Body compositions phenotypes of older adults with COPD.

Purpose: Changes in nutritional status are important extrapulmonary manifestations of the chronic obstructive pulmonary disease (COPD). The study aimed to assess the prevalence of different body composition phenotypes in older patients with COPD and to investigate the relationship between these phenotypes and the severity of the disease, as well as physical performance of the subjects. Patients and methods: The study included 124 subjects aged ≥60 with COPD. In all of them body composition analysis and muscle strength measurement were performed. Additionally, data from patients' medical records were analyzed. Study sample was divided into four groups based on the phenotypic body composition: normal phenotype (N), sarcopenia, obesity and sarcopenic obesity (SO). Results: Incidence of sarcopenia was significantly higher in patients with severe or very severe COPD based on GOLD in comparison with subjects with mild or moderate obstruction (p = 0.043). Participants with sarcopenia, obesity and SO had lower results of the 6-min walk test than subjects with N (225.77 m, 275.33 m, 350.67 m, 403.56 m, respectively). Moreover, sarcopenia and SO had lower results than obesity (p = 0.001, p = 0.041, respectively). Conclusion: Sarcopenia is common in patients with advanced COPD. Sarcopenia and SO are associated with poorer physical performance. All older people with COPD should routinely have their body composition assessed, instead of simply measuring of body weight or body mass index (BMI).

Prevalence of sarcopenic obesity in patients with gastric cancer and effects on adverse outcomes: A meta-analysis and systematic review.

PURPOSE: To assess the prevalence of sarcopenic obesity in patients with gastric cancer and its impact on adverse outcomes. METHODS: A computerized search of PubMed, Embase, Cochrane Library, Web of Science, and CINAHL databases was performed to search for articles related to sarcopenic obesity in patients with gastric cancer. The search was conducted until June 16, 2024, from the date of the creation of the database. RESULTS: A total of sixteen studies were included, including fifteen cohort studies and one cross-sectional study involving 4087 patients. The results of the meta-analysis showed that the prevalence of sarcopenic obesity in gastric cancer patients was 16.3 % (95 % CI: 12.2 %-20.4 %). Sarcopenic obesity significantly shortened the overall survival of gastric cancer patients (HR = 1.64, 95 % CI: 1.20 to 2.25, P = 0.002) and increased the risk of postoperative significant complications (OR = 2.84, 95 % CI: 1.95 to 4.16, P < 0.001), severe complications (OR = 2.60, 95 % CI: 1.45 to 4.64, P = 0.001), surgical site infection (OR = 3.82, 95 % CI: 1.47 to 9.89, P = 0.006), and mortality (OR = 4.84, 95 % CI: 1.38 to 17.02, P = 0.014), but no significant effect on 30-day readmission (OR = 1.90, 95 % CI: 0.31 to 11.84, P = 0.491). CONCLUSIONS: The prevalence of sarcopenic obesity is high in patients with gastric cancer and is strongly associated with poor postoperative outcomes. Healthcare providers should evaluate patients with gastric cancer for sarcopenic obesity early to prevent or reduce the incidence of adverse outcomes.

Association between bone microarchitecture and sarcopenia in postmenopausal women with type 2 diabetes.

Bone microarchitecture, as assessed using high-resolution peripheral quantitative computed tomography, is adversely affected in postmenopausal women with type 2 diabetes mellitus having sarcopenia/sarcopenic obesity while areal bone mineral density does not differ between those with and without sarcopenia. PURPOSE: Type 2 diabetes (T2D) increases the risk of sarcopenia, which independently contributes to bone fragility. We aimed to explore the association between sarcopenia/sarcopenic obesity and bone quality using second-generation high-resolution peripheral quantitative computed tomography (HR-pQCT) in T2D. METHODS: We analyzed the baseline participant characteristics of an ongoing randomized clinical pilot trial (CTRI/2022/02/039978). Postmenopausal women (≥ 50 years) with T2D and high risk of fragility fractures were included. Areal BMD (aBMD), trabecular bone score (TBS), and body composition were measured using DXA. Bone microarchitecture was assessed at distal radius/distal tibia using HR-pQCT. Muscle strength was estimated using dominant handgrip strength (HGS). Sarcopenia was defined as low HGS (< 18.0 kg) and low appendicular skeletal muscle index (ASMI) (< 4.61 kg/m2). Probable sarcopenia was defined as low HGS with normal ASMI. Sarcopenic obesity was classified as co-existence of sarcopenia and obesity (BMI ≥ 25.0 kg/m2). RESULTS: We recruited 129 postmenopausal women (mean age 64.2 ± 6.7 years). Participants were categorized into four mutually exclusive groups: group A (normal HGS and ASMI, n = 17), group B (probable sarcopenia, n = 77), group C (non-obese sarcopenia, n = 18), and group D (obese sarcopenia, n = 18). The four groups did not differ significantly with regard to baseline characteristics, fracture prevalence, HbA1c, aBMD, and TBS. However, HR-pQCT-derived volumetric BMD and cortical/trabecular microarchitecture were significantly poorer in group C/group D than in group A/group B. CONCLUSIONS: Bone quality rather than bone density (quantity) is adversely affected in T2D postmenopausal women with sarcopenia/sarcopenic obesity, which could increase the fracture risk in this patient sub-population.

