed in individuals aged 60-85 at diagnosis I (OR: 2.3, 95%CI 1.4-3.8, P = 0.007) and diagnosis II (OR: 2.7, 95%CI 1.5-4.9, P = 0.004).

CONCLUSION

The new ESPEN-EASO definition of SO identified a high prevalence of SO cases. A significant association between SO and poor cognitive function in older individuals was observed.

Regimen on Dnaja3 haploinsufficiency mediated sarcopenic obesity with imbalanced mitochondrial homeostasis and lipid metabolism

BACKGROUND

Sarcopenic obesity is characterized by excess fat mass and diminished muscular mass/function. DNAJA3, a mitochondrial co-chaperone protein, plays a crucial role in skeletal muscle development. GMI, an immunomodulatory protein, promotes myogenic differentiation through DNAJA3 activation. This study aims to elucidate the physiological effects of muscular Dnaja3 haploinsufficiency on mitochondrial dysfunction and dysregulated lipid metabolism and to assess the efficacy of GMI in rescuing sarcopenic obesity both in vitro and in vivo.

METHODS

We generated mouse strain with Dnaja3 heterozygosity (HSA-Dnaja3f/+) specifically in skeletal muscle. The body weight, body composition, and locomotor activity of WT and HSA-Dnaja3f/+ mice were examined. The isolated skeletal muscles and primary myoblasts from the WT and HSA-Dnaja3f/+ mice, at young or old age, were utilized to study the molecular mechanisms, mitochondrial respiration and ROS level, mitochondrial proteomes, and serological analyses, respectively. To evaluate the therapeutic efficacy of GMI, both short-term and long-term GMI treatment were administrated intraperitoneally to the HSA-Dnaja3f/+ young (4 weeks old) or adult (3 months old) mice for a duration of either 1 or 6 months, respectively.

RESULTS

Muscular Dnaja3 heterozygosity resulted in impaired locomotor activity (P < 0.05), reduced muscular cross-sectional area (P < 0.0001), and up-regulation of lipogenesis (ACC2) and pro-inflammation (STAT3) in skeletal muscles (P < 0.05). Primary myoblasts from the HSA-Dnaja3f/+ mice displayed impaired mitochondrial respiration (P < 0.01) and imbalanced mitochondrial ROS levels. A systemic proteomic analysis of the purified mitochondria from the primary myoblasts was conducted to show the abnormalities in mitochondrial function and fatty acid metabolism (P < 0.0001). At age of 13 to 14 months, the HSA-Dnaja3f/+ mice displayed increased body fat mass (P < 0.001), reduced fat-free mass (P < 0.01), and impaired glucose and insulin tolerance (P < 0.01). The short-term GMI treatment improved locomotor activity (P < 0.01) and down-regulated the protein levels of STAT3 (P < 0.05), ACC2, and mitochondrial respiratory complex III (UQCRC2) (P < 0.01) via DNAJA3 activation. The long-term GMI treatment ameliorated fat mass accumulation, glucose intolerance, and systemic inflammation (AST) (P < 0.05) in skeletal muscle, while enhancing thermogenesis (UCP1) (P < 0.01) in eWAT. GMI treatment promoted myogenesis, enhanced oxygen consumption, and ameliorated STAT3 (P < 0.01) through DNAJA3 activation (P < 0.05) in vitro.

CONCLUSIONS

Muscular Dnaja3 haploinsufficiency dysregulates mitochondrial function and lipid metabolism then leads to sarcopenic obesity. GMI emerges as a therapeutic regimen for sarcopenic obesity treatment through DNAJA3 activation.

The role of dynapenia and obesity on cognitive function in older adults

BACKGROUND & AIMS

Dynapenia and obesity have been independently associated with cognitive decline in older adults, but their co-occurring effects has not been well-studied. The study objective is to examine the relationship between dynapenic-obesity and cognitive impairment in older adults 75 years and older with normal or high cognitive function at baseline over 12 years of follow-up. We hypothesize that those with dynapenic obesity will have greater odds of cognitive function impairment than those with dynapenia only, obesity only, or no dynapenia no obesity (reference group).

METHODS

A total of 761 participants with a mean age of 81.5 and Mini-Mental State Examination (MMSE) > 21 at baseline were divided into four groups: no dynapenia no obesity (n = 316), obesity only (n = 142), dynapenia only (n = 217), and dynapenic obesity (n = 86). Measures included socio-demographics, medical conditions, body mass index, depressive symptoms, handgrip strength, and limitations in activities of daily living. We performed a mixed models estimate for cognitive decline for these groups over a 12-year period. Handgrip strength (HGS) was measured with a handgrip dynamometer and cognitive function was assessed with MMSE.

RESULTS

Participants in the dynapenia-obesity group experienced a greater (β = - 1.29, Standard Error = 0.60, p-value = 0.0316) cognitive decline over time compared to those in the no dynapenia and no obesity group, after controlling for all covariates.

CONCLUSION

Older adults with dynapenic-obesity were at high risk of cognitive decline over time. These findings highlight the need for interventions that target both conditions in this population to help maintain cognitive health. Community-based strength training programs and educational initiatives on nutrition and diet can help older adults reduce their risk of age-related cognitive decline.

Nomogram for predicting intolerable postoperative early enteral nutrition following definitive surgery for small intestinal fistula: a cohort study

BACKGROUND

This study was designed to develop and validate a nomogram for predicting intolerable early enteral nutrition (EEN) following definitive surgery (DS) for small intestinal fistula.

METHODS

A total of 377 patients, recruited from January 2016 to September 2023, was randomly allocated into development ( n =251) and validation ( n =126) groups in a 2:1 ratio. Risk factors were identified using the nomogram. Its performance was assessed based on calibration, discrimination, and clinical utility, with validation confirming its effectiveness.

RESULTS

Of the 377 patients, 87 (23.1%) were intolerant to EEN, including 59 (23.1%) in the development cohort and 28 (22.1%) in the validation cohort ( P =0.84). Four factors were identified as predictive of intolerable EEN: severe abdominal adhesion, deciliter of blood loss during DS, human serum albumin (Alb) input >40 g during and within 48 h post-DS, and the visceral fat area (VFA)/total abdominal muscle area index (TAMAI) ratio. The model demonstrated excellent discrimination, with a C-index of 0.79 (95% CI: 0.74-0.87, including internal validation) and robust calibration. In the validation cohort, the nomogram showed strong discrimination (C-index=0.77; 95% CI: 0.64-0.87) and solid calibration. Decision curve analysis affirmed the nomogram's clinical utility.

CONCLUSION

This research introduces a nomogram that enables the individualized prediction of intolerable EEN following DS for small intestinal fistula, demonstrating a possible clinical utility.

Association between coffee intake and skeletal muscle mass among U.S. adults: a population-based study

Background

A limited number of studies have reported that the possible effects of coffee intake on skeletal muscle mass, but the results have been inconsistently conclusive and there are no large sample studies concerning the U.S. population. Therefore, the purpose of our study was to explore the connection between coffee consumption and skeletal muscle mass in U.S. adults.

