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Sarkopenik Obezite ile Mücadelede Egzersiz ve Beslenme Stratejileri

Yıl 2023, Sayı: 20, 677 - 691, 09.09.2023

Ayşe Şimşek Musa Güneş Büşra Demirer

https://doi.org/10.38079/igusabder.1272892

Öz

İskelet kas kütlesindeki azalma ile birlikte yağ kütlesindeki artış sarkopenik obezite (SO) olarak tanımlanmaktadır. Dünya nüfusunun yaşlanmasına bağlı olarak kronik hastalık ve fiziksel yetersizlik ile yaşayan bireylerin sayısı da hızla artmaktadır. Yaşlanma, visseral yağda artış ve kas kütlesinde azalma gibi vücut kompozisyonunda çeşitli değişikliklere neden olmaktadır. İnsan vücudu yaşlandıkça, iskelet kas kütlesi 30 yaşından itibaren yılda yaklaşık %0,1-0,5 oranında azalmakta ve orta yaştan sonra bu oran her on yılda yaklaşık %6’ya kadar yükselmektedir. Dünya genelinde SO prevalansı %5-10 arasında değişmektedir. SO kardiyo-metabolik hastalıklar ve bunlardan kaynaklanan morbidite-mortalite ile yakından ilişkilidir ve tek başına sarkopeni ya da obeziteye göre klinik sonuçları çok daha kötüdür. Etyopatogenezinde; diyet, düşük fiziksel aktivite, sigara, hormonal değişiklikler, oksidatif stres, nörömusküler değişiklikler ve immünolojik faktörler rol oynamaktadır. SO yönetiminde yaşanan temel problem yağ kütlesini azaltırken iskelet kas kütlesini korumaktır. Egzersiz ve beslenme SO’nun önlenmesi ve yönetiminde kullanılan en önemli farmakolojik olmayan bileşenlerdir. Ancak tek başına egzersiz veya beslenme stratejileri SO’daki iskelet kas kaybını engellemede tam olarak başarılı değildir. Literatüre göre protein ve D vitamini takviyesi içeren, gün içine yayılmış bir diyetle birlikte kombine dirençli ve aerobik egzersiz şu an için en etkili yönetim stratejisi olarak görülmektedir. Bu derlemenin amacı, SO’nun tanımı, klinik sonuçları, önlenmesi ve/veya tedavisine yönelik etkili egzersiz ve beslenme stratejileri ile ilgili güncel verilerin özetini sunmak ve literatürdeki sınırlamaları vurgulamaktır.

Anahtar Kelimeler

Beslenme egzersiz obezite sarkopeni

Kaynakça

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  • Donini LM, Busetto L, Bauer JM, et al. Critical appraisal of definitions and diagnostic criteria for sarcopenic obesity based on a systematic review. Clinical Nutrition. 2020;39(8):2368-2388. doi:10.1016/j.clnu.2019.11.024.
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  • Kim H, Kim M, Kojima N, et al. Exercise and nutritional supplementation on community-dwelling elderly japanese women with sarcopenic obesity: a randomized controlled trial. Journal of the American Medical Directors Association. 2016;17(11):1011-1019. doi:10.1016/j.jamda.2016.06.016.
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  • Petroni ML, Caletti MT, Dalle Grave R, Bazzocchi A, Aparisi Gómez MP, Marchesini G. Prevention and treatment of sarcopenic obesity in women. Nutrients. 2019;11(6):1302. doi:10.3390/nu11061302.
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  • Delmonico MJ, Harris TB, Visser M, et al. Longitudinal study of muscle strength, quality, and adipose tissue infiltration. American Journal of Clinical Nutrition. 2009;90(6):1579-1585. doi:10.3945/ajcn.2009.28047.
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  • Hita-Contreras F, Bueno-Notivol J, Martínez-Amat A, Cruz-Díaz D, Hernandez AV, Pérez-López FR. Effect of exercise alone or combined with dietary supplements on anthropometric and physical performance measures in community-dwelling elderly people with sarcopenic obesity: A meta-analysis of randomized controlled trials. Maturitas. 2018;116:24-35. doi:10.1016/j.maturitas.2018.07.007.

