The effect of combining nutrient intake and physical activity levels on central obesity, sarcopenia, and sarcopenic obesity: a population-based cross-sectional study in South Korea

Dietary ω-3 polyunsaturated fatty acid intake improves skeletal muscle mass in patients with metabolic dysfunction-associated fatty liver disease: A nationwide cross-sectional study

BACKGROUND

Improving our understanding of whether increased dietary intake of ω-3 polyunsaturated fatty acids (PUFAs) is beneficial for increasing skeletal muscle mass in patients with metabolic dysfunction-associated fatty liver disease (MAFLD) could provide an important clinical evidence base for the development of relevant nutritional guidelines.

AIM

To investigate the effect of total dietary ω-3 PUFAs and their subtypes on skeletal muscle mass in MAFLD.

METHODS

This cross-sectional study involved 2316 participants from four National Health and Nutrition Examination Survey cycles between 2011 and 2018. Dietary intake of ω-3 PUFAs was collected through 24-hour dietary recall interviews. Appendicular skeletal muscle mass index (ASMI) was calculated by dividing ASM in kilograms by height squared.

RESULTS

The multiple linear regression model showed significant relationships for dietary intake of total ω-3 PUFAs with higher ASMI (β: 0.06, 95%CI: 0.01–0.11) in MAFLD patients. Dietary a-linolenic acid (ALA) (β: 0.06, 95%CI: 0.01–0.12), docosapentaenoic acid (β: 1.28, 95%CI: 0.01–2.54), and docosahexaenoic acid (DHA) (β: 0.19, 95%CI: 0.01–0.37) were significantly associated with higher ASMI, while intake of stearidonic acid and eicosapentaenoic acid did not improve ASMI. In patients with high probability of liver fibrosis, dietary intake of ALA was associated with higher ASMI (β: 0.11, 95%CI: 0.03–0.18). Stratified analysis found that DHA was associated with higher ASMI in patients with obesity and higher metabolic risk.

CONCLUSION

Increasing dietary intake of ω-3 PUFAs improved skeletal muscle health in patients with MAFLD. Patient with obesity and higher metabolic risk were more likely to benefit from intake of DHA.

Multifactorial Determinants of Body Composition in the Korean Older Adults: Using Data from the 2022-2023 National Health and Nutrition Examination Survey

Background/Objectives: Sarcopenia, abdominal obesity, and sarcopenic obesity are prevalent and clinically significant in older adults, each shaped by diverse biopsychosocial factors. However, integrative analyses using nationally representative data remain limited in Korea. Methods: We analyzed 2118 adults aged ≥65 years from the 2022-2023 Korea National Health and Nutrition Examination Survey (KNHANES). Body composition was classified into sarcopenia, abdominal obesity, and sarcopenic obesity. Guided by Engel's Biopsychosocial Model, we examined biological (e.g., sex, chronic disease, nutrition, exercise), psychological (e.g., stress, sleep, self-rated health), and social (e.g., income, education, living status) variables. Complex-sample multinomial logistic regression identified condition-specific associations. Results: Prevalence rates were 18.2% for sarcopenia, 41.0% for abdominal obesity, and 3.4% for sarcopenic obesity. Eating alone and a lack of resistance exercise were common risk factors across all three conditions. Sarcopenia was associated with male sex, insufficient dietary intake, alcohol consumption, poor self-rated health, and low household income. Abdominal obesity was linked to recent weight gain, hypertension, diabetes, prolonged sedentary time, perceived obesity, and low educational attainment. Sarcopenic obesity was associated with male sex, diabetes, elevated hs-CRP, perceived stress, poor self-rated health, and economic inactivity. Conclusions: Body composition abnormalities among older Korean adults are influenced by complex, condition-specific interactions across biological, psychological, and social domains. These findings emphasize the significance of adopting an integrative perspective that considers physical, psychological, and social health components when addressing age-related body composition issues.

