Common condition that leads to bone loss. The impact on the elderly, devastating

Sarcopenia is a medical condition characterized by the progressive loss of muscle mass and muscle strength associated with aging. It is the result of an imbalance between muscle protein synthesis and breakdown, which can be influenced by several factors, including physical inactivity, malnutrition, chronic inflammation, and hormonal changes associated with aging.

This condition can have significant consequences on the quality of life and functional independence of affected individuals, increasing the risk of falls, bone fractures, inability to carry out daily activities and increased dependence on the care of others.

Prevention and management of sarcopenia often involve interventions such as resistance exercise and strength training to maintain and increase muscle mass, as well as ensuring a diet rich in protein and essential nutrients. It is also important to identify and treat risk factors associated with the condition, such as low levels of physical activity and malnutrition.

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Obesity leads to sarcopenia

Sarcopenic obesity, characterized by excess adiposity and loss of muscle mass, is an “underestimated and underdiagnosed” condition, said the panelists during a session of the XVth Latin American Congress on Obesity (FLASO 2024) and 2nd Paraguayan Obesity Congress.

This condition is more common in older adults, but it can occur at any age as a result of unhealthy habits or intensive or repeated weight loss efforts.

“Medications currently used to manage obesity promote significant weight loss, but with fat loss, muscle is also lost.

We must handle these drugs with extreme care. When using a strategy that achieves this significant weight loss, we must ensure that the patient receives adequate protein intake and engages in resistance exercise, otherwise the cure may be worse than the disease,” said Fabiola Romero Gómez, MD , professor of medicine at the National University of Asunción and president of the Paraguayan Society of Endocrinology and Metabolism, according to Medscape.

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How sarcopenic obesity can occur

Some patients develop sarcopenic obesity after using glucagon-like peptide 1 (GLP-1) analogs, after bariatric surgery or after restrictive diets, Romero told the Spanish-language edition of Medscape. The condition is more common when there are prolonged cycles of weight loss and gain, “which is the majority of our patients,” she said.

“An important, largely ignored aspect of weight loss, whether through pharmacological intervention or lifestyle intervention, is that part of the weight loss consists of lean muscle.

But the weight gain is almost entirely fat. People with chronic obesity lose and regain weight in repeated cycles, each of which results in changes in body composition (even though they experience some net weight loss).

This cycle puts people who can’t maintain their weight loss at risk of being metabolically less healthy than they were before the initial weight loss was achieved—basically, at risk of developing sarcopenic obesity,” according to a recent editorial in Nature Medicine.

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Hidden problem

Sarcopenic obesity – PHOTO: Freepik@Vladyslav Babenko

Sarcopenic obesity is “something hidden, something we often don’t see. Why? Because if we don’t measure body composition, we won’t know,” Romero said. According to the 2022 consensus of the European Society of Clinical Nutrition and Metabolism and the European Association for the Study of Obesity, clinical signs or factors suggestive of sarcopenic obesity include age over 70 years, diagnosis of a chronic disease, repeated falls or weakness, and nutritional events such as recent loss weight or rapid gain, long-term restrictive diets and bariatric surgery.

European guidelines also propose screening in at-risk individuals to check for an increase in body mass index (BMI) or waist circumference and suspicious parameters of sarcopenia. In this group of patients, the diagnosis should be established based on the analysis of alterations in functional musculoskeletal parameters, such as grip or grip strength or the 30-second chair rise test, followed by a determination of the alterations body mass using dual-energy X-ray absorptiometry or electrical bioimpedance.

Electrical bioimpedance is Romero’s preferred method. It’s an inexpensive, simple and easy-to-carry test that calculates lean muscle mass, fat mass and body water based on electrical conductivity, she said. Experts pointed out that bioimpedance scales “will revolutionize the way we measure obesity”, she added.

In a yet-to-be-published study that received an honorable mention at last year’s third Paraguayan Congress of Endocrinology, Diabetes and Metabolism, Romero and colleagues studied 126 patients (median age, 45 years) with obesity defined by percent of fat mass determined by bioimpedance. When their BMI was analyzed, 11.1% were of “normal” weight, and 35.7% were “overweight”.

Even measuring waist circumference suggested that about 15% of participants were not obese. Moreover, nearly one in four participants had sarcopenia, “implying a decrease in quality of life and physical disability in the future if not properly investigated, diagnosed and treated,” Romero said.

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Sarcopenic obesity, prevention

Exercise and nutrition are two key components in the prevention and management of sarcopenic obesity. Physicians who prescribe glucagon-like peptide 1 (GLP-1) receptor agonists “should also counsel patients to incorporate aerobic exercise and resistance training into their treatment plan, as well as ensure that they consume a diet rich in in protein,” wrote Yoon Ji Ahn, MD, and Vibha Singhal, MD, MPH, of the Massachusetts General Hospital Weight Management Center in Boston, in a commentary published on Medscape.

Paraguayan nutritionist Patricia López Soto, a diabetes educator with postgraduate degrees in obesity, diabetes and bariatric surgery at Favaloro University in Buenos Aires, issued several general recommendations to prevent sarcopenic obesity in patients undergoing weight loss treatment:

– Follow a healthy and balanced Mediterranean or DASH diet.

– Increase protein intake at three or four main meals to a minimum of 1.4-1.5 g/kg/day.

– Try to make your protein intake mainly high biological value: beef, chicken, fish, eggs, seafood, cheese, skim milk and yogurt.

– Ensure protein intake at each meal is between 25g and 30g to increase protein synthesis. For example, a 150g portion of meat or chicken provides 30g of protein.

– If protein intake is not achieved through diet, a supplement such as whey protein isolate and hydrolyzate is a good option.

– Participate in strength or resistance training (weight lifting) three or four times a week and 30 minutes of cardiovascular exercise each day.

– To improve adherence, treatment should be performed with a multidisciplinary team that includes a physician, a nutritionist, and a physical trainer, with frequent check-ups and bioimpedance body composition studies.

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