Effects of Sarcopenic Obesity on Metabolic Syndrome in Korean Elders: Using Data from the Korea National Health and Nutrition Examination Survey (2008-2011)

Hyun-A Choi; Kyung-Min Park

doi:10.12799/jkachn.2016.27.3.231

Journal List > J Korean Acad Community Health Nurs > v.27(3) > 1058424

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Choi and Park: Effects of Sarcopenic Obesity on Metabolic Syndrome in Korean Elders: Using Data from the Korea National Health and Nutrition Examination Survey (2008-2011)

Original Article

J Korean Acad Community Health Nurs 2016;27(3):231-241.

Published online: 12 September 2016

DOI: https://doi.org/10.12799/jkachn.2016.27.3.231

Effects of Sarcopenic Obesity on Metabolic Syndrome in Korean Elders: Using Data from the Korea National Health and Nutrition Examination Survey (2008-2011)

Hyun-A Choi¹, Kyung-Min Park²

¹Department of Nursing, Sunlin University, Pohang, Korea

²College of Nursing, Keimyung University, Daegu, Korea

Corresponding author: Park, Kyung-Min College of Nursing, Keimyung University, 1095 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea. Tel: +82-53-580-3900, Fax: +82-53-580-3916, E-mail: kmp@kmu.ac.kr

Received 11 July 2016 Revised 3 September 2016 Accepted 3 September 2016

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

Purpose

This study was conducted to examine effects of sarcopenic obesity on metabolic syndrome in Korean elders.

Methods

This study is based on the analysis of the Korea National Health and Nutrition Examination Survey (KNHANES) with 1,155 subjects (524 men, and 631 women) aged 60 or older, from 2008 to 2011. Sarcopenia was defined as an appendicular skeletal muscle (ASM), divided by weight (%) of <1 SD (standard deviation) below the sex-specific mean for young adults. Obesity was defined as a total body fat percent (men≥25%, women≥35%).

Results

The prevalence of SO (sarcopenic obesity) was 13.3% among men and 22.5% among women. Both sexes showed a higher total body fat percent, and the SMI (skeletal muscle index) was the lowest in the SO group. Metabolic syndrome was highly prevalent in the SO group (52.5% men, 60.4% women). The SO group showed a higher risk for metabolic syndrome (odds ratio men 6.57 [95% CI 5.19~7.27], women 3.89 [95% CI 2.41~6.29]) than the obese group (men 3.14 [95% CI 1.76~4.14], women 2.54 [95% CI 1.38~4.65]).

Conclusion

SO is a major risk factor for metabolic syndrome in Korean elders. Therefore, a nursing program should be given to the Korean elderly SO group to prevent metabolic syndrome.

Keywords: Sarcopenia, Obesity, Metabolism, Syndrome

References

1. Jang HC. Recent progression in sarcopenia and sarcopenic obesity. Journal of the Korean Geriatrics Society. 2011; 15(1):1–7. http://dx.doi.org/10.4235/jkgs.2011.15.1.1.

2. Statistics Korea. The prevalence of obesity trend [Internet]. Seoul: Korean Statistical Information Service;2014. [cited 2016 January 13]. Available from:. http://kosis.kr/statHtml/statHtml.do?orgId=117&tblId=DT_11702_N101&conn_path=I2.

3. Lim S, Kim JH, Yoon JW, Kang SM, Choi SH, Park YJ. . Sarcopenic obesity: Prevalence and association with metabolic syndrome in the Korean Longitudinal Study on Health and Aging (KLoSHA). Diabetes Care. 2010; 33(7):1652–1654. http://dx.doi.org/10.2337/dc10-0107.

4. Park SW. Sarcopenia of the old age. Journal of Korean Endocrine Society. 2007; 22(1):1–7. http://dx.doi.org/10.3803/jkes.2007.22.1.1.