Comparative efficacy of exercise, nutrition, and combined exercise and nutritional interventions in older adults with sarcopenic obesity: a protocol for systematic review and network meta-analysis

BACKGROUND

Sarcopenic obesity (SO) in older adults is associated with certain adverse outcomes, including falls, fractures, and disability, all of which affect patient quality of life, represent an economic burden, and potentially enhance the risk of death. Although a number studies have examined the effects of exercise, nutrition, and combined exercise and nutritional interventions on older adults with SO, the optimal therapeutic approach has yet to be sufficiently established. In this systematic review and network meta-analysis (NMA) protocol for SO in older adults, we aim to compare the combined effects of exercise and nutrition with those of exercise or nutritional interventions alone on the body composition and physical performance of older adults with SO.

METHODS

The PubMed, Web of Science, Embase, OVID, CINAHL, CNKI, Wanfang Data, and VIP databases will be used to systematically search for randomized controlled trials published from the time of database inception to December 2024. Outcomes will include body composition and physical performance, and data will be extracted independently by two researchers. In cases of disagreement, a consensus will be reached by consulting a third researcher. The Cochrane risk-of-bias tool will be used to assess randomized controlled trials, and data analysis will be performed using Stata 15.0 and R software, based on homogeneity, sensitivity, transitivity, consistency, and publication bias tests.

DISCUSSION

By comprehensively assessing the relative efficacies of exercise, nutrition, and combined interventions in older adults with SO, we aim in this systematic review and NMA to fill an important gap in the existing literature. These findings will provide a reference for healthcare providers and policymakers and facilitate the development of evidence-based guidelines that will contribute to optimizing SO management and gaining more favorable outcomes for this vulnerable population.

SYSTEMATIC REVIEW REGISTRATION

CRD42024504706.

Association of fear of falling and low physical activity with fall risk among older Taiwanese community-dwellers

BACKGROUND AND PURPOSE

Fear of falling and low physical activity become prevalent in an aged society, but their association with fall risk warrants further investigation.

METHODS

Our study involved 600 individuals aged 70.8-96.1 years who completed two rounds of community surveys. During the second survey, we analyzed the correlations between fall incidents and a range of factors, including age, sex, gait maneuverability, vision, comorbidity count, depressive symptoms, cognitive function, history of falls, fear of falling, and physical activity level. The chi-square test and univariate and multivariate logistic regression models were used, with further analyses either adjusted for or stratified by the full-factor combinations of fear of falling (with versus without) and low physical activity (low versus moderate-to-high).

RESULTS

Falls exhibited a prevalence rate of 13.8%. A fall risk gradient by the full-factor combinations was observed. Multivariate logistic regression modeling identified independent risk predictors for falls, including the number of comorbidities, depressive symptoms, a history of falls, and fear of falling. Fear of falling and low physical activity presented a synergistic effect to increase the fall risk by two- and one-third times (adjusted odds ratio: 2.35, 95% confidence interval: 1.12-4.91). Depressive symptoms, cognitive impairment, and a history of falls remained as significant risk predictors for older adults with both factors, those with fear of falling only, and those with neither, respectively, when the models were further stratified.

CONCLUSION

Fear of falling and low physical activity presented likely synergism to increase the fall risk. Those older community-dwellers with both risk factors warrant fall prevention resources as a priority over those with either or neither.

Dietary Patterns Associated with Body-Composition Phenotype in a Middle-Aged and Elderly Population: A Population-Based Cross-Sectional Study

BACKGROUND/OBJECTIVES

There is currently limited understanding of the intricate dynamics between fat and muscle mass and the potential effect of dietary patterns. This study aimed to investigate the effects of overall dietary patterns on four body composition phenotypes associated with central obesity and low muscle mass in the middle-aged and elderly population of Korea.

METHODS

We examined data from 6120 adults aged ≥ 50 years, collected during the 4th (2008-2009) and 5th (2010-2011) Korea National Health and Nutrition Examination Survey. Participants were classified into four groups according to their combined status of central obesity and low muscle mass: healthy control, central obesity, low muscle mass, and sarcopenic obesity. Using factor analysis on the twenty-two pre-defined food groups, we identified three distinct dietary patterns: the "Healthy dietary pattern", "Convenience-based dietary pattern", and "Alcohol and side dish pattern". Multivariate analysis included potential confounders such as age, sex, place of residence, marital status, educational level, occupation, household income, and physical activity level.

