Dynapenia, Sarcopenia and Obesity: Clinical Impacts and Treatments

2013-10-07

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Dynapenia, Sarcopeniaand Obesity : Clinical

Impacts and Treatments

Isabelle J. Dionne, PhDFaculté d’éducation physique et sportive

Université de Sherbrooke

Striking a Balance... Weigh in with Knowledge, Research, Practice SYMPOSIUM

Ottawa Chapter - Diabetes Educator Sector, Canadian Diabetes Association

Monday, September 30, 2013

OUTLINEOUTLINEOUTLINEOUTLINE

� Body composition and aging

� Sarcopenia and Dynapenia

� Sarcopenic and dynapenic obesity

� Clinical outcomes

- Dynapenic obesity and physical capacity

- Dynapenic obesity and metabolic consequences

� Treatment

- Weight loss

- Exercise

- Protein intake

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Body composition and Aging

SarcopeniaDynapenia

Sarcopenic and Dynapenic Obesity




Body composition and aging

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Gallagher et al., Am J Physiol Endocrinol Metab 2000.

Body composition changes in Body composition changes in Body composition changes in Body composition changes in agingagingagingaging

Sarcopenia

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Baumgartner et al. Mech Ageing Dev, 1999

Sarcos Flesh

Penia Poverty

DefiningDefiningDefiningDefining sarcopeniasarcopeniasarcopeniasarcopenia

Janssen et al, 2004

Prevalence of sarcopenia

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Narichi and Maffulli, Br Med Bull, 2010

Janssen I. Journal of the American Geriatrics Society , 2006.

Figure 1. Cross-sectional analysis: Odds ratios for disability according to baseline categories of muscle mass. Longitudinal analysis: Hazard ratios for disability according to baseline categories of muscle mass.

Severe sarcopenia is related with increased risks for disability, especially when examined cross-sectionally.

DisabilityDisabilityDisabilityDisability and muscle massand muscle massand muscle massand muscle mass

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Men Women Men Women

Quadricep strength Bicep strength

Maximal voluntary strength

14% 11% 28%40%

Beliaeff et al, JAPA 2008, 16(4), 484-493.

AgePhysical activityHeightBody fat

Muscle mass

HoWHoWHoWHoWmuchmuchmuchmuch of muscle of muscle of muscle of muscle strenthstrenthstrenthstrenth isisisis explainedexplainedexplainedexplained

by mass??by mass??by mass??by mass??

Dynapenia

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Vandervoot et Symons, 2001

StrengthStrengthStrengthStrength and and and and agingagingagingaging

Clark et Manini, 2008

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Sarcopenia and Dynapenic Obesity

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CDC/NCHS, Health,

United States, 2008,

Figure 7. Data from the

National Health and

Nutrition Examination

Survey.

Bouchard DR et al., J Gerontol 2007

Body fat (%)

ASMI (kg/m2)

Age (yrs)

Physical activity

Chronic cond. (n)

Physical capacity

Walking speed

Balance

r=-0.61; p<.001

Hypothetical model for physical capacity in a

cohort of 437 older men.

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How body composition changes impact on

metabolic and functionalhealth

Metabolic OutcomesPhysical Capacity




Metabolic outcomes

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« Sarcopenia and obesity alone were not sufficient to increase CVD risk. Sarcopenic-obesity, based on muscle strength but not muscle mass, was modestly associated with increased CVD risk. These findings imply that strength may be more important than muscle mass for CVD protection in old age. »

Stephen and Janssen, JNHA 2009

Hasard

ratio;

P=0.06

Muscle mass Strength

SarcopeniaSarcopeniaSarcopeniaSarcopenia and CVDand CVDand CVDand CVD

Karelis et al., Appl Physiol Nutr Metab, 2007

InsulinInsulinInsulinInsulin sensitivitysensitivitysensitivitysensitivity and muscle and muscle and muscle and muscle strengthstrengthstrengthstrength

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Sayer et al., Diabetes care, 2005

Muscle Muscle Muscle Muscle StrengthStrengthStrengthStrength and type 2 and type 2 and type 2 and type 2 diabetesdiabetesdiabetesdiabetes

statusstatusstatusstatus

Jurca R., Med Sci Sports Exerc, 2005

Incident rate of Incident rate of Incident rate of Incident rate of metabolicmetabolicmetabolicmetabolic diseasesdiseasesdiseasesdiseases////yearyearyearyear

per per per per quatilesquatilesquatilesquatiles of of of of muclemuclemuclemucle strengthstrengthstrengthstrength

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Adapted from Sénéchal et al., 2012

Energy intake, lifestylebehaviors, and age were all similar between groups.

MetabolicMetabolicMetabolicMetabolic outcomesoutcomesoutcomesoutcomes basedbasedbasedbased on on on on dynapeniadynapeniadynapeniadynapenia

and and and and obesityobesityobesityobesity statusesstatusesstatusesstatuses

Impact on physical capacity

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Bouchard DR. et al, Obesity, 2009

PhysicalPhysicalPhysicalPhysical capacitycapacitycapacitycapacity, , , , sarcopeniasarcopeniasarcopeniasarcopenia and and and and

obesityobesityobesityobesity

Probability rate of a new mobility

disability (95% confidence intervals)

according to the combination of low

muscle strength and obesity among

persons aged 65–85 years.

Probabilities are adjusted to represent

a 74-year-old female.

