Sapienza University, Rome, Italy.
University of Padua, Italy.
Clin Nutr. 2020 Aug;39(8):2368-2388. doi: 10.1016/j.clnu.2019.11.024. Epub 2019 Nov 27.
Sarcopenic obesity is a clinical and functional condition characterized by the coexistence of excess fat mass and sarcopenia. Currently, different definitions of sarcopenic obesity exist and its diagnostic criteria and cut-offs are not universally established. Therefore, the prevalence and sensitivity of this condition for any disease risk prediction is affected significantly.
This work was conducted under the auspices of the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO). An international expert panel performed a systematic review as an initial step to analyze and summarize the available scientific literature on the definitions and the diagnostic criteria for sarcopenic obesity proposed and/or applied in human studies to date.
The present systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The search was conducted in April 2018 in three databases (PubMed, Scopus, Web of Science). Human studies conducted in both sexes, irrespective of ethnicity, and published from 2007 to 2018 were included; cohorts of individuals with obesity and acute or chronic conditions and treatments reported to negatively influence skeletal muscle mass and function independently of obesity were excluded from final analyses. The quality of the studies was evaluated using the Newcastle-Ottawa Scale (NOS) adapted for cross sectional studies.
The electronic search retrieved 2335 papers of which 75 met the eligibility criteria. A marked heterogeneity in definitions and approaches to diagnose sarcopenic obesity was observed. This was mainly due to differences in the definitions of obesity and sarcopenia, in the methodologies used to assess body composition and physical function, and in the reference values for the variables that have been used (different cut-offs, interquartile analysis, diverse statistical stratification methods). This variability may be attributable, at least in part, to the availability of the methodologies in the different settings, to the variability in specialties and backgrounds of the researcher, and to the different settings (general population, clinical settings, etc.) where studies were performed.
The results of the current work support the need for consensus proposals on: 1) definition of sarcopenic obesity; 2) diagnostic criteria both at the level of potential gold-standards and acceptable surrogates with wide clinical applicability, and with related cut-off values; 3) methodologies to be used in actions 1 and 2. First steps should be aimed at reaching consensus on plausible proposals that would need subsequent validation based on homogeneous studies and databases, possibly based on analyses of existing cohorts, to help define the prevalence of the condition, its clinical and functional relevance as well as most effective prevention and treatment strategies.
肌少症合并肥胖是一种临床和功能状态，其特征是体脂肪量过多和肌少症同时存在。目前，肌少症合并肥胖有不同的定义，其诊断标准和切点尚未得到普遍确立。因此，这种情况对任何疾病风险预测的患病率和敏感性都有显著影响。
本工作由欧洲临床营养与代谢学会（ESPEN）和欧洲肥胖研究协会（EASO）主持。一个国际专家小组进行了系统评价，作为分析和总结迄今为止在人类研究中提出和/或应用的肌少症合并肥胖定义和诊断标准的可用科学文献的初步步骤。
本系统评价根据系统评价和荟萃分析的首选报告项目（PRISMA）声明进行。检索于 2018 年 4 月在三个数据库（PubMed、Scopus、Web of Science）进行。纳入了无论种族如何，在两性中进行的、发表于 2007 年至 2018 年的研究；最终分析排除了报告有肥胖和急性或慢性疾病以及有治疗措施的队列，这些治疗措施独立于肥胖对骨骼肌质量和功能有负面影响。使用适用于横断面研究的纽卡斯尔-渥太华量表（NOS）评估研究质量。
电子检索检索到 2335 篇论文，其中 75 篇符合入选标准。观察到肌少症合并肥胖的定义和诊断方法存在显著异质性。这主要是由于肥胖和肌少症的定义、用于评估身体成分和身体功能的方法以及所使用变量的参考值（不同的切点、四分位间距分析、不同的统计分层方法）存在差异所致。这种可变性至少部分归因于不同环境中方法的可用性、研究人员的专业和背景的变异性以及研究进行的不同环境（一般人群、临床环境等）。
目前工作的结果支持就以下方面达成共识建议的需求：1）肌少症合并肥胖的定义；2）潜在金标准和可接受的替代方法的诊断标准，以及具有广泛临床适用性的标准，以及相关的切点值；3）在行动 1 和 2 中使用的方法。第一步应旨在就合理的建议达成共识，这些建议需要基于同质研究和数据库进行后续验证，可能基于对现有队列的分析，以帮助确定该疾病的患病率、其临床和功能相关性以及最有效的预防和治疗策略。
