The danger of weight loss in the elderly

Aging is generally accompanied by weight loss made up of both fat mass and fat-free mass. As more people, including elderly, are overweight or obese, weight loss is recommended to improve health. Health risks are decreased in overweight children and adults by dieting and exercise, but the health benefits of weight loss in elderly, particularly by calorie restriction, are uncertain. Rapid unintentional weight loss in elderly is usually indicative of underlying disease and accelerates the muscle loss which normally occurs with aging. Intentional weight loss, even when excess fat mass is targeted also includes accelerated muscle loss which has been shown in older persons to correlate negatively with functional capacity for independent living. Sarcopenic obesity, the coexistence of diminished lean mass and increased fat mass, characterizes a population particularly at risk for functional impairment since both sarcopenia (relative deficiency of skeletal muscle mass and strength) and obesity have been shown to predict disability. However, indices of overweight and obesity such as body mass index (BMI) do not correlate as strongly with adverse health outcomes such as cardiovascular disease in elderly as compared to younger individuals. Further, weight loss and low BMI in older persons are associated with mortality in some studies. On the other hand, studies have shown improvement in risk factors after weight loss in overweight/obese elderly. The recent focus on pro-inflammatory factors related to adiposity suggest that fat loss could ameliorate some catabolic conditions of aging since some cytokines may directly impact muscle protein synthesis and breakdown. Simply decreasing weight may also ease mechanical burden on weak joints and muscle, thus improving mobility. However, until a strategy is proven whereby further loss of muscle mass can be prevented, weight loss by caloric restriction in individuals with sarcopenic obesity should likely be avoided.     

Body weight, body composition, and energy metabolism in lean and obese Zucker rats fed soybean oil or butter.

BACKGROUND: Dietary fat composition is thought to affect body weight regulation independent of the amount of fat ingested. OBJECTIVE: We analyzed the feeding behavior, body weight gain, body composition, and energy metabolism in lean and obese rats fed a diet in which fat was in the form of either butter or soybean oil. DESIGN: Ten lean (Fa/?) and 10 obese (fa/fa) adult Zucker rats were divided into 4 groups according to a 2 x 2 experimental design. They were fed a normally balanced diet over 11 wk in which 30% of energy was either soybean oil or butter. Food intake, body weight gain, and body composition were measured. Indirect calorimetry was used to study energy metabolism at rest and in relation to feeding and activity. RESULTS: Food intake increased similarly in lean and obese rats after butter feeding. Body weight gain increased in obese rats and decreased in lean rats after butter feeding. Body weight gain in obese rats was due mainly to an increase in the weight of lean tissues besides muscle, whereas adiposity and distribution of fat between the various pads did not change. Resting metabolic rates and postprandial lipid oxidation increased in butter-fed obese rats. Lipid oxidation during exercise was not significantly different between obese and lean rats. Fat oxidation increased in butter-fed lean rats during treadmill running at moderate intensity. CONCLUSIONS: In obese rats, basal metabolism and postprandial lipid oxidation increased during butter feeding, which appeared to prevent fat accumulation in the long term. In lean rats, butter feeding favored lipid utilization by working muscles, an observation that deserves further investigation in terms of endurance and performance.     

Adaptations of adult lean and obese zucker rats during food restriction

The adaptations that occur during prolonged food restriction of adult lean and obese Zucker rats were examined. Lean Zucker rats were restricted until they lost 31% (RL-31) or 42% (RL-42) of their starting weight. Obese Zucker rats were restricted until they lost 53% (RO-53) or 78% (RO-78) of their initial weight. Weights of five skeletal muscles, three fat pads and two organs were determined. During restriction, the obese rats catabolized less muscle protein per day than the lean animals. The percentage of muscle lost by the obese was lower than the percentage body weight loss. After prolonged restriction, both lean and obese rats were essentially depleted of fat stores. Obese rats relied to a greater extent on fat stores for energy and to a lesser extent on catabolism of lean body mass than lean rats. The ratios of protein/DNA and RNA/DNA were significantly reduced in muscles from all restricted animals and the DNA content was lower in the groups that lost the most weight (RL-42 and RO-78). In conclusion, obese Zucker rats have an enhanced ability to adapt to restriction with a slower rate of skeletal muscle catabolism. However, “survival” during prolonged restriction is dependent on the initial amount of adipose tissue and not loss of a critical amount of lean body mass.     

