The Association Between Sarcopenic Obesity and Hypertension, Diabetes, and Abnormal Lipid Metabolism in Chinese Adults

Type 2 diabetes: is obesity for diabetic retinopathy good or bad? A cross-sectional study

BACKGROUND

The relationship between obesity and diabetic retinopathy (DR) remains controversial, and the relationship between sarcopenic obesity and DR is still unclear. The purpose of this study is to investigate the relationship between obesity, sarcopenic obesity, and DR in patients with type 2 diabetes mellitus (T2DM).

METHODS

A cross-sectional study was conducted on patients with T2DM. Obesity was assessed by body mass index (BMI), fat mass index (FMI), android fat mass, gynoid fat mass, and visceral adipose tissue (VAT) mass. Sarcopenia was defined according to the criteria of Consensus of the Asian Working Group for Sarcopenia (AWGS 2019). Sarcopenic obesity was defined as the coexistence of sarcopenia and obesity. The association between obesity, sarcopenic obesity, and DR was examined using univariable and multivariable logistic regression models.

RESULTS

A total of 367 patients with T2DM (mean age 58.3 years; 57.6% male) were involved in this study. The prevalence of DR was 28.3%. In total patients, significant adverse relationships between obesity and DR were observed when obesity was assessed by BMI (adjusted odds ratio [aOR] 0.54, 95% confidence interval [CI] 0.31 to 0.96, p = 0.036), FMI (aOR 0.49, 95% CI 0.28 to 0.85, p = 0.012), android fat mass (aOR 0.51, 95% CI 0.29 to 0.89, p = 0.019), gynoid fat mass (aOR 0.52, 95% CI 0.30 to 0.91, p = 0.021) or VAT mass (aOR 0.45, 95% CI 0.25 to 0.78, p = 0.005). In patients with T2DM and obesity, the prevalence of sarcopenic obesity was 14.8% (n = 23) when obesity was assessed by BMI, 30.6% (n = 56) when assessed by FMI, 27.9% (n = 51) when assessed by android fat mass, 28.4% (n = 52) when assessed by gynoid fat mass, and 30.6% (n = 56) when assessed by VAT mass. Sarcopenic obesity was associated with DR when obesity was assessed by BMI (aOR 2.61, 95% CI 1.07 to 6.37, p = 0.035), android fat mass (aOR 3.27, 95% CI 1.37 to 7.80, p = 0.007), or VAT mass (aOR 2.50, 95% CI 1.06 to 5.92, p = 0.037).

CONCLUSIONS

Patients with T2DM showed a substantial inverse relationship between DR and obesity, and sarcopenic obesity was considerably favorably associated with DR. Detection of sarcopenia in patients with T2DM, especially in obese T2DM, is essential to guide clinical intervention in DR.

The agreement of low lean mass with obesity using different definitions and its correlation with hyperuricemia

Background

The agreement on the identification of sarcopenic obesity remains elusive, and its association with hyperuricemia remains unestablished. This study sought to evaluate the agreement of low lean mass (LLM) with obesity and its correlation with hyperuricemia.

Methods

A total of 25,252 study participants, comprising 4,597 individuals with hyperuricemia, were obtained from the National Health and Nutrition Examination Survey spanning the years 1999-2006 and 2011-2018. LLM with obesity was characterized by the coexistence of LLM, determined by the ratio of appendicular lean mass to body mass index (BMI), and three categories of obesity including BMI, body fat percentage (BF%), and waist circumference (WC). We employed Cohen's kappa to evaluate the agreement among the different diagnostic criteria and implemented survey multiple logistic regression and stratified analyses to explicate the connection between LLM with obesity and the risk of hyperuricemia.

Results

When defining obesity using BF%, BMI, and WC, the prevalence of LLM with obesity varied from 6.6 to 10.1%, with moderate-to-strong agreement. In the fully adjusted model, individuals with LLM or any of the three types of obesity exhibited notably elevated odds of developing hyperuricemia. Likewise, participants with LLM and obesity had 2.70 (LLM + BMI), 2.44 (LLM + BF%), and 3.12 (LLM + WC) times the risk of hyperuricemia, respectively, compared with healthy individuals. The association between LLM with obesity and hyperuricemia remained stable and significant across different age and sex subgroups.

Conclusion

When employing the three definitions of obesity, the incidence of LLM with obesity was not high, and the diagnostic agreement was relatively good. The participants with LLM and obesity exhibited an increased risk of hyperuricemia.

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.

