Maturitas 74 (2013) 109 113

Contents lists available at SciVerse ScienceDirect

Maturitas

j ourna l h o me page: www.elsev ier .com/

Review

Sarcobesity: A metabolic conundrum

Evelyn BExercise & Nut

a r t i c l

Article history:Received 19 OAccepted 22 O

Keywords:DietExerciseMuscle massObesitySarcopeniaWeight-loss inSarcobesity

energy-restricted high-protein diets for healthy weight loss as a primary intervention for sarcobesity. 2012 Elsevier Ireland Ltd. All rights reserved.

Contents

1. Introd2. Sarcob3. Lifesty

3.1. 3.2. 3.3. 3.4.

4. SummContrCompProveRefere

1. Introdu

During tstandards owith chron

Corresponcal Sciences, RTel.: +61 3 992

E-mail add

0378-5122/$ http://dx.doi.ouction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109esity: a double-edged sword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110le interventions to combat sarcobesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110Low energy diets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110Diet macronutrient content . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110Exercise training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111Diet and exercise interactions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111ary and recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112

ibutors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112eting interests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112nance and peer review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112nces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112

ction

he last fty years, advances in health care and higherf living have increased longevity, even in individualsic diseases. However, data on longevity does not tell

ding author at: Exercise & Nutrition Research Group, School of Medi-MIT University, PO Box 71, Bundoora, Victoria 3083, Australia.5 7353; fax: +61 3 9467 8181.ress: john.hawley@rmit.edu.au (J.A. Hawley).

the whole story: the gap between life expectancy and healthy lifeexpectancy is of primary importance for maintaining optimal func-tion in activities of daily living. In developing countries the low lifeexpectancy is related to ill health and disability, while in the major-ity of developed countries the issues affecting life expectancy aregenerally restricted to the greater incidence of life-style diseasesand chronic conditions of old age.

Two independent but inter-related conditions that have a grow-ing impact on healthy life expectancy and health care costs indeveloped nations are an age-related loss of muscle mass (i.e., sar-copenia) and obesity. Sarcopenia affects approximately one-third

see front matter 2012 Elsevier Ireland Ltd. All rights reserved.rg/10.1016/j.maturitas.2012.10.014. Parr, Vernon G. Coffey, John A. Hawley

rition Research Group, School of Medical Sciences, RMIT University, Bundoora, Victoria 3083, Australia

e i n f o

ctober 2012ctober 2012

terventions

a b s t r a c t

Two independent but inter-related conditions that have a growing impact on healthy life expectancyand health care costs in developed nations are an age-related loss of muscle mass (i.e., sarcopenia) andobesity. Sarcopenia is commonly exacerbated in overweight and obese individuals. Progression towardsobesity promotes an increase in fat mass and a concomitant decrease in muscle mass, producing anunfavourable ratio of fat to muscle. The coexistence of diminished muscle mass and increased fat mass(so-called sarcobesity) is ultimately manifested by impaired mobility and/or development of life-style-related diseases. Accordingly, the critical health issue for a large proportion of adults in developed nationsis how to lose fat mass while preserving muscle mass. Lifestyle interventions to prevent or treat sar-cobesity include energy-restricted diets and exercise. The optimal energy decit to reduce body massis controversial. While energy restriction in isolation is an effective short-term strategy for rapid andsubstantial weight loss, it results in a reduction of both fat and muscle mass and therefore ultimatelypredisposes one to an unfavourable body composition. Aerobic exercise promotes benecial changes inwhole-body metabolism and reduces fat mass, while resistance exercise preserves lean (muscle) mass.Current evidence strongly supports the inclusion of resistance and aerobic exercise to complement mildlocate /matur i tas

110 E.B. Parr et al. / Maturitas 74 (2013) 109 113

Mobility/f railtyGlucose regulaon

Fig. 1. Lifestylnia and obesicapacity.

of adults ovyears [1], wwith the agcal activity.(WHO) hasobese (bodrisk factor fand cardiovin overweigsity promotin muscle mcle.

