DOI QR코드

DOI QR Code

Sarcopenia and sarcopenic obesity

  • Choi, Kyung Mook (Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine)
  • Received : 2016.06.22
  • Accepted : 2016.10.23
  • Published : 2016.11.01

Abstract

Sarcopenia is an age-associated loss of muscle mass and decline in muscle strength; it is common in older adults and is associated with significant morbidity and mortality. Despite its prevalence, there is currently no universally adopted definition of sarcopenia. In addition to low muscle mass measurements, recent research has recognized the importance of muscle strength and physical performance. Aging induces changes in body composition, such as an increase in visceral fat and reduced muscle mass. Recently, the new concept of sarcopenic obesity has emerged, reflecting a combination of sarcopenia and obesity. The rapidly increasing prevalence and serious consequences of sarcopenic obesity are recognized as a critical public health risk in the aging society. Sarcopenia and obesity share several pathophysiological mechanisms, and they may potentiate each other. The present paper reviews the definitions and techniques used to measure sarcopenia, as well as the health outcomes of sarcopenic obesity. It also highlights the role of diminished muscle mass and strength in cardiometabolic disease mortality. Additional research may be needed to promote the identification and management of sarcopenia and sarcopenic obesity in the elderly population.

Keywords

Acknowledgement

Supported by : National Research Foundation of Korea (NRF)

References

  1. Janssen I. Evolution of sarcopenia research. Appl Physiol Nutr Metab 2010;35:707-712. https://doi.org/10.1139/H10-067
  2. Newman AB, Haggerty CL, Goodpaster B, et al. Strength and muscle quality in a well-functioning cohort of older adults: the Health, Aging and Body Composition Study. J Am Geriatr Soc 2003;51:323-330. https://doi.org/10.1046/j.1532-5415.2003.51105.x
  3. Janssen I. The epidemiology of sarcopenia. Clin Geriatr Med 2011;27:355-363. https://doi.org/10.1016/j.cger.2011.03.004
  4. Rosenberg IH. Sarcopenia: origins and clinical relevance. J Nutr 1997;127(5 Suppl):990S-991S. https://doi.org/10.1093/jn/127.5.990S
  5. Lang T, Streeper T, Cawthon P, Baldwin K, Taaffe DR, Harris TB. Sarcopenia: etiology, clinical consequences, intervention, and assessment. Osteoporos Int 2010;21:543-559. https://doi.org/10.1007/s00198-009-1059-y
  6. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010;39:412-423. https://doi.org/10.1093/ageing/afq034
  7. Edwards MH, Buehring B. Novel approaches to the diagnosis of sarcopenia. J Clin Densitom 2015;18:472-477. https://doi.org/10.1016/j.jocd.2015.04.010
  8. Kim HT, Kim HJ, Ahn HY, Hong YH. An analysis of age-related loss of skeletal muscle mass and its significance on osteoarthritis in a Korean population. Korean J Intern Med 2016;31:585-593. https://doi.org/10.3904/kjim.2015.156
  9. Wannamethee SG, Atkins JL. Muscle loss and obesity: the health implications of sarcopenia and sarcopenic obesity. Proc Nutr Soc 2015;74:405-412. https://doi.org/10.1017/S002966511500169X
  10. Baumgartner RN, Koehler KM, Gallagher D, et al. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol 1998;147:755-763. https://doi.org/10.1093/oxfordjournals.aje.a009520
  11. Janssen I, Heymsfield SB, Ross R. Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc 2002;50:889-896. https://doi.org/10.1046/j.1532-5415.2002.50216.x
