Sarcopenic Obesity

Tae Nyun Nyun; Kyung Mook Choi

doi:10.4093/jkd.2013.14.4.166

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Nyun and Choi: Sarcopenic Obesity

Statement

J Korean Diabetes 2013;14(4):166-173.

Published online: 10 January 2013

DOI: https://doi.org/10.4093/jkd.2013.14.4.166

Sarcopenic Obesity

Tae Nyun Nyun¹, Kyung Mook Choi²

¹Department of Internal Medicine, Cardiovascular and Metabolic Disease Center, Inje University, Busan, Korea

²Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Obesity is a major public health problem. The population is growing older, and the prevalence of obesity in the elderly is rising. In normal aging, changes in the body composition occur that result in a shift toward decreased muscle mass and increased fat mass. This age-related progressive loss of muscle mass and strength is called sarcopenia. Sarcopenic obesity, which describes the process of muscle loss combined with increased body fat as people age, is associated with loss of strength and function, reduced quality of life, and even mortality. The pathogenesis of sarcopenic obesity is complex and involves multiple interactions between lifestyle, endocrine, and immunological factors. Recent epidemiological studies suggest that sarcopenic obesity is related to accelerated functional decline and high risk of diseases and mortality and, therefore, the identification of affected older patients should be an essential goal of clinicians. This paper addresses the definition and epidemiology of sarcopenic obesity and its underlying pathophysiology. In addition, this article describes the clinical significance and management strategies of sarcopenic obesity.

Keywords: Aging, Sarcopenia, Obesity

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Fig. 1.

Schematic hypothesis to demonstrate how sarcopenic obesity can lead to functional limitations, metabolic disorder and cardiovascular disease (adapted from Nutr Metab Cardiovasc Dis 2008;18:388–95 [42]).

Table 1.

Comparison of different sarcopenic obesity definitions and prevalences

	Measuring techniques	Definition of sarcopenia (cut-off value)	Definition of obesity (cut-off value)	Mean age (SD)	Prevalence (%)
New Mexico Aging Process Study (Baumgartner et al.) [19]	DXA	ASM/height2 −2SD below mean of young population (＜ 7.26 kg/m² in men and ＜ 5.45 kg/m² in women)	Body fat percentage greater than median (＞ 27% in men and 38% in women)	60 and over	M: 4.4 F: 3.0
NHANES III (Davison et al.) [20]	BIA	Two lower quintiles of total skeletal muscle mass/height² (＜ 9.12 kg/m² in men and ＜ 6.53 kg/m² in women)	Two highest quintiles of body fat percentage (＞ 27% in men and 38% in women)	M: 76.3 (1.7^a) F: 77.3 (2.2^_a)	M: 9.6 F:7.4
Community-dwelling older people in Verona (Zoico et al.) [21]	DXA	Two lower quintiles of ASM/height² (＜ 5.7 kg/m² in women)	Two highest quintiles of body fat percentage (＞ 42.9% in women)	F:71.7 (2.4)	F: 12.4
Korean Sarcopenic Obesity Study (Kim et al.) [23, 26]	DXA	SMI −2SD below mean of young population (＜ 7.26 kg/m² in men and ＜ 5.45 kg/m² in women)	Two highest quintiles of body fat percentage (＞ 27% in men and 38% in women)	60 and over	M: 5.1 F: 12.5
	DXA and CT	MFR: ASM/VFA

Adapted from Curr Opin Clin Nutr Metab Care 2008;11:693–700 [17] ASM, appendicular skeletal muscle mass; BIA, bioelectric impedence analysis; CT, computed tomography; DXA, dual energy X-ray absorptiometry; F, female; M, male; MFR, muscle-to-fat ratio; SMI, skeletal muscle index (total skeletal muscle mass (kg)/weight (kg) × 100); VFA, visceral fat area.

^a Standard error.

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