Влияние физических упражнений и нутритивной поддержки на пациентов пожилого и старческого возраста с саркопеническим ожирением

Цель обзора. Проанализировать распространённость саркопенического ожирения среди людей пожилого и старческого возраста, оценить причины его возникновения, представить современные методы профилактики и физической реабилитации.
В данной обзорной статье обсуждаются самые последние данные о возрастных изменениях в состоянии жировой и мышечной ткани, а также об ограничении калорий и комплексах физических упражнений, которые оказывают положительное влияние на физические показатели пожилых людей с саркопеническим ожирением. Кроме того, выявлены и проанализированы потенциальные пробелы в рекомендациях по клинической практике, которые заслуживают внимания в будущих исследованиях.
Стратегия поиска. Ключевые слова, используемые для определения условий участия в обзоре: «саркопеническое ожирение», «саркопения с ожирением», «саркопения», «пожилой/преклонный возраст».
Критерии включения и исключения. В обзор включались оригинальные результаты исследований (обзоры, метаанализы). Редакционные статьи, тезисы конференций, протоколы исследований были исключены. Выборка для исследования включала женщин и мужчин любой расы в возрасте ≥ 60 лет с диагнозом «саркопеническое ожирение» и сохранённой функцией локомоции. Также исключены статьи с участием госпитализированных пациентов. Исследования, не связанные с людьми, и исследования, в которых не сообщалось точных критериев вмешательства (например, питание, упражнения, продолжительность и т. д.), были исключены.
Поиск литературы был проведён в четырёх электронных базах данных: PubMed, Cochrane Library, Springer, Scopus, – за период c 2013 г. по 1 августа 2023 г. Ограничений на языковой уклон публикации введено не было

1. Nations U. World population prospects: The 2017 revisions, key findings and advance tables. Working Paper No ESA/P/WP/248. 2017. URL: https://desapublications.un.org/publications/worldpopulation-prospects-2017-revision [date of access: 01.09.2023].

2. Batsis JA, Villareal DT. Sarcopenic obesity in older adults: An etiology, epidemiology and treatment strategies. Nat Rev Endocrinol. 2018; 14(9): 513-537. doi: 10.1038/s41574-018-0062-9

3. Bray GA, Kim KK, Wilding JPH, World Obesity Federation. Obesity: A chronic relapsing progressive disease process. A position statement of the World Obesity Federation. Obes Rev. 2017; 18(7): 715-723. doi: 10.1111/obr.12551

4. Bluher M. Obesity: Global epidemiology and pathogenesis. Nat Rev Endocrinol. 2019; 15(5): 288-298. doi: 10.1038/s41574-019-0176-8

5. Fielding RA, Vellas B, Evans WJ, Bhasin S, Morley JE, Newman AB, et al. Sarcopenia: An undiagnosed condition in older adults. Current consensus definition: Prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc. 2011; 12(4): 249-256. doi: 10.1016/j.jamda.2011.01.003

6. Colleluori G, Aguirre L, Phadnis U, Fowler K, Armamento-Villareal R, Sun Z, et al. Aerobic plus resistance exercise in obese older adults improves muscle protein synthesis and preserves myocellular quality despite weight loss. Cell Metab. 2019; 30(2): 261-273.e6. doi: 10.1016/j.cmet.2019.06.008

7. Cartee GD, Hepple RT, Bamman MM, Zierath JR. Exercise promotes healthy aging of skeletal muscle. Cell Metab. 2016; 23(6): 1034-1047. doi:10.1016/j.cmet.2016.05.007

8. Piccoli A, Cannata F, Strollo R, Pedone C, Leanza G, Russo F, et al. Sclerostin regulation, microarchitecture, and advanced glycation end-products in the bone of elderly women with type 2 diabetes. J Bone Miner Res. 2020; 35(12): 2415-2422. doi: 10.1002/jbmr.4153