  12. Newman AB, Kupelian V, Visser M, et al. Sarcopenia: alternative definitions and associations with lower extremity function. J Am Geriatr Soc 2003;51:1602-1609. https://doi.org/10.1046/j.1532-5415.2003.51534.x
  13. Kim TN, Yang SJ, Yoo HJ, et al. Prevalence of sarcopenia and sarcopenic obesity in Korean adults: the Korean Sarcopenic Obesity Study. Int J Obes (Lond) 2009;33:885-892. https://doi.org/10.1038/ijo.2009.130
  14. Studenski SA, Peters KW, Alley DE, et al. The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates. J Gerontol A Biol Sci Med Sci 2014;69:547-558. https://doi.org/10.1093/gerona/glu010
  15. Cawthon PM, Peters KW, Shardell MD, et al. Cutpoints for low appendicular lean mass that identify older adults with clinically significant weakness. J Gerontol A Biol Sci Med Sci 2014;69:567-575. https://doi.org/10.1093/gerona/glu023
  16. Kim KM, Jang HC, Lim S. Differences among skeletal muscle mass indices derived from height-, weight-, and body mass index-adjusted models in assessing sarcopenia. Korean J Intern Med 2016;31:643-650. https://doi.org/10.3904/kjim.2016.015
  17. Al Snih S, Markides KS, Ottenbacher KJ, Raji MA. Hand grip strength and incident ADL disability in elderly Mexican Americans over a seven-year period. Aging Clin Exp Res 2004;16:481-486. https://doi.org/10.1007/BF03327406
  18. Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994;49:M85-M94. https://doi.org/10.1093/geronj/49.2.M85
  19. Guralnik JM, Ferrucci L, Pieper CF, et al. Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci 2000;55:M221-M231. https://doi.org/10.1093/gerona/55.4.M221
  20. Peel NM, Kuys SS, Klein K. Gait speed as a measure in geriatric assessment in clinical settings: a systematic review. J Gerontol A Biol Sci Med Sci 2013;68:39-46. https://doi.org/10.1093/gerona/gls174
  21. Abbatecola AM, Paolisso G, Fattoretti P, et al. Discovering pathways of sarcopenia in older adults: a role for insulin resistance on mitochondria dysfunction. J Nutr Health Aging 2011;15:890-895. https://doi.org/10.1007/s12603-011-0366-0
  22. Bijlsma AY, Meskers CG, van Heemst D, Westendorp RG, de Craen AJ, Maier AB. Diagnostic criteria for sarcopenia relate differently to insulin resistance. Age (Dordr) 2013;35:2367-2375. https://doi.org/10.1007/s11357-013-9516-0
  23. Choi KM. Sarcopenia and sarcopenic obesity. Endocrinol Metab (Seoul) 2013;28:86-89. https://doi.org/10.3803/EnM.2013.28.2.86
  24. Wang C, Bai L. Sarcopenia in the elderly: basic and clinical issues. Geriatr Gerontol Int 2012;12:388-396. https://doi.org/10.1111/j.1447-0594.2012.00851.x
  25. Jensen GL. Inflammation: roles in aging and sarcopenia. JPEN J Parenter Enteral Nutr 2008;32:656-659. https://doi.org/10.1177/0148607108324585
  26. Meng SJ, Yu LJ. Oxidative stress, molecular inflammation and sarcopenia. Int J Mol Sci 2010;11:1509-1526. https://doi.org/10.3390/ijms11041509
  27. Lang CH, Frost RA, Nairn AC, MacLean DA, Vary TC. TNF-alpha impairs heart and skeletal muscle protein synthesis by altering translation initiation. Am J Physiol Endocrinol Metab 2002;282:E336-347. https://doi.org/10.1152/ajpendo.00366.2001
  28. Schaap LA, Pluijm SM, Deeg DJ, Visser M. Inflammatory markers and loss of muscle mass (sarcopenia) and strength. Am J Med 2006;119:526.e9-526.e17. https://doi.org/10.1016/j.amjmed.2005.10.049
  29. McPherron AC, Lawler AM, Lee SJ. Regulation of skeletal muscle mass in mice by a new TGF-beta superfamily member. Nature 1997;387:83-90. https://doi.org/10.1038/387083a0