Methods

The population for this cross-sectional study was drawn from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018. Appendicular lean mass was accurately obtained from DXA, and skeletal muscle mass was assessed using appendicular skeletal muscle mass adjusted for body mass index (ASMBMI). Coffee and caffeine consumptions were obtained on a 24-h dietary recall questionnaire. Furthermore, the associations between coffee and caffeine intake and skeletal muscle mass were evaluated using three multiple linear regression models and smoothed curve fitting. Subgroup analyses based on age, gender, ethnicity and body mass index (BMI) were performed to assess the robustness of these relationships.

Results

This cross-sectional survey included a total of 8,333 participants. After adjusting for all covariates, higher intake of coffee, caffeinated coffee, and caffeine was associated with elevated ASMBMI (coffee: β = 0.01, 95% CI: 0.01, 0.02, P-value < 0.001; caffeinated coffee: β = 0.01, 95% CI: 0.01, 0.02, P-value < 0.001; caffeine: β = 0.02, 95% CI: 0.01, 0.04, P-value < 0.001). Meanwhile, smoothed curve fitting showed that coffee, caffeinated coffee, and caffeine intake were linearly and positively associated with ASMBMI. After further stratification by sex, age, and ethnicity, the positive relationships between coffee (especially caffeinated coffee) and caffeine intake and ASMBMI were not modified (P for interaction > 0.05). However, these relationships disappeared when the BMI over 30 kg/m2.

Conclusions

In general, consumption of coffee and caffeine is positively associated with skeletal muscle mass. Therefore, an appropriate increase in coffee and caffeine intake may be advocated in populations at high risk for low skeletal muscle mass.

Association between systemic immune-inflammation index and sarcopenic obesity in middle-aged and elderly Chinese adults: a cross-sectional study and mediation analysis

BACKGROUND

Despite the known association between chronic inflammation and reduced muscle mass, there is a gap in research regarding the association between the systemic immune-inflammation index (SII) and sarcopenic obesity (SO). This study aims to assess the relationship between SII and SO in middle-aged and elderly adults and the mediating role of triglyceride-glucose index (TyG).

METHODS

This cross-sectional study involved 2,719 participants aged 45-90 years who underwent health check-ups. SO was evaluated by combining sarcopenia [assessed by handgrip strength and appendicular skeletal muscle index (ASMI)] with obesity (determined by body fat percentage). Association between SII and SO, sarcopenia, and obesity in middle-aged and elderly individuals was examined using multivariable logistic regression, restricted cubic spline analysis, and subgroup analysis. Bidirectional mediation analysis was conducted to determine the direct and indirect effects through SII and TyG.

RESULTS

The study included 2,719 participants, of which 228 had SO (8.4%). SO prevalence increased as the SII quartiles rose (Pfor trend <0.001). SII (per SD increase) had a significantly positive association with SO in both middle-aged individuals (OR = 1.69, 95% CI: 1.43 ~ 1.99) and older adults (OR = 2.52, 95% CI: 1.68 ~ 3.77). The relationship between SII and SO was found to be non-linear (Pnonlinear<0.05). In addition, SII showed a strong negative relationship with both handgrip strength and ASMI across all participants. In subgroup analysis, SII was still shown to significantly increase the risk of SO in all subgroups by gender, body mass index, waist circumference, smoking, drinking, hypertension, diabetes, dyslipidemia. TyG was found to mediate 21.36%, 11.78%, and 9.94% of the associations between SII and SO, sarcopenia, and obesity, respectively. SII had no mediation effect on the association between TyG and SO, sarcopenia, and obesity (P>0.05).

CONCLUSIONS

Elevated levels of SII were associated with an increased risk of SO in middle-aged and elderly adults, especially in the elderly population, and elevated TyG levels played a role in this relationship.

Neural network model for prediction of possible sarcopenic obesity using Korean national fitness award data (2010-2023)

Sarcopenic obesity (SO) is characterized by concomitant sarcopenia and obesity and presents a high risk of disability, morbidity, and mortality among older adults. However, predictions based on sequential neural network SO studies and the relationship between physical fitness factors and SO are lacking. This study aimed to develop a predictive model for SO in older adults by focusing on physical fitness factors. A comprehensive dataset of older Korean adults participating in national fitness programs was analyzed using sequential neural networks. Appendicular skeletal muscle/body weight was defined as SO using an anthropometric equation. Independent variables included body fat (BF, %), waist circumference, systolic and diastolic blood pressure, and various physical fitness factors. The dependent variable was a binary outcome (possible SO vs normal). We analyzed hyperparameter tuning and stratified K-fold validation to optimize a predictive model. The prevalence of SO was significantly higher in women (13.81%) than in men, highlighting sex-specific differences. The optimized neural network model and Shapley Additive Explanations analysis demonstrated a high validation accuracy of 93.1%, with BF% and absolute grip strength emerging as the most influential predictors of SO. This study presents a highly accurate predictive model for SO in older adults, emphasizing the critical roles of BF% and absolute grip strength. We identified BF, absolute grip strength, and sit-and-reach as key SO predictors. Our findings underscore the sex-specific nature of SO and the importance of physical fitness factors in its prediction.

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.

Prevalence of body composition phenotypes and their associations with glycemic, lipidic, and inflammatory biomarkers: a population-based study

We aimed to verify the prevalence of body composition phenotypes and the association of glycemic, lipidic, and inflammatory biomarkers with such phenotypes. This is a cross-sectional, population-based study, with 720 participants aged 20 to 59 years. Body composition was assessed by dual-energy X-ray absorptiometry. Obesity was defined as body fat percentage ≥ 25% in males and ≥ 32% in females and sarcopenia by appendicular muscle mass index < 7.0kg/m2 in males and < 5.5kg/m2 in females. Sarcopenic obesity (SO) was defined as the presence of both sarcopenia and obesity. The prevalence of obesity, sarcopenia, and SO were 62.5%, 4.5%, and 6.2%, respectively. The association between biomarkers and phenotypes was verified using multinomial logistic regression models adjusted for confounding factors. The models showed that increased glycemia (OR = 3.39; 95%CI: 1.83-6.27), total cholesterol (TC) (OR = 2.24; 95%CI: 1.35-3.70), LDL-c (OR = 1.01; 95%CI: 1.00-1.02), VLDL-c (OR = 1.04; 95%CI: 1.02-1.06), non-HDL-c (OR = 1.02; 95%CI: 1.01-1.03), triglycerides (Tg) (OR = 3.66; 95%CI: 2.20-6.06), and decreased HDL-c (OR = 0.97; 95%CI: 0.95-0.98) were significantly associated with the obesity phenotype. Increased HOMA-IR (OR = 3.94; 95%CI: 1.69-9.21), LDL-c (OR = 1.01; 95%CI: 1.00-1.02), non-HDL-c (OR = 1.01; 95%CI: 1.00-1.02), and hs-CRP (OR = 2.42; 95%CI: 1.04-5.66) were independently associated with SO phenotype. Our findings indicate that increased glycemia, TC, Tg, LDL-c, VLDL-c, non-HDL-c, and decreased HDL-c may be indicators of the obesity phenotype and that increased hs-CRP, HOMA-IR, LDL-c, and non-HDL-c appear to be indicators of the SO phenotype. Those parameters may be used as additional markers for screening.

