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The effect of sarcopenic obesity on cardiovascular disease and all-cause mortality in older people

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

Obesity is a major public health problem with increasing prevalence worldwide. It is well recognized as a risk factor for cardiovascular morbidity and mortality in adult populations. Obesity prevalence is also increasing with age, and this may be particularly important in an ageing population. Ageing is associated with an increase in visceral fat and a progressive loss of muscle mass. Sarcopenia has been defined as the age-associated loss of skeletal muscle mass and has been associated with metabolic impairment, cardiovascular disease (CVD) risk factors, physical disability and mortality. Sarcopenia is often associated with obesity. Sarcopenic obesity is a new category of obesity in older adults who have high adiposity coupled with low muscle mass. Thus sarcopenia with obesity may synergistically increase their effect on metabolic disorders, CVD and mortality. This review focuses on the effects of sarcopenic obesity on the risk of cardiovascular disease and mortality in older adults.

Corresponding author
Address for correspondence: Mrs JL Atkins, Department of Primary Care and Population Health, University College London Medical School, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK. Email:
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1World Health Organisation. Obesity and Overweight. Fact Sheet Number 311. August 2014. Available at: (accessed 17 October 2014).
2Department of Health. Healthy Lives, Healthy People: A call to action on obesity in England. London; Department of Health, 2011.
3Scarborough, P, Bhatnagar, P, Wickramasinghe, Ket al.Coronary Heart Disease Statisitcs. British Heart Foundation: London, 2010.
4Zamboni, M, Mazzali, G, Fantin, F, Rossi, A, Di Francesco, V. Sarcopenic obesity: a new category of obesity in the elderly. Nutr Metab Cardiovasc Dis 2008; 18: 388–95.
5Myint, PK, Welch, AA. Healthier ageing. BMJ 2012; 344: e1214.
6Zamboni, M, Mazzali, G, Zoico, Eet al.Health consequences of obesity in the elderly: a review of four unresolved questions. Int J Obes (Lond) 2005; 29: 1011–29.
7Choi, KM. Sarcopenia and Sarcopenic Obesity. Endocrinol Metab (Seoul) 2013; 28: 8689.
8Kohara, K. Sarcopenic obesity in aging population: current status and future directions for research. Endocrine 2014; 45: 1525.
9Stenholm, S, Harris, TB, Rantanen, Tet al.Sarcopenic obesity: definition, cause and consequences. Curr Opin Clin Nutr Metab Care 2008; 11: 693700.
10Baumgartner, RN. Body composition in healthy aging. Ann N Y Acad Sci 2000; 904: 437–48.
11Baumgartner, RN, Koehler, KM, Gallagher, Det al.Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol 1998; 147: 755–63.
12Filippin, LI, Teixeira, VN, MP, da Silva, Miraglia, F, da Silva, FS. Sarcopenia: a predictor of mortality and the need for early diagnosis and intervention. Aging Clin Exp Res 2014 (4 Nov, Epub ahead of print).
13Han, K, Park, YM, Kwon HS, et al.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 2014; 9: e86902.
14Snijder, MB, Henry, RM, Visser, M, et al.Regional body composition as a determinant of arterial stiffness in the elderly: The Hoorn Study. J Hypertens 2004; 22: 2339–47.
15Prado, CM, Wells, JC, Smith, SR, Stephan, BC, Siervo, M. Sarcopenic obesity: a critical appraisal of the current evidence. Clin Nutr 2012; 31: 583601.
16Waters, DL, Baumgartner, RN. Sarcopenia and obesity. Clin Geriatr Med 2011; 27: 401–21.
17Cruz-Jentoft, AJ, Baeyens, JP, Bauer, JMet al.Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010; 39: 412–23.
18World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO Consultation. WHO Technical Report Series, No. 894. Geneva, WHO, 2000.
19Janssen, I, Mark, AE. Elevated body mass index and mortality risk in the elderly. Obes Rev 2007; 8: 4159.
20Winter, JE, MacInnis, RJ, Wattanapenpaiboon, N, Nowson, CA. BMI and all-cause mortality in older adults: a meta-analysis. Am J Clin Nutr 2014; 99: 875–90.