The Performance and Associated Risks of the Criteria for Sarcopenic Obesity Proposed by the European Association for the Study of Obesity in a Geriatric Population.

BACKGROUND: There is no gold standard definition of sarcopenic obesity (SO). Our objective is to evaluate the benefit of using the new definition proposed by the European Association for the Study of Obesity (EASO) in older people. METHODS: Data from the Toledo Study of Healthy Aging, a study based on a cohort of community-dwelling older adults, were used. SO was defined according to the EASO and by a composite of the Foundation for the National Institute of Health (FNIH) for the diagnosis of sarcopenia and the WHO's criteria for obesity (Body Mass Index, BMI ≥ 30 kg/m2; waist circumference, >88 cm for women and >102 cm for men). Frailty [Frailty Phenotype (FFP) and Frailty Trait Scale-5 (FTS5)] and disability (Katz Index) statuses were assessed at baseline and at the follow-up (median 2.99 years). Mortality at a 5-year follow-up was also assessed. The Logistic and Cox regression models were used to assess the associations. RESULTS: Of the 1559 subjects (age 74.79 ± 5.76 years; 45.54% men), 30.15% (EASO/ESPEN) vs. 16.36% (FNIH) met the SO criteria (Kappa = 0.42). SO was associated with the prevalence of frailty by both the EASO's [OR(95%CI): FFP: 1.70 (1.33-2.16); FTS-5 binary: 2.29 (1.60-3.27); ß(95%CI): FTS-5 continuous 3.63 (3.00-4.27)] and FNIH+WHO's criteria [OR (95%CI): 2.20 (1.61, 3.00)]. The FNIH + WHO's criteria were cross-sectionally associated with disability [OR: 1.52 (1.07, 2.16); p-value 0.018], while the EASO's criteria were not. The EASO's criteria did not show any association at the follow-up, while the FNIH + WHO's criteria were associated with incident frailty. CONCLUSIONS: The EASO's new criteria for sarcopenic obesity demonstrate moderate agreement with the traditional definition and are cross-sectionally associated with adverse events, but they do not effectively predict the outcomes generally associated with sarcopenic obesity in older adults. Therefore, the performance of the EASO's criteria in older people raises the need for refinement before recommending it for generalized use in this population.

Differences in sarcopenia indices in elderly Japanese women and their relationships with obesity classified according to waist circumference, BMI, and body fat percentage.

BACKGROUND: Sarcopenic obesity (SO) is defined as a decrease in lean body mass and an increase in body fat mass (BFM) due to aging. Detecting SO in elderly women is important from the perspective of extending healthy life expectancy. While various indices of SO are currently used, there is no global consensus regarding diagnostic criteria for SO. This study aimed to examine the relationship between obesity indices (waist circumference (WC), body mass index (BMI), and body fat percentage (BFP)) and sarcopenia indices (total body muscle mass (TBM), appendicular lean mass (ALM), skeletal mass index (SMI)), and physical function (gait speed (GS), handgrip strength (HGS)). METHODS: Subjects were 170 community-dwelling healthy elderly women aged 65-79 years (mean: 72.7 ± 5.78 years) who underwent measurements for WC, BMI, and BFP. A WC of ≥ 90cm was defined as the obese group, BMI was determined as weight (kg) divided by height squared (m2) and a cutoff of ≥ 25 kg/m2 was used to define the obesity group. BFM was measured using the bioelectrical impedance analysis (BIA) method and BFP was calculated from body weight and a cutoff of ≥ 30% was used to define the obesity group. TBM and ALM (kg) were measured using the BIA method, ALM (kg) was corrected for height (m2) to obtain SMI (kg/m2). Physical function was assessed by GS and HGS, which were measured by the 5-m walk test and a digital grip strength meter, respectively. RESULTS: When obesity was assessed using BMI, WC and BFP, obese individuals had higher TBM, ALM and SMI, and lower GS among the sarcopenia indicators. HGS did not differ significantly between the non-obese and obese groups. CONCLUSION: Our findings suggest HGS is thought to reflect muscle strength without being affected by obesity indices, suggesting that it may be useful in detecting possible sarcopenia in obese individuals.

