Sarcopenia and Sarcopenic Obesity and Mortality Among Older People

Abstract

ImportanceSarcopenia and obesity are 2 global concerns associated with adverse health outcomes in older people. Evidence on the population-based prevalence of the combination of sarcopenia with obesity (sarcopenic obesity [SO]) and its association with mortality are still limited.ObjectiveTo investigate the prevalence of sarcopenia and SO and their association with all-cause mortality.Design, Setting, and ParticipantsThis large-scale, population-based cohort study assessed participants from the Rotterdam Study from March 1, 2009, to June 1, 2014. Associations of sarcopenia and SO with all-cause mortality were studied using Kaplan-Meier curves, Cox proportional hazards regression, and accelerated failure time models fitted for sex, age, and body mass index (BMI). Data analysis was performed from January 1 to April 1, 2023.ExposuresThe prevalence of sarcopenia and SO, measured based on handgrip strength and body composition (BC) (dual-energy x-ray absorptiometry) as recommended by current consensus criteria, with probable sarcopenia defined as having low handgrip strength and confirmed sarcopenia and SO defined as altered BC (high fat percentage and/or low appendicular skeletal muscle index) in addition to low handgrip strength.Main Outcome and MeasureThe primary outcome was all-cause mortality, collected using linked mortality data from general practitioners and the central municipal records, until October 2022.ResultsIn the total population of 5888 participants (mean [SD] age, 69.5 [9.1] years; mean [SD] BMI, 27.5 [4.3]; 3343 [56.8%] female), 653 (11.1%; 95% CI, 10.3%-11.9%) had probable sarcopenia and 127 (2.2%; 95% CI, 1.8%-2.6%) had confirmed sarcopenia. Sarcopenic obesity with 1 altered component of BC was present in 295 participants (5.0%; 95% CI, 4.4%-5.6%) and with 2 altered components in 44 participants (0.8%; 95% CI, 0.6%-1.0%). An increased risk of all-cause mortality was observed in participants with probable sarcopenia (hazard ratio [HR], 1.29; 95% CI, 1.14-1.47) and confirmed sarcopenia (HR, 1.93; 95% CI, 1.53-2.43). Participants with SO plus 1 altered component of BC (HR, 1.94; 95% CI, 1.60-2.33]) or 2 altered components of BC (HR, 2.84; 95% CI, 1.97-4.11) had a higher risk of mortality than those without SO. Similar results for SO were obtained for participants with a BMI of 27 or greater.Conclusions and RelevanceIn this study, sarcopenia and SO were found to be prevalent phenotypes in older people and were associated with all-cause mortality. Additional alterations of BC amplified this risk independently of age, sex, and BMI. The use of low muscle strength as a first step of both diagnoses may allow for early identification of individuals at risk for premature mortality.

Examining the mediating role of muscle quantity in adolescents: associations with adiposity, cardiorespiratory fitness, muscular fitness, and cardiometabolic risk factors

“…In adults and the elderly, the diagnosis can be made by the decrease in physical capacity or muscle strength associated with low skeletal muscle mass. The greatest concern is the repercussions of sarcopenic obesity in the elderly 17 , but there are indications that it starts earlier, in the youth phase 18 , due to the inflammatory process associated with obesity. In a systematic review, the authors conclude that there is a need to develop a definition and standardize assessment in pediatric population, as well, they suggest carrying out studies to understand the relationship between obesity and sarcopenia, and their association with health problems in children and adolescents 18 .…”

The Association between Sarcopenic Obesity and DXA-Derived Visceral Adipose Tissue (VAT) in Adults

“…In those, SO was found to be associated with several medical (i.e., noncommunicable diseases, etc.) [ 5 ] as well as psychosocial comorbidities (i.e., depression, impaired health-related quality of life (HRQoL)) [ 6 ] and an increased rate of mortality [ 7 ] when compared to those with overweight or obesity but without SO. Moreover, SO appears to be associated with a decreased resting energy expenditure [ 4 ], a more sedentary lifestyle [ 4 ], and reduced physical fitness [ 4 ].…”