The Risk of Sarcopenia among Adults with Normal-Weight Obesity in a Nutritional Management Setting

Diet and Physical Activity Intervention in Normal Weight Obesity Population Base on Smartphone App: Protocol for a Randomized Controlled Trial

Background

Normal weight obesity (NWO) is defined as normal body mass index (BMI) but increased body fat percentage (BF%). NWO population tend to develop metabolic syndrome, type 2 diabetes and cardiovascular disease. BF% is the key parameter applied in the evaluation of NWO. The exact prevalence of NWO and the cutoff point for the diagnosis of NWO are not well established. Diet and physical activity interventions are the main approach for NWO management. Smartphone apps are widely used for their effectiveness and individualization, making them ideal tool for simplifying the follow-up process in behavioral interventions for both investigators and participants.

Methods

A single center, prospective, randomized trial will be conducted in Beijing, China. The aim of this 12-week trial is to assess the efficacy of different lifestyle interventions, including diet control only, aerobic training only, resistance training only, and a combination of aerobic and resistance training based on a smartphone app on BF% and metabolic parameters in the NWO population. The primary outcome is the change of BF% between the baseline and 12 weeks post-intervention. The secondary outcomes include changes in measures of anthropometry, blood glucose, insulin, lipids and uric acid between the baseline and 12 weeks of intervention. A sample size of 200 subjects with normal BMI and glucose abnormality confirmed by oral glucose tolerance test will be recruited. Two follow-ups face-to-face and five follow-ups via smartphone app will be included in this trial. Statistical analyses will focus on the differences among different lifestyle interventions and the cutoff point of BF% for diagnosis of NWO.

Discussion

This trial will provide evidence of the efficacy of lifestyle interventions based on smartphone app. The differences in effect among different lifestyle intervention groups will be elucidated. It will be helpful to propose the cutoff point of BF% for diagnosis of NWO.

Trial Registration Number

This study was registered with chictr.org.cn: ChiCTR2200063583.

An Indian Consensus on Sarcopenia: Epidemiology, Etiology, Clinical Impact, Screening, and Therapeutic Approaches

The burden of sarcopenia in India continues to be of significant concern. Its diagnosis is challenging due to the lack of standardized cutoffs for assessing muscle strength, quantity, and function among Indians. This consensus aims to identify features of sarcopenia in Indians and provide culturally relevant recommendations for its management. An expert panel from diverse medical specialties across India arrived at a consensus using the modified Delphi method. The panel recommended that a baseline handgrip strength (HGS) cutoff value of <27.5 kg in males and 18.0 kg in females be defined as low muscle strength for the Indian population. All patients with comorbidities should be screened for sarcopenia. In people with sarcopenia, resistance exercise and nutrition with specialized nutrients such as protein, beta-hydroxy-beta-methylbutyrate (HMB), and micronutrients for at least 3 months were recommended as key interventions.

Global prevalence, metabolic characteristics, and outcomes of lean-MAFLD: a systematic review and meta-analysis

BACKGROUND

Metabolic Dysfunction-Associated Fatty Liver disease (MAFLD) among lean individuals is increasingly recognized. We aimed to compare the prevalence, metabolic characteristics, and outcomes of lean vs overweight/obese-MAFLD patients.

METHODS

Databases of Embase, Medline, and Web of Science were searched from inception till October 2023. Only cohorts adhering to the lean-MAFLD criteria as defined by the international consensus statement were included.

RESULTS

In the pooled analysis of 10,013,382 individuals, the prevalence of lean-MAFLD in the general population was 1.94% (95% CI 1.10-3.39%, I2 = 98.7%). Lean and overweight/obese-MAFLD patients had similar metabolic characteristics for blood pressure, LDL, TG, blood glucose, and HbA1c. There was an increased incidence rate and likelihood for liver-related mortality for lean-MAFLD vs overweight/obese-MAFLD [1.33 per 1000 patient-years (95% CI 1.28-1.39) vs 0.76 (95% CI 0.25-2.28), (OR 3.56 (95% CI 3.45-3.67), p < 0.01). There were similar incidence rates and odds ratios between lean vs overweight/obese-MAFLD for: (1) all-cause mortality [10.08 per 1000 patient-years (95% CI 9.93-10.23) vs 8.94 per 1000 patient-years (95% CI 4.08-19.57), (OR 1.92 (95% CI 0.01-220.57), p = 0.33)]; (2) cardiovascular-related mortality [2.53 per 1000 patient-years (95% CI 0.65-9.96) vs 2.07 per 1000 patient-years (95% CI 0.80-5.39), (OR 1.91 (95% CI 0.02-142.76), p = 0.58)]; and (3) cancer-related mortality [3.42 per 1000 patient-years (95% CI 3.33-3.51) vs 3.15 per 1000 patient-years (95% CI 1.21-8.19), (OR 1.99 (95% CI 0.29-13.52), p = 0.13).