The effect of sarcopenic obesity on glycaemic status based on fasting plasma glucose and glycated haemoglobin: A prospective cohort study.

AIM: To investigate the effect of sarcopenic obesity on the progression of glycaemic status in middle-aged and older adults without diabetes. MATERIALS AND METHODS: This research involved 4637 participants without diabetes from the China Health and Retirement Longitudinal Study 2011-2015. Sarcopenic obesity at baseline was evaluated based on the Asian Working Group for Sarcopenia 2019 criteria. According to the American Diabetes Association criteria, we used fasting plasma glucose and glycated haemoglobin to define glycaemic status. Cox proportional hazard models were applied to obtain adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: The mean age of included participants was 58.98 ± 8.82 years, and 45.35% were men. During 18,497 person-years of follow-up, 1743 (37.59%) cases with glycaemic status progression were identified. Compared with participants without sarcopenia and obesity, participants with sarcopenic obesity, but not sarcopenia only or obesity only, exhibited a higher risk of progression from normoglycaemia to diabetes (HR = 2.11; 95% CI: 1.10-4.04). Moreover, participants with sarcopenic obesity (HR = 1.65; 95% CI: 1.04-2.63), sarcopenia only (HR = 1.78; 95% CI: 1.11-2.86), or obesity only (HR = 2.00; 95% CI: 1.29-3.12) had increased the risk of progression from prediabetes to diabetes. CONCLUSIONS: The effect of sarcopenic obesity on the progression of glycaemic status based on fasting plasma glucose and glycated haemoglobin may be more pronounced than that of sarcopenia only or obesity only.

Body composition and muscle composition phenotypes in patients on waitlist and shortly after liver transplant - results from a pilot study.

BACKGROUND: Sarcopenia is common in end-stage liver disease and negatively impacts patients awaiting or undergoing liver transplantation (LT). Magnetic resonance imaging (MRI) may be used to measure body composition and sarcopenia. We aimed to evaluate the feasibility of MRI-based LT body composition profiling, describe waitlist body composition, and assess the natural rate of change in body composition while on the waitlist and post-LT. METHODS: This prospective pilot study recruited adults listed for LT at an urban, tertiary care facility. Eighteen participants were scanned at time of waitlisting and 15 had follow-up MRIs (waitlist and/or post-LT). An 8-min MRI was used to measure body composition (AMRA® Researcher) including thigh fat-free muscle volume (FFMV) and fat infiltration (MFI), visceral (VAT) and abdominal subcutaneous (ASAT) adipose tissue volumes, and liver fat. A sex- and BMI invariant FFMV z-score (z-FFMV) was calculated, and muscle composition (MC) phenotypes were defined using the muscle assessment score (consisting of the FFMV z-score and sex-adjusted MFI). Rate of body composition change was calculated using mixed-effect modelling and is presented as rate per 30 days. RESULTS: At time of waitlisting, 73% of the 18 participants had high MFI and 39% had the adverse MC (low FFMV z-score and high MFI) phenotype. Seven participants received an LT. Post-LT serial MRIs, at a median of 147 days apart within the first 200 days post-LT, demonstrated increased z-FFMV 0.22 SDs/(30 days) (p = 0.002), VAT 0.23 (p < 0.001), and ASAT 0.52 (p = 0.001) L/(30 days), but no change in MFI (p = 0.200) nor liver fat (p = 0.232). CONCLUSION: MRI-based body composition profiling is feasible in LT patients and shortly after LT. This can be amended to routine clinical scans and may help in early identification of patients who may benefit from interventions to improve body composition. In addition, body composition changes significantly over time after LT.

Exploring Adiposity and Chronic Kidney Disease: Clinical Implications, Management Strategies, Prognostic Considerations.