9. Garvey WT, Mechanick JI, Brett EM, Garber AJ, Hurley DL, Jastreboff AM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract. 2016; 22(3): 1-203. doi: 10.4158/EP161365.GL

10. Roh E, Choi KM. Health consequences of sarcopenic obesity: A narrative review. Front Endocrinol (Lausanne). 2020; 11: 332. doi: 10.3389/fendo.2020.00332

11. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyere O, Cederholm T, et al. Sarcopenia: Revised European consensus on definition and diagnosis. Age Ageing. 2019; 48(1): 16-31. doi: 10.1093/ageing/afz046

12. Плещёв И.Е., Ачкасов Е.Е., Николенко В.Н., Шкребко А.Н., Иванова И.В. Роль и специфика физических нагрузок при саркопении у пожилых людей. Acta biomedica scientifica. 2023; 8(2): 80-92.

13. Ghiotto L, Muollo V, Tatangelo T, Schena F, Rossi AP. Exercise and physical performance in older adults with sarcopenic obesity: A systematic review. Front Endocrinol (Lausanne). 2022; 13: 913953. doi: 10.3389/fendo.2022.913953

14. Kong HH, Won CW, Kim W. Effect of sarcopenic obesity on deterioration of physical function in the elderly. Arch Gerontol Geriatr. 2020; 89: 104065. doi: 10.1016/j.archger.2020.104065

15. Wannamethee SG, Atkins JL. Muscle loss and obesity: The health implications of sarcopenia and sarcopenic obesity. Proc Nutr Soc. 2015; 74(4): 405-412. doi: 10.1017/S002966511500169X

16. Choi KM. Sarcopenia and sarcopenic obesity. Korean J Intern Med. 2016; 31: 1054-1060. doi: 10.3904/kjim.2016.193

17. Donini LM, Busetto L, Bauer JM, Bischoff S, Boirie Y, Cederholm T, et al. Critical appraisal of definitions and diagnostic criteria for sarcopenic obesity based on a systematic review. Clin Nutr. 2020; 39(8): 2368-2388. doi: 10.1016/j.clnu.2019.11.024

18. Hong SH, Choi KM. Sarcopenic obesity, insulin resistance, and their implications in cardiovascular and metabolic consequences. Int J Mol Sci. 2020; 21(2): 494. doi: 10.3390/ijms21020494

19. Mc Phee JS, French DP, Jackson D, Nazroo J, Pendleton N, Degens H. Physical activity in older age: Perspectives for healthy ageing and frailty. Biogerontology. 2016; 17: 567-580. doi: 10.1007/s10522-016-9641-0

20. Гриценко О.В., Груздева О.В., Чумакова Г.А., Барбараш О.Л. Лабораторные маркеры остеосаркопенического ожирения. Российский кардиологический журнал. 2023; 28(12): 5563. doi: 10.15829/1560-4071-2023-5563

21. Colleluori G, Villareal DT. Aging, obesity, sarcopenia and the effect of diet and exercise intervention. Exp Gerontol. 2021; 155: 111561. doi: 10.1016/j.exger.2021.111561

22. Wei S, Nguyen TT, Zhang Y, Ryu D, Gariani K. Sarcopenic obesity: Epidemiology, pathophysiology, cardiovascular disease, mortality, and management. Front Endocrinol (Lausanne). 2023; 14: 1185221. doi: 10.3389/fendo.2023.1185221

23. Wagenaar CA, Dekker LH, Navis GJ. Prevalence of sarcopenic obesity and sarcopenic overweight in the general population: The lifelines cohort study. Clin Nutr. 2021; 40: 4422-4429. doi: 10.1016/j.clnu.2021.01.005

24. Gao Q, Mei F, Shang Y, Hu K, Chen F, Zhao L, et al. Global prevalence of sarcopenic obesity in older adults: A systematic review and meta-analysis. Clin Nutr. 2021; 40: 4633-4641. doi: 10.1016/j.clnu.2021.06.009