RESULTS

Higher scores in the "Healthy dietary pattern" were associated with lower odds of sarcopenic obesity (OR = 0.61, 95% CI = 0.40-0.92, p for trend = 0.018). For the "Convenience-based dietary pattern", individuals in the third tertile of the dietary pattern score showed a marginal association with low muscle mass (OR = 1.18, 95% CI = 0.99-1.41, p for trend = 0.056). The "Alcohol and side dish pattern" was linked to higher odds of central obesity (OR = 1.22, 95% CI = 1.03-1.44, p for trend = 0.016) and low muscle mass (OR = 1.21, 95% CI = 1.01-1.45, p for trend = 0.043).

CONCLUSIONS

The drinking practice of consuming foods high in saturated fats and salt alongside alcoholic drinks may negatively affect fat accumulation and muscle composition among older adults. Adopting a healthy eating pattern characterized by grains, vegetables, legumes, fruits, fish, and seaweed could be notably advantageous for promoting and maintaining healthy body composition and optimal skeletal muscle health.

Association of the dietary inflammatory index with sarcopenic obesity and frailty in older adults

OBJECTIVES

This study examined whether a higher dietary inflammatory index (DII®) is associated with the risk of sarcopenic obesity (SO) and frailty among Korean older adults.

METHODS

A total of 950 participants aged 70-84 years, who completed the baseline nutrition survey of the Korean Frailty and Aging Cohort Study, were included in the analysis. The DII, quantifying the dietary inflammatory potential, was calculated using 23 foods and nutrients as assessed by a 24-h dietary recall. SO was defined as the coexistence of sarcopenia (dual-energy X-ray absorptiometry-measured appendicular skeletal muscle mass index of < 7.0 for males; <5.4 for females) and abdominal obesity (waist circumference of ≥ 90 cm for males; ≥85 cm for females). Frailty status was assessed using the Fried frailty index (range, 0-5), a simple tool for defining frailty that consists of three or more of five frailty items. Multinomial logistic regression models were used to estimate odds ratios (ORs) with 95% confidence intervals (CIs), adjusting for confounders.

RESULTS

The prevalence of SO and frailty was 9.8% and 10.8%, respectively. The DII was significantly higher in the frail group (2.7) compared to the robust and SO groups (2.0 vs. 1.8) (P < 0.001). Among nutrients and foods included in the DII, the frail group exhibited lower vitamin E, niacin, vitamin B6, energy, and protein intakes than the robust and SO groups. Multivariable-adjusted OR (95% CI) for frailty versus robust (comparing DII tertile 3 to tertile 1) was 2.3 (1.1-4.8; P-trend = 0.02). However, no significant association was observed between the DII and SO (OR, 1.1; 95% CI, 0.5-2.1; P-trend = 0.6).

CONCLUSIONS

A higher DII score was associated with increased odds of frailty but not with SO in Korean older adults, suggesting that proinflammatory diets have a greater impact on frailty than that on SO in the older population.

Identification of factors associated with sarcopenic obesity development: Literature review and expert panel voting

Sarcopenic obesity (SO) is defined as the combination of excess fat mass (obesity) and low skeletal muscle mass and function (sarcopenia). The identification and classification of factors related to SO would favor better prevention and diagnosis. The present article aimed to (i) define a list of factors related with SO based on literature analysis, (ii) identify clinical conditions linked with SO development from literature search and (iii) evaluate their relevance and the potential research gaps by consulting an expert panel. From 4746 articles screened, 240 articles were selected for extraction of the factors associated with SO. Factors were classified according to their frequency in the literature. Clinical conditions were also recorded. Then, they were evaluated by a panel of expert for evaluation of their relevance in SO development. Experts also suggested additional factors. Thirty-nine unique factors were extracted from the papers and additional eleven factors suggested by a panel of experts in the SO field. The frequency in the literature showed insulin resistance, dyslipidemia, lack of exercise training, inflammation and hypertension as the most frequent factors associated with SO whereas experts ranked low spontaneous physical activity, protein and energy intakes, low exercise training and aging as the most important. Although literature and expert panel presented some differences, this first list of associated factors could help to identify patients at risk of SO. Further work is needed to confirm the contribution of factors associated with SO among the population overtime or in randomized controlled trials to demonstrate causality.

