Sarcopenic Obesity Predicts Early Attrition in Treatment-Seeking Patients with Obesity: A Longitudinal Pilot Study

The Association between Sarcopenic Obesity and DXA-Derived Visceral Adipose Tissue (VAT) in Adults

Many people with overweight and obesity are affected by sarcopenia, which is represented by a phenotype known as sarcopenic obesity (SO), characterized by excessive body fat (BF), combined with reduced muscle mass and strength. In this population, it is vital to identify the factors associated with SO. With this aim in mind, we investigated the association between visceral adipose tissue (VAT) mass and SO in patients with overweight or obesity in a nutritional setting. A total of 256 participants (23.8% female) with overweight or obesity were involved and completed a body composition assessment, including VAT mass, using dual-energy X-ray absorptiometry (DXA). The sample was initially categorized according to whether the individual had the SO phenotype; they were then classified according to their VAT mass into three tertiles (lowest, medium, and highest). Among the 256 participants, who had a median body mass index (BMI) of 29.3 (interquartile range (IQR): 27.0-32.4) kg/m2 and a median age of 51.0 (IQR: 47.0-54.0) years, 32.4% were identified as having SO, and they displayed a higher median VAT mass (517.0 (IQR: 384.5-677.0) vs. 790.0 (IQR: 654.0-1007.0) g; p < 0.05). The logistic regression model that accounted for age, sex and BMI revealed that a higher VAT mass increases the risk of SO (odds ratio (OR) = 1.003; 95% confidence interval (CI): 1.001-1.004; p < 0.05). In conclusion, VAT mass appears to be an independent factor associated with SO in people with overweight or obesity. However, due to the cross-sectional design, no information regarding any causality between higher VAT mass and SO can be provided. Additional longitudinal research in this direction should therefore be conducted.

Understanding sarcopenic obesity in young adults in clinical practice: a review of three unsolved questions

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.

Approaching Sarcopenic Obesity in Young and Middle-Aged Female Adults in Weight Management Settings: A Narrative Review

This paper presents a review of the available literature on sarcopenic obesity (SO) in young and middle-aged female adults with obesity in weight management settings. A literature review using the PubMed/Medline and Science Direct databases was conducted, and the data were summarized through a narrative approach. Firstly, some physical performance tests and questionnaires are available for screening young and middle-aged female adults with a high risk of SO. Secondly, these patients can undergo instrumental measurements such as dual-energy X-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA) to confirm or reject a diagnosis of SO, applying definitions that account for body mass. Thirdly, SO is a prevalent phenotype in females seeking weight management treatment, as well as being strongly associated (vs. non-SO) with obesity-related comorbidities that need to be promptly managed, initially with nutritional programs or/and in combination with medications. Finally, patients with SO have a reduced baseline resting energy expenditure and more sedentary behaviors, which seem to account for the relationship between SO and poorer weight management outcomes, such as a higher early dropout rate and major later difficulties in weight loss maintenance. Therefore, specific strategies for personalized weight management programs for patients with SO should be incorporated to determine a successful management of this phenotype.

Can Intentional Weight Loss Ameliorate Sarcopenia in Individuals with Obesity? A Longitudinal Interventional Study

Little remains known regarding the impact of weight loss on sarcopenic obesity (SO), and for this reason we aimed to assess the relationship between the two during a weight management program. Body composition was measured at baseline and six-month follow-up using the Tanita BC-418, and step measurements were obtained daily over a period of six months using an Omron HJ-320 pedometer, in 41 adults of both genders with obesity. The participants were then categorized according to the presence or absence of SO. After a significant weight loss, an improvement in the appendicular skeletal mass (ASM) to weight ratio (24.5 ± 3.5 vs. 26.2 ± 3.6, p < 0.01), indicated a decrease in the prevalence of SO by 12.2%. Moreover, these findings were confirmed by logistic regression analysis revealing a significant WL% ≥ 5% combined with an active lifestyle (i.e., ≥8000 steps/day), decreased the risk of SO by 91% (OR = 0.09; 95% CI: 0.02–0.56), after adjusting for age and gender. In conclusion, in a weight management setting, a personalized program for individuals with SO that incorporates new strategies in terms of weight loss and physical activity targets may be adopted to improve the sarcopenia-related index and reduce the prevalence of SO in this population.