Role of insulin in age-related changes in macronutrient metabolism

Age is associated with an increase in body fat mass and a decrease of protein mass. As body substrate turnover is under insulin control, defects in insulin secretion and/or action may in part account for these changes. As regards secretion, current evidence suggest that no clear defect in insulin secretion is found in the aged. The wide spectrum of glucose tolerance of the elderly may be associated with different patterns of insulin secretion. Insulin sensitivity to glucose metabolism is more or less normal in the aged, despite subtle delays in the onset of its action. Normalization of the data by either body weight or lean body mass is important in defining the insulin sensitivity of the elderly. Increased rates of free fatty acid (FFA) flux and oxidation rates have been found in healthy elderly subjects, both when post-absorptive and during hyperinsulinemia. These differences however disappeared following normalization by fat mass, suggesting that FFA kinetics reflect the established changes in fat mass. Thus, the mechanism(s) leading to an increase in the fat mass in elderly cannot simply be derived from studies of fat kinetics. The operation of the Randle cycle (ie, inverse relationships between fat and glucose oxidation) in the elderly has also been suggested. Finally, the insulin effects on whole-body amino acid and protein metabolism do not seem to be impaired in the aged. However, in the human muscle a decreased synthesis of contractile as well as mitochondrial proteins was found, in association with decreased specific gene expression. The degree of physical activity probably interacts with these changes, possibly playing a causative role. The possible interaction between insulin and exercise in the maintenance of muscle mass in the elderly needs to be studied further.     

The combination of dietary conjugated linoleic acid and treadmill exercise lowers gain in body fat mass and enhances lean body mass in high fat-fed male Balb/C mice

Nearly half of the U.S. adult population is overweight or obese, which may be related to increased energy intake combined with lack of physical activity. Obesity increases the risk of several chronic diseases including diabetes, coronary heart disease, hypertension, and stroke. Conjugated linoleic acids (CLA) were shown to decrease fat and increase lean mass in several animal studies. However, the effects of CLA in combination with exercise (Ex) on body composition have not been studied in an animal model. We examined the effect of a low concentration of either safflower oil as control (0.5%) or mixed isomers of CLA (0.4%) along with treadmill exercise on body composition in male Balb/C mice fed a high-fat diet (20% corn oil) in a 2 x 2 factorial design. CLA consumption lowered change in fat mass (P < 0.001) confirming the results of other studies, and change in fat mass decreased further (P < 0.001) with CLA and exercise. Change in lean mass did not increase with exercise alone; it increased, although not significantly, with CLA alone and increased significantly (P < 0.05) due to the combination of CLA and exercise. This effect was accompanied by decreased serum leptin levels and lower leptin mRNA expression in peritoneal fat (P < 0.001). Serum insulin, glucose, tumor necrosis factor (TNF)-alpha, and interleukin-6 were lower in CLA-fed mice than in controls (P < 0.05), whereas serum TNF-alpha was increased by exercise (P < 0.05). Exercise increased oxygen consumption and energy expenditure when measured under resting conditions (P < 0.05). In summary, the combination of dietary CLA and exercise decreased fat mass and increased lean mass in mice fed a high-fat diet, and these effects may be related in part to decreased serum leptin and exercise-induced increases in oxygen consumption and energy expenditure.     