The coexmass is refesarcobesityand/or devecritical heanations is hSeveral recephysiology as the effereview we as counter-nutrient-ricmens.

2. Sarcobe

Skeletal mental roleas well as mcle mass is and thereafof sarcopenMuscle maThis loss is the age of 6loss in stren

When cotant to coexacerbatedadulthood (then preserual physicaas age increnergy intaing populatrisk factorsvance is thabut concomexacerbate

amino acid incorporation and reduces protein synthesis in skeletalmuscle [1113].

The double-edged sword dening sarcobesity is that sarcopenianergistically with obesity in older adults to decrease healthand fhus, ssionaalth y prity.

style

w en

lth pindivt. Wtratectionposesf we

lean that-rela

neghteded af

demt masitio

meeriodeplactaboeigntioals ats whathr

optiergy

dieto 40nergy

ener resuompecov

to ennagiurrence f sevrm Obesity Sa rcopeniaStren gth/p ower

Joint dis orde rs

Cardio vascul ar disease

Hyper tension Fu nconal cap acity

Depression

e-related chronic diseases or disease states associated with sarcope-ty, and their synergistic negative effect on health and functional

er 60 years of age and more than 50% of those over 80ith the progression of sarcopenia strongly associatede-related trend towards lower levels of habitual physi-

With regards to obesity, the World Health Organisation projected that by 2015 over 700 million adults will bey mass index [BMI] 30 kg/m2) [2]. Obesity is a majoror chronic diseases including type 2 diabetes mellitusascular disease. Sarcopenia is commonly exacerbatedht and obese individuals and progression towards obe-es an increase in fat mass and a concomitant decreaseass, producing an unfavourable ratio of fat to mus-

istence of diminished muscle mass and increased fatrred to as sarcopenic obesity or what we have termed and is ultimately manifested by impaired mobilitylopment of life-style-related diseases. Accordingly, thelth issue for a large proportion of adults in developedow to lose fat mass while preserving muscle mass.nt reviews in this journal have focused on the patho-and treatment of sarcopenia in the elderly [3] as wellcts of menopause on sarcopenia [4]. In the presentconsider evidence for exercise-nutrient interventionsmeasures for sarcobesity and the health benets ofh, high-protein diets and appropriate exercise regi-

sity: a double-edged sword

muscle mass is critical to metabolic health with funda-s in whole-body glucose disposal and insulin sensitivityobility and functional capacity [5]. Peak skeletal mus-

generally attained within the rst three decades of lifeter begins to decline with the incidence and severityia progressively increasing over the remaining lifespan.ss is lost in the course of healthy ageing from age 30.accelerated to a rate of approximately 1% per year after5 [6,7] and is associated with a corresponding 23 foldgth [7].nsidering strategies to combat sarcopenia it is impor-

nsider that a loss of muscle mass with ageing is

acts systatus [14]. Tprofesthe heneousldisabil

3. Life

3.1. Lo

Heaobese weighterm sa redupredis25% odiets isgestedobesity

Thehighligregainclearly80% facompoelderlyyear pwas rfor mebody wintervefessionpatienis the b

Thewith encalorieby up ttotal eof lowVLCDsmass ctially rreturnfor mations cpreferelence olong-te by failure to maintain peak muscle mass in mid-30-50 years) [8]. One of the barriers to attaining andving a healthy muscle mass is that the levels of habit-l activity in developed nations are low and decreaseeases [9]. Inactivity combined with increased dietaryke increases the prevalence of obesity and in the age-ion this is associated with an escalation in a number of

for numerous co-morbidities (Fig. 1). Of clinical rele-t individuals are not only losing skeletal muscle massitantly gaining fat mass [10]. Greater fat mass may alsosarcopenia because lipid accumulation both prevents

