Sarcopenic obesity is a type of obesity that occurs in the elderly. It is characterized by an increase in the amount of adipose tissue while losing muscle mass. What are the causes of sarcopenic obesity and how is it treated?

Contents :

  1. Sarcopenic obesity - what is it?
  2. Sarcopenic obesity - causes
  3. Sarcopenic obesity - consequences
  4. Sarcopenic obesity - treatment
  5. Sarcopenic obesity - diet
  6. Sarcopenic obesity - exercise
  7. Sarcopenic obesity - medications

Sarcopenic obesity - what is it?

Sarcopenic obesityis most often associated with age-dependent changes in body composition. As the body ages, its muscle mass gradually decreases. This reaction occurs even in physically very active people. But some seniors may gain fat mass at the same time. Research confirms the close relationship between old age, obesity and loss of muscle mass. The development of one of these factors leads to the appearance or intensification of the other, causing a "closed circle" phenomenon.

Sarcopenic obesityis diagnosed in those who are diagnosed with:

  • sarcopenia, i.e. low skeletal muscle mass, determined through research and testing, and the associated loss of muscle strength and endurance,
  • increased body fat - 28% and more for men and 40% and more for women.

Sarcopenic obesity - causes

1. Age-related changes in body compositionAs you age, the proportions of muscle and fat tissue change in your body. From around the age of 40, a steadily progressive process of loss of muscle mass and strength begins, and around the age of 60-75, the amount of fat begins to increase. In the elderly, adipose tissue usually accumulates around internal organs and penetrates into the muscles. However, changes in body composition may go unnoticed for long periods in people who maintain a relatively constant body weight.2. Low or no physical activity.The term "low physical activity" covers activities that do not increase expensesenergy of the body, e.g. sleeping, sitting, lying down. With little or no activity, muscle mass decreases and the risk of wasted energy being stored as fat increases. Another "vicious circle" appears. Obese people, due to being significantly overweight, are less active in everyday life and it is more difficult for them to exercise, which contributes to the reduction of strength and to atrophy, i.e. muscle wasting. On the other hand, when they lose their strength, they start to avoid exercise, which in turn promotes the development of obesity.3. Too much body fat.The more adipose tissue (especially visceral and internal fat) accumulates in the body, the more it secretes the so-called cytokines - substances that trigger inflammatory reactions. They have a direct impact on the operation of many systems, incl. accelerate changes in body composition typical of the aging process and cause chronic inflammation. Some of them (e.g. interleukin-6 - IL-6) accelerate the rate of muscle breakdown, thus leading to a decrease in their strength and the development of sarcopenia.4. Insulin resistance . A secondary effect of insulin resistance is increased insulin levels, which accelerate the breakdown of skeletal muscle tissue. In turn, the atrophy of skeletal muscles leads to an increase in insulin resistance, which in turn promotes the development of obesity.

Read also : Insulin Resistance (Insulin Sensitivity) - Causes, Symptoms and Treatment5. Hormonal changes.The more body fat, the more free fatty acids appear in the bloodstream that inhibit the production of growth hormone (GH) and testosterone. And the fewer of these hormones, the lower the muscle strength and the less effective the muscles of obese people.Read also:Growth hormone. Preparations containing growth hormone6. Incorrect nutrition.Elderly people do not know or forget that their body's need for calories decreases with age. Accustomed for many years to certain foods, sizes and amounts of meals, they find it difficult to introduce dietary restrictions. The caloric value of the products they eat daily exceeds the needs of their body, which leads to the development of overweight and obesity. It also often happens that the elderly, especially women, limit the amount of protein consumed. And when there is not enough protein in the diet, muscle loss progresses faster.

Worth knowing

Nutritional factors that contribute to sarcopenic obesity:

  • excess simple sugars and fats in the diet
  • too little protein in the diet
  • a small amount of fiber as a result of too little consumption of raw fruits and vegetables
  • deficiency of vitamins and food ingredients with anti-inflammatory and antioxidant properties, e.g. vitamins D3, C, E, B6 and B12 and folic acid
  • eating too much
  • disturbed absorption of some nutrients, especially protein, calcium, vitamins B12, B6, B12, folates and water
  • changes in the digestive system associated with aging - from missing teeth, through reduced saliva secretion, gastric juice and digestive enzymes, disturbances in the perception of hunger and satiety, and ending with slowing intestinal motility, weight loss and liver weakness and pancreas.