5. Baumgartner RN. Body composition in healthy aging. Annals of the New York Academy of Sciences. 2000; 904(1):437–448. http://dx.doi.org/10.1111/j.1749-6632.2000.tb06498.x.

6. Kim TN, Yang SJ, Yoo HJ, Lim KI, Kang HJ, Song W. . Prevalence of sarcopenia and sarcopenic obesity in Korean adults: The Korean sarcopenic obesity study. International Journal of Obesity. 2009; 33(8):885–892. http://dx.doi.org/10.1038/ijo.2009.130.

7. Baumgartner RN, Wayne SJ, Waters DL, Janssen I, Gallagher D, Morley JE. Sarcopenic obesity predicts instrumental activities of daily living disability in the elderly. Obesity Research. 2004; 12(12):1995–2004. http://dx.doi.org/10.1038/oby.2004.250.

8. Roubenoff R. Sarcopenic obesity: The confluence of two epidemics. Obesity Research. 2004; 12(6):887–888. http://dx.doi.org/10.1038/oby.2004.107.

9. Cauley JA. An overview of sarcopenic obesity. Journal of Clinical Densitometry. 2015; 18(4):499–505. http://dx.doi.org/10.1016/j.jocd.2015.04.013.

10. Clark BC, Manini TM. Sarcopenia≠ dynapenia. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2008; 63(8):829–834.

11. Hong SM, Choi WH. Clinical and physiopathological mechanism of sarcopenia. The Korean Journal of Medicine. 2012; 83(4):444–454. http://dx.doi.org/10.3904/kjm.2012.83.4.444.

12. Chung JY, Kang HT, Lee DC, Lee HR, Lee YJ. Body composition and its association with cardiometabolic risk factors in the elderly: A focus on sarcopenic obesity. Archives of Gerontology and Geriatrics. 2013; 56(1):270–278. http://dx.doi.org/10.1016/j.archger.2012.09.007.

13. Zamboni M, Mazzali G, Fantin F, Rossi A, Di Francesco V. Sarcopenic obesity: A new category of obesity in the elderly. Nutrition, Metabolism and Cardiovascular Diseases. 2008; 18(5):388–395. http://dx.doi.org/10.1016/j.numecd.2007.10.002.

14. Bouchard DR, Dionne IJ, Brochu M. Sarcopenic/obesity and physical capacity in older men and women: Data from the nutrition as a determinant of successful aging (NuAge)-the Quebec longitudinal study. Obesity. 2009; 17(11):2082–2088. http://dx.doi.org/10.1038/oby.2009.109.

15. Villareal DT, Banks M, Siener C, Sinacore DR, Klein S. Physical frailty and body composition in obese elderly men and women. Obesity Research. 2004; 12(6):913–920. http://dx.doi.org/10.1038/oby.2004.111.

16. Scott D, Sanders KM, Aitken D, Hayes A, Ebeling PR, Jones G. Sarcopenic obesity and dynapenic obesity: 5 year associations with falls risk in middle aged and older adults. Obesity. 2014; 22(6):1568–1574. http://dx.doi.org/10.1002/oby.20734.

17. Lu CW, Yang KC, Chang HH, Lee LT, Chen CY, Huang KC. Sarcopenic obesity is closely associated with metabolic syndrome. Obesity Research & Clinical Practice. 2013; 7(4):e301–e307. http://dx.doi.org/10.1016/j.orcp.2012.02.003.

18. Kyle UG, Pirlich M, Lochs H, Schuetz T, Pichard C. Increased length of hospital stay in underweight and overweight patients at hospital admission: A controlled population study. Clinical Nutrition. 2005; 24(1):133–142. http://dx.doi.org/10.1016/j.clnu.2004.08.012.

