Skip to main content
×
×
Home

Muscle loss and obesity: the health implications of sarcopenia and sarcopenic obesity

  • S. Goya Wannamethee (a1) and Janice L. Atkins (a1)
Abstract

This paper reviews the health implications of obesity, sarcopenia and sarcopenic obesity on CVD and mortality in older adults and discusses the obesity paradox seen in patients with CVD. Obesity is a major public health problem with increasing prevalence worldwide. It is an established risk factor for cardiovascular morbidity and mortality in adult populations. However, there is controversy surrounding the effects of obesity as measured by BMI in older people, and overweight and obesity (BMI ⩾ 25 kg/m2) are apparently associated with increased survival in those with CVD (obesity paradox). Ageing is associated with an increase in visceral fat and a progressive loss of muscle mass which have opposing effects on mortality. Thus BMI is not a good indicator of obesity in older adults. Sarcopenia, the age-associated loss of skeletal muscle mass, is a major concern in ageing populations and has been associated with metabolic impairment, CVD risk factors, physical disability and mortality. Sarcopenia often coexists with obesity. Sarcopenic obesity is a new category of obesity in older adults who have high adiposity coupled with low muscle mass. To fully understand the effect of obesity on mortality in the elderly it is important to take muscle mass into account. The evidence suggests that sarcopenia with obesity may be associated with higher levels of metabolic disorders and an increased risk of mortality than obesity or sarcopenia alone. Efforts to promote healthy ageing should focus on both preventing obesity and maintaining or increasing muscle mass.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Muscle loss and obesity: the health implications of sarcopenia and sarcopenic obesity
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Muscle loss and obesity: the health implications of sarcopenia and sarcopenic obesity
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Muscle loss and obesity: the health implications of sarcopenia and sarcopenic obesity
      Available formats
      ×
Copyright
Corresponding author
* Corresponding author: Professor S. G. Wannamethee, email g.wannamethee@ucl.ac.uk
References
Hide All
1. World Health Organisation (2014) Obesity and Overweight. Fact Sheet Number 311. http://www.who.int/mediacentre/factsheets/fs311/en/ (accessed 17 October 2014).
2. Department of Health (2011) Healthy Lives, Healthy People: a Call to Action on Obesity in England. London: Department of Health.
3. Zamboni, M, Mazzali, G, Zoico, E et al. (2005) Health consequences of obesity in the elderly: a review of four unresolved questions. Int J Obes 29, 10111029.
4. Janssen, I & Mark, AE (2007) Elevated body mass index and mortality risk in the elderly. Obes Rev 8, 4159.
5. Winter, JE, MacInnis, RJ, Wattanapenpaiboon, N et al. (2014) BMI and all-cause mortality in older adults: a meta-analysis. Am J Clin Nutr 99, 875890.
6. Oreopoulos, A, Padwal, R, Kalantar-Zadeh, K et al. (2008) Body mass index and mortality in heart failure: a meta-analysis. Am Heart J 56, 1322.
7. Romero-Corral, A, Montori, VM, Somers, VK et al. (2006) Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. Lancet 368, 666678.
8. Angerås, O, Albertsson, P, Karason, K et al. (2013) Evidence for obesity paradox in patients with acute coronary syndromes: a report from the Swedish Coronary Angiography and Angioplasty Registry. Eur Heart J 34, 345353.
9. Oreopoulos, A, McAlister, FA, Kalantar-Zadeh, K et al. (2009) The relationship between body mass index, treatment and mortality in patients with established coronary artery disease: a report from APPROACH. Eur Heart J 30, 25842592.
10. Lavie, CJ, de Schutter, A, Patel, DA et al. (2012) Body composition and survival in stable coronary heart disease. J Am Coll Cardiol 60, 13741380.
11. Dorner, TE & Rieder, A (2012) Obesity paradox in elderly patients with cardiovascular diseases. Int J Cardiol 155, 5665.
12. Lavie, CJ, Milani, RV & Ventura, HO (2011) Impact of obesity on outcomes in myocardial infarction: combating the “obesity paradox”. J Am Coll Cardiol 58, 26512653.
