2013-10-07
1
Dynapenia, Sarcopenia
and Obesity : Clinical
Impacts and Treatments
Isabelle J. Dionne, PhD
Faculté d’éducati...
2013-10-07
2
Body composition and
Aging
Sarcopenia
Dynapenia
Sarcopenic and Dynapenic Obesity
Striking a Balance... Weigh ...
2013-10-07
3
Gallagher et al., Am J Physiol Endocrinol Metab 2000.
Body composition changes inBody composition changes inB...
2013-10-07
4
Baumgartner et al. Mech Ageing Dev, 1999
Sarcos Flesh
Penia Poverty
DefiningDefiningDefiningDefining sarcopen...
2013-10-07
5
Narichi and Maffulli, Br Med Bull,
2010
Janssen I. Journal of the American
Geriatrics Society , 2006.
Figure ...
2013-10-07
6
Men Women Men Women
Quadricep strength Bicep strength
Maximal voluntary strength
14% 11% 28%40%
Beliaeff et a...
2013-10-07
7
Vandervoot et Symons, 2001
StrengthStrengthStrengthStrength andandandand agingagingagingaging
Clark et Manini...
2013-10-07
8
Sarcopenia and Dynapenic Obesity
2013-10-07
9
CDC/NCHS, Health,
United States, 2008,
Figure 7. Data from the
National Health and
Nutrition Examination
Surv...
2013-10-07
10
How body composition
changes impact on
metabolic and functional
health
Metabolic Outcomes
Physical Capacity
...
2013-10-07
11
« Sarcopenia and obesity alone were not sufficient to increase CVD risk.
Sarcopenic-obesity, based on muscle...
2013-10-07
12
Sayer et al., Diabetes care, 2005
MuscleMuscleMuscleMuscle StrengthStrengthStrengthStrength and type 2and ty...
2013-10-07
13
Adapted from Sénéchal et al., 2012
Energy intake, lifestyle
behaviors, and age were all
similar between grou...
2013-10-07
14
Bouchard DR. et al, Obesity, 2009
PhysicalPhysicalPhysicalPhysical capacitycapacitycapacitycapacity,,,, sarc...
2013-10-07
15
Physicalcapacityimpairmeents
inthelowesttertileofmobility
Choquette et al, JNHA, 2010
PhysicalPhysicalPhysic...
2013-10-07
16
Bouchard and Janssen, J Gerontol., 2010
PhysicalPhysicalPhysicalPhysical functionfunctionfunctionfunction ac...
2013-10-07
17
Weight Loss
« The focus of treatment should be
on reduction of intra-abdominal fat
and preservation of muscl...
2013-10-07
18
Position Statement of the
American Society for Nutrition
and NAASO, The Obesity Society
“…weight-loss therap...
2013-10-07
19
Exercise
Increases strength
Decreases fat mass
Improves physical function
Physical
independence
Toth et al, ...
2013-10-07
20
Hunter et al., 2004
AgingAgingAgingAging
vsvsvsvs
trainingtrainingtrainingtraining
◦ During the first weeks ...
2013-10-07
21
Villareal et al, AJCN, 2006
Adapted from Villareal, DT et al., Ach Int Med, 2006
2013-10-07
22
Diet and exercise to improveDiet and exercise to improveDiet and exercise to improveDiet and exercise to imp...
2013-10-07
23
Protein intake
• Protein intake goes down with aging;
• Actual Recommended Daily Intake
(0,8 g/kg/d) have be...
2013-10-07
24
• Leucine appears to be the
main mediator in the
balance between protein
degradation and synthesis
(Katsanos...
2013-10-07
25
Fiatarone, M.A. et al, 1994
+15g/d of proteins
ExerciseExerciseExerciseExercise XXXX proteinsproteinsprotein...
2013-10-07
26
Kukuljan et al., JAP, 2009
Resistance
exercise and
fortified milk on
muscle size
Timing?
Conclusion
Striking...