21World Health Organization. Waist circumference and waist-hip ratio: report of a WHO expert consultation. Geneva: World Health Organization, 2008.
22Czernichow, S, Kengne, AP, Stamatakis, E, Hamer, M, Batty, GD. 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 2011; 12: 680–87.
23Donini, LM, Savina, C, Coletti, Cet al.Obesity in the elderly. Annali di igiene 2010; 22: 499511.
24de Koning, L, Merchant, AT, Pogue, J, Anand, SS. Waist circumference and waist-to-hip ratio as predictors of cardiovascular events: meta-regression analysis of prospective studies. Eur Heart J 2007; 28: 850–56.
25Decaria, JE, Sharp, C, Petrella, RJ. Scoping review report: obesity in older adults. Int J Obes (Lond) 2012; 36: 1141–50.
26de Hollander, EL, Bemelmans, WJ, Boshuizen, HCet al.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 2012; 41: 805–17.
27Dorner, TE, Rieder, A. Obesity paradox in elderly patients with cardiovascular diseases. Int J Cardiol 2012; 155: 5665.
28Donini, LM, Savina, C, Gennaro, Eet al.A systematic review of the literature concerning the relationship between obesity and mortality in the elderly. J Nutr Health Aging 2012; 16: 8998.
29Wijnhoven, HA, Snijder MB, , van Bokhorst-de van der Schueren, MA, Deeg, DJ, Visser, M. Region-specific fat mass and muscle mass and mortality in community-dwelling older men and women. Gerontology 2012; 58: 3240.
30Han, SS, Kim, KW, Kim, KIet al.Lean mass index: a better predictor of mortality than body mass index in elderly Asians. J Am Geriatr Soc 2010; 58: 312–17.
31Landi, F, Russo, A, Liperoti, Ret al.Midarm muscle circumference, physical performance and mortality: results from the aging and longevity study in the Sirente geographic area (ilSIRENTE study). Clin Nutr 2010; 29: 441–47.
32Wannamethee, SG, Shaper, AG, Lennon, L, Whincup, PH. Decreased muscle mass and increased central adiposity are independently related to mortality in older men. Am J Clin Nutr 2007; 86: 1339–46.
33Wijnhoven, HA, van Bokhorst-de van der Schueren, MA, Heymans, MW, et al.Low mid-upper arm circumference, calf circumference, and body mass index and mortality in older persons. J Gerontol A Biol Sci Med Sci 2010; 65: 1107–14.
34Dominguez, LJ, Barbagallo, M. The cardiometabolic syndrome and sarcopenic obesity in older persons. J Cardiometab Syndr 2007; 2: 183–89.
35Prado, CMM, Liefers, JR, McCargar, LJet al.Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncology 2008; 9: 629–35.
36Atkins, JL, Whincup, PH, Morris, RWet al.Sarcopenic obesity and risk of cardiovascular disease and mortality: a population-based cohort study of older men. J Am Geriatr Soc 2014; 62: 253–60.
37Batsis, JA, Mackenzie, TA, Barre, LK, Lopez-Jimenez, F, Bartels, SJ. Sarcopenia, sarcopenic obesity and mortality in older adults: results from the National Health and Nutrition Examination Survey III. Eur J Clin Nutr 2014; 68: 1001–7.
38Cesari, M, Pahor, M, Lauretani, Fet al.Skeletal muscle and mortality results from the InCHIANTI Study. J Gerontol Ser A Biol Sci Med Sci 2009; 64: 377–84.
39Rantanen, T, Harris, T, Leveille, SGet al.Muscle strength and body mass index as long-term predictors of mortality in initially healthy men. J Gerontol A Biol Sci Med Sci 2000; 55: M168–73.
40Kim, TN, Yang, SJ, Yoo, HJet al.Prevalence of sarcopenia and sarcopenic obesity in Korean adults: the Korean sarcopenic obesity study. Int J Obesity 2009; 33: 885–92.
