Phenotypes of Sarcopenic Obesity: Exploring the Effects on Peri-Muscular Fat, the Obesity Paradox, Hormone-Related Responses and the Clinical Implications

Abstract

Sarcopenic obesity combines the words sarcopenia and obesity. This definition of obesity should be better differentiated between visceral and subcutaneous fat phenotypes. For this reason, this review lays the foundation for defining the subcutaneous and the visceral fat into the context of sarcopenia. Thus, the review aims to explore the missing links on pathogenesis of visceral fat and its relationship on age: defining the peri-muscular fat as a new entity and the subcutaneous fat as a first factor that leads to the obesity paradox. Last but not least, this review underlines and motivates the mechanisms of the hormonal responses and anti-inflammatory adipokines responsible for the clinical implications of sarcopenic visceral obesity, describing factor by factor the multiple axis between the visceral fat-sarcopenia and all mortality outcomes linked to cancer, diabetes, cardiovascular diseases, cirrhosis, polycystic ovary, disability and postoperative complications.

Chronic Stress Contributes to Osteosarcopenic Adiposity via Inflammation and Immune Modulation: The Case for More Precise Nutritional Investigation

“…This suggests that visceral obesity may be more common and more dangerous within the OSO than the subcutaneous obesity. Within the sarcopenic obesity, Alalwan [54] argues that the main reason for the loss of muscle strength and mass is the increase in ectopic fat in muscle, or peri-muscular adipose tissue (not subcutaneous fat) and its increase with age and infiltration into the muscle [54]. Similar outcomes have been argued for the bone and subsequent osteoporotic obesity [12].…”

“…The heterogeneity of adipose tissue is becoming increasingly recognized and was recently addressed [52,54,55]. In that view, Perna et al suggest that osteosarcopenic obesity be regarded as two different phenotypes: Osteosarcopenic visceral obesity and osteosarcopenic subcutaneous obesity [53].…”

The Role of Sarcopenic Obesity in Cancer and Cardiovascular Disease: A Synthesis of the Evidence on Pathophysiological Aspects and Clinical Implications

“…Therefore, higher CVD risk in sarcopenic obese individuals can be expected [ 78 ]. However, it has been shown that older adults with greater body mass index (BMI) are less likely to die from CVD, which is called the “obesity paradox” [ 79 , 80 , 81 ]. It seems that the favorable effects of obesity on CVD prognosis are meditated through greater lean mass (LM).…”

“…In other words, high-fat mass may not be deleterious in the absence of systemic inflammation (hsCRP > 3 mg/dL) [ 82 ]. However, it seems that this paradox is more evident in chronic heart failure and coronary heart disease patients [ 81 ]. In addition, since a decline in skeletal muscle mass and function adversely affect health-related quality of life in older adults, obesity cannot effectively reduce the risk of chronic diseases in sarcopenic elderly individuals [ 81 ].…”

Once/Day Provision of Essential Amino Acid Enriched Meal Replacement Improves Body Composition and Physical Function in Obese Elderly

“…It is therefore predictable that sarcopenic obesity has also been linked to the development of metabolic syndrome and diabetes [3]. While losing weight might seem like the obvious solution, data from epidemiological studies suggest an obesity paradox by which body weight has a protective effect against mortality [4]. The efficacy of weight loss in addressing sarcopenic obesity is further complicated by low fitness levels in the obese elderly [5]; not surprisingly co-mingled with low interest in physical activity as a viable intervention [6].…”