Obesity poses a significant and growing risk factor for chronic kidney disease (CKD), requiring comprehensive evaluation and management strategies. This review explores the intricate relationship between obesity and CKD, emphasizing the diverse phenotypes of obesity, including sarcopenic obesity and metabolically healthy versus unhealthy obesity, and their differential impact on kidney function. We discuss the epidemiological evidence linking elevated body mass index (BMI) with CKD risk while also addressing the paradoxical survival benefits observed in obese CKD patients. Various measures of obesity, such as BMI, waist circumference, and visceral fat assessment, are evaluated in the context of CKD progression and outcomes. Mechanistic insights into how obesity promotes renal dysfunction through lipid metabolism, inflammation, and altered renal hemodynamics are elucidated, underscoring the role of adipokines and the renin-angiotensin-aldosterone system. Furthermore, the review examines current strategies for assessing kidney function in obese individuals, including the strengths and limitations of filtration markers and predictive equations. The management of obesity and associated comorbidities like arterial hypertension, type 2 diabetes mellitus, and non-alcoholic fatty liver disease in CKD patients is discussed. Finally, gaps in the current literature and future research directions aimed at optimizing the management of obesity-related CKD are highlighted, emphasizing the need for personalized therapeutic approaches to mitigate the growing burden of this intertwined epidemic.

The Association Between Preoperative Sarcopenia and Sarcopenic Obesity and the Occurrence of Postoperative Complications in Patients Undergoing Pancreaticoduodenectomy for Periampullary Malignancies-A Literature Review.

BACKGROUND: Sarcopenia and sarcopenic obesity, perceived as a reflection of cancer-induced cachexia, are often diagnosed in patients with periampullary malignancies. The pathophysiology of those conditions is multifactorial regarding the tumor microenvironment, immunological response, and the relationship to surrounding tissues. METHODS: The PubMed and SCOPUS databases were systematically searched between November 2023 and December 2023. A total of 254 studies were primarily identified. Regarding the inclusion and exclusion criteria, 26 studies were finally included in the review. RESULTS: Evaluated papers disclosed that sarcopenia was significantly associated with a higher incidence of postoperative complications, including pancreatic fistula (POPF) type B and C, with the odds ratio (OR) ranging from 2.65 (95%CI 1.43-4.93, p = 0.002) to 4.30 (95%CI 1.15-16.01, p < 0.03). Sarcopenic patients also suffered more often from delayed gastric emptying (DGE) with an OR of 6.04 (95%CI 1.13-32.32, p = 0.036). Infectious complications, postoperative hemorrhage, and intra-abdominal abscesses occurred more often in sarcopenic patients. Surgical complications were also noted more frequently when sarcopenic obesity was present. Preoperative nutritional prehabilitation seems to reduce the risk of postoperative complications. However, more prospective studies are needed. CONCLUSIONS: Sarcopenia and sarcopenic obesity were associated with a higher incidence of multiple postoperative complications, including POPF (type B and C), DGE, hemorrhage, and infectious complications.

Analysis of body composition, functionality and muscle-specific strength of older women with obesity, sarcopenia and sarcopenic obesity: a cross-sectional study.

During aging, changes in body composition can result in sarcopenic obesity, which is a condition in which obesity occurs accompanied by the loss of muscle mass and strength caused by sarcopenia. Although the effects of obesity and sarcopenia on body composition are known, the muscle-specific strength in older women with sarcopenic obesity remains under-researched. The objective of this study was to evaluate community-dwelling older women for the absence or presence of obesity, sarcopenia and sarcopenic obesity and compare them in terms of body composition, functional physical performance and muscle-specific strength. One hundred and fifty-six older women (± 74 years) were evaluated for body composition using Dual X-ray Absorptiometry, handgrip strength with a Jamar dynamometer and functional performance using gait speed and timed up and go tests. The presence of obesity, sarcopenia and sarcopenic obesity was found in 32.7%, 15.4% and 25% of the sample, respectively. Comparing groups, community-dwelling older women with sarcopenic obesity exhibited poorer functional physical performance (TUG ± 14 s), and lower muscle-specific strength (± 1.18). Sarcopenic obesity was associated with muscle-specific strength (95% IC 0.016-0.241), and TUG (95% CI 1.001-1.137). These findings indicate that the combination of obesity and sarcopenia has a negative impact on skeletal muscle, reducing muscle-specific strength and physical performance in older women with more declines than either disease alone. Therefore, this comprehensive assessment gives useful information for incorporating muscle-specific strength into the diagnosis of sarcopenic obesity in the older people.

Association between sarcopenic obesity and osteoarthritis: The potential mediating role of insulin resistance.