体育课不同持续性运动时间和强度对初中生体成分的影响

探究体育课不同运动强度和持续性运动时间对初中生体成分的影响,为初中生体育课有效运动负荷的安排提供参考依据.方法 上海市某中学共6个班级226名学生参与实验干预.在3×40 min/周、共8周的体育课中,各班级分别嵌入15,10或5 min的大强度或中等强度持续性运动.结果 学生体质量指数(BMI)和腰臀比(WHR)呈现不同的变化幅度,前后测和班级间差异均无统计学意义.在体脂肪量(SFV)上,实验6班学生前后测差异有统计学意义(P=0.01);在去脂体重(FFM)上,实验2班、3班、4班、5班和6班学生前后测差异均有统计学意义;在体脂肪率(PBF)和去脂体重百分比(PFFM)上,各班级学生间差异无统计学意义,但呈现出不同的变化幅度;在肌肉量(LMM)上,实验2班、4班、5班和6班学生前后测差异均有统计学意义(P值均<0.05);在肌肉量百分比(PLMM)上,实验1班、4班和6班学生前后测差异均有统计学意义(P值均<0.05).结论 体育课10 min以上持续性大强度运动和15 min持续性中等强度运动可以提高学生PFFM,降低学生PBF;体育课5 min以上持续性大强度运动和15 min持续性中等强度运动可以提高学生PLMM.     

Effect of dietary supplements and physical exercise on sensory perception, appetite, dietary intake and body weight in frail elderly subjects

This present study investigated the effect of a 17-week intervention programme with nutrient-dense foods (enriched with vitamins and minerals at 25-100% of the Dutch recommended dietary allowance) and/or physical exercise in 159 frail elderly subjects (forty-six men, 113 women, mean age 78.7 (SD 5.6) years). Subjects were randomized into four groups: (1) control, (2) nutrition intervention, (3) exercise or (4) both nutrition intervention and exercise. Main outcome variables were sensory perception (smell test and questionnaire), appetite (questionnaire), energy intake (3 d food record) and body weight (on a weighing scale and with dual energy X-ray absorptiometry measurements). At baseline, moderate but significant correlations were found between appetite and energy intake (r 0.30, P < 0.0001), between smell test and smell perception assessed by questionnaire (r 0.40, P < 0.0001) and between lean body weight and energy intake (r 0.50, P < 0.0001). Results after 17-weeks intervention revealed neither change in smell test scores (P = 0.19) nor in appetite (P = 0.17). A slight positive effect of exercise compared with non-exercising groups on energy intake (difference 0.5 MJ, P = 0.05) was shown next to a preserving effect of exercise on lean body mass (+0.08 kg) compared with a decrease (-0.4 kg) in non-exercisers (P < 0.02). The correlation between the change in lean body mass and change in energy intake was 0.18 (P = 0.05). In conclusion, an interesting preserving effect on lean body mass in frail elderly subjects due to 17 weeks of exercise was shown. Since a decline in lean body mass was observed in the non-exercisers, effects may be attributable to change in activity pattern. Changes in lean mass were also slightly, but significantly, correlated with changes in energy intake. In turn, energy intake was not related to a change in reported appetite or sensory perception. Nutrient-dense foods were not able to improve any of the outcome variables in this study.     

Diet composition, energy intake, and exercise in relation to body fat in men and women

This study examined the relationships among body fat, diet composition, energy intake, and exercise in adults. Male (n = 107) and female (n = 109) adults aged 18-71 y (36.6 +/- 1.0 y, means +/- SEM) were hydrostatically weighed to determine body fat (5.7-49.0% of total weight). Diet and exercise behaviors were determined by use of a questionnaire. As body fat increased, percent of energy intake derived from fat increased (p less than 0.001) whereas the percent from carbohydrate decreased (p less than 0.001). There was no relationship between energy intake and adiposity although leanness and exercise were related (p less than 0.001). When subgroups of lean and obese subjects were compared, the lean subjects derived approximately 29% of their energy from fat and 53% from carbohydrate vs 35% and 46%, respectively, for the obese subjects. No differences were found between groups for energy intake but the lean individuals exercised more often than did the obese individuals. These data suggest that diet composition may play as important a role in fat deposition as do energy intake and lack of exercise.     

