Sarcopenic obesity: epidemiology, pathophysiology, cardiovascular disease, mortality, and management

Abstract

Sarcopenic obesity is defined as the coexistence of sarcopenia and obesity in the same individual, characterized by of the co-presence of body fat accumulation and muscle loss. This condition is currently a major concern as it is associated with frailty and disabilities such as cardiovascular disease, fractures, dementia, cancer, and increased all-cause mortality. Particularly, older individuals remain at risk of sarcopenic obesity. Progress at several levels is needed to improve the global prognostic outlook for this condition, including the elaboration and implementation of a more uniform definition that may favor the identification and specification of prevalence by age group. Furthermore, improvements in the understanding of the pathogenesis of sarcopenic obesity may lead to the development of more specific therapeutic interventions to improve prognosis. We reviewed the knowledge on sarcopenic obesity and its associations with cardiovascular diseases and mortality.

Keywords: cardiovascular disease; endocrine; obesity; pathogenesis; sarcopenia.

Figure 1

(A) Pathophysiology and risk factors for sarcopenic obesity development. Aging and obesity that is induced by unhealthy diet and lack of exercise will promote the development of sarcopenic obesity. Sarcopenic obesity is associated with several deleterious biological mechanisms such as insulin resistance, lipotoxicity, mitochondrial dysfunction, oxidative stress, chronic inflammation, and proteostasis. Sarcopenic obesity is characterized by adipose tissue expansion and muscle loss that cause increased pro-inflammatory cytokine levels, increased leptin, reduced adiponectin, and intramyocellular lipid deposits. Individuals with sarcopenic obesity are more at risk of several conditions such as cardiovascular disease, cancer, diabetes, fracture, and hospitalization. GDF15, Growth differentiation factor 15; FGF21, Fibroblast growth factor 21. (B) As a result of sarcopenic obesity, there is an increased risk of cardiovascular disease, cancer, diabetes, fractures, and frailty, as well as hospitalizations, morbidity and mortality, disability, and decreased quality of life.

Figure 2

Therapeutic strategies to counter-act sarcopenic development. Various therapeutic approaches are proposed against sarcopenic obesity. Caloric restriction could be considered cautiously, especially in elderly subjects associated with high-quality protein intake. Physical activity is a cornerstone in the management of sarcopenic obesity and should combine aerobic and resistance exercises. Various pharmacological treatments are considered and include myostatin inhibitors, anamorelin, vitamin D, testosterone and selective androgen receptor modulators, and weight loss therapies. ActRII, Activin type II receptor.