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Sarcopenia, and
Sarcopenic Obesity
Normal age-related changes
in body composition
• Fat mass increases from birth, peaks around 60-75 y
• Differences in adipose tissue distribution over lifespan
• Visceral fat and intramuscular fat tend to increase
• Subcutaneous does not (or, in fact, decreases)
• Fat infiltration into muscle is associated with lower
muscle strength
Defining Sarcopenia
(a continuously evolving definition…)



A muscle mass
index 2 or
more SD
below the sex-
- 2 SD
specific mean
Appendicular Skeletal Muscle (kg/m2) for young,
Muscle Mass Index (MMI) (kg/m2) healthy adult

Baumgartner et al, Am J Epidemiol 1998

Body Composition Methods to Quantify Sarcopenia
• CT / MRI / DXA
• Can characterize specific tissue mass and changes in such tissues
Here are 2 patients with the same BMI but large
variation in muscle mass
(Left = sarcopenic, Right = normal)

slide from Dr. Marina Mourtzakis, University of Waterloo

loss of muscle mass and strength
Leads to:
– Neuromuscular impairment
– Loss of mobility
– Balance problems
– Increased falls and fractures
• Lead to hospitalization and immobilization….
A vicious cycle!
Sarcopenia occurs naturally with aging
Clinical problems are only evident once a threshold of
muscle loss and strength
Muscle Mass vs Strength?
Is it better to characterize sarcopenia by…
a loss in muscle mass?
OR a loss in muscle strength?

There is no generally accepted criteria for “low muscle

strength” yet we know it is an important measurement to
make (also easier and cheaper to measure!)
Why is muscle strength important?
Muscle mass ≠ muscle function
• Both muscle mass and strength decline with aging, but the
decline in strength exceeds what is expected based on the
decline in mass (Goodpaster et al. 2006)
Due to progressive decline in muscle “quality” : expressed as force
per unit of cross-sectional area
– Decreased fiber size and number
– Decreased contractile activity in intact fibers
– Fat infiltration
– Impaired neurological modulation of contraction
Decreased “metabolic quality” with aging
“High Quality” from
a metabolic
1. High oxidative
2. High capacity
for transport of
3. High capacity
for transport of

From Dr. S. Phillips, McMaster University