19. Lee HW. Diagnosis and treatment of metabolic syndrome. Korean Journal of Medicine. 2006; 71(4):463–467.

20. Dos Santos EP, Gadelha AB, Safons MP, Nóbrega OT, Oliveira RJ, Lima RM. Sarcopenia and sarcopenic obesity classifications and cardiometabolic risks in older women. Archives of Gerontology and Geriatrics. 2014; 59(1):56–61. http://dx.doi.org/10.1016/j.archger.2014.03.012.

21. Kwon HS, Park YM, Lee HJ, Lee JH, Choi YH, Ko SH. . Prevalence and clinical characteristics of the metabolic syndrome in middle-aged Korean adults. The Korean Journal of Internal Medicine. 2005; 20(4):310–316. http://dx.doi.org/10.3904/kjim.2005.20.4.310.

22. Korea Centers for Disease Control and Prevention. Nutrition survey guidelines for the Korea national health and nutrition examination survey IV (2007-2009), V (2010-2012) [Internet]. Seoul: Korea Centers for Disease Control and Prevention;2016. [cited 2016 April 1]. Available from:. https://knhanes.cdc.go.kr/knhanes/index.do.

23. Janssen I, Heymsfield SB, Ross R. Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. Journal of the American Geriatrics Society. 2002; 50(5):889–896. http://dx.doi.org/10.1046/j.1532-5415.2002.50216.x.

24. Gallagher D, Heymsfield SB, Heo M, Jebb SA, Murgatroyd PR, Sakamoto Y. Healthy percentage body fat ranges: An approach for developing guidelines based on body mass index. The American Journal of Clinical Nutrition. 2000; 72(3):694–701.

25. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA. . Diagnosis and management of the metabolic syndrome. An American heart association/national heart, lung, and blood institute scientific statement. Circulation. 2005; 112(17):2735–2752. http://dx.doi.org/10.1161/CIRCULATIONAHA.105.169404.

26. Lee SY, Park HS, Kim DJ, Han JH, Kim SM, Cho GJ. . Appropriate waist circumference cutoff points for central obesity in Korean adults. Diabetes Research and Clinical Practice. 2007; 75(1):72–80. http://dx.doi.org/10.1016/j.diabres.2006.04.013.

27. Hwang BK, Lim JY, Lee JY, Choi NK, Ahn YO, Park BJ. Prevalence rate and associated factors of sarcopenic obesity in Korean elderly population. Journal of Korean Medical Science. 2012; 27(7):748–755. http://dx.doi.org/10.3346/jkms.2012.27.7.748.

28. Lim J, Kim S, Ke S, Cho B. The prevalence of obesity, abdominal obesity and metabolic syndrome among elderly in general population. Korean Journal of Family Medicine. 2011; 32(2):128–134. http://dx.doi.org/10.4082/kjfm.2011.32.2.128.

29. Lee SE, Moon JH, Oh YS, Shinn SH. The association between plasma adiponectin and the components of metabolic syndrome in adults with abdominal obesity. The Korean Journal of Obesity. 2007; 16(4):147–153.

30. Stephen WC, Janssen I. Sarcopenic-obesity and cardiovascular disease risk in the elderly. JNHA-The Journal of Nutrition, Health and Aging. 2009; 13(5):460–466. http://dx.doi.org/10.1007/s12603-009-0084-z.

Table 1.

Differences in Demographic, Health related Characteristics according to Sarcopenia & Obesity Status

