Sarcopenic obesity in the elderly and strategies for weight management

Sarcopenia and the analysis of body composition

Reduction of lean mass is a primary body composition change associated with aging. Because many factors contribute to lean mass reduction, the problem has been given various names depending on the proposed cause, such as "age-related sarcopenia," "dynapenia," "myopenia," "sarcopenic obesity," or simply "sarcopenia." There is currently no consensus on how to best diagnose the reduction of lean mass and its consequences on health. We propose that simple body composition methods can be used to indirectly evaluate sarcopenia, provided that those techniques are validated against the "quality of lean" criterion that associates muscle mass and metabolic function with the components of fat-free mass. Promising field methods include the use of stable isotopes for the evaluation of water compartments and new approaches to bioelectrical impedance analysis, which is also associated with the monitoring of water homeostasis.

Prevalence of sarcopenia among healthy ambulatory subjects: the sarcopenia begins from 45 years

BACKGROUND AND AIMS

Sarcopenia has been indicated as a reliable marker of frailty and poor prognosis among the oldest individuals. There are only few data on sarcopenia in healthy general population. We evaluated the prevalence of sarcopenia and its association with functional and clinical status in a population of healthy ambulatory subjects over 45 years living at home, in Paris (France).

METHODS

This study was conducted selecting all ambulatory participants (n = 1,445) aged 45 years and older from October 2008 to September 2011, consulting in the Institute of Physiology (Institut de Jaeger) from Paris (France) for a functional and muscular evaluation, and did not have limitations to moderate physical exercise. All were healthy people. All subjects performed a medical examination, associated with evaluation of muscle mass (body composition assessment using dual-energy X-ray absorptiometry) and of muscle function (by hand grip strength). Diagnosis of sarcopenia required the documentation of low muscle mass with low muscle strength according to the current international consensus definition of sarcopenia.

RESULTS

From 1,421 participants (553 males and 868 females) definitively enrolled, 221 subjects (135 females and 86 males) (15.5 %) were identified as sarcopenic. Results from multivariate logistic regression models showed that sarcopenia was inversely associated with BMI with those participants with BMI higher than 22 kg/m(2) showing a lower risk of sarcopenia relative to those with BMI less than 21 kg/m(2) (OR 0.72; 95 % CI 0.60-0.91). Similarly, probability of sarcopenia was lower among subjects involved in leisure physical activities for 3 h or more per week (OR 0.45; 95 % CI 0.24-0.93). According to the category of age [45-54; 55-64; 65-74; 75-84 and 85 years or more], the prevalence of sarcopenia in women increase from 9.1; 12.7; 14.5; 19.4; to 33.3 %, respectively. For the men, the percentage of sarcopenia increase with aging from 8.6; 15.6; 13.6; 63.8 to 45.5 %, respectively.

CONCLUSIONS

The present study suggests that among healthy ambulatory subjects over 45 years living at home, sarcopenia is frequent, even to the youngest subjects of the studied population, taking place from 9 % from 45 years, until 64.3 % for the subjects over 85 years. Our findings support the hypothesis that muscle mass and function are associated with BMI and physical activity, whatever the age of the subject.

Dietary pattern classifications with nutrient intake and body composition changes in Korean elderly

BACKGROUND/OBJECTIVES

The body composition changes in aging increased the risk of metabolic disorder. Recent dietary studies have increasingly focused on the correlations between dietary patterns and chronic diseases to overcome the limitations of traditional single-nutrient studies because nutrients in food have complex relations that interact.

SUBJECTS/METHODS

This study was conducted to classify a dietary pattern among Korean elderly using cluster analysis and to explore the relationships between dietary patterns and body composition changes in Korean elderly aged 65 years or older. The study subjects (n = 1,435) were individuals who participated in the Korean National Health Examination and Nutrition Survey (KNHANES) in 2011.

