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Metabolism: Clinical and Experimental Sep 2023Sarcopenic obesity, or the loss of muscle mass and function associated with excess adiposity, is a largely untreatable medical condition associated with diminished... (Review)
Review
Sarcopenic obesity, or the loss of muscle mass and function associated with excess adiposity, is a largely untreatable medical condition associated with diminished quality of life and increased risk of mortality. To date, it remains somewhat paradoxical and mechanistically undefined as to why a subset of adults with obesity develop muscular decline, an anabolic stimulus generally associated with retention of lean mass. Here, we review evidence surrounding the definition, etiology, and treatment of sarcopenic obesity with an emphasis on emerging regulatory nodes with therapeutic potential. We review the available clinical evidence largely focused on diet, lifestyle, and behavioral interventions to improve quality of life in patients with sarcopenic obesity. Based upon available evidence, relieving consequences of energy burden, such as oxidative stress, myosteatosis, and/or mitochondrial dysfunction, is a promising area for therapeutic development in the treatment and management of sarcopenic obesity.
Topics: Humans; Sarcopenia; Quality of Life; Muscle, Skeletal; Obesity; Adiposity; Body Composition
PubMed: 37380015
DOI: 10.1016/j.metabol.2023.155639 -
JAMA Network Open Sep 2023Body mass index (BMI) is an easily obtained adiposity surrogate. However, there is variability in body composition and adipose tissue distribution between individuals...
IMPORTANCE
Body mass index (BMI) is an easily obtained adiposity surrogate. However, there is variability in body composition and adipose tissue distribution between individuals with the same BMI, and there is controversy regarding the BMI associated with the lowest mortality risk.
OBJECTIVE
To evaluate which of BMI, fat mass index (FMI), and waist-to-hip (WHR) has the strongest and most consistent association with mortality.
DESIGN, SETTING, AND PARTICIPANT
This cohort study used incident deaths from the UK Biobank (UKB; 2006-2022), which includes data from 22 clinical assessment centers across the United Kingdom. UKB British participants of British White ancestry (N = 387 672) were partitioned into a discovery cohort (n = 337 078) and validation cohort (n = 50 594), with the latter consisting of 25 297 deaths and 25 297 controls. The discovery cohort was used to derive genetically determined adiposity measures while the validation cohort was used for analyses. Exposure-outcome associations were analyzed through observational and mendelian randomization (MR) analyses.
EXPOSURES
BMI, FMI, and WHR.
MAIN OUTCOMES AND MEASURES
All-cause and cause-specific (cancer, cardiovascular disease [CVD], respiratory disease, or other causes) mortality.
RESULTS
There were 387 672 and 50 594 participants in our observational (mean [SD] age, 56.9 [8.0] years; 177 340 [45.9%] male, 210 332 [54.2%], female), and MR (mean [SD] age, 61.6 [6.2] years; 30 031 [59.3%] male, 20 563 [40.6%], female) analyses, respectively. Associations between measured BMI and FMI with all-cause mortality were J-shaped, whereas the association of WHR with all-cause mortality was linear using the hazard ratio (HR) scale (HR per SD increase of WHR, 1.41 [95% CI, 1.38-1.43]). Genetically determined WHR had a stronger association with all-cause mortality than BMI (odds ratio [OR] per SD increase of WHR, 1.51 [95% CI, 1.32-1.72]; OR per SD increase of BMI, 1.29 [95% CI, 1.20-1.38]; P for heterogeneity = .02). This association was stronger in male than female participants (OR, 1.89 [95% CI, 1.54-2.32]; P for heterogeneity = .01). Unlike BMI or FMI, the genetically determined WHR-all-cause mortality association was consistent irrespective of observed BMI.
CONCLUSIONS AND RELEVANCE
In this cohort study, WHR had the strongest and most consistent association with mortality irrespective of BMI. Clinical recommendations should consider focusing on adiposity distribution compared with mass.