A Worksite Program for Overweight Middle-Aged Men Achieves Lesser Weight Loss With Exercise Than With Dietary Change

Objective To compare changes in total and regional body composition using dual energy X-ray absorptiometry (DEXA) after subjects lost weight through change in diet or exercise.Design A 12-month, randomized, controlled study of two weight-loss interventions — low-fat diet ad libitum or moderate, unsupervised exercise — in free-living, middle-aged men. Compliance was determined at monthly measurement sessions through food records and activity logs; DEXA scans were performed every 3 months.Subjects/setting Fifty-eight overweight men (mean body mass INDEX=29.0±2.6; mean AGE=43.4±5.7 years) recruited from a national corporation were assigned randomly to diet, exercise, or control groups.Interventions One group reduced dietary fat to 26.4% of energy intake but kept activity unchanged; another group self-selected aerobic exercise (three sessions per week at 65% to 75% maximum heart rate) but kept diet unchanged. A control group maintained weight.Main outcome measures At 12 months, measurements of weight, total and regional fat mass and lean mass, energy intake, and percentage dietary fat; physical activity indexes. Statistical analyses Results were analyzed using paired t tests and analysis of variance.Results Mean weight loss was 6.4±3.3 kg in dieters and 2.6+3.0 kg in exercisers; control subjects maintained weight. DEXA scans revealed that 40% of dieters’ weight loss was lean tissue; more than 80% of weight lost by exercisers was fat. Exercisers maintained limb lean tissue and lost fat mass.Conclusions Greater total weight and lean tissue loss occurred when subjects lost weight through a low-fat diet consumed ad libitum than when subjects participated in unsupervised aerobic exercise. Use of DEXA enabled identification of progressive total and regional changes in fat and lean tissue. J Am Diet Assoc. 1997; 97:37–42.     

Effects of Internet-Based Nutrition and Exercise Interventions on the Prevention and Treatment of Sarcopenia in the Elderly

Effective nutrition and exercise interventions may improve sarcopenia in the elderly. The purpose of our study was to investigate the effectiveness of Internet-based nutrition and exercise interventions in the elderly with sarcopenia. Participants were divided into 4 groups: control, nutrition, exercise, and comprehensive (nutrition plus exercise) groups; there was at least 50 participants in each group. Our trial lasted 12 weeks. We conducted dietary and exercise interventions through an app and collected feedback from the participants every three weeks. Information on the diet, skeletal muscle mass, and muscle function was collected before and after the interventions. The comprehensive group had higher high-quality protein intake than the control (p = 0.017) and exercise (p = 0.012) groups. After the interventions, we obtained differences in skeletal muscle mass, skeletal muscle mass/height², skeletal muscle mass/weight, muscle mass/BMI, and skeletal muscle mass/body fat percentage (p < 0.05). Changes in average daily energy and total daily protein intakes were not significantly different; however, there was an overall improvement in the intervention groups relative to baseline data. There were no changes in the average daily time of moderate physical activity. The Internet was an effective tool of nutrition intervention in the elderly with sarcopenia. The Internet-based nutrition intervention improved high-quality protein intake and skeletal muscle mass in the elderly with sarcopenia.     

Obesity in the elderly: who should we be treating, and why, and how?

PURPOSE OF REVIEW: To investigate emerging data on the relationship between obesity, increased morbidity and mortality, and decreased function in the elderly. To examine what is known about the effectiveness of interventions, and how treatment might be improved. RECENT FINDINGS: Obesity is a common problem in the elderly, although its prevalence decreases in extreme old age. Decreased physical activity and decreased energy expenditure with ageing predispose to fat accumulation and fat redistribution. Reduction in muscle mass (sarcopenic obesity) is an important determinant of physical function and metabolic rate. Chronic inflammation and endocrine changes contribute to the changes in metabolism and body composition that accompany ageing, and are potential therapeutic targets. Body weight and body mass index are imperfect indicators of risk from obesity. The focus of treatment should be on reduction of intra-abdominal fat and preservation of muscle mass and strength. A number of recent studies have confirmed the effectiveness of exercise interventions in the elderly. Progressive resistance training, rather than endurance exercise, may be more effective in many cases. Reduced function and decreased quality of life accompany development of the complications of obesity such as diabetes and vascular disorders. There is considerable scope to impede the development of these complications in the elderly with lifestyle interventions. SUMMARY: Sarcopenic obesity, with accumulation of intra-abdominal fat, is a major determinant of health status in the elderly. As in the younger population, prevention and treatment programmes have the potential to decrease the impact of diabetes, vascular disease, and other complications of obesity.     