Prevalence of sarcopenic obesity in patients with diabetes and adverse outcomes: A systematic review and meta-analysis

BACKGROUND & AIMS

Sarcopenic obesity (SO), which refers to the coexistence of sarcopenia and obesity. The aim of this systematic review and meta-analysis was first to assess the prevalence of SO in patients with diabetes, and second, to evaluate possible adverse outcomes.

METHODS

This study was conducted in adherence to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines and the data were collated by means of meta-analysis and narrative synthesis. We comprehensively and systematically searched PubMed, Embase, Web of Science, CBM, CNKI, Wanfang Database from the establishment of the database to December 2022, and collected related studies on SO in patients with diabetes. Using Stata 16.0 software to pool the estimates for the prevalence of SO in patients with diabetes, and a descriptive systematic review of possible adverse outcomes was performed.

RESULTS

The prevalence of 20 included studies were pooled by a random-effects model, which showed that the prevalence of SO in patients with diabetes was 27%. Subgroup analyses showed that the prevalence of SO was higher among studies using BIA (24%) to assess muscle mass, and those focused on literature of moderate-quality (29%), being published from 2013 to 2016 (29%), female patients with diabetes (17%), North Americans (30%). SO in patients with diabetes can lead to adverse outcomes including decreased glomerular filtration rate, massive proteinuria, cognitive decline, and insulin resistance.

CONCLUSION

The systematic review and meta-analysis revealed a prevalence of 27% for SO in patients with diabetes, and it is associated with potential serious adverse outcomes. Therefore, we should attach importance to the screening of SO in patients with diabetes and early detection of susceptible groups, then selecting appropriate interventions to reduce the occurrence of it and various adverse outcomes in this demographic.

Sarcopenic Obesity as a Risk Factor for Cardiovascular Disease: An Underrecognized Clinical Entity

Sarcopenic obesity (SO) is a chronic condition and an emerging health challenge, in view of the growing elderly population and the obesity epidemic. Due to a lack of awareness among treating doctors and the non-specific nauture of the associated symptoms, SO remains grossly underdiagnosed. There is no consensus yet on a standard definition or diagnostic criteria for SO, which limits the estimation of the global prevalence of this condition. It has been linked to numerous metabolic derangements, cardiovascular disease (CVD) and mortality. The treatment of SO is multimodal and requires expertise across multiple specialties. While dietary modifications and exercise regimens have shown a potential therapeutic benefit, there is currently no proven pharmacological management for SO. However, numerous drugs and the role of bariatric surgery are still under trial, and have great scope for further research. This article covers the available literature regarding the definition, diagnostic criteria, and prevalence of SO, with available evidence linking it to CVD, metabolic disease and mortality, and an overview of current directives on management.

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.

Frizzled receptors and SFRP5 in lipid metabolism: Current findings and potential applications

Lipid metabolism plays a very important role as the central metabolic process of the body. Lipid metabolism interruptions may cause many chronic diseases, for example, non-alcoholic fatty liver disease (NAFLD), diabetes, and obesity. Secreted Frizzled Related Protein 5 (SFRP5) and Frizzled receptors (FZD) are two newly discovered adipokines that are involved in lipid metabolism as well as lipogenesis. Both of these adipokines affect lipid metabolism and adipogenesis through three WNT signaling pathways (WNTSP): WNT/β-catenin, WNT/Ca²⁺, and WNT/JNK. FZD consists of 10 species, which have a cysteine-rich domain (CRD) to bind to the WNT protein for signal transduction. Depending on the type of ligand or co-receptor, they can stimulate or inhibit adipogenesis. In lipid metabolism, they play a role in recognizing fatty acids. In obesity, gene expression of the WNT/FZD receptors is significantly increased. In contrast, SFPR5 serves as an antagonist that can compete with FZD for inhibition of WNTSP. It is believed to have anti-inflammatory potential in obesity and diseases related to abnormal lipid metabolism. In these cases, the expression of SFRP5 is found to be very low leading to the promoted production of proinflammatory cytokines (PICS). Some methods that include using recombinant SFRP5 to improve non-alcoholic steatohepatitis (NASH), using secreted Ly-6/uPAR-related protein 1 (Slurp1) to regulate fat accumulation in the liver through SFRP5, and dietary and lifestyle interventions to improve overweight/obesity have been studied. However, understandings of the molecular mechanisms of these two adipokines and their interactions are very limited. Therefore, more in-depth studies are needed in the future.

Waist-to-calf circumstance ratio and cognitive function among Chinese older adults: Mediating roles of physical performance and social activity

Background

In light of the potentially detrimental effects of central fat and decreased muscle mass on cognitive function, it would be beneficial to learn more about the mediating mechanisms underpinning the association between the two. The purpose of this study is to determine the association between waist-to-calf circumstance ratio (WCR) and cognitive function, as well as to investigate whether physical performance and social activity mediate the relationship between WCR and cognitive function among older Chinese adults.

