The prevalence of obesity in combination with sarcopenia (the age-related loss of muscle mass and strength or physical function) is increasing in adults aged 65 years and older. A major subset of adults over the age of 65 is now classified as having sarcopenic obesity, a high-risk geriatric syndrome predominantly observed in an ageing population that is at risk of synergistic complications from both sarcopenia and obesity. This Review discusses pathways and mechanisms leading to muscle impairment in older adults with obesity. We explore sex-specific hormonal changes, inflammatory pathways and myocellular mechanisms leading to the development of sarcopenic obesity. We discuss the evolution, controversies and challenges in defining sarcopenic obesity and present current body composition modalities used to assess this condition. Epidemiological surveys form the basis of defining its prevalence and consequences beyond comorbidity and mortality. Current treatment strategies, and the evidence supporting them, are outlined, with a focus on calorie restriction, protein supplementation and aerobic and resistance exercises. We also describe weight loss-induced complications in patients with sarcopenic obesity that are relevant to clinical management. Finally, we review novel and potential future therapies including testosterone, selective androgen receptor modulators, myostatin inhibitors, ghrelin analogues, vitamin K and mesenchymal stem cell therapy.

Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies.

BACKGROUND  Body fat percentage (BF%) determined by bioelectrical impedance analysis is widely used at home and in medical check-ups. However, the clinical significance of measuring BF% has not been studied in detail. METHODS AND RESULTS  A cross-sectional study was carried out on a cohort of 10,774 middle-aged Japanese men who had undergone an annual check-up in 2008. Cut-off points were evaluated for body mass index (BMI), waist circumference (WC), and BF% for detecting participants with cardiovascular disease (CVD) risk factors (diabetes mellitus, hypertension, dyslipidemia), and effectiveness compared for each marker's cut-off point. Additionally, the effects of smoking on cut-off points were evaluated. The cut-off points of BMI, WC, and BF% for detecting participants with 1 or more CVD risk factors were 22.7kg/m(2), 81.4cm, and 20.3%, respectively. The cut-off points of BF% for 1 or more CVD risk factors classified 3.43% more subjects into correct categories than those of BMI (P<0.001). The cut-off points of BMI, WC, and BF% for detecting individuals with 3 CVD risk factors in current smokers were 24.9kg/m(2), 87.8cm, and 23.7%, while those in non-smokers were 23.3kg/m(2), 83.9cm, and 22.3%, respectively. CONCLUSIONS  BF% could be more effective in detecting individuals with early stage CVD risk accumulation than BMI. The cut-off points for current smokers were lower than those for non-smokers in all markers.

https://www.jstage.jst.go.jp/article/circj/76/10/76_CJ-12-0337/_pdf

The significance of measuring body fat percentage determined by bioelectrical impedance analysis for detecting subjects with cardiovascular disease risk factors.

It has been well documented that obesity is closely associated with metabolic syndrome (MetS). Although body mass index (BMI) is the most frequently used method to assess overweightness and obesity, this method has been criticized because BMI does not always reflect true body fatness, which may be better evaluated by assessment of body fat and fat-free mass. The objective of this study was to investigate the best indicator to predict the presence of MetS among fat mass index, BMI and percentage of body fat (BF %) and determine its optimal cut-off value in the screening of MetS in practice. A cross-sectional study of 1698 subjects (aged 20–79 years) who participated in the annual health check-ups was employed. Body composition was measured by bioelectrical impedance analysis (BIA). Fat mass index (FMI) was calculated. Sex-specific FMI quartiles were defined as follows: Q1: <4.39, Q2:4.39- < 5.65, Q3:5.65- < 7.03, Q4:≥7.03,in men; and Q1:<5.25, Q2:5.25- < 6.33, Q3:6.33- < 7.93,Q4:≥7.93, in women. MetS was defined by National Cholesterol Education Program/Adult Treatment Panel III criteria. The association between FMI quartiles and MetS was assessed using Binary logistic regression. Receiver operating curve(ROC) analysis was used to determine optimal cutoff points for BMI,BF% and FMI in relation to the area under the curve(AUC),sensitivity and specificity in men and women. The adjusted odds ratios (95% CI) for the presence of MetS in the highest FMI quartile versus lowest quartile were 79.143(21.243-294.852) for men( P < 0.01) and 52.039(4.144-653.436) for women( P < 0.01) after adjusting age, BMI, BF%, TC, LDL, CRP, smoking status and exercise status, and the odds ratios were 9.166(2.157-38.952) for men( P < 0.01) and 25.574(1.945-336.228) for women( P < 0.05) when WC was also added into the adjustment. It was determined that BMI values of 27.45 and 23.85 kg/m2, BF% of 23.95% and 31.35% and FMI of 7.00 and 7.90 kg/m2 were the optimal cutoff values to predict the presence of MetS among men and women according to the ROC curve analysis. Among the indicators used to predict MetS, FMI was the index that showed the greatest area under the ROC curve in both sexes. Higher FMI levels appear to be independently and positively associated with the presence of MetS regardless of BMI and BF%. FMI seems to be a better screening tool in prediction of the presence of metabolic syndrome than BMI and percentage of body fat in men and women.

