SARCOPENIC OBESITY:

A NEW-ish SYNDROME

WHY?

Two key factors in today’s society contribute to

sarcopenic obesity:

1. Obesity

2. Aging of the population

 Fat Mass and Muscle Mass
§ The more adipose tissue you have, the more muscle mass
you need – a mechanical loading effect
§ If you add 1 kg adipose tissue, need 0.1 kg (women) and
0.24 kg (men) of skeletal muscle
§ Thus, adding fat mass per se brings about a need to increase
muscle mass, yet….
§ Yet…muscle mass and strength start to decline
progressively around 30 y (accelerated after age 50-60 y)
Sarcopenic Obesity: a worst case scenario!

• Excess body weight à Increase in fat mass with **low

muscle mass**

• Increased weakness due to sarcopenia and a need to

carry greater weight due to obesity!

• Obesity in the elderly acts synergistically with

sarcopenia to maximize disability in this population
 Multiple factors implicated in sarcopenic obesity!

Nutrition?
– Decreased dietary protein intake can lead to sarcopenia
– Increased energy intake contributes to obesity
Physical inactivity?
– Muscle disuse and atrophy contribute to sarcopenia
– Decreased total energy expenditure contributes to obesity
Low-grade inflammation?
– Cytokines/adipokines contribute to obesity-related
insulin resistance
– Inflammatory cytokines also induce muscle catabolism
Insulin action?
– Insulin normally stimulates protein synthesis
– Decreased ability to respond to this anabolic stimuli
– Insulin is vasodilatory, allows for amino acids to be
delivered to muscle for protein synthesis
– Stimulatory effect of food intake on protein synthesis
(and its inhibitory effect on proteolysis) is blunted in
old/aging muscle

Hormonal changes?
– Decreased growth hormone, decreased testosterone
 Inter-relationships between adipose tissue and muscle:
A mechanism leading to sarcopenic obesity
Inflammatory
cytokines
produced by
adipose tissue,
especially visceral
fat, can accelerate
muscle
catabolism and
thus contribute to
the vicious cycle
that initiates and
sustains
sarcopenic
obesity!
Zamboni et al. NMCD 2008
 Is sarcopenic obesity associated with impaired
physical function?

Zamboni et al. 2007

 In summary…
Sarcopenic obesity is a “silent” condition characterized by increased fat
mass that masks reduced skeletal muscle mass and function; associated
with poor outcomes
§ Not possible to identify sarcopenic obesity merely by use of body
mass or BMI
§ CT scans are useful, but not widely available!
§ Other indices are needed!
§ Also, firm diagnostic criteria are lacking
Mechanism(s) are uncertain but likely multifactorial including:
§ dysregulation of energy balance
§ malnutrition/overnutrition these factors may
§ hormonal, inflammatory mediators act synergistically
§ reduced physical activity
 Treatment of Sarcopenic Obesity?
Goal: to simultaneously increase muscle mass and decrease body fat
• Resistance training and caloric restriction via nutrition and/or aerobic
exercise? Most likely, yes!
From Dr. S. Phillips, McMaster University

Resistance mitochondria
Aerobic
Fat transporter
FABPm Glucose transporter
GLUT4

capillary

• Strength • Improve oxidative metabolism

• Power • Glucose transport, lipid transport
• Quality • Metabolic quality
• Reduce falls • Blood lipids
• Benefits in daily living • Insulin Resistance/Diabetes
• Independence • CVD
 Other intervention targets?
Low grade inflammation is another important
target for interventions that aim to limit
sarcopenia in the elderly and obese
population.

Can you think of lifestyle strategies that might

be of benefit?