PMC:4159494 / 27475-33284 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/4159494","sourcedb":"PMC","sourceid":"4159494","source_url":"https://www.ncbi.nlm.nih.gov/pmc/4159494","text":"Countermeasures and future directions\nFuture research is needed to identify the countermeasures to osteosarcopenic obesity. As this is a complex condition, it is very likely that a multifactorial approach would be the best strategy. An option for clinical practice may be non-pharmacological approaches that may play a vital therapeutic role in ameliorating potential negative consequences of osteosarcopenic obesity.\nSubstantial evidence exists to suggest that long-term resistance training (RT) alone can promote favorable changes in body composition, muscular strength and endurance, and lipid metabolism thereby having a positive impact on obesity [88]. Other research has demonstrated increases in FFM with resistance training [89].\nResistance exercise can also be used as an effective intervention to improve BMD; however, the precise physiological actions that modulate bone remodeling are not clearly understood. Although beyond the scope of this review, some potential mechanism of action involve mechanical mechanotransduction [90, 91], production of nitric oxide (NO) as a result of mechanical loading [92–94], and prostaglandin release [92, 95].\nAdditionally, resistance exercise improves muscle strength and quality through a variety of different mechanisms that include satellite cell recruitment [96] and stimulation of the mammalian target of rapamycin (mTOR) pathway (which regulates skeletal muscle growth) [96]. Certain hormones (e.g., growth hormone, insulin-like growth factor I, and testosterone) are also implicated in promoting anabolism [97–99]. Finally, resistance exercise has been shown to increase lipolysis and fat oxidation [100] in overweight and obese individuals, and the combination of resistance and aerobic exercise has been shown to favorably alter body adiposity [101, 102]. Recently, the combination of aerobic and resistance training was also shown to improve weight loss and physical function among elderly obese individuals (potentially susceptible to osteosarcopenic obesity) [103].\nNutrition also plays an important role in the development of obesity and sarcopenia. Protein intake is important for both preventing loss of muscle mass and promoting increased muscular strength and endurance [104]. In fact, evidence is mounting to suggest that manipulation of the protein/carbohydrate ratio in the diet may improve muscle mass, fat mass, and BMD in overweight and obese individuals [101, 105]. In a study of 90 free-living overweight and obese adults, it was demonstrated that a whey protein supplement providing 56 g per day of protein (with no other dietary alterations) resulted in a significantly lower body weight (−1.8 kg; p \u003c 0.006) and fat mass (−2.3 kg; p \u003c 0.005) over 23 weeks compared to an isocaloric carbohydrate supplement [106]. This higher protein intake is thought to best manage body composition via its influence on metabolism, satiety, and muscle mass [48, 107, 108].\nResistance training and protein supplementation combined together are possible therapies to attenuate many of the previously mentioned side effects that are associated with osteosarcopenic obesity due to lack of physical activity. A high-protein dietary intake combined with exercise training has been shown to effectively reduce both body weight and body fat in obese men and women [101] while also helping to maintain or even improve muscle mass in overweight or obese men and women [101, 105] and in sarcopenic individuals [109]. Data indicate that exercise training (six times per week) combined with a higher protein intake (40 % of total energy intake) over a period of 12 weeks improves body weight (−6.2 %), percent total body fat (−15.8 %), percent abdominal body fat (−26.4 %), and BMI (−6.0 %) in healthy but overweight and obese men and women [101]. Likewise, it was reported [105] that moderate protein intake (25 % of