Sarcopenic obesity in nursing home residents: a multi-center study on diagnostic methods and their association with instrumental activities of daily living

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Abstract

Background

Sarcopenic obesity (SO) in nursing home residents is rarely studied. We aimed to evaluate and compare the prevalence and consistency of different SO diagnostic methods and to investigate which criterion demonstrated a stronger association with instrumental activities of daily living (IADL) disability.

Methods

We consecutively recruited older adults aged ≥ 60 years, residing in 15 nursing homes in Zigong City, China. Sarcopenia obesity was defined according to the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity criteria (SO _ESPEN), recommending skeletal muscle mass (SMM) adjusted by body weight (SMM/W) to identify low muscle mass. Further, we adapted ESPEN criteria (SO _ESPEN−M) by employing SMM adjusted by body mass index (SMM/BMI).

Results

We included 832 participants (median age 73.0 years, 296 women). The prevalence of SO _ESPEN and SO _ESPEN−M was 43.5% and 45.3%, respectively. SO _ESPEN showed good consistency with SO _ESPEN−M (Cohen’s kappa = 0.759). More than one-third of participants in the normal weight group were diagnosed with SO _ESPEN or SO _ESPEN−M. Even within the underweight group, the prevalence of SO _ESPEN and SO _ESPEN−M was 8.9% and 22.2%, respectively. Participants with IADL disability had significantly lower SMM/W and SMM/BMI, but higher fat mass percentage of body weight (FM%) than participants without IADL disability. After full adjustment for potential confounders, SO _ESPEN−M (OR 1.68, 95% CI 1.21 to 2.32), but not SO _ESPEN (OR 1.28, 95% CI 0.93 to 1.75), remained significantly associated with IADL disability.

Conclusions

Both SO _ESPEN and SO _ESPEN−M showed a high prevalence among nursing home residents, even among individuals with underweight or normal weight. While SO _ESPEN had a good consistency with SO _ESPEN−M, only SO _ESPEN−M was independently associated with IADL disability. Screening and diagnosis of SO should be conducted in nursing home residents irrespective of BMI.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-024-04955-w.

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Most cited references 33

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What is polypharmacy? A systematic review of definitions

Nashwa Masnoon, Sepehr Shakib, Lisa Kalisch-Ellett … (2017)

Background Multimorbidity and the associated use of multiple medicines (polypharmacy), is common in the older population. Despite this, there is no consensus definition for polypharmacy. A systematic review was conducted to identify and summarise polypharmacy definitions in existing literature. Methods The reporting of this systematic review conforms to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist. MEDLINE (Ovid), EMBASE and Cochrane were systematically searched, as well as grey literature, to identify articles which defined the term polypharmacy (without any limits on the types of definitions) and were in English, published between 1st January 2000 and 30th May 2016. Definitions were categorised as i. numerical only (using the number of medications to define polypharmacy), ii. numerical with an associated duration of therapy or healthcare setting (such as during hospital stay) or iii. Descriptive (using a brief description to define polypharmacy). Results A total of 1156 articles were identified and 110 articles met the inclusion criteria. Articles not only defined polypharmacy but associated terms such as minor and major polypharmacy. As a result, a total of 138 definitions of polypharmacy and associated terms were obtained. There were 111 numerical only definitions (80.4% of all definitions), 15 numerical definitions which incorporated a duration of therapy or healthcare setting (10.9%) and 12 descriptive definitions (8.7%). The most commonly reported definition of polypharmacy was the numerical definition of five or more medications daily (n = 51, 46.4% of articles), with definitions ranging from two or more to 11 or more medicines. Only 6.4% of articles classified the distinction between appropriate and inappropriate polypharmacy, using descriptive definitions to make this distinction. Conclusions Polypharmacy definitions were variable. Numerical definitions of polypharmacy did not account for specific comorbidities present and make it difficult to assess safety and appropriateness of therapy in the clinical setting.

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Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies

John A Batsis, Dennis T. Villareal (2018)

The prevalence of obesity in combination with sarcopenia (the age-related loss of muscle mass and strength or physical function) is increasing in adults aged 65 years and older. A major subset of adults over the age of 65 is now classified as having sarcopenic obesity, a high-risk geriatric syndrome predominantly observed in an ageing population that is at risk of synergistic complications from both sarcopenia and obesity. This Review discusses pathways and mechanisms leading to muscle impairment in older adults with obesity. We explore sex-specific hormonal changes, inflammatory pathways and myocellular mechanisms leading to the development of sarcopenic obesity. We discuss the evolution, controversies and challenges in defining sarcopenic obesity and present current body composition modalities used to assess this condition. Epidemiological surveys form the basis of defining its prevalence and consequences beyond comorbidity and mortality. Current treatment strategies, and the evidence supporting them, are outlined, with a focus on calorie restriction, protein supplementation and aerobic and resistance exercises. We also describe weight loss-induced complications in patients with sarcopenic obesity that are relevant to clinical management. Finally, we review novel and potential future therapies including testosterone, selective androgen receptor modulators, myostatin inhibitors, ghrelin analogues, vitamin K and mesenchymal stem cell therapy.

