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

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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

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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

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Gallagher et al., Am J Physiol Endocrinol Metab 2000.
Body composition changes inBody composition changes inBody composition changes inBody composition changes in agingagingagingaging
Sarcopenia

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Baumgartner et al. Mech Ageing Dev, 1999
Sarcos Flesh
Penia Poverty
DefiningDefiningDefiningDefining sarcopeniasarcopeniasarcopeniasarcopenia
Janssen et al, 2004
Prevalence of sarcopenia

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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

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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.
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

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Vandervoot et Symons, 2001
StrengthStrengthStrengthStrength andandandand 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 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

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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 muscleand muscleand muscleand muscle strengthstrengthstrengthstrength

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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

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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

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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

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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

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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

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Weight Loss
« The focus of treatment should be
on reduction of intra-abdominal fat
and 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 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

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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
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

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Villareal et al, AJCN, 2006
Adapted from Villareal, DT et al., Ach Int Med, 2006

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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
* *
*
*

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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 andandandand AAAAgingginggingging

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• 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

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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

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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. 2013-10-07
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…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?

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Thank
you!