https://link.springer.com/content/pdf/10.1186%2F1471-2458-13-629.pdf

The utility of fat mass index vs. body mass index and percentage of body fat in the screening of metabolic syndrome

Current technologies in body composition assessment: advantages and disadvantages

Low vitamin D status and obesity have concomitantly reached epidemic levels worldwide. Up to now the direction of the association between low vitamin D status and obesity, the exact mechanisms responsible for this association and the clinical usefulness to increase vitamin D status for reducing adiposity still warrant further evaluation. The aim of the present review was to examine the current evidence linking low vitamin D status and obesity in relation to the role of the nutritionist. On the one side, considering obesity as a causal factor, low sun exposure in obese individuals due to their sedentary lifestyle and less outdoor activity, vitamin D sequestration in adipose tissue, and volumetric dilution of ingested or cutaneously synthesized vitamin D3 in the large fat mass of obese patients, might represent some of the factors playing a major role in the pathogenesis of the low vitamin D status. On the other side, the expression of both vitamin D3 receptors and enzymes responsible for vitamin D3 metabolism in adipocytes depicted a role for the low vitamin D status per se in the development of obesity by modulating adipocyte differentiation and lipid metabolism. Nutritionists need to accurately address the aspects influencing the low vitamin D status in obesity and the vitamin D supplementation in obese individuals.

Low vitamin D status and obesity: Role of nutritionist

Comparisons of body-composition prediction accuracy: a study of 2 bioelectric impedance consumer devices in healthy Chinese persons using DXA and MRI as criteria methods.

An updated systematic review and meta-analysis of fecal microbiota transplantation for the treatment of ulcerative colitis

Background Although pain is commonly observed among medical staff, studies on pain among intensive care unit personnel are uncommon, especially intensive care unit (ICU) doctors and workers. Moreover, few studies have focused on the prevalence of pain and the associated factors. Purpose The aim of this study was to estimate the prevalence of pain among ICU personnel (including doctors, nurses and workers) and explore the risk factors for their pain. Methods We conducted an online survey that included sociodemographic and work-related items and questions about pain, ergonomics, and psychological factors. We used the short version of the validated Depression–Anxiety–Stress Scale (DASS-21) to assess the relationship between pain and mental disorders. All ICU personnel at West China Hospital of Sichuan University participated in this study. Results A total of 356 ICU personnel were included in the final analysis. The prevalence of pain was 72.2% among ICU nurses, 64.4% among ICU doctors and 52.9% among ICU workers. The most frequent location of pain was the lower back among nurses (65.9%) and workers (47.1%) and the neck among doctors (49.1%). The factors contributing to pain among ICU personnel were bending or twisting the neck, high levels of psychological fatigue, low self-perceived health status, female sex and high body mass index (BMI). Moreover, participants with pain indicated significantly higher depression (p ≤ 0.001), anxiety (p ≤ 0.001), and stress levels (p = 0.002) than those without pain. Conclusion This study indicates that ICU personnel exhibit a high prevalence of pain. Many factors, especially psychosocial and ergonomic factors, contribute to pain levels among ICU personnel and the poorer mental health levels observed in those experiencing pain. Therefore, disease prevention and health promotion measures are needed to protect the health of ICU personnel.

https://www.dovepress.com/getfile.php?fileID=81605

Prevalence of Pain and Its Risk Factors Among ICU Personnel in Tertiary Hospital in China: A Cross-Sectional Study

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Comparisons of body-composition prediction accuracy: a study of 2 bioelectric impedance consumer devices in healthy Chinese persons using DXA and MRI as criteria methods.

An updated systematic review and meta-analysis of fecal microbiota transplantation for the treatment of ulcerative colitis

Prevalence of Pain and Its Risk Factors Among ICU Personnel in Tertiary Hospital in China: A Cross-Sectional Study