View
1.054
Download
5
Category
Tags:
Preview:
DESCRIPTION
Evaluation of Sarcopenia
Citation preview
Sarcopenic Obesity Prof Mauro Zamboni
Department of Medicine-Geriatric Division
University of Verona-Italy
4ST International Seminar on Preventive Geriatrics
Athens
April 1st-3rd 2011
Sarcopenic Obesity
R Roubenoff, 2004
Epidemicof Obesity
Prevalence of Obesity and Overweight for Adults Aged 20 Years or Older
Flegal, K. M. et al. 2010;303:235-241
BMI
underweight
normalweight
overweight
obesity
morbid obesity
< 18.5
18.5-25
25-30
> 30
>40
WHO, 1998
weight (kg)
height (m)2 BMI =
Obesity should be identified as the degree of fat storage associated with elevated health risk.
The practical definition of Obesity is based on BMI
Sarcopenic Obesity
Epidemicof Obesity
Aging of the
population
Age related body composition changes
Age related increase in body fat for normal males at constant body mass
index (BMI)
10
20
30
40
25 35 45 55 65 75
0
10
20
30
40
50
60
70
80
90
100
Body fat (%)
Body weight
(kg)
Age (years)
Prentice AM & Jebb SA, 2001
Age-related decreases in thigh muscle area, knee extensor strenght, and aerobic capacity
in 78 healthy persons
Nair KS, Am J Clin Nutr 2005
Normal Obese
SarcopenicSarcopeni
cObese
5.0
6.0
7.0
Rela
tive M
usc
le M
ass
(kg
/m2
)
20 30 40% Body Fat
Median
-2 S
D b
el o
wYou
ng a
dult
mean
Baumgartner, 2000
Body composition in healthy aging: the New Mexico Body composition in healthy aging: the New Mexico Elder Health Survey and the New Mexico Aging Elder Health Survey and the New Mexico Aging
Process StudyProcess Study
Definition of Sarcopenic Obesity
SarcopeniaMuscle mass/ height squared
less than -2SD below the young adult mean
Sarcopenic obesityMuscle mass/ height squared
less than -2SD below the young adult reference mean
with % Fat > 27 in men and 38 in women
or BMI > 30
Prevalences of obesity, sarcopenia and sarcopenic-Prevalences of obesity, sarcopenia and sarcopenic-obesity by age in the combined New Mexico Elder obesity by age in the combined New Mexico Elder
Health Survey and New Mexico Aging Process StudyHealth Survey and New Mexico Aging Process Study
0
10
20
30
40
50
60%
<70 y
70-74 y 75-79 y >80 y
Obese
Normal
SarcopenicSarcopenic-Obese
Baumgartner et al, 1998
Comparison of different sarcopenic obesity definitions and prevalences
Definition of sarcopenic obesity
N Mean age (SD) Prevalence*
New Mexico Aging Process Study
•Sarcopenia: skeletal muscle mass -2 SD below mean of young population or < 7.26 kg/m2 in men and < 5.45 kg/m2 in women. •Obesity: percentage body fat greater than median or > 27% in men and 38% in women.
831 60 and over M: 4.4%F: 3.0%
NHANES III •Sarcopenia: two lower quintiles of muscle mass (<9.12 kg/m2 in men and <6.53 kg/m2 in women) •Obesity: two highest quintiles of fat mass (>37.16% in men and > 40.01% in women).
M: 1391F: 1591
M: 76.3 (1.7†)F: 77.3 (2.2†)
M: 9.6%F: 7.4%
Zoico et al •Sarcopenia: two lower quintiles of muscle mass (<5.7 kg/m2) •Obesity: two highest quintiles of fat mass (>42.9%)
F: 167 71.7 (2.4) F: 12.4%
*Age and gender adjusted prevalence.
†Standard error Stenholm Curr Opin Clin Nutr Metab Care 2008
Quantity or Quality Quantity or Quality of fat free mass and fat of fat free mass and fat
mass ? mass ?
a potential problems with definition of Sarcopenic Obesity:
Loss of leg lean mass and muscle strength in older Results from the Health, Aging and
Body Composition Study
Goodpaster et al. J Gerontol Med Sci, 2006
Definition based on hand grip strength
(instead of muscle mass) and BMI in four
epidemiological studies gives a
prevalence of Sarcopenic Obesity
between 4-9%
With Sarcopenic Obesity increases in
Intermuscular Fat
and Intramuscular
fat: Low Density
Lean Tissue by CT
0
0,5
1
1,5
2
2,5
3
3,5
VAT IMAT VAT IMAT
<35
35-59
60+
kilog
ram
s
of
ad
ipose
Visceral adipose tissue (VAT) and intermuscular adipose tissue (IMAT) increase
with age
Men Women
Gallagher et al., 2004
Body fat changes and ectopic fat deposition
in the elderly
Abdominal subcutaneous fat
Inter-intramuscular fat
Hepatic and pancreatic fat Abdominal
visceral AT
Epicardial fat, perivascular fat
Subcutaneous fatLower body
If loss of muscle mass or strength
Sarcopenic obesity
Muscle-Fat
a two-way cross-talk ?