Mapping Knowledge Landscapes and Emerging Trends of Sarcopenic Obesity in Older Adults: A Bibliometric Analysis From 2004 to 2023

Background The prevalence of obesity in combination with sarcopenia, the age-related loss of muscle mass and strength or physical function, is on the rise among adults aged 65 years and older. A significant portion of this demographic now falls under the classification of sarcopenic obesity, a high-risk geriatric syndrome predominantly seen in an aging population vulnerable to compounded complications from both sarcopenia and obesity. It is essential to promptly evaluate the impact of academic research in this field, taking into account factors such as geographical regions, authors, journals, and institutions. Furthermore, exploring current topics and identifying potential areas that could inspire future researchers to conduct additional studies is crucial for advancing overall health in this population. Methodology A search was conducted in the Web of Science Core Collection database to identify English language articles and reviews focusing on sarcopenic obesity in older adults, published between January 1, 2004, and December 31, 2023. Bibliometric analysis was performed using VOSviewer (v.1.6.18) and CiteSpace (v.6.1.R2). Results A total of 985 original English-language articles were collected, consisting of 783 articles and 202 reviews. The volume of research publications in this field has shown significant growth since 2012. The United States leads in contributions, with 239 articles (24.3% of the total) and the highest number of citations at 18,403, along with the highest total link strength. The University of Melbourne in Australia stands out with 25 published articles (2.5% of the total). University of Verona in Italy has the most citations at 9,405, and Monash University in Australia has the highest total link strength at 53. Among prolific authors, John A. Batsis from Duke University is the most productive with 24 articles (2.4% of the total). The journal "Nutrients" has the most articles on sarcopenic obesity in older adults, publishing 54 articles (5.5% of the total). Key topics in this area include sarcopenia, obesity, sarcopenic obesity, and elderly. Recent interventions focus on "nutrition" and "exercise" for sarcopenic obesity in older adults. Conclusions Research on sarcopenic obesity in older adults has seen significant growth on a global scale from 2004 to 2023, indicating a promising area for further study with potential benefits from current advancements. Although academic inquiries have shed light on various aspects of sarcopenic obesity in older adults, there remains a noticeable dearth of clinical research and evidence-based medicine on the effective management of this condition in elderly individuals. Future studies could focus on developing tailored interventions for older adults with sarcopenic obesity.

Multidimensional Assessment of Sarcopenia and Sarcopenic Obesity in Geriatric Patients: Creatinine/Cystatin C Ratio Performs Better than Sarcopenia Index

The serum creatinine/cystatin C ratio (CCR) and the sarcopenia index (SI) are novel indicators for sarcopenia, but their accuracy may depend on various confounders. To assess CCR and SI diagnostic accuracy, we studied the clinical and biophysical parameters associated with sarcopenia or sarcopenic obesity. A total of 79 elderly patients (65-99 yrs, 33 females) underwent clinical, anthropometric, body composition, geriatric performance, and blood chemistry evaluation. The CCR and SI accuracy were assessed to identify sarcopenia. Sarcopenia was confirmed in 40.5%, and sarcopenic obesity in 8.9% of the subjects. Sarcopenic patients showed an increased Charlson comorbidity index, cardiovascular disease (CVD) rates and frailty, and decreased physical performance than non-sarcopenic subjects. Patients with sarcopenic obesity had increased body fat and inflammatory markers compared to obese subjects without sarcopenia. Sarcopenia was associated with a decreased CCR and SI. However, when the logistic regression models were adjusted for possible confounders (i.e., age, gender, Charlson comorbidity index, presence of CVD, and frailty score), a significant OR was confirmed for the CCR (OR 0.021, 95% CI 0.00055-0.83) but not for the SI. The AUC for the CCR for sarcopenia discrimination was 0.72. A higher performance was observed in patients without chronic kidney diseases (CKD, AUC 0.83). CCR, more than the SI, is a useful, non-invasive, and cost-effective tool to predict sarcopenia, irrespective of the potential confounders, particularly in subjects without CKD.

Association of the triglyceride-glucose index and its related parameters with frailty

BACKGROUND

Frailty is a dynamic geriatric condition. Limited studies have examined the association of the triglyceride-glucose (TyG) index and its related indicators [TyG index, triglyceride glucose-waist to height ratio (TyG-WHtR), triglyceride glucose-waist circumference (TyG-WC), and triglyceride glucose-body mass index (TyG-BMI)] with frailty, and the potential links among them remain unclear. On the basis of data from the National Health and Nutrition Examination Survey (NHANES), this study investigated the potential relationships of the TyG index and its related indices with frailty.

METHODS

This research included 7,965 participants from NHANES 2003-2018. The relationship of the TyG index and its related indices with frailty was investigated with binary logistic regression analyses, restricted cubic spline (RCS), and receiver operating characteristic (ROC) curve. Potential influences were further investigated through stratified analyses and interaction tests.

RESULTS

The prevalence of frailty in the participants of this study was 25.59%, with a average frailty index of 0.16 (0.00). In the three regression analysis models, the continuous TyG index and its associated indices were positively associated with frailty. In addition, quartiles of TyG, TyG-WC, TyG-WHtR, and TyG-BMI were significantly associated with increased frailty prevalence in the fully adjusted models (TyG Q4 vs. Q1, OR = 1.58, 95% CI: 1.19, 2.09, P = 0.002; TyG-WC Q4 vs. Q1, OR = 2.40, 95% CI: 1.90, 3.04, P < 0.001; TyG-WHtR Q4 vs. Q1, OR = 2.26, 95% CI: 1.82, 2.81, P < 0.001; TyG- BMI Q4 vs. Q1, OR = 2.16, 95% CI: 1.76, 2.64, P < 0.001). According to RCS analysis, TyG, TyG-WC, TyG-WHtR, and TyG-BMI were linearly and positively associated with frailty. ROC curves revealed that TyG-WHtR (AUC: 0.654) had greater diagnostic value for frailty than TyG (AUC: 0.604), TyG-BMI (AUC: 0.621), and TyG-WC (AUC: 0.629). All of the stratified analyses and interaction tests showed similar results.

CONCLUSIONS

Elevated TyG and its associaed indices are associated with an increased prevalence of frailty. Reasonable control of blood glucose and blood lipids, and avoidance of obesity, may aid in reducing the occurrence of frailty in middle-aged and older adults.

Associations of Dynapenic Abdominal Obesity and Frailty Progression: Evidence from Two Nationwide Cohorts

The associations of dynapenic abdominal obesity and transitions with frailty progression remain unclear among middle-aged and older adults. We included 6937 participants from the China Health and Retirement Longitudinal Study (CHARLS) and 3735 from the English Longitudinal Study of Aging (ELSA). Participants were divided into non-dynapenia and non-abdominal obesity (ND/NAO), abdominal obesity alone (AO), dynapenia alone (D), and dynapenic abdominal obesity (D/AO). Frailty status was assessed by the frailty index (FI), and a linear mixed-effect model was employed to analyze the associations of D, AO, D/AO, and transitions with frailty progression. Participants with AO, D, and D/AO had increased FI progression compared with ND/NAO in both cohorts. D/AO possessed the greatest additional annual FI increase of 0.383 (95% CI: 0.152 to 0.614), followed by D and AO in the CHARLS. Participants with D in the ELSA had the greatest magnitude of accelerated FI progression. Participants who transitioned from ND/NAO to D and from AO to D/AO presented accelerated FI progression in the CHARLS and ELSA. In conclusion, dynapenic abdominal obesity, especially for D/AO and D, presented accelerated frailty progression. Our findings highlighted the essential intervention targets of dynapenia and abdominal obesity for the prevention of frailty progression.

