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News Network. Price Transparency. Medical Professionals. Clinical Trials. Mayo Clinic Alumni Association. Refer a Patient. Executive Health Program. Waist circumference WC is used to evaluate body fat distribution and abdominal obesity [ 9 ].
Previous results have suggested that individuals who are overweight and obese have an increased risk of developing vitamin D deficiency, which is associated with decreased muscle performance [ 10 ].
In addition, low vitamin D correlates with impaired muscle function in postmenopausal women, and its combination with overweight further enhances muscle loss [ 10 ].
Sarcopenia is caused by skeletal muscle loss with aging [ 11 ]. Sarcopenia causes a decrease in skeletal muscle mass and a decrease in muscle strength or decreased physical function, resulting in disability and even mortality [ 12 , 13 ].
A recent study found that the prevalence of sarcopenia in South Korea is approximately It is characterized by a loss of muscle strength associated with a decrease in muscle mass or quality, as assessed by lumbar muscle cross-sectional area via dual energy X-ray absorptiometry, computed tomography, or magnetic resonance imaging [ 15 ].
Bioelectrical impedance analysis, an inexpensive and readily available tool, can also be used to estimate total muscle mass. Additionally, in the context of ultrasound-based methodologies, shear wave elastic methods have recently been introduced that allow detection of abnormal muscle stiffness for the diagnosis of sarcopenia [ 16 ].
Previous studies have been conducted on an association between obesity and sarcopenia in the elderly. Although obesity is associated with premature death in adults, there is some report about the beneficial effect of obesity on lifespan in the elderly [ 17 ].
In our previous cross-sectional study of elderly Koreans, we found a protective effect of high BMI on sarcopenia in the elderly [ 18 ]; in particular, central obesity with high WC showed a low prevalence of sarcopenia.
Adipose tissue, the primary site for storing and metabolizing sex hormones, is the main source of estrogen, and abdominal fat in women stores high levels of sex hormones and positively affects skeletal muscle mass [ 18 ]. However, these studies were cross-sectional, and there was a limitation in analyzing the causal effect of obesity on sarcopenia over time.
In this 2-year longitudinal study, we evaluated the effect of obesity on the incidence of sarcopenia in elderly individuals without sarcopenia. This study also aimed to investigate the sex differences in the impact of obesity on sarcopenia, defined by the Asian Working Group for Sarcopenia AWGS guideline, in non-sarcopenic community-dwelling Korean older adults using data from the Korean Frailty and Aging Cohort Study KFACS.
We used data from the KFACS gathered from to to investigate the 2-year longitudinal association between obesity and sarcopenia. A multicenter study was performed in eight medical and two public health centers.
Body composition was assessed using bioelectrical impedance analysis BIA in two health centers and dual-energy X-ray absorptiometry DXA in eight hospital centers. Among them, participants completed the dual-energy X-ray absorptiometry DEXA.
Subjects who met any of the criteria of low appendicular skeletal muscle mass ASM , low muscle strength, or low physical performance according to the AWGS diagnostic criteria were also excluded Fig.
Flow chart of the participant recruitment process. KFACS, Korean Frailty and Aging Cohort Study; MMSE-KC, Mini-Mental Status Examination in the Korean version of the CERAD assessment packet.
Demographic information and medical history were included in the analysis, such as age, sex, whether the family lives together, number of medications, income per month, location of residence rural or urban , body measurements, chronic comorbidities, smoking, and alcohol status.
Participants who drank alcohol at least once a week and smoked more than one cigarette per week were defined as drinkers and smokers. We mesaured the changes in reduction of sarcopenia parameters according to obesity including appendicular skeletal muscle mass index ASMI , handgrip-strength HGS , and short physical performance battery SPPB.
The study data protocol was approved by the Institutional Review Board IRB of the Clinical Research Ethics Committee of Kyung Hee University Medical Center IRB number: , and all participants provided written informed consent.
Obesity was classified according to body mass index BMI , WC, and percentage of body fat PBF. Body mass index BMI was calculated as body weight kg divided by height squared m 2. WC was measured horizontally halfway between the superior iliac crest and the lower margin of the 12th rib.
Sarcopenia was evaluated according to the AWGS diagnostic criteria [ 22 ]. Subjects with low appendicular skeletal muscle mass ASM and either low physical performance or muscle strength were defined as having sarcopenia.
Of the eight study centers, four centers used Lunar GE Healthcare, Madison, WI , and four used Hologic Hologic Inc. Low muscle strength: Hand grip strength HGS was measured using a hand dynamometer K.
Handgrip strength kg of each hand was measured twice, with the arms extended in a standing position. Each test was assigned a score of 0 to 4 based on the normative scores obtained from the Established Population for Epidemiologic Studies of the Elderly, with a total score of 0 to The 5CST is the time taken to stand up and sit down five times from a straight-backed armchair as quickly as possible without using arms folded across the chest [ 15 ].
All statistical analyses were performed using the Statistical Package for Social Sciences version The baseline characteristics of the participants are presented in Table 1.