(20004000

3.2. Diet m

The optihighly contcontributiotion and reloss [25]. Ais a compenunctional capacity beyond either condition in isolationarcobesity presents a complex challenge for healthcarels trying to prescribe appropriate treatment to reducerisks associated with excess fat mass, while simulta-eserving muscle mass to reduce the risk of (further)

interventions to combat sarcobesity

ergy diets

rofessionals frequently prescribe low energy diets foriduals as a rst line of defence in the battle to losehile energy restriction in isolation is an effective short-gy for rapid and substantial weight loss, it results in

of both fat and muscle mass and therefore ultimately one to an unfavourable body composition. Specically,ight loss achieved through short-term energy restricted

muscle mass [1519]. Not surprisingly, it has been sug- weight loss per se should not be the sole objective forted disease risk reduction [for review see 20].ative consequences of focusing on body weight are

by the results from several investigations of weightter low energy diet-induced weight loss. It has beenonstrated that weight regained is comprised of up toss which compounds an already unfavourable bodyn [21,22]. Newman et al. also demonstrated that inn and women who were weight-stable across a four, only maintained weight because a loss of lean massed with fat mass [21]. This has negative consequenceslic health but also creates a deceptive paradigm whenht, and not composition, is the sole focus of healthns. Indeed, failure to recognise and educate health pro-bout the importance of body composition penalisesose sole criteria for gauging obesity reduction successoom scale.mal energy decit to reduce body mass is controversial

restricted diets tting broadly into two categories: Lows (LCD) where daily energy intake is typically reduced00 kJ per day or very low calorie diets (VLCD) where the

availability is 10 kg of weight loss shows thatlt in greater losses in the percentage of fat-free (lean)ared to LCDs [23]. Muscle lost with VLCDs is only par-ered during a weight regain period when individualsergy balance or excess. Therefore, in terms of a directiveng healthy weight loss in overweight or obese popula-nt evidence suggests LCDs should be recommended into a severe energy restricted VLCDs. Despite the preva-ere energy restriction for weight loss the most benecialoutcomes are achieved with a modest energy decit

kJ d1) [24].

acronutrient content

mal macronutrient content of a low energy diet is alsoentious. Fat intake in a Western diet makes a substantialn (40% energy intake (EI)) to total energy consump-ducing fat intake has been shown to result in weight

natural consequence of reduced fat intake in the dietsatory increase in the contribution of carbohydrate to

E.B. Parr et al. / Maturitas 74 (2013) 109 113 111

Fig. 2. Inapprlead to a cascadchronic metab

EI. Howeveappear to r[26,27]. Theunclear butinsulin conc

The conlation is thmany as 38Recommenhabitual dieOrganizatiocient high mass [30]. Itshould be gulation whomuscle losswomen abolean mass bshown to inhigh carbohto achieve essential ththere is a strent RDA asto combat s

3.3. Exercis

Exercisehuman bodinterventiodiseases [34lation exerclack of adheof inactivity

Aerobic-swimming)weight andon skeletalan increase[35,36]. Ondiovascularfat metaboing behaviohabitual diedietary habbenecial talso elevatein muscle m

The capsarcopenia ies in previ

6-12% increases in quadriceps volume concomitant with 1330%improvements in aerobic capacity after 12 weeks of aerobic training[42,43]. These short-term studies have shown that aerobic train-ing enhances adaptations in mitochondrial structure and function

l as p potbic wth,ary t

masistan48 h)g follncedscle on a5]. O

anad sucse ano theistancle cnce-

to mal leoug

ty of assot effe

incrc tra

fat uentrly, rt whmaryn is

retaiumm

meeservl exenanc

exey, fa

qualcoper exel appe-di

the d

et an

ny stopriate levels of physical activity combined with a low protein diete of events in skeletal muscle that predispose to a greater risk of manyolic diseases, resulting in a substantial loss of functional capacity.

