Sarcopenic obesity (SO) is a complex metabolic state of the body, attributable to a synergistic combination, mutual reinforcement and aggravation of the pathological mechanisms of sarcopenia and obesity. SO is associated with a decrease in the quality of life, dependence on outside help, an increased risk of disability and premature death. Currently, the urgency of the SO problem is increasing due to the global demographic aging of the population, the high incidence of obesity, type 2 diabetes mellitus (DM2), geriatric syndromes of sarcopenia and frailty in the developed countries of the modern world. It is of interest to review current literature data on the prevalence, etiology, pathogenesis, as well as the principles of diagnosis, prevention and treatment of sarcopenic obesity.
Среди множества гериатрических синдромов несомненно одно из первых мест занимают старческая астения и саркопения. Несмотря на широкое их освещение в современной научной медицинской литературе, до сих пор актуальным остается вопрос о взаимосвязи этих гериатрических синдромов. Какой из вышеуказанных синдромов является первичным, а какой - вторичным? Они конкурируют между собой, взаимно отягощают друг друга, не зависят один от другого либо же объединены общими патологическими механизмами? Рассмотрению этих вопросов посвящен данный обзор литературы. Among the many geriatric syndromes, undoubtedly, one of the first places is, in other words, the leading positions are occupied by frailty and sarcopenia. Despite their wide coverage in the modern scientific medical literature, the question of the relationship of these geriatric syndromes with each other is still relevant. Which of the above syndromes is primary and which is secondary? Do they compete with each other, mutually burden each other, do not depend on each other, or are they united by common pathological mechanisms? This literature review is devoted to these issues.
Objectives to identify the correlations between the Charlson comorbidity index and the results of functional activity tests as predictors of sarcopenia among elderly and senile women with polymorbidity. Material and methods. The study included 269 elderly and senile women aged from 65 to 84 years, having polypathology. Results. Sarcopenia was detected in 14.63% of the elderly, and in 27.40% of senile women. The Charlson comorbidity index was associated with the risk of progression of frailty, a decrease in basic functional activity, increased muscle weakness and impaired function of skeletal muscles. Conclusion. Dynamometry and functional activity tests can be used in clinical practice to diagnose sarcopenia syndrome in elderly and senile women.
Due to the high prevalence of sarcopenia among elderly and old patients, early prevention and treatment of sarcopenia and its complications are relevant. Protein supplements can be used to maintain muscle strength and mass during aging. The possibility of using branched-chain amino acids (BCAAs) in the treatment and prevention of sarcopenia in geriatric patients is of scientific interest. BCAAs promote the synthesis and inhibit the degradation of muscle tissue proteins, are involved in the regulation of tissue sensitivity to insulin, ammonia utilization, the tricarboxylic acid cycle, etc.Search strategy. The search for scientific articles for literature review was carried out in the PubMed and PubMed Central databases. The selection criterion was scientific articles published up to December 2022. We used the following search keywords: “branched-chain amino acids”, “BCAA”, “body composition”, “sarcopenia”, “aging”. The 2019 European Working Group on Sarcopenia in Older People 2 (EWGSOP2) Consensus was included in the list of articles.Conclusions. The possibility of using BCAAs in elderly and old patients for the prevention and treatment of sarcopenia is a relevant topic that continues to be actively studied. The effectiveness of BCAA supplementation in the diet is debatable as long as sufficient protein is consumed daily. On the other hand, BCAA supplementation may be justified in cases where it is not possible to consume enough high-quality protein in the diet. More research is needed on this topic.
На фоне постарения населения отмечается увеличение частоты и распространенности хронических неинфекционных заболеваний с возрастом. Синдром старческой астении, частота которого также растет по мере старения, рассматривается как прогностический фактор неблагоприятных исходов хронических заболеваний и смертности у гериатрических пациентов. При этом у женщин старческая хрупкость встречается чаще, чем у мужчин. Более ранняя диагностика и выявление признаков старческой астении необходимо для профилактики прогрессирования как самого синдрома, так и множественных возрастассоциированных хронических заболеваний. Against the background of an aging population, there is an increase in the frequency and prevalence of chronic non-infectious diseases with age. The syndrome of frailty, the frequency of which also increases with aging, is considered as a prognostic factor for the adverse outcomes of chronic diseases and mortality among geriatric patients. Moreover, in women, frailty is more common than in men. An earlier diagnosis and identification of signs of frailty is necessary to prevent the progression of both the syndrome itself and multiple age-associated chronic diseases.