Methods

An analysis of 9,652 older Chinese adults was conducted during the 2018 wave of the Chinese Longitudinal Health Longevity Survey (CLHLS). The Mini-Mental State Examination (MMSE) and a self-reported scale were used to measure cognitive function, physical performance, and social activity, respectively. Multiple linear regression and mediation analyses were conducted.

Results

The findings suggest that a high WCR had a significant negative association with cognitive function (B = -0.535, 95% CI: -0.754, -0.317). Mediation analysis revealed that a high WCR influenced old adults' cognitive function in three ways: first, through the partial mediating effect of physical performance (B = -0.270; 95% CI: -0.340, -0.203); second, through the partial mediating effect of social activity (B = -0.035; 95% CI: -0.055, -0.017); and third, through the serial mediating effects of physical performance and social activity (B = -0.021, 95% CI: -0.029, -0.015).

Conclusion

The study results suggest the adverse impact of a high WCR on older adults' cognitive function, and the possible mechanisms of physical performance and social activity by which the association takes place. Multidimensional health and social interventions aimed at improving physical, social, and cognitive functioning among older adults with sarcopenic obesity are recommended.

Prevalence and risk factors of sarcopenia without obesity and sarcopenic obesity among Chinese community older people in suburban area of Shanghai: A cross-sectional study

Objectives

The aim of the present study was to explore the prevalence and risk factors of sarcopenia without obesity (S) and sarcopenic obesity (SO) among community-dwelling older people in the Chongming District of Shanghai, China, according to the Asian Working Group for Sarcopenia (AWGS) 2019 Consensus as the diagnostic criteria of sarcopenia.

Methods

In this cross-sectional study, a total of 1,407 subjects aged ≥65 years were included, where the mean age of the subjects was 71.91 ± 5.59 years and their mean body mass index (BMI) was 24.65 ± 3.32 kg/m². According to the Asian Working Group for Sarcopenia (AWGS) 2019 Consensus, sarcopenia was defined as a low appendicular skeletal muscle mass index (≤7.0 kg/m² in males and ≤5.7 kg/m² in females), decreased handgrip strength (<28.0 kg in males and <18.0 kg in females), and/or low gait speed (<1.0 m/s) or poor 5-time chair stand test (5CST) (≥12s). The SO met both the diagnostic criteria for sarcopenia and obesity, meanwhile obesity was defined as an increased percentage of body fat (PBF) (≥25% in males and ≥35% in females). Univariate and multiple logistic regression analyses were performed to explore the risk factors of both S and SO.

Results

The prevalence of S and SO was 9.74% (M: 9.29%, F: 10.05%) and 9.95% (M: 13.94%, F: 7.14%). Lower BMI (OR = 0.136, 95% CI: 0.054-0.340, p < 0.001), lower hip circumference (OR = 0.858, 95% CI: 0.816-0.903, p < 0.001), farming (OR = 1.632, 95% CI: 1.053-2.530, p = 0.028), higher high-density lipoprotein cholesterol (HDL-C) level (OR = 2.235, 95% CI: 1.484-3.367, p < 0.001), and a sleep duration <7 h (OR = 0.561, 95% CI: 0.346-0.909, p = 0.019) were risk factors for S. While aging (70-74 y, OR = 1.923, 95% CI: 1.122-3.295, p = 0.017; 75-79 y, OR = 3.185, 95% CI: 1.816-5.585, p < 0.001; ≥80 y, OR = 7.192, 95% CI: 4.133-12.513, p < 0.001), male (OR = 1.981, 95% CI: 1.351-2.904, p < 0.001), higher BMI (OR = 4.865, 95% CI: 1.089-21.736, p = 0.038), higher monocyte level (OR = 4.203, 95% CI: 1.340-13.181, p = 0.014), and a sleep duration >9 h (OR = 1.881, 95% CI: 1.117-3.166, p = 0.017) were risk factors for SO.

Conclusion

Our study showed the high prevalence of S and SO among community-dwelling older people in the Chongming District. The SO was more prevalent in males. Behavioral factors and lifestyle (such as farming and sleep duration) were associated more with the development of S, while age and male gender were associated more with the development of SO.