  30. Grobet L, Martin LJ, Poncelet D, et al. A deletion in the bovine myostatin gene causes the double-muscled phenotype in cattle. Nat Genet 1997;17:71-74. https://doi.org/10.1038/ng0997-71
  31. White TA, LeBrasseur NK. Myostatin and sarcopenia: opportunities and challenges: a mini-review. Gerontology 2014;60:289-293. https://doi.org/10.1159/000356740
  32. Srikanthan P, Hevener AL, Karlamangla AS. Sarcopenia exacerbates obesity-associated insulin resistance and dysglycemia: findings from the National Health and Nutrition Examination Survey III. PLoS One 2010;5:e10805. https://doi.org/10.1371/journal.pone.0010805
  33. Kim TN, Park MS, Yang SJ, et al. Prevalence and determinant factors of sarcopenia in patients with type 2 diabetes: the Korean Sarcopenic Obesity Study (KSOS). Diabetes Care 2010;33:1497-1499. https://doi.org/10.2337/dc09-2310
  34. Jang HC. Sarcopenia, frailty, and diabetes in older adults. Diabetes Metab J 2016;40:182-189. https://doi.org/10.4093/dmj.2016.40.3.182
  35. Hong HC, Hwang SY, Choi HY, et al. Relationship between sarcopenia and nonalcoholic fatty liver disease: the Korean Sarcopenic Obesity Study. Hepatology 2014;59:1772-1778. https://doi.org/10.1002/hep.26716
  36. Han K, Park YM, Kwon HS, et al. Sarcopenia as a determinant of blood pressure in older Koreans: findings from the Korea National Health and Nutrition Examination Surveys (KNHANES) 2008-2010. PLoS One 2014;9:e86902. https://doi.org/10.1371/journal.pone.0086902
  37. Snijder MB, Henry RM, Visser M, et al. Regional body composition as a determinant of arterial stiffness in the elderly: The Hoorn Study. J Hypertens 2004;22:2339-2347. https://doi.org/10.1097/00004872-200412000-00016
  38. Sanada K, Iemitsu M, Murakami H, et al. Adverse effects of coexistence of sarcopenia and metabolic syndrome in Japanese women. Eur J Clin Nutr 2012;66:1093-1098. https://doi.org/10.1038/ejcn.2012.43
  39. Wijnhoven HA, Snijder MB, van Bokhorst-de van der Schueren MA, Deeg DJ, Visser M. Region-specific fat mass and muscle mass and mortality in community-dwelling older men and women. Gerontology 2012;58:32-40. https://doi.org/10.1159/000324027
  40. Han SS, Kim KW, Kim KI, et al. Lean mass index: a better predictor of mortality than body mass index in elderly Asians. J Am Geriatr Soc 2010;58:312-317. https://doi.org/10.1111/j.1532-5415.2009.02672.x
  41. Wannamethee SG, Shaper AG, Lennon L, Whincup PH. Decreased muscle mass and increased central adiposity are independently related to mortality in older men. Am J Clin Nutr 2007;86:1339-1346. https://doi.org/10.1093/ajcn/86.5.1339
  42. Atkins JL, Whincup PH, Morris RW, Lennon LT, Papacosta O, Wannamethee SG. Sarcopenic obesity and risk of cardiovascular disease and mortality: a population-based cohort study of older men. J Am Geriatr Soc 2014;62:253-260. https://doi.org/10.1111/jgs.12652
  43. Hirani V, Blyth F, Naganathan V, et al. Sarcopenia is associated with incident disability, institutionalization, and mortality in community-dwelling older men: the concord health and ageing in men project. J Am Med Dir Assoc 2015;16:607-613. https://doi.org/10.1016/j.jamda.2015.02.006
  44. Kim JH, Lim S, Choi SH, et al. Sarcopenia: an independent predictor of mortality in community-dwelling older Korean men. J Gerontol A Biol Sci Med Sci 2014;69:1244-1252. https://doi.org/10.1093/gerona/glu050
  45. Filippin LI, Teixeira VN, da Silva MP, Miraglia F, da Silva FS. Sarcopenia: a predictor of mortality and the need for early diagnosis and intervention. Aging Clin Exp Res 2015;27:249-254. https://doi.org/10.1007/s40520-014-0281-4
