Insulin resistance (IR) in skeletal muscle is a key defect mediating the link between obesity and type 2 diabetes, a disease that typically affects people in later life. Sarcopenia (age-related loss of muscle mass and quality) is a risk factor for a number of frailty-related conditions that occur in the elderly. In addition, a syndrome of 'sarcopenic obesity' (SO) is now increasingly recognised, which is common in older people and is applied to individuals that simultaneously show obesity, IR and sarcopenia. Such individuals are at an increased risk of adverse health events compared with those who are obese or sarcopenic alone. However, there are no licenced treatments for sarcopenia or SO, the syndrome is poorly defined clinically and the mechanisms that might explain a common aetiology are not yet well characterised. In this review, we detail the nature and extent of the clinical syndrome, highlight some of the key physiological processes that are dysregulated and discuss some candidate molecular pathways that could be implicated in both metabolic and anabolic defects in skeletal muscle, with an eye towards future therapeutic options. In particular, the potential roles of Akt/mammalian target of rapamycin signalling, AMP-activated protein kinase, myostatin, urocortins and vitamin D are discussed.
R67-R81 229:2 Muscle insulin resistance and sarcopenia
Associations between obesity, diabetes and skeletal muscle ageingThe International Diabetes Federation has estimated that there were 382 million people living with diabetes in 2013, with this number predicted to rise to 592 million by 2035, of which the significant majority would be of >40 years old (IDF 2013). Of these, 90% suffer from type 2 diabetes (T2D), which is characterised by both β-cell failure and resistance to the actions of insulin at the tissue level (insulin resistance, IR). As skeletal muscle is responsible for the majority of the body's postprandial glucose disposal, IR in this tissue results in substantial whole-body metabolic disturbances. However, it is likely that the metabolic disturbances associated with T2D are further exacerbated by the marked loss of skeletal muscle mass that can also be associated with these conditions (Park et al. 2009, Kim et al. 2010. Specifically, loss of muscle mass induces a 2-3% decline in basal metabolic rate per decade after the age of 20 years and 4% per decade after the age of 50 years, resulting from concomitant loss of mitochondrial volume density and oxidative capacity (Conley et al. 2000).
Journal of EndocrinologyThis loss of muscle mass in the elderly is also the principal factor responsible for 'frailty', a syndrome that has been clinically defined as the possession of three of: unintentional weight loss (10 pounds (~4.5 kg) in the past year), self-reported exhaustion, weakness (poor grip strength), slow walking speed and low physical activity (Fried et al. 2001). Loss of muscle mass (atrophy) is an inevitable, although somewhat modifiable, process that occurs with ageing (Sayer et al. 2008), w...