Sarcopenic Obesity in Adults: Endocrine-Metabolic Mechanisms, Body Composition, and Nutritional Strategies in the Latin American Context
DOI:
https://doi.org/10.64784/325Palabras clave:
sarcopenic obesity, sarcopenia, obesity, body composition, skeletal muscle, insulin resistance, inflammation, nutrition, resistance training, Latin AmericaResumen
Sarcopenic obesity is a complex clinical condition characterized by the coexistence of excessive adiposity and reduced skeletal muscle mass, strength, or function, generating a phenotype associated with metabolic dysfunction, physical limitation, and increased clinical vulnerability. This study aimed to analyze the endocrine-metabolic mechanisms, body-composition alterations, diagnostic approaches, and nutritional and exercise strategies related to sarcopenic obesity in adults, with particular emphasis on the Latin American context. An integrative literature review structured according to the Scientific Method was conducted using evidence from systematic reviews, meta-analyses, clinical trials, observational studies, and international consensus statements. The analyzed evidence showed a high burden of abdominal obesity in Latin America, considerable variability in sarcopenic obesity prevalence according to diagnostic criteria, and a relevant coexistence of obesity with impaired muscle function in adult and older populations. Insulin resistance, chronic low-grade inflammation, ectopic fat accumulation, hormonal alterations, mitochondrial dysfunction, and impaired anabolic signaling were identified as major mechanisms linking adipose tissue dysfunction with skeletal muscle deterioration. Body mass index alone was insufficient to characterize the phenotype, supporting the integration of waist circumference, body-composition assessment, handgrip strength, gait speed, and functional tests. Nutritional interventions were associated with modest reductions in fat mass, while resistance training showed more consistent improvements in body fat, muscle mass, strength, and physical performance. The findings support a multidimensional approach in which therapeutic success is defined not only by weight reduction but also by preservation or improvement of skeletal muscle and metabolic health. In Latin America, standardized diagnostic criteria, culturally adapted interventions, and greater access to body-composition and functional assessment are needed to improve early detection and management.
Referencias
• Barazzoni, R., Bischoff, S., Boirie, Y., Busetto, L., Cederholm, T., Dicker, D., Toplak, H., Van Gossum, A., Yumuk, V., & Vettor, R. (2018). Sarcopenic obesity: Time to meet the challenge. Obesity Facts, 11(4), 294–305. https://doi.org/10.1159/000490361
• Batsis, J. A., & Villareal, D. T. (2018). Sarcopenic obesity in older adults: Aetiology, epidemiology and treatment strategies. Nature Reviews Endocrinology, 14(9), 513–537. https://doi.org/10.1038/s41574-018-0062-9
• Bauer, J., Biolo, G., Cederholm, T., Cesari, M., Cruz-Jentoft, A. J., Morley, J. E., Phillips, S., Sieber, C., Stehle, P., Teta, D., Visvanathan, R., Volpi, E., & Boirie, Y. (2013). 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, 14(8), 542–559. https://doi.org/10.1016/j.jamda.2013.05.021
• Contillo, A. T., Rodriguez, N. R., & Pescatello, L. S. (2023). Exercise and protein supplementation recommendations for older adults with sarcopenic obesity: A meta-review. Journal of Aging and Physical Activity, 31(5), 878–886. https://doi.org/10.1123/japa.2022-0245
• Cruz-Jentoft, A. J., Bahat, G., Bauer, J., Boirie, Y., Bruyère, O., Cederholm, T., Cooper, C., Landi, F., Rolland, Y., Sayer, A. A., Schneider, S. M., Sieber, C. C., Topinkova, E., Vandewoude, M., Visser, M., & Zamboni, M. (2019). Sarcopenia: Revised European consensus on definition and diagnosis. Age and Ageing, 48(1), 16–31. https://doi.org/10.1093/ageing/afy169
• Deutz, N. E. P., Bauer, J. M., Barazzoni, R., Biolo, G., Boirie, Y., Bosy-Westphal, A., Cederholm, T., Cruz-Jentoft, A., Krznariç, Z., Nair, K. S., Singer, P., Teta, D., Tipton, K., & Calder, P. C. (2014). Protein intake and exercise for optimal muscle function with aging: Recommendations from the ESPEN Expert Group. Clinical Nutrition, 33(6), 929–936. https://doi.org/10.1016/j.clnu.2014.04.007
