Article: Deciphering the “obesity paradox” in the elderly: A systematic review and meta-analysis of sarcopenic obesity
Ageing is associated with increased fat accumulation and weight gain due to altered energy metabolism. Sarcopenia, defined as a loss of muscle mass and function associated with increased mortality risk, is also linked to ageing.
Sarcopenia obesity (SO) refers to the combination of age-related sarcopenia and obesity, and stems from the negative correlation between intermuscular adipose tissue accumulation and muscle performance.
While elderly patients with obesity possess lower death rates than those with lower body mass indexes, patients with SO have higher mortality rates than these same peers. This, as well as obesity’s protective role against sarcopenia in the elderly, is the basis of the commonly known ‘obesity paradox’.
The aim of this review was to assess the current clinical evidence relating to SO.
SO’s prevalence was estimated to be 9% in both men and women. Paradoxically, obesity was associated with a 34% reduction in the risk of developing sarcopenia.
SO was also significantly associated with increased risk of cardiovascular disease and mortality, metabolic disorders, cognitive impairment, arthritis, functional limitation, and lung diseases. Elderly patients with SO also had a higher IMAT, as well as increased circulating levels of adipokines, chemokines, and metabolic risk factors. These increases were significantly associated with poor clinical outcomes, which underscores the importance of improving body composition to attenuate age-related adverse events.
Future research must focus on subphenotyping affected patients to achieve the unified diagnosis and adequate management of SO.
Reviewed by: S. Duarte
Authors: Liu C, Wong PY, Chung YL et al.
Published in: Obesity Reviews 2022