  46. Baumgartner RN. Body composition in healthy aging. Ann N Y Acad Sci 2000;904:437-448.
  47. Lim KI, Yang SJ, Kim TN, et al. The association between the ratio of visceral fat to thigh muscle area and metabolic syndrome: the Korean Sarcopenic Obesity Study (KSOS). Clin Endocrinol (Oxf) 2010;73:588-594. https://doi.org/10.1111/j.1365-2265.2010.03841.x
  48. Kim TN, Park MS, Lim KI, et al. Relationships between sarcopenic obesity and insulin resistance, inflammation, and vitamin D status: the Korean Sarcopenic Obesity Study. Clin Endocrinol (Oxf) 2013;78:525-532. https://doi.org/10.1111/j.1365-2265.2012.04433.x
  49. Kim TN, Choi KM. The implications of sarcopenia and sarcopenic obesity on cardiometabolic disease. J Cell Biochem 2015;116:1171-1178. https://doi.org/10.1002/jcb.25077
  50. Zamboni M, Mazzali G, Fantin F, Rossi A, Di Francesco V. Sarcopenic obesity: a new category of obesity in the elderly. Nutr Metab Cardiovasc Dis 2008;18:388-395. https://doi.org/10.1016/j.numecd.2007.10.002
  51. Gregor MF, Hotamisligil GS. Inflammatory mechanisms in obesity. Annu Rev Immunol 2011;29:415-445. https://doi.org/10.1146/annurev-immunol-031210-101322
  52. Kim TN, Park MS, Ryu JY, et al. Impact of visceral fat on skeletal muscle mass and vice versa in a prospective cohort study: the Korean Sarcopenic Obesity Study (KSOS). PLoS One 2014;9:e115407. https://doi.org/10.1371/journal.pone.0115407
  53. Kohara K. Sarcopenic obesity in aging population: current status and future directions for research. Endocrine 2014;45:15-25. https://doi.org/10.1007/s12020-013-9992-0
  54. Stenholm S, Harris TB, Rantanen T, Visser M, Kritchevsky SB, Ferrucci L. Sarcopenic obesity: definition, cause and consequences. Curr Opin Clin Nutr Metab Care 2008;11:693-700. https://doi.org/10.1097/MCO.0b013e328312c37d
  55. Lim S, Kim JH, Yoon JW, et al. Sarcopenic obesity: prevalence and association with metabolic syndrome in the Korean Longitudinal Study on Health and Aging (KLo-SHA). Diabetes Care 2010;33:1652-1654. https://doi.org/10.2337/dc10-0107
  56. Chung JY, Kang HT, Lee DC, Lee HR, Lee YJ. Body composition and its association with cardiometabolic risk factors in the elderly: a focus on sarcopenic obesity. Arch Gerontol Geriatr 2013;56:270-278. https://doi.org/10.1016/j.archger.2012.09.007
  57. Kim TN, Park MS, Kim YJ, et al. Association of low muscle mass and combined low muscle mass and visceral obesity with low cardiorespiratory fitness. PLoS One 2014;9:e100118. https://doi.org/10.1371/journal.pone.0100118
  58. Lu CW, Yang KC, Chang HH, Lee LT, Chen CY, Huang KC. Sarcopenic obesity is closely associated with metabolic syndrome. Obes Res Clin Pract 2013;7:e301-e307. https://doi.org/10.1016/j.orcp.2012.02.003
  59. Messier V, Karelis AD, Lavoie ME, et al. Metabolic profile and quality of life in class I sarcopenic overweight and obese postmenopausal women: a MONET study. Appl Physiol Nutr Metab 2009;34:18-24. https://doi.org/10.1139/H08-135
  60. dos Santos EP, Gadelha AB, Safons MP, Nobrega OT, Oliveira RJ, Lima RM. Sarcopenia and sarcopenic obesity classifications and cardiometabolic risks in older women. Arch Gerontol Geriatr 2014;59:56-61. https://doi.org/10.1016/j.archger.2014.03.012
