Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia; School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
School of Public Health, University of Sydney, New South Wales, Sydney, Australia; Centre for Education and Research, Department of Geriatric Medicine, Concord Hospital, Sydney, New South Wales, Australia; The ARC Centre of Excellence in Population Ageing Research, University of Sydney, New South Wales, Sydney, Australia.
Clin Nutr. 2023 Sep;42(9):1610-1618. doi: 10.1016/j.clnu.2023.07.014. Epub 2023 Jul 17.
BACKGROUND & AIMS: The potential for older adults with obesity to also have sarcopenia, and the health consequences of 'sarcopenic obesity', may be underappreciated by health professionals. The primary aim of this secondary analysis of a prospective cohort study of older men was to explore the prevalence and functional outcomes of sarcopenic obesity based on different consensus definitions.
1416 community-dwelling men aged ≥70 years were classified into sarcopenia categories according to the European Working Group on Sarcopenia in Older People (EWGSOP2) definition, and sarcopenic obesity categories according to the European Society for Clinical Nutrition and Metabolism and the European Association for the Study of Obesity (ESPEN-EASO) definition. Descriptive analyses determined prevalence of sarcopenia in obese and non-obese older men. Multivariable analyses compared associations with functional outcomes including activity of daily living (ADL) and instrumental activity of daily living (IADL) disability and 12-month incident falls.
According to the EWGSOP2 definition, 12.6% of men had confirmed sarcopenia but only 0.3% of men had sarcopenia and obesity (BMI ≥30 kg/m). Conversely, 9.6% of men had sarcopenic obesity according to the ESPEN-EASO definition. Notably, no men with a BMI ≥32 kg/m were classified as having EWGSOP2-confirmed sarcopenia, despite the fact that 60.8% of all men with BMI ≥32 kg/m had low muscle strength. Due to low numbers (N = 4) of obese older men with EWGSOP2-confirmed sarcopenia, associations with functional outcomes were not assessed. Men with sarcopenic obesity according to the ESPEN-EASO definition had significantly lower hand grip strength, higher chair-stands time and slower gait speed (all P < 0.05), increased odds for ADL (odds ratio: 5.02, 95% CI: 1.85-13.58) and IADL (2.18, 1.38-3.45) disability, and higher 12-month incident falls rates (incident rate ratio: 1.59, 95% CI: 1.03-2.44) than men with neither sarcopenia nor obesity.
Low muscle strength is common in older men with obesity, but the prevalence of sarcopenia is likely to be underestimated when the EWGSOP2 operational definition is applied in this population. The ESPEN-EASO operational definition of sarcopenic obesity appears to provide a valid approach for identifying older men with obesity who are at risk of poor functional outcomes related to sarcopenia.
肥胖的老年人也可能患有肌肉减少症，而“肌肉减少性肥胖”的健康后果可能被健康专业人员所忽视。本研究对一项针对老年男性的前瞻性队列研究的二次分析的主要目的是，根据不同的共识定义，探讨基于肌肉减少性肥胖的患病率和功能结局。
对年龄≥70 岁、居住在社区的 1416 名男性，根据欧洲肌肉减少症工作组（EWGSOP2）的定义进行肌肉减少症分类，并根据欧洲临床营养与代谢学会和欧洲肥胖研究协会（ESPEN-EASO）的定义进行肌肉减少性肥胖分类。描述性分析确定了肥胖和非肥胖老年男性中肌肉减少症的患病率。多变量分析比较了与功能结局的相关性，包括日常生活活动（ADL）和工具性日常生活活动（IADL）残疾和 12 个月内发生跌倒的情况。
根据 EWGSOP2 定义，12.6%的男性被确诊患有肌肉减少症，但只有 0.3%的男性患有肌肉减少症和肥胖症（BMI≥30kg/m²）。相反，根据 ESPEN-EASO 定义，9.6%的男性患有肌肉减少性肥胖症。值得注意的是，尽管所有 BMI≥32kg/m²的男性中，有 60.8%的人肌肉力量较低，但没有 BMI≥32kg/m²的男性被归类为 EWGSOP2 确诊的肌肉减少症。由于肥胖老年男性中 EWGSOP2 确诊的肌肉减少症人数较少（N=4），因此未评估其与功能结局的相关性。根据 ESPEN-EASO 定义，患有肌肉减少性肥胖症的男性握力明显较低，从座位站起的时间较长，步速较慢（所有 P<0.05），ADL（比值比：5.02，95%置信区间：1.85-13.58）和 IADL（2.18，1.38-3.45）残疾的可能性更高，12 个月内发生跌倒的比率也更高（发生率比：1.59，95%置信区间：1.03-2.44）。
在肥胖的老年男性中，肌肉力量较低很常见，但当 EWGSOP2 操作定义应用于该人群时，肌肉减少症的患病率可能被低估。ESPEN-EASO 肌肉减少性肥胖症的操作定义似乎为确定存在与肌肉减少症相关的不良功能结局风险的肥胖男性提供了一种有效的方法。