Exercise and Nutrition Strategies for Combating Sarcopenic Obesity

Yıl 2023, Sayı: 20, 677 - 691, 09.09.2023

Ayşe Şimşek Musa Güneş Büşra Demirer

https://doi.org/10.38079/igusabder.1272892

Öz

The increase in fat mass, together with the decrease in skeletal muscle mass, is defined as sarcopenic obesity (SO). Due to the aging of the world population, the number of individuals living with chronic disease and physical limitation is increasing rapidly. Aging causes various changes in body composition, such as increased visceral fat and decreased muscle mass. As the human body ages, skeletal muscle mass decreases by about 0.1-0.5% per year from the age of 30, and after middle age, this rate rises to about 6% per decade. The prevalence of SO in the world varies between 5-10%. SO is closely associated with cardio-metabolic diseases, and the resulting morbidity-mortality and clinical outcomes are much worse than sarcopenia or obesity alone. Diet, low physical activity, smoking, hormonal changes, oxidative stress, neuromuscular changes, and immunological factors play a role in its etiopathogenesis. The main problem in SO management is to preserve skeletal muscle mass while reducing fat mass. Exercise and nutrition are the most important non-pharmacological components used in the prevention and management of SO. However, exercise or nutritional strategies alone are not entirely successful in preventing skeletal muscle losing in SO. According to the literature, combined resistance and aerobic exercise with a spread throughout-the-day diet containing protein and vitamin D supplementation is currently the most effective management strategy. Although the current literature on sarcopenia and obesity is quite rich, studies on SO are limited. The purpose of this review is to provide a summary of recent data on the definition, clinical outcomes, effective exercise, and nutritional strategies for the prevention and/or treatment of SO and to highlight the limitations in the literature.

