2013-10-07 1 Dynapenia, Sarcopenia and Obesity : Clinical Impacts and Treatments Isabelle J. Dionne, PhD Faculté d’éducation physique et sportive Université de Sherbrooke Striking a Balance... Weigh in with Knowledge, Research, Practice SYMPOSIUM Ottawa Chapter - Diabetes Educator Sector, Canadian Diabetes Association Monday, September 30, 2013 OUTLINE OUTLINE OUTLINE OUTLINE Body composition and aging Sarcopenia and Dynapenia Sarcopenic and dynapenic obesity Clinical outcomes - Dynapenic obesity and physical capacity - Dynapenic obesity and metabolic consequences Treatment - Weight loss - Exercise - Protein intake
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Dynapenia, Sarcopenia and Obesity: Clinical Impacts and Treatments
Presentation by Isabelle Dionne, MSc, PhD at Striking a Balance Symposium 2013
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2013-10-07
1
Dynapenia, Sarcopeniaand Obesity : Clinical
Impacts and Treatments
Isabelle J. Dionne, PhDFaculté d’éducation physique et sportive
Université de Sherbrooke
Striking a Balance... Weigh in with Knowledge, Research, Practice SYMPOSIUM
Ottawa Chapter - Diabetes Educator Sector, Canadian Diabetes Association
Monday, September 30, 2013
OUTLINEOUTLINEOUTLINEOUTLINE
� Body composition and aging
� Sarcopenia and Dynapenia
� Sarcopenic and dynapenic obesity
� Clinical outcomes
- Dynapenic obesity and physical capacity
- Dynapenic obesity and metabolic consequences
� Treatment
- Weight loss
- Exercise
- Protein intake
2013-10-07
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Body composition and Aging
SarcopeniaDynapenia
Sarcopenic and Dynapenic Obesity
Striking a Balance... Weigh in with Knowledge, Research, Practice SYMPOSIUM
Ottawa Chapter - Diabetes Educator Sector, Canadian Diabetes Association
Monday, September 30, 2013
Body composition and aging
2013-10-07
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Gallagher et al., Am J Physiol Endocrinol Metab 2000.
Body composition changes in Body composition changes in Body composition changes in Body composition changes in agingagingagingaging
Janssen I. Journal of the American Geriatrics Society , 2006.
Figure 1. Cross-sectional analysis: Odds ratios for disability according to baseline categories of muscle mass. Longitudinal analysis: Hazard ratios for disability according to baseline categories of muscle mass.
Severe sarcopenia is related with increased risks for disability, especially when examined cross-sectionally.
DisabilityDisabilityDisabilityDisability and muscle massand muscle massand muscle massand muscle mass
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Men Women Men Women
Quadricep strength Bicep strength
Maximal voluntary strength
14% 11% 28%40%
Beliaeff et al, JAPA 2008, 16(4), 484-493.
AgePhysical activityHeightBody fat
Muscle mass
HoWHoWHoWHoWmuchmuchmuchmuch of muscle of muscle of muscle of muscle strenthstrenthstrenthstrenth isisisis explainedexplainedexplainedexplained
by mass??by mass??by mass??by mass??
Dynapenia
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Vandervoot et Symons, 2001
StrengthStrengthStrengthStrength and and and and agingagingagingaging
Clark et Manini, 2008
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Sarcopenia and Dynapenic Obesity
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CDC/NCHS, Health,
United States, 2008,
Figure 7. Data from the
National Health and
Nutrition Examination
Survey.
Bouchard DR et al., J Gerontol 2007
Body fat (%)
ASMI (kg/m2)
Age (yrs)
Physical activity
Chronic cond. (n)
Physical capacity
Walking speed
Balance
r=-0.61; p<.001
Hypothetical model for physical capacity in a
cohort of 437 older men.
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How body composition changes impact on
metabolic and functionalhealth
Metabolic OutcomesPhysical Capacity
Striking a Balance... Weigh in with Knowledge, Research, Practice SYMPOSIUM
Ottawa Chapter - Diabetes Educator Sector, Canadian Diabetes Association
Monday, September 30, 2013
Metabolic outcomes
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« Sarcopenia and obesity alone were not sufficient to increase CVD risk. Sarcopenic-obesity, based on muscle strength but not muscle mass, was modestly associated with increased CVD risk. These findings imply that strength may be more important than muscle mass for CVD protection in old age. »
Stephen and Janssen, JNHA 2009
Hasard
ratio;
P=0.06
Muscle mass Strength
SarcopeniaSarcopeniaSarcopeniaSarcopenia and CVDand CVDand CVDand CVD
Karelis et al., Appl Physiol Nutr Metab, 2007
InsulinInsulinInsulinInsulin sensitivitysensitivitysensitivitysensitivity and muscle and muscle and muscle and muscle strengthstrengthstrengthstrength
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Sayer et al., Diabetes care, 2005
Muscle Muscle Muscle Muscle StrengthStrengthStrengthStrength and type 2 and type 2 and type 2 and type 2 diabetesdiabetesdiabetesdiabetes
statusstatusstatusstatus
Jurca R., Med Sci Sports Exerc, 2005
Incident rate of Incident rate of Incident rate of Incident rate of metabolicmetabolicmetabolicmetabolic diseasesdiseasesdiseasesdiseases////yearyearyearyear
per per per per quatilesquatilesquatilesquatiles of of of of muclemuclemuclemucle strengthstrengthstrengthstrength
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Adapted from Sénéchal et al., 2012
Energy intake, lifestylebehaviors, and age were all similar between groups.