BACKGROUND: Sarcopenic obesity (SO) and osteoarthritis (OA) are highly prevalent musculoskeletal conditions that significantly impair health-related quality of life. AIM: This study investigated the association between SO and OA, and explored the potential mediating role of insulin resistance in this relationship. We utilized data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. METHODS: This cross-sectional analysis employs NHANES data collected from 1999 to 2018, including participants aged 18 years and older. SO was assessed using dual-energy X-ray absorptiometry (DXA) measurements. Insulin resistance was estimated using the triglyceride-glucose (TyG) index. OA status was based on self-reported physician diagnosis. Statistical analyses included weighted logistic regression, restricted cubic spline (RCS) interaction analysis, mediation analysis using structural equation modeling (SEM), and receiver operating characteristic (ROC) curve analysis. Subgroup analyses were conducted based on age, sex, and diabetes status. RESULTS: The sarcopenic obese group demonstrated the highest prevalence of OA (23.4 %), hypertension (47.8 %), and diabetes (12.0 %). Additionally, they exhibited elevated levels of triglycerides, cholesterol, glucose, blood urea nitrogen (BUN), creatinine, and uric acid. Logistic regression revealed significant positive associations between sarcopenic obesity, the TyG index, and OA risk. RCS analysis identified significant non-linear relationships and interactions of the TyG index with age, sex, and diabetes status on OA risk. Mediation analysis indicated that the TyG index mediated approximately 4.9 % of the effect of sarcopenic obesity on OA risk. ROC curve analysis demonstrated moderate diagnostic accuracy for the TyG index (AUC = 0.65), which improved when incorporated into the multivariate model (AUC = 0.78). Subgroup analyses confirmed significant associations between the TyG index and sarcopenic obesity with OA risk across different age, sex, and diabetes status categories. CONCLUSION: Our findings suggest a significant correlation between insulin resistance, as measured by the TyG index, and elevated OA risk in individuals with sarcopenic obesity. Targeting insulin resistance through future research may be a promising avenue to lower OA risk in this population.

Association between Sarcopenic Obesity and Arterial Stiffness in Korean Adults.

Objectives: This study examined the association between sarcopenic obesity and arterial stiffness using bioelectrical impedance analysis (BIA). Methods: This retrospective cross-sectional study included 20,601 Korean adults from January 2016 to December 2023. Sarcopenia was defined as height-adjusted appendicular skeletal muscle mass [(ASM/height2) <5.7 in women and <7.0 in men] using BIA. Obesity was defined by body mass index or waist circumference. Arterial stiffness was assessed by measuring brachial-ankle pulse wave velocity (baPWV). The participants were categorized into four groups: normal, sarcopenia, obesity, and sarcopenic obesity. The baPWV values were compared among the four groups to investigate the association between sarcopenic obesity and arterial stiffness using adjusted multivariate analyses. Results: The mean baPWV of the sarcopenic obesity group was higher (p < 0.001) than that of the other groups. The odds ratio for having high baPWV (>1800 cm/s) in the sarcopenic obesity group was 2.40 (95% CI, 1.07-5.38) after adjusting for age, sex, exercise, smoking, heavy alcohol consumption, hypertension, and dyslipidemia. Conclusions: Sarcopenic obesity was independently associated with increased arterial stiffness.

Malnutrition and Obesity in Patients with COPD Exacerbation, Insights from the National Inpatient Sample.

Background: The obesity paradox suggests that obese patients with Chronic Obstructive Pulmonary Disease Exacerbation (COPDE) may have better outcomes. COPD patients are at a higher risk of becoming malnourished, which has been linked to poor outcomes. Objective: This paper aims to study the impact of malnutrition in patients with and without obesity hospitalized with COPDE. Methods: Our retrospective study analyzed data from the National Inpatient Sample dataset between 2017 and 2020 to observe patients who were hospitalized with COPDE. The patients were divided into two groups: with and without malnutrition. The outcomes included all-cause mortality, invasive mechanical ventilation, length of stay, and total charge. We adjusted for confounders using multivariate regression model analysis. Results: The study involved 392,920 patients with COPDE, out of which 5720 (1.45%) were diagnosed with malnutrition. Most of the patients in both groups were female, white, and under Medicare coverage. The mean age was higher in patients with malnutrition (67.6 vs. 64 years). In both groups, the rates of admissions were lowest in 2020 compared to three years prior. The rates and adjusted odds ratios of all-cause mortality were higher in patients with malnutrition (3.59% vs. 0.61%, P <0.01; adjusted odds ratio (aOR) 2.36, P<0.01, CI 1.8-3.7). We observed comparable findings when using invasive mechanical ventilation (13.2% vs. 2.82%, P<0.01, aOR 4.9, P<0.01, 3.9-6). Malnourished patients had a lengthier hospital stay and a greater total charge. Conclusion: Malnutrition was identified as an independent risk factor associated with worse outcomes in obese patients admitted with COPD exacerbation.

