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Background & Aims: The role of sarcopenic obesity (SO) in impaired cognitive function has been investigated in several observational studies, but results have been mixed. This study applied the proposed European Society for Clinical Nutrition and Metabolism (ESPEN)-European Association for the Study of Obesity (EASO) definition of SO to a representative population aged ≥50 years to identify the association between SO and cognitive function., Methods: Data from the National Health and Nutrition Examination Survey 1999-2002 waves were used. At the screening phase, body mass index or waist circumference were used to evaluate obesity; sarcopenia was identified using the SARC-F questionnaire. At the diagnostic phase I and II, sarcopenia was assessed using knee extensor isometric strength and appendicular lean mass, and fat mass percent was used to assess obesity. Cognitive function in older participants (60-85 years) was assessed using the Digit Symbol Substitution Test. A self-reported memory question was used in middle-aged individuals (50-59 years)., Results: The sample included 2356 participants (men, 44.7%). The prevalence of SO was 32.3%, 21.2% and 15.0% at the screening, diagnosis I, and diagnosis II, respectively. Significant associations between SO and cognitive impairment were observed in individuals aged 60-85 at diagnosis I (OR: 2.3, 95%CI 1.4-3.8, P = 0.007) and diagnosis II (OR: 2.7, 95%CI 1.5-4.9, P = 0.004)., Conclusion: The new ESPEN-EASO definition of SO identified a high prevalence of SO cases. A significant association between SO and poor cognitive function in older individuals was observed., Competing Interests: Declaration of competing interest I.A.M. was a member of the UK Government Scientific Advisory Committee on Nutrition, the Mars Scientific Advisory Council, the Mars Europe Nutrition Advisory Board, the Nestle Research Scientific Advisory Board, the Novozymes Scientific Advisory Board, and was a Scientific Adviser to the Waltham Centre for Pet Nutrition until 2020. On 1 August 2020 he became Professor Emeritus at the University of Nottingham and took up the post of Scientific Director of the Nestle Institute of Health Sciences in Lausanne, Switzerland, which terminated in August 2022. Other authors No conflicts to declare., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: The nutrition transition model provides an integrated approach to analyse global changes in food consumption and lifestyle patterns. Whether variability in food availability for consumption, lifestyle and sociodemographic factors is associated with the worldwide prevalence distribution of overweight, obesity and hypertension is unclear., Design: Ecological analysis., Setting: Country-specific prevalence estimates of overweight, obesity and hypertension were obtained. Prevalence estimates were then matched to year- and country-specific food and energy availability for consumption of cereals, sugar, sweeteners and honey, vegetable oils, fruits, starchy roots, pulses, total vegetables, alcoholic beverages, total meat, animal fat, eggs, milk, and fish and seafood. The per capita Gross Domestic Product (GDP), urbanization rates and prevalence of physical inactivity for each country were also obtained., Subjects: The overweight, obesity and hypertension databases included information from 128, 123 and seventy-nine countries, respectively., Results: Consumption of sugar and animal products were directly associated with GDP and urbanization rates. In a multivariate regression model, physical inactivity (B = 0·01, se = 0·005, P = 0·003), cereal consumption (B = -0·02, se = 0·006, P < 0·001) and sugar consumption (B = 0·03, se = 0·01, P = 0·03) were significant predictors of obesity prevalence. Midpoint age (B = 0·21, se = 0·10, P = 0·02), prevalence of overweight (B = 0·18, se = 0·08, P = 0·02) and consumption of cereals (B = -0·22, se = 0·10, P = 0·02) were significant predictors of hypertension. Women appeared to have a significant obesity excess compared with men., Conclusions: High sugar consumption and sedentary lifestyle are associated with increased obesity prevalence. The non-linear association of sugar consumption with prevalence of obesity suggests that effective strategies to reduce its consumption may have differential effects in countries at different stages of the nutrition transition.

Purpose: Body adiposity index (BAI) is a novel index for the assessment of percentage fat mass (FM%). We tested the association between BAI and metabolic outcomes in overweight and obese women of different ages., Methods: 260 young women (24.7 ± 5.3 years, 31.0 ± 5.0 kg/m(2)) and 328 older women (66.9 ± 4.6 years, 34.8 ± 4.7 kg/m(2)) were recruited. BAI was calculated using hip circumference and height. Bioimpedance analysis was used to measure FM%. Metabolic risk was assessed using a composite z score integrating standardised measurements of fasting glucose, total cholesterol, liver enzymes and triglycerides., Results: The association between BAI and FM% was modest in both young (r = 0.56, p < 0.001) and older (r = 0.49, p < 0.001) groups. BAI was directly associated with metabolic risk in young women (r = 0.29, p < 0.001), whereas it showed a weak, inverse association in the older group (r = -0.14, p = 0.01)., Conclusions: BAI validity needs to be re-assessed in older individuals for better definition of its predictive accuracy.