25. Batsis JA, Mackenzie TA, Lopez-Jimenez F, Bartels SJ. Sarcopenia, sarcopenic obesity, and functional impairments in older adults: National Health and Nutrition Examination Surveys 1999–2004. Nutr Res. 2015; 35(12): 1031-1039. doi: 10.1016/j.nutres.2015.09.003

26. Atkins JL, Whincup PH, Morris RW, Lennon LT, Papacosta O, Wannamethee SG. Sarcopenic obesity and risk of cardiovascular disease and mortality: A population-based cohort study of older men. J Am Geriatr Soc. 2014; 62(2): 253-260. doi: 10.1111/jgs.12652

27. von Berens А, Obling SR, Nydahl M, Koochek A, Lissner L, Skoog I, et al. Sarcopenic obesity and associations with mortality in older women and men – A prospective observational study. BMC Geriatr. 2020; 20(1): 199. doi:10.1186/s12877-020-01578-9

28. Farmer RE, Mathur R, Schmidt AF, Bhaskaran K, Fatemifar G, Eastwood SV, et al. Associations between measures of sarcopenic obesity and risk of cardiovascular disease and mortality: A cohort study and Mendelian randomization analysis using the UK biobank. J Am Heart Assoc. 2019; 8(13): e011638. doi: 10.1161/JAHA.118.011638

29. Zhang X, Xie X, Dou Q, Liu C, Zhang W, Yang Y, et al. Association of sarcopenic obesity with the risk of all-cause mortality among adults over a broad range of different settings: An updated meta-analysis. BMC Geriatr. 2019; 19(1): 183. doi: 10.1186/s12877-019-1195-y

30. Sanada K, Chen R, Willcox B, Ohara T, Wen A, Takenaka C, et al. Association of sarcopenic obesity predicted by anthropometric measurements and 24-y all-cause mortality in elderly men: The Kuakini Honolulu Heart Program. Nutrition. 2018; 46: 97-102. doi: 10.1016/j.nut.2017.09.003

31. Donini LM, Busetto L, Bischoff SC, Cederholm T, Ballesteros-Pomar MD, Batsis JA, et al. Definition and diagnostic criteria for sarcopenic obesity: ESPEN and EASO consensus statement. Obes Facts. 2022; 15(3): 321-335. doi: 10.1159/000521241

32. Poggiogalle E, Lubrano C, Sergi G, Coin A, Gnessi L, Mariani S, et al. Sarcopenic obesity and metabolic syndrome in adult Caucasian subjects. J Nutr Health Aging. 2016; 20(9): 958-963. doi: 10.1007/s12603-015-0638-1

33. Axelrod CL, Dantas WS, Kirwan JP. Sarcopenic obesity: Emerging mechanisms and therapeutic potential. Metabolism. 2023; 146: 155639. doi: 10.1016/j.metabol.2023.155639

34. Leduc-Gaudet JP, Hussain SNA, Barreiro E, Gouspillou G. Mitochondrial dynamics and mitophagy in skeletal muscle health and aging. Int J Mol Sci. 2021; 22(15): 8179. doi: 10.3390/ijms22158179

35. Chen X, Ji Y, Liu R, Zhu X, Wang K, Yang X, et al. Mitochondrial dysfunction: Roles in skeletal muscle atrophy. J Transl Med. 2023; 72: 33-58. doi: 10.1186/s12967-023-04369-z

36. Mooren FC, Krüger K. Exercise, autophagy, and apoptosis. Prog Mol Biol Transl Sci. 2015; 135: 407-422. doi: 10.1016/bs.pmbts.2015.07.023

37. Englund DA, Sharp RL, Selsby JT, Ganesan SS, Franke WD. Resistance training performed at distinct angular velocities elicits velocity-specific alterations in muscle strength and mobility status in older adults. Exp Gerontol. 2017; 91: 51-56. doi: 10.1016/j.exger.2017.02.072

