Sarcopenic obesity and complex interventions with nutrition and exercise in community-dwelling older persons – a narrative review

Figures & data

Figure 1 Contributing factors for sarcopenia and obesity.

Abbreviation: PA, physical activity.

Figure 2 Influences of physical activity and nutrition on sarcopenic obesity.

Table 1 Evidence on interventions in sarcopenic obesity

Type of intervention			Target
			Sarcopenic (or “frail”) obesity	Sarcopenia	Obesity
Combined (exercise + nutrition)	Exercise + WLD	WLD type: energy restriction	+?	Not appropriate	++
			R^Citation31,Citation37,Citation56		SR^Citation41,Citation121,Citation122
			S^Citation89		R^Citation12,Citation15,Citation16,Citation31,Citation37,Citation57,Citation123,Citation126
		Other WLD types	???	Not appropriate	+?
					R^Citation31
	Exercise + supplements	Supplements: protein or AAs	???	+?	???
				SR^Citation47,Citation88,Citation92
				R^Citation33,Citation64,Citation69,Citation70,Citation87,Citation90,Citation93
				S^Citation81
		Other supplements	???	?	?
				SR^Citation47,Citation88	R^Citation31
				R^Citation64,Citation87
Exercise only	Complex		+?	+?	+
			R^Citation31,Citation37	SR^Citation88	SR^Citation41
			S^Citation89	R^Citation33,Citation87	R^Citation16,Citation31,Citation37
	Single	Strength	???	++	?
				SR^Citation88	S^Citation128
				R^Citation40,Citation42,Citation87,Citation96,Citation97
		WB-EMS	???	+?	???
				R^Citation103
		Aerobic	???	?	−?
				R^Citation87,Citation97	R^Citation126
	Physical activity		???	???	+
					R^Citation50,Citation126
Nutrition only	WLD + supplements	Energy restriction + protein or AA	???	Not appropriate	?
					R^Citation31
	WLD	Energy restriction	+?	Not appropriate	+
			R^Citation31,Citation37		SR^Citation41
			S^Citation89		R^Citation16,Citation37
		Other WLD type	???	Not appropriate	?
					R^Citation31
	Supplements	Protein or AA	???	+?	?
				SR^Citation47,Citation88,Citation110	R^Citation31
				R^Citation33,Citation46,Citation49,Citation64,Citation65,Citation69,Citation74,Citation86,Citation87
				S^Citation113
		Vitamin D	???	−?	???
				SR^Citation116^–^Citation118
				R^Citation33,Citation46,Citation49,Citation85,Citation86
		Other supplements	?	?	?
			R^Citation31	SR^Citation47,Citation88	R^Citation31
				R^Citation31,Citation46,Citation49,Citation61,Citation64,Citation65,Citation68,Citation69,Citation86,Citation87

Notes: ++, good evidence on effects; +, some evidence on effects; −, no effects; ?, more evidence needed; ???, no evidence found.

Abbreviations: SR, systematic review; R, review; S, single study; WLD, weight loss diet; AA, amino acid; WB-EMS, whole-body electromyostimulation.

PoggiogalleEMigliaccioSLenziADoniniLMTreatment of body composition changes in obese and overweight older adults: insight into the phenotype of sarcopenic obesityEndocrine201447369971624952725

 PubMed Web of Science ®Google Scholar

Porter StarrKNMcDonaldSRBalesCWObesity and physical frailty in older adults: a scoping review of lifestyle intervention trialsJ Am Med Dir Assoc201415424025024445063

 PubMed Web of Science ®Google Scholar

ParrEBCoffeyVGHawleyJA‘Sarcobesity’: a metabolic conundrumMaturitas201374210911323201324

 PubMed Web of Science ®Google Scholar

WeinheimerEMSandsLPCampbellWWA systematic review of the separate and combined effects of energy restriction and exercise on fat-free mass in middle-aged and older adults: implications for sarcopenic obesityNutr Rev201068737538820591106

 PubMed Web of Science ®Google Scholar

WithamMDAvenellAInterventions to achieve long-term weight loss in obese older people: a systematic review and meta-analysisAge Ageing201039217618420083615

 PubMed Web of Science ®Google Scholar

McTigueKMHessRZiourasJObesity in older adults: a systematic review of the evidence for diagnosis and treatmentObesity20061491485149717030958

 PubMed Web of Science ®Google Scholar

VillarealDTChodeSParimiNWeight loss, exercise, or both and physical function in obese older adultsN Engl J Med2011364131218122921449785

 PubMed Web of Science ®Google Scholar

HanTSTajarALeanMEObesity and weight management in the elderlyBr Med Bull20119716919621325341

 PubMed Web of Science ®Google Scholar

Mathus-VliegenEMObesity and the elderlyJ Clin Gastroenterol201246753354422772735

 PubMed Web of Science ®Google Scholar

RejeskiWJMarshAPChmeloERejeskiJJObesity, intentional weight loss and physical disability in older adultsObes Rev201011967168519922431

 PubMed Web of Science ®Google Scholar

WatersDLWardALVillarealDTWeight loss in obese adults 65years and older: a review of the controversyExp Gerontol201348101054106123403042

 PubMed Web of Science ®Google Scholar

FelixHCWestDSEffectiveness of weight loss interventions for obese older adultsAm J Health Promot201327319119923286596

 PubMed Web of Science ®Google Scholar

SwiftDLJohannsenNMLavieCJEarnestCPChurchTSThe role of exercise and physical activity in weight loss and maintenanceProg Cardiovasc Dis201456444144724438736

 PubMed Web of Science ®Google Scholar

MalafarinaVUriz-OtanoFIniestaRGil-GuerreroLEffectiveness of nutritional supplementation on muscle mass in treatment of sarcopenia in old age: a systematic reviewJ Am Geriatr Soc20131411017

