Abstract
Sarcopenic obesity (SO) is referred to as the combination of obesity with low skeletal muscle mass and function. However, its definition and diagnosis is debated. SO represents a sizable risk factor for the development of disability, possibly with a worse prognosis in women. The present narrative review summarizes the current evidence on pharmacological, nutrition and exercise strategies on the prevention and/or treatment of SO in middle-aged and older-aged women. A literature search was carried out in Medline and Google Scholar between 29th January and 14th March 2019. Only controlled intervention studies on mid-age and older women whose focus was on the prevention and/or treatment of sarcopenia associated with obesity were included. Resistance training (RT) appears effective in the prevention of all components of SO in women, resulting in significant improvements in muscular mass, strength, and functional capacity plus loss of fat mass, especially when coupled with hypocaloric diets containing at least 0.8 g/kg body weight protein. Correction of vitamin D deficit has a favorable effect on muscle mass. Treatment of SO already established is yet unsatisfactory, although intense and prolonged RT, diets with higher (1.2 g/kg body weight) protein content, and soy isoflavones all look promising. However, further confirmatory research and trials combining different approaches are required.
Highlights
In Europe, the prevalence of obesity in older adults has already reached epidemic proportions.In 2013, 19.9% of European women ≥ 50 years were affected by obesity, with a peak prevalence (21.6%)between 70 and 79 years [1]
American descent lose less than 1% total fat-free mass—measured by dual-energy x-ray absorptiometry (DEXA)—during menopause but this figure decreases to −12 and −9% respectively between the age group of 40–49 and >75 years [9]
Unlike non-obese subjects in whom a higher percent change in Appendicular skeletal muscle mass (ASMM) was observed in males compared to females, no sex-related effect was observed in the group with pre-sarcopenic obesity [43]
Summary
In Europe, the prevalence of obesity in older adults has already reached epidemic proportions. Primary metabolic abnormalities have been described such as systemic and muscle oxidative stress, inflammation and insulin resistance, and adipose tissue derangement due to increased lipid storage These alterations—which are interrelated—promote catabolic processes as well as a state of “anabolic resistance” to nutrients in the skeletal muscle [11]. Decreased resting metabolic rate as a consequence of loss of metabolically active fat-free mass, reduced physical activity and increased sedentary time all contribute to the development of obesity in women from midto old-age. Women with obesity have been found to have a larger lower limb muscle size and increased pennation angle [15,16] They have greater absolute maximum muscle strength compared to non-obese persons of same age [16]. Further research is needed in order to understand the effects of obesity on skeletal muscle ageing
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