Epicardial adipose tissue and muscle distribution affect outcomes in very old patients after transcatheter aortic valve replacement.

Aims: To analyse the relevance of body composition and blood markers for long-term outcomes in very old patients after transcatheter aortic valve replacement (TAVR). Methods and results: A total of 403 very old patients were characterized with regard to subcutaneous, visceral, and epicardial fat, psoas muscle area, plasma growth differentiation factor 15 (GDF-15), and leptin. Cohorts grouped by body mass index (BMI) were analysed for long-term outcomes. Patients underwent transapical and transfemoral TAVR (similar 30-day/1-year survival). Body mass index >35 kg/m2 showed increased 2- and 3-year mortality compared with BMI 25-34.9 kg/m2 but not compared with BMI <25 kg/m2. Fat areas correlated positively to BMI (epicardial: R 2 = 0.05, P < 0.01; visceral: R 2 = 0.20, P < 0.001; subcutaneous: R 2 = 0.13, P < 0.001). Increased epicardial or visceral but not subcutaneous fat area resulted in higher long-term mortality. Patients with high BMI (1781.3 mm2 ± 75.8, P < 0.05) and lean patients (1729.4 ± 52.8, P < 0.01) showed lower psoas muscle area compared with those with mildly elevated BMI (2055.2 ± 91.7). Reduced psoas muscle area and increased visceral fat and epicardial fat areas were independent predictors of long-term mortality. The levels of serum GDF-15 were the highest in BMI >40 kg/m2 (2793.5 pg/mL ± 123.2) vs. BMI <25 kg/m2 (2017.6 pg/mL ±130.8), BMI 25-30 kg/m2 (1881.8 pg/mL ±127.4), or BMI 30-35 kg/m2 (2054.2 pg/mL ±124.1, all P < 0.05). Increased GDF-15 level predicted mortality (2587 pg/mL, area under the receiver operating characteristic curve 0.94). Serum leptin level increased with BMI without predictive value for long-term mortality. Conclusion: Morbidly visceral and epicardial fat accumulation, reduction in muscle area, and GDF-15 increase are strong predictors of adverse outcomes in very old patients post-TAVR.

The L-shaped relationship between composite dietary antioxidant index and sarcopenic obesity in elderly adults: a cross-sectional study.

Background: This study aimed to examine the associations of the Composite Dietary Antioxidant Index (CDAI) with sarcopenic obesity (SO) using the National Health and Nutrition Examination Survey (NHANES) database. Methods: Data were gathered from NHANES between 2001 and 2004. To examine the relationship between CDAI and the occurrence of SO, multiple logistic regression analyses were performed. Subgroup analyses were performed to demonstrate the stability of the results. Restricted cubic splines were utilized to examine the non-linear correlations. Results: A total of 2,333 elderly individuals were included in the study. In the multivariate logistic regression crude model, we revealed an odds ratio (OR) of 0.928 [95% confidence interval (CI), 0.891-0.965, p < 0.001] for the correlation between CDAI and SO. The ORs were 0.626 (95% CI, 0.463-0.842) and 0.487 (95% CI, 0.354-0.667) for CDAI tertiles 2 and 3, respectively (p for trend <0.001), after full adjustment. The subgroup analysis findings demonstrated a reliable and enduring connection between CDAI and SO across various subgroups. However, the strength of the correlation between CDAI and SO was significantly affected by diabetes (p for interaction = 0.027). Moreover, restricted cubic spline analysis revealed an L-shaped relationship. Conclusion: The present study identified an L-shaped correlation between CDAI and SO in elderly participants' demographics. The implications of these findings were significant for future studies and the formulation of dietary guidelines.

Liver transplant recipients have worse metabolic body phenotype compared with matched non-transplant controls.