Sarcopenic obesity - consequences

How weak muscles and excess body fat affect the he alth and life of an elderly person?

  • limit motor functions - they cause the patient to withdraw from many daily activities, become less and less fit and independent,
  • increase the risk of falls and fractures, which additionally reduce the patient's mobility,
  • they reduce the walking speed and change the walking style - the patient also has difficulties climbing and descending stairs,
  • reduce lung function,
  • lead to metabolic syndrome - including glucose intolerance, diabetes, dyslipidemia, and high blood pressure, as well as stroke, which causes ischemic brain damage and cognitive impairment,
  • pose a greater risk of cardiovascular disease.

Sarcopenic obesity - treatment

The main goal of treating sarcopenic obesity is to lose weight and increase muscle strength, and as a result, improve the daily functionality of the patient and keep his body in good condition for the longest possible time. Sarcopenic obesity therapy focuses on the so-called conservative treatment, i.e. changing the rules of nutrition and improving physical activity. In some patients with sarcopenic obesity, pharmacotherapy is also introduced.

Sarcopenic obesity - diet

Weight reduction in the elderly should not be pursued "at all costs". The first necessary step to modify the diet is to assess the nutritional status of the patient. This can be done with the practical, publicly available Mini Nutritional Assessment - MNA. If an elderly person is malnourished or at risk of malnutrition, the main goal of the new diet is to improve the body's nutritional status, not to lose weight.

In the elderly with obesitysarcopenic treatment is a slimming therapy that minimizes the loss of muscle mass. As elderly people often suffer from many other diseases and take many medications, the introduction of a new diet must be monitored by a doctor and a dietitian.

If an elderly person with sarcopenic obesity is taking medications that cause weight gain (e.g. insulin, antidepressants, steroid hormones), or drugs the effect of which may change during weight loss (e.g. diuretics, painkillers), the attending physician treatment should consider introducing other pharmacological solutions.

Diet in sarcopenic obesity is determined individually for each patient, and its planning takes into account parameters such as providing the amount of vitamins and minerals appropriate for the age and condition of the patient, caloric requirements, preferences and eating habits, the degree of patient mobility and forms of physical activity, as well as accompanying diseases and pharmacotherapy. The goal of the diet is to lose 5% -10% of the patient's initial body weight within 6 months, but mainly in the area of ​​adipose tissue, with the maximum preservation of muscle tissue. This effect can be achieved by reducing the daily caloric intake of a sick person by 500-700 kcal.

Nutrients necessary in the diet of a person with sarcopenic obesity:

  • carbohydrates - the basic source of energy for the body; the best source of carbohydrates in the diet of the elderly should be whole grains, legumes, and fruit and vegetables; an excess of simple sugars (e.g. sugar, sweets, cookies) negatively affects the formation of muscle proteins,
  • fiber - regulates the work of the intestines and cleans them of food residues, prevents constipation; sources: vegetables and fruits; elderly people can eat them in a ground form, in the form of salads and salads, as purees and juices; especially recommended are: pumpkin, zucchini, squashes, tomatoes, as well as root vegetables, e.g. carrots, celery, parsley, beets,
  • calcium - helps to reduce body fat, improves muscle function; source: fermented milk products, e.g. kefir, yoghurt and lean curd cheeses,
  • protein - more than in the reduction diet of younger people; for the elderly, 1.0-1.2 g per kg of body weight per day is recommended in the amount of 20-25 g in each meal; source: low-fat meat products, lean poultry meat (chicken, skinless turkey), lean fish, low-fat dairy products, egg white,
  • antioxidants and anti-inflammatory compounds - prevent oxidation processes andrelieve inflammation in the body; source: colorful fruit and vegetables, especially with orange, red and purple tones, e.g. blueberries, blueberries, raspberries, cherries, apricots, pumpkin, beets,
  • vitamin D3 - source: fish oil (fish oil), oily sea fish (salmon, herring, mackerel),
  • liquids - water, fruit teas, herbal infusions, vegetable juices; the recommended daily amount for the elderly is min. 2 liters.
Worth knowing

The slimming diet is not applied to the elderly with:

  • diagnosed with malnutrition,
  • significant muscle loss found with the use of measuring devices,
  • moderate to severe dementia,
  • osteoporosis,
  • medical conditions that cause weight loss and exhaustion of the body,
  • unable to move, e.g. lying in bed,
  • over 75,
  • covered by palliative care.