  61. Stephen WC, Janssen I. Sarcopenic-obesity and cardiovascular disease risk in the elderly. J Nutr Health Aging 2009;13:460-466. https://doi.org/10.1007/s12603-009-0084-z
  62. Batsis JA, Mackenzie TA, Barre LK, Lopez-Jimenez F, Bartels SJ. Sarcopenia, sarcopenic obesity and mortality in older adults: results from the National Health and Nutrition Examination Survey III. Eur J Clin Nutr 2014;68:1001-1007. https://doi.org/10.1038/ejcn.2014.117
  63. Tian S, Xu Y. Association of sarcopenic obesity with the risk of all-cause mortality: a meta-analysis of prospective cohort studies. Geriatr Gerontol Int 2016;16:155-166. https://doi.org/10.1111/ggi.12579

Cited by

  1. Kidney disease and obesity paradox vol.36, pp.1, 2016, https://doi.org/10.23876/j.krcp.2017.36.1.1
  2. Nutmeg Extract Increases Skeletal Muscle Mass in Aging Rats Partly via IGF1-AKT-mTOR Pathway and Inhibition of Autophagy vol.2018, pp.None, 2016, https://doi.org/10.1155/2018/2810840
  3. PECULIARITIES OF BODY MASS COMPOSITE IN PATIENTS WITH OVERWEIGHT AND OBESITY vol.14, pp.64, 2016, https://doi.org/10.26724/2079-8334-2018-2-64-48-52
  4. Osteosarcopenic Visceral Obesity and Osteosarcopenic Subcutaneous Obesity, Two New Phenotypes of Sarcopenia: Prevalence, Metabolic Profile, and Risk Factors vol.2018, pp.None, 2016, https://doi.org/10.1155/2018/6147426
  5. Sarcopenic Obesity: Definition, Health Consequences and Clinical Management vol.12, pp.None, 2016, https://doi.org/10.2174/1874288201812010070
  6. Sarcopenic Obesity in Elderly Korean Women: A Nationwide Cross-sectional Study vol.25, pp.1, 2018, https://doi.org/10.11005/jbm.2018.25.1.53
  7. Effects of Seahorse Supplementation on Muscle Mass, Exercise Performance Abilities and the Related Blood Factors in Healthy Elderly Women vol.30, pp.2, 2018, https://doi.org/10.13000/jfmse.2018.04.30.2.409
  8. Exercise and Nutrition Strategies to Counteract Sarcopenic Obesity vol.10, pp.5, 2016, https://doi.org/10.3390/nu10050605
  9. Palliative and end of life care of people with diabetes: Issues, challenges and strategies vol.143, pp.None, 2016, https://doi.org/10.1016/j.diabres.2017.09.018
  10. Utility of the Z-score of log-transformed A Body Shape Index (LBSIZ) in the assessment for sarcopenic obesity and cardiovascular disease risk in the United States vol.9, pp.None, 2019, https://doi.org/10.1038/s41598-019-45717-8
  11. Effects of PM2.5 on Skeletal Muscle Mass and Body Fat Mass of the Elderly in Taipei, Taiwan vol.9, pp.None, 2016, https://doi.org/10.1038/s41598-019-47576-9
  12. Coexistence of Pre-sarcopenia and Metabolic Syndrome in Arab Men vol.104, pp.2, 2016, https://doi.org/10.1007/s00223-018-0477-2
  13. Targeting White Adipose Tissue with Exercise or Bariatric Surgery as Therapeutic Strategies in Obesity vol.8, pp.1, 2016, https://doi.org/10.3390/biology8010016
  14. Osteosarcopenic Obesity: Current Knowledge, Revised Identification Criteria and Treatment Principles vol.11, pp.4, 2016, https://doi.org/10.3390/nu11040747
  15. Plasma Transthyretin as A Biomarker of Sarcopenia in Elderly Subjects vol.11, pp.4, 2019, https://doi.org/10.3390/nu11040895
