Mortality, sarcopenic obesity, and sarcopenia: Frailty in Brazilian Older People Study – FIBRA – RJ

Abstract

OBJECTIVE: To investigate the risk of mortality associated with sarcopenic obesity (SO), obesity (OB), and sarcopenia in elderlies. METHODS: We analyzed longitudinal data from 270 participants > 65 years of age of Phase III of the Study on Frailty in Brazilian Older People (FIBRA–RJ–2012). Socioeconomic, demographic, lifestyle, morbidity, and functional data were collected by home based interviews. DXA and body composition assessment was conducted in a laboratory. In women, OB was diagnosed when body fat percentage ≥ 38% and sarcopenia by an Appendicular Lean Mass Index (ALMI) < 6.00 kg/m² and muscle strength < 16 Kgf. In men, OB was diagnosed when body fat percentage ≥ 27%, and sarcopenia was diagnosed with ALMI < 7.00 kg/m² and muscle strength < 27 Kgf. SO was assessed by combining variables used to diagnose obesity and sarcopenia. The probabilistic linkage method was used to obtain deaths in the 2012-January 2017 period from the Brazilian Mortality Registry. Cox regression models were tested, and crude and adjusted hazard ratio calculations were conducted. RESULTS: After adjusting for sex, age, race/skin color, walking as an exercise, and hypertension, individuals with sarcopenia were 5.7 times more likely to die (95%CI: 1.17–27.99) than others without sarcopenia and obesity. CONCLUSION: A high risk of death was observed in individuals with sarcopenia. These results show the need for preventive strategies of early detection and treatment in order to increase survival employing multimodal interventions.

Prevalence of sarcopenic obesity in the older non-hospitalized population: a systematic review and meta-analysis

“…Finally, 46 studies met the inclusion and exclusion criteria. Among them, 17 [ 6 , 9 , 13 , 15 , 20 – 32 ] were cohort studies, and 29 [ 7 – 8 , 10 , 14 , 17 , 33 – 56 ] were cross-sectional studies. Articles published in the last 3 years (post-2020) accounted for 28 [ 6 – 7 , 9 – 10 , 15 , 20 – 21 , 23 , 26 – 31 , 36 , 39 , 41 , 44 – 47 , 49 – 50 , 52 – 56 ] studies.…”

“…The included studies used varying diagnostic criteria for sarcopenia (low muscle mass, low muscle strength, or low muscle strength and mass) combined with different obesity criteria (percentage of body fat [PBF], BMI, or waist circumference [WC]) to diagnose SO. Among them, 14 [ 6 – 8 , 10 , 13 , 17 , 20 , 22 , 28 , 34 , 45 , 47 , 51 , 54 ] studies used low muscle mass as the diagnostic criterion for sarcopenia, 10 [ 9 , 20 , 26 , 29 , 40 – 41 , 49 – 50 , 55 – 56 ] studies used low muscle strength as the diagnostic criterion for sarcopenia, and 20 [ 14 – 15 , 21 – 25 , 27 , 30 – 31 , 35 – 36 , 39 , 42 – 44 , 46 , 48 , 52 – 53 ] studies used low muscle mass plus low muscle strength as the diagnostic criterion for sarcopenia. In addition, one [ 6 ] study, a multicenter population study, did not provide a specific cutoff for their obesity diagnostic criteria (PBF).…”

“…Most studies were of fair [ 6 , 8 , 10 , 2 – 13 , 16 , 19 , 25 – 26 , 29 , 31 , 32 , 35 – 37 , 42 , 48 , 51 – 53 ] or high [ 7 , 9 , 15 , 21 – 25 , 28 – 29 , 31 , 33 , 35 , 36 , 40 – 43 , 45 , 49 , 51 , 52 – 56 ] quality because they scored “yes” for at least five items in the quality assessment checklist. Specifically, 26 [ 7 , 9 , 15 , 21 – 25 , 28 – 29 , 31 , 33 , 35 – 36 , 40 – 43 , 45 – 49 , 51 – 52 , 56 ] studies scored “yes” for 8–9 items, 18 [ 6 , 8 , 13 – 14 , 17 , 20 , 26 – 27 , 30 , 32 , 34 , 37 , 39 , 44 , ...…”

“…The pooled prevalence of SO diagnosed using low muscle mass + low muscle strength combined with different diagnostic criteria for obesity was 10% (95% CI: 6–14%, I 2 = 98%, P < 0.01, 20 studies [ 14 – 15 , 21 – 25 , 27 , 30 – 31 , 35 – 36 , 39 , 42 – 44 , 46 , 48 , 52 – 53 ]). Among them, the pooled prevalence of SO diagnosed using low muscle mass + low muscle + PBF, low muscle mass + low muscle + BMI, and low muscle mass + low muscle + BMI + WC + PBF was 10% (95% CI: 6–14%, I 2 = 98%, P < 0.01, 9 studies [ 14 – 15 , 22 , 24 , 35 , 42 – 43 , 46 , 52 ]), 18% (95% CI: 15–20%, I 2 = 57%, P = 0.07, 4 studies [ 15 , 31 , 44 , 48 ]), and 9% (95% CI: 9–17%, I 2 = 94%, P < 0.01, 3 studies [ 27 , 36 , 53 ]), respectively (Table 1 ).…”

“…A Korean cohort study using muscle mass and waist circumference to diagnose SO demonstrated an SO prevalence of 41.6%, with 35.2% prevalence in men and 48.2% in women [ 13 ]. A cross-sectional study in China defined sarcopenia as low muscle mass and strength and obesity as high body fat percentage; they showed an SO prevalence of only 4.0%, including 7.0% in men and 2.4% in women [ 14 ].…”