What is the biological connection between
Sarcopenia and Obesity?
Nair KS, 2005
Does muscle loss cause fat gain ?
Adipose tissue
Pro-inflammatory cytokines
Pathways to sarcopenia ?
Does Fat gain cause Muscle loss?
Anti-inflammatory cytokines
Juge-Aubry CE et al, 2005
Man 79 years
BMI 35.21 Kg/m²
Obese sarcopenic subject Normal weight subject
80 years80 yearsBMI 26 Kg/m²BMI 26 Kg/m²
79 years79 yearsBMI 35.2 Kg/m²BMI 35.2 Kg/m²
Rossi et al. Obesity 2010 Mar 18
Association between intermuscular
adipose tissue area (IMAT), metabolic
variables, indices of sistemic and local
inflammation in 20 elderly men
Insulin HOMA Leptin hs-CRP
r 0.55 r 0.49
r 0.76
r 0.40
p<0.05
p<0.001
p<0.01
IL-6
r 0.11
IL-6 mRNA SAT
r 0.50
p<0.05
Zoico E, Zamboni M et al. 2009
Subcutaneous AT
Peritoneal AT
Peri Aortic AT
Epicardial AT
35 men aged 65.7±5 with coronary artery diseases or valve diseases35 men aged 65.7±5 with coronary artery diseases or valve diseases
SAT EAT
SAT
SAT
AOAT
EAT
EAT
AOAT
AOAT
*
*
Ad
ipon
ect
Ad
ipon
ect
ininM
CP
-1M
CP
-1
CD
-3C
D-3
*=p<0,05
**
**
Bambace et al. Cardiovascular Pathology 2010
A. B.
C. D.
Inflammatory cells and pericardial fat
macrophages
linphocytes
University of Verona 2010, to be submitted
University of Verona 2010, to be submitted
Human atrium stained with hematoxylin and eosin; Magnification. A. 10x; B. 20x; Scale bar: A. = 200μm; B.= 100μm
9 subjects of 35 (4 CAD; 5 nonCAD)
Age M ± SD 69,55 ± 7.50 years
BMI 27.33±1.98 kg/m2
University of Verona 2010, to be submitted
Staining: Perilipin + hematoxylin; Magnification: A.B. 10x ; C. 100x ; D. 40x
Scale bar: A. and B.= 200μm; C. = 20μm; D. = 50μm
Grp-75 marker of mithocondrial
stress
Grp-78 marker of
endoplasmatic reticolus stress
Grp-75 Grp-78University
of Verona and Brescia. Unpublished
Grp-75 Grp-78
subject 42
University of Verona and Brescia.
Unpublished
fibrosis
Miosteatosis plus MiofibrosisMiosteatosis plus Miofibrosisfor muscle quality?for muscle quality?
University of Verona Unpublished
miofibrosismiofibrosis
miosteatosismiosteatosis
Obesity acts synergistically with sarcopenia
to maximize the risk of physical
disability
Associations between purely sarcopenic, purely obese, or sarcopenic-obese subjects and self-reported difficulties
with physical function
Rolland Y, 2009
Incidence of Sarcopenia and Sarcopenic Incidence of Sarcopenia and Sarcopenic Obesity Obesity
(7 year follow-up)(7 year follow-up)
0
10
20
30
40
50
60
70
80
90
100
sarcopenic obese sarcopenic
%
19%
49%
Rossi A et al, 2008
Relative Risk of Pulmonary declineRelative Risk of Pulmonary declineby body composition changesby body composition changes(adjusted by sex and smoking)(adjusted by sex and smoking)
0
2
4
6
8
10
12
14
16
18
20
FFM decline FFM stable
SAD decline
SAD increas
* p<0.05
OR
*
*
Sarcopenic obeseOR=14
Rossi A et al, 2008
Differences in muscle density , muscle area ratio and fat area ratio, according frailty syndrome status
923 subjects, aged 65 years or older
The fat frail sarcopenic subject
Sarcopeniareduced muscle mass
and strenght
Obesitymainly
visceral obesity
Risk Falls
Fractures
PhysicalDisability
DiabetesHypertensionDyslipidemia
CVD
Insulin resistance
Zamboni et al, 2008
The concept of Sarcopenic Obesity
could help us understand the
complexity of the relation between
obesity, mortality and morbidity in
the elderly
Better knowledge of the biological
connection between sarcopenia and
obesity is needed
Better definition of sarcopenic
obesity is warranted
Recommended