13. Allison, DB, Zhu, SK, Plankey, M et al. (2002) Differential associations of body mass index and adiposity with all-cause mortality among men in the first and second National Health and Nutrition Examination Surveys (NHANES I and NHANES II) follow-up studies. Int J Obes Relat Metab Disord 26, 410416.
14. Baumgartner, RN (2000) Body composition in healthy aging. Ann N Y Acad Sci 904, 437448.
15. Zamboni, M, Mazzali, G, Fantin, F et al. (2008) Sarcopenic obesity: a new category of obesity in the elderly. Nutr Metab Cardiovasc Dis 18, 388395.
16. Choi, KM (2013) Sarcopenia and sarcopenic obesity. Endocrinol Metab (Seoul) 28, 8689.
17. Kohara, K (2014) Sarcopenic obesity in aging population: current status and future directions for research. Endocrine 45, 1525.
18. Stenholm, S, Harris, TB, Rantanen, T et al. (2008) Sarcopenic obesity: definition, cause and consequences. Curr Opin Clin Nutr Metab Care 11, 693700.
19. Waters, DL & Baumgartner, RN (2011) Sarcopenia and obesity. Clin Geriatr Med 27, 401421.
20. Prado, CM, Wells, JC, Smith, SR et al. (2012) Sarcopenic obesity: a critical appraisal of the current evidence. Clin Nutr 31, 583601.
21. World Health Organization (2000) Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation. WHO Technical Report Series, No 894. Geneva: WHO.
22. Czernichow, S, Kengne, AP, Stamatakis, E et al. (2011) Body mass index, waist circumference and waist-hip ratio: which is the better discriminator of cardiovascular disease mortality risk? Evidence from an individual-participant meta-analysis of 82 864 participants from nine cohort studies. Obes Rev 12, 680687.
23. Donini, LM, Savina, C, Gennaro, E et al. (2012) A systematic review of the literature concerning the relationship between obesity and mortality in the elderly. J Nutr Health Aging 16, 8998.
24. de Koning, L, Merchant, AT, Pogue, J et al. (2007) Waist circumference and waist-to-hip ratio as predictors of cardiovascular events: meta-regression analysis of prospective studies. Eur Heart J 28, 850856.
25. Decaria, JE, Sharp, C & Petrella, RJ (2012) Scoping review report: obesity in older adults. Int J Obes (Lond) 36, 11411150.
26. de Hollander, EL, Bemelmans, WJ, Boshuizen, HC et al. (2012) The association between waist circumference and risk of mortality considering body mass index in 65- to 74-year-olds: a meta-analysis of 29 cohorts involving more than 58 000 elderly persons. Int J Epidemiol 41, 805817.
27. World Health Organization (2008) Waist Circumference and Waist-hip Ratio: Report of a WHO Expert Consultation. Geneva: World Health Organization.
28. Baumgartner, RN, Koehler, KM, Gallagher, D et al. (1998) Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol 147, 755763.
29. Cruz-Jentoft, AJ, Baeyens, JP, Bauer, JM et al. (2010) Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 39, 412423.
30. Wijnhoven, HA, Snijder, MB, van Bokhorst-de van der Schueren, MA et al. (2012) Region-specific fat mass and muscle mass and mortality in community-dwelling older men and women. Gerontology 58, 3240.
31. Han, SS, Kim, KW, Kim, KI et al. (2010) Lean mass index: a better predictor of mortality than body mass index in elderly Asians. J Am Geriatr Soc 58, 312317.
32. Landi, F, Russo, A, Liperoti, R et al. (2010) Midarm muscle circumference, physical performance and mortality: results from the aging and longevity study in the Sirente geographic area (ilSIRENTE study). Clin Nutr 29, 441447.
33. Wannamethee, SG, Shaper, AG, Lennon, L et al. (2007) Decreased muscle mass and increased central adiposity are independently related to mortality in older men. Am J Clin Nutr 86, 13391346.
34. Wijnhoven, HA, van Bokhorst-de van der Schueren, MA, Heymans, MW et al. (2010) Low mid-upper arm circumference, calf circumference, and body mass index and mortality in older persons. J Gerontol A Biol Sci Med Sci 65, 11071114.
35. Cesari, M, Pahor, M, Lauretani, F et al. (2009) Skeletal muscle and mortality results from the InCHIANTI Study. J Gerontol Ser A Biol Sci Med Sci 64, 377384.