Variables	Categories	Men (n=649,423)				x² or F(p)	Women (n=807,990)				x² or F(p)
		Normal (n=361,874)	Obesity (n=65,336)	Sarcopenia (n=28,623)	SO (n=193,590)		Normal (n=361,874)	Obesity (n=65,336)	Sarcopenia (n=28,623)	SO (n=193,590)
		% or M±SD	% or M±SD	% or M±SD	% or M±SD		% or M±SD	% or M±SD	% or M±SD	% or M±SD
Age (year)	60~69	67.2	66.4	66.8	58.0	11.62 (.152)	53.4	69.6	46.0	52.9	1.06(.370)
	70~79	30.6	25.0	27.6	34.2		35.3	27.5	39.0	38.5
	≥80	2.2	8.6	5.6	7.8		11.3	2.9	15.0	8.6
		67.6±0.38	67.8±0.90	67.3±1.93	68.3±0.58	0.35 (.788)	69.4±0.64	67.9±0.71	69.9±2.76	69.4±0.54	13.26(.169)
Education	≤Elementary	47.8	44.3	34.3	33.2	16.52 (.250)	82.1	84.7	88.2	79.0	3.94 (.901)
	Middle school	15.8	18.2	29.0	25.6		8.9	6.4	8.1	11.0
	High school	25.7	21.5	31.8	24.8		6.9	7.0	3.7	8.8
	≥University	10.7	16.0	4.9	16.4		2.1	1.9	−	1.2
Income	Low	21.9	17.9	43.3	13.4	17.65 (.199)	27.8	34.3	8.2	27.3	14.32 (.298)
	Middle low	24.5	33.0	24.5	27.2		22.5	23.1	50.0	20.5
	Middle high	24.7	28.4	25.2	28.4		28.6	17.2	25.1	23.9
	High	28.9	20.7	7.0	31.0		21.1	25.4	16.7	28.3
Perceived health status		2.69±0.06	2.80±0.11	2.84±0.22	2.73±0.12	0.37 (.775)	3.11±0.08	3.1±0.10	3.25±0.28	3.07±0.09	0.16 (.925)
Alcohol frequency^†	None	35.7	42.4	33.8	25.6	9.73 (.374)	76.9	83.0	90.2	79.4	14.70 (.064)
	Sometimes	22.1	13.7	19.6	29.3		13.9	15.5	9.8	17.4
	Often	42.2	43.9	46.6	45.1		9.2	1.5	−	3.2
Depression	Yes	89.8	95.9	82.7	91.5	3.86 (.350)	78.7	76.1	93.1	86.5	8.62 (.075)
	No	10.2	4.1	17.3	8.5		21.3	23.9	6.9	13.5
Smoking	Non-smoking	15.3	20.6	25.0	12.3	16.57 (.098)	88.5	97.5	90.1	93.9	11.42 (.221)
	Past-smoking	52.6	61.9	43.4	68.1		6.1	2.1	9.9	3.4
	Current-smoking	32.1	17.5	31.6	19.6		5.4	0.4	−	2.7
Exercise: strength	No	69.9	74.9	60.5	67.6	10.76 (.234)	87.5	86.9	96.3	90.4	4.77 (.620)
Exercise: strength	1~2 times/week	8.3	6.3	2.0	14.5		3.7	1.5	−	3.3
	≥3 times/week	21.8	18.8	37.5	17.9		8.8	11.6	3.7	6.3
Exercise: walking	No	53.5	47.8	42.3	56.3	2.36 (.601)	59.4	58.8	26.1	63.3	6.59 (.241)
Exercise: walking	Yes	46.5	52.2	57.7	43.7		40.6	41.2	73.9	36.7

Note. Values are presented as M±SD or %. All data are weighted to the residential population of Korea.

SO=sarcopenic-obesity; ^†Alcohol frequency: none ≤1 time/month, sometimes 1~4 times/month, often 2~4 times/weeks.

Table 2.

Differences in Body Composition and Metabolic Component according to Sarcopenia & Obesity Status