  16. Association between sarcopenic obesity and higher risk of type 2 diabetes in adults: A systematic review and meta-analysis vol.10, pp.5, 2016, https://doi.org/10.4239/wjd.v10.i5.311
  17. The impact of sarcopenia on health-related quality of life in elderly people: Korean National Health and Nutrition Examination Survey vol.34, pp.4, 2016, https://doi.org/10.3904/kjim.2017.182
  18. Association between sarcopenia and hypertension, ways of mutual influence on clinical course in the elderly (literature review) vol.9, pp.2, 2016, https://doi.org/10.22141/2224-1507.9.2.2019.172123
  19. Association between sarcopenia and hypertension, ways of mutual influence on clinical course in the elderly (literature review) vol.9, pp.2, 2016, https://doi.org/10.22141/2224-1507.9.2.2019.172123
  20. Sarcopenic obesity predicts nonremission of late‐life depression vol.34, pp.8, 2016, https://doi.org/10.1002/gps.5121
  21. Resveratrol prevents sarcopenic obesity by reversing mitochondrial dysfunction and oxidative stress via the PKA/LKB1/AMPK pathway vol.11, pp.8, 2016, https://doi.org/10.18632/aging.101910
  22. Impact of dietary protein intake and obesity on lean mass in middle-aged individuals after a 12-year follow-up: the Korean Genome and Epidemiology Study (KoGES) vol.122, pp.3, 2019, https://doi.org/10.1017/s000711451900117x
  23. Dietary protein and exercise for preservation of lean mass and perspectives on type 2 diabetes prevention vol.244, pp.12, 2016, https://doi.org/10.1177/1535370219861910
  24. Does the Metabolically Healthy Obese Phenotype Protect Adults with Class III Obesity from Biochemical Alterations Related to Bone Metabolism? vol.11, pp.9, 2019, https://doi.org/10.3390/nu11092125
  25. Sarcopenia in systemic sclerosis: the impact of nutritional, clinical, and laboratory features vol.39, pp.10, 2016, https://doi.org/10.1007/s00296-019-04401-w
  26. Intervention Study on the Efficacy and Safety of Platycodon grandiflorus Ethanol Extract in Overweight or Moderately Obese Adults: A Single-Center, Randomized, Double-Blind, Placebo-Controlled Trial vol.11, pp.10, 2019, https://doi.org/10.3390/nu11102445
  27. Beneficial Effects of Leucine Supplementation on Criteria for Sarcopenia: A Systematic Review vol.11, pp.10, 2019, https://doi.org/10.3390/nu11102504
  28. The relationship between all-cause mortality sarcopenia and sarcopenic obesity among hospitalized older people vol.31, pp.11, 2019, https://doi.org/10.1007/s40520-019-01277-5
  29. Whole-body vibration improves the functional parameters of individuals with metabolic syndrome: an exploratory study vol.19, pp.1, 2016, https://doi.org/10.1186/s12902-018-0329-0
  30. 한의 비만 표준 상담 매뉴얼의 개발 vol.19, pp.2, 2016, https://doi.org/10.15429/jkomor.2019.19.2.113
  31. Osteosarcopenic obesity, the coexistence of osteoporosis, sarcopenia and obesity and consequences in the quality of life in older adults ≥65 years-old in Greece vol.4, pp.4, 2016, https://doi.org/10.22540/jfsf-04-091
  32. Radiologic Assessment of Muscle and Fat Stores in Long-Term Type I Diabetics Referred for Pancreas Transplant Compared to Healthy Controls vol.13, pp.None, 2016, https://doi.org/10.2147/dmso.s257992