CONCLUSION

Lean-MAFLD patients have an equivalent metabolic burden compared to overweight/obese-MAFLD patients and thus a similar incidence rate of major extrahepatic complications. However, they have an increased risk of liver-related mortality.

Body composition of older adults with normal body mass index. Cross-sectional analysis of the Toulouse Frailty clinic

BACKGROUND

Body mass index (BMI) determines general corpulence and health, whatever age, sex or clinical background. Normal BMI (18.5-24.9 kgm2) is defined as healthy, normal, weight leading to a false impression that no intervention is needed.

OBJECTIVES

Assess the prevalence of body impairments in the presence of normal BMI.

DESIGN

Cross-sectional design. Bivariate and a multivariate regression analysis assessed the association of body composition with clinical parameters in the presence of normal BMI.

SETTING

Community dwelling older adults attending the Toulouse Frailty Clinic at the University Hospital, Toulouse.

PARTICIPANTS

876 community dwelling, autonomous older adults, 70 years and over.

MEASUREMENTS

Dual X-ray Absorptiometry (DXA) assessment, and cognitive, physical, nutritional, and demographic evaluations were included in the present analysis.

RESULTS

Of the initial sample, 347 (39.61 %) patients had normal BMI, and among them, 152 (43.80 %) had low lean mass, 144 (41.49 %) were osteoporotic and 2 (0.58 %) increased fat mass. A poor nutritional status (Mini-Nutritional Assessment score, MNA-score, <24) was the only independent variable associated with body impairments in the presence of normal BMI (Odd Ratio 2.83; 95 % Confidence Interval 1.64-4.89).

CONCLUSION

Nearly 70 % of the adults with normal BMI had at least one impairment in body composition (low lean mass, osteoporosis, or obesity). In the light of the present study, older adults with normal BMI and an MNA-score under 24 should be assessed with DXA to identify the age-associated impairments in body composition in order to lead to specific interventions.

Weight-Adjusted Waist Index (WWI)-A Promising Anthropometric Indicator of Depressive Symptoms in Hospitalized Older Patients

OBJECTIVES

The aim of this study was to evaluate which anthropometric index, either body mass index (BMI) or weight-adjusted waist index (WWI), is more accurately associated with the prevalence of the most common chronic diseases and components of geriatric assessment in hospitalized older adults.

METHODS

The study included a total of 2945 hospitalized older adults (median age 82 years). The associations between the presence of chronic diseases and Comprehensive Geriatric Assessment (CGA) results were compared with WWI and BMI values.

RESULTS

The WWI was significantly higher in both sex groups suffering from hypertension, diabetes, osteoarthritis, and depression. In women, the parameter was increased among individuals with previous myocardial infarction, who presented heart failure symptoms or had chronic kidney disease diagnosed, whereas in men, among those with pulmonary diseases and osteoporosis, WWI was related to many CGA parameters oftentimes where BMI proved to fail. There was a positive correlation of WWI with the presence of depressive symptoms assessed with the geriatric depression scale (GDS) but no significant correlation with BMI. In multiple logistic regression models, WWI was a stronger predictor of depression as compared to waist circumference or the waist-to-height ratio.

CONCLUSIONS

There is an association between a higher WWI and depression diagnosis as well as the presence of depressive symptoms according to the GDS in hospitalized older adults, both women and men. There is no such correlation between depression and BMI. Both high BMI and high WWI values seem to identify older patients with cardiometabolic diseases such as hypertension and diabetes. According to this study, WWI seems to be a promising indicator of depression risk and, similarly to BMI, a useful parameter for the assessment of cardiometabolic risk in older hospitalized adults.