r, diets of higher carbohydrate content (>4045% of EI)educe the extent of weight loss and loss of body fat

mechanism for the attenuation of weight loss remains is likely related to daily variations in blood glucose andentrations [28].sensus on appropriate nutrition for the ageing popu-at high protein diets are most benecial. However, as% of men and 41% of women do not meet the currentded Dietary Allowance (RDA) of 0.8 g kg1 d1 in theirt [29]. The guidelines of the World Gastroenterologyn for obesity recommend an energy decit with suf-quality protein (1.0 g kg1 d1) to maintain lean muscle

has been argued that protein intakes for healthy ageingreater than the RDA which is based on the younger pop-

are likely maintaining muscle rather than preventing. High habitual intakes of protein in elderly men andve RDA values has been shown to reduce the loss ofy up to 40% [31,32]. High protein diets have also beencrease fat loss during energy restriction compared withydrate, low protein equivalents [33]. Therefore, in orderhealthy ageing (i.e., minimal losses in lean mass) it isat the minimum RDA for protein is met. Furthermore,rong case for increasing protein intake above the cur-

an essential component and modiable life-style factorarcobesity.

e training

promotes a multiplicity of benecial effects on they and regular exercise is a cost effective and potentn for the prevention and treatment of many chronic]. However, only a small proportion of the adult popu-ise for the recommended 30 min per day [9] and therence to regular exercise can promote a vicious cycle

and progression of chronic diseases (Fig. 2). or endurance-based exercise (e.g., walking, cycling,

is the most accessible form of training for most over-/or obese individuals. The benets of aerobic training

muscle include improved oxidative metabolism via in both capillary density and mitochondrial content

a whole-body level, aerobic training increases car- function, aerobic capacity, basal metabolic rate and

as welhas theas aerocle gronecessmuscle

Resup to feedinis enhatal muaccretitions [4but theblunteresponpared ton resin musresistaelderlymaxim

Althquantimentsmodesstratedaerobiloss ofconseqSimilaceral fathe priisolatiorole in

In smusclecise proptimamainteof boththis wacientfor sarregulaoptimaexercisliorate

3.4. Di

Ma

lism while concomitantly producing changes in eat-urs that may reduce energy intake in an individualst [37,38]. Such changes in whole body metabolism andits induced by regular aerobic exercise are undoubtedlyo promote weight management. Aerobic exercise can

muscle protein synthesis and elicit modest increasesass [3941].

acity of aerobic exercise to ameliorate the effects ofis not well dened. However, the results of recent stud-ously sedentary older men and women (>70 y) reveal

ical activityrestriction sue [17,52]prescribinginterventioporated diehave genermoting weithose with [53] found romoting gains in muscle mass. Thus, aerobic trainingential to ameliorate the effects of sarcopenia. However,endurance training does not lead to substantial mus-

the addition of other training modes are likely to beo maximise retention and/or promote enhancement ofs with prolonged periods of training.ce-based exercise generates acute and sustained (i.e.

increases in muscle protein synthesis. When proteinows resistance exercise this acute synthetic response

and promotes positive net protein balance in skele-[44]. With chronic resistance training there is proteinnd increases in muscle mass in young healthy popula-lder adults retain the capacity to enhance muscle massbolic response to both exercise and protein feeding ish that the magnitude of the muscle protein syntheticd muscle hypertrophy is generally less profound com-ir younger counterparts [46]. Studies that have focusedce exercise in the elderly have shown improvementsross-sectional area and strength [17,47,48]. Therefore,training remains an essential exercise modality for theaintain or increase muscle mass and strength and retainvels of functional capacity.h resistance training retains or improves the relativelean tissue to total body mass the low energetic require-ciated with this type of exercise typically result in onlycts on fat loss. Willis and colleagues recently demon-eased lean mass with resistance training compared toining; however resistance training failed to promotemass of a similar magnitude to aerobic training andly the resistance-training group gained weight [49].esistance exercise has been ineffective at reducing vis-en compared with aerobic exercise [50]. Consequently,

consideration with resistance exercise prescription inthat effects on fat metabolism are modest but that itsning/increasing muscle mass is invaluable [51].ary, aerobic exercise promotes benecial changes in

tabolism and reduces fat mass while resistance exer-es muscle mass. Accordingly, it seems intuitive that thercise prescription for healthy weight loss and musclee for individuals with sarcobesity is the incorporationrcise modalities in a balanced training programme. Int loss may be effectively achieved while maintaining suf-ity and quantity of muscle mass as a countermeasurenia, extending the healthy lifespan [10]. Importantly,rcise without appropriate dietary intervention is a sub-roach for healthy weight loss and it is imperative that

et interventions are employed to most effectively ame-ebilitating effects of sarcobesity.