Associations of body composition with physical performance and self-reported functional limitation in elderly men and women

To understand how body composition relates to functional impairment, the authors examined cross-sectional associations of absolute and relative measures of fat and lean mass with physical performance and self-reported functional limitation. The sample consisted of a community-based cohort of 1,655 older women and men from Sonoma, California, who had complete baseline data in 1993-1994 on body composition, physical performance, and functional limitation. Physical performance was assessed by walking speed and grip strength, while global functional limitation, across several domains, was assessed by self-report using standard questions. Lean mass and fat mass were estimated from bioelectric impedance using population-specific prediction equations derived from dual x-ray energy absorptiometry. Higher fat mass was associated with slower walking speed and greater likelihood of functional limitation, while higher lean mass was generally associated only with increased grip strength. A higher lean mass-to-fat mass ratio, a relative measure of body composition, was associated with faster walking speed and less limitation. These findings suggest that fat mass negatively impacts some domains of physical performance and overall functioning, while lean mass is less significant in absolute terms but is important relative to amount of body fat.     

Obesity and sarcopenia after menopause are reversed by sex hormone replacement therapy

OBJECTIVE: Menopause is linked to an increase in fat mass and a decrease in lean mass exceeding age-related changes, possibly related to reduced output of ovarian steroids. In this study we examined the effect of combined postmenopausal hormone replacement therapy (HRT) on the total and regional distribution of fat and lean body mass. RESEARCH METHODS AND PROCEDURES: Sixteen healthy postmenopausal women (age: 55 +/- 3 years) were studied in a placebo-controlled, crossover study and were randomized to 17beta estradiol plus cyclic norethisterone acetate (HRT) or placebo in two 12-week periods separated by a 3-month washout. Total and regional body composition was measured by DXA at baseline and in the 10th treatment week in both periods. Changes were compared by a paired Student's t test. RESULTS: The change in body weight during HRT was equal to the change during placebo (-24.6 g vs. -164 g, p = 0.42), but relative fat mass was significantly reduced (-0.5% vs. +1.24%, p < 0.01). During HRT, compared with during placebo, lean body mass increased (+347 g vs. -996 g, p < 0.01) and total fat mass decreased (-400 g vs. +836 g, p = 0.06). Total bone mineral content increased (+28.9 g vs. -4.4 g, p = 0.04) and abdominal fat decreased (-185 g vs. +253 g, p = 0.04) during HRT compared with placebo. DISCUSSION: HRT is linked to the reversal of both menopause-related obesity and loss of lean mass, without overall change in body weight. The increase in lean body mass during HRT is likely explained by muscle anabolism, which in turn, prevents disease in the elderly.     

Changes in protein, carbohydrate, and fat metabolism with aging: possible role of insulin

Age is associated with modifications of body composition, i.e., an increase in body fat mass and a decrease in protein mass. Because insulin controls substrate disposal and production, these changes could theoretically be related to changes in either insulin action or secretion on the various substrates. On the basis of available evidence, insulin action on whole-body amino acid and protein metabolism seems not to be impaired in the aged. Decreased synthesis of contractile and mitochondrial proteins in muscle, associated with decreased gene expression, was described in humans. Decreased physical activity apparently represents an important factor responsible for decreased muscle protein synthesis and mass in the elderly. Exercise in the elderly may acutely revert these changes, although its chronic effects are still uncertain. In addition, the possible interaction between insulin and exercise in the maintenance of muscle mass needs to be specifically investigated in aged people. Higher free fatty acid (FFA) absolute flux and oxidation rates were observed in healthy elderly subjects in both the fasting state and following hyperinsulinemia, but not when normalized over fat mass. This suggests that FFA kinetics reflect the established changes in fat mass. Insulin sensitivity on glucose metabolism is usually normal in the aged, despite subtle impairments in insulin secretion, hepatic uptake, and onset of action. Finally, data support the operation of the Randle cycle (i.e., inverse relationships between fat and glucose oxidation) in the elderly.     