The Relationship between Sarcopenic Obesity, Weight-Loss and Maintenance Outcomes during Obesity Management: Are Additional Strategies Required?

The lack of long-term maintenance of the weight loss achieved during weight-management programs is the major cause of failure in obesity treatments. The identification of factors related to this outcome has clinical implications. Therefore, we aimed to assess the relationship between sarcopenic obesity (SO) and the weight-loss percentage (WL%). The WL% was measured at the six-month follow-up and after more than 12 months, in 46 adult participants with obesity, during an individualized weight-management program where participants were categorized as having or not having SO at the baseline. At the six-month follow-up, participants with SO did not display a significant difference in terms of WL%, when compared to those without SO (-10.49 ± 5.75% vs. -12.73 ± 4.30%; p = 0.148). However, after a longer term (i.e., >12 months), the WL% appeared to be significantly lower in the former (SO vs. non-SO) (-7.34 ± 6.29% vs. -11.43 ± 4.31%; p = 0.024). In fact, partial correlation analysis revealed a relationship between SO at the baseline and a lower WL% after more than 12 months (ρ = -0.425, p = 0.009), after controlling for age, sex, and body mass index (BMI). Participants with SO appeared to face more difficulties in maintaining the achieved WL over a longer term (>12 months follow-up) by comparison with their counterparts (i.e., non-SO). Should this finding be replicated in larger-sample studies, new strategies should be adopted for these patients in order to improve this clinical outcome, especially during the weight-maintenance phase.

Association between Levels of Physical Activity, Sarcopenia, Type 2 Diabetes and the Quality of Life of Elderly People in Community Dwellings in Lebanon

There is a lack of data from developing countries on the link between physical activity (PA) on health outcomes. This study examines the association between the level of PA and sarcopenia, cardiovascular risk factors (i.e., dyslipidemia, type 2 diabetes (T2D), and cardiovascular diseases), and the health-related quality of life (HRQoL) among elderly people, in community dwellings in Lebanon. In this cross-sectional, observational study, body composition, levels of PA, and the HRQoL of 243 elderly people living in community dwellings, are obtained. The participants are then categorized based on a PA cut-off point of 600 metabolic equivalent task minutes per week (MET-min/week). In our sample, the prevalence of physical inactivity, defined as performing less than 600 MET-min/week, is 51.44% (125/243 participants).They displayed a higher prevalence of sarcopenia (36.0% vs. 18.6%), T2D (39.6% vs. 21.1%), as well as a lower physical (65.67 ± 20.72 vs. 75.08 ± 17.29) and mental (67.58 ± 21.51 vs. 76.95 ± 17.16) HRQoL. On the other hand, regression analysis shows that an increased rate of PA to ≥600 MET-min/week is associated with a lower risk of T2D (OR = 0.43, 95% CI: 0.22–0.84, p = 0.013) and sarcopenia (OR= 0.40, 95% CI: 0.22–0.73, p = 0.003) by 60%, and higher scores of the physical (β = −7.65; −11.87, −3.43, p = 0.0004) and mental (β = −8.47; −13.08, −3.85, p = 0.0004) HRQoL by nearly eight points. Our results show a high prevalence of physical inactivity in Lebanese adults over the age of 60; however, an adequate level of PA among this population seemed to be associated with a lower risk of sarcopenia and T2D, as well as a better HRQoL. However, future longitudinal studies are still needed to clarify if intervention based on increasing levels of PA can determine improvement in these clinical outcomes. If this is shown to be the case, it emphasizes the importance of implementing strategies to increase physical activity within this population.