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Prevalence and Characteristics of Sarcopenic Obesity in Adults with Class II/III Obesity Open Access

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Other title
Subject/Keyword
sarcopenia
obesity
body composition
dual energy X-ray absorptiometry
bariatric
bioelectrical impedance analysis
class II/III obesity
activities of daily living
appendicular skeletal mass
fat free mass
fat mass
lean soft tissue
Type of item
Thesis
Degree grantor
University of Alberta
Author or creator
Johnson Stoklossa, Carlene A.
Supervisor and department
Prado, Carla (Agricultural, Food and Nutritional Science)
Examining committee member and department
Chan, Catherine (Dept. Physiology and Dept. Agricultural, Food, and Nutritional Science
Forhan, Mary (Occupational Therapy)
Padway, Raj (Medicine)
Department
Department of Agricultural, Food, and Nutritional Science
Specialization
Nutrition and Metabolism
Date accepted
2016-09-30T10:39:33Z
Graduation date
2016-06:Fall 2016
Degree
Master of Science
Degree level
Master's
Abstract
Adults with class II/III obesity (BMI ≥35 kg/m2) are at increased health risk, and may also present with lower lean mass in relation to excess adiposity, a condition termed sarcopenic obesity. A variety of body composition indices and cutpoints have been used to define this condition, mostly in older adults (>65 years), leading to conflicting prevalence and risk prediction. Sarcopenia is associated with increased morbidity and mortality in the elderly, but the clinical implications in adults with class II/III obesity are unknown. The objective of this thesis was two-fold. First, to explore the prevalence of sarcopenia in a sample of adults with class II/III obesity using different diagnostic criteria, and second, to describe the clinical characteristics of participants with sarcopenic obesity, compared to their counterparts (non-sarcopenic obese). Eighteen definitions for sarcopenic obesity were initially identified from a literature review of studies using dual-energy X-ray absorptiometry (DXA) to assess lean mass, and applied to a sample of patients from an obesity specialty clinic. In this cross-sectional analysis, baseline data on demographic, anthropometric, biochemical, comorbidity, and activity variables were collected. Body composition was assessed by DXA. Self-reported difficulties with activities of daily living (ADL) were evaluated from 11 items on a questionnaire. A total of 120 participants (86 % female) aged 46 ± 11 years were included. Lean mass was extremely variable in individuals, even with similar body sizes, and across the age spectrum. The prevalence of sarcopenic obesity ranged from 0 – 84.5 % in females and 0 – 100 % in males, depending upon the diagnostic criteria applied, with higher prevalence among definitions accounting for measures of body size or fat mass. In order to select a cohort-specific definition of sarcopenic obesity for this young-to-middle aged cohort, we explored five criteria, which were tested in relation to self-reported ADL using receiver operating characteristic analysis. The appendicular skeletal mass by weight x 100 (%) definition was the best correlate for both sexes [females (r= -0.232, p=.024); males (rs =-0.510, p=.037)], and therefore chosen as the method to define sarcopenia in this cohort. Sex-specific cutpoints of appendicular skeletal mass/weight x 100 (%) were <19.35 % for females and < 24.33 % for males, which resulted in a prevalence of sarcopenic obesity of 25% (females 22.3 %, males 41.2 %). Sarcopenic obesity was significantly associated with older age (50.7 ± 12.7 vs. 45.7 ± 10.3 years for non-sarcopenic, p=.033), higher waist circumference (130.2 ± 21.1 vs. 121.1 ± 11.7 cm for non-sarcopenic, p=.004), and higher triglycerides (2.06 ± 1.00 vs. 1.62 ± 0.73 mmol/L, p=.040). Only two participants had hypoalbuminemia and both were identified with sarcopenia. The use of anti-hypertensive medications was greater among individuals with sarcopenic obesity, compared to their counterparts (50 vs. 28.9%, respectively, p=0.035). Individuals with sarcopenic obesity were less likely to meet physical activity guidelines (3.3 vs. 25.6 % of participants without sarcopenia, p=0.007). In participants who met guidelines, 95.8 % were identified as non-sarcopenic. Nearly three-quarters of participants with sarcopenic obesity reported difficulty with ≥3 ADL items compared to less than half (44 %) of the non-sarcopenic obese group. (p=0.08). Individuals with sarcopenic obesity were 5.4 times more likely to report ≥ 3 items for difficulty with ADL, independent of age, sex and multimorbidity. In summary, sarcopenic obesity was present in a sample of young-to-middle aged adults with class II/III obesity and associated with poorer clinical characteristics, when compared the non-sarcopenic obese group. Investigating the prevalence and clinical characteristics of sarcopenic obesity is an important step towards recognition of this condition as a significant health problem, and for the establishment of adequate prevention and treatment strategies.
Language
English
DOI
doi:10.7939/R3D795N2Z
Rights
This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for the purpose of private, scholarly or scientific research. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
Citation for previous publication
Johnson Stoklossa CA, Forhan M, Padwal RS, Gonzalez MC and Prado CM, Practical considerations for body composition assessment of adults with class II/III obesity using bioelectrical impedance analysis or dual-energy X-ray absorptiometry. Current Obesity Reports, 2016. DOI: 10.1007/s13679-016-0228-5.

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