36. Rantanen, T, Harris, T, Leveille, SG et al. (2000) Muscle strength and body mass index as long-term predictors of mortality in initially healthy men. J Gerontol A Biol Sci Med Sci 55, M168M173.
37. Arango-Lopera, VE, Arroyo, P, Gutiérrez-Robledo, LM et al. (2013) Mortality as an adverse outcome of sarcopenia. J Nutr Health Aging 17, 259262.
38. Kim, JH, Lim, S, Choi, SH et al. (2014) Sarcopenia: an independent predictor of mortality in community-dwelling older Korean men. J Gerontol A Biol Sci Med Sci 69, 12441252.
39. Filippin, LI, Teixeira, VN, da Silva, MP et al. (2014) Sarcopenia: a predictor of mortality and the need for early diagnosis and intervention. Aging Clin Exp Res [Epublication ahead of print version].
40. Jensen, GL (2008) Inflammation: roles in aging and sarcopenia. JPEN J Parenter Enteral Nutr 32, 656659.
41. Han, K, Park, YM, Kwon, HS et al. (2014) Sarcopenia as a determinant of blood pressure in older Koreans: findings from the Korea National Health and Nutrition Examination Surveys (KNHANES) 2008–2010. PLoS ONE 9, e86902.
42. Snijder, MB, Henry, RM, Visser, M et al. (2004) Regional body composition as a determinant of arterial stiffness in the elderly: The Hoorn Study. J Hypertens 22, 23392347.
43. Atkins, JL, Whincup, PH, Morris, RW et al. (2014) Sarcopenic obesity and risk of cardiovascular disease and mortality: a population-based cohort study of older men. J Am Geriatr Soc 62, 253260.
44. Stephen, WC & Janssen, I (2009) Sarcopenic-obesity and cardiovascular disease risk in the elderly. J Nutr Health Aging 13, 460466.
45. Gregor, MF & Hotamisligil, GS (2011) Inflammatory mechanisms in obesity. Annu Rev Immunol 29, 415445.
46. Dominguez, LJ & Barbagallo, M (2007) The cardiometabolic syndrome and sarcopenic obesity in older persons. J Cardiometab Syndr 2, 183189.
47. Batsis, JA, Mackenzie, TA, Barre, LK et al. (2014) Sarcopenia, sarcopenic obesity and mortality in older adults: results from the National Health and Nutrition Examination Survey III. Eur J Clin Nutr 68, 10011007.
48. Kim, TN, Park, MS, Lim, KI et al. (2013) Relationships between sarcopenic obesity and insulin resistance, inflammation, and vitamin D status: the Korean Sarcopenic Obesity Study. Clin Endocrinol (Oxf) 78, 525532.
49. Lim, S, Kim, JH, Yoon, JW et al. (2010) Sarcopenic obesity: prevalence and association with metabolic syndrome in the Korean Longitudinal Study on Health and Aging (KLoSHA). Diab Care 33, 16521654.
50. Chung, JY, Kang, HT, Lee, DC et al. (2013) Body composition and its association with cardiometabolic risk factors in the elderly: a focus on sarcopenic obesity. Arch Gerontol Geriatr 56, 270278.
51. Hwang, B, Lim, JY, Lee, J et al. (2012) Prevalence rate and associated factors of sarcopenic obesity in Korean elderly population. J Korean Med Sci 27, 748755.
52. Park, SH, Park, JH, Song, PS et al. (2013) Sarcopenic obesity as an independent risk factor of hypertension. J Am Soc Hypertens 7, 420425.
53. Park, SH, Park, JH, Park, HY et al. (2014) Additional role of sarcopenia to waist circumference in predicting the odds of metabolic syndrome. Clin Nutr 33, 668672.
54. Baek, SJ, Nam, GE, Han, KD et al. (2014) Sarcopenia and sarcopenic obesity and their association with dyslipidemia in Korean elderly men: the 2008–2010 Korea National Health and Nutrition Examination Survey. J Endocrinol Invest 37, 247260.
55. Kim, TN, Park, MS, Kim, YJ et al. (2014) Association of low muscle mass and combined low muscle mass and visceral obesity with low cardiorespiratory fitness. PLoS ONE 9, e100118.