Variables	Men (n=649,423)				x² or F(p)	Women (n=807,990)				x² or F(p))
	Normal (n=361,874)	Obesity (n=65,336)	Sarcopenia (n=28,623)	SO (n=193,590)		Normal (n=334,112)	Obesity (n=131,586)	Sarcopenia (n=14,236)	SO (n=328,056)
	M±SD	M±SD	M±SD	M±SD		M±SD	M±SD	M±SD	M±SD
Height (cm)	165.6	165.8	167.0	165.1	0.78	151.9	152.7	148.7	151.7	1.47
	±0.35	±0.90	±1.35	±0.52	(.509)	±0.44	±0.51	±2.16	±0.44	(.227)
Weight (kg)	61.0^a	69.3^b	63.3^a	69.2^b	24.69	50.8^a	58.2^b	50.4^a	60.2^b	59.62
	±0.57	±1.42	±1.98	±0.75	(＜.001)	±0.50	±0.76	±2.27	±0.61	(＜.001)
Waist	81.28^a	89.31^b	84.48^a	89.85^b	30.51	77.10^a	84.94^b	80.03^a	87.64^c	65.92
circumference (cm)	±0.59	±1.17	±1.60	±0.75	(＜.001)	±0.57	±0.78	±2.93	±0.55	(＜.001)
Body mass index	22.17^a	25.13^b	22.65^a	25.38^b	39.53	21.97^a	24.95^b	22.74^a	26.12^c	86.05
(BMI, kg/m²)	±0.18	±0.35	±0.53	±0.27	(＜.001)	±0.16	±0.30	±0.70	±0.24	(＜.001)
ASM (kg)	20.24^b	21.52^c	18.74^a	19.53^a	8.31	13.65^c	14.27^d	11.69^a	13.16^b	13.56
	±0.21	±0.44	±0.67	±0.20	(＜.001)	±0.15	±0.20	±0.55	±0.14	(＜.001)
Skeletal muscle	33.52^d	31.23^c	29.81^b	28.44^a	213.10	27.17^d	24.74^c	23.40^b	22.05^a	234.61
index (SMI%)	±0.14	±0.08	±0.23	±0.15	(＜.001)	±0.18	±0.08	±0.12	±0.12	(＜.001)
Total body fat	19.33^a	26.61^c	23.43^b	29.22^d	343.80	29.92^a	37.02^c	33.00^b	40.27^d	181.07
(%)	±0.24	±0.14	±0.25	±0.29	(＜.001)	±0.36	±0.12	±0.55	±0.26	(＜.001)
Systolic BP	126.22	128.85	136.11	129.80	1.53	129.88^a	132.59^ab	138.90^ab	134.11^b	2.87
(mmHg)	±1.50	±2.98	±6.18	±1.49	(.210)	±1.43	±2.72	±8.15	±1.02	(＜.05)
Diastolic BP	74.42^a	78.58^b	83.82^ab	76.21^ab	3.23	74.29	75.75	77.07	76.85	2.51
(mmHg)	±0.73	±1.40	±5.33	±1.11	(＜.05)	±0.77	±1.30	±3.50	±0.62	(.062)
FPG (mg/dL)	97.41	98.39	99.46	103.46	1.83	94.11^a	96.67^b	99.56^ab	97.86^b	3.04
	±1.31	±1.60	±2.50	±2.23	(.146)	±0.81	±1.09	±4.27	±1.21	(＜.05)
Total cholesterol	184.35	184.34	188.41	186.84	0.22	198.48^a	198.40^a	184.96^a	209.14^b	3.58
(mg/dL)	±2.40	±3.88	±6.39	±3.57	(.881)	±2.61	±3.78	±10.66	±2.66	(＜.05)
HDL-cholesterol	48.31^b	44.89^ab	48.18^ab	42.48^a	4.33	48.26^b	48.47^b	52.41^ab	45.77^a	2.93
(mg/dL)	±0.70	±1.87	±4.02	±1.35	(＜.01)	±0.65	±1.08	±5.78	±0.75	(＜.05)
Triglyceride	125.30^a	155.83^b	153.59^ab	157.24^b	4.04	126.59^a	133.71^a	120.10^a	157.41^b	3.58
(mg/dL)	±5.42	±11.14	±24.01	±8.48	(＜.01)	±6.04	±9.40	±15.36	±7.78	(＜.05)

Note. Values are presented as M±SD. All data are weighted to the residential population of Korea.