  33. Risks of Sarcopenia in Patients with Hematological and Oncological Factors who Underwent Hematopoietic Stem Cell Transplantation vol.57, pp.4, 2016, https://doi.org/10.2490/jjrmc.19001
  34. Combined Aerobic and Resistance Exercise Training Reduces Circulating Apolipoprotein J Levels and Improves Insulin Resistance in Postmenopausal Diabetic Women vol.44, pp.1, 2016, https://doi.org/10.4093/dmj.2018.0160
  35. Effect of Sarcopenia and Body Shape on Cardiovascular Disease According to Obesity Phenotypes vol.44, pp.None, 2020, https://doi.org/10.4093/dmj.2019.0223
  36. Exploring the Preventive Effect and Mechanism of Senile Sarcopenia Based on “Gut–Muscle Axis” vol.8, pp.None, 2016, https://doi.org/10.3389/fbioe.2020.590869
  37. Diabetes and Sarcopenic Obesity: Pathogenesis, Diagnosis, and Treatments vol.11, pp.None, 2016, https://doi.org/10.3389/fendo.2020.00568
  38. Sarcopenia, Obesity and Sarcopenia Obesity in Comparison: Prevalence, Metabolic Profile, and Key Differences: Results from WCHAT Study vol.24, pp.4, 2016, https://doi.org/10.1007/s12603-020-1332-5
  39. Android to gynoid fat ratio and its association with functional capacity in male patients with heart failure vol.7, pp.3, 2016, https://doi.org/10.1002/ehf2.12657
  40. Handgrip strength and muscle quality in Australian women: cross‐sectional data from the Geelong Osteoporosis Study vol.11, pp.3, 2016, https://doi.org/10.1002/jcsm.12544
  41. Effect of resistance training on quality of life in older people with sarcopenic obesity living in long‐term care institutions: A quasi‐experimental study vol.29, pp.13, 2016, https://doi.org/10.1111/jocn.15277
  42. Impact of Protein Intake in Older Adults with Sarcopenia and Obesity: A Gut Microbiota Perspective vol.12, pp.8, 2016, https://doi.org/10.3390/nu12082285
  43. What you need to know about malnutrition in older adults vol.81, pp.9, 2016, https://doi.org/10.12968/hmed.2020.0393
  44. What Was First, Obesity or Inflammatory Bowel Disease? What Does the Gut Microbiota Have to Do with It? vol.12, pp.10, 2016, https://doi.org/10.3390/nu12103073
  45. Airway invasion in non-neurologically ill patients with dysphagia : Contributing factors and associated problems during swallowing process. A retrospective observational study vol.99, pp.45, 2016, https://doi.org/10.1097/md.0000000000022977
  46. Container-aided integrative QTL and RNA-seq analysis of Collaborative Cross mice supports distinct sex-oriented molecular modes of response in obesity vol.21, pp.1, 2016, https://doi.org/10.1186/s12864-020-07173-x
  47. Frailty in Acute Care: Not Just Your Grandparents' Medical Condition vol.12, pp.3, 2016, https://doi.org/10.1097/jat.0000000000000152
  48. Use it or lose it - Sarcopenia and physical activity vol.17, pp.3, 2021, https://doi.org/10.4103/jiag.jiag_24_21
  49. The Critical Role of Oxidative Stress in Sarcopenic Obesity vol.2021, pp.None, 2016, https://doi.org/10.1155/2021/4493817
  50. Examining the Association Between Serum Leptin and Sarcopenic Obesity vol.14, pp.None, 2016, https://doi.org/10.2147/jir.s320445
  51. Prevalence, diagnostic criteria, and factors associated with sarcopenic obesity in older adults from a low middle income country: A systematic review vol.41, pp.None, 2016, https://doi.org/10.1016/j.clnesp.2020.11.004