Endothelin-1-mediated miR-let-7g-5p triggers interlukin-6 and TNF-α to cause myopathy and chronic adipose inflammation in elderly patients with diabetes mellitus

Background: Diabetes and sarcopenia are verified as mutual relationships, which seriously affect the quality of life of the elderly. Endothelin-1 is well investigated, is elevated in patients with diabetes, and is related to muscle cellular senescence and fibrosis. However, the mechanism of ET-1 between diabetes and myopathy is still unclear. The aim of this study was to evaluate the prevalence of sarcopenia in the elderly with diabetes and to clarify its relationship with ET-1 molecular biological mechanism, progress as well as changes in muscle and fat.

Methods: We recruited 157 type 2 diabetes patients over 55 years old and investigated the prevalence of sarcopenia in diabetes patients and examined the association of ET-1 alterations with HbA1c, creatinine, or AMS/ht2. Next, sought to determine how ET-1 regulates inflammation in muscle cells by western blot and qPCR assay. Using XF Seahorse Technology, we directly quantified mitochondrial bioenergetics in 3T3-L1 cells.

Results: ET-1 was positively correlated with HbA1c, creatinine levels, and duration of disease, and negatively correlated with AMS/ht2. We found that ET-1 dose-dependently induces tumor necrosis factor-α (TNF-α) and interleukin (IL)-6β expression through the PI3K/AKT, and NF-κB signaling pathways in C2C12 cells. Also identified that TNF-α, IL-6β, and visfatin releases were found in co-cultured with conditioned medium of ET-1/C2C12 in 3T3-L1 cells. ET-1 also reduces the energy metabolism of fat and induces micro-environment inflammation which causes myopathy. ET-1 also suppresses miR-let-7g-5p expression in myocytes and adipocytes.

Conclusion: We describe a new mechanism of ET-1 triggering chronic inflammation in patients with hyperglycemia.

Association of Obesity, Sarcopenia, and Sarcopenic Obesity With Hypertension in Adults: A Cross-Sectional Study From Ravansar, Iran During 2014-2017

BACKGROUND AND AIMS

Hypertension may lead to disability and death by increasing the risk of cardiovascular disease, kidney failure, and dementia. This study aimed to determine the association between obesity, sarcopenia and sarcopenic obesity, and hypertension in adults resident in Ravansar, a city in the west of Iran.

METHODS

This cross-sectional study was conducted on 4,021 subjects from the baseline data of the Ravansar Non-Communicable Disease (RaNCD) cohort study, in the west region of Iran, from October 2014 up to February 2017. Body composition was categorized into obese, sarcopenia, sarcopenic obese, and normal based on measurements of muscle strength, skeletal muscle mass, and waist circumference. Univariate and multiple logistic regression models were used to examine the relationships, using the STATA 15 software.

RESULTS

The mean age of the participant was 47.9 years (SD: 8.4), the body mass index (BMI) was 26.84 kg/m² (SD: 4.44), and the prevalence of hypertension was 15.12%. The prevalence of obesity, sarcopenia, and sarcopenic obesity were 24.37, 22.01, and 6.91%, respectively. Body composition groups had significant differences in age, total calorie intake, BMI, skeletal muscle mass, and muscle strength (P-value ≤ 0.001). In crude model, the obese (OR = 2.64; 95% CI: 2.11-3.30), sarcopenic (OR = 2.45; 95% CI: 1.94-3.08), and sarcopenic obese (OR = 3.83; 95% CI: 2.81-5.22) groups had a higher odds of hypertension. However, in adjusted models, only the obese group had a higher likelihood of hypertension (OR = 2.18; 95% CI: 1.70-2.80).

CONCLUSION

This study showed that obesity was associated with hypertension, whereas sarcopenia and sarcopenic obesity had no significant relationship with hypertension.

The Critical Role of Oxidative Stress in Sarcopenic Obesity

Sarcopenic obesity (SO) is a combination of obesity and sarcopenia that primarily develops in older people. Patients with SO have high fat mass, low muscle mass, low muscle strength, and low physical function. SO relates to metabolic syndrome and an increased risk of morbimortality. The prevalence of SO varies because of lacking consensus criteria regarding its definition and the methodological difficulty in diagnosing sarcopenia and obesity. SO includes systemic alterations such as insulin resistance, increased proinflammatory cytokines, age-associated hormonal changes, and decreased physical activity at pathophysiological levels. Interestingly, these alterations are influenced by oxidative stress, which is a critical factor in altering muscle function and the generation of metabolic dysfunctions. Thus, oxidative stress in SO alters muscle mass, the signaling pathways that control it, satellite cell functions, and mitochondrial and endoplasmic reticulum activities. Considering this background, our objectives in this review are to describe SO as a highly prevalent condition and look at the role of oxidative stress in SO pathophysiology.