Anahtar Kelimeler

Nutrition exercise obesity sarcopenia

Kaynakça

  • Trouwborst I, Verreijen A, Memelink R, et al. Exercise and nutrition strategies to counteract sarcopenic obesity. Nutrients. 2018;10(5):605. doi:10.3390/nu10050605.
  • Curcio F, Ferro G, Basile C, et al. Biomarkers in sarcopenia: A multifactorial approach. Experimental Gerontology. 2016;85:1-8. doi:10.1016/j.exger.2016.09.007.
  • Janssen I. Evolution of sarcopenia research. Appl Physiology, Nutrition, and Metabolism. 2010;35(5):707-712. doi:10.1139/H10-067.
  • Morley JE, Baumgartner RN, Roubenoff R, Mayer J, Nair KS. Sarcopenia. The Journal of Laboratory and Clinical Medicine. 2001;137(4):231-243. doi:10.1067/mlc.2001.113504.
  • Dent E, Morley JE, Cruz-Jentoft AJ, et al. International Clinical Practice Guidelines for Sarcopenia (ICFSR): Screening, diagnosis and management. The Journal of Nutrition, Health & Aging. 2018;22(10):1148-1161. doi:10.1007/s12603-018-1139-9.
  • Donini LM, Busetto L, Bauer JM, et al. Critical appraisal of definitions and diagnostic criteria for sarcopenic obesity based on a systematic review. Clinical Nutrition. 2020;39(8):2368-2388. doi:10.1016/j.clnu.2019.11.024.
  • Lee DC, Shook RP, Drenowatz C, Blair SN. Physical activity and sarcopenic obesity: definition, assessment, prevalence and mechanism. Future Science OA. 2016;2(3):Fso127. doi:10.4155/fsoa-2016-0028.
  • Kim H, Kim M, Kojima N, et al. Exercise and nutritional supplementation on community-dwelling elderly japanese women with sarcopenic obesity: a randomized controlled trial. Journal of the American Medical Directors Association. 2016;17(11):1011-1019. doi:10.1016/j.jamda.2016.06.016.
  • Liao CD, Tsauo JY, Wu YT, et al. Effects of protein supplementation combined with resistance exercise on body composition and physical function in older adults: A systematic review and meta-analysis. The American Journal of Clinical Nutrition. 2017;106(4):1078-1091. doi:10.3945/ajcn.116.143594.
  • Martínez-Amat A, Aibar-Almazán A, Fábrega-Cuadros R, et al. Exercise alone or combined with dietary supplements for sarcopenic obesity in community-dwelling older people: A systematic review of randomized controlled trials. Maturitas. 2018;110:92-103. doi:10.1016/j.maturitas.2018.02.005.
  • Petroni ML, Caletti MT, Dalle Grave R, Bazzocchi A, Aparisi Gómez MP, Marchesini G. Prevention and treatment of sarcopenic obesity in women. Nutrients. 2019;11(6):1302. doi:10.3390/nu11061302.
  • Prado CM, Wells JC, Smith SR, Stephan BC, Siervo M. Sarcopenic obesity: A critical appraisal of the current evidence. Clinical Nutrition. 2012;31(5):583-601. doi:10.1016/j.clnu.2012.06.010.
  • Delmonico MJ, Harris TB, Visser M, et al. Longitudinal study of muscle strength, quality, and adipose tissue infiltration. American Journal of Clinical Nutrition. 2009;90(6):1579-1585. doi:10.3945/ajcn.2009.28047.
  • Polyzos SA, Margioris AN. Sarcopenic obesity. Hormones International Journal of Endocrinology and Metabolism. 2018;17(3):321-331. doi:10.1007/s42000-018-0049-x.
  • Guillet C, Boirie Y. Insulin resistance: a contributing factor to age-related muscle mass loss? Diabetes & Metabolism. 2005;31SpecNo2:5s20-26. doi:10.1016/s1262-3636(05)73648-x.
  • Woodrow G. Body composition analysis techniques in the aged adult: indications and limitations. Current Opinion in Clinical Nutrition Metabolic Care. 2009;12(1):8-14. doi:10.1097/MCO.0b013e32831b9c5b.
  • Hita-Contreras F. Female Sarcopenic Obesity. In: Pérez-López, FR, ed. Postmenopausal Diseases and Disorders. Manhattan, New York: Springer; 2019:405-422.
  • Choi KM. Sarcopenia and sarcopenic obesity. The Korean Journal of Internal Medicine. 2016;31(6):1054-1060. doi:10.3904/kjim.2016.193.
  • Kohara K. Sarcopenic obesity in aging population: Current status and future directions for research. Endocrine. 2014;45(1):15-25. doi:10.1007/s12020-013-9992-0.