Discriminant analysis of ecological factors influencing sarcopenia in older people in South Korea

This study aimed to investigate the ecological system factors that influence discrimination of sarcopenia among older individuals living in contemporary society. Data analysis included information from 618 older adults individuals aged 65 years or older residing in South Korea. To assess variations in ecological system factors related to SARC-F scores, we conducted correlation analysis and t-tests. Discriminant analysis was used to identify factors contributing to group discrimination. The key findings are summarized as follows. First, significant differences at the p < 0.001 level were observed between the SARC-F score groups in various aspects, including attitudes toward life, wisdom in life, health management, social support, media availability, sports environment, collectivist values, and values associated with death. Further, service environment differences were significant at p < 0.01 level, while social belonging and social activities exhibited significance at p < 0.05. Second, factors influencing group discrimination based on the SARC-F scores were ranked in the following order: health management, attitudes toward life, fear of own death, wisdom in life, physical environment, sports environment, media availability, social support, fear of the own dying, collectivist values, service environment, social activities, and social belonging. Notably, the SARC-F tool, which is used for sarcopenia discrimination, primarily concentrates on physical functioning and demonstrates relatively low sensitivity. Therefore, to enhance the precision of sarcopenia discrimination within a score-based group discrimination process, it is imperative to incorporate ecological system factors that exert a significant influence. These modifications aimed to enhance the clarity and precision of the text in an academic context.

Prevalence of sarcopenic obesity in the older non-hospitalized population: a systematic review and meta-analysis

BACKGROUND

Sarcopenic obesity emerges as a risk factor for adverse clinical outcomes in non-hospitalized older adults, including physical disabilities, metabolic diseases, and even mortality. In this systematic review and meta-analysis, we investigated the overall SO prevalence in non-hospitalized adults aged ≥ 65 years and assessed the sociodemographic, clinicobiological, and lifestyle factors related to SO.

METHODS

We searched the PubMed, Embase, Cochrane Library, and Web of Science databases for studies reporting the prevalence of SO from database inception to October 2023. Two researchers independently screened the literature, evaluated the study quality, and extracted the data. Both fixed- and random-effects models were used in the meta-analysis to estimate the pooled SO prevalence and perform subgroup analyses. Publication and sensitivity bias analyses were performed to test the robustness of the associations.

RESULTS

Among 46 studies eligible for review and a total of 71,757 non-hospitalized older adults, the combined prevalence of SO was 14% (95% CI:11-17%, I2 = 99.5%, P < 0.01). Subgroup analysis according to lifestyle factors demonstrated that the SO prevalence was 17% (95% CI: 8-29%, I2 = 99.5%, P < 0.01) in older adults without exercise habits. Regarding clinicobiological factors, older adults with a history of falls (15% [95% CI: 10-22%, I2 = 82%, P < 0.01]), two or more chronic diseases (19% [95% CI: 10-29%, I2 = 97%, P < 0.01]), functional impairment (33% [95% CI: 29-37%, I2 = 0%, P = 0.95]), cognitive impairment (35% [95% CI: 9-65%, I2 = 83%, P = 0.02]), osteoporosis (20% [95% CI: 8-35%, I2 = 96%, P < 0.01]), high fasting glucose level (17% [95% CI: 1-49%, I2 = 98%, P < 0.01]), or the use of antipsychotics (13% [95% CI: 2-28%, I2 = 0%, P = 0.32]) exhibited a higher SO prevalence.