MetabolicMetabolicMetabolicMetabolic outcomesoutcomesoutcomesoutcomes basedbasedbasedbased on on on on dynapeniadynapeniadynapeniadynapenia
and and and and obesityobesityobesityobesity statusesstatusesstatusesstatuses
Impact on physical capacity
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Bouchard DR. et al, Obesity, 2009
PhysicalPhysicalPhysicalPhysical capacitycapacitycapacitycapacity, , , , sarcopeniasarcopeniasarcopeniasarcopenia and and and and
obesityobesityobesityobesity
Probability rate of a new mobility
disability (95% confidence intervals)
according to the combination of low
muscle strength and obesity among
persons aged 65–85 years.
Probabilities are adjusted to represent
a 74-year-old female.
Stenholm S., et al. Int J Obes, 2009.
PhysicalPhysicalPhysicalPhysical capacitycapacitycapacitycapacity, , , , strengthstrengthstrengthstrength and and and and ObesityObesityObesityObesity
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Physi
cal
capac
ity
impai
rmee
nts
in t
he
low
est
tert
ile
of
mobil
ity
Choquette et al, JNHA, 2010
PhysicalPhysicalPhysicalPhysical capacitycapacitycapacitycapacity and relative and relative and relative and relative strengthstrengthstrengthstrength
Cesari M. et al, J Gerontol, 2009
SurvivalSurvivalSurvivalSurvival rate rate rate rate basedbasedbasedbased on on on on sarcopeniasarcopeniasarcopeniasarcopenia or or or or
slow slow slow slow walkingwalkingwalkingwalking and and and and obesityobesityobesityobesity
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Bouchard and Janssen, J Gerontol., 2010
PhysicalPhysicalPhysicalPhysical functionfunctionfunctionfunction accordingaccordingaccordingaccording to to to to ObesityObesityObesityObesity
and and and and DynapeniaDynapeniaDynapeniaDynapenia statusstatusstatusstatus
TreatmentWeight Loss
ExerciseProtein intake
Striking a Balance... Weigh in with Knowledge, Research, Practice SYMPOSIUM
Ottawa Chapter - Diabetes Educator Sector, Canadian Diabetes Association
Monday, September 30, 2013
2013-10-07
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Weight Loss
« The focus of treatment should be on reduction of intra-abdominal fatand preservation of muscle mass and strength. »
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Position Statement of the American Society for Nutrition and NAASO, The Obesity Society
“…weight-loss therapy that minimizes muscle and bone losses is recommended for older persons who are obese and who have functional impairments or medical complications that can benefit from weight loss. “
Villareal et al, American Journal of Clinical Nutrition,
Vol. 82, No. 5, 923-934, 2005
Should weight loss be a goal??
� It is not clear whether weight loss benefits longevity and hence whether weight reduction is justified as a prime goalfor all older individuals who are overweight (BMI > 25 kg/m2).
� Other aspects of a healthy lifestyle, especially exercise and dietary quality, should be considered.
� Further trial evidence is needed with regards to the effect of weight loss with and without exercise on CVD risk, quality of life and physical function, especially in the “older” older adults.
Harrington, M. et al. (2009) Nutrition research reviewsWitham and Avenell (2010) Age and Ageing
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Exercise
Increases strength
Decreases fat mass
Improves physical function
Physical
independence
Toth et al, MSSE, 1999;
Raguso et al, Clin Nutr, 2006;
Bouchard et al, Menopause, 2009;
Paterson and Warburton, Int J Behav Nutr Phys Act, 2010.
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Hunter et al., 2004
AgingAgingAgingAging
vs vs vs vs
trainingtrainingtrainingtraining
◦ During the first weeks off training, improvements are mostly neurological
◦ Gains in strength are improvedwithout gains in muscle mass
Adapted from Villareal, DT et al., Ach Int Med, 2006
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Diet and exercise to improve Diet and exercise to improve Diet and exercise to improve Diet and exercise to improve
physical function in older physical function in older physical function in older physical function in older
adultsadultsadultsadults
* *
*
*
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Protein intake
• Protein intake goes down with aging;
• Actual Recommended Daily Intake (0,8 g/kg/d) have been suggested to be insufficient (Wolfe et al, 2008);
• An intake of 1,25 g/kg/d has been suggested as safe and optimal for muscle mass maintenance (Wolfe et al, 2008).
• Our results show that protein intake from healthy animal sources is the best nutritional determinant of fat-free mass in older adults (Lord et al., 2007).
ProteinProteinProteinProtein intakeintakeintakeintake and and and and AAAAgingginggingging
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• Leucine appears to be the main mediator in the balance between proteindegradation and synthesis(Katsanos et al, 2006);
• This may explain the association betweenanimal protein intake and muscle mass.