Prevalence of Sarcopenic Obesity and Factors Influencing Body Composition in Persons with Spinal Cord Injury in Japan

Abstract

This study aims to investigate the prevalence of sarcopenic obesity and factors influencing body composition in persons with spinal cord injury (SCI) in Japan. Adults with SCI aged ≥ 20 years who underwent whole-body dual-energy X-ray absorptiometry between 2016 and 2022 were retrospectively analyzed. Data from 97 patients were examined. The primary outcome was appendicular skeletal muscle mass (ASM). Multiple linear regression analysis was conducted to assess factors influencing the lean and adipose indices in persons with SCI. Sarcopenia, obesity, and sarcopenic obesity were prevalent in 76%, 85%, and 64% of patients, respectively. Multivariate linear regression analysis revealed that sex (β = 0.34, p < 0.001), lesion level (β = 0.25, p = 0.007), severity (β = 0.20, p = 0.043), and ability to walk (β = 0.29, p = 0.006) were independently associated with ASM. Sex (β = −0.63, p < 0.001) was independently associated with percent body fat. In conclusion, sarcopenia, obesity, and sarcopenic obesity were prevalent among patients with SCI in Japan. Female sex, tetraplegia, motor-complete injury, and inability to walk were risk factors for sarcopenia, whereas female sex was a risk factor for obesity in persons with SCI. A routine monitoring of body composition is necessary, especially among those with multiple risk factors, to identify individuals in need of preventive and therapeutic interventions.

Secondary Sarcopenia and Spinal Cord Injury: Clinical Associations and Health Outcomes

“…Considering the mentioned genetic traits, it is more likely that women would develop sarcopenia compared to men, androgens having a powerful anabolic effect that promotes muscle regeneration, while estrogen has muscle-protective effect through antiinflammatory pathways that inhibit proteolysis [42]. On the other hand, the number of male patients was significantly higher compared to the number of female patients participating in this study, in agreement with previous studies [33]. Our results showed a significant association between gender and the likelihood of having sarcopenia.…”

“…This finding was in line with the results of a study published by Hwang and Park (2022, N = 2697) that examined the prevalence of sarcopenia according to gender in young-old adults, reporting a higher prevalence of sarcopenia in females [38]. Ishimoto et al [33], in a retrospective analysis (2023, N = 97), reported that female gender was a risk factor for sarcopenia. On the contrary, Zhang et al in their published meta-analysis (2021) revealed no statistically significant difference in the pooled prevalence of sarcopenia in patients with heart failure between men and women [39].…”

“…Their study revealed two clinical observations. Sarcopenia, obesity and sarcopenic obesity were prevalent among individuals with SCI and female gender, tetraplegia, motor-complete injury and inability to walk were identified as risk factors for muscle atrophy comparable to sarcopenia in persons with SCI [33]. Gater DR Jr et al also stated that physiological changes occurring in the adipose tissue in SCI cases should be characterized as neurogenic obesity due to an obligatory sarcopenia, neurogenic osteoporosis, neurogenic anabolic deficiency, sympathetic dysfunction and blunted satiety associated with SCI [34].…”

Potential protective effects of increased serum uric acid concentration in sarcopenia: A meta-analysis and systematic review

“…Therefore, the adoption of uniform criteria for diagnosing sarcopenia across diverse global populations may not be scientifically justified. [47] Third, the inconsistency in the results can also be attributed to the incomplete adjustment for certain significant confounding factors. Notably, dietary protein intake affects sarcopenia [48] ; however, only Beavers et al [25] adjusted for protein intake.…”

Rehabilitation: Neurogenic Bone Loss after Spinal Cord Injury

“…Immobility and disuse are other causes of osteopenia and sarcopenia in SCI patients due to the decrease in mechanical loading in the bone while one recovers from SCI. Sarcopenia, also known as muscle loss, has been linked to being a possible cause of osteopenia; however, more research is needed to evaluate the relationship between osteopenia and sarcopenia in SCI [ 11 , 19 ]. Diagnosis, prevention, and treatment for decreasing osteopenia and osteoporosis after SCI are critical to helping the thousands of individuals who suffer from SCI each year [ 15 , 17 ].…”