RESULTS

There were three dietary patterns derived by cluster analysis in this study: 'Traditional Korean' (37.49% of total population), 'Meat and Alcohol' (19.65%) and 'Westernized Korean' (42.86%). The (1) 'Traditional Korean' pattern was characterized by high consumptions of white rice and low protein, low fat, and low milk products, while (2) 'Westernized Korean' pattern ate a Korean-style diet base with various foods such as noodles, bread, eggs and milk, (3) 'Meat and Alcohol' pattern had high consumptions of meat and alcohol. In body composition changes, compared with the 'Traditional Korean' pattern, the 'Meat & alcohol' pattern was associated with a 50% increased risk of having elevated BMI (kg/m²), 'Westernized Korean' pattern was associated with a 74% increased abnormality of ASM/Wt (kg) by logistics analysis. Most of the Korean adult population continues to follow ether a traditional Korean having beneficial effects for successful aging. However, the 'Traditional Korean' pattern showed low protein intake (0.7 g/kg), calcium intake, and vitamin D intake as well as low of appendicular skeletal muscle mass (ASM (kg)) among 3 groups.

CONCLUSIONS

Considering the low ASM, consumption of protein, calcium and vitamin D should be increased for Korean elderly health body composition.

Sarcopenic obesity in aging population: current status and future directions for research

The combination of sarcopenia and obesity, an age-related change in body composition, is a concern in the aged society. Sarcopenic obesity is not the combination of two conditions, but is more related to cardio-metabolic and functional abnormalities. Sarcopenic obesity is associated with more physical functional decline than simple obesity. Sarcopenic obesity may be more insulin resistant, and have a higher risk for metabolic syndrome and atherosclerosis than simple obesity. However, the prevalence of sarcopenic obesity differs substantially among studies because of the lack of a standard definition. For further understanding of the pathophysiological role of sarcopenic obesity, a standardized definition for both sarcopenia and obesity is necessary.

Adequate dietary protein is associated with better physical performance among post-menopausal women 60-90 years

OBJECTIVES

Sarcopenia, the involuntary loss of skeletal muscle with age, affects up to one-quarter of older adults. Evidence indicates a positive association between dietary protein intake and lean muscle mass and strength among older persons, but information on dietary protein's effect on physical performance in older adults has received less attention.

DESIGN

Cross-sectional observational analysis of the relationship of dietary protein on body composition and physical performance.

SETTING

Clinical research center.

PARTICIPANTS

387 healthy women aged 60 - 90 years (mean 72.7 ± 7.0 y).

MEASUREMENTS

Measures included body composition (fat-free mass, appendicular skeletal mass and fat mass) via dual x-ray absorptiometry (DXA), physical performance (Physical Performance Test [PPT] and Short Physical Performance Battery [SPPB]), handgrip strength, Physical Activity Scale in the Elderly (PASE), quality of life measure (SF-8), falls, fractures, nutrient and macromolecule intake (four-day food record). Independent samples t-tests determined mean differences between the above or below RDA protein groups.

STATISTICAL ANALYSIS

Analysis of covariance was used to control for body mass index (BMI) between groups when assessing physical performance, physical activity and health-related quality of life.

RESULTS

The subjects consumed an average of 72.2 g protein/day representing 1.1 g protein/kg body weight/day. Subjects were categorized as below the recommended daily allowance (RDA) for protein (defined as less than 0.8 g protein/kg) or at or above the RDA (equal to or higher than 0.8 g protein/kg). Ninety-seven subjects (25%) were in the low protein group, and 290 (75%) were in the higher protein group. Women in the higher protein group had lower body mass, including fat and lean mass, and fat-to-lean ratio than those in the lower-protein group (p <0.001). Composite scores of upper and lower extremity strength were impaired in the group with low protein intake; SPPB score was 9.9±1.9 compared to 10.6±1.6 in those with higher protein intake and PPT was 19.8± 2.9 compared to 20.9± 2.1 in the low and higher protein groups, respectively. The results were attenuated by correction for BMI, but remained significant. The physical component of the SF-8 was also lower in the low protein group but did not remain significant when controlling for BMI. No significant differences were found in hand grip strength or reported physical activity.

CONCLUSION

Healthy, older postmenopausal women consumed, on average, 1.1 g/kg/d protein, although 25% consumed less than the RDA. Those in the low protein group had higher body fat and fat-to-lean ratio than those who consumed the higher protein diet. Upper and lower extremity function was impaired in those who consumed a low protein diet compared to those with a higher protein intake. Protein intake should be considered when evaluating the multi-factorial loss of physical function in older women.

