Sarcopenic obesity is associated with metabolic syndrome! Liu Boen reveals: Sarcopenia obesity may lead to 7 major diseases

Elderly people are more susceptible to sarcopenia due to the gradual decline in muscle mass and function. However, have you heard of "sarcopenia obesity"? As the name suggests, it means less muscle and more fat. Obesity specialist Dr. Liu Bowen said that when elderly people suffer from both obesity and insufficient muscle mass, it is called "sarcopenia obesity." The impact on the health of the elderly is that it is more likely to cause cardiovascular and cerebrovascular diseases than simple obesity or sarcopenia, and also includes metabolic syndrome, endocrine abnormalities, and is even related to the occurrence of dementia.

What is sarcopenia?

Sarcopenia is a phenomenon of aging. As we age, the functions of various physiological organs gradually decline, and this is especially true for muscle quality. When muscle mass, strength, and function all decline, it is called "sarcopenia."

Sarcopenia is a common morbid syndrome among the elderly, and its incidence rate varies slightly in different countries and regions. The prevalence of sarcopenia in Europe and the United States is about 5% to 12%, and about 11% to 40% for people over 80 years old. Local research in Taiwan shows that the prevalence of sarcopenia in people over 65 years old is about 4% to 7.5% (about 2.6% to 6.6% for women and about 5.5% to 8.3% for men). The prevalence of sarcopenia varies according to screening method and ethnic group, but is expected to continue to increase as the population ages.

What is sarcopenia?

Liu Bowen, executive director of the Taiwan Obesity Education and Prevention Association and an obesity specialist, said that the so-called "sarcopenia obesity" includes "reduced muscle mass" and "obesity". The muscle mass of ordinary people begins to increase since adolescence, reaches a peak around the age of 30, and then declines year by year. After the age of 50, it is lost at a rate of 1 to 2% per year. The reduction in muscle mass should make people look thin, but the fat accumulation that accompanies obesity fills the original space, resulting in a seemingly medium-sized body, regardless of whether the amount of subcutaneous fat or visceral fat is high or the body fat percentage exceeds the standard.

Possible complications of sarcopenia and obesity

Sarcopenia, combined with the physiological symptoms caused by obesity, affects a wide range of organs. In addition to cardiovascular and cerebrovascular diseases, it also includes metabolic syndrome, accidental falls and trauma, endocrine abnormalities, and is even related to dysphagia and dementia. Dr. Liu Boen specifically listed some of the research conclusions related to sarcopenia from past domestic and foreign literature as follows:

Sarcopenia, combined with the physiological symptoms caused by obesity, affects a wide range of organs. In addition to cardiovascular and cerebrovascular diseases, it also includes metabolic syndrome, accidental falls and trauma, endocrine abnormalities, and is even related to dysphagia and dementia.

Pathological mechanism of sarcopenic obesity

1. Neuromuscular diseases caused by degeneration and aging, such as the reduction of motor neurons, damage to the myelin sheath of peripheral nerves and the reduction in the number of muscle fibers.

2. Changes in hormone concentration and effectiveness, such as a decrease in growth hormone (GH), IGF-1, androgens, estrogens and insulin, and an increase in insulin resistance, will affect protein assimilation. The reduction of vitamin D is also related to the decrease of muscle strength.

3. Production of inflammatory substances such as TNF- à, IL-6, IL-1, and CRP.

4. Nutritional imbalance, such as lack of protein and calories.

5. Long-term bed rest or lack of activity.

Pathological association between sarcopenia and obesity

A research report pointed out that elderly patients with muscle-less obesity in the ICU will have a lower recurrence rate of symptoms, increase the number of days of hospitalization, and their quality of life after recovery will be significantly reduced. The principle of treatment is to supplement high protein, low carbohydrates and sufficient vitamin D. Omeng3 fatty acid. and increase physical fitness exercise. (Sarcopenic obesity in the ICU.)

Research reports show that fat in muscles is one of the main causes of fat inflammatory response, and is also related to the physiological dysfunction caused by sarcopenia obesity. (poor functional outcomes) (Inter-muscular adipose tissues is association with adipose tissue inflammation and poorer functional performance in central adiposity.)

A research report published in the January 2019 issue of Curr.Opin.Nutr.Metab.Care magazine showed that the proportion of obesity in the elderly has been on the rise in recent years, and therefore a higher proportion of people will develop so-called sarcopenia obesity, which is characterized by some mismatched connections between muscle tissue and fat tissue. Therefore, in clinical treatment, especially surgical treatment, its indications have caused some confusion. Therefore, before some invasive obesity surgeries are performed, it is necessary to distinguish whether it is sarcopenia obesity or primary obesity. Only after confirmation can better treatment effects be achieved. (Sarcopenia and obesity).

