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ICC Sydney

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Sarcopenia in metabolic and neurological diseases

Session outline

Sarcopenia is a geriatric syndrome with progressive loss of mass, quality and function of skeletal muscles associated with aging. Its prevalence may reach 30% for people over 60 in European populations. Sarcopenia is a multifactorial process: some factors lead to the development of sarcopenia and its associated negative effect on physical function. The loss of skeletal muscle fibers secondary to the reduced number of motor neurons appears to contribute significantly to the disorder, which may further include reduced levels of hormones (particularly GH, IGF-1, MGF, and testosterone), lack of protein and calories of the diet, oxidative stress, inflammatory processes etc. Sarcopenia requires a rehabilitation program to improve physical performance but also nutritional interventions: protein supplementation combined with exercise, leucine-enriched amino acids and vitamin D supplementation, as adjunctive therapy. There is a lack of studies with outcome interventions to counteract sarcopenic obesity. However, there are recommendations for sarcopenia and / or weight loss. Strength exercise combined we proper diet demonstrated positive effects on muscle function and combination of a dietary weight loss intervention and additional protein supplements may reduce body fat. Nutrition is a common factor in both entities: sarcopenia and obesity, although interventions differ due to different pathophysiological mechanisms causing the problem: inadequate nutrition vs. excess consumption is the case. The problem is how to increase muscle mass in a situation of energy deficit, while during weight loss, which is effective in reducing fat mass, skeletal muscle mass may also be lost and consequently reduced. Higher protein intakes prevent muscle mass loss, especially when combined with an exercise intervention. Exercise programs containing strength and aerobic exercise in combination with dietary weight loss program may possibly have positive effects on sarcopenic obesity. The analysis of body composition for assessing the health and nutrition of the individual is a useful test. Diseases such as diabetes mellitus may be associated with adverse changes in body composition. However, there is a lack of studies that examine the association of sarcopenia in patients with type 2 diabetes mellitus (T2DM). The prevalence of sarcopenia in patients with T2DM is moderate and gradually increases significantly in older men. Muscle mass, -strength and -density, sarcopenia, exercise, and physical activity are correlated with bone mass, bone density and osteoporotic fractures. Bone and muscle decay and dysfunction are seen in ageing, but in neurological disorders with muscular atrophy, bone loss can be seen also at younger ages. The pathophysiology of osteosarcopenia in neurological diseases is complicated. One factor is unloading of affected skeletal muscle, and consequently deconditioning which occurs in any muscle that is not active. In subjects with post poliomyelitis syndrome lowest BMD scores were present in patients with visible and clear lower limb muscle atrophy. The correlation found between low muscle mass and BMD, can be explained by neurogenic bone loss, both due to muscle atrophy and disturbed regulation of bone by the central nervous system.

Learning outcomes

  • Understand sarcopenia (pathophysiology, aetiology)
  • Explaining sarcopenic obesity and related complications
  • New information of sarcopenia in neurogenic diseases
  • Explaining the new syndrome of osteosarcopenia
  • Differential diagnosis of sarcopenia vs. sarcopenic obesity vs. osteosarcopenia
  • Rehabilitation interventions for primary and secondary sarcopenia

Target audience

  • Medical practitioners
  • Students
  • Trainees
  • Nursing staff