SO=sarcopenic-obesity; ASM (kg)=appendicular skeletal muscle mass; FPG=fasting plasma glucose; HDL=high-density lipoprotein; post-hocanalysis: a＜b＜c＜d.

Table 3.

Frequency of Metabolic Component and Metabolic Syndrome according to Sarcopenia & Obesity Status

Variables	Men (n=649,423)				x² (p)	Women (n=807,990)				x² (p)
	Normal (n=361,874)	Obesity (n=65,336)	Sarcopenia (n=28,623)	SO (n=193,590)		Normal (n=334,112)	Obesity (n=131,586)	Sarcopenia (n=14,236)	SO (n=328,056)
	%	%	%	%		%	%	%	%
Abdominal obesity	14.9	47.8	20.3	51.1	75.84 (＜.001)	14.6	47.1	32.5	61.8	123.88 (＜.001)
High blood pressure	51.7	73.0	62.6	68.7	17.04 (＜.01)	61.4	68.3	82.5	76.4	14.59 (＜.05)
Hypertriglyceridemia	28.3	46.8	48.1	46.8	19.29 (＜.01)	31.9	45.2	35.9	47.1	13.75 (＜.05)
Low HDL cholesterolemia	28.9	45.8	40.6	53.5	27.36 (＜.01)	64.5	61.6	47.4	66.5	2.24 (.679)
High fasting plasma glucose	31.8	36.9	46.0	44.0	7.39 (.188)	22.2	29.8	39.2	35.9	12.30 (.054)
Metabolic syndrome	24.2	45.1	39.9	52.5	38.26 (＜.001)	31.1	48.4	57.3	60.4	45.52 (＜.001)

Note. Values are presented as %. All data are weighted to the residential population of Korea. SO=sarcopenic-obesity; HDL=high-density lipoprotein.

Table 4.

Adjusted Odds Ratio Metabolic Syndrome according to Sarcopenia & Obesity Status

Variables	Men				Women
	Normal OR (95%CI)	Obesity OR (95%CI)	Sarcopenia OR (95%CI)	SO OR (95%CI)	Normal OR (95%CI)	Obesity OR (95%CI)	Sarcopenia OR (95%CI)	SO OR (95%CI)
	p	p	p	p	p	p	p	p
Unadjusted	1.00	2.57	2.07	3.46	1.00	2.08	2.98	3.38
		(1.22~5.38)	(0.61~6.98)	(2.11~5.65)		(1.12~3.88)	(0.62~14.34)	(2.19~5.21)
		＜.05	.238	＜.001		＜.05	.171	＜.001
Model 1^†	1.00	2.70	2.13	3.80	1.00	2.39	2.91	3.52
		(1.29~5.62)	(0.67~6.82)	(2.24~6.45)		(1.30~4.38)	(0.49~17.16)	(2.24~5.54)
		＜.01	.201	＜.001		＜.01	.236	＜.001
Model 2^‡	1.00	3.05	2.02	4.07	1.00	2.67	3.13	3.84
		(1.47~6.35)	(0.61~6.64)	(2.35~7.04)		(1.46~4.89)	(0.51~19.18)	(2.39~6.17)
		＜.01	.247	＜.001		＜.01	.216	＜.001
Model 3^§	1.00	3.14	1.50	6.57	1.00	2.54	3.40	3.89
		(1.76~4.14)	(0.60~2.35)	(5.19~7.27)		(1.38~4.65)	(0.60~19.46)	(2.41~6.29)
		＜.01	.302	＜.001		＜.01	.168	＜.001

SO=sarcopenic-obesity; OR (95% CI)=odds ratio (95% confidential interval).

^† Model 1: adjusted age;

^‡ Model 2: adjusted age, smoking, alcohol, exercise;

^§ Model 3: Model 2＋education, income.

TOOLS

Similar articles