2013-10-07
27
…CONCLUSIONS
Losses in muscle strength have a
significant impact on metabolic
outcomes and physical capacity...
2013-10-07
28
Thank
you!
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Dynapenia, Sarcopenia and Obesity: Clinical Impacts and Treatments

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Presentation by Isabelle Dionne, MSc, PhD at Striking a Balance Symposium 2013

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Dynapenia, Sarcopenia and Obesity: Clinical Impacts and Treatments

  1. 1. 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 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
  2. 2. 2013-10-07 2 Body composition and Aging Sarcopenia Dynapenia 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
  3. 3. 2013-10-07 3 Gallagher et al., Am J Physiol Endocrinol Metab 2000. Body composition changes inBody composition changes inBody composition changes inBody composition changes in agingagingagingaging Sarcopenia
  4. 4. 2013-10-07 4 Baumgartner et al. Mech Ageing Dev, 1999 Sarcos Flesh Penia Poverty DefiningDefiningDefiningDefining sarcopeniasarcopeniasarcopeniasarcopenia Janssen et al, 2004 Prevalence of sarcopenia
  5. 5. 2013-10-07 5 Narichi and Maffulli, Br Med Bull, 2010 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
  6. 6. 2013-10-07 6 Men Women Men Women Quadricep strength Bicep strength Maximal voluntary strength 14% 11% 28%40% Beliaeff et al, JAPA 2008, 16(4), 484-493. Age Physical activity Height Body fat Muscle mass HoWHoWHoWHoW muchmuchmuchmuch of muscleof muscleof muscleof muscle strenthstrenthstrenthstrenth isisisis explainedexplainedexplainedexplained by mass??by mass??by mass??by mass?? Dynapenia
  7. 7. 2013-10-07 7 Vandervoot et Symons, 2001 StrengthStrengthStrengthStrength andandandand agingagingagingaging Clark et Manini, 2008
  8. 8. 2013-10-07 8 Sarcopenia and Dynapenic Obesity
  9. 9. 2013-10-07 9 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.
  10. 10. 2013-10-07 10 How body composition changes impact on metabolic and functional health Metabolic Outcomes Physical 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
  11. 11. 2013-10-07 11 « 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 muscleand muscleand muscleand muscle strengthstrengthstrengthstrength
  12. 12. 2013-10-07 12 Sayer et al., Diabetes care, 2005 MuscleMuscleMuscleMuscle StrengthStrengthStrengthStrength and type 2and type 2and type 2and type 2 diabetesdiabetesdiabetesdiabetes statusstatusstatusstatus Jurca R., Med Sci Sports Exerc, 2005 Incident rate ofIncident rate ofIncident rate ofIncident rate of metabolicmetabolicmetabolicmetabolic diseasesdiseasesdiseasesdiseases////yearyearyearyear perperperper quatilesquatilesquatilesquatiles ofofofof muclemuclemuclemucle strengthstrengthstrengthstrength
  13. 13. 2013-10-07 13 Adapted from Sénéchal et al., 2012 Energy intake, lifestyle behaviors, and age were all similar between groups. MetabolicMetabolicMetabolicMetabolic outcomesoutcomesoutcomesoutcomes basedbasedbasedbased onononon dynapeniadynapeniadynapeniadynapenia andandandand obesityobesityobesityobesity statusesstatusesstatusesstatuses Impact on physical capacity
  14. 14. 2013-10-07 14 Bouchard DR. et al, Obesity, 2009 PhysicalPhysicalPhysicalPhysical capacitycapacitycapacitycapacity,,,, sarcopeniasarcopeniasarcopeniasarcopenia andandandand 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 andandandand ObesityObesityObesityObesity