38. Nikseresht M, Sadeghifard N, Agha-Alinejad H, Ebrahim K. Inflammatory markers and adipocytokine responses to exercise training and detraining in men who are obese. J Strength Cond Res. 2014; 28(12): 3399-3410. doi: 10.1519/JSC.0000000000000553

39. 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. J Am Geriatr Soc. 2017; 65(4): 827-832. doi: 10.1111/jgs.14722

40. Liao CD, Tsauo JY, Lin LF, Huang SW, Ku JW, Chou LC, 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 (Baltimore). 2017; 96(23): e7115. doi: 10.1097/MD.0000000000007115

41. 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. Sci Rep. 2018; 8(1): 2317. doi: 10.1038/s41598-018-20677-7

42. Hanach NI, McCullough F, Avery A. The impact of dairy protein intake on muscle mass, muscle strength, and physical performance in middle-aged to older adults with or without existing sarcopenia: A systematic review and meta-analysis. Adv Nutr. 2019; 10(1): 59-69. doi: 10.1093/advances/nmy065

43. Xie WQ, Xiao WF, Tang K, Wu YX, Hu PW, Li YS, et al. Caloric restriction: Implications for sarcopenia and potential mechanisms. Aging (Albany NY). 2020; 12(23): 24441-24452. doi: 10.18632/aging. 103987

44. Camajani E, Feraco A, Proietti S, Basciani S, Barrea L, Armani A, et al. Very low calorie ketogenic diet combined with physical interval training for preserving muscle mass during weight loss in sarcopenic obesity: A pilot study. Front Nutr. 2022; 9: 1076667. doi: 10.3389/fnut.2022.955024

45. Camajani E, Persichetti A, Watanabe M, Contini S, Vari M, Di Bernardo S, et al. Whey protein, L-leucine and vitamin D supplementation for preserving lean mass during a low-calorie diet in sarcopenic obese women. Nutrients. 2022; 14(9): 1884. doi: 10.3390/nu14091884

46. Nabuco HCG, Tomeleri CM, Fernandes RR, Sugihara Junior P, Cavalcante EF, Cunha PM, et al. Effect of whey protein supplementation combined with resistance training on body composition, muscular strength, functional capacity, and plasmametabolism biomarkers in older women with sarcopenic obesity: A randomized, double-blind, placebo-controlled trial. Clin Nutr ESPEN. 2019; 32: 88-95. doi: 10.1016/j.clnesp.2019.04.007

47. Gagliano-Jucá T, Basaria S. Testosterone replacement therapy and cardiovascular risk. Nat Rev Cardiol. 2019; 16(9): 555-574. doi: 10.1038/s41569-019-0211-4

48. Geraci A, Calvani R, Ferri E, Marzetti E, Arosio B, Cesari M. Sarcopenia and menopause: The role of estradiol. Front Endocrinol (Lausanne). 2021; 12: 682012. doi: 10.3389/fendo.2021.682012

49. Espinoza SE, Lee JL, Wang CP, Ganapathy V, MacCarthy D, Pascucci C, et al. Intranasal oxytocin improves lean muscle mass and lowers LDL cholesterol in older adults with sarcopenic obesity: A pilot randomized controlled trial. J Am Med Dir Assoc. 2021; 22(9): 1877-1882.e2. doi: 10.1016/j.jamda.2021.04.015

50. Shin MJ, Jeon YK, Kim IJ. Testosterone and sarcopenia. World J Mens Health. 2018; 36(3): 192-198. doi: 10.5534/wjmh.180001

51. Vasconcelos KS, Dias JM, Araújo MC, Pinheiro AC, Moreira BS, Dias RC. Effects of a progressive resistance exercise program with high-speed component on the physical function of older women with sarcopenic obesity: A randomized controlled trial. Braz J Phys Ther. 2016; 20(5): 432-440. doi: 10.1590/bjpt-rbf.2014.0174