Sarcopenic obesity (SO) is assuming a prominent role as a risk factor because of the double metabolic burden derived from low muscle mass (sarcopenia) and excess adiposity (obesity). The increase in obesity prevalence rates in older subjects is of concern given the associated disease risks and more limited therapeutic options available in this age group. This review has two main objectives. The primary objective is to collate results from studies investigating the effects of SO on physical and cardio-metabolic functions. The secondary objective is to evaluate published studies for consistency in methodology, diagnostic criteria, exposure and outcome selection. Large between-study heterogeneity was observed in the application of diagnostic criteria and choice of body composition components for the assessment of SO, which contributes to the inconsistent associations of SO with cardio-metabolic outcomes. We propose a metabolic load:capacity model of SO given by the ratio between fat mass and fat free mass, and discuss how this could be operationalised. The concept of regional fat distribution could be incorporated into the model and tested in future studies to advance our understanding of SO as a predictor of risk for cardio-metabolic diseases and physical disability., (Copyright © 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background: Increased levels of vascular endothelial growth factor (VEGF) have been observed in patients with metabolic syndrome (MetS). Nitric oxide (NO) formation is reduced in MetS, but its relationship to VEGF production remains poorly defined. We evaluated the association between VEGF/NO synthesis and insulin sensitivity in obese subjects and investigated the secretory response of VEGF to an acute elevation of glucose., Materials and Methods: Seven healthy normal-weight subjects, seven obese subjects without MetS and seven obese subjects with MetS were recruited. Anthropometry, body composition and cardiometabolic functions (blood pressure, glucose, insulin, triglycerides, total cholesterol, HDL-C and VEGF) were measured, and a novel stable isotope method was used to assess in vivo rates of NO production. A frequent sampling intravenous glucose tolerance test was performed to study the dynamics of VEGF release., Results: Fasting VEGF levels were significantly higher in the two obese groups compared to the control group (P for trend = 0·02), but the difference was not significant after adjustment for age. Vascular endothelial growth factor levels were associated with systolic blood pressure (ρ = 0·54; P = 0·01) and NO production (ρ = -0·44; P = 0·04). Vascular endothelial growth factor levels increased in response to acute hyperglycaemia in normal-weight and obese subjects (P < 0·001)., Conclusions: Vascular endothelial growth factor levels rapidly increase during hyperglycaemia and are inversely related to NO production at steady state. The potential link between the acute secretion of VEGF and atherosclerotic risk in subjects with poorly controlled glycaemia as well as the potential of lowering elevated VEGF levels by increasing NO production and/or availability warrants further investigation., (© 2012 The Authors. European Journal of Clinical Investigation © 2012 Stichting European Society for Clinical Investigation Journal Foundation.)

Objectives: Obesity is a risk factor for cognitive decline and dementia. Whether weight loss improves cognition in older obese adults is not known. The objective was to investigate the effects of intentional weight loss on physical and cognitive function in middle-aged and older obese adults attending a weight loss clinic., Method: Eleven male and 39 female nonsmoking, adult obese (body mass index 30-50 kg/m(2)) participants were recruited. Participants were stratified by age: middle aged (30-59 years) and older aged (≥ 60 years). The weight loss target for each subject was 8% to 12% of initial body weight. Information on anthropometry, bioelectrical impedance, hand-grip strength, Mini-Mental State Examination (MMSE), Short Portable Mental Status Questionnaire (SPMSQ), and Trail-Making Test (TMT) A and B were collected at baseline and after weight loss., Results: At baseline, older participants showed a nonsignificant trend for lower global cognitive function (MMSE, SPMSQ) and significantly slower processing speed (TMT-A). Twenty-one participants completed the weight loss study. The average weight loss relative to baseline was 9.7% ± 2.1%. Weight loss was associated with significant improvements in hand-grip strength and cognitive function (MMSE, TMT-A, and TMT-B). MMSE scores improved significantly only in older obese participants (p < 0.05)., Conclusions: Weight loss in middle-aged and in older obese participants has a beneficial effect on cognitive and physical function. If confirmed in future trials, weight loss can significantly affect public health strategies for the prevention of dementia as well as on the clinical management of obesity.

High adiposity in middle age is associated with higher dementia risk. The association between weight loss and cognitive function in older adults is still controversial. A meta-analysis was undertaken to estimate the effectiveness of intentional weight loss on cognitive function in overweight and obese adults. A structured strategy was used to search randomized and non-randomized studies reporting the effect of intentional and significant weight loss on cognitive function in overweight and obese subjects. Information on study design, age, nutritional status, weight-loss strategy, weight lost and cognitive testing was extracted. A random-effect meta-analysis was conducted to obtain summary effect estimates for memory and attention-executive domains. Twelve studies met inclusion criteria. Seven were randomized trials and the remaining five included a control group. A low-order significant effect was found for an improvement in cognitive performance with weight loss in memory (effect size 0.13, 95% CI 0.00-0.26, P=0.04) and attention/executive functioning (effect size 0.14, 95% CI 0.01-0.27, P<0.001). Studies were heterogeneous in study design, sample selection, weight-loss intervention and assessment of cognitive function. Weight loss appears to be associated with low-order improvements in executive/attention functioning and memory in obese but not in overweight individuals., (© 2011 The Authors. obesity reviews © 2011 International Association for the Study of Obesity.)

Background: Birth order has been associated with variability in early life growth and subsequent obesity risk, but the consequent metabolic risks have not been assessed., Objective: To quantify the metabolic risk in young adulthood of being first-born relative to those born second or subsequently., Methods: Body composition, resting metabolic rate and metabolic risk were assessed in 383 women, aged 18-35 years, from a clinical setting in southern Italy., Results: First-borns had increased body mass index, adiposity and metabolic risk (p<0.05) and increased resting metabolic rate adjusted for fat-free mass (p<0.05) in the Italian women., Conclusion: First-born status is associated with significantly elevated metabolic risk in a clinical population of overweight and obese young women attending a weight loss clinic. If these findings are confirmed in other studies, they may suggest that the prevalence of the metabolic syndrome worldwide may increase as a function of the trend to smaller family size.