Department of Medicine, Division of Endocrinology, Orlando VA Medical Center and University of Central Florida College of Medicine, Orlando, FL 32827, USA.
School of Medicine, Promise Department, University of Palermo, 90100 Palermo, Italy.
Medicina (Kaunas). 2024 Oct 8;60(10):1648. doi: 10.3390/medicina60101648.
The older segment of the global population is increasing at a rapid pace. Advancements in public health and modern medicine lengthened life expectancy and reduced the burden of disease in communities worldwide. Concurrent with this demographic change is the rise in overweight people and obesity, which is evident in all age groups. There is also an aging-related reduction in muscle mass and function, or sarcopenia, that is exacerbated by sedentary lifestyle and poor nutrition. The coexistence of muscle loss and elevated body mass index, termed "sarcopenic obesity", has particularly deleterious consequences in older individuals. Worsening insulin resistance and a proinflammatory state operate at the pathophysiologic level and lead to adverse health outcomes such as a proclivity to cardiovascular disease, type 2 diabetes, and even cognitive dysfunction. Although the concept of sarcopenic obesity as a disease construct is being increasingly recognized, a clearer understanding is warranted in order to define its components and health impact. Research is needed at the molecular-cellular level to tie together derangements in insulin action, cytokines, myokines, and endothelial dysfunction with clinical outcomes. Lifestyle modifications as well as targeted nonpharmacologic approaches, such as supplements and antioxidants, appear to have a promising role in reducing the chronic burden of this emerging disorder. Breakthroughs in drug therapies that retard or even reverse the underlying dynamics of sarcopenia and obesity in older persons are being actively explored.
全球人口中的老年群体正在迅速增加。公共卫生和现代医学的进步延长了预期寿命，并减轻了世界各地社区的疾病负担。与这一人口结构变化同时发生的是超重和肥胖人数的增加，所有年龄段都存在这种情况。与衰老相关的肌肉量和功能减少，即肌少症，也因久坐不动的生活方式和不良的营养而加剧。肌肉减少和身体质量指数升高同时存在，被称为“肌少症性肥胖”，在老年人中尤其具有严重的后果。在病理生理层面上，胰岛素抵抗和促炎状态的恶化会导致不良的健康后果，如易患心血管疾病、2 型糖尿病，甚至认知功能障碍。尽管肌少症性肥胖作为一种疾病概念正日益得到认可，但为了确定其组成部分和对健康的影响，仍需要更明确的认识。需要在分子-细胞水平进行研究，以将胰岛素作用、细胞因子、肌因子和内皮功能障碍的紊乱与临床结果联系起来。生活方式的改变以及有针对性的非药物方法，如补充剂和抗氧化剂，似乎在减轻这种新出现的疾病的慢性负担方面具有广阔的前景。人们正在积极探索延缓甚至逆转老年人肌少症和肥胖症潜在动态的药物治疗突破。