 Google Scholar

Cruz-JentoftAJLandiFSchneiderSMPrevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS)Age Ageing201443674875925241753

 PubMed Web of Science ®Google Scholar

CermakNMResPTde GrootLCSarisWHvan LoonLJProtein supplementation augments the adaptive response of skeletal muscle to resistance-type exercise training: a meta-analysisAm J Clin Nutr20129661454146423134885

 PubMed Web of Science ®Google Scholar

BurtonLASumukadasDOptimal management of sarcopeniaClin Interv Aging2010521722820852669

 PubMed Web of Science ®Google Scholar

BauerJBioloGCederholmTEvidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study GroupJ Am Med Dir Assoc201314854255923867520

 PubMed Web of Science ®Google Scholar

BauerJMDiekmannRProtein supplementation with agingCurr Opin Clin Nutr Metab Care2015181243110.1097/MCO.000000000000012425474010

 PubMed Web of Science ®Google Scholar

DideriksenKReitelsederSHolmLInfluence of amino acids, dietary protein, and physical activity on muscle mass development in humansNutrients20135385287623486194

 PubMed Web of Science ®Google Scholar

ForbesSCLittleJPCandowDGExercise and nutritional interventions for improving aging muscle healthEndocrine2012421293822527891

 PubMed Web of Science ®Google Scholar

BreenLStewartCEOnambéléGLFunctional benefits of combined resistance training with nutritional interventions in older adults: a reviewGeriatr Gerontol Int200774326340

 Web of Science ®Google Scholar

EvansWJProtein nutrition, exercise and agingJ Am Nutr2004236 Suppl601S609S

 PubMed Web of Science ®Google Scholar

TielandMDirksMLvan der ZwaluwNProtein supplementation increases muscle mass gain during prolonged resistance-type exercise training in frail elderly people: a randomized, double-blind, placebo-controlled trialJ Am Med Dir Assoc201213871371922770932

 PubMed Web of Science ®Google Scholar

BocaliniDSEffects of circuit-based exercise programs on the body composition of elderly obese womenClin Interv Aging2012755155623271901

 PubMed Web of Science ®Google Scholar

Montero-FernandezNSerra-RexachJARole of exercise on sarcopenia in the elderlyEur J Phys Rehabil Med201349113114323575207

 PubMed Web of Science ®Google Scholar

PetersonMDSenAGordonPMInfluence of resistance exercise on lean body mass in aging adults: a meta-analysisMed Sci Sports Exerc201143224925820543750

 PubMed Web of Science ®Google Scholar

LiuCLathamNKProgressive resistance strength training for improving physical function in older adultsCochrane Database Syst Rev20093CD00275919588334

 PubMed Web of Science ®Google Scholar

PillardFLaoudj-ChenivesseDCarnacGPhysical activity and sarcopeniaClin Geriatr Med201127344947021824557

 PubMed Web of Science ®Google Scholar

KemmlerWvon StengelSAlternative exercise technologies to fight against sarcopenia at old age: a series of studies and reviewJ Aging Res2012201210901322500224

 PubMedGoogle Scholar

BannDKuhDWillsAKAdamsJBrageSCooperRPhysical activity across adulthood in relation to fat and lean body mass in early old age: findings from the Medical Research Council National Survey of Health and Development, 1946–2010Am J Epidemiol2014179101197120724722997

 PubMed Web of Science ®Google Scholar

KomarBSchwingshacklLHoffmannGEffects of leucine-rich protein supplements on anthropometric parameter and muscle strength in the elderly: a systematic review and meta-analysisJ Nutr Health Aging201419443744625809808

 PubMed Web of Science ®Google Scholar

WelchAANutritional influences on age-related skeletal muscle lossProc Nutr Soc2014731163324229650

 PubMed Web of Science ®Google Scholar

MillwardDJNutrition and sarcopenia: evidence for an interactionProc Nutr Soc201271456657522429879

 PubMed Web of Science ®Google Scholar

BeasleyJMShikanyJMThomsonCAThe role of dietary protein intake in the prevention of sarcopenia of agingNutr Clin Pract201328668469024163319

 PubMed Web of Science ®Google Scholar

FukagawaNKProtein and amino acid supplementation in older humansAmino Acids20134461493150923563921

 PubMed Web of Science ®Google Scholar

MithalABonjourJPBoonenSImpact of nutrition on muscle mass, strength, and performance in older adultsOsteoporosis Int201324515551566

 PubMed Web of Science ®Google Scholar

TielandMVan de RestODirksMLProtein supplementation improves physical performance in frail elderly people: a randomized, double-blind, placebo-controlled trialJ Am Med Dir Assoc201213872072622889730

 PubMed Web of Science ®Google Scholar

AnnweilerCSchottAMBerrutGFantinoBBeauchetOVitamin D-related changes in physical performance: a systematic reviewJ Nutr Health Aging2009131089389819924350

 PubMed Web of Science ®Google Scholar

MuirSWMontero-OdassoMEffect of vitamin D supplementation on muscle strength, gait and balance in older adults: a systematic review and meta-analysisJ Am Geriatr Soc201159122291230022188076

 PubMed Web of Science ®Google Scholar

CiprianiCPepeJPiemonteSColangeloLCilliMMinisolaSVitamin D and its relationship with obesity and muscleInt J Endocrinol2014201484124825161666

 PubMed Web of Science ®Google Scholar

RobinsonSCooperCAihie SayerANutrition and sarcopenia: a review of the evidence and implications for preventive strategiesJ Aging Res2012201251080122506112

 PubMedGoogle Scholar

DeutzNEBauerJMBarazzoniProtein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert GroupClin Nutr201433692993624814383

 PubMed Web of Science ®Google Scholar