|dc.description.abstract||Background: Sarcopenic obesity is the condition where obesity and sarcopenia (age-related low muscle mass and strength) occur together, which may predispose older individuals to more adverse health effects than either of the two conditions alone. Thus, improvements in body composition and function are of vital importance.
Aim: The aims of this study were to A) systematically search the databases for nutritional and/or exercise interventions in sarcopenic obesity and assess their effectiveness in augmenting body composition and function. B) Screen Scottish older community-dwellers for sarcopenia and obesity. C) Implement a nutritional and exercise programme for individuals with sarcopenic obesity.
Methods: A) Four databases were systematically searched for trials with sarcopenic obese older adults. B) Scottish community dwellers (≥ 65 years) were screened for body fat (using bioelectrical impedance analysis; BIA), body mass index (BMI), muscle mass, and grip strength. C) Those with a high % body fat (≥ 28 % in men; ≥ 40 % in women) and low skeletal muscle mass index (≤ 10.75 kg·m-2 in men; ≤ 6.75 kg·m-2 in women) were randomly allocated to a 16-week intervention with exercise (EX) or exercise plus dietary modifications (EXD). The EX group followed a mixed-exercise training programme, whereas the EXD followed the same exercise protocol alongside an energy-deficit (500 kcal daily deficit) and high protein diet (1.2 – 1.5 g kg bodyweight-1).
Results: A) Two studies were identified from the literature with sarcopenic obese participants (one diet and one resistance-exercise trial) but neither noted a significant change in body composition. However, resistance exercise training significantly improved physical function. B) In total, 108 (men, n=29; women, n=79) adults (median (IQR) age, 70 (67, 75) yr) took part in the screening test. Prevalence of sarcopenia was 14.8%, of obesity 27.8 % (using BMI) vs 63.0 % (using BIA), and sarcopenic obesity 4.6 % (using BMI) vs 12.0 % (using BIA). C) After 16 weeks of the intervention, the median (IQR) changes in EXD vs EX in bodyweight, fat mass and muscle mass were: -5.0 (-5.0, -6.8) kg vs. +0.5 (0.0, 1.0) kg, -4.7 (-4.8, -4.2) kg vs 0.0 (-0.4, 0.7) kg, and +0.1 (-0.4, 0.7) kg vs +0.5 (0.3, 0.7) kg, respectively. Improvements that may be of clinical significance were noted in both groups for strength and physical function.
Conclusion: More intervention trials are needed with sarcopenic obese older adults. Prevalence of high adiposity in Scottish older adults may be higher than what has been previously documented. High adiposity and the use of BMI may mask sarcopenia and sarcopenic obesity. A high-protein energy-restriction diet with exercise training can potentially improve body compostion, and augment physical function in older adults with low muscle and high fat mass.
Keywords: sarcopenia, obesity, sarcopenic obesity, body composition, older age, weight loss, high protein diet, exercise training, physical function||en