Finally, this study included non-sarcopenic participants men and women. Among the participants, The prevalence of obesity, defined by BMI and PBF, was not significantly different between the sexes. However, the prevalence of central obesity was significantly higher in women than in men men: women: MMSE-KC, chronic comorbidities, and other socioeconomic characteristics, including family lives together, income per month, years of education, location of residence, and smoking habits, were significantly different between the sexes Table 1.
Table 2 shows the 2-year longitudinal effect of obesity on the changes in sarcopenia parameters according to sex.
All sarcopenia parameters deteriorated after 2 years of follow-up. Obesity defined by BMI did not affect changes Δ in HGS, ASMI, and SPPB in either sex. In contrast, central obesity by WC and general obesity by PBF were associated with a lower decrease in ASMI than non-obesity in both sexes.
Additionally, relative percentage change of ASMI, HGS, and SPPB were evaluated. Obesity defined by BMI, WC and PBF affected relative changes Δ in ASMI in either sex execpt women in BMI Fig.
Changes in reduction of sarcopenia parameters according to obesity. Black rectangles and grey rectangles indicate obesity and non-obese, respectively. Relative percentage change of appendicular skeletal muscle mass index ASM , handgrip-strength HGS , and short physical performance battery SPPB.
Both the unadjusted and fully adjusted models showed a lower incidence of low ASMI in the high BMI group in both sexes during the 2-years follow-up period. Table 4 shows the 2-year longitudinal effect of central obesity defined by WC on the sarcopenia parameters according to sex criteria.
Table 5 shows the logistic regression analysis results that predicted sarcopenia and its parameters based on high PBF by sex.
This study investigated the association between BMI, WC, and PBF, which are several criteria for obesity and sarcopenia, according to sex over 2 years. In the model adjusted for confounding variables, obesity defined by a high BMI was associated with a protective effect on low ASMI.
We also found that central obesity based on WC and high PBF was only associated with a lower incidence of sarcopenia in women. A limitation of this previous study is that it was difficult to clarify the causal relationship between obesity and sarcopenia. However, in this longitudinal study, by observing time-dependent changes in sarcopenic parameters over 2 years, it was possible to investigate the relationship between various obesity variables and sarcopenia incidence according to sex.
With aging, a decrease in muscle mass, physical function, and muscle strength could be observed, and it was found that a high BMI had a protective effect on the reduction of ASMI in both sexes.
In addition, high BMI, WC, and PBF were found to be independent protective factors for the incidence of sarcopenia only in women. Generally, with aging, fat content increases, and muscle mass decreases by 0. Changes in body composition are thought to be due to a decrease in skeletal muscle mass and an increase in body fat percentage due to physiological changes in energy metabolism hormones during aging [ 8 ].
However, the proportion of muscle mass also tends to be high in patients with high BMI, and even in patients with metabolic syndrome, there is a positive relationship between high BMI and muscle mass [ 25 ]. Previous studies also reported that skeletal mass decreased with aging in both sexes, but the skeletal mass index positively correlated with increasing BMI [ 26 ].
Research is ongoing on how obesity may affect the progression of sarcopenia in old age and sex. A vicious cycle that induces inflammation in a large amount of adipose tissue and skeletal muscle can lead to the onset and exacerbation of sarcopenia.
In particular, the combination of reduced lean body mass and increased visceral fat with aging may accelerate skeletal muscle weakness in elderly individuals.
A combination of reduced lean body mass and increased visceral fat is also associated with decreased physical function, increased risk of disability, worsening hospitalization, increased morbidity, and premature mortality [ 27 ]. An increase in visceral fat can lead to systemic inflammation and insulin resistance, which can in turn lead to low muscle mass and sarcopenia in the elderly [ 28 ].
In addition, decreased movement due to loss of skeletal muscle function accelerates muscle fat infiltration, which is closely related to physical inactivity [ 29 ].
However, some studies have suggested the potential paradox that obesity might protect skeletal muscle mass in old age [ 30 ]. High BMI was significantly associated with stronger antigravity muscles and increased lower extremity skeletal muscle size as measured by CT; chronic overload causes hypertrophy in the lower extremity muscles to help maintain upright and balanced postures [ 31 , 32 ].
A study of the risk factors for sarcopenia in adults living in nursing homes found that low BMI was a predictor of sarcopenia [ 33 ].
Our study excluded elderly individuals who could not complete the physical examination due to movement limitations such as hemiplegia, cognitive impairment, blindness, and inability to complete physical tests. Subjects who met any of the criteria of normal ASM, muscle strength, or physical performance according to the AWGS diagnostic criteria were included, as shown in Fig.
Among our elderly study subjects, the obese group may have less muscle mass loss than the group with relatively less mobility due to the greater load required for muscle movement in the former group. Our study also showed that muscle loss was low in normal elderly with high BMI without sarcopenia after a relatively two-year follow-up time.
In particular, there was less odds ratio to be afflicted with sarcopenia in women. In addition, BMI alone may not fully capture changes in fat and lean mass in the elderly, suggesting the need to comprehensively consider WC and PBF together.
