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El Ghoch M, Rossi AP, Verde L, Barrea L, Muscogiuri G, Savastano S, Colao A. Understanding sarcopenic obesity in young adults in clinical practice: a review of three unsolved questions. Panminerva Med 2022; 64:537-547. [PMID: 36533664 DOI: 10.23736/s0031-0808.22.04784-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
INTRODUCTION Our aim was to summarize the available literature on three yet unsolved questions, namely: 1) the dilemma surrounding definition of sarcopenic obesity (SO), especially in young adults; 2) the potential impact of this phenotype on weight-loss programme outcomes; and 3) the strategies for optimum management (prevention/treatment) of SO in clinical practice. EVIDENCE ACQUISITION A literature review using the PubMed/Medline database was conducted, and data were summarized based on a narrative approach. EVIDENCE SYNTHESIS Firstly, SO can be screened by the 30-sec sit-to-stand test; ≤25 and ≤21; and confirmed by the ratio of (appendicular lean mass/Body Mass Index) ≤0.789 and 0.512 in males and females, respectively. Secondly, SO is associated with impaired physical fitness, reduced resting energy expenditure and an inactive lifestyle, that seems to negatively impact on weight-management outcomes, namely increasing early dropout and difficulty in maintaining weight loss in the long term. Finally, prevention/treatment of SO in young adults must be realized through tailored lifestyle intervention (diet+exercise) to preserve and improve strength and muscle mass, even where weight loss is necessary. CONCLUSIONS Our findings have clinical implications since they may help in screening, managing and improving the weight-loss outcomes of patients with SO in clinical settings.
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Affiliation(s)
- Marwan El Ghoch
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Arab University of Beirut, Beirut, Lebanon
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea P Rossi
- Division of Geriatrics, Department of Medicine, Healthy Aging Center, University of Verona, Verona, Italy
- Division of Geriatrics, Department of Medicine, Ospedale Ca' Foncello ULSS2 Treviso, Treviso, Italy
| | - Ludovica Verde
- Centro Italiano per la cura e il benessere del paziente (C.I.B.O), Unit of Endocrinology, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Luigi Barrea
- Centro Italiano per la cura e il benessere del paziente (C.I.B.O), Unit of Endocrinology, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
- Department of Human Sciences, Pegaso Telematic University, Naples, Italy
| | - Giovanna Muscogiuri
- Centro Italiano per la cura e il benessere del paziente (C.I.B.O), Unit of Endocrinology, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy -
- Department of Clinical Medicine and Surgery, Section of Endocrinology, University Federico II, Naples, Italy
- UNESCO Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy
| | - Silvia Savastano
- Centro Italiano per la cura e il benessere del paziente (C.I.B.O), Unit of Endocrinology, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
- Department of Clinical Medicine and Surgery, Section of Endocrinology, University Federico II, Naples, Italy
| | - Annamaria Colao
- Centro Italiano per la cura e il benessere del paziente (C.I.B.O), Unit of Endocrinology, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
- Department of Clinical Medicine and Surgery, Section of Endocrinology, University Federico II, Naples, Italy
- UNESCO Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy
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Metabolically Healthy Obesity (MHO) vs. Metabolically Unhealthy Obesity (MUO) Phenotypes in PCOS: Association with Endocrine-Metabolic Profile, Adherence to the Mediterranean Diet, and Body Composition. Nutrients 2021; 13:nu13113925. [PMID: 34836180 PMCID: PMC8624317 DOI: 10.3390/nu13113925] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 01/08/2023] Open
Abstract
Obesity and obesity-related low-grade inflammation are common findings in polycystic ovary syndrome (PCOS), the most common endocrine-metabolic disorder-affecting women in reproductive age. The terms metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO) have been introduced to define individuals with obesity in whom cardio-metabolic risk factors are absent or present, respectively. To date, evidence investigating differences in body composition and adherence to the Mediterranean diet (MD) between MHO and MUO-PCOS women are lacking. Aim of this study was to better characterize the determinants of the metabolic health status in PCOS patients with obesity according to MHO and MUO phenotypes by evaluating endocrine-metabolic profile, inflammatory status, adherence to the MD, and body composition. The study population consisted of 94 treatment-naïve women with PCOS and obesity (BMI = 38.23 ± 6.62 kg/m2 and age = 24.12 ± 3.68 years). Compared PCOS MHO with PCOS MUO patients, the latter had higher levels of high-sensitivity C-reactive protein (hs-CRP) (p < 0.001), testosterone (p < 0.001), and insulin (p < 0.001), worse metabolic parameters, and higher Homeostatic Model Assessment of Insulin Resistance (HoMA-IR), Visceral Adiposity Index (VAI), and Fatty liver Index (FLI) (p < 0.001). Furthermore, PCOS MUO patients had lower adherence to the MD (p < 0.001) in spite of the same total energy intake (p = 0.102) as compared to PCOS MHO. The presence of MUO was associated with highest hs-CRP levels (OR = 1.49, p < 0.001), more severe hyperandrogenism and cardio-metabolic indices (p < 0.001). On the contrary, being PCOS MUO was associated with lower adherence to the MD (OR = 0.28, p < 0.001), and smaller PhAs (OR = 0.04, p < 0.001). Using a regression linear analysis model PREDIMED score entered at the first step (p < 0.001), followed by VAI (p < 0.001), and FLI (p = 0.032) in this analysis. At ROC analysis, a PREDIMED score of ≤4 (p < 0.001, AUC 0.926) could serve as a threshold for a significantly increased risk of presence the MUO-PCOS phenotype. To the best of our knowledge, this is the first study that characterized MHO and MUO-PCOS women on the basis of their adherence to the MD, body composition, and cardio-metabolic indices, providing evidence of the usefulness of adjunctive diagnostic parameters to better differentiate the MHO/MHO phenotypes in this cohort of PCOS patients with obesity.