CONCLUSION

SO prevalence is high among non-hospitalized older adults, especially those with functional and cognitive impairments. Thus, SO is a potential problem for the aging population; implementation of planned interventions in the community is needed to reduce the prevalence and adverse outcomes of SO.

Sex-Specific Effects of Dietary Factors on Sarcopenic Obesity in Korean Elderly: A Nationwide Cross-Sectional Study

This study aimed to compare the dietary factors related to sarcopenia and obesity status in 5458 elderly individuals (2391 men and 3076 women) aged ≥65 years from the Korean National Health and Nutrition Examination Survey (2016-2019). Participants were categorized into normal, sarcopenia, obesity, and sarcopenic obesity groups. Sarcopenic obesity showed a higher prevalence of diabetes and lower HDL cholesterol levels compared to obesity. Sarcopenic obesity exhibited a lower total KHEI score and lower adequacy, including meat/fish/eggs/beans, than normal or obesity. In women, sarcopenic obesity scored lower than obesity on the total KHEI, adequacy for most foods, and balance of energy intake, and lower than sarcopenia on the adequacy of breakfast and milk/milk products. Sarcopenic obesity showed no significant difference in energy intake compared to sarcopenia, and less physical activity compared to sarcopenia and obesity, with a BMI/waist circumference comparable to that of obesity. Low total KHEI scores and scores for meat/fish/eggs/beans were most closely associated with sarcopenia in men and with sarcopenic obesity in women. In conclusion, low dietary quality and inadequate protein-rich foods are possibly associated with the prevalence of sarcopenic obesity in elderly Koreans, especially in women. Adequate energy intake and dietary diversity may be effective in managing sarcopenic obesity.

Association of Combining Diet and Physical Activity on Sarcopenia and Obesity in Elderly Koreans with Diabetes

This study aimed to identify the combined factors of physical activity and diet associated with non-sarcopenic non-obese status in 1586 diabetic patients aged ≥65 years from the Korean National Health and Nutrition Examination Survey (2016 to 2019). Participants were categorized into non-sarcopenic non-obesity (NSNO), sarcopenia non-obesity (SNO), non-sarcopenic obesity (NSO), and sarcopenic obesity (SO) groups. NSNO had lower insulin, HOMA-IR, and triglycerides compared to NSO and SO. NSNO had lower perceived stress, higher nutrition education and dietary supplement intake. As assessed by the Korean Healthy Eating Index, NSNO scored higher total than SNO and SO, in breakfast and energy balance compared to SO, and in the adequacy of vegetables and meat/fish/egg/bean compared to SNO. NSNO had significantly higher energy and protein intake and physical activity, with BMI/waist circumference lower than NSO, SO, and comparable to SNO. Physical activity was positively associated with NSNO. Low Total KHEI score and protein intake level reduced the odds ratio (OR) of NSNO, particularly when physical activity was insufficient, with OR = 0.38 for KHEI Q1 and OR = 0.32 for protein T1. In conclusion, physical activity, diet quality, and protein intake are associated with NSNO prevalence in Korean elderly with diabetes, and energy balance through active intake and expenditure may be effective.

Effects of low-volume functional and running high-intensity interval training on physical fitness in young adults with overweight/obesity