Глобальное старение населения в современном мире приводит к увеличению численности людей старших возрастных групп. Полиморбидная патология и гериатрические синдромы, к числу которых относят старческую астению и саркопению, могут служить причиной неустойчивости организма к различным факторам внешней и внутренней среды. Продолжающаяся в настоящее время пандемия COVID-19, сопровождающаяся значительным увеличением смертности лиц пожилого и старческого возраста, вызывает необходимость исследования причин, лежащих в основе повышенной уязвимости гериатрических пациентов к этому заболеванию. Этой проблеме посвящен данный обзор литературы. The global aging of the population in the modern world leads to an increase in the number of people of older age groups. Polymorbid pathology and geriatric syndromes, which include frailty and sarcopenia, can cause organism instability to various factors of the external and internal environment. The current COVID-19 pandemic, accompanied by a significant increase in mortality among the elderly and senile, makes it necessary to investigate the reasons underlying the increased vulnerability of geriatric patients to this disease. This review of the literature is devoted to this problem.
Саркопения и старческая астения сопровождаются изменениями состава тела. Биоимпедансный фазовый угол (фазовый угол, PhA) является одним из параметров, который может быть измерен с помощью биоимпедансного анализа состава тела (BIA). BIA, наряду с двухфотонной рентгеновской абсорбциометрией (DEXA), используют для определения мышечной массы тела согласно протоколу диагностики саркопении EWGSOP2. Современные исследования отмечают такие положительные аспекты BIA, по сравнению с DEXA, как быстрота диагностики, отсутствие ионизирующей лучевой нагрузки на организм пациента, более низкая стоимость исследования при высокой информативности. Фазовый угол отражает целостность клеточных мембран и активность метаболизма. Низкие значения PhA ассоциированы с прогрессированием старческой астении и саркопении, инвалидизацией и неблагоприятными исходами для гериатрических пациентов. Данный обзор литературы посвящен рассмотрению современных аспектов применения BIA с измерением PhA в гериатрической практике. Sarcopenia and frailty are accompanied by changes in body composition. Bioimpedance phase angle (phase angle, PhA) is one of the parameters that can be measured using Bioimpedance body composition analysis (BIA). BIA, along with Dual-Energy X-ray Absorptiometry (DEXA), is used to determine lean body mass according to the EWGSOP2 sarcopenia diagnostic protocol. Modern studies note such positive aspects of BIA, as compared to DEXA, as the speed of diagnosis, no ionizing radiation exposure on the patient’s body, the lower cost of the study with high information content. The phase angle shows the quality of cell membranes and metabolic activity. Low PhA is associated with the progression of frailty and sarcopenia, disability and poor outcomes for geriatric patients. This review of the literature is devoted to the consideration of modern aspects of the use of BIA with PhA measurement in geriatric practice.
Aim to assess the prevalence of low muscle mass and low bone density in elderly patients with type 2 diabetes (T2DM), depending on the level of glycated hemoglobin (HbA1c). Material and methods.The study included 187 patients (mean age 65.16 4.31 years), who were tested for fasting blood glucose, HbA1c, osteocalcin (OC), procollagen type 1 N-terminal propeptide (P1NP), C-terminal type I collagen telopeptides (B-CTX), 25-hydroxyvitamin D, body composition and bone mineral density. Results.The prevalence of low muscle mass, osteopenia, and osteoporosis in elderly patients with T2DM was 35.8%, 38.5%, and 30.5%, respectively. The prevalence of low muscle mass was significantly higher in women with HbA1c 9.0% (p =0.035). Osteopenia and osteoporosis prevailed in men with HbA1c 9.0% (p=0.007 and p=0.048, respectively). The appendicular skeletal muscle index (ASMI), bone mineral content (BMC) and bone mineral density (BMD) of the lumbar spine, BMC and BMD of the thigh were significantly reduced in the osteoporosis and osteopenia groups (p0.05); while B-CTX, P1NP were significantly increased. In men, both ASMI (p=0.007) and P1NP levels (p=0.001) were important risk factors for osteopenia/osteoporosis, and in women such risk factor was ASMI (p=0.019). Conclusion.In T2DM patients, the high HbA1c levels were associated with higher rates of low muscle mass in women and osteoporosis in men, and ASMI was a risk factor for osteoporosis in both sexes.
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