Sarcopenic obesity is associated with impaired physical function and mortality in older patients with heart failure: insight from FRAGILE-HF

Abstract

Background The purpose of this study was to clarify the prevalence, association with frailty and exercise capacity, and prognostic implication of sarcopenic obesity in patients with heart failure. Methods The present study included 779 older adults hospitalized with heart failure (median age: 81 years; 57.4% men). Sarcopenia was diagnosed based on the guidelines by the Asian Working Group for Sarcopenia. Obesity was defined as the percentage of body fat mass (FM) obtained by bioelectrical impedance analysis. The FM cut-off points for obesity were 38% for women and 27% for men. The primary endpoint was 1-year all-cause death. We assessed the associations of sarcopenic obesity occurrence with the short physical performance battery (SPPB) score and 6-minute walk distance (6MWD). Results The rates of sarcopenia and obesity were 19.3 and 26.2%, respectively. The patients were classified into the following groups: non-sarcopenia/non-obesity (58.5%), non-sarcopenia/obesity (22.2%), sarcopenia/non-obesity (15.3%), and sarcopenia/obesity (4.0%). The sarcopenia/obesity group had a lower SPPB score and shorter 6MWD, which was independent of age and sex (coefficient, − 0.120; t-value, − 3.74; P < 0.001 and coefficient, − 77.42; t-value, − 3.61; P < 0.001; respectively). Ninety-six patients died during the 1-year follow-up period. In a Cox proportional hazard analysis, sarcopenia and obesity together were an independent prognostic factor even after adjusting for a coexisting prognostic factor (non-sarcopenia/non-obesity vs. sarcopenia/obesity: hazard ratio, 2.48; 95% confidence interval, 1.22–5.04; P = 0.012). Conclusion Sarcopenic obesity is a risk factor for all-cause death and low physical function in older adults with heart failure. Trial registration University Hospital Information Network (UMIN-CTR: UMIN000023929).

Nutritional Status Predicts the Length of Stay and Mortality in Patients Undergoing Electrotherapy Procedures

“…Sarcopenic obesity is defined as excessive fat mass accompanied by reduced muscular mass [ 24 ]. It is worth noting that this complex disorder is suggested to be associated with a higher health outcome risk than low body cell mass or high fat mass alone [ 23 , 24 , 25 ]. However, detailed body composition is needed for a full diagnosis of sarcopenic obesity [ 28 ], which is why this aspect needs further research.…”

“…In addition, sarcopenic obesity is another condition associated with higher mortality risk [ 23 , 24 , 25 ]. It is characterized by excessive fat mass combined with reduced muscular mass; thus, it cannot be identified by body mass measurements alone [ 24 ].…”

“…It is characterized by excessive fat mass combined with reduced muscular mass; thus, it cannot be identified by body mass measurements alone [ 24 ]. Studies suggest that sarcopenic obesity can result in even worse outcomes than sarcopenia alone [ 24 , 25 ].…”

Characteristics of resistance training-based protocols in older adults with sarcopenic obesity: a scoping review of training procedure recommendations

“…Even though different exercise orders did not affect chronic adaptations in muscle strength, hypertrophy, anabolic hormones, magnitude, and duration of postexercise hypotension in healthy older women ( 53 , 54 ), it was not possible to assume the same responses in older adults with SO. Indeed, older adults with SO potentially present impaired physical performance ( 55 ), muscle strength, and quality ( 4 ), which together can be responsible for triggering different exercise responses according to exercise order ( 56 ). Therefore, a critical evaluation of exercise order is recommended when dealing with older adults with SO, since training performance can be compromised throughout the session.…”

Defying Age: can active older adults with sarcopenic obesity overcome muscle strength and physical performance losses?

“…For example, one study of 11,803 older Canadian adults with SO found reduced handgrip strength but no signi cant difference in gait speed [33]. Another study of older adults with heart failure and SO found reduced physical performance, as measured by short physical performance battery score and 6-minute walk distance, and a 2.48 times higher risk of all-cause mortality compared to older adults without sarcopenia/obesity [34]. However, a study of 904 community-dwelling older adults reported no differences between the SO condition and physical performance, as measured by time up and go, sit to stand, one leg stand, walking speed at normal/fastest pace [35].…”