Topics: Humans; Female; Male; Middle Aged; Adiposity; Cohort Studies; Obesity; Body Fat Distribution; Biomarkers
PubMed: 37728925
DOI: 10.1001/jamanetworkopen.2023.34836 -
Nutrients Jan 2024Intermittent fasting is one of the most popular types of diet at the moment because it is an effective nutritional strategy in terms of weight loss. The main objective... (Review)
Review
Intermittent fasting is one of the most popular types of diet at the moment because it is an effective nutritional strategy in terms of weight loss. The main objective of this review is to analyze the effects that intermittent fasting has on sports performance. We analyzed physical capacities: aerobic capacity, anaerobic capacity, strength, and power, as well as their effect on body composition. For this, a bibliographic search was carried out in several databases where 25 research articles were analyzed to clarify these objectives. Inclusion criteria: dates between 2013 and present, free full texts, studies conducted in adult human athletes, English and/or Spanish languages, and if it has been considered that intermittent fasting is mainly linked to sports practice and that this obtains a result in terms of performance or physical capacities. This review was registered in PROSPERO with code ref. 407024, and an evaluation of the quality or risk of bias was performed. After this analysis, results were obtained regarding the improvement of body composition and the maintenance of muscle mass. An influence of intermittent fasting on sports performance and body composition is observed. It can be concluded that intermittent fasting provides benefits in terms of body composition without reducing physical performance, maintenance of lean mass, and improvements in maximum power. But despite this, it is necessary to carry out new studies focusing on the sports field since the samples have been very varied. Additionally, the difference in hours of intermittent fasting should be studied, especially in the case of overnight fasting.
Topics: Adult; Humans; Intermittent Fasting; Athletic Performance; Fasting; Athletes; Body Composition
PubMed: 38201996
DOI: 10.3390/nu16010168 -
Nutrients Aug 2023Over the last decade, studies suggested that dietary behavior modification, including fasting, can improve metabolic and cardiovascular markers as well as body... (Review)
Review
Over the last decade, studies suggested that dietary behavior modification, including fasting, can improve metabolic and cardiovascular markers as well as body composition. Given the increasing prevalence of people with type 1 (T1DM) and type 2 diabetes mellitus (T2DM) and the increasing obesity (also in combination with diabetes), nutritional therapies are gaining importance, besides pharmaceutical interventions. Fasting has demonstrated beneficial effects for both healthy individuals and those with metabolic diseases, leading to increased research interest in its impact on glycemia and associated short- and long-term complications. Therefore, this review aimed to investigate whether fasting can be used safely and effectively in addition to medications to support the therapy in T1DM and T2DM. A literature search on fasting and its interaction with diabetes was conducted via PubMed in September 2022. Fasting has the potential to minimize the risk of hypoglycemia in T1DM, lower glycaemic variability, and improve fat metabolism in T1DM and T2DM. It also increases insulin sensitivity, reduces endogenous glucose production in diabetes, lowers body weight, and improves body composition. To conclude, fasting is efficient for therapy management for both people with T1DM and T2DM and can be safely performed, when necessary, with the support of health care professionals.
Topics: Humans; Diabetes Mellitus, Type 2; Diabetes Mellitus, Type 1; Fasting; Behavior Therapy; Body Composition
PubMed: 37630716
DOI: 10.3390/nu15163525 -
Frontiers in Endocrinology 2023Oral semaglutide is the first glucagon-like peptide-1 receptor agonist (GLP-1RA) designed for oral administration; it offers a promising opportunity to facilitate an...
BACKGROUND
Oral semaglutide is the first glucagon-like peptide-1 receptor agonist (GLP-1RA) designed for oral administration; it offers a promising opportunity to facilitate an early approach to Type 2 Diabetes (T2D). The study aimed to evaluate, in a real-life setting, the effects of oral semaglutide on the body composition of patients with T2D after 26 weeks of therapy.
METHODS
Thirty-two patients with T2D were evaluated at baseline (T0) and after three (T3) and six (T6) months of therapy with oral semaglutide. At each time point, body composition was assessed using a phase sensitive bioimpedance analyzer. Clinical, anthropometric and laboratory parameters, and the main biometric surrogates of liver steatosis and fibrosis, were also analyzed and compared.