Sarcopenic obesity - exercise

In the treatment of sarcopenic obesity, forms of physical activity are used that strengthen muscles, improve their strength and flexibility, and improve balance. However, it is worth encouraging the patient to any activity that increases energy expenditure, and thus contributes to the loss of adipose tissue and intramuscular fat. The most effective method of strengthening muscle strength is exercise, the so-called thrust. They can be performed by elderly people of different age and condition, even the weakest and most fragile. For exercises, you can use strength training devices and rehabilitation rubbers, but also household items. Moderately intensive training, adapted to the he alth condition and capabilities of an elderly person, carried out 1-2 times a week, will gradually improve strength and well-being. In the case of elderly people who are not active at all, the exercises should be introduced slowly, grading their difficulty, intensity and duration.

Worth knowing

How physical activity affects the he alth of the elderly?

  • increases the production of muscle proteins,
  • increases the secretion of IGF-1 - a hormone similar to insulin, which stimulates tissue growth, supports the formation of collagen, balances the concentration of calcium, magnesium and potassium,
  • restores or improves the sensitivity of tissues to insulin,
  • improves the transport of nutrients to the muscles,
  • alleviates the effects of inflammation in tissues,
  • has a positive effect on the cardiovascular system,
  • oxygenates tissues and the brain,
  • improves the flexibility of the respiratory muscles, improves respiratory ventilation and deepens the inhalation,
  • slows down destructive changes in the osteoarticular system - improves the elasticity of periarticular tissues,
  • strengthens the immune system, prevents infections,
  • improves intestinal peristalsis - prevents constipation,
  • improves balance, physical condition and well-being.

Sarcopenic obesity - medications

Lifestyle change is of great importance in the treatment of sarcopenic obesity, but it is not always feasible. The effectiveness of therapy may be weakened by limitations resulting from the ill he alth of the patient, lack of motivation or simply not following new rules. In such situations, consideration is given to enhancing conservative treatment with drugs that support weight reduction. Pharmacotherapy and additional supplementation in the treatment of sarcopenic obesity, however, are introduced very carefully, because the elderly usually already take many medications for other diseases.

Bibliography:-Buamgartner Richard N., et al.Sarcopenic obesity predicts instrumental activities of daily living disability in the elderly.Obesity, 2004, 12/12: 1995-2004. -Gębka Dominika, Kędziora-Kornatowska Kornelia.Benefits from he alth training in elderly people.Problems of Hygiene and Epidemiology, 2012, 93.2: 256-259. -Han T. S .; Tajar Abdelouahid; Lean M. E. J.Obesity and weight management in the elderly.British medical bulletin, 2011, 97.1: 169-196. -Jarosz Patricia A .; Bellar Ann.Sarcopenic obesity: an emerging cause of frailty in older adults.Geriatric Nursing, 2009, 30.1: 64-70 .-Kotwas Marzena, et al.Pathogenesis and treatment of obesity in the elderly.In: Family Medicine Forum. 2008. p. 435-444. -Leal Ana Rita São João Oliveira.Obesidade sarcopénica no idoso.2015. Master's Thesis. -Stenholm Sari, et al.Sarcopenic obesity-definition, etiology and consequences.Current opinion in clinical nutrition and metabolic care, 2008, 11.6: 693. -Strzelecki Adrian; Ciechanowicz Robert; Zdrojewski Zbigniew.Elderly Sarcopenia.Gerontology Poland, 2011, 19.3-4. -Węgielska Iwona; Poor Weronika; Suliborska Joanna.Diet therapy and pharmacological treatment of obesity in the aspect of the problem of malnutrition of obese people.In: Metabolic Disorders Forum. 2011. p. 239-244. - Other sources available from the author.

Important

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Obesity