Systematic review and meta-analysis of lean mass and mortality: Rationale and study description

Cheung, Ching‐Lung; Lee, Grace Koon-Yee; Au, Philip Chun-Ming; Li, Gloria Hoi-Yee; Chan, Marcus; Li, Hang-Long; Cheung, Bmy; Wong, Ian C. K.; Lee, Victor; Mok, James; Yip, Ben; Cheng, Kenneth; Wu, Chih‐Hsing

doi:10.1016/j.afos.2021.01.001

Cited by 10 publications

(3 citation statements)

References 210 publications

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“…However, other relevant pathophysiological features including muscle quality and composition, muscle energy metabolism derangements and neuromuscular junction alterations may alter the relationship between skeletal muscle mass and function, thereby supporting the need to directly assess the latter to define and diagnose SO. Although skeletal muscle mass per se may be relevant for metabolic outcomes, altered muscle function is indeed associated with global individual functional impairment, reduced quality of life and shorter survival [90, 91].…”

Section: Discussionmentioning

confidence: 99%

Definition and Diagnostic Criteria for Sarcopenic Obesity: ESPEN and EASO Consensus Statement

et al. 2022

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Introduction: Loss of skeletal muscle mass and function (sarcopenia) is common in individuals with obesity due to metabolic changes associated with a sedentary lifestyle, adipose tissue derangements, comorbidities (acute and chronic diseases) and during the ageing process. Co-existence of excess adiposity and low muscle mass/function is referred to as sarcopenic obesity (SO), a condition increasingly recognized for its clinical and functional features that negatively influence important patient-centred outcomes. Effective prevention and treatment strategies for SO are urgently needed, but efforts are hampered by the lack of a universally established SO definition and diagnostic criteria. Resulting inconsistencies in the literature also negatively affect the ability to define prevalence as well as clinical relevance of SO for negative health outcomes. Aims and Methods: The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) launched an initiative to reach expert consensus on a definition and diagnostic criteria for SO. The jointly appointed international expert panel proposes that SO is defined as the co-existence of excess adiposity and low muscle mass/function. The diagnosis of SO should be considered in at-risk individuals who screen positive for a co-occurring elevated body mass index or waist circumference, and markers of low skeletal muscle mass and function (risk factors, clinical symptoms, or validated questionnaires). Diagnostic procedures should initially include assessment of skeletal muscle function, followed by assessment of body composition where presence of excess adiposity and low skeletal muscle mass or related body compartments confirm the diagnosis of SO. Individuals with SO should be further stratified into stage I in the absence of clinical complications or stage II if cases are associated with complications linked to altered body composition or skeletal muscle dysfunction. Conclusions: ESPEN and EASO, as well as the expert international panel, advocate that the proposed SO definition and diagnostic criteria be implemented into routine clinical practice. The panel also encourages prospective studies in addition to secondary analysis of existing data sets, to study the predictive value, treatment efficacy and clinical impact of this SO definition.

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Section: Discussionmentioning

confidence: 99%

Definition and Diagnostic Criteria for Sarcopenic Obesity: ESPEN and EASO Consensus Statement

et al. 2022

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“…In another study, a classic VLCD showed the loss of an excess of lean mass [133] and this is known as a negative prognostic factor on the healthy state, quality of life, and weight loss maintenance [134,135]. Although in the context of BS, VLCD is not considered a major factor for weight regain, it is possibly an underappreciated one [136].…”

