Sarcopenic Obesity Research Tour PDF

Sarcopenic Obesity: A Research Tour Jana Jabbour PhD, MPH, LD  Sarcopenic Obesity Sarcopenia: Decline in muscle mass and function...

Sarcopenic Obesity: A Research Tour Jana Jabbour PhD, MPH, LD  Sarcopenic Obesity Sarcopenia: Decline in muscle mass and function Unique clinical profile that Sarcopenic increases Obesity morbidity & (SO) mortality Obesity: Excessive fat accumulation Donini LM, Busetto L, Bischoff SC, Cederholm T, Ballesteros-Pomar MD, Batsis JA, Bauer JM, et.al. Definition and Diagnostic Criteria for Sarcopenic Obesity: ESPEN and EASO Consensus Statement. Obes Facts. 2022;15(3):321-335. doi: 10.1159/000521241. Epub 2022 Feb 23. PMID: 35196654; PMCID: PMC9210010. Epidemiology Prevalence by gender: Projections: SO to affect 100 to Prevalence among older adults: - Females: 0.8%- 22.3% 200 million people globally by ~14% - Males: 1.3%- 15.4% 2050 Batsis JA, Villareal DT. Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies. Nat Rev Endocrinol. 2018 Sep;14(9):513-537. doi: 10.1038/s41574-018-0062-9. PMID: 30065268; PMCID: PMC6241236. Luo, Y., Wang, Y., Tang, S. et al. Prevalence of sarcopenic obesity in the older non-hospitalized population: a systematic review and meta-analysis. BMC Geriatr 24, 357 (2024). https://doi.org/10.1186/s12877-024-04952-z  Pathophysiology Chronic low-grade inflammation: The expansion of white adipose tissue in obesity leads to the secretion of pro- inflammatory cytokines → promoting muscle catabolism & impairing muscle regeneration. Adipokines: Decreased levels of adiponectin negatively affect insulin sensitivity and promote muscle inflammation. Oxidative stress → High reactive oxygen species (ROS) → damage muscle fibers & impair mitochondrial function. Age-related hormonal changes (↓ anabolic hormones such as testosterone and growth hormone) exacerbate the loss of muscle mass while promoting fat accumulation. Aging and obesity → muscle quality deterioration characterized by ↓ fiber size, number, and contractility. Wei S, Nguyen TT, Zhang Y, Ryu D, Gariani K. Sarcopenic obesity: epidemiology, pathophysiology, cardiovascular disease, mortality, and management. Front Endocrinol (Lausanne). 2023 Jun 30;14:1185221. doi: 10.3389/fendo.2023.1185221. PMID: 37455897; PMCID: PMC10344359. Pathophysiology SO & Insulin Resistance Obesity impairs insulin signaling pathways → reduced glucose uptake by muscles → muscle wasting. Muscle wasting → reduces the body's ability to utilize glucose effectively. Low muscle mass + High fat mass → Metabolic dysregulation, increasing the risk for DM2 & CVD Wei S, Nguyen TT, Zhang Y, Ryu D, Gariani K. Sarcopenic obesity: epidemiology, pathophysiology, cardiovascular disease, mortality, and management. Front Endocrinol (Lausanne). 2023 Jun 30;14:1185221. doi: 10.3389/fendo.2023.1185221. PMID: 37455897; PMCID: PMC10344359. Risk Factors Aging due to hormonal and metabolic changes, decreased physical activity, and nutritional deficiencies. Sedentary lifestyle accelerates muscle loss while promoting fat accumulation. Nutritional deficiencies including inadequate protein intake Insulin resistance promotes muscle catabolism. Inflammatory conditions characterized by increased insulin resistance and inflammatory cytokines Stenholm S, Harris TB, Rantanen T, Visser M, Kritchevsky SB, Ferrucci