Sarcopenic obesity does not impair lower limb strength and physical performance in sufficiently active older adults: a cross-sectional study

This study investigated the associations of sarcopenic obesity (SO) with muscle strength and physical performance in sufficiently active older adults. Data from 72 older sarcopenic obese adults classified as sufficiently active were analyzed. Participants were categorized into four groups based on sex and SO status. Muscle strength/physical performance tests were compared using independent sample t-tests. Multiple linear regression and binary logistic regression were performed to examine the associations between SO and muscle strength and physical performance, adjusting for confounding variables. Only handgrip strength showed differences between SO groups, regardless of sex (p < 0.05). SO negatively explained the variability of handgrip strength (p < 0.05). An increase in handgrip strength values was associated with a decrease in the chances of older adults being classified as SO (p < 0.05). The findings suggest that even with SO, sufficiently active older adults did not present a significant reduction in muscle strength in the lower limbs and physical performance.

Immunogenetic Aspects of Sarcopenic Obesity

Sarcopenic obesity (SO) is a combination of obesity and sarcopenia, with diagnostic criteria defined as impaired skeletal muscle function and altered body composition (e.g., increased fat mass and reduced muscle mass). The mechanism of SO is not yet perfectly understood; however, the pathogenesis includes aging and its complications, chronic inflammation, insulin resistance (IR), and hormonal changes. Genetic background is apparent in the pathogenesis of isolated obesity, which is most often polygenic and is characterized by the additive effect of various genetic factors. The genetic etiology has not been strictly established in SO. Still, many data confirm the existence of pathogenic gene variants, e.g., Fat Mass and Obesity Associated Gene (FTO), beta-2-adrenergic receptor (ADRB2) gene, melanocortin-4 receptor (MC4R) and others with obesity. The literature on the role of these genes is scarce, and their role has not yet been thoroughly established. On the other hand, the involvement of systemic inflammation due to increased adipose tissue in SO plays a significant role in its pathophysiology through the synthesis of various cytokines such as monocyte chemoattractant protein-1 (MCP-1), IL-1Ra, IL-15, adiponectin or CRP. The lack of anti-inflammatory cytokine (e.g., IL-15) can increase SO risk, but further studies are needed to evaluate the exact mechanisms of implications of various cytokines in SO individuals. This manuscript analyses various immunogenetic and non-genetic factors and summarizes the recent findings on immunogenetics potentially impacting SO development.

Phenotyping obesity: A focus on metabolically healthy obesity and metabolically unhealthy normal weight

Over the past 4 decades, research has shown that having a normal body weight does not automatically imply preserved metabolic health and a considerable number of lean individuals harbour metabolic abnormalities typically associated with obesity. Conversely, excess adiposity does not always equate with an abnormal metabolic profile. In fact, evidence exists for the presence of a metabolically unhealthy normal weight (MUHNW) and a metabolically healthy obese (MHO) phenotype. It has become increasingly recognised that different fat depots exert different effects on the metabolic profile of each individual by virtue of their location, structure and function, giving rise to these different body composition phenotypes. Furthermore, other factors have been implicated in the aetiopathogenesis of the body composition phenotypes, including genetics, ethnicity, age and lifestyle/behavioural factors. Even though to date both MHO and MUHNW have been widely investigated and documented in the literature, studies report different outcomes on long-term cardiometabolic morbidity and mortality. Future large-scale, observational and population-based studies are required for better profiling of these phenotypes as well as to further elucidate the pathophysiological role of the adipocyte in the onset of metabolic disorders to allow for better risk stratification and a personalised treatment paradigm.

Landscape and research trends of sarcopenic obesity research: A bibliometric analysis

Background

Sarcopenic obesity (SO) is a condition characterized by the coexistence of sarcopenia (loss of muscle mass and function) and obesity. This condition has emerged as a public health concern, particularly with the aging population. Despite an approximately 30-year history of SO research, detailed quantitative analysis of existing research was never undertaken. We aimed to depict the landscape of SO research using bibliometric analysis of literature.

Methods

We searched the Web of Science Core Collection on January 15, 2023. The following bibliometric indicators were included: publication trend, the most influential country, the most active discipline, productive institutions, productive journals, prolific and highly cited authors, and highly cited publications. We constructed co-authorship network to explore individual-level, institutional-level, and international-level collaborative patterns in the VOSviewer or Sci2 software. Furthermore, keywords co-occurrence network was extracted by the VOSviewer software, and the burst-detection analysis of keywords was performed using the CiteSpace software.

Results

A total of 2023 original articles were retrieved for data analysis. The publications increased dramatically in the last decade. The United States had the highest number of publications on SO (n = 904). The Seoul National University Hospital was the most prolific institution (n = 54) among the 2675 institutions analyzed. As for journals, Clinical Nutrition had the highest number of publications on SO (n = 75). Kim JH was the most prolific author (n = 25), while Cederholm T authored the most cited publication (9381 citations). More than 80 disciplines were involved in SO research, of which, "Geriatrics and Gerontology" was the most activated discipline. The European Working Group on Sarcopenia in Older People (EWGSOP) consensus was the most cited publication (7209 citations). Moreover, the hotspots of SO have been shifting from its biology, prevalence, and risk factors to its outcomes, prognostic factors, complications, and quality of life. Its relationships also evolved from being between SO and aging to being between SO and other diseases.

Conclusions

Our study provided a comprehensive landscape of SO research, which may help researchers better identify key information and research trends in this field.

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.

Dynapenic Abdominal Obesity, Single and Recurrent Falls in Older Brazilian Adults: Elsi-Brazil Results

Objective: Cross-sectional study to verify the association between dynapenic abdominal obesity and the occurrence of single and recurrent falls among Brazilian adults aged 50 years and over. Methods: Baseline data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), comprising 8374 individuals aged 50 years and over, were analyzed. Participants were categorized according to the report of falls, dynapenic abdominal obesity was determined by combining the presence of abdominal obesity (waist circumference) and dynapenia (handgrip strength). A multinomial regression adjusted for multiple variables was conducted. Results: The prevalence of a fall was 10.4% (95% CI: 9.7-11.2) and 10.8% for single and recurrent (95% CI: 9.9-11.9). Dynapenic abdominal obesity was associated with a single fall (OR: 1.3; 95% CI 1.1-1.7) and showed greater strength of association with recurrent falls (OR: 2.8; 95% CI 2.1-3.8). Conclusions: Our data showed that the coexistence of abdominal obesity and dynapenia in older adults creates additional challenges for aging.

Age-Related Study of Anthropometry Indicators, Body Composition, Strength and Vital Capacity at Masters Athletics: How to Postpone Sarcopenia

Purpose

The purpose of this study was to compare the anthropometric indicators of sports veterans, former athletes who stopped training, and non-sports people aged 40 years and older to assess the impact of regular sports on the stability of the body.