  • Wannamethee SG, Atkins JL. Muscle loss and obesity: The health implications of sarcopenia and sarcopenic obesity. The Proceedings Nutrition Society. 2015;74(4):405-412. doi:10.1017/S002966511500169X.
  • Choi KM. Sarcopenia and sarcopenic obesity. Endocrinology and Metabolism. 2013;28(2):86-89. doi:10.3803/EnM.2013.28.2.86.
  • Stenholm S, Harris TB, Rantanen T, Visser M, Kritchevsky SB, Ferrucci L. Sarcopenic obesity-definition, etiology and consequences. Current Opinion in Clinical Nutrition and Metabolic Care. 2008;11(6):693. doi:10.1097/MCO.0b013e328312c37d.
  • 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(6):e100118. doi:10.1371/journal.pone.0100118.
  • 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 (KLoSHA). Diabetes Care. 2010;33(7):1652-1654. doi:10.2337/dc10-0107.
  • 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. Archives of Gerontology and Geriatrics. 2013;56(1):270-278. doi:10.1016/j.archger.2012.09.007.
  • Stephen WC, Janssen I. Sarcopenic-obesity and cardiovascular disease risk in the elderly. The Journal of Nutrition, Health & Aging. 2009;13(5):460-466. doi:10.1007/s12603-009-0084-z.
  • Tian S, Xu Y. Association of sarcopenic obesity with the risk of all-cause mortality: A meta-analysis of prospective cohort studies. Geriatrics & Gerontology International. 2016;16(2):155-166. doi:10.1111/ggi.12579.
  • Naseeb MA, Volpe SL. Protein and exercise in the prevention of sarcopenia and aging. Nutrition Research. 2017;40:1-20. doi:10.1016/j.nutres.2017.01.001.
  • Reiner M, Niermann C, Jekauc D, Woll A. Long-term health benefits of physical activity-a systematic review of longitudinal studies. BMC Public Health. 2013;13:813. doi:10.1186/1471-2458-13-813.
  • Theodorakopoulos C, Jones J, Bannerman E, Greig CA. Effectiveness of nutritional and exercise interventions to improve body composition and muscle strength or function in sarcopenic obese older adults: A systematic review. Nutrition Research. 2017;43:3-15. doi:10.1016/j.nutres.2017.05.002.
  • Villareal DT, Aguirre L, Gurney AB, et al. Aerobic or resistance exercise, or both, in dieting obese older adults. The New England Journal of Medicine. 2017;376(20):1943-1955. doi:10.1056/NEJMoa1616338ç.
  • Schoufour JD, Tieland M, Barazzoni R, et al. The relevance of diet, physical activity, exercise, and persuasive technology in the prevention and treatment of sarcopenic obesity in older adults. Frontiers in Nutrition. 2021;8:661449. doi:10.3389/fnut.2021.661449.
  • Güneş M, Demirer B, Şimşek A. Dirençli egzersiz eğitiminin obez bireylerde vücut kas ve yağ parametreleri üzerine etkisi. Türkiye Diyabet ve Obezite Dergisi. 2021;5(1):75-80. doi:10.25048/tudod.822698.
  • Liu CJ, Chang WP, Araujo de Carvalho I, Savage KEL, Radford LW, Amuthavalli Thiyagarajan J. Effects of physical exercise in older adults with reduced physical capacity: Meta-analysis of resistance exercise and multimodal exercise. International Journal of Rehabilitation Research. 2017;40(4):303-314. doi:10.1097/MRR.0000000000000249.
  • Peterson MD, Rhea MR, Sen A, Gordon PM. Resistance exercise for muscular strength in older adults: A meta-analysis. Ageing Research Reviews. 2010;9(3):226-237. doi:10.1016/j.arr.2010.03.004.
  • Peterson MD, Sen A, Gordon PM. Influence of resistance exercise on lean body mass in aging adults: A meta-analysis. Medicine and Science in Sports and Exercise. 2011;43(2):249-258. doi:10.1249/MSS.0b013e3181eb6265.
  • Gadelha AB, Paiva FM, Gauche R, de Oliveira RJ, Lima RM. Effects of resistance training on sarcopenic obesity index in older women: A randomized controlled trial. Archives of Gerontology and Geriatrics. 2016;65:168-173. doi:10.1016/j.archger.2016.03.017.
  • Liao CD, Tsauo JY, Huang SW, Ku JW, Hsiao DJ, Liou TH. Effects of elastic band exercise on lean mass and physical capacity in older women with sarcopenic obesity: A randomized controlled trial. Scientific Reports. 2018;8(1):2317. doi:10.1038/s41598-018-20677-7.