Nutritional influences on age-related skeletal muscle loss

Age-related muscle loss impacts on whole-body metabolism and leads to frailty and sarcopenia, which are risk factors for fractures and mortality. Although nutrients are integral to muscle metabolism the relationship between nutrition and muscle loss has only been extensively investigated for protein and amino acids. The objective of the present paper is to describe other aspects of nutrition and their association with skeletal muscle mass. Mechanisms for muscle loss relate to imbalance in protein turnover with a number of anabolic pathways of which the mechanistic TOR pathway and the IGF-1–Akt–FoxO pathways are the most characterised. In terms of catabolism the ubiquitin proteasome system, apoptosis, autophagy, inflammation, oxidation and insulin resistance are among the major mechanisms proposed. The limited research associating vitamin D, alcohol, dietary acid–base load, dietary fat and anti-oxidant nutrients with age-related muscle loss is described. Vitamin D may be protective for muscle loss; a more alkalinogenic diet and diets higher in the anti-oxidant nutrients vitamin C and vitamin E may also prevent muscle loss. Although present recommendations for prevention of sarcopenia focus on protein, and to some extent on vitamin D, other aspects of the diet including fruits and vegetables should be considered. Clearly, more research into other aspects of nutrition and their role in prevention of muscle loss is required.

Effectiveness of the MOVE! Multidisciplinary weight loss program for veterans in Los Angeles

Introduction

The purpose of this study was to evaluate the effectiveness of the MOVE! Weight Management Program for Veterans (MOVE!) in achieving weight loss in veterans who attended the multidisciplinary weight management program in the VA Greater Los Angeles Healthcare System.

Methods

From April 1, 2006, to December 31, 2009, 382 veterans enrolled in the MOVE! program; 377 veterans attended at least 3 group sessions and were included in this study. All veterans were encouraged to complete 8 weekly group sessions on nutrition, lifestyle changes, and behavior modification in a group setting led by a multidisciplinary team. After completing the session, veterans had the option of continuing with a support group that meets monthly. The change in weight from 1 year pre-enrollment in MOVE! to 1, 2, and 3 years postenrollment was analyzed.

Results

Veterans gained 1.4 kg per year (standard error [SE] = 0.47, P = .003) before enrolling in MOVE!. One year after the enrollment participants lost on average 2.2 kg (SE = 0.42; P < .001). The pre-enrollment slope for weight change was significantly different from the postenrollment slope.

Conclusion

Findings from this study support the need for a long-term weight management program such as MOVE! in primary care settings to assist overweight and obese VA patients in achieving and maintaining weight loss to reduce the risk and progression of age-related chronic diseases such as diabetes and heart disease.

Intentional weight loss in older adults: useful or wasting disease generating strategy?

PURPOSE OF REVIEW

Strategies for weight management in older adults remain controversial as overweight may protect them against mortality whereas weight loss may have harmful effects by promoting sarcopenia and bone loss. It has been suggested that weight management for obese older adults should focus more on maintaining weight and improving physical function than promoting weight loss. This review aims to specify whether intentional weight loss in older adults is a useful or a wasting disease generating strategy.

RECENT FINDINGS

Recent randomized controlled studies have shown that a supervised, moderate caloric restriction coupled with regular exercise (both aerobic and resistance) in obese older adults do not increase mortality risk and may conversely reduce insulin resistance, metabolic complications, and disabilities without exacerbating lean mass and bone mineral density loss.

SUMMARY

In obese older adults, moderate weight loss may have beneficial effects on comorbidities, functional performances, and quality of life provided that regular physical activity can be associated. An individual approach considering life expectancy, chronic comorbidities, functional status, personal motivation, and social support should be preferred. More research is needed to define the circumstances in which cautious dietary restrictions are reasonably justified in older adults. In any case, in the oldest (≥80 years) as in frail individuals, it seems reasonable to abstain from recommending weight loss.

Substrains of inbred mice differ in their physical activity as a behavior

Recent studies strengthen the belief that physical activity as a behavior has a genetic basis. Screening wheel-running behavior in inbred mouse strains highlighted differences among strains, showing that even very limited genetic differences deeply affect mouse behavior. We extended this observation to substrains of the same inbred mouse strain, that is, BALB/c mice. We found that only a minority of the population of one of these substrains, the BALB/c J, performs spontaneous physical activity. In addition, the runners of this substrain cover a significantly smaller distance than the average runners of two other substrains, namely, the BALB/c ByJ and the BALB/c AnNCrl. The latter shows a striking level of voluntary activity, with the average distance run/day reaching up to about 12 kilometers. These runners are not outstanders, but they represent the majority of the population, with important scientific and economic fallouts to be taken into account during experimental planning. Spontaneous activity persists in pathological conditions, such as cancer-associated cachexia. This important amount of physical activity results in a minor muscle adaptation to endurance exercise over a three-week period; indeed, only a nonsignificant increase in NADH transferase+ fibers occurs in this time frame.