Toward Body Composition Reference Data for Infants,Children, and Adolescents

Growth charts for weight and height have provided the basis for assessment of children’s nutritional status for over half a century, with charts for body mass index (BMI) introduced in the 1990s. However, BMI does not provide information on the proportions of fat and lean mass; and within the past decade, growth charts for children’s body composition have been produced by using techniques such as skinfold thicknesses, body circumferences, bioelectrical impedance analysis (BIA), and dual-energy X-ray absorptiometry (DXA). For public health research, BIA and skinfold thicknesses show negligible average bias but have wider limits of agreement than specialized techniques. For patients, DXA is the best individual method, but multicomponent models remain ideal because they address perturbations in lean mass composition. Data can be expressed in age- and sex-specific SD scores, in some cases adjusting for height. Most such reference data derive from high-income countries, but techniques such as air-displacement plethysmography allow infant body composition growth charts to be developed in low- and middle-income settings, where the data may improve understanding of the effects of low birth weight, wasting, and stunting on body composition. Recent studies suggest that between-population variability in body composition may derive in part from genetic factors, suggesting a universal human body composition reference may not be viable. Body composition growth charts may be extended into adult life to evaluate changes in fat and lean mass through the entire life course. These reference data will improve the understanding of the association between growth, body composition, health, and disease.     

Relationship between Appetite, Food Intake and Body Composition among Elderly Malays from an Urban Residential Area in Kuala Lumpur, Malaysia

Loss of appetite, decrease in food intake and changes in body composition appear to be inter-related factors that can influence the well-being of older individuals. Therefore, a study was conducted to determine the level of appetite, food intake and its relation to body composition and functional status among noninstitutionalised elderly Malays in Cheras, Kuala Lumpur. The Council on Nutrition Appetite Questionnaire (CNAQ), Diet History Questionnaire (DHQ), Bio-impedance Analysis (BIA) and Instrumental Activity of Daily Living (IADL) questionnaire and handgrip dynamometer were used to measure appetite, food intake, body composition and functional status respectively. A total of 112 subjects (41.1% men and 58.9% women) participated with mean age being 66.0 ± 5.0 years for men and 66.3 ± 6.2 years for women. Prevalence of poor appetite was higher in elderly women (72.3%) than in men (52.3%) (p<0.05). Pearson's correlation test showed that CNAQ score correlated significantly with age (r=-0.255, p<0.01), energy intake (r=0.272, p<0.01), IADL score (r=0.408, p<0.01) and handgrip strength (r=0.263, p<0.05). Energy intake correlated significantly with fat free mass (r=0.424, p<0.05), muscle mass (r=0.456, p<0.05) and total body water (r=0.403, p<0.05). Multiple regression analysis showed that 27.0% of poor appetite could be explained by advanced age, low energy intake and decreased functional status. In conclusion, the study showed that poor appetite was prevalent among the subjects, especially women and this was influenced by aging, inadequate energy intake and decreased functional status.     

Lower extremity muscle mass predicts functional performance in mobility-limited elders

Objectives: This study examined the influence of lower extremity body composition and muscle strength on the severity of mobility-disability in community-dwelling older adults.Methods: Fifty-seven older males and females (age 74.2 ± 7 yrs; BMI 28.9 ± 6 kg/m²) underwent an objective assessment of lower extremity functional performance, the Short Physical Performance Battery test (SPPB). Participants were subsequently classified as having moderate (SPPB score > 7: n = 38) or severe mobility impairments (SPPB score ≤ 7: n = 19). Body composition was assessed using dual-energy X-ray absorptiometry and provided measures of bone mineral density (BMD), total leg lean mass (TLM) and total body fat. Maximal hip extensor muscle strength was estimated using the bilateral leg press exercise. Multiple logistic regression analysis was utilized to identify the significant independent variables that predicted the level of mobility-disability.Results: TLM was a strong independent predictor of the level of functional impairment, after accounting for chronic medical conditions, BMD, body fat, body weight and habitual physical activity. In a separate predictive model, reduced muscle strength was also a significant predictor of severe functional impairment. The severity of mobility-disability was not influenced by gender (p = 0.71). A strong association was elicited between TLM and muscle strength (r = 0.78, p < 0.01).Conclusions: These data suggest that lower extremity muscle mass is an important determinant of physical performance among functionally-limited elders. Such findings may have important implications for the design of suitable strategies to maintain independence in older adults with compromised physical functioning. Additional studies are warranted to assess the efficacy of lifestyle, exercise or therapeutic interventions for increasing lean body mass in this population.     