RESULTS
A significant and early reduction in anthropometric and glucometabolic parameters, alanine aminotransferase, Fatty Liver Index, and Fat Mass was observed. Visceral Adipose Tissue (VAT) decreased, while Fat Free Mass and Skeletal Muscle Mass (SMM) were preserved during therapy, resulting in a beneficial increase in the SMM/VAT ratio. Finally, an overall improvement in body fluid distribution was observed.
CONCLUSION
Our real-world data confirm the clinical efficacy of oral semaglutide and highlight its ability to improve the nutritional status of patients with T2D.
Topics: Humans; Body Composition; Diabetes Mellitus, Type 2; Glucagon-Like Peptide-1 Receptor; Hypoglycemic Agents; Prospective Studies; Gastrointestinal Agents
PubMed: 37780624
DOI: 10.3389/fendo.2023.1240263 -
Nutrients May 2024Metabolism encompasses the entire array of chemical reactions continuously occurring within the body that sustain life and maintain normal physiological functions [...].
Metabolism encompasses the entire array of chemical reactions continuously occurring within the body that sustain life and maintain normal physiological functions [...].
Topics: Humans; Body Composition; Nutritional Status; Energy Metabolism; Nutritional Physiological Phenomena
PubMed: 38794695
DOI: 10.3390/nu16101457 -
JAMA Network Open Oct 2023Strategies targeting body composition may help prevent chronic diseases in persons with excess weight, but randomized clinical trials evaluating lifestyle interventions... (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Strategies targeting body composition may help prevent chronic diseases in persons with excess weight, but randomized clinical trials evaluating lifestyle interventions have rarely reported effects on directly quantified body composition.
OBJECTIVE
To evaluate the effects of a lifestyle weight-loss intervention on changes in overall and regional body composition.
DESIGN, SETTING, AND PARTICIPANTS
The ongoing Prevención con Dieta Mediterránea-Plus (PREDIMED-Plus) randomized clinical trial is designed to test the effect of the intervention on cardiovascular disease prevention after 8 years of follow-up. The trial is being conducted in 23 Spanish research centers and includes men and women (age 55-75 years) with body mass index between 27 and 40 and metabolic syndrome. The trial reported herein is an interim subgroup analysis of the intermediate outcome body composition after 3-year follow-up, and data analysis was conducted from February 1 to November 30, 2022. Of 6874 total PREDIMED-Plus participants, a subsample of 1521 individuals, coming from centers with access to a dual energy x-ray absorptiometry device, underwent body composition measurements at 3 time points.
INTERVENTION
Participants were randomly allocated to a multifactorial intervention based on an energy-reduced Mediterranean diet (MedDiet) and increased physical activity (PA) or to a control group based on usual care, with advice to follow an ad libitum MedDiet, but no physical activity promotion.
MAIN OUTCOMES AND MEASURES
The outcomes (continuous) were 3-year changes in total fat and lean mass (expressed as percentages of body mass) and visceral fat (in grams), tested using multivariable linear mixed-effects models. Clinical relevance of changes in body components (dichotomous) was assessed based on 5% or more improvements in baseline values, using logistic regression. Main analyses were performed in the evaluable population (completers only) and in sensitivity analyses, multiple imputation was performed to include data of participants lost to follow-up (intention-to-treat analyses).
RESULTS
A total of 1521 individuals were included (mean [SD] age, 65.3 [5.0] years; 52.1% men). In comparison with the control group (n=761), participants in the intervention arm (n=760) showed greater reductions in the percentage of total fat (between group differences after 1-year, -0.94% [95% CI, -1.19 to -0.69]; 3 years, -0.38% [95% CI, -0.64 to -0.12] and visceral fat storage after 1 year, -126 g [95% CI, -179 to -73.3 g]; 3 years, -70.4 g [95% CI, -126 to -15.2 g] and greater increases in the percentage of total lean mass at 1 year, 0.88% [95% CI, 0.63%-1.12%]; 3-years 0.34% [95% CI, 0.09%-0.60%]). The intervention group was more likely to show improvements of 5% or more in baseline body components (absolute risk reduction after 1 year, 13% for total fat mass, 11% for total lean mass, and 14% for visceral fat mass; after 3-years: 6% for total fat mass, 6% for total lean mass, and 8% for visceral fat mass). The number of participants needed to treat was between 12 and 17 to attain at least 1 individual with possibly clinically meaningful improvements in body composition.