Background and Aim: Quantification of body compartments, particularly the interaction between adipose tissue and skeletal muscle, is emerging as novel a biomarker of metabolic health. The present study evaluated the impact of liver transplant (LT) on body compartments. Methods: Totally 66 adult LT recipients were enrolled in whom body compartments including visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue (ASAT), muscle fat infiltration (MFI), fat-free muscle volume (FFMV), and liver fat (LF) were quantified via whole body magnetic resonance imaging (MRI). To provide non-LT comparison, each LT recipient was matched to at least 150 non-LT controls for same sex, age, and body mass index (BMI) from the UK Biobank registry. Results: LT recipients (vs matched non-LT controls) had significantly higher subcutaneous (13.82 ± 5.47 vs 12.10 ± 5.10 L, P < 0.001) and visceral fat (7.59 ± 3.75 vs 6.72 ± 3.06 L, P = 0.003) and lower LF (5.88 ± 7.14 vs 8.75 ± 6.50%, P < 0.001) and muscle volume (11.69 ± 2.95 vs 12.12 ± 2.90 L, P = 0.027). In subgroup analysis, patients transplanted for metabolic dysfunction-associated steatohepatitis (MASH) cirrhosis (vs non-MASH cirrhosis) had higher ASAT, VAT, and MFI. A trend toward higher LF content was noted; however, this did not reach statistical significance (6.90 ± 7.35 vs 4.04 ± 6.23%, P = 0.189). Finally, compared with matched non-LT controls, patients transplanted for MASH cirrhosis had higher ASAT and VAT; however, FFMV and MFI were similar. Conclusion: Using non-LT controls, the current study established the higher-than-expected adiposity burden among LT recipients, which is even higher among patients transplanted for MASH cirrhosis. These findings provide data needed to design future studies developing radiomics-based risk-stratification strategies in LT recipients.

Prevalence of sarcopenic obesity among older adults in communities of China: A multicenter, cross-sectional study.

BACKGROUND: This study investigated the prevalence of sarcopenic obesity (SO) among older adults in Chinese communities and its association with chronic diseases. METHODS: We conducted a post-hoc analysis of a 2014-2015 multicenter cross-sectional study involving adults aged ≥60 years from three representative cities in China. The Asian Working Group for Sarcopenia diagnostic criteria and Chinese local cutoffs were employed to define SO. Data on medical history, lifestyle, quality of life, and cognitive function were collected. RESULTS: The overall prevalence of SO was 3.58% in men and 2.88% in women among 2821 participants. There was a notable increase in prevalence with age, with rates reaching 6.58% for men and 4.40% for women aged 70-79 years. In the group aged ≥80 years, the prevalence rate increased significantly, reaching 13.16% for men and 18.18% for women. Those with SO had higher body mass index (25.29 ± 1.55 kg/m² vs 24.16 ± 2.48 kg/m²; P < 0.001) and triceps skinfold thickness (21.17 ± 5.93 mm vs 19.34 ± 6.87 mm; P < 0.05) than the normal group. The prevalence of cardiovascular disease (15.38% vs 6.59%; P < 0.01), hypertension (56.04% vs 38.93%; P < 0.01), and stroke (7.69% vs 2.25%; P < 0.01) was also significantly higher in the SO group. Logistic regression showed that those with SO were more likely to have cardiac disease (odds ratio [OR] = 2.20; P = 0.016) and stroke (OR = 2.61; P = 0.039). CONCLUSION: The prevalence of SO increases with age among the older adult population in China, notably after age 80 years. SO individuals were more likely to have cardiac disease and stroke. It is important to focus on early identification and management strategies.

Prevalence of sarcopenic obesity: comparison of different diagnostic criteria and exploration of optimal screening methods.

BACKGROUND AND AIMS: Despite concerns on the adverse health outcomes of sarcopenic obesity (SO), exploration regarding the applicability of different diagnostic criteria and the optimal screening methods is still lacking. This study aims to compare the prevalence and diagnostic agreement of SO under four diagnostic criteria in Chongming, Shanghai, China and assess the diagnostic value of nine screening methods for SO. METHODS: The study population included older people aged ≥ 65 years. The Asian Working Group for Sarcopenia-2019 (AWGS-2019) was used to diagnose sarcopenia. Obesity was defined using percentage of body fat (PBF), percent of body fat exceeding the 60th percentile (60% PBF), body mass index (BMI) and waist circumference (WC). The four diagnostic criteria for SO were AWGS + PBF, AWGS + 60% PBF, AWGS + BMI and AWGS + WC. Nine screening methods were the sarcopenia questionnaire [the questionnaire with five items to screen for sarcopenia (SARC-F), the addition of calf circumference to the SARC-F (SARC-CalF), and the addition of elderly age and BMI to the SARC-F (SARC-F + EBM)] combined with commonly used obesity indicators. Cohen's kappa compared agreement between diagnostic criteria, whilst sensitivity, specificity, receiver operating characteristics (ROC) and area under the ROC curve (AUC) compared the diagnostic value of nine screening methods. RESULTS: A total of 1407 older people were enrolled. The prevalence of SO ranged from 0.3 to 9.9%. The highest agreement between AWGS + 60% PBF and AWGS + PBF. When the AWGS + PBF was used as the 'gold standard' (due to its high agreement and high prevalence), SARC-CalF + PBF had the highest AUC value, and SARC-F + BMI had the highest sensitivity. The recommended cut-off values for SARC-F + BMI are SARC-F ≥ 1 score and BMI ≥ 19.845 kg/m², and the recommended cut-off values for SARC-CalF + PBF are SARC-CalF ≥ 5 score and PBF ≥ 34.55%. CONCLUSION: The prevalence of SO varied greatly amongst the four diagnostic criteria. AWGS + PBF is recommended for diagnosing SO in older people. SARC-F + BMI and SARC-CalF + PBF can be used as screening methods for SO.