52. 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. Arch Gerontol Geriatr. 2016; 65: 168-173. doi: 10.1016/j.archger.2016.03.017

53. Kemmler W, Weissenfels A, Teschler M, Willert S, Bebenek M, Shojaa M, et al. Whole-body electromyostimulation and protein supplementation favorably affect sarcopenic obesity in community-dwelling older men at risk: The randomized controlled FranSO study. Clin Interv Aging. 2017; 12: 1503-1513. doi: 10.2147/CIA.S137987

54. Wittmann K, Sieber C, von Stengel S, Kohl M, Freiberger E, Jakob F, et al. Impact of whole body electromyostimulation on cardiometabolic risk factors in older women with sarcopenic obesity: The randomized controlled FORMOsA-sarcopenic obesity study. Clin Interv Aging. 2016; 11: 1697-1706. doi: 10.2147/CIA.S116430

55. Kemmler W, Weissenfels A, Willert S, Shojaa M, von Stengel S, Filipovic A, et al. Efficacy and safety of low frequency wholebody electromyostimulation (WB-EMS) to improve health-related outcomes in non-athletic adults. A systematic review. Front Physiol. 2018; 9: 573. doi: 10.3389/fphys.2018.00573

56. de Oliveira Silva A, Dutra MT, de Moraes WMAM, Funghetto SS, Lopes de Farias D, Dos Santos PHF, et al. Resistance training-induced gains in muscle strength, body composition, and functional capacity are attenuated in elderly women with sarcopenic obesity. Clin Interv Aging. 2018; 13: 411-417. doi: 10.2147/CIA.S156174

57. Trouwborst I, Verreijen A, Memelink R, Massanet P, Boirie Y, Weijs P, et al. Exercise and nutrition strategies to counteract sarcopenic obesity. Nutrients. 2018; 10(5): 605. doi: 10.3390/nu10050605

58. Sammarco R, Marra M, Di Guglielmo ML, Naccarato M, Contaldo F, Poggiogalle E, et al. Evaluation of hypocaloric diet with protein supplementation in middle-aged sarcopenic obese women: A pilot study. Obes Facts. 2017; 10(3): 160-167. doi: 10.1159/000468153

59. Moyer VA. U.S. Preventive Services Task Force*. Vitamin D and calcium supplementation to prevent fractures in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013; 158(9): 691-696. doi: 10.7326/0003-4819-158-9-201305070-00603

60. Anderson JJ, Kruszka B, Delaney JA, He K, Burke GL, Alonso A, et al. Calcium intake from diet and supplements and the risk of coronary artery calcification and its progression among older adults: 10-year follow-up of the Multi-Ethnic Study of Atherosclerosis (MESA). J Am Heart Assoc. 2016; 5(10): e003815. doi: 10.1161/JAHA.116.003815

61. Malafarina V, Uriz-Otano F, Malafarina C, Martinez JA, Zulet MA. Effectiveness of nutritional supplementation on sarcopenia and recovery in hip fracture patients. A multi-centre randomized trial. Maturitas. 2017; 101: 42-50. doi: 10.1016/j.maturitas.2017.04.010

62. American Geriatrics Society Workgroup on Vitamin D Supplementation for Older Adults. Recommendations abstracted from the American Geriatrics Society Consensus Statement on vitamin D for prevention of falls and their consequences. J Am Geriatr Soc. 2014; 62(1): 147-152. doi: 10.1111/jgs.12631

63. Papa EV, Dong X, Hassan M. Resistance training for activity limitations in older adults with skeletal muscle function deficits: A systematic review. Clin Interv Aging. 2017; 12: 955-961. doi: 10.2147/CIA.S104674

64. Liu C, Wong PY, Chung YL, Chow SK, Cheung WH, Law SW, et al. Deciphering the “obesity paradox” in the elderly: A systematic review and meta-analysis of sarcopenic obesity. Obes Rev. 2023; 24(2): e13534. doi: 10.1111/obr.13534