d exercise interactions

udies have manipulated combinations of diet and phys- in a weight loss regimen and have shown that caloric(in the absence exercise) results in a loss of lean tis-

(Fig. 3). This becomes an essential consideration when nutritional modications in the absence of any exercisen as a treatment for sarcobesity. Studies that have incor-tary restriction together with an exercise programmeally resulted in better outcomes with regard to pro-ght loss and improving body composition compared todiet or exercise modication alone (Fig. 3). Frimel et al.that combining resistance and aerobic exercise with a

112 E.B. Parr et al. / Maturitas 74 (2013) 109 113

Weig ht LOSS Weig ht GA IN

A.

C.

B.

-12 -8 -4 -2 kg +2

[16]

[15]

[15]

Fig. 3. Data fralone, (B) exermass (dark gre

low caloriefor maintaicant loss inoverweightmenting wcapacity to decit is ex

High promass associcise [54]. Hthat high pduring prolhave demonprotein maycise in a weturnover antraining [45also providincreasing resistance tprotein intacombined wresult in anthat increasfollowing a[57,58]. Indprotein inglating the cfertile area

4. Summa

Current and aerobichealthy wesity. The apduring enecobesity remshould targ

restricted carbohydrate and fat intake. While high protein diets (e.g.1.5 g kg1 d1) have not been shown to enhance lean (muscle) massduring periods of energy restriction, it seems unlikely that elevated

intake would be detrimental to the aim of reducing fat mass.oncl

on teseee thedulthntainrcopeent

in tal aca sho

seek durid m

restion r/daintioces o

buto

of au.

ting

wriealtC.

anc

mis

nces

mgar amon-3.6

-9.5 -3.2

-4.1 -1.6

-7.4 -4.1

-8.3 -3.4

-4.8

-4.7

-4.3

1.1

-2.4

-

-8.2

-2.1

-1.7

-6.1

1.1

[17]

[18]

[19]

[17]

[49]

[49]

[49]

[19]

[19]

[17]

[59]

[18]

om weight loss studies showing the effects of (A) energy restrictioncise alone, and (C) caloric restriction and exercise, on changes in faty bars) and fat-free mass (white bars) [1519,49,59].

diet (an energy decit of 12 000 kJ d1) was successfulning skeletal muscle mass concomitant with signi-

fat mass [53]. Similar ndings have been reported in, post-menopausal women [15]. Therefore, when imple-eight loss strategies, the only intervention with themitigate the loss of lean mass during a period of energyercise.tein diets are benecial for minimising the loss of leanated with energy-restricted diets in the absence of exer-owever, there is no evidence to support the contentionrotein intake can prevent loss of skeletal muscle massonged periods of energy decit. Of note, Frimel et al.strated that diets providing >20% of energy intake from

not be necessary with the inclusion of resistance exer-ight loss intervention [53], possibly due to lower leucined increased nitrogen retention with chronic resistance]. Previous work from Andrews et al. and Iglay et al.

proteinIn c

burdenthe forincludearly ato maipre-saimplemerationphysiccopenishouldtrientsloss anbic andrestricregulaintervesequen

Contri

All equally

Compe

TheDairy Hand VG

Proven

Com

Refere

[1] Bauniae evidence to show a lack of effect on lean mass whenprotein intake above the RDA when combined with araining programme [55,56]. Nonetheless, while totalke above RDA levels during energy restriction whenith chronic training has yet to be demonstrated to

additive effect, emerging evidence supports the notioned protein ingestion in the early post-exercise period

n acute bout of exercise is benecial in older individualseed, the interplay between the quantity and timing ofestion after resistance exercise is a major factor regu-apacity of the protein synthetic machinery and this is afor future research.