Objectives: This study examined and compared the effects of functional and running high-intensity interval training (HIIT) on body composition, cardiorespiratory fitness, and muscular fitness of young adults with overweight or obesity. Methods: Forty-five participants (22.1 ± 2.1 years, BMI = 25.2 ± 1.0 kg/m2) were assigned to functional HIIT (HIIT-F; n = 15), running HIIT (HIIT-R; n = 15), or non-training control group (CON; n = 15). Participants in HIIT-F and HIIT-R performed functional exercise based-HIIT (four sets of all-out whole-body exercises including jumping jacks, squats, twist jumps and mountain climbers, et al.) and running HIIT (four sets of running on a treadmill) for 12 weeks, respectively. Body composition, muscular fitness, and cardiorespiratory fitness were assessed pre and post intervention. Results: Both HIIT-F and HIIT-R significantly improved the body composition and cardiorespiratory fitness, with HIIT-F induced greater improvements in lean mass (+1.623 vs. -1.034 kg, p < 0.001), back strength (+6.007 vs. +3.333 kg, p < 0.01), and push-ups (+5.692 vs. 1.923 reps, p < 0.001) than that in HIIT-R. HIIT-R reduced more visceral fat area (VFA) (-11.416 vs. -4.338 cm2, p = 0.052) and induced similar improvement in cardiorespiratory fitness (VO2max, +2.192 vs. +2.885 mL/kg/min, p = 0.792) with HIIT-F. Conclusion: Twelve weeks of HIIT-R or HIIT-F improved physical fitness among young adults with overweight or obesity. Despite the similar impact on cardiorespiratory fitness, HIIT-F generates a better positive effect on muscular fitness relative to HIIT-R, which could be partly explained by the greater increase in lean mass after HIIT-F intervention.

Sleep Duration and Sarcopenia: An Updated Systematic Review and Meta-Analysis

OBJECTIVES

In adults, short and long sleep duration has been associated with sarcopenia risk. Studies have shown that various factors, including biological and psychological factors, could be the underlying cause of the association between aberrant sleep duration and sarcopenia risk. In this study, we have qualitatively and quantitatively summarized previously published studies on sleep duration to assess the relationship between sleep duration and sarcopenia risk in adults. This would aid in enhancing our understanding of recent advancements in this field and the association between sleep duration and sarcopenia risk.

DESIGN

Systematic review and meta-analysis.

SETTING AND PARTICIPANTS

In this review, we included studies evaluating the association between the duration of sleep and sarcopenia in adults in observational studies.

METHODS

Five electronic databases (PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Web of Science) were searched to April 20, 2023, to identify studies related to sarcopenia and sleep duration. Next, we calculated the odds ratios (ORs) for sarcopenia prevalence based on the adjusted data from individual studies. Statistical analyses were performed using Stata 11.0.

RESULTS

Sarcopenia prevalence was high (18%) in adults with long sleep duration. Our results showed a significant association between short duration of sleep and high sarcopenia prevalence in older adults (OR 1.2, 95% CI 1.02-1.41, I2 = 56.6%). Furthermore, a significant association was observed between all participants with long-duration sleep and high sarcopenia prevalence (OR 1.53, 95% CI 1.34-1.75, I2 = 56.8%). We also observed significant heterogeneity in the adjusted ORs.

CONCLUSIONS AND IMPLICATIONS

There was a correlation between sarcopenia and short or long sleep duration, especially in older adults. In adults with a long duration of sleep, sarcopenia prevalence was relatively high.

A Comprehensive Review of Pathological Mechanisms and Natural Dietary Ingredients for the Management and Prevention of Sarcopenia

Sarcopenia is characterized by an age-related loss of skeletal muscle mass and function and has been recognized as a clinical disease by the World Health Organization since 2016. Substantial evidence has suggested that dietary modification can be a feasible tool to combat sarcopenia. Among various natural dietary ingredients, the present study focused on botanical and marine extracts, phytochemicals, and probiotics. Aims of this review were (1) to provide basic concepts including the definition, diagnosis, prevalence, and adverse effects of sarcopenia, (2) to describe possible pathological mechanisms including protein homeostasis imbalance, inflammation, mitochondrial dysfunction, and satellite cells dysfunction, and (3) to analyze recent experimental studies reporting potential biological functions against sarcopenia. A recent literature review for dietary ingredients demonstrated that protein homeostasis is maintained via an increase in the PI3K/Akt pathway and/or a decrease in the ubiquitin-proteasome system. Regulation of inflammation has primarily targeted inhibition of NF-κB signaling. Elevated Pgc-1α or Pax7 expression reverses mitochondrial or satellite cell dysfunction. This review provides the current knowledge on dietary components with the potential to assist sarcopenia prevention and/or treatment. Further in-depth studies are required to elucidate the role of and develop various dietary materials for healthier aging, particularly concerning muscle health.