Does the Presence of Sarcopenic Obesity Affect Cardiometabolic Risk and Quality of Life in Children and Adolescents?
Project no. 30847 · Status: Kapanmış (Yayın bekleniyor) · 2024
Summary
<p>Individuals with obesity are at risk of losing muscle mass and strength, potentially leading to the development of sarcopenia. The term sarcopenia is defined as a decrease in skeletal muscle mass and function (muscle strength and physical performance). When low muscle quantity/quality, low muscle strength, and low physical performance coexist, sarcopenia is considered severe. Sarcopenic obesity (SO) is the concurrent presence of increased fat mass and sarcopenia. Although sarcopenia is often associated with advanced age, SO is expected to lead to negative health outcomes even in pediatric populations. However, the prevalence of SO in this age group and its association with adverse health outcomes are not well defined. In evaluating SO in children and adolescents, only two studies have assessed both muscle mass and strength together, and no study has evaluated muscle mass, muscle strength, and performance simultaneously. This study aims to assess the presence of sarcopenia by concurrently evaluating muscle mass, muscle strength, and performance in obese children and adolescents, and to investigate the impact of SO on cardiometabolic issues and quality of life. In our clinic, the demographic and clinical characteristics of patients aged 10 to 18 years with a diagnosis of obesity will be prospectively examined. A total of 80 obese patients and an age- and sex-matched healthy control group of 80 individuals with normal weight will be included in the study. For both groups, muscle mass and muscle function (strength and physical performance) will be evaluated for the diagnosis of sarcopenia through body composition analysis. Hand grip strength will be measured using a hand grip dynamometer; the 6-minute walk test will be utilized to assess physical performance. The presence of sarcopenia will be compared between the two groups. The "Impact of Weight on Quality of Life Scale for Children (IWQOL-Kids)" will be applied to the obese group. Serum glucose levels, lipid profile [triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol levels (HDL-C)], liver functions (AST/ALT), insulin, HOMA-IR, and HbA1c results from the medical files of the obese patients will be recorded in the case report form. The impact of the presence of sarcopenia on cardiometabolic issues and quality of life will be evaluated in the obese group. INTRODUCTION Obesity is defined as an excessive accumulation of fat with negative health consequences. In recent years, there has been an emphasis on the risk of individuals with obesity losing muscle mass and strength, thereby developing sarcopenia. The term sarcopenia refers to a reduction in skeletal muscle mass and function (muscle strength and physical performance). When low muscle quantity/quality, low muscle strength, and low physical performance are present together, sarcopenia is considered severe. Sarcopenic obesity (SO) refers to the co-occurrence of increased fat mass and sarcopenia. While higher body mass may correlate with a parallel increase in skeletal muscle mass in the general population, obesity and excess adipose tissue could be related to catabolic processes in muscle tissue, potentially worsening with the onset of metabolic complications such as insulin resistance, metabolic syndrome, and type 2 diabetes. Commonly observed poor nutritional habits and sedentary lifestyle in obesity may further increase muscle catabolism. Loss of skeletal muscle mass and function typically occurs with aging and is generally parallel to relative or absolute body fat gain, supporting the potential development and onset of SO. However, sarcopenia can occur at any age in individuals with obesity. Obesity has adverse effects on muscle tissue through metabolic dysfunctions such as oxidative stress, inflammation, and insulin resistance caused by adipose tissue, often leading to muscle mass and function loss. Studies, primarily conducted on adults, have shown a direct relationship between low skeletal muscle mass and higher insulin resistance and the risk of type 2 diabetes. Moreover, since skeletal muscle plays a direct role in exercise capacity and respiratory function, sarcopenia can be directly associated with poor prognosis regarding cardiopulmonary function. The presence of sarcopenia also significantly adversely affects quality of life and general well-being. While sarcopenia is often attributed to advanced age, it is conceivable that SO could lead to negative health outcomes even in the pediatric population. Limited studies conducted in children and adolescents have demonstrated significant associations between SO and cardiometabolic outcomes, severity of non-alcoholic fatty liver disease (NAFLD), inflammation, and mental health. However, the prevalence of SO and its relationship with negative health outcomes have not been well defined in this age group. Another critical issue is the lack of consensus regarding the definition of SO, diagnostic methods, and age and sex-specific cutoff points in children and adolescents. In only two studies assessing SO in children and adolescents have muscle mass and strength been evaluated together, but no study has focused on evaluating muscle mass, muscle strength, and performance concurrently. RATIONALE: The diagnostic criteria for sarcopenia have primarily been developed from cohorts of non-obese older adults. There are limited studies assessing the relationship between the presence of SO and adverse health outcomes in children and adolescents. Therefore, the effectiveness of currently recommended tools for screening and diagnosing sarcopenia in obese young individuals is insufficient. There are not clear-cut insights in the literature regarding muscle mass and function in children and adolescents with obesity, related to low physical activity, unhealthy eating habits, and insulin resistance. The absence of universally recognized diagnostic criteria for SO in this age group affects patient characterization, reliable evaluation of SO prevalence, and, most importantly, the prevention of SO-related outcomes. Awareness surrounding sarcopenia and the implementation of diagnostic protocols in clinical practice remains limited, with a substantial lack of evaluation regarding therapeutic strategies. Accordingly, this study is significant for understanding the definition of age-related and obesity-linked sarcopenia and the impact of SO on cardiometabolic outcomes and quality of life. OBJECTIVE: The aim of this study is to assess the presence of sarcopenia by evaluating muscle mass, muscle strength, and performance together in obese children and adolescents and to investigate the impact of SO on cardiometabolic issues and quality of life.</p>