In 2018, an academic research report pointed out that sarcopenia obesity can lead to the decline of physiological functions and is closely related to mortality. This is an analysis of 992 people: the body fat rate exceeds the average: men are 27.3%, women are 40.7%, but the rate of sarcopenia obesity is 0.3% for men and 0.1% for women. This report shows that although the obesity rate is high, the rate of sarcopenia is not high. The main reason is that the skeletal muscle composition is overestimated during measurement.

A 2016 research report pointed out that people with sarcopenia and obesity have a poorer prognosis after suffering from cancer, and will have higher surgical complications, drug toxic reactions, and even shorter survival rates during treatment. (Clinical Implication of Sarcopenic Obesity In Cancer. Curr Oncol. Rep. 2016.Oct.18)

According to a statistical result of data collected by the South Korean Ministry of Health and Welfare in 2018, it was found that people with sarcopenic obesity have a higher rate of chronic diseases such as hypertension, diabetes, hyperlipidemia, etc. This study also found that higher calorie intake is a major factor causing sarcopenic obesity, and lifestyle habits such as vitamin D2 deficiency and smoking are also one of the factors causing sarcopenic obesity. (Association between Scrcopenic Obesity and Chronic Disease in Korean Elderly.)

Effective treatment for sarcopenic obesity

1. Weight loss

●Excessive obesity has been confirmed to be associated with a low-grade chronic inflammatory state, especially the accumulation of fat in skeletal muscle and the impairment of muscle strength. Weight loss is an effective strategy for treating sarcopenia. Some scholars may think that weight loss is not suitable for the elderly, but in comparison, weight loss, especially a moderate reduction in fat, can improve the loss of muscle and the deterioration of their physiological fragility.

●The patient's dietary flow chart shows that the starch intake still exceeds the healthy ratio. Among them, about 60% of the patients, according to the research results of some local primary medical units, for more than 200 patients over 65 years old with sarcopenia and obesity, the starch ratio exceeded 70%. After dietary education, after reducing the amount of starch intake and relatively increasing the protein intake, about 50% of the patients had a significant decrease in weight and body fat rate. In addition, for the issue of medication for elderly obese people, such as patients with morbid obesity, three high metabolic syndrome, and abnormal bulimia, overeating, etc., giving appropriate drug treatment under the supervision of a doctor is still a safe and feasible way to treat elderly obesity.

●In addition to dietary calorie regulation, which is an important part of weight loss, appropriate physical fitness exercise is also an important method for treating sarcopenic obesity. As people age, their physiological activity decreases, causing a considerable proportion of muscles to atrophy or decrease. Appropriate exercise has been shown to improve muscle atrophy obesity in many aspects, especially in increasing muscle protein synthesis, enhancing mitochondrial function, reducing myostatin, and increasing intramuscular IGF-1. The exercise prescription includes progressive resistance training (PRT), with 30 minutes of low-intensity aerobic exercise, 30 minutes of high-intensity PRT, and 15 minutes of balance training per week.

Appropriate physical fitness exercise intervention is also an important method for treating sarcopenic obesity.

2. Nutritional intervention

●Generally, aging is associated with a decrease in dietary protein intake and a slow protein response to essential amino acid intake. Therefore, for the elderly, it is necessary to appropriately increase essential amino acids to enhance protein synthesis. Especially in the dietary pattern of Oriental people, due to the particularity of their living habits, the local elderly people's carbohydrate intake tends to be higher than that of Westerners. Research reports also confirm that high amounts of carbohydrates have a negative impact on muscle protein synthesis in the elderly, and research reports also show that leucine supplementation can stimulate protein synthesis. Therefore, it can also be used to prevent the occurrence of sarcopenia.

3. Medication

Since some patients have poor compliance, the drug intervention treatment model tends to be increasingly valued.

Myostatin inhibitors

●Myostatin is produced by skeletal muscle and adipose tissue. It is one of the components of the secreted growth factor TGF-β. Its function is to negatively regulate muscle mass. Some animal studies have confirmed that myostatin inhibitors can improve sarcopenic obesity, but in human experiments, long-term and larger data are still needed to prove the safety and effectiveness of myostatin inhibitors.

●Growth hormone also promotes fat metabolism, reduces body fat, promotes protein metabolism, anti-wrinkle, and maintains immune function.

●In short, exercising muscles can promote the secretion of growth hormone and also help to beautify and maintain your skin.

●The body starts to degenerate from the lower body muscles. When muscles decrease, you will feel tired easily, and then fall into a vicious cycle of "reduced activity due to fatigue → reduced calorie consumption → easy to gain weight". In order to make the body full of energy, the most important part to exercise is the lower body muscles.

●Just moving your large muscles can burn calories. In other words, increasing the muscle mass in the lower body can improve metabolism, effectively burn fat, and make people have a physique that is easy to lose weight.

Dr. Liu Boen said that general aging is associated with a decrease in dietary protein intake and a slow protein response to essential amino acid intake. Therefore, for the elderly, it is necessary to appropriately increase essential amino acids to enhance protein synthesis. (Photo provided by Dr. Liu Boen)