The obesity paradox in younger adult patients with sepsis: analysis of the MIMIC-IV database

BACKGROUND

The obesity paradox suggests that individuals with obesity may have a survival advantage against specific critical illnesses, including sepsis. However, whether this paradox occurs at younger ages remains unclear. Therefore, we aimed to investigate whether obesity could improve survival in younger adult patients with sepsis.

METHODS

We used clinical data sourced from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Patients with Sequential Organ Failure Assessment score ≥2 and suspected infection at the time of ICU admission were identified as having sepsis, following the Sepsis-3 definition. Individuals were classified into the obesity (BMI ≥30 kg/m²) and non-obesity (BMI <30 kg/m²) groups. Patients aged <50 and ≥50 years were categorized as younger adult patients and older patients, respectively.

RESULTS

Of 73,181 patients in the MIMIC-IV ICU database, 18,120 satisfied the inclusion criteria: 2642 aged <50 years and 15,478 aged ≥50 years. The Kaplan-Meier curve showed that obesity was not associated with an improved mortality rate among younger adult patients with sepsis (log-rank test: P = 0.197), while obesity exhibited a survival benefit in older patients with sepsis (log-rank test: P < 0.001). After propensity score matching, in-hospital mortality did not differ significantly between the obesity and non-obesity groups (13.3% vs. 12.2%; P = 0.457) in the younger adult patients with sepsis. Multivariate logistic regression analysis revealed that BMI was not an independent risk factor for in-hospital mortality in younger adult patients with sepsis (underweight: adjusted odds ratio [aOR] 1.72, P = 0.076; overweight: aOR 0.88, P = 0.437; obesity: aOR 0.93, P = 0.677; and severe obesity: aOR 1.22, P = 0.580, with normal weight as the reference).

CONCLUSION

Contrary to findings regarding older patients with sepsis, our findings suggest that the obesity paradox does not apply to younger adult patients with sepsis.

Obesity and 1-year all-cause survival of adult intensive care patients with heart failure: data from the MIMIC-IV

BACKGROUND

Heart failure is a disease that threatens global public safety. In recent years, the obesity paradox has been studied in cardiovascular disease and other fields. With the progress of aging, metabolic changes and regulation of fat function, it also provides many bridges for the dialogue between disease and molecular metabolism. The purpose of this study is to investigate the effect of obesity on the outcome of adult intensive care patients with heart failure combined with age factors.

METHOD

Data were derived from the fourth-generation Medical Information Marketplace for Intensive Care (MIMIC-IV version2.1) using structured query language on the Navicat (12.0.11) platform. People were divided into two groups based on the body mass index (BMI), one group with BMI ≥ 30 kg/m² and another group with BMI < 30 kg/m². Afterwards, the patients were divided into two subgroups based on their ages. One group included patients aged<60, and the other included patients aged ≥ 60. The extracted information includes demographic characteristics, laboratory findings, comorbidities, scores. Main results included in-hospital mortality, ICU mortality, and 1-year mortality. Secondary outcomes included hospital interval and ICU interval, use of renal replacement therapy, and rates of noninvasive and invasive ventilation support.

RESULT

In this cohort study, 3390 people were in the BMI<30 group, 2301 people were in the BMI ≥ 30 group, 960 people were in the age<60 group, and 4731 people were in the age ≥ 60 group, including 3557 patients after propensity score matching in high age group. Among patients aged ≥ 60, BMI ≥ 30 group vs. BMI<30 group showed significantly lower in-hospital mortality (13% vs. 16%) and one-year mortality (41% vs. 55%), respectively. Neither primary nor secondary outcomes were significantly described in the competition among patients aged under 60. Restricted cubic spline reveals a J-shaped nonlinear association between BMI and clinical endpoints within the entire cohort. Kaplan-Meier curves revealed a survival advantage in BMI ≥ 30 group (p < 0.001). Following age stratification, a beneficial effect of BMI categories on one-year mortality risk was observed in heart failure patients aged ≥ 60 (Univariable HR, 0.71, 95% CI, 0.65-0.78, p < 0.001; Multivariable HR, 0.74, 95% CI, 0.67-0.81, p < 0.001), but not in those under 60 years old.