ry and recommendations

evidence strongly supports the inclusion of resistance exercise to complement mild energy restriction foright loss as the primary intervention for sarcobe-propriate protein content and daily timings of intakergy restriction for treatment and prevention of sar-

ains to be clearly established, but the initial strategyet a minimum protein intake equal to the RDA with

1998;147[2] World H

two: Theand impsity. 201part2 ch1

[3] Malafarindiagnosis

[4] Messier VLeheudreMaturita

[5] Zierath JRmetaboli

[6] Frontera Aging of ology 200

[7] Goodpastmass, andThe Journ2006;61(

[8] Sayer AAmental o2008;12(

[9] Haskell Wrecommethe Amer2007;39(

[10] Wannamand incremen. Theusion, sarcobesity will continue to place an increasinghe health and welfare systems of developed nations inable future. A focus for prevention of sarcobesity should

goal of attaining the highest functional muscle mass inood along with appropriate diet-exercise interventions

and preserve lean tissue for as long as possible intonic adult life (i.e., 5565 years). Early treatment (the

ation of strategies and/or legislation to promote mod-otal energy intake, combined with increased habitualtivity) of individuals at risk for, or diagnosed with sar-uld be the focus of health professionals. Future research

to determine the optimal balance of dietary macronu-ng energy restriction to promote maximal rates of fatuscle mass retention/growth with a concurrent aero-istance exercise programme. Meanwhile, mild energywith sufcient protein content (>0.8 g kg1 d1) andly exercise remains a low cost, practical and provenn as a counter-measure for the debilitating health con-f sarcobesity.

rs

thors contributed to the preparation of this manuscript

interests

ting of this review was supported by a grant from theh and Nutrition Consortium (DHNC-MM&M06) to JAH

e and peer review

sioned and externally peer reviewed.

tner RN, Koehler KM, Gallagher D, et al. Epidemiology of sarcope-g the elderly in New Mexico. American Journal of Epidemiology(April (8)):75563.ealth Organisation. Chronic diseases and health promotion. Part

urgent need for action; Ch 1 Chronic dieseases: Health causesact; Section 17 Risk factor projections: Overweight and obe-2; available from: http://www.who.int/chp/chronic disease report//en/index16.html [updated 2012; cited 05.10.12].a V, riz-Otano F, Iniesta R, Gil-Guerrero L. Sarcopenia in the elderly:, physiopathology and treatment. Maturitas 2011;71(2):10914., Rabasa-Lhoret R, Barbat-Artigas S, Elisha B, Karelis AD, Aubertin-

M. Menopause and sarcopenia: a potential role for sex hormones.s 2011;68(4):3316., Hawley JA. Skeletal muscle ber type: inuence on contractile and

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quality in older adults: the health, aging and body composition study.als of Gerontology Series A, Biological Sciences and Medical Sciences10):105964., Syddall H, Martin H, Patel H, Baylis D, Cooper C. The develop-rigins of sarcopenia. The Journal of Nutrition, Health and Aging7):42732.L, Lee I, Pate RR, et al. Physical activity and public health: updated

ndation for adults from the American College of Sports Medicine andican Heart Association. Medicine and Science in Sports and Exercise8):142334.ethee SG, Shaper AG, Lennon L, Whincup PH. Decreased muscle massased central adiposity are independently related to mortality in older

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[17] Ballor DL,restrictioClinical N

[18] Campbellfree massin older w

[19] Foster-Scalone or cpostmeno

[20] Ross R, related ca2008;24(

[21] Newmanlean massJournal o

[22] Beavers lost leanregain in2011;94(

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Sarcobesity: A metabolic conundrum1 Introduction2 Sarcobesity: a double-edged sword3 Lifestyle interventions to combat sarcobesity3.1 Low energy diets3.2 Diet macronutrient content3.3 Exercise training3.4 Diet and exercise interactions

4 Summary and recommendationsContributorsCompeting interestsProvenance and peer reviewReferences