Section: Weight Loss Strategies Prior To Bariatric Surgerymentioning

confidence: 99%

Nutritional Management in Bariatric Surgery Patients

Deledda

Pintus²,

Loviselli

et al. 2021

IJERPH

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The obesity epidemic, mainly due to lifestyle changes in recent decades, leads to serious comorbidities that reduce life expectancy. This situation is affecting the health policies of many nations around the world. Traditional measures such as diet, physical activity, and drugs are often not enough to achieve weight loss goals and to maintain the results over time. Bariatric surgery (BS) includes various techniques, which favor rapid and sustained weight loss. BS is a useful and, in most cases, the best treatment in severe and complicated obesity. In addition, it has a greater benefit/risk ratio than non-surgical traditional therapies. BS can allow the obese patient to lose weight quickly compared with traditional lifestyle changes, and with a greater probability of maintaining the results. Moreover, BS promotes improvements in metabolic parameters, even diabetes remission, and in the quality of life. These changes can lead to an increase of life expectancy by over 6 years on average. The nutrition of people before and after BS must be the subject of indications from a trained staff, and patients must be followed in the subsequent years to reduce the risk of malnutrition and the associated problems. In particular, it is still debated whether it is necessary to lose weight prior to surgery, a procedure that can facilitate the surgeon’s work reducing the surgical risk, but at the same time, lengthens preparation times increasing the risks associated with concomitant pathologies. Furthermore, preventing nutritional deficiencies prior to the intervention can improve the results and reduce short- and long-term mortality.

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“…In contrast, an increase in the total lean mass is inextricably linked to an improved quality of life and better prognosis [ 6 ]. However, this point is controversial as some studies report different relationships between lean body mass with all-cause mortality and cause-specific mortality [ 7 – 11 ]. Thus, it is very early to rely entirely on the total lean body mass to discriminate participants’ prognosis, considering that the abnormal distribution of lean body mass may have an unexpected impact on the patient’s prognosis.…”

Section: Introductionmentioning

confidence: 99%

Muscle distribution in relation to all-cause and cause-specific mortality in young and middle-aged adults

Liu

et al. 2023

J Transl Med

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Background The relationship between muscle and prognosis, especially that between muscle distribution across different body parts, and the related prognosis is not well established. Objective To investigate the relationship between muscle distribution and all-cause and cause-specific mortality and their potential modifiers. Design Longitudinal cohort study. C-index, IDI, and NRI were used to determine the best indicator of prognosis. COX regression analysis was performed to explore the relationship between variables and outcomes. Interaction and subgroup analyses were applied to identify the potential modifiers. Participants A total of 5052 participants (weighted: 124,841,420) extracted from the NHANES 2003–2006 of median age 45 years and constituting 50.3% men were assessed. For validation, we included 3040 patients from the INSCOC cohort in China. Main measures Muscle mass and distribution. Key Results COX regression analysis revealed that upper limbs (HR = 0.41, 95% CI 0.33–0.51), lower limbs (HR = 0.54, 95% CI 0.47–0.64), trunk (HR = 0.71, 95% CI, 0.59–0.85), gynoid (HR = 0.47, 95% CI 0.38–0.58), and total lean mass (HR = 0.55, 95% CI 0.45–0.66) were all associated with the better survival of participants (P trend < 0.001). The changes in the lean mass ratio of the upper and lower limbs and the lean mass ratio of the android and gynoid attenuated the protective effect of lean mass. Age and sex acted as potential modifiers, and the relationship between lean mass and the prognosis was more significant in men and middle-aged participants when compared to that in other age groups. Sensitive analyses depicted that despite lean mass having a long-term impact on prognosis (15 years), it has a more substantial effect on near-term survival (5 years). Conclusion Muscle mass and its distribution affect the prognosis with a more significant impact on the near-term than that on the long-term prognosis. Age and sex acted as vital modifiers.

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Systematic review and meta-analysis of lean mass and mortality: Rationale and study description

Cited by 10 publications

References 210 publications

Definition and Diagnostic Criteria for Sarcopenic Obesity: ESPEN and EASO Consensus Statement

Definition and Diagnostic Criteria for Sarcopenic Obesity: ESPEN and EASO Consensus Statement

Nutritional Management in Bariatric Surgery Patients

Muscle distribution in relation to all-cause and cause-specific mortality in young and middle-aged adults

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