Abstract:
Introduction: Sarcopenic obesity despite being first mentioned in literature decades ago to date lacks globally recognized definition. This is partially due to lack of consensus on the cut-off points for sacrcopenia and obesity and hence standard diagnostsic critarae for sarcopenic obesity is yet to be established. It is not uniquely a geriatric condition is a rising clinical entity due to increased co-morbidities,lifestyle choices and increasing use of injectable weight loss pharmacotherapies. It can increase risk of insulin resistance, Type 2 Diabetes, atherosclerotic heart disease,fraility, osteopenia and cognitive dysfunction in relatively younger individuals as well.
Discussion: Sarcopenic obesity is defined as co-existence of sarcopenia-low relative muscle mass and obesity in the same individual characterized by co-presence of body fat accumulation and muscle loss. It can be part of aging -called primary SO or can occur in context of dysfunctional or pathological co-existing comorbidities like cancer, chronic liver disease, heart failure, malnutrition, prolonged hospitalisations, immobilization or obesity etc called secondary SO. Pathophysiology includes pro-inflammatory cytokines released by adipose tissue, insulin resistance,increasing circulatory fatty acids and lower growth hormones, circulatory free testosterone and lower estradiol and higher FSH. It is not just the quantity of skeletal muscle mass being decreased but also the quality can be adversely affected by ectopic fat deposition in muscle.
Healthcare providers should screen everyone with high BMI or waist circumference for surrogate parameters of sarcopenia. These include skeletal muscle function and body composition for skeletal muscle mass. This is specially relevant in our patients who are at high risk-prolonged hospitalisations, hormonal treatment for prostate or breast cancer, liver cirrhosis, heart failure,chronic kidney disease and certain endocrine disorder
By screening and diagnosing individuals actively it will enable healthcare professionals to mitigate the poor prognosis associated with SO by offering more aggressive preventive measures, treatment and followups.
Though multiple prevention and treatment modalities have been mentioned in literature including Vit D/Ca supplementation, bariatric surgery to loose weight, creatine, omega 3 fatty acids and betahydroxymethylbutyarate-metabolite of leucine, selective androgen receptor modulators (SARM), whole body vibration therapy, potential use of mesenchymal stem cells in future and different biological agents however they are not recommended currently due to lack of evidence. The best therapeutic approach for SO with largest evidence is lifestyle including calorie restriction with aim to reduce obesity with high protein intake-leucine coupled with individualized exercise prescription for combining cardio with resistance training.
Conclusion: Further research in this field will help prevent complications -metabolic and biomechanical associated with sarcopenic obesity which represents an emerging challenge in clinical practice specially in era of injectable pharmacotherapy.
As primary care physicians it is imperative that we actively play role in identifying, screening and diagnosing these individuals so they can be supported by an MDT approach including physician, nursing staff, dietician and physiotherapist/sports physiologist to prevent increase mortality and morbidity. Further research is needed to establish larger panel of tests for muscle function assessment,investigative modalities which are cost-effective and easily assessable and evidence-based treatments which can address sarcopenic obesity. However good diet, probiotics, physical activity, polypharmacy, and its discontinuation (deprescribing) all of which are sarcopenia countermeasures that can be implemented relatively easily in clinical practice in real-world settings.