Daidzein Inhibits Muscle Atrophy by Suppressing Inflammatory Cytokine- and Muscle Atrophy-Related Gene Expression.

BACKGROUND: Sarcopenic obesity, which is associated with a poorer prognosis than that of sarcopenia alone, may be positively affected by soy isoflavones, known inhibitors of muscle atrophy. Herein, we hypothesize that these compounds may prevent sarcopenic obesity by upregulating the gut metabolites with anti-inflammatory effects. METHODS: To explore the effects of soy isoflavones on sarcopenic obesity and its mechanisms, we employed both in vivo and in vitro experiments. Mice were fed a high-fat, high-sucrose diet with or without soy isoflavone supplementation. Additionally, the mouse C2C12 myotube cells were treated with palmitic acid and daidzein in vitro. RESULTS: The isoflavone considerably reduced muscle atrophy and the expression of the muscle atrophy genes in the treated group compared to the control group (Fbxo32, p = 0.0012; Trim63, p < 0.0001; Foxo1, p < 0.0001; Tnfa, p = 0.1343). Elevated levels of daidzein were found in the muscles and feces of the experimental group compared to the control group (feces, p = 0.0122; muscle, p = 0.0020). The real-time PCR results demonstrated that the daidzein decreased the expression of the palmitate-induced inflammation and muscle atrophy genes in the C2C12 myotube cells (Tnfa, p = 0.0201; Il6, p = 0.0008; Fbxo32, p < 0.0001; Hdac4, p = 0.0002; Trim63, p = 0.0114; Foxo1, p < 0.0001). Additionally, it reduced the palmitate-induced protein expression related to the muscle atrophy in the C2C12 myotube cells (Foxo1, p = 0.0078; MuRF1, p = 0.0119). CONCLUSIONS: The daidzein suppressed inflammatory cytokine- and muscle atrophy-related gene expression in the C2C12 myotubes, thereby inhibiting muscle atrophy.

Sarcopenic obesity is associated with cardiometabolic multimorbidity in Chinese middle-aged and older adults: a cross-sectional and longitudinal study.

OBJECTIVES: Sarcopenic obesity (SO) has been found to increase the risk of metabolic disorders, however, its relationship with cardiometabolic multimorbidity (CMM) remains unexplored. This study aims to investigate the potential association between SO and CMM in the middle-aged and older population. METHODS: Our study subjects were from CHARLS. SO was defined as the combination of impaired grip strength (grip strength <28 kg for men and <18 kg for women) and increased body mass index (BMI ≥25 kg/m2). CMM was defined as having two or more cardiometabolic diseases, including diabetes mellitus, stroke, and heart disease. The participants were divided into four groups according to their sarcopenia and obesity status, and logistic regression analysis was used to examine the association between SO and CMM. RESULTS: A total of 15,252 study subjects were included in the cross-sectional study, with an average age of 60.6 years and a male proportion of 47.4%. In the cross-sectional analysis conducted in 2015, the prevalence of CMM was highest in the SO group (9.1%), followed by the obesity (3.7%) and sarcopenia (3.5%) group. After adjustment for confounding factors, SO [OR (95%CI): 2.453 (1.742-3.455)], sarcopenia [OR (95% CI): 1.601 (1.157-2.217)], obesity [OR (95% CI): 1.446 (1.107-1.888)] were all observed to be associated with CMM, with the strongest association in the SO group. Furthermore, in the longitudinal analysis, only the SO group demonstrated a significant risk for developing CMM [OR (95% CI): 2.302 (1.239-4.228)]. CONCLUSIONS: SO was independently and positively associated with CMM in middle-aged and older population.