• Donini, L. M., Busetto, L., Bischoff, S. C., Cederholm, T., Ballesteros-Pomar, M. D., Batsis, J. A., Bauer, J. M., Boirie, Y., Cruz-Jentoft, A. J., Dicker, D., Frara, S., Frühbeck, G., Genton, L., Gepner, Y., Giustina, A., Gonzalez, M. C., Han, H.-S., Heymsfield, S. B., Higashiguchi, T., . . . Barazzoni, R. (2022). Definition and diagnostic criteria for sarcopenic obesity: ESPEN and EASO consensus statement. Clinical Nutrition, 41(4), 990–1000. https://doi.org/10.1016/j.clnu.2021.11.014
• Eglseer, D., Traxler, M., Schoufour, J. D., Weijs, P. J. M., Voortman, T., Boirie, Y., Cruz-Jentoft, A. J., Reiter, L., & Bauer, S. (2023). Nutritional and exercise interventions in individuals with sarcopenic obesity around retirement age: A systematic review and meta-analysis. Nutrition Reviews, 81(9), 1077–1090. https://doi.org/10.1093/nutrit/nuad007
• Hong, S. H., & Choi, K. M. (2020). Sarcopenic obesity, insulin resistance, and their implications in cardiovascular and metabolic consequences. International Journal of Molecular Sciences, 21(2), 494. https://doi.org/10.3390/ijms21020494
• Hsu, K.-J., Liao, C.-D., Tsai, M.-W., & Chen, C.-N. (2019). Effects of exercise and nutritional intervention on body composition, metabolic health, and physical performance in adults with sarcopenic obesity: A meta-analysis. Nutrients, 11(9), 2163. https://doi.org/10.3390/nu11092163
• Kalinkovich, A., & Livshits, G. (2017). Sarcopenic obesity or obese sarcopenia: A cross talk between age-associated adipose tissue and skeletal muscle inflammation as a main mechanism of the pathogenesis. Ageing Research Reviews, 35, 200–221. https://doi.org/10.1016/j.arr.2016.09.008
• Koliaki, C., Liatis, S., Dalamaga, M., & Kokkinos, A. (2019). Sarcopenic obesity: Epidemiologic evidence, pathophysiology, and therapeutic perspectives. Current Obesity Reports, 8(4), 458–471. https://doi.org/10.1007/s13679-019-00359-9
• Lynch, G. M., Murphy, C. H., de Marco Castro, E., & Roche, H. M. (2020). Inflammation and metabolism: The role of adiposity in sarcopenic obesity. Proceedings of the Nutrition Society, 79(4), 435–447. https://doi.org/10.1017/S0029665120007119
• Nabuco, H. C. G., Tomeleri, C. M., Fernandes, R. R., Sugihara, P., Jr., Cavalcante, E. F., Cunha, P. M., Antunes, M., Nunes, J. P., Venturini, D., Barbosa, D. S., Burini, R. C., Silva, A. M., Sardinha, L. B., & Cyrino, E. S. (2019). 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, 32, 88–95. https://doi.org/10.1016/j.clnesp.2019.04.007
• Prado, C. M., Batsis, J. A., Donini, L. M., Gonzalez, M. C., & Siervo, M. (2024). Sarcopenic obesity in older adults: A clinical overview. Nature Reviews Endocrinology, 20(5), 261–277. https://doi.org/10.1038/s41574-023-00943-z
• Reiter, L., Bauer, S., Traxler, M., Schoufour, J. D., Weijs, P. J. M., Cruz-Jentoft, A., Topinková, E., & Eglseer, D. (2023). Effects of nutrition and exercise interventions on persons with sarcopenic obesity: An umbrella review of meta-analyses of randomised controlled trials. Current Obesity Reports, 12(3), 250–263. https://doi.org/10.1007/s13679-023-00509-0
• Stenholm, S., Harris, T. B., Rantanen, T., Visser, M., Kritchevsky, S. B., & Ferrucci, L. (2008). Sarcopenic obesity: Definition, cause and consequences. Current Opinion in Clinical Nutrition and Metabolic Care, 11(6), 693–700. https://doi.org/10.1097/MCO.0b013e328312c37d
• Villareal, D. T., Chode, S., Parimi, N., Sinacore, D. R., Hilton, T., Armamento-Villareal, R., Napoli, N., Qualls, C., & Shah, K. (2011). Weight loss, exercise, or both and physical function in obese older adults. The New England Journal of Medicine, 364(13), 1218–1229. https://doi.org/10.1056/NEJMoa1008234
• Villareal, D. T., Aguirre, L., Gurney, A. B., Waters, D. L., Sinacore, D. R., Colombo, E., Armamento-Villareal, R., & Qualls, C. (2017). Aerobic or resistance exercise, or both, in dieting obese older adults. The New England Journal of Medicine, 376(20), 1943–1955. https://doi.org/10.1056/NEJMoa1616338
• Waters, D. L., Aguirre, L., Gurney, B., Sinacore, D. R., Fowler, K., Gregori, G., Armamento-Villareal, R., Qualls, C., & Villareal, D. T. (2022). Effect of aerobic or resistance exercise, or both, on intermuscular and visceral fat and physical and metabolic function in older adults with obesity while dieting. The Journals of Gerontology: Series A, 77(1), 131–139. https://doi.org/10.1093/gerona/glab111