OUTCOME

In ICU patients with heart failure, obesity offers a survival benefit to those aged ≥ 60. No obesity paradox was observed in patients younger than 60 years old. The obesity paradox applies to patients aged ≥ 60 with heart failure.

Sarcopenia prevalence and risk factors in obese Tunisian adults

INTRODUCTION

Sarcopenia is a clinical condition defined as low skeletal muscle mass and function. It has been identified and described as a geriatric syndrome, but it may arise in individuals with obesity at any age.

AIM

screen for sarcopenia in obese adults and identify the nutritional, clinical and biological risk factors associated with the development of sarcopenic obesity (SO+).

METHODS

Descriptive cross-sectional study, including 53 obese patients. Screening for sarcopenia has been established according to pathological thresholds proposed by the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO).

RESULTS

Mean age was 44.34±13.51 years. Prevalence of Sarcopenia was 7.5% (SO+). The average intakes of calorie, lipids and saturated fatty acids were higher in SO+. A statistically significant relationship was found between low skeletal muscle mass (SMM/W) and the average intake of vitamin PP (p=0.014) and vitamin B9 (p=0.009). Mean BMI (45.86 kg/m² for SO+ versus 39.29 kg/m² for SO-; p=0.03) and mean visceral fat (16.55 l for SO+, versus 10.93 l for SO-; p=0.043) were significantly higher in SO+. A statistically significant relationship was found between insulin resistance and low (SMM/W), as attested by mean insulinemia (28.81 µIU/mL for low SMM/W, versus 14.48 µIU/mL for normal SMM/W; p=0.004) and HOMA index (7.94 for low SMM/W, versus 3.49 for normal SMM/W; p=0.002), which were higher in cases of low (SMM/W).

CONCLUSION

We recommend promoting a balanced, low-energy-density diet to improve insulin sensibility and thus reduce the risk of sarcopenia. Regular physical activity is also strongly recommended.

Association between normal-weight obesity and bone mineral density in older Korean adults: A population-based cross-sectional study

The effects of normal-weight obesity, which is defined as having a high level of body fat despite a normal body mass index, on the health of bones in older adults are poorly understood. This cross-sectional study examined the relationship between normal-weight obesity and bone mineral density in Korean adults aged 50 years or more (2815 men and 2744 women) from the 2008-2011 Korea National Health and Nutrition Examination Surveys. Between the ages of 50 and 69 years, individuals with normal-weight obesity had a higher risk of low bone mineral density (odds ratio = 1.596, 95 % confidence interval = 1.189-2.141, p = 0.002) compared with individuals with normal-weight non-obesity. However, no significant association between normal-weight obesity and bone mineral density was observed among people between the ages of 70 and 89 years. The study findings support the clinical significance of normal-weight obesity as a proxy biomarker to identify in primary care settings people who are at increased risk of developing osteoporosis at an early stage of aging.

Association between Sarcopenia and Reduced Bone Mass: Is Osteosarcopenic Obesity a New Phenotype to Consider in Weight Management Settings?

Sarcopenic obesity (SO) is a frequent phenotype in people with obesity; however, it is unclear whether this links with an impaired bone status. In this study, we aimed to investigate the association between SO and low bone mass, and to assess the prevalence of a new entity that combines excessive fat deposition, reduced muscle mass and strength, and low bone mass defined as osteosarcopenic obesity (OSO). Body composition was completed by a DXA scan in 2604 participants with obesity that were categorized as with or without SO, and with low or normal bone mineral content (BMC). Participants with both SO and low BMC were defined as OSO. Among the entire sample, 901 (34.6%) participants met the criteria for SO. This group showed a reduced mean BMC (2.56 ± 0.46 vs. 2.85 ± 0.57, p < 0.01) and displayed a higher prevalence of individuals with low BMC with respect to those without SO (47.3% vs. 25.9%, p < 0.01). Logistic regression analysis showed that the presence of SO increases the odds of having low BMC by 92% [OR = 1.92; 95% CI: (1.60-2.31), p < 0.05] after adjusting for age, body weight, and body fat percentage. Finally, 426 (16.4%) out of the total sample were affected by OSO. Our findings revealed a strong association between SO and reduced bone mass in adults with obesity, and this introduces a new phenotype that combines body fat, muscle, and bone (i.e., OSO) and appears to affect 16% of this population.