  52. Sarcopenic Obesity in Non-Alcoholic Fatty Liver Disease-The Union of Two Culprits vol.11, pp.2, 2016, https://doi.org/10.3390/life11020119
  53. The Association of Healthy Lifestyle Behaviors with Overweight and Obesity among Older Adults from 21 Countries vol.13, pp.2, 2016, https://doi.org/10.3390/nu13020315
  54. The Role of Sarcopenic Obesity in Cancer and Cardiovascular Disease: A Synthesis of the Evidence on Pathophysiological Aspects and Clinical Implications vol.22, pp.9, 2016, https://doi.org/10.3390/ijms22094339
  55. Paravertebral Muscles as Indexes of Sarcopenia and Sarcopenic Obesity: Comparison With Imaging and Muscle Function Indexes and Impact on Cardiovascular and Metabolic Disorders vol.216, pp.6, 2016, https://doi.org/10.2214/ajr.20.22934
  56. Proteomic profiling of low muscle and high fat mass: a machine learning approach in the KORA S4/FF4 study vol.12, pp.4, 2016, https://doi.org/10.1002/jcsm.12733
  57. Construct and Predictive Validity of Sarcopenia in Lung Transplant Candidates vol.18, pp.9, 2016, https://doi.org/10.1513/annalsats.202007-796oc
  58. Muscle mass and cellular membrane integrity assessment in patients with nonalcoholic fatty liver disease vol.67, pp.9, 2021, https://doi.org/10.1590/1806-9282.20201016
  59. Hypothesizing Nutrigenomic-Based Precision Anti-Obesity Treatment and Prophylaxis: Should We Be Targeting Sarcopenia Induced Brain Dysfunction? vol.18, pp.18, 2016, https://doi.org/10.3390/ijerph18189774
  60. Sarcopenia, Obesity, and Sarcopenic Obesity: Relationship with Skeletal Muscle Phenotypes and Single Nucleotide Polymorphisms vol.10, pp.21, 2021, https://doi.org/10.3390/jcm10214933
  61. Inflammation in Relation to Sarcopenia and Sarcopenic Obesity among Older Adults Living with Chronic Comorbidities: Results from the National Health and Nutrition Examination Survey 1999-2006 vol.13, pp.11, 2016, https://doi.org/10.3390/nu13113957
  62. Using Dietary Macronutrient Patterns to Predict Sarcopenic Obesity in Older Adults: A Representative Korean Nationwide Population-Based Study vol.13, pp.11, 2016, https://doi.org/10.3390/nu13114031
  63. Psoas muscle area and paraspinal muscle fat in children and young adults with or without obesity and fatty liver vol.16, pp.11, 2016, https://doi.org/10.1371/journal.pone.0259948
  64. Sarcopenic obesity as a determinant of cardiovascular disease risk in older people: a systematic review vol.133, pp.8, 2021, https://doi.org/10.1080/00325481.2021.1942934
  65. High-Fructose, High-Fat Diet Alters Muscle Composition and Fuel Utilization in a Juvenile Iberian Pig Model of Non-Alcoholic Fatty Liver Disease vol.13, pp.12, 2016, https://doi.org/10.3390/nu13124195
  66. Significant Association of Diabetes With Mortality of Chronic Hemodialysis Patients, Independent of the Presence of Obesity, Sarcopenia, and Sarcopenic Obesity vol.32, pp.1, 2022, https://doi.org/10.1053/j.jrn.2021.07.003
  67. Lipoprotein subfractions in patients with sarcopenia and their relevance to skeletal muscle mass and function vol.159, pp.None, 2016, https://doi.org/10.1016/j.exger.2021.111668