Patients and Methods

100 athletes and 31 people non-sports were included in the study. Athletes were divided into two groups depending on the mode of motor activity. The first group (n=75) continued their regular sports activities. The second group (n=25) stopped training. Height, weight, chest circumference, mobility, waist, shoulder circumference, forearm, hip, ankle, fat mass, and muscle mass were measured, and dynamometry was performed.

Results

Body weight is statistically significantly (p<0.05) less in those who continue sports (70.7±10.2) classes after 60 years compared with the control group (82.4±9.3). In sports veterans, the chest excursion and the shoulder circumference is statistically significantly (p<0.05) greater than in the control group. In the subjects of the first group aged from 40 to 49 (4551±612) and from 50 to 59 (4242±416), the FVC index was statistically significantly (p<0.05) higher than in the control group (3890±344 and 3786±401, respectively). The body composition of veterans is characterized by a high level of muscle mass and a low level of fat mass. At the age of 40-49, the percentage of muscle tissue in sports veterans was statistically significantly higher (46.32±2.74) (p<0.05) than in the group of athletes who stopped sports activities (44.09±5.29).

Conclusion

Veterans of sports demonstrate higher indicators of limb girth and muscle strength compared to untrained people of the same age. In addition, sports veterans have a lower content of adipose tissue and a greater expression of muscle mass. Thus, the data obtained by us show that sports prevent the development of sarcopenia and can also affect cardiovascular risk.

Association between dietary antioxidant and fatty acids and low muscle mass in obese and non-obese community-dwelling older adults: An NHANES analysis

Sarcopenia increases disability, hospital stays, readmissions, and mortality in older adults. Antioxidative nutrients and fatty acids consumption may help maintain muscle mass by reducing oxidative stress. This study aims to assess the association between antioxidant and fatty acid intake and low muscle mass in community-dwelling older people. This retrospective analysis used data from the National Health and Nutrition Examination Survey from 1999 to 2004. Participants ≥ 60 years with information on muscle mass measured by Dual energy X-ray absorptiometry (DXA) were included. Appendicular skeletal muscle mass was assessed. Associations between antioxidants and fatty acids intake, and low muscle mass were evaluated using logistic regressions. 3648 (1748 men and 1900 women) were included. The prevalence of low muscle mass was 41% and 26% among men and women ≥ 75 years, and 45.2% and 28.4% among obese men and women. In obese males, a natural-log-unit increase of vitamin A (aOR = 0.806, 95% CI: 0.652-0.996), vitamin C (aOR = 0.878, 95% CI: 0.779-0.990), selenium intake (aOR = 0.716, 95% CI: 0.517-0.993), and higher saturated fatty acids (aOR = 0.956, 95% CI: 0.915-0.998) and monounsaturated fatty acids (aOR = 0.959, 95% CI: 0.925-0.994) intake were associated with decreased odds for low muscle mass. Among obese females, a natural-log-unit increase of vitamin E (P = .036), vitamin B12 (P = .014), total folate (P = .015), zinc (P = .005), and selenium intake (P = .018) were associated with increased odds of low muscle mass, whereas higher saturated fatty acids (P < .001), monounsaturated fatty acids (P = .001), and polyunsaturated fatty acids intake (P = .006) were associated with decreased odds for low muscle mass. Antioxidants (vitamin A, C, E, B6, B12, total folate, zinc, magnesium, selenium) intake does not consistently relate to low muscle mass across age and sex. Higher intake of saturated, monounsaturated, and polyunsaturated fatty acids are independently associated with reduced likelihood of low muscle mass in both obese older men and women.

The mediatory role of inflammatory markers on the relationship between the NOVA classification system and obesity phenotypes among obese and overweight adult women: a cross-sectional study

Background

Diet and inflammation both play important roles in the occurrence of obesity. We aimed to investigate the role of inflammation in the development of both metabolically healthy obese (MHO) and metabolically unhealthy obese (MUHO) individuals.

Methods

This cross-sectional study included 221 overweight and obese women aged 18-56 years. The study assessed the metabolic health phenotypes of the participants using the Karelis criterion score. Additionally, dietary intakes were evaluated using a 147-item semi-quantitative questionnaire and the NOVA classification system (comprising 37 food groups and beverages). The study also collected and analyzed the blood parameters, as well as biochemical and anthropometric indices, for all participants.

Results

Among the women included in the study, 22.9% had MHO phenotypes but 77.1% had MUHO phenotypes. A significant association between the third quartile of the NOVA classification system and the increased likelihood of having the MUHO phenotype was observed (OR = 1.40, 95% CI = 1.09-4.92, p = 0.04). Regarding the potential role of inflammatory markers, high-sensitivity C-reactive protein (hs-CRP) (p = 0.84), transforming growth factor-β (TGF-β) (p = 0.50), monocyte chemoattractant protein-1 (MCP-1) (p = 0.49), plasminogen activator inhibitor-1 (PAI-1) (p = 0.97), and homeostatic model assessment for insulin resistance (HOMA-IR) (p = 0.92) were found to be mediators.

Conclusion

We observed a significant positive association between ultra-processed food (UPF) consumption and the MUHO phenotype in overweight and obese women. This association appeared to be mediated by some inflammatory markers, such as hs-CRP, TGF-β, MCP-1, PAI-1, and HOMA-IR. Additional studies are needed to validate these findings.

The association of lipid metabolism with bone metabolism and the role of human traits: a Mendelian randomization study

Background

The impact of lipid metabolism on bone metabolism remains controversial, and the extent to which human traits mediate the effects of lipid metabolism on bone metabolism remains unclear.

Objective

This study utilized mendelian randomization to investigate the effects of blood lipids on bone mineral density (BMD) at various skeletal sites and examined the mediating role of human traits in this process.

Methods

We leveraged genetic data from large-scale genome-wide association studies on blood lipids (n=1,320,016), forearm bone mineral density (FA-BMD) (n=10,805), lumbar spine bone mineral density (LS-BMD) (n=44,731), and femoral neck bone mineral density (FN-BMD) (n=49,988) to infer causal relationships between lipid and bone metabolism. The coefficient product method was employed to calculate the indirect effects of human traits and the proportion of mediating effects.

Results

The results showed that a 1 standard deviation(SD) increase in HDL-C, LDL-C and TC was associated with a decrease in LS-BMD of 0.039 g/cm2, 0.045 g/cm2 and 0.054 g/cm2, respectively. The proportion of mediating effects of systolic blood pressure (SBP) on HDL-C to LS-BMD was 3.17%, but suppression effects occurred in the causal relationship of LDL-C and TC to LS-BMD. Additionally, the proportion of mediating effects of hand grip strength (HGS) on the TC to LS-BMD pathway were 6.90% and 4.60% for the left and right hands, respectively.

Conclusion

In conclusion, a negative causal relationship was established between lipid metabolism and bone metabolism. Our results indicated that SBP and HGS served as mediators for the effects of lipid metabolism on bone metabolism.

High visceral fat-to-muscle ratio predicated a recurrent fistula after definitive surgery for a small intestinal fistula with diffuse extensive abdominal adhesions: a cohort study

BACKGROUND

In patients diagnosed with sarcopenia, the presence of chronic preoperative inflammation, assessed by the ratio of the visceral fat area (VFA) to the total abdominal muscle area index (TAMAI) (VFA/TAMAI), has been found to adversely affect wound healing. An elevated VFA/TAMAI may contribute to a higher incidence of postoperative recurrent fistulas (RFs) following definitive surgery (DS) for small intestinal fistulas accompanied by diffuse extensive abdominal adhesions. The objective of this study was to evaluate the predictive value of VFA/TAMAI for postoperative RFs.

METHODS

The study enrolled 183 sarcopenic patients, with a median age of 51 years [interquartile range (IQR): 38-61 years), a median body mass index of 19.6 kg/m 2 (IQR: 18.9-21.0 kg/m 2 ) who underwent DS for small intestinal fistulas between January 2018 and October 2022 were included in the multicenter study. The outcomes assessed were RFs and postoperative length of stay (LOS). VFA/TAMAI was examined as a potential risk factor for each outcome.

RESULTS

Out of the 183 patients, 20.2% ( n =37) developed RFs. The multivariate regression analysis identified VFA/TAMAI as the sole factor associated with RFs [odds ratio=1.78, 95% confidence interval (CI): 1.09-2.87, P =0.02]. The multivariable Cox regression analysis demonstrated that an elevated VFA/TAMAI was linked to a reduced postoperative LOS (hazard ratio=0.69, 95% CI: 0.59-0.81, P <0.001).

CONCLUSION

In sarcopenic patients, a high VFA/TAMAI predicated the occurrence of RFs after DS for small intestinal fistulas in the presence of diffuse extensive abdominal adhesions.

A Korean Nationwide Cross-Sectional Study Investigating Risk Factors, Prevalence, and Characteristics of Sarcopenia in Men in Early Old Age

The present study investigated the risk factors, prevalence, and characteristics of sarcopenia among men aged 50-64 years. A total of 2868 participants were enrolled in this study. Of these, 328 individuals were classified into a sarcopenia group; the remaining 2540 were assigned to a control group. This study examined several variables, including skeletal muscle mass index, age, height, weight, body mass index, waist circumference, systolic and diastolic blood pressure, fasting glucose, triglyceride and total cholesterol levels, alcohol consumption, and tobacco use. It employed a stratified, clustered, and multistage probability sampling design. Complex sampling was used for the data analysis. The prevalence of sarcopenia was 10.25% (95% CI: 8.98-11.69). All anthropometric measures, including height, weight, BMI, and waist circumference, were significantly different between the two groups (p < 0.05). In terms of blood pressure, only systolic blood pressure (SBP) was significant (p < 0.05), and fasting glucose and triglyceride levels were risk factors for sarcopenia (p < 0.05). Tobacco use differed significantly between the two groups (p < 0.05). This study reported the specific prevalence of sarcopenia and identified its risk factors among men in early old age.

Lower skeletal muscle mass is associated with diabetes and insulin resistance: A cross-sectional study

AIMS

The association between skeletal muscle mass and diabetes incidence/insulin resistance/glycated hemoglobin (HbA1C) is unknown. The aim of this study was to investigate such association in clinically apparently healthy males and females.

METHODS

A cross-sectional study of 372,399 Korean males and females who completed bioelectrical impedance analysis (BIA) in a health-screening programme was performed. Skeletal muscle index was used as an indicator of skeletal muscle mass. Skeletal muscle index (%) [appendicular skeletal muscle mass (kg)/body weight (kg)X100] was estimated using BIA. The study outcomes were diabetes incidence, homoeostasis model assessment of insulin resistance (HOMA-IR), and HbA1C.

RESULTS

The mean age of study participants was 38.92 ± 8.54 years. Multiple logistic regression analysis revealed a significant negative association between Skeletal muscle index and diabetes incidence/HOMA-IR/HbA1C after adjusting for various confounding factors. Odds ratios (95% confidence interval (CI)) of diabetes incidence in Q2, Q3, and Q4 compared to the lowest quantile (Q1) were 0.95 (0.85-1.05), 0.88 (0.78-0.99), and 0.79 (0.69-0.9), respectively. Beta coefficients (95% CI) of HOMA-IR in Q2, Q3, and Q3 with Q1 were 0.05 (0.03-0.07), -0.06 (-0.09∼-0.04), and -0.19 (-0.22∼-0.16), respectively. Beta coefficients (95% CI) of HbA1C in Q2, Q3, and Q4 with Q1 were 0.02 (0.01-0.03), -0.001 (-0.01∼0.01), and -0.02 (-0.03∼-0.01), respectively.

CONCLUSIONS

This study demonstrated negative associations of skeletal muscle mass with diabetes incidence, insulin resistance, and HbA1C levels in healthy adults.

Adiposity is associated with widespread transcriptional changes and downregulation of longevity pathways in aged skeletal muscle

BACKGROUND

Amongst healthy older people, a number of correlates of impaired skeletal muscle mass and function have been defined. Although the prevalence of obesity is increasing markedly in this age group, information is sparse about the particular impacts of obesity on ageing skeletal muscle or the molecular mechanisms that underlie this and associated disease risk.

METHODS

Here, we examined genome-wide transcriptional changes using RNA sequencing in muscle biopsies from 40 older community-dwelling men from the Hertfordshire Sarcopenia Study with regard to obesity (body mass index [BMI] >30 kg/m2 , n = 7), overweight (BMI 25-30, n = 19), normal weight (BMI < 25, n = 14), and per cent and total fat mass. In addition, we used EPIC DNA methylation array data to investigate correlations between DNA methylation and gene expression in aged skeletal muscle tissue and investigated the relationship between genes within altered regulatory pathways and muscle histological parameters.

RESULTS

Individuals with obesity demonstrated a prominent modified transcriptional signature in muscle tissue, with a total of 542 differentially expressed genes associated with obesity (false discovery rate ≤0.05), of which 425 genes were upregulated when compared with normal weight. Upregulated genes were enriched in immune response (P = 3.18 × 10-41 ) and inflammation (leucocyte activation, P = 1.47 × 10-41 ; tumour necrosis factor, P = 2.75 × 10-15 ) signalling pathways and downregulated genes enriched in longevity (P = 1.5 × 10-3 ) and AMP-activated protein kinase (AMPK) (P = 4.5 × 10-3 ) signalling pathways. Furthermore, differentially expressed genes in both longevity and AMPK signalling pathways were associated with a change in DNA methylation, with a total of 256 and 360 significant cytosine-phosphate-guanine-gene correlations identified, respectively. Similar changes in the muscle transcriptome were observed with respect to per cent fat mass and total fat mass. Obesity was further associated with a significant increase in type II fast-fibre area (P = 0.026), of which key regulatory genes within both longevity and AMPK pathways were significantly associated.

CONCLUSIONS

We provide for the first time a global transcriptomic profile of skeletal muscle in older people with and without obesity, demonstrating modulation of key genes and pathways implicated in the regulation of muscle function, changes in DNA methylation associated with such pathways and associations between genes within the modified pathways implicated in muscle regulation and changes in muscle fibre type.

Higher abdominal adiposity is associated with higher lean muscle mass but lower muscle quality in middle-aged and older men and women: the Framingham Heart Study

BACKGROUND

The objective was to determine if abdominal fat is related to poor muscle health.

METHODS

This cross-sectional study included 428 males and 534 females with appendicular lean mass (ALM, kg) from dual-energy X-ray absorptiometry (DXA), grip strength (kg), and upper extremity muscle "quality" (grip strength/arm lean mass) measured (1996-2001) in the Framingham Offspring Study. Sex-specific linear regressions associated adiposity measures [waist circumference (WC, cm) and visceral adipose tissue (VAT, cm3), and subcutaneous adipose tissue (SAT, cm3)] as Z-scores with each measure of muscle, adjusting for covariates. Models were further stratified by body mass index (BMI, < 30, ≥ 30 kg/m2).

RESULTS

Mean (± SD) age was 60 ± 9 years and BMI was 28.9 ± 4.6 kg/m2 (men) and 27.7 ± 5.8 kg/m2, (women). In men, the BMI-stratified analyses showed higher WC was associated with higher ALM (P < 0.0001 each) but with lower muscle quality (P < 0.02) in both BMI groups. Higher SAT was also associated with higher ALM (P = 0.0002) and lower muscle quality (P = 0.0002) in men with BMI < 30, but not in obese men. In women, higher WC, SAT, and VAT were each associated with higher ALM but lower muscle quality, particularly in obese women. Higher SAT (P = 0.05) and VAT (P = 0.04) were associated with higher quadriceps strength in women with BMI < 30 kg/m2 but not in obese women.

CONCLUSIONS

Higher abdominal fat may be associated with greater lean mass but poorer muscle quality, particularly in obese women. This suggests that adipose tissue may have endocrine influences on muscle, which should be confirmed in longitudinal studies.

Muscle Traits, Sarcopenia, and Sarcopenic Obesity: A Vitamin D Mendelian Randomization Study

(1) Background: Observational studies associate vitamin D deficiency with muscle disorders, while some clinical trial data support a minor association between the vitamin and skeletal muscle performance in healthy subjects. Vitamin D receptor knockout mice studies confirm the relationship between vitamin D and skeletal muscle; however, causal inference in humans is challenging due to the ethical implications of including vitamin D-deficient participants in randomized trials. This study uses genetic methods to safely explore causal underpinnings for the relationship between 25(OH)D concentrations and skeletal muscle-related traits, including grip strength and combined arm skeletal muscle mass, and extends this analysis to suspected pathophysiology in the form of probable sarcopenia and sarcopenic obesity. (2) Methods: We conducted Mendelian randomization (MR) analyses in up to 307,281 participants from the UK Biobank of whom 25,414 had probable sarcopenia and 16,520 had sarcopenic obesity. In total, 35 variants were used to instrument 25(OH)D and MR analyses conducted using multiple approaches. (3) Results: Genetic analyses provided support for a relationship between genetically predicted higher 25(OH)D and skeletal muscle traits, with linear MR analyses for grip strength showing 0.11 kg (95% CI 0.04, 0.19) greater contractile force per 10 unit higher 25(OH)D, while there was a modest association with skeletal muscle mass (0.01 kg (95% CI 0.003, 0.02) greater muscle mass). For probable sarcopenia risk, there was suggestive evidence for lower odds by higher 25(OH)D (OR 0.96 (95% CI 0.92, 1.00)); however, this did not reflect an association with sarcopenic obesity (OR 0.97 (95% CI 0.93, 1.02)), but was seen in probable sarcopenia cases who were not obese (OR 0.92 (95% CI 0.86, 0.98)). Results were similar across multiple MR approaches. (4) Conclusions: Our study supports a causal relationship between 25(OH)D and skeletal muscle health. While evidence for benefit did not extend to lower risk of sarcopenic obesity, effective vitamin D-deficiency prevention strategies may help reduce age-related muscle weakness.

Effects of whey and soy protein supplementation on inflammatory cytokines in older adults: a systematic review and meta-analysis

BACKGROUND AND AIMS

Low-grade inflammation is a mediator of muscle proteostasis. This study aimed to investigate the effects of isolated whey and soy proteins on inflammatory markers.

METHODS

We conducted a systematic literature search of randomised controlled trials (RCT) through MEDLINE, Web of Science, Scopus and Cochrane Library databases from inception until September 2021. To determine the effectiveness of isolated proteins on circulating levels of C-reactive protein (CRP), IL-6 and TNF-α, a meta-analysis using a random-effects model was used to calculate the pooled effects (CRD42021252603).

RESULTS

Thirty-one RCT met the inclusion criteria and were included in the systematic review and meta-analysis. A significant reduction of circulating IL-6 levels following whey protein [Mean Difference (MD): -0·79, 95 % CI: -1·15, -0·42, I² = 96 %] and TNF-α levels following soy protein supplementation (MD: -0·16, 95 % CI: -0·26, -0·05, I² = 68 %) was observed. The addition of soy isoflavones exerted a further decline in circulating TNF-α levels (MD: -0·20, 95 % CI: -0·31, -0·08, I² = 34 %). According to subgroup analysis, whey protein led to a statistically significant decrease in circulating IL-6 levels in individuals with sarcopenia and pre-frailty (MD: -0·98, 95 % CI: -1·56, -0·39, I² = 0 %). These findings may be dependent on participant characteristics and treatment duration.

CONCLUSIONS

These data support that whey and soy protein supplementation elicit anti-inflammatory effects by reducing circulating IL-6 and TNF-α levels, respectively. This effect may be enhanced by soy isoflavones and may be more prominent in individuals with sarcopenia.

Assessment of existing anthropometric indices for screening sarcopenic obesity in older adults

Sarcopenic obesity is defined as the presence of high fat mass and low muscle mass combined with low physical function, and it is closely related with the onset of cardiovasular diseases (CVD). The existing anthropometric indices, which are being utilised in clinical practice as predictors of CVD, may also be used to screen sarcopenic obesity, but their feasibility remained unknown. Using cross-sectional data of 2031 participants aged 70-84 years (mean age, 75·9 ± 3·9 years; 49·2 % women) from the Korean Frailty and Aging Cohort Study, we analysed the association of anthropometric indices, including body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and weight-adjusted waist index (WWI) with sarcopenic obesity. Body composition was measured using dual-energy X-ray absorptiometry. Higher WWI, WHtR and WC quartiles were associated with higher risk of sarcopenic obesity; the odds ratio (OR) of sarcopenic obesity were highest in the fourth quartile of the WWI (OR: 10·99, 95 % CI: 4·92-24·85, P_{for trend} < 0·001). WWI provided the best diagnostic power for sarcopenic obesity in men (area under the receiver operating characteristic curve: 0·781, 95 % CI: 0·751-0·837). No anthropometric indices were significantly associated with sarcopenic obesity in women. WWI was the only index that was negatively correlated with physical function in both men and women. WWI showed the strongest association with sarcopenic obesity, defined by high fat mass and low muscle mass combined with low physical function only in older men. No anthropometric indices were associated with sarcopenic obesity in older women.