  • Balachandran A, Krawczyk SN, Potiaumpai M, Signorile JF. High-speed circuit training vs hypertrophy training to improve physical function in sarcopenic obese adults: A randomized controlled trial. Experimental Gerontology. 2014;60:64-71. doi:10.1016/j.exger.2014.09.016.
  • Huang SW, Ku JW, Lin LF, Liao CD, Chou LC, Liou TH. Body composition influenced by progressive elastic band resistance exercise of sarcopenic obesity elderly women: A pilot randomized controlled trial. European Journal of Physical and Rehabilitation Medicine. 2017;53(4):556-563. doi:10.23736/S1973-9087.17.04443-4.
  • Liao CD, Tsauo JY, Lin LF, et al. Effects of elastic resistance exercise on body composition and physical capacity in older women with sarcopenic obesity: A CONSORT-compliant prospective randomized controlled trial. Medicine. 2017;96(23):e7115. doi:10.1097/MD.0000000000007115.
  • Voet NB, van der Kooi EL, Riphagen, II, Lindeman E, van Engelen BG, Geurts AC. Strength training and aerobic exercise training for muscle disease. The Cochrane Database of Systematic Reviews. 2013(7):Cd003907. doi:10.1002/14651858.CD003907.pub4.
  • Forbes SC, Little JP, Candow DG. Exercise and nutritional interventions for improving aging muscle health. Endocrine. 2012;42(1):29-38. doi:10.1007/s12020-012-9676-1.
  • Landi F, Marzetti E, Martone AM, Bernabei R, Onder G. Exercise as a remedy for sarcopenia. Current Opinion in Clinical Nutrition and Metabolic Care. 2014;17(1):25-31. doi:10.1097/MCO.0000000000000018.
  • Agarwal SK. Cardiovascular benefits of exercise. International Journal of General Medicine. 2012;5:541-545. doi:10.2147/IJGM.S30113.
  • Laughlin MH, Roseguini B. Mechanisms for exercise training-induced increases in skeletal muscle blood flow capacity: differences with interval sprint training versus aerobic endurance training. J Physiol Pharmacol. 2008;59Suppl7(Suppl7):71-88.
  • Lundby C, Jacobs RA. Adaptations of skeletal muscle mitochondria to exercise training. Experimental Physiology. 2016;101(1):17-22. doi:10.1113/EP085319.
  • Misic MM, Rosengren KS, Woods JA, Evans EM. Muscle quality, aerobic fitness and fat mass predict lower-extremity physical function in community-dwelling older adults. Gerontology. 2007;53(5):260-266. doi:10.1159/000101826.
  • Short KR, Vittone JL, Bigelow ML, Proctor DN, Nair KS. Age and aerobic exercise training effects on whole body and muscle protein metabolism. American Journal of Physiology, Endocrinology and Metabolism. 2004;286(1):E92-101. doi:10.1152/ajpendo.00366.2003.
  • Sawyer BJ, Bhammar DM, Angadi SS, et al. Predictors of fat mass changes in response to aerobic exercise training in women. Journal of Strength and Conditioning Research. 2015;29(2):297-304. doi:10.1519/JSC.0000000000000726.
  • Chen HT, Chung YC, Chen YJ, Ho SY, Wu HJ. Effects of different types of exercise on body composition, muscle strength, and IGF-1 in the elderly with sarcopenic obesity. Journal of the American Geriatrics Society. 2017;65(4):827-832. doi:10.1111/jgs.14722.
  • Yurtseven M. Sarkopenik obezitede egzersiz yaklaşımları. Journal of Medical Sciences. 2023;4(1):1-7. doi:10.46629/JMS.2023.100.
  • Bell GJ, Syrotuik D, Martin TP, Burnham R, Quinney HA. Effect of concurrent strength and endurance training on skeletal muscle properties and hormone concentrations in humans. European Journal of Applied Physiology. 2000;81(5):418-427. doi:10.1007/s004210050063.
  • Koliaki C, Liatis S, Dalamaga M, Kokkinos A. Sarcopenic obesity: epidemiologic evidence, pathophysiology, and therapeutic perspectives. Current Obesity Reports. 2019;8(4):458-471. doi:10.1007/s13679-019-00359-9.
  • Heymsfield SB, Gonzalez MC, Shen W, Redman L, Thomas D. Weight loss composition is one-fourth fat-free mass: A critical review and critique of this widely cited rule. Obesity Reviews. 2014;15(4):310-321. doi:10.1111/obr.12143.