56. Lu, CW, Yang, KC, Chang, HH et al. (2013) Sarcopenic obesity is closely associated with metabolic syndrome. Obes Res Clin Pract 7, e301e307.
57. Srikanthan, P, Hevener, AL & Karlamangla, AS (2010) Sarcopenia exacerbates obesity-associated insulin resistance and dysglycemia: findings from the National Health and Nutrition Examination Survey III. PLoS ONE 5, e10805.
58. Baumgartner, RN, Wayne, SJ, Waters, DL et al. (2004) Sarcopenic obesity predicts instrumental activities of daily living disability in the elderly. Obes Res 12, 19952004.
59. Messier, V, Karelis, AD, Lavoie, M-E et al. (2009) Metabolic profile and quality of life in class I sarcopenic overweight and obese postmenopausal women: a MONET study. Appl Physiol Nutr Metab 34, 1824.
60. dos Santos, EP, Gadelha, AB, Safons, MP et al. (2014) Sarcopenia and sarcopenic obesity classifications and cardiometabolic risks in older women. Arch Gerontol Geriatr 59, 5661.
61. Schrager, MA, Metter, EJ, Simonsick, E et al. (2007) Sarcopenic obesity and inflammation in the InCHIANTI study. J Appl Physiol 102, 919925.
62. Cesari, M, Kritchevsky, SB, Baumgartner, RN et al. (2005) Sarcopenia, obesity, and inflammation – results from the Trial of Angiotensin Converting Enzyme Inhibition and Novel Cardiovascular Risk Factors study. Am J Clin Nutr 82, 428434.
63. Chin, SO, Rhee, SY, Chon, S et al. (2013) Sarcopenia is independently associated with cardiovascular disease in older Korean adults: the Korea National Health and Nutrition Examination Survey (KNHANES) from 2009. PLoS ONE 8, e60119.
64. Zeller, M, Steg, PG, Ravisy, J et al. (2008) Relation between body mass index, waist circumference and death after acute myocardial infarction. Circulation 118, 482490.
65. Kanhai, DA, Kapelle, LJ, van der Graaf, Y et al. (2012) The risk of general and abdominal adiposity in the occurrence of new vascular events and mortality in patients with various manifestations of vascular disease. Int J Obes 36, 695702.
66. Coutinho, T, Goel, K, Corrêa de Sá, D et al. (2011) Central Obesity and survival in subjects with coronary artery disease: a systematic review of the literature and collaborative analysis with individual subject data. J Am Coll Cardiol 57, 18771886.
67. Wannamethee, SG, Shaper, AG, Whincup, PH et al. (2014) The obesity paradox in men with coronary heart disease and heart failure: the role of muscle mass and leptin. Int J Cardiol 171, 4955.
68. Marques, MB & Langouche, L (2013) Endocrine, metabolic and morphologic alterations of adipose tissue during critical illness. Crit Care Med 41, 317325.
69. Anker, SD & Rauchhaus, M (1999) Insights into the pathogenesis of chronic heart failure:immune activation and cachexia. Curr Opin Cardiol 14, 211216.
70. Clerico, A, Giannoni, A, Vittorini, S et al. (2012) The paradox of low BNP levels in obesity. Heart Fail Rev 17, 8196.
71. McGaffin, KR, Moravec, CS & Mctiernan, CF (2009) Leptin signalling in the failing and mechanically unloaded human heart. Circ Heart Fail 2, 676683.
72. Kistorp, C, Faber, J, Galatius, S et al. (2005) Plasma adiponectin, body mass index and mortality in patients with chronic heart failure. Circulation 112, 17561762.
73. Hascoet, S, Elbaz, M, Bongard, V et al. (2013) Adiponectin and long term mortality in coronary artery disease participants and controls. Arterioscler Thromb Vasc Biol 33, e19e29.
74. Wannamethee, SG, Whincup, PH, Lennon, L et al. (2007) Circulating adiponectin levels and mortality in elderly men with and without cardiovascular disease and heart failure. Arch Intern Med 167, 15101517.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Proceedings of the Nutrition Society
  • ISSN: 0029-6651
  • EISSN: 1475-2719
  • URL: /core/journals/proceedings-of-the-nutrition-society
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed