Sarcopenia and obesity Zamboni, Mauro; Rubele, Sofia; Rossi, Andrea P
Current opinion in clinical nutrition and metabolic care,
2019-January, 2019-01-00, 20190101, Letnik:
22, Številka:
1
Journal Article
Recenzirano
PURPOSE OF REVIEWTogether with age-related body composition changes, the increased prevalence of obesity observed in the past few decades in older individuals has led to a condition called sarcopenic ...obesity, characterized by a mismatch between muscle mass and fat mass. The operative definition of sarcopenic obesity is still under discussion and creates difficulties in clinical practice. Muscle weakness, rather than low muscle mass, was previously proposed as an alternative criterion and, more recently, the dynapenic abdominal obese phenotype is of increasing interest because of its unfavorable health consequences and usability in clinical practice.
RECENT FINDINGSThis review focuses on the most recent findings of pathogenic inter-relationships between adipose tissue and muscle. Recent studies on health consequences of sarcopenic obesity and dynapenic abdominal obesity are also examined. Despite the lack of consensus on a definition for sarcopenic obesity, progress has been made in the delineation of the treatment principles for this condition.
SUMMARYFurther research is needed to compare different definitions of sarcopenic/dynapenic obesity to clarify the relationship between obesity and the most important adverse outcomes in the elderly. The next step will be the definition of best possible therapeutic approaches for this condition.
In medullary sponge kidney (MSK)-a common malformative renal condition in patients with calcium nephrolithiasis-hypercalciuria, incomplete distal renal tubular acidosis, and hypocitraturia are ...common. Clinical conditions with concomitant hypercalciuria and/or incomplete distal renal tubular acidosis are almost invariably associated with bone disease, making osteopathy highly likely in MSK, too. Patients with MSK have never been investigated for osteopathy; neither has the potential effect of potassium citrate administration (CA) on their urinary metabolic risk factors and on bone mineralization.
These issues were retrospectively analyzed in 75 patients with MSK and primary stone risk factor (PSRF; hypercalciuria, hypocitraturia, hyperuricosuria, and/or hyperoxaluria) on an outpatient basis; 65 received CA (2.9 +/- 0.8 g/d), whereas 10 received only general "stone clinic" suggestions. The 24-h urinary excretion of calcium, phosphate, oxalate, uric acid, and citrate; morning urine pH; serum biochemistry; and bone mineral density were investigated at baseline and at the end of follow-up (78 +/- 13 and 72 +/- 15 mo in groups A and B, respectively).
CA led to a significant rise in urinary pH and citrate and decreased urinary calcium and phosphate (all P < 0.001). Patients with MSK and PSRF had reduced bone density. Bone density improved significantly in the group that was treated with oral CA.
Bone disease is very frequent in patients with MSK and concomitant PSRF. Long-term CA improves bone density. The concurrent effects of treatment on PSRF suggest that the subtle acidosis plays a pivotal role in bone disease and hypercalciuria in patients with MSK.
A decrease in lean muscular mass causes sarcopenia, a disease frequently found in the elderly population. The reduction of muscle mass may be responsible for reduced insulin sensitivity and decreased ...glucose uptake, thus increasing the risk for hyperglycemia and insulin-resistance syndrome in elderly subjects with type 2 diabetes mellitus. We therefore wanted to determine the effect of a special mixture of oral amino acids (AAs) on elderly subjects with type 2 diabetes. A randomized, open-label, crossover study was conducted in 34 subjects with diabetes (age range, 65–85 years) assigned to 2 distinct treatments (AAs and placebo). In spite of treatment with oral hypoglycemic drugs or insulin, all subjects were in poor metabolic control (glycated hemoglobin HbA1c >7%). The subjects studied had normal body weight (ie, body mass index within 19–23). AAs consisted of 70.6 kcal/day (1 kcal = 4.2 kJ) of 8 g of AA snacks, given at 10.00 am and 5.00 pm . Fasting and postprandial (1 hour and 2 hours) blood glucose, serum insulin, and homeostatic model assessment of insulin resistance (an index of insulin resistance) significantly decreased during AA treatment. Furthermore, a significant reduction of HbA1c levels was found throughout the study. No significant adverse effects were observed during the active treatment. We suggest that nutritional supplementation with a special mixture of oral AAs is safe and significantly improves metabolic control and insulin sensitivity in poorly controlled elderly subjects with type 2 diabetes. This effect was consistent during the long-term observation period of 60 weeks and was also present after the crossover from AAs to placebo.
To date, only a few studies have evaluated the effect of physical activity on PWVcf in the elderly. In the current study, 21 community-dwelling women, with a mean age of 68.19±5.72 years and a mean ...BMI of 28.63±4.69 kg m(-2), participated in moderate physical activity sessions for 1 h per day and 2 days each week under the supervision of a qualified physical education instructor for a total of 24 weeks. At the beginning of the study, at 3 months and at 6 months, the study participants' body weight, waist circumference, sagittal abdominal diameter (SAD) and body composition by dual energy X-ray absorptiometry (DEXA) were recorded along with the participants' Physical Activity Scale for the Elderly questionnaire. Total low-density-lipoprotein and high-density lipoprotein cholesterol; triglycerides (TGs) and HbA1c; blood pressure (BP); and arterial stiffness, as determined by carotid-femoral and carotid-radial pulse wave velocity (PWVcf, PWVcr), were also assessed. During the follow-up period, the waist and SAD significantly decreased, whereas fat-free mass, BMI and weight did not decrease. A significant decline in TGs was observed. A significant decline in PWVcf, even after adjusting for mean arterial pressure, heart rate triglycerides and waist diameter changes, was observed. In a sub-analysis that examined the effect of physical activity separately in the hypertensive and normotensive subjects, we observed a significant decline in PWVcf in the hypertensive subjects and a nonsignificant tendency in the normotensive subjects. The data showed an association between light aerobic physical activity in the elderly and decreased PWVcf, even after adjusting for changes in systolic BP (SBP), TGs and central adiposity. These results suggest a beneficial effect of moderate physical activity on subclinical vascular damage, particularly in hypertensive subjects.
This book reconstructs and classifies, according to ideal-typical models, the different positions taken by the major contemporary legal theories as to whether and how law relates to politics. It ...presents a possible explanation as to why different legal theories, though often reaching diametric results, somehow must still begin from common basic points.
The purpose of this paper is to use legal theory to clarify the nature and the components of effectiveness in legislation, in particular when it comes to choosing legislative policy, ie the ...legislative model used to tackle a certain issue via legislation. Part II is devoted to revealing the true meaning of the idea of effectiveness, ie as a functional link helping legislative drafters to move among three elements (ideals, situation, results) rather than as an absolute value that drafters should pursue in their work. Part III continues by investigating the problems that such confusion has produced within legislative discourse and practice, in particular by focusing upon two types of effectiveness as external and internal to the legislative process. Finally, Part IV proposes how this idea of effectiveness as a functional element of legislative work (and the consequent distinction between an external and an internal version) can (and should) affect the work of legislative drafters. This idea becomes particularly relevant in relation to the optimal location of the non-legal experts in the legislative process as a means of increasing the effectiveness of legislative policy.
Purpose To provide national, population-based estimates of the prevalence of overweight and obesity in the Italian population. Methods Prevalence estimates of overweight and obesity were calculated ...in seven waves (2001–2008) of the cross-sectional Multipurpose Household Survey organized by the Italian National Institute of Statistics, which are representative of the general adult Italian population. Sampling weights were used to estimate prevalence figures as well as their standard errors. Mean-difference plot was used to evaluate changes in the distribution of body mass index across sex and age categories. Results Almost half of Italian men and about 1 of 3 Italian women are overweight or obese. Between 2001 and 2008 the age-standardized prevalence of overweight (obesity) increased 1.4% (1.9%) in men and 0.4% (0.5%) in women. Mean-difference plots showed an upward shift for body mass index distribution with an increasing skewness. Conclusions The obesity epidemic is one of the major issues in United States and other developed countries. However, if for “epidemic” we mean that in Italy obesity is steadily increasing, then our data give little support to this interpretation. In fact, trends observed between 1983 and 2008 suggest that the rates of changes in the prevalence of overweight and/or obesity are not increasing.
With body composition it is possible to divide human body in compartments on the basis of different physical properties. The two level body composition model subdividing the whole body in fat mass ...and fat free mass is the most used in epidemiological and clinical studies in the elderly. Body composition techniques may be used to study ageing process. Changes in body composition occur as part of the normal ageing process and are associated with important effects on health and function. It has been shown that body composition changes with aging, with an increase in fat mass and a decrease in muscle mass, have important consequences on health and physical disability. Moreover body fat distribution changes with adverse metabolic profiles and increased cardiovascular risk. The purpose of this review is to describe the basic principles and techniques for fat free mass and fat mass evaluation, highlighting the advantages and limitations of different available body composition methods.
Metastatic spinal cord compression (MSCC) is a condition that impacts directly on the patient's prognosis.
Objective
The study purpose was to identify predictors of overall survival in non‐small‐cell ...lung cancer (NSCLC) patients with MSCC.
Methods
A cohort study involving NSCLC patients enrolled between 2008 and 2017 was performed. Sixty‐four patients treated with short‐course radiotherapy were included. Clinical and socio‐demographic data were extracted from medical records. Data were analysed using survival analysis and Cox proportional hazard regression analysis.
Results
The median survival time was 2.5 months (95% CI: 1.6–3.5). Patients >60 years had shorter survival than younger patients (HR 1.85; 95% CI 1.06–3.24; p = 0.02), and patients with performance status (PS) >2 had shorter survival than those with PS≤2 (HR 1.93; 95% CI 1.12–3.33; p = 0.01).
Conclusion
This study found worse PS and higher age are independent predictors of overall survival in NSCLC patients with MSCC treated with short‐course radiotherapy after adjusting the potential confounding factors (PS, age and target therapy).
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