EMAS position statement: Diet and health in midlife and beyond

INTRODUCTION

There is increasing evidence that life-style factors, such as nutrition, physical activity, smoking and alcohol consumption have a profound modifying effect on the epidemiology of most major chronic conditions affecting midlife health.

AIMS

To provide guidance concerning the effect of diet on morbidity and mortality of the most frequent diseases prevalent in midlife and beyond.

MATERIALS AND METHODS

Literature review and consensus of expert opinion.

RESULTS AND CONCLUSIONS

A healthy diet is essential for the prevention of all major chronic non-communicable diseases in midlife and beyond, both directly, through the effect of individual macro- and micronutrients and indirectly, through the control of body weight. Type 2 diabetes mellitus is best prevented or managed by restricting the total amount of carbohydrate in the diet and by deriving carbohydrate energy from whole-grain cereals, fruits and vegetables. The substitution of saturated and trans-fatty acids by mono-unsaturated and omega-3 fatty acids is the most important dietary intervention for the prevention of cardiovascular disease. Obesity is also a risk factor for a variety of cancers. Obese elderly persons should be encouraged to lose weight. Diet plans can follow the current recommendations for weight management but intake of protein should be increased to conserve muscle mass. The consumption of red or processed meat is associated with an increase of colorectal cancer. Adequate protein, calcium and vitamin D intake should be ensured for the prevention of osteoporotic fractures. Surveillance is needed for possible vitamin D deficiency in high risk populations. A diet rich in vitamin E, folate, B12 and omega-3 fatty acids may be protective against cognitive decline. With increasing longevity ensuring a healthy diet is a growing public health issue.

Recumbent cross-training is a feasible and safe mode of physical activity for significantly motor-impaired adults with cerebral palsy

OBJECTIVE

To examine the feasibility and potential benefits of using recumbent cross-training for nonambulatory adults with cerebral palsy (CP).

DESIGN

Observational.

SETTING

Clinical center for CP treatment and rehabilitation.

PARTICIPANTS

Significantly motor-impaired adults with CP (N=11) with a mean age ± SD of 36.3±13.2 years and Gross Motor Function Classification System (GMFCS) levels III and IV.

INTERVENTIONS

Participants completed a 40-minute session of aerobic exercise using the NuStep Recumbent Cross Trainer, in which resistance was progressively increased at 5-minute intervals.

MAIN OUTCOME MEASURES

Every 5 minutes during the exercise session, heart rate, blood pressure, oxygen consumption (VO(2)), energy expenditure, and respiratory exchange ratios (RERs) were recorded along with rating of perceived exertion. Immediately after, and 24 hours postexercise, participants received a standard survey to assess levels of pain and discomfort.

RESULTS

All participants were able to complete the 40-minute exercise protocol. Five of the 11 participants achieved a heart rate of at least 60% maximum throughout the duration, 10 participants had a significant elevation in VO(2) from baseline, and all participants had elevated RER values. Six participants reported pain during exercise, but only 2 reported pain after exercise was over.

CONCLUSIONS

The NuStep Recumbent Cross Trainer is a feasible exercise modality for significantly motor-impaired adults with CP, GMFCS III and IV. Moreover, this mode was sufficient to stimulate a significant cardiorespiratory response in all participants, and thus it and similar devices may serve as a viable option for aerobic exercise interventions in this population, to prevent obesity and related cardiometabolic consequences.

Lifestyle and sarcopenia-etiology, prevention, and treatment

The term sarcopenia describes the loss of skeletal muscle mass, strength, and function in old age. As the world population continues to grow older, more attention is given to the phenomena of sarcopenia and the search for strategies of prevention and treatment. The progression of sarcopenia is affected by age-related physiological and systemic changes in the body, including alterations in skeletal muscle tissue, hormonal changes, increased inflammatory activities, and oxidative stress. Sarcopenia progression is also affected by lifestyle factors which are far more controllable. These factors include various aspects of nutrition, physical activity, exercise, alcohol intake, and tobacco use. Raising the public awareness regarding the impact of these factors, as causes of sarcopenia and potential strategies of prevention and treatment, is of great importance. In this review we aim to describe various lifestyle factors that affect the etiology, prevention, and treatment of sarcopenia.