CONCLUSIONS AND RELEVANCE
The findings of this trial suggest a weight-loss lifestyle intervention based on an energy-reduced MedDiet and physical activity significantly reduced total and visceral fat and attenuated age-related losses of lean mass in older adults with overweight or obesity and metabolic syndrome. Continued follow-up is warranted to confirm the long-term consequences of these changes on cardiovascular clinical end points.
TRIAL REGISTRATION
isrctn.org Identifier: ISRCTN89898870.
Topics: Male; Humans; Female; Aged; Middle Aged; Metabolic Syndrome; Diet, Mediterranean; Cardiovascular Diseases; Exercise; Weight Loss; Body Composition
PubMed: 37851444
DOI: 10.1001/jamanetworkopen.2023.37994 -
Physiological Reports Nov 2023The existence of spot reduction, exercise-induced local body fat reduction, has been debated for half a century. Although the evidence is equivocal, no study has applied... (Randomized Controlled Trial)
Randomized Controlled Trial
The existence of spot reduction, exercise-induced local body fat reduction, has been debated for half a century. Although the evidence is equivocal, no study has applied aerobic endurance training closely matching interventions for energy expenditure. Sixteen overweight (BMI: 29.8 ± 3.3(SD) kg m ) males (43 ± 9 years) were randomized to: (1) abdominal endurance exercise (AG), combining treadmill running at 70% HR (27 min) with 4 × 4 min (30%-40% maximal strength, 1RM) of torso rotation and abdominal crunches (57 min), 4 days⋅week for 10 weeks; or (2) control group (CG) performing only treadmill running (45 min) at 70% HR . Local fat mass was measured by dual-energy x-ray absorptiometry (DEXA), along with 1RM, and pulmonary oxygen uptake (to control energy expenditure during training). Trunk fat mass decreased more (697 g, 3%, p < 0.05) in AG (1170 ± 1093 g, 7%; p < 0.05) than in CG (no change). Total fat mass (AG: 1705 ± 1179 g, 6%; CG: 1134 ± 731 g, 5%; both p < 0.01) and body weight (AG: 1.2 ± 1.2 kg, 1%, p < 0.05; CG: 2.3 ± 0.9 kg, 3%, p < 0.01) decreased similarly in AG/CG. Torso rotation (AG: 32 ± 16 kg, 39%, p < 0.01; CG: no change) and abdominal crunch 1RM (AG: 35 ± 16 kg, 36%, p < 0.01; CG: 13 ± 12 kg, 17%, p < 0.05) increased more (p < 0.05/0.01) in AG than CG. Abdominal endurance exercise utilized more local fat than treadmill running, indicating that spot reduction exists in adult males.
Topics: Adult; Male; Humans; Exercise Therapy; Exercise; Abdominal Muscles; Body Weight; Adipose Tissue; Body Composition
PubMed: 38010201
DOI: 10.14814/phy2.15853 -
Sports Medicine (Auckland, N.Z.) Dec 2023Resting metabolic rate (RMR) prediction equations are often used to calculate RMR in athletes; however, their accuracy and precision can vary greatly. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Resting metabolic rate (RMR) prediction equations are often used to calculate RMR in athletes; however, their accuracy and precision can vary greatly.
OBJECTIVE
The aim of this systematic review and meta-analysis was to determine which RMR prediction equations are (i) most accurate (average predicted values closest to measured values) and (ii) most precise (number of individuals within 10% of measured value).
DATA SOURCES
A systematic search of PubMed, CINAHL, SPORTDiscus, Embase, and Web of Science up to November 2021 was conducted.
ELIGIBILITY CRITERIA
Randomised controlled trials, cross-sectional observational studies, case studies or any other study wherein RMR, measured by indirect calorimetry, was compared with RMR predicted via prediction equations in adult athletes were included.
ANALYSIS
A narrative synthesis and random-effects meta-analysis (where possible) was conducted. To explore heterogeneity and factors influencing accuracy, subgroup analysis was conducted based on sex, body composition measurement method, athlete characteristics (athlete status, energy availability, body weight), and RMR measurement characteristics (adherence to best practice guidelines, test preparation and prior physical activity).