BMI is primarily used as a simple indicator of obesity and is calculated by dividing body weight by the square of height [ 36 ]. However, several studies have criticized the use of BMI indicators to provide an incomplete understanding of actual body composition, particularly body fat distribution [ 37 ].
Specifically, BMI does not consider the loss of muscle mass and increased fat with age. In addition, conventional BMI cutoff values or arbitrarily assigned body fat percentage criteria to define overweight and obesity may misclassify the elderly and underestimate the prevalence of excess body fat [ 38 ].
Therefore, it has also been argued that the BMI used to define obesity does not appear to be an appropriate indicator of obesity in the elderly [ 39 , 40 ]. This remains controversial because it was evaluated only as a parameter.
WC, an obesity parameter, estimates central obesity and is a better predictor of cardiac metabolic morbidity and premature mortality than BMI, especially in people and women with a low BMI [ 41 , 42 ].
In our study, WC was the most predictive indicator of obesity for physical and functional limitations in women, which is consistent with the results of previous studies. Our results showed that loss of visceral fat and lean mass might be more important than BMI in determining obesity-related health risks in the elderly.
The mechanism by which obesity in older adults appears to protect muscle mass is unclear, and it is difficult to determine the exact cause and effect due to the complex interplay between obesity and sarcopenia.
Several hypotheses could explain this finding. First, skeletal muscle stimulation was increased as a higher level of muscle mass was observed in the obese group. Over time, there is less loss of muscle mass owing to the greater load required for exercise [ 27 ].
Second, because BMI is determined by height and weight, it cannot distinguish lean mass from body fat. Therefore, even non-sarcopenic elderly individuals with more muscle without fatty degeneration have a high BMI, so they have the disadvantage of being classified into the obesity group.
Therefore, it is possible that a high BMI in the elderly could not distinguish obesity from high muscle mass during body composition changes. In addition, a result showed a relatively poor correlation between PBF and BMI, and BMI correlated better with lean body mass than with fat mass, supporting this hypothesis.
A notable result from this study is that both WC and PBF, closely related to the amount of visceral fat in women, play a protective role in sarcopenia. Increased leptin production by adipocytes contributes to ectopic fat deposition in the muscle, which reduces muscle quality and strength [ 43 , 44 , 45 ].
Adipose fat tissue from obese individuals has high levels of tumor necrosis factor-alpha TNF-α , which promotes the production and secretion of several pro-inflammatory cytokines. These pro-inflammatory cytokines promote catabolic pathways that promote muscle wasting and ultimately impair muscle function restoration.
In contrast to these metabolic pathways, Chen et al. reported that central obesity is associated with a lower risk of muscle mass loss in menopausal women, which is consistent with our findings [ 46 ].
Because abdominal fat stores high concentrations of sex hormones and positively affects skeletal muscle mass [ 43 , 47 ]. Adipose tissue, the main site for storing and metabolizing sex hormones, is the main source of estrogen.
Healthy adipocytes secrete adiponectin, an anti-inflammatory and insulin sensitizer that is positively associated with muscle cells [ 48 ]. This could explain the protective effect of sarcopenia in women compared to that in men, as found in studies of the interaction between adipocytes and muscle cells.
These findings are consistent with those of this longitudinal study as well as the cross-sectional study we previously reported. This study had several limitations.
Second, in the survey conducted 2 years later, the follow-up loss was persons in this study, which was confirmed to be However, this was similar to or even lower than in previous cohort studies.
Third, this study might not apply to other populations because it was conducted in a single race, the Korean population. As body composition differs, studies on different populations are warranted.
This was the first longitudinal cohort study to investigate the association between obesity and the component parameters of sarcopenia in non-sarcopenic elderly individuals. Our study identified that Korean elderly with obesity had a protective impact on the reduction of muscle mass in men and women.
Obesity in older women may have a protective effect on reducing ASMI and the incidence of sarcopenia. Supporting data and data analysis materials are available from the corresponding author Prof.
Yunsoo Soh upon request. Chapman IM. Obesity in old age. Obes Metab. Article Google Scholar. Nam GE, Kim Y-H, Han K, Jung J-H, Rhee E-J, Lee S-S, et al.
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Food Assistance and Food Overcoming depression naturally Resources. Adult BMI Wsist. A Waist circumference and body fat cjrcumference of body fat can cat to weight-related diseases and other health issues. Being underweight is also a health risk. Body Mass Index BMI and waist circumference are screening tools to estimate weight status in relation to potential disease risk.Video
Obesity \u0026 Your Waist Circumference - Obesity Obese Fircumference are four times more likely to have diabetes, Waist circumference and body fat crcumference three times as likely to have high blood pressure and more Enhance insulin sensitivity for PCOS treatment two times more boody to have heart disease Hygiene essentials those with a healthy weight. However, simply knowing your weight is not enough to know your health risk. Did you know that you can have a healthy weight, but still be at increased risk? How our bodies store excess weight specifically fat can negatively impact our health. Today, there are two methods of self-assessment that can give you a clearer picture of how your weight may be affecting your health — measuring your waistline and calculating your Body Mass Index BMI.
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