Sarcopenia and Appendicular Muscle Mass as Predictors of Impaired Fasting Glucose/Type 2 Diabetes in Elderly Women

Elderly women exhibit a high risk of type 2 diabetes (T2D), but no definitive data exist about the possible role of postmenopausal increases in visceral adiposity, the loss of lean body mass, or decreases in the sum of the lean mass of arms and legs (appendicular skeletal muscle mass (ASMM)). This retrospective, longitudinal study investigated whether body composition (bioelectrical impedance analysis) predicted the development of impaired fasting glucose (IFG) or T2D in a cohort of 159 elderly women (age: 71 ± 5 years, follow-up: 94 months) from southern Italy (Clinical Nutrition and Geriatric Units of the “Mater Domini” University Hospital in Catanzaro, Calabria region, and the “P. Giaccone ”University Hospital in Palermo, Sicily region). Sarcopenia was defined in a subgroup of 128 women according to the EWGSOP criteria as the presence of low muscle strength (handgrip strength <16 kg) plus low muscle mass (reported as appendicular skeletal muscle mass <15 kg). Participants with a low ASMM had a higher IFG/T2D incidence than those with a normal ASMM (17% vs. 6%, p-adjusted = 0.044); this finding was independent of BMI, fat mass, waist circumference, and habitual fat intake (OR = 3.81, p = 0.034). A higher incidence of IFG/T2D was observed in the subgroup with sarcopenia than those without sarcopenia (33% vs. 7%, p-adjusted = 0.005) independent of BMI and fat mass (OR = 6.75, p = 0.007). In conclusion, this study demonstrates that elderly women with low ASMM had a higher probability of developing IFG/T2D. Further studies are needed to confirm these results in men and in other age groups.     

Lean Tissue Imaging

Body composition refers to the amount of fat and lean tissues in our body; it is a science that looks beyond a unit of body weight, accounting for the proportion of different tissues and its relationship to health. Although body weight and body mass index are well‐known indexes of health status, most researchers agree that they are rather inaccurate measures, especially for elderly individuals and those patients with specific clinical conditions. The emerging use of imaging techniques such as dual energy x‐ray absorptiometry, computerized tomography, magnetic resonance imaging, and ultrasound imaging in the clinical setting have highlighted the importance of lean soft tissue (LST) as an independent predictor of morbidity and mortality. It is clear from emerging studies that body composition health will be vital in treatment decisions, prognostic outcomes, and quality of life in several nonclinical and clinical states. This review explores the methodologies and the emerging value of imaging techniques in the assessment of body composition, focusing on the value of LST to predict nutrition status.     

The Effect of Exercise and Nutritional Interventions on Body Composition in Patients with Advanced or Metastatic Cancer: A Systematic Review

Advanced and metastatic cancers significantly alter body composition, leading to decreased lean mass and variable effects on fat mass. These effects on body composition are associated with significant physical dysfunction and poor prognosis in patients with cancer. Whilst exercise and nutritional interventions are likely to be of benefit in counteracting these effects, relatively little is known about using such interventions in patients with advanced or metastatic cancer. Therefore, in this systematic review we examine the effect of exercise and combined exercise and nutritional interventions on lean mass and fat mass among patients diagnosed with advanced or metastatic cancer. Following PRISMA guidelines, we identified 20 articles from PubMed, EMBASE, CINAHL, Cochrane CENTRAL, PEDro, SPORTDiscus, and REHABDATA. Overall, advanced or metastatic cancer populations comprising of mixed cancer types were most commonly examined (n = 8) with exercise or combined exercise and nutritional interventions being well-tolerated with few adverse effects. Both intervention approaches may preserve lean mass, while only combined interventions may lead to alterations in fat mass. However, further exercise and nutritional studies are needed to definitively understand their effects on body composition. As exercise and nutrition-related research continues in this understudied population, the knowledge gained will help guide supportive clinical treatments.