RESULTS
Twenty-nine studies (mixed sports/disciplines n = 8, endurance n = 5, recreational exercisers n = 5, rugby n = 3, other n = 8), with a total of 1430 participants (822 F, 608 M) and 100 different RMR prediction equations were included. Eleven equations satisfied criteria for meta-analysis for accuracy. Effect sizes for accuracy ranged from 0.04 to - 1.49. Predicted RMR values did not differ significantly from measured values for five equations (Cunningham (1980), Harris-Benedict (1918), Cunningham (1991), De Lorenzo, Ten-Haaf), whereas all others significantly underestimated or overestimated RMR (p < 0.05) (Mifflin-St. Jeor, Owen, FAO/WHO/UNU, Nelson, Koehler). Of the five equations, large heterogeneity was observed for all (p < 0.05, I range: 80-93%) except the Ten-Haaf (p = 0.48, I = 0%). Significant differences between subgroups were observed for some but not all equations for sex, athlete status, fasting status prior to RMR testing, and RMR measurement methodology. Nine equations satisfied criteria for meta-analysis for precision. Of the nine equations, the Ten-Haaf was found to be the most precise, predicting 80.2% of participants to be within ± 10% of measured values with all others ranging from 40.7 to 63.7%.
CONCLUSION
Many RMR prediction equations have been used in athletes, which can differ widely in accuracy and precision. While no single equation is guaranteed to be superior, the Ten-Haaf (age, weight, height) equation appears to be the most accurate and precise in most situations. Some equations are documented as consistently underperforming and should be avoided. Choosing a prediction equation based on a population of similar characteristics (physical characteristics, sex, sport, athlete status) is preferable. Caution is warranted when interpreting RMR ratio of measured to predicted values as a proxy of energy availability from a single measurement.
PROSPERO REGISTRATION
CRD42020218212.
Topics: Adult; Humans; Basal Metabolism; Cross-Sectional Studies; Athletes; Sports; Body Composition; Body Mass Index
PubMed: 37632665
DOI: 10.1007/s40279-023-01896-z -
Journal of the International Society of... Dec 2023It is unclear whether resistance (RT) and concurrent training (CT; resistance plus endurance training) combined with different protein intakes have differential effects...
Effects of 16 weeks of two different high-protein diets with either resistance or concurrent training on body composition, muscular strength and performance, and markers of liver and kidney function in resistance-trained males.
PURPOSE
It is unclear whether resistance (RT) and concurrent training (CT; resistance plus endurance training) combined with different protein intakes have differential effects on muscle hypertrophy, strength, and performance. Therefore, we compared the effects of two high-protein diets (1.6 or 3.2 g.kgd) during 16 weeks of either CT or RT alone in resistance-trained males.
METHODS
Forty-eight resistance-trained males (age: 26 ± 6 yr, body mass index: 25.6 ± 2.9 kg.m) performed 16 weeks (four sessions·w) of CT or RT with either 1.6 g.kgd protein (CT1; = 12; RT1; = 12) or 3.2 g.kgd protein (CT2; = 12; RT2; = 12). Training adaptations were assessed pre-, mid-, and post-intervention.
RESULTS
All measures of performance (endurance, vertical jump, and pull-up), lean mass, muscle strength, and power significantly increased post-intervention in all groups, but peak power gains were greater in RT2 compared with RT1 and CT1 ( < .05). VO significantly increased in both CT groups ( < .001). Select biochemical markers of kidney and liver function significantly increased within the RT2 and CT2 groups ( < .05), however, no between-group differences were apparent ( > .05).
CONCLUSIONS
With the exception of peak power, intake of 1.6 g.kgd of protein appears sufficient to maximize gains in lean mass, muscle strength, performance, and aerobic capacity during both RT and CT without influencing markers of kidney and liver function, indicating this daily protein amount is effective and safely tolerated in young, healthy adults.
Topics: Adult; Male; Humans; Young Adult; Liver; Body Composition; Kidney; Diet, High-Protein; Muscle Strength
PubMed: 37516903
DOI: 10.1080/15502783.2023.2236053