Division of Geriatrics, Department of Internal Medicine, Istanbul University, Istanbul Medical School, 34093, Istanbul, Turkey.
Division of Geriatrics, Department of Internal Medicine, Istanbul University, Istanbul Medical School, 34093, Istanbul, Turkey.
Clin Nutr. 2022 Nov;41(11):2509-2516. doi: 10.1016/j.clnu.2022.09.005. Epub 2022 Sep 15.
BACKGROUND & AIMS: Ageing brings alterations in body composition, as skeletal muscle gradually declines and accumulation of adipose tissue accompanies it. Although sarcopenia (S) and obesity (O) were separately reported to be associated with frailty and poor physical performance, whether they bring more detrimental or favorable effect when they coexist (i.e. sarcopenic obesity; SO) is an issue needs clarification. We aimed to study the associations of SO and S alone with frailty and poor physical performance, by using probable S definition.
This was a retrospective, cross-sectional study including community dwelling older adults who were ≥60 years old and admitted to the outpatient clinic of a tertiary hospital between 2012 and 2020. We measured handgrip strength via hand dynamometer and defined decreased muscle strength as probable S. We performed bioimpedance analysis to evaluate body composition and used fat percentile method to define obesity. We assessed nutritional status via Mini-Nutritional Assessment-Short Form, frailty via FRAIL scale, and physical performance via Timed Up and Go (TUG) test. We examined the associations of four body phenotypes, i.e. non-S non-O, SO, S alone and O alone with frailty and impaired TUG in univariate and multivariate analyses (Model 1). We further performed a head to head analysis of SO vs S to see if one of them was associated more with frailty and impaired TUG (Model 2).
There were 1366 older adults included in the study (mean age: 74.6 ± 6.9; 68.3% female). The prevalences of non-S non-O, S alone, SO and O alone were 53.5, 7.5, 2.8 and 36.2%, respectively. Multivariate analysis adjusted for age, gender and nutritional status revealed that both SO and S alone were independently associated with frailty and impaired TUG, with SO demonstrating lower odds than S alone (OR = 5.9 and 6.05 for frailty, and 3.9 and 4.4 for TUG, respectively). Head-to-head comparison between SO and S alone in Model 2 showed that two groups did not demonstrate significant difference in terms of the frailty and impaired TUG risk.
Although SO and S groups demonstrated similar risks, obesity accompanying sarcopenia might show a favorable trend in terms of frailty and poor physical performance, compared to sarcopenia alone. Longitudinal studies are needed to reveal whether an obesity paradox exists for frailty and physical performance in older adults.
随着年龄的增长，身体成分会发生变化，骨骼肌逐渐减少，脂肪组织堆积。尽管肌少症（Sarcopenia）和肥胖（Obesity）分别与虚弱和身体机能下降有关，但当它们同时存在时（即肌少型肥胖症；Sarcopenic Obesity；SO），哪个因素会带来更不利或更有利的影响仍需要明确。我们旨在使用可能的肌少症定义，研究 SO 和 S 单独存在与虚弱和身体机能下降之间的关联。
这是一项回顾性、横断面研究，纳入了 2012 年至 2020 年期间在一家三级医院门诊就诊的年龄≥60 岁的社区居住老年人。我们使用手持测力计测量握力，并将肌肉力量下降定义为可能的肌少症。我们通过生物阻抗分析评估身体成分，并使用体脂百分比法定义肥胖。我们使用 Mini-Nutritional Assessment-Short Form 评估营养状况，使用 FRAIL 量表评估虚弱程度，使用计时起立行走测试（Timed Up and Go；TUG）评估身体机能。我们在单变量和多变量分析（模型 1）中检查了四种体型，即非 S 非 O、SO、S 单独和 O 单独与虚弱和 TUG 受损的关联。我们进一步对 SO 与 S 进行了头对头分析，以确定其中一种是否与虚弱和 TUG 受损的关联更密切（模型 2）。
共有 1366 名老年人纳入研究（平均年龄：74.6±6.9 岁；68.3%为女性）。非 S 非 O、S 单独、SO 和 O 单独的患病率分别为 53.5%、7.5%、2.8%和 36.2%。多变量分析调整了年龄、性别和营养状况，结果表明 SO 和 S 单独与虚弱和 TUG 受损均独立相关，SO 组的虚弱和 TUG 受损风险低于 S 单独组（OR 分别为 5.9 和 6.05，OR 分别为 3.9 和 4.4）。在模型 2 中，SO 和 S 单独组之间的头对头比较表明，两组在虚弱和 TUG 受损风险方面没有显著差异。
尽管 SO 和 S 组表现出相似的风险，但与单纯肌少症相比，肌少症伴肥胖可能在虚弱和身体机能下降方面显示出有利趋势。需要进行纵向研究，以揭示肥胖对老年人虚弱和身体机能的悖论是否存在。