41Lim, S, Kim, JH, Yoon, JWet al.Sarcopenic obesity: prevalence and association with metabolic syndrome in the Korean Longitudinal Study on Health and Aging (KLoSHA). Diabetes Care 2010; 33: 1652–54.
42Chung, JY, Kang, HT, Lee, DC, Lee, HR, Lee, YJ. Body composition and its association with cardiometabolic risk factors in the elderly: a focus on sarcopenic obesity. Arch Gerontol Geriatr 2013; 56: 270–78.
43Hwang, B, Lim, JY, Lee, Jet al.Prevalence rate and associated factors of sarcopenic obesity in korean elderly population. J Korean Med Sci 2012; 27: 748–55.
44Park, SH, Park, JH, Song, PSet al.Sarcopenic obesity as an independent risk factor of hypertension. J Am Soc Hypertens 2013; 7: 420–25.
45Park, SH, Park, JH, Park, HYet al.Additional role of sarcopenia to waist circumference in predicting the odds of metabolic syndrome. Clin Nutr 2014; 33: 668–72.
46Baek, SJ, Nam, GE, Han, KD et al. 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 2014; 37: 247–60.
47Kim, TN, Park, MS, Kim, YJet al.Association of low muscle mass and combined low muscle mass and visceral obesity with low cardiorespiratory fitness. PLoS One 2014; 9: e100118.
48Kim, TN, Park, MS, Lim, KIet al.Relationships between sarcopenic obesity and insulin resistance, inflammation, and vitamin D status: The Korean Sarcopenic Obesity Study. Clin Endocrinol (Oxf) 2013; 78: 525–32.
49Lu, CW, Yang, KC, Chang, HHet al.Sarcopenic obesity is closely associated with metabolic syndrome. Obesity Res Clin Practice 2013; 7: e301–7.
50Srikanthan, P, Hevener, AL, Karlamangla, AS. Sarcopenia exacerbates obesity-associated insulin resistance and dysglycemia: findings from the National Health and Nutrition Examination Survey III. PLoS One 2010; 5: e10805.
51Baumgartner, RN, Wayne, SJ, Waters, DLet al.Sarcopenic obesity predicts instrumental activities of daily living disability in the elderly. Obes Res 2004; 12: 19952004.
52Messier, V, Karelis, AD, Lavoie, M-Eet al.Metabolic profile and quality of life in class I sarcopenic overweight and obese postmenopausal women: a MONET study. Appl Physiol Nutrition Metab 2009; 34: 1824.
53dos Santos, EP, Gadelha, AB, Safons, MPet al.Sarcopenia and sarcopenic obesity classifications and cardiometabolic risks in older women. Arch Gerontol Geriatr 2014; 59: 5661.
54Helfand, M, Buckley, DI, Freeman, Met al.Emerging risk factors for coronary heart disease: a summary of systematic reviews conducted for the U.S. Preventive Services Task Force. Ann Intern Med 2009; 151: 496507.
55Jensen, GL. Inflammation: roles in aging and sarcopenia. JPEN J Parenter Enteral Nutr 2008; 32: 656–59.
56Gregor, MF, Hotamisligil, GS. Inflammatory mechanisms in obesity. Annu Rev Immunol 2011; 29: 415–45.
57Schrager, MA, Metter, EJ, Simonsick, Eet al.Sarcopenic obesity and inflammation in the InCHIANTI study. J Appl Physiol 2007; 102: 919–25.
58Cesari, M, Kritchevsky, SB, Baumgartner, RNet al.Sarcopenia, obesity, and inflammation – results from the Trial of Angiotensin Converting Enzyme Inhibition and Novel Cardiovascular Risk Factors study. Am J Clin Nutr 2005; 82: 428–34.
59Chin, SO, Rhee, SY, Chon, Set al.Sarcopenia is independently associated with cardiovascular disease in older Korean adults: the Korea National Health and Nutrition Examination Survey (KNHANES) from 2009. PLoS One 2013; 8: e60119.
60Stephen, WC, Janssen, I. Sarcopenic-obesity and cardiovascular disease risk in the elderly. J Nutr Health Aging 2009; 13: 460–66.
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Reviews in Clinical Gerontology
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