DEXA measures of body fat percentage and acute phase proteins among breast cancer survivors: a cross-sectional analysis

Background

C-reactive protein (CRP) and Serum amyloid A protein (SAA) increases with systemic inflammation and are related to worse survival for breast cancer survivors. This study examines the association between percent body fat and SAA and CRP and the potential interaction with NSAID use and weight change.

Methods

Participants included 134 non-Hispanic white and Hispanic breast cancer survivors from the Health, Eating, Activity, and Lifestyle Study. Body fat percentage, measured with Dual Energy X-ray Absorptiometer (DEXA), and circulating levels of CRP and SAA were obtained 30 months after breast cancer diagnosis.

Results

Circulating concentrations of CRP and SAA were associated with increased adiposity as measured by DEXA after adjustment for age at 24-months, race/ethnicity, dietary energy intake, weight change, and NSAID use. Survivors with higher body fat ≥35% had significantly higher concentrations of CRP (2.01 mg/l vs. 0.85 mg/l) and SAA (6.21 mg/l vs. 4.21 mg/l) compared to non-obese (body fat < 35%). Women who had gained more than 5% of their body weight since breast cancer diagnosis had non-statistically significant higher geometric mean levels of CRP and SAA. Mean levels of CRP and SAA were higher among obese women who were non-users of NSAIDs compared to current users; the association with SAA reached statistical significance (Mean SAA = 7.24, 95%CI 6.13-8.56 for non-NSAID; vs. 4.87; 95%CI 3.95-6.0 for NSAID users respectively).

Conclusions

Breast cancer survivors with higher body fat had higher mean concentrations of CRP and SAA than women with lower body fat. Further assessment of NSAID use and weight control in reducing circulating inflammatory markers among survivors may be worthwhile to investigate in randomized intervention trials as higher inflammatory markers are associated with worse survival.

Prospective treatment of age-related diseases by slowing down aging

Atherosclerosis, hypertension, obesity, diabetic complications, cancer, benign prostate hyperplasia, Alzheimer and Parkinson diseases, age-related macular degeneration, osteoarthritis, osteoporosis, and seborrheic keratosis are strongly associated with aging, implying a common underlying process. Each disease is treated separately and, in most cases, symptomatically. Suppression of aging itself should delay or treat all age-related diseases, thus increasing healthy life span and maximal longevity. But, is it possible to slow down aging? Recent evidence indicates that the target of rapamycin signaling pathway is involved in cellular senescence and organismal aging. Preclinical and clinical studies demonstrated the therapeutic effects of rapamycin in diverse age-related diseases. One simple reason why a single drug is indicated for so many age-related diseases is that it inhibits the aging process.

Phentermine and topiramate for the management of obesity: a review

Obesity is now a major public health concern worldwide with increasing prevalence and a growing list of comorbidities and complications. The morbidity, mortality and reduced productivity associated with obesity and its complications result in a major burden to health care costs. Obesity is a complex chronic medical syndrome often with multiple different etiologic factors in individual patients. The long term successful management of obesity remains particularly challenging and invariably requires a multifaceted approach including lifestyle and behavioral modification, increased physical activity, and adjunctive pharmacotherapy. Bariatric surgery remains a last resort though at present it has the best results for achieving sustained robust weight loss. Obesity pharmacotherapy has been very limited in its role for long term obesity management because of the past history of several failed agents as well as the fact that presently available agents are few, and generally utilized as monotherapy. The recent FDA approval of the fixed drug combination of phentermine and extended release topiramate (topiramate-ER) (trade name Qsymia™) marks the first FDA approved combination pharmacotherapeutic agent for obesity since the Phen-Fen combination of the 1990s. This review details the history and clinical trial basis for the use of both phentermine and topiramate in obesity therapeutics as well as the results of clinical trials of their combination for obesity treatment in humans. The initial clinical approval trials offer evidence that this fixed drug combination offers synergistic potential for effective, robust and sustained weight loss with mean weight loss of at least 10% of baseline achieved and sustained for up to 2 years in over 50% of subjects treated. It is anticipated that this agent will be the first in a new trend of multi-agent combination therapy for the chronic adjunctive management of obesity.