  15. 15. 2013-10-07 15 Physicalcapacityimpairmeents inthelowesttertileofmobility Choquette et al, JNHA, 2010 PhysicalPhysicalPhysicalPhysical capacitycapacitycapacitycapacity and relativeand relativeand relativeand relative strengthstrengthstrengthstrength Cesari M. et al, J Gerontol, 2009 SurvivalSurvivalSurvivalSurvival raterateraterate basedbasedbasedbased onononon sarcopeniasarcopeniasarcopeniasarcopenia orororor slowslowslowslow walkingwalkingwalkingwalking andandandand obesityobesityobesityobesity
  16. 16. 2013-10-07 16 Bouchard and Janssen, J Gerontol., 2010 PhysicalPhysicalPhysicalPhysical functionfunctionfunctionfunction accordingaccordingaccordingaccording totototo ObesityObesityObesityObesity andandandand DynapeniaDynapeniaDynapeniaDynapenia statusstatusstatusstatus Treatment Weight Loss Exercise Protein intake Striking a Balance... Weigh in with Knowledge, Research, Practice SYMPOSIUM Ottawa Chapter - Diabetes Educator Sector, Canadian Diabetes Association Monday, September 30, 2013
  17. 17. 2013-10-07 17 Weight Loss « The focus of treatment should be on reduction of intra-abdominal fat and preservation of muscle mass and strength. »
  18. 18. 2013-10-07 18 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 goal for 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 reviews Witham and Avenell (2010) Age and Ageing
  19. 19. 2013-10-07 19 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.
  20. 20. 2013-10-07 20 Hunter et al., 2004 AgingAgingAgingAging vsvsvsvs trainingtrainingtrainingtraining ◦ During the first weeks off training, improvements are mostly neurological ◦ Gains in strength are improved without gains in muscle mass McDonagh et al, 1983 ResistanceResistanceResistanceResistance traningtraningtraningtraning
  21. 21. 2013-10-07 21 Villareal et al, AJCN, 2006 Adapted from Villareal, DT et al., Ach Int Med, 2006
  22. 22. 2013-10-07 22 Diet and exercise to improveDiet and exercise to improveDiet and exercise to improveDiet and exercise to improve physical function in olderphysical function in olderphysical function in olderphysical function in older adultsadultsadultsadults * * * *
  23. 23. 2013-10-07 23 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 andandandand AAAAgingginggingging
  24. 24. 2013-10-07 24 • Leucine appears to be the main mediator in the balance between protein degradation and synthesis (Katsanos et al, 2006); • This may explain the association between animal protein intake and muscle mass. EssentialEssentialEssentialEssential AminoAminoAminoAmino AcidsAcidsAcidsAcids AnimalAnimalAnimalAnimal proteinsproteinsproteinsproteins, muscle, muscle, muscle, muscle functionfunctionfunctionfunction,,,, and glucoseand glucoseand glucoseand glucose metabolisMmetabolisMmetabolisMmetabolisM Maltais et al., IJNSM, 2011
  25. 25. 2013-10-07 25 Fiatarone, M.A. et al, 1994 +15g/d of proteins ExerciseExerciseExerciseExercise XXXX proteinsproteinsproteinsproteins Tieland et al, J Am Diet Ass, 2012 Prot. Suppl. 15g 2X day ExerciseExerciseExerciseExercise XXXX proteinsproteinsproteinsproteins
  26. 26. 2013-10-07 26 Kukuljan et al., JAP, 2009 Resistance exercise and fortified milk on muscle size Timing? Conclusion Striking a Balance... Weigh in with Knowledge, Research, Practice SYMPOSIUM Ottawa Chapter - Diabetes Educator Sector, Canadian Diabetes Association Monday, September 30, 2013
  27. 27. 2013-10-07 27 …CONCLUSIONS Losses in muscle strength have a significant impact on metabolic outcomes and physical capacity. The presence of obesity exacerbates these problems. …CONCLUSIONS Interventions aiming to counteract dynapenic obesity should focus on resistance and aerobic training. Weight loss may be considered if it includes an exercise component. Adequate protein intake is also important. Few questions remaining: Animal? Milk? Timimg?
  28. 28. 2013-10-07 28 Thank you!

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