Body composition and its association with cardiometabolic risk factors in the elderly: A focus on sarcopenic obesity
Introduction
The two greatest public health concerns in developed countries are the aging of the population and the obesity epidemic (Mokdad et al., 2001). Each of these trends has important effects on body composition, functional disability, and mortality. Aging causes a progressive loss of muscle mass and strength, called sarcopenia, which is derived from the Greek for ‘poverty of flesh’ (Rosenberg, 1989). Another important change in body composition with aging is the increase of fat mass and visceral fat (Riechman, Schoen, Weissfeld, Thaete, & Kriska, 2002), which increases susceptibility to metabolic syndrome and CVD (Ryan & Necklas, 1999). Therefore, the coexistence of sarcopenia and obesity in the elderly may synergistically maximize their effects on metabolic and CVD risk (Stenholm et al., 2008, Zamboni et al., 2008). These age-related body composition changes, with the decrease of skeletal muscle mass and the increase of body fat mass, may occur even in an individual elderly person of stable body weight, which has recently been defined as sarcopenic obesity (Lim et al., 2010, Zamboni et al., 2008). Sarcopenic obesity may be particularly deleterious because of its possible association with a proinflammatory state. Adiopocytes actively secrete leptin and proinflammatory cytokines (Mohamed-Ali et al., 1998, Reuben et al., 2003), both of which stimulate muscle catabolism (Bullo-Bonet et al., 1999, Hotamisligil, 1999, Roubenoff et al., 1997) and activate a vicious cycle leading to accelerated sarcopenia, additional weight gain largely in the form of fat.
The Korean population is rapidly aging and becoming an aged society as are other developed countries. Approximately 10.3% of the Korean population was aged 65 and older in 2008, and the percentage is expected to rapidly rise to 20.3% in 2027 and 34.4% in 2050 (Korea National Statistical Office, 2005). Despite their enormous clinical importance, body composition changes such as sarcopenic obesity in the elderly are often under-recognized. Moreover, there is a paucity of data that measure the effects of body composition on insulin resistance and CVD risk factors, and those data that do exist are often with conflicting results. We examined the relationship between body composition and a wide variety of cardiometabolic risk factors among a representative elderly population, aged 60 years or older, who participated in the KNHANES.
Section snippets
Study population
This study was based on data obtained from the 2008 to 2009 KNHANES, a cross-sectional and nationally representative survey conducted by the Korean Ministry of Health and Welfare. The survey target population was non-institutionalized civilians over one year of age in Korea. The sampling units were households selected through a stratified, multistage, probability-sampling design based on geographic area, sex, and age group using household registries. Participants completed four parts of a
Results
Table 1 shows the characteristics 1250 elderly men and 1693 elderly women with a mean age of 69.0 ± 6.3 years for the men and 69.3 ± 6.4 years for the women. The proportion of the population with sarcopenia was 42.0% for men and 42.7% for women. The mean values for BMI, WC, total body fat mass, total body fat percentage, fasting plasma glucose, fasting insulin, HOMA-IR, total cholesterol, triglycerides, WBC count, alanine aminotransferase (ALT), and the prevalence of metabolic syndrome were
Discussion
In this representative sample of elderly Koreans, we found that the sarcopenic obese group defined by ASM/Wt was more closely associated with insulin resistance, metabolic syndrome, and CVD risk factors than any other group in both men and women. To date, contradictory results have been reported when relating sarcopenic obesity with insulin resistance and metabolic syndrome. Baumgartner et al. (2004) showed that the prevalence of metabolic syndrome was highest in a group of non-sarcopenic obese
Conflict of interest statement
No potential conflicts of interest relevant to this article are reported.
Authors’ contributions
Study concept and design were done by Ji-Youn Chung, Duk-Chul Lee and Yong-Jae Lee. Ji-Youn Chung, Hee-Taik Kang and Yong-Jae Lee performed the statistical analyses and interpretation of data. Ji-Youn Chung drafted the manuscript. Completion of the first draft into final manuscript version was done by Yong-Jae Lee. All authors have read the draft versions and approved the final version of the manuscript.
Sources of support for research
None.
Acknowledgment
The authors would like to thank all of the staff members who were involved in conducting the study.
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