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Barrea L, Framondi L, DI Matteo R, Verde L, Vetrani C, Graziadio C, Pugliese G, Laudisio D, Vitale G, Iannicelli A, Savastano S, Colao A, Muscogiuri G. The role of the nurse in the obesity clinic: a practical guideline. Panminerva Med 2021; 63:539-546. [PMID: 34544231 DOI: 10.23736/s0031-0808.21.04540-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Obesity is a major public health problem, and its trend is increasing worldwide. Interventions to effectively treat obesity and its related diseases are advocated. Given the complexity of obesity management, nurses need specific core skills to work in the Obesity Clinic and can act as key players in the multidisciplinary team of the Obesity Clinic. To provide practical guidelines for nurses working in Obesity Clinic for effective management of obesity and its related diseases, the current evidence on the role nurses in the obesity clinic was reviewed. Nurses can play a pivotal role in the management of patients with obesity and associated diseases that may require a stricter follow-up than usual care. Given the complexity of the treatment of obesity and its comorbidity, nurses should receive a specific training for: 1) methods and tools to effectively treat obesity and obesity-related disease, 2) patients and families education on nutrition, lifestyle changes, and prevention/management of obesity-related diseases; 3) motivation of patients towards adherence to treatment to achieve their specific goals. This manuscript highlights the need of specific core skills for nurses working in the Obesity Clinic.
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Affiliation(s)
- Luigi Barrea
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Napoli, Italy - .,Centro italiano per la cura e il benessere del paziente con obesità (C.I.B.O), University Federico II, Naples, Italy -
| | - Lydia Framondi
- Department of Clinical Medicine and Surgery, Endocrinology Unit, University Federico II, Naples, Italy
| | - Rossana DI Matteo
- Department of Clinical Medicine and Surgery, Endocrinology Unit, University Federico II, Naples, Italy
| | - Ludovica Verde
- Department of Clinical Medicine and Surgery, Endocrinology Unit, University Federico II, Naples, Italy
| | - Claudia Vetrani
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Chiara Graziadio
- Centro italiano per la cura e il benessere del paziente con obesità (C.I.B.O), University Federico II, Naples, Italy.,Department of Clinical Medicine and Surgery, Endocrinology Unit, University Federico II, Naples, Italy
| | - Gabriella Pugliese
- Centro italiano per la cura e il benessere del paziente con obesità (C.I.B.O), University Federico II, Naples, Italy.,Department of Clinical Medicine and Surgery, Endocrinology Unit, University Federico II, Naples, Italy
| | - Daniela Laudisio
- Centro italiano per la cura e il benessere del paziente con obesità (C.I.B.O), University Federico II, Naples, Italy.,Department of Clinical Medicine and Surgery, Endocrinology Unit, University Federico II, Naples, Italy
| | - Giovanni Vitale
- Laboratory of Geriatric and Oncologic Neuroendocrinology Research, Istituto Auxologico Italiano IRCCS, Cusano Milanino, Milan, Italy.,Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Annamaria Iannicelli
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Silvia Savastano
- Centro italiano per la cura e il benessere del paziente con obesità (C.I.B.O), University Federico II, Naples, Italy.,Department of Clinical Medicine and Surgery, Endocrinology Unit, University Federico II, Naples, Italy
| | - Annamaria Colao
- Centro italiano per la cura e il benessere del paziente con obesità (C.I.B.O), University Federico II, Naples, Italy.,Department of Clinical Medicine and Surgery, Endocrinology Unit, University Federico II, Naples, Italy.,Cattedra Unesco "Educazione alla salute e allo sviluppo sostenibile", University Federico II, Naples, Italy
| | - Giovanna Muscogiuri
- Centro italiano per la cura e il benessere del paziente con obesità (C.I.B.O), University Federico II, Naples, Italy.,Department of Clinical Medicine and Surgery, Endocrinology Unit, University Federico II, Naples, Italy.,Cattedra Unesco "Educazione alla salute e allo sviluppo sostenibile", University Federico II, Naples, Italy
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