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Definition and Diagnostic Criteria for Sarcopenic Obesity: ESPEN and EASO Consensus Statement

Lorenzo M. Donini, Luca Busetto, Stephan C. Bischoff … (2022)

Introduction: Loss of skeletal muscle mass and function (sarcopenia) is common in individuals with obesity due to metabolic changes associated with a sedentary lifestyle, adipose tissue derangements, comorbidities (acute and chronic diseases) and during the ageing process. Co-existence of excess adiposity and low muscle mass/function is referred to as sarcopenic obesity (SO), a condition increasingly recognized for its clinical and functional features that negatively influence important patient-centred outcomes. Effective prevention and treatment strategies for SO are urgently needed, but efforts are hampered by the lack of a universally established SO definition and diagnostic criteria. Resulting inconsistencies in the literature also negatively affect the ability to define prevalence as well as clinical relevance of SO for negative health outcomes. Aims and Methods: The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) launched an initiative to reach expert consensus on a definition and diagnostic criteria for SO. The jointly appointed international expert panel proposes that SO is defined as the co-existence of excess adiposity and low muscle mass/function. The diagnosis of SO should be considered in at-risk individuals who screen positive for a co-occurring elevated body mass index or waist circumference, and markers of low skeletal muscle mass and function (risk factors, clinical symptoms, or validated questionnaires). Diagnostic procedures should initially include assessment of skeletal muscle function, followed by assessment of body composition where presence of excess adiposity and low skeletal muscle mass or related body compartments confirm the diagnosis of SO. Individuals with SO should be further stratified into stage I in the absence of clinical complications or stage II if cases are associated with complications linked to altered body composition or skeletal muscle dysfunction. Conclusions: ESPEN and EASO, as well as the expert international panel, advocate that the proposed SO definition and diagnostic criteria be implemented into routine clinical practice. The panel also encourages prospective studies in addition to secondary analysis of existing data sets, to study the predictive value, treatment efficacy and clinical impact of this SO definition.

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Author and article information

Contributors

Jiaojiao Jiang: jiangjiaojiao1997@163.com

Ming Yang: yangmier@gmail.com , yangmier@scu.edu.cn

Journal

Journal ID (nlm-ta): BMC Geriatr

Journal ID (iso-abbrev): BMC Geriatr

Title: BMC Geriatrics

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2318

Publication date (Electronic): 21 May 2024

Publication date PMC-release: 21 May 2024

Publication date Collection: 2024

Volume: 24

Electronic Location Identifier: 446

Affiliations

[1 ]GRID grid.13291.38, ISNI 0000 0001 0807 1581, Center of Gerontology and Geriatrics, West China Hospital, , Sichuan University, ; Chengdu, China

[2 ]GRID grid.13291.38, ISNI 0000 0001 0807 1581, Health Management Center, West China Hospital, , Sichuan University, ; Chengdu, China

[3 ]GRID grid.13291.38, ISNI 0000 0001 0807 1581, Rehabilitation Center, West China Hospital, , Sichuan University, ; Chengdu, China

[4 ]West China Hospital, National Clinical Research Center for Geriatrics, Sichuan University, ( https://ror.org/011ashp19) Chengdu, China

Article

Publisher ID: 4955

DOI: 10.1186/s12877-024-04955-w

PMC ID: 11110436

PubMed ID: 38773403

SO-VID: ad773e2f-3045-4bf7-93c1-562c5613d20a

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 29 January 2024

Date accepted : 8 April 2024

Funding

Funded by: Sichuan Science and Technology Program

Award ID: 2022YFS0130

Funded by: FundRef http://dx.doi.org/10.13039/501100010032, Health and Family Planning Commission of Sichuan Province;

Award ID: No. ZH2023-103

Custom metadata

ScienceOpen disciplines: Geriatric medicine

Keywords: obese sarcopenia,functional assessment,physical function,long-term care,muscle quality

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ScienceOpen disciplines: Geriatric medicine

Keywords: obese sarcopenia, functional assessment, physical function, long-term care, muscle quality

Sarcopenic obesity in nursing home residents: a multi-center study on diagnostic methods and their association with instrumental activities of daily living

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Supplementary Information

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Hearing Loss and Restoration

Most cited references 33

What is polypharmacy? A systematic review of definitions

Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies

Definition and Diagnostic Criteria for Sarcopenic Obesity: ESPEN and EASO Consensus Statement

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