  • Batsis JA, Villareal DT. Sarcopenic obesity in older adults: Aetiology, epidemiology and treatment strategies. Nature Reviews Endocrinology. 2018;14(9):513-537. doi:10.1038/s41574-018-0062-9.
  • Dam TT, Peters KW, Fragala M, et al. An evidence-based comparison of operational criteria for the presence of sarcopenia. The Journals of Gerontology. 2014;69(5):584-590. doi:10.1093/gerona/glu013.
  • Malafarina V, Uriz-Otano F, Iniesta R, Gil-Guerrero L. Effectiveness of nutritional supplementation on muscle mass in treatment of sarcopenia in old age:A systematic review. Journal of the American Medical Directors Association. 2013;14(1):10-17. doi:10.1016/j.jamda.2012.08.001.
  • Dangin M, Guillet C, Garcia-Rodenas C, et al. The rate of protein digestion affects protein gain differently during aging in humans. J Physiol. 2003;549(Pt2):635-644. doi:10.1113/jphysiol.2002.036897.
  • Jonker R, Engelen MP, Deutz NE. Role of specific dietary amino acids in clinical conditions. The British Journal of Nutrition. 2012;108Suppl2(02):S139-148. doi:10.1017/S0007114512002358.
  • Schoenfeld BJ, Aragon AA, Krieger JW. The effect of protein timing on muscle strength and hypertrophy: A meta-analysis. Journal of Internation Society of Sports Nutrition. 2013;10(1):53. doi:10.1186/1550-2783-10-53.
  • van Vliet S, Burd NA, van Loon LJ. The skeletal muscle anabolic response to plant- versus animal-based protein consumption. The Journal of Nutrition. 2015;145(9):1981-1991. doi:10.3945/jn.114.204305.
  • Mamerow MM, Mettler JA, English KL, et al. Dietary protein distribution positively influences 24-h muscle protein synthesis in healthy adults. The Journal of Nutrition. 2014;144(6):876-880. doi:10.3945/jn.113.185280.
  • Bauer J, Biolo G, Cederholm T, et al. Evidence-based recommendations for optimal dietary protein intake in older people: A position paper from the PROT-AGE Study Group. Journal of the American Medical Directors Association. 2013;14(8):542-559. doi:10.1016/j.jamda.2013.05.021.
  • Kim JE, O'Connor LE, Sands LP, Slebodnik MB, Campbell WW. Effects of dietary protein intake on body composition changes after weight loss in older adults: A systematic review and meta-analysis. Nutrition Reviews. 2016;74(3):210-224. doi:10.1093/nutrit/nuv065.
  • Chanet A, Verlaan S, Salles J, et al. Supplementing breakfast with a vitamin D and leucine-enriched whey protein medical nutrition drink enhances postprandial muscle protein synthesis and muscle mass in healthy older men. The Journal of Nutrition. 2017;147(12):2262-2271. doi:10.3945/jn.117.252510.
  • Nabuco HCG, Tomeleri CM, Fernandes RR, et al. Effect of whey protein supplementation combined with resistance training on body composition, muscular strength, functional capacity, and plasma-metabolism biomarkers in older women with sarcopenic obesity: A randomized, double-blind, placebo-controlled trial. Clinical Nutrition ESPEN. 2019;32:88-95. doi: 10.1016/j.clnesp.2019.04.007.
  • Hita-Contreras F, Bueno-Notivol J, Martínez-Amat A, Cruz-Díaz D, Hernandez AV, Pérez-López FR. Effect of exercise alone or combined with dietary supplements on anthropometric and physical performance measures in community-dwelling elderly people with sarcopenic obesity: A meta-analysis of randomized controlled trials. Maturitas. 2018;116:24-35. doi:10.1016/j.maturitas.2018.07.007.
Toplam 68 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Tıp Bilimleri
Bölüm Makaleler
Yazarlar

Ayşe Şimşek 0000-0001-9315-1534

Musa Güneş 0000-0001-8532-2575

Büşra Demirer 0000-0003-1945-0485

Erken Görünüm Tarihi 31 Ağustos 2023
Yayımlanma Tarihi 9 Eylül 2023
Kabul Tarihi 10 Temmuz 2023
Yayımlandığı Sayı Yıl 2023 Sayı: 20

Kaynak Göster

JAMA Şimşek A, Güneş M, Demirer B. Sarkopenik Obezite ile Mücadelede Egzersiz ve Beslenme Stratejileri. IGUSABDER. 2023;:677–691.
 Kapak Resmi İndir

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