Stenholm S., et al. Int J Obes, 2009.

PhysicalPhysicalPhysicalPhysical capacitycapacitycapacitycapacity, , , , strengthstrengthstrengthstrength and and and and ObesityObesityObesityObesity

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Physi

cal

capac

ity

impai

rmee

nts

in t

he

low

est

tert

ile

of

mobil

ity

Choquette et al, JNHA, 2010

PhysicalPhysicalPhysicalPhysical capacitycapacitycapacitycapacity and relative and relative and relative and relative strengthstrengthstrengthstrength

Cesari M. et al, J Gerontol, 2009

SurvivalSurvivalSurvivalSurvival rate rate rate rate basedbasedbasedbased on on on on sarcopeniasarcopeniasarcopeniasarcopenia or or or or

slow slow slow slow walkingwalkingwalkingwalking and and and and obesityobesityobesityobesity

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Bouchard and Janssen, J Gerontol., 2010

PhysicalPhysicalPhysicalPhysical functionfunctionfunctionfunction accordingaccordingaccordingaccording to to to to ObesityObesityObesityObesity

and and and and DynapeniaDynapeniaDynapeniaDynapenia statusstatusstatusstatus

TreatmentWeight Loss

ExerciseProtein intake




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Weight Loss

« The focus of treatment should be on reduction of intra-abdominal fatand preservation of muscle mass and strength. »

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Position Statement of the American Society for Nutrition and NAASO, The Obesity Society

“…weight-loss therapy that minimizes muscle and bone losses is recommended for older persons who are obese and who have functional impairments or medical complications that can benefit from weight loss. “

Villareal et al, American Journal of Clinical Nutrition,

Vol. 82, No. 5, 923-934, 2005

Should weight loss be a goal??

� It is not clear whether weight loss benefits longevity and hence whether weight reduction is justified as a prime goalfor all older individuals who are overweight (BMI > 25 kg/m2).

� Other aspects of a healthy lifestyle, especially exercise and dietary quality, should be considered.

� Further trial evidence is needed with regards to the effect of weight loss with and without exercise on CVD risk, quality of life and physical function, especially in the “older” older adults.

Harrington, M. et al. (2009) Nutrition research reviewsWitham and Avenell (2010) Age and Ageing

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Exercise

Increases strength

Decreases fat mass

Improves physical function

Physical

independence

Toth et al, MSSE, 1999;

Raguso et al, Clin Nutr, 2006;

Bouchard et al, Menopause, 2009;

Paterson and Warburton, Int J Behav Nutr Phys Act, 2010.

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Hunter et al., 2004

AgingAgingAgingAging

vs vs vs vs

trainingtrainingtrainingtraining

◦ During the first weeks off training, improvements are mostly neurological

◦ Gains in strength are improvedwithout gains in muscle mass

McDonagh et al, 1983

ResistanceResistanceResistanceResistance traningtraningtraningtraning

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Villareal et al, AJCN, 2006

Adapted from Villareal, DT et al., Ach Int Med, 2006

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Diet and exercise to improve Diet and exercise to improve Diet and exercise to improve Diet and exercise to improve

physical function in older physical function in older physical function in older physical function in older

adultsadultsadultsadults

* *

*

*

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Protein intake

• Protein intake goes down with aging;

• Actual Recommended Daily Intake (0,8 g/kg/d) have been suggested to be insufficient (Wolfe et al, 2008);

• An intake of 1,25 g/kg/d has been suggested as safe and optimal for muscle mass maintenance (Wolfe et al, 2008).

• Our results show that protein intake from healthy animal sources is the best nutritional determinant of fat-free mass in older adults (Lord et al., 2007).

ProteinProteinProteinProtein intakeintakeintakeintake and and and and AAAAgingginggingging

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• Leucine appears to be the main mediator in the balance between proteindegradation and synthesis(Katsanos et al, 2006);

• This may explain the association betweenanimal protein intake and muscle mass.

Essential Essential Essential Essential AminoAminoAminoAmino

AcidsAcidsAcidsAcids

Animal Animal Animal Animal proteinsproteinsproteinsproteins, muscle , muscle , muscle , muscle functionfunctionfunctionfunction, , , ,

and glucose and glucose and glucose and glucose metabolisMmetabolisMmetabolisMmetabolisM

Maltais et al., IJNSM, 2011

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Fiatarone, M.A. et al, 1994

+15g/d of proteins

ExerciseExerciseExerciseExercise X X X X proteinsproteinsproteinsproteins

Tieland et al, J Am Diet Ass, 2012

Prot. Suppl. 15g 2X day

ExerciseExerciseExerciseExercise X X X X proteinsproteinsproteinsproteins

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Kukuljan et al., JAP, 2009

Resistanceexercise and fortified milk on muscle size

Timing?

Conclusion




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…CONCLUSIONS

Losses in muscle strength have asignificant impact on metabolicoutcomes and physical capacity.

The presence of obesity exacerbatesthese problems.

…CONCLUSIONS

Interventions aiming to counteract dynapenic obesityshould focus on resistance and aerobic training.

Weight loss may be considered if it includes an exercise component.

Adequate protein intake is alsoimportant.

Few questions remaining: Animal? Milk? Timimg?

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Thank

you!

Dynapenia, Sarcopenia and Obesity: Clinical Impacts and Treatments

Health & Medicine

Transcript of Dynapenia, Sarcopenia and Obesity: Clinical Impacts and Treatments