Aging, Physical Exercise, Telomeres, and Sarcopenia: A Narrative Review

Human aging is a gradual and adaptive process characterized by a decrease in the homeostatic response, leading to biochemical and molecular changes that are driven by hallmarks of aging, such as oxidative stress (OxS), chronic inflammation, and telomere shortening. One of the diseases associated with the hallmarks of aging, which has a great impact on functionality and quality of life, is sarcopenia. However, the relationship between telomere length, sarcopenia, and age-related mortality has not been extensively studied. Moderate physical exercise has been shown to have a positive effect on sarcopenia, decreasing OxS and inflammation, and inducing protective effects on telomeric DNA. This results in decreased DNA strand breaks, reduced OxS and IA, and activation of repair pathways. Higher levels of physical activity are associated with an apparent increase in telomere length. This review aims to present the current state of the art of knowledge on the effect of physical exercise on telomeric maintenance and activation of repair mechanisms in sarcopenia.

Acceptability of a high-protein Mediterranean-style diet and resistance exercise protocol for cardiac rehabilitation patients: Involving service users in intervention design using a mixed-methods participatory approach

Background

Current cardiac rehabilitation (CR) practices focus on aerobic-style exercise with minimal nutrition advice. This approach may not be optimal for CR patients with reduced muscle mass and elevated fat mass. Higher protein, Mediterranean-style diets combined with resistance exercise (RE) may improve muscle mass and reduce the risk of future cardiovascular events, although such an approach is yet to be trialed in a CR population.

Objective

We explored patient perspectives on the proposed design of a feasibility study. Patients reflected on the acceptability of a proposed high-protein Mediterranean-style diet and RE protocol, emphasizing research methodology and the acceptability of the proposed recipes and exercises.

Design

We applied quantitative and qualitative (mixed methods) approaches. The quantitative approach involved an online questionnaire (n = 40) regarding the proposed study methodology and relevance. A subset of participants (n = 12) received proposed recipe guides and were asked to prepare several dishes and complete an online questionnaire regarding their experience. Another subset (n = 18) received links to videos of the proposed RE and completed a questionnaire regarding their impressions of them. Finally, semi-structured interviews (n = 7) were carried out to explore participants' impressions of the proposed diet and exercise intervention.

Results

Quantitative data indicated a high level of understanding of the intervention protocol and its importance within the context of this research. There was a high degree of willingness to participate in all aspects of the proposed study (>90%). The trialed recipes were enjoyed and found to be easy to make by a majority of participants (79 and 92.1%, respectively). For the proposed exercises 96.5% of responses agreed they would be willing to perform them and, 75.8% of responses agreed they would enjoy them. Qualitative analysis revealed that participants viewed the research proposal, diet, and exercise protocol in a positive light. The research materials were considered appropriate and well explained. Participants suggested practical recommendations for improving recipe guides and requested more individual-focused exercise recommendations, and more information on the specific health benefits of the diet and exercise protocols.

Conclusion

The study methodology and the specific dietary intervention and exercise protocol were found to be generally acceptable with some suggested refinements.

Fermented Foods in the Management of Obesity: Mechanisms of Action and Future Challenges

Fermented foods are part of the staple diet in many different countries and populations and contain various probiotic microorganisms and non-digestible prebiotics. Fermentation is the process of breaking down sugars by bacteria and yeast species; it not only enhances food preservation but can also increase the number of beneficial gut bacteria. Regular consumption of fermented foods has been associated with a variety of health benefits (although some health risks also exist), including improved digestion, enhanced immunity, and greater weight loss, suggesting that fermented foods have the potential to help in the design of effective nutritional therapeutic approaches for obesity. In this article, we provide a comprehensive overview of the health effects of fermented foods and the corresponding mechanisms of action in obesity and obesity-related metabolic abnormalities.

Intake of omega-3 polyunsaturated fatty acids and fish associated with prevalence of low lean mass and muscle mass among older women: Analysis of Korea National Health and Nutrition Examination Survey, 2008-2011

The effects of dietary n-3 PUFA and fish on the risk of sarcopenia and muscle mass remain unclear. The present study investigated the hypothesis that intake of n-3 PUFA and fish is negatively associated with the prevalence of low lean mass (LLM) and positively correlated with muscle mass in older adults. Data from the Korea National Health and Nutrition Examination Survey, 2008-2011, 1,620 men and 2,192 women aged over 65 years were analyzed. LLM was defined as appendicular skeletal muscle mass divided by body mass index < 0.789 kg for men and <0.512 kg for women. Women and men with LLM consumed less eicosapentaenoic acid (EPA) docosahexaenoic acid (DHA) and fish. In women, but not men, the prevalence of LLM was associated with the intake of EPA and DHA (odds ratio, 0.65; 95% confidence interval, 0.48-0.90; p = 0.002) and fish (odds ratio, 0.59; 95% confidence interval, 0.42-0.82; p < 0.001). Muscle mass was also positively associated with the intake of EPA, DHA (p = 0.026), and fish (p = 0.005) in women, but not men. α-Linolenic acid intake was not associated with the prevalence of LLM and was not correlated with muscle mass. The findings suggest that consumption of EPA, DHA, and fish are negatively associated with the prevalence of LLM, and positively correlated with muscle mass in Korean older women, but not in older men.

Ageing of skeletal muscle extracellular matrix and mitochondria: finding a potential link

Aim: To discuss the progress of extracellular matrix (ECM) characteristics, mitochondrial homeostasis, and their potential crosstalk in the pathogenesis of sarcopenia, a geriatric syndrome characterized by a generalized and progressive reduction in muscle mass, strength, and physical performance.Methods: This review focuses on the anatomy and physiology of skeletal muscle, alterations of ECM and mitochondria during ageing, and the role of the interplay between ECM and mitochondria in the pathogenesis of sarcopenia.Results: Emerging evidence points to a clear interplay between mitochondria and ECM in various tissues and organs. Under the ageing process, the ECM undergoes changes in composition and physical properties that may mediate mitochondrial changes via the systematic metabolism, ROS, SPARC pathway, and AMPK/PGC-1α signalling, which in turn exacerbate muscle degeneration. However, the precise effects of such crosstalk on the pathobiology of ageing, particularly in skeletal muscle, have not yet been fully understood.Conclusion: The changes in skeletal muscle ECM and mitochondria are partially responsible for the worsened muscle function during the ageing process. A deeper understanding of their alterations and interactions in sarcopenic patients can help prevent sarcopenia and improve its prognoses.

Skeletal Muscle and Fat Mass Reflect Chronic Pain in Older Adult

Objectives: The prevalence of chronic pain increases with age. It has been reported that chronic pain is associated with sarcopenia and obesity. Age-related skeletal muscle loss and fat gain are known to occur due to chronic inflammation. The aim of this study was to analyze how skeletal muscle and fat, caused by chronic inflammation due to aging, regulate the development of geriatric chronic pain. Methods: The results of skeletal muscle and fat mass, 412 participants aged ≥65 years with non-specific chronic pain lasting ≥6 months, including low back, neck, and knee pain, was compared with the control without chronic pain. Body composition threshold regulating chronic pain was calculated. Results: A significantly lower skeletal muscle mass index and higher body fat percentage were observed in patients with chronic pain than that in the control. The muscle fat ratio (MFR) was significantly lower in the chronic pain group than in the control group. When the MFR threshold related to chronic pain was calculated by sex, it was 2.984 for men and 1.867 for women. Conclusions: Evaluation of the body composition of elderly patients with non-specific chronic pain revealed that the MFR was useful as an index related to chronic pain.