Sarcopenic Obesity, what’s the difference?

⁴Sarcopenic obesity is defined as “reduced lean mass with excess fat as a percentage of body weight”.

Generally, with advancing age, cause of sarcopenia is multi-faceted associated with co-morbid condition(s). These causes and effect form a vicious cycle feeding one- another leading to rapid muscle loss and accumulation of body fat.

Any forms of morbidity, accelerate break-down of muscle, while conversely, preserve and very often, increase Body Fat Mass (BFM). Statistically, preservation of BFM alone with loss of Skeletal Muscle Mass (SMM) leads to rise in Percentage Body Fat (PBF). High PBF, in turn aggravate the co-morbid condition(s) and adverse cycle continues.

Besides Age, what causes Sarcopenia?

Well-described ²pathophysiological causes include

• Age (non-modifiable)
• Gender (non-modifiable)
  • Obesity
  • Bone Mineral Density (BMD)
  • Vitamin D and calcium
• Physical activity (Modifiable)
  • Duration
  • Intensity (resistance exercise)

Other co-morbid condition(s), e.g. diabetes, malignancies, rheumatoid arthritis, bed- ridden due to any disorder etc., accelerates rate of progression of sarcopenia. The accelerated sarcopenia is due to increase production of proinflammatory cytokines, triggering proteolysis (breaking of muscle), hence reducing muscle mass.

How would Sarcopenia affect me?

As individual aged with time, the progressive nature of sarcopenia renders the individual frail; decreased in muscle strength, increased in response time (slower action and reaction) leading to loss of stability and risking accident.

Sarcopenia ultimately limits physical movement and subsequently physical capability. Soon, the individual loses independence and ability to perform Activities of Daily Living (ADL), requires long-term personal care and higher healthcare expenditure aside from emotional disturbances.

In case of accidental fall, coupled with low BMD (osteoporosis), bone fracture especially spine, pelvic or leg bone, would invariably results in dependency or hospitalization. Having to endure pain, immobility and loss of ability to perform ADL, a vicious cycle of cause and effect, accelerates the existing sarcopenia and disease status.

What can I do?

Sarcopenia being a progressive generalized loss of SMM is evidently related to nutritional status, physical activities and co-morbid condition(s). Henceforth, altering these MODIFIABLE causes may assist to postpone or prevent, if not slow down the process of sarcopenia. Below are few scientific statements which prove such modifications could affect a positive outcome:

1. Nutrient intake is the most important anabolic stimulus for skeletal muscle.
   1. ⁵Specifically the amino acid leucine and meal-induced insulin, independently stimulate skeletal muscle protein synthesis.
   2. ⁴Evidence suggests a protective role for protein supplementation in older adults in order to preserve lean body mass and prevent frailty. A controlled trials of muscle protein synthesis demonstrated that whey protein increases synthesis more so than casein or soy isolates. Studies also suggest that essential amino acids stimulate muscle protein synthesis to a greater extent than non-essential amino acids.
   3. ³A recent work reported a novel and specific dietary approach may best prevent or slow-muscle loss with ageing. Rather than recommending a large, global increase in the recommended dietary allowance (RDA) for protein for all elderly individuals, clinicians should stress the importance of ingesting a sufficient amount of protein with each meal. To maximize muscle protein synthesis while being cognizant of total energy intake, a dietary plan that includes 30g of high quality protein per meal.
2. Resistance exercise is another anabolic stimulus increases myofibrillar muscle protein synthesis in both young and older individuals.
   1. ⁵The increased muscle anabolism is apparent within 2-3 hours after a single bout of heavy resistance exercise and remains elevated up to 2 days following the exercise.
   2. ^6,7 Interestingly insulin resistance muscle protein metabolism in elderly can be reversed by aerobic exercise through improved endothelial function, insulin induced vasodilation, and intracellular insulin signaling.
3. Optimal Management of Co-morbidity
   1. ⁵Insulin is a potent muscle anabolic agent. Hence insulin resistance muscle anabolism resulted from aging is invariably adversely affected by co-morbid conditions e.g. cancer, diabetes, burnt.
   2. ⁸In the context of muscle aging, it is important to remember that it is not just a decline in muscle mass which contributes to the deterioration of muscle function.
   3. ⁹Sarcopenia and osteoporosis are linked from a biological and functional perspective and are related to an increased fracture risk in the elderly.

How can I know about my status and why does it matter?

Previously, Body Mass Index (BMI) alone was use to analyze physical structure, in fact has limited interpretation. The weight against height measured, only allows clinician/dietitian to affirm an individual as underweight, normal, overweight or obese.

Fortunately, as technology progresses, health and medical evaluation tools improve. Recently introduced, Body Composition Test (BCT) is able to evaluate and illustrate briefly and precisely the muscle and fat masses of an individual within a short span of less than a minute.

The BCT analyses body weight into FOUR components; namely body fat mass, lean body mass, mineral and body water. These components weight against one another provide a more definitive nature of overall physique; identifying sarcopenia from sarcopenic obesity.

In addition, the results provide detailed information about specific segments where fat, muscle, and body levels which may require more action, hereto help and guide, clinician, dietitian or individual to achieve desired goals: whether to target muscle building and/ or fat burning in the segment of interest.

Benefits of higher SMM is very important in general wellbeing of an individual. It’s not just about looking great or being stronger, sufficient amounts of SMM are actually critical for building a healthy life over long-term. Ability to burn fat is determined by the amount of calories burnt at rest known as Basal Metabolic Rate; in turn depends on SMM.

Please visit https://mjhealthscreening.com/ for more information and details.

References:

1. SK Norshafarina, MS Noor Ibrahim, S. Suzana, et al. 2013. Sarcopenia and Its Impact on Health: Do They have Significant Associations?. Sains Malaysiana 42(9)(2013) 1345-1355.
2. Valter Santili, Andrea Bernetti, Massimiliano Mangone, et al. 2014. Clinical Definition of Sarcopenia. Clinical Cases in Mineral and Bone Metabolism 11(3)(2014) 177-180 (Mini-Review).
3. Douglas Paddon-Jones and Blake B. Rasmussen. 2009. Dietary Protein Recommendations and the Prevention of Sarcopenia: Protein, Amino Acid Metabolism and Therapy. Curr Opin Clin Nutr Metab Care 12(1): 86-90
4. Jeannette M Beasley, James M. Shikany, Cynthia A. Thomson. 2013. The Role of Dietary Protein Intake in the Prevention of Sarcopenia of Aging. Nutr Clin Pract 28(6): 684–690
5. Yuhei Makanae and Satoshi Fujitha. 2015. Role of Exercise and Nutrition in Prevention of Sarcopenia. J Nutri Sci Vitaminol 61: S125-S127.
6. Rasmussen BB, Fujita S, Wolf RR, Mittentdorffer B, Row M, et al. 2006. Insulin Resistance of Muscle Protein Metabolism in Aging. FASEB J 20: 768-769.
7. Fujita S, Rasmussen BB, Cadenas JG, Drummond MJ, Glyn L et al. 2007. Aerobic Exercise Overcomes the Age-Related Insulin Resistance of Muslce Protein Metabolism by Improving Endothelial Function and AKT/ mammalian target of rapamysin signaling. Diabetes 56: 1615-1622
8. Elizabeth Curtis, Anna Litwic, Cyrus Cooper et al. 2015. Determinants of Muscle and Bone Aging. J Cell Physiol 230(11): 2618-25
9. Umberto Tarantino et al. 2015. Sarcopenia and Fragility Fractures: Molecular and Clinical Evidence of the Bone-Muscle Interaction. Bone Joint Surg Am 97(5):429-37.