L. Sarcopenic obesity: definition, cause and consequences. Curr Opin Clin Nutr Metab Care. 2008 Nov;11(6):693-700. doi: 10.1097/MCO.0b013e328312c37d. PMID: 18827572; PMCID: PMC2633408. Diagnosis 10  Diagnosis Voulgaridou, G., Tyrovolas, S., Detopoulou, P. et al. (2024). Diagnostic Criteria and Measurement Techniques of Sarcopenia: A Critical Evaluation of the Up-to-Date Evidence. Nutrients, 16(3), 436. https://doi.org/10.3390/nu16030436 10 Interventions Enhancing protein and energy intake Enhancing physical activity Nutritional supplementation (vitamin D, vitamin C, leucine, selenium, etc.) Liu, S., Zhang, L., & Li, S. (2023). Advances in nutritional supplementation for sarcopenia management. Frontiers in Nutrition, 10. https://doi.org/10.3389/fnut.2023.1189522 Research Gap Association between Effect of high dose SO and mortality in Effect of nutritional vitamin D individuals undergoing counseling on supplementation on Hematopoietic Stem nutritional status of sarcopenic obesity in Cell Transplantation HSCT elderly (HSCT) Welcome to our Tour  Background - Obesity hypovitaminosis D - 10% ↑ in BMI 4.2% ↓ [25(OH)D]. - Proposed etiology o Volumetric dilution o ↓ hydroxylase activity o ↑ 25 (OH) D degradation o ↓ sun exposure o.. Pereira‐Santos et al. 2015. Obesity reviews. 16 (4): 341-9 Vimaleswaran et al. 2013. PLOS Medicine. 10 (2): e1001383 Drincic et al. 2012. Obesity. 20 (7): 1444-8 Background Hypovitaminosis D Sarcopenia - Proposed etiology - ↑ Protein degradation - 1,25D on Ca homeostasis → impact contractile properties of muscle cells - Muscle fiber atrophy & fibrosis - Muscle infiltration with fat cells Hirani et al. 2018. The Journals of Gerontology: Series A. 73 (1): 131-8 Ceglia and Harris. 2013. Calcified tissue international. 92 (2): 151-62  Background Beaudart et al. 2014. The Journal of Clinical Endocrinology & Metabolism. 99 (11): 4336-45  Background Golzarand et al. 2018. European Journal of Clinical Nutrition. 72 (10): 1345-57  Aim Assess the effect of vitamin D3 (VD3) supplementation on indices of sarcopenic obesity at 12 months. Methods  Eligibility Inclusion Exclusion Fracture risk >10% Baseline vitamin D 65 years) kidney or liver failure Baseline [25(OH) D]: Diabetes, impaired glucose tolerance on 10- 30 ng/mL medication  Design Double-blind, randomized, controlled multicenter trial. Simple randomization by pharmacist. Stratification by gender & facility. 3 major referral medical centers in Beirut, Lebanon January 2011 → July 2013  a Design Baseline 3 Months 6 Months 9 Months 12 Months Randomization Low Dose Group High Dose Group 600 IU/day VD3 3750 IU/day VD3 (IOM recommended dose) + 1000 mg Calcium + 1000 mg Calcium Citrate Citrate  Assessment Baseline 3 Months 6 Months 9 Months 12 Months Biochemical and metabolic data Total Body DXA Anthropometric (weight, height, Subcutaneous, Visceral mass and area waist circumference) Appendicular Skeletal Muscle mass Hand Grip Strength (HGS) Index (ASMI) Dietary Intake Lifestyle Assessment Calcium Physical activity Caffeine Smoking Body Composition Phenotypes Diminished Visceral Muscle Sarcopenia Adiposity Mass EWGSOP 1: Def. 1 (VAT area) 70 cm2 Females Obesity 90% o From baseline until 12 months, 25 (OH) D increased: - Low dose: 19.9 ± 6.9 → 25.7 ± 6.7 ng/mL (p< 0.01) - High dose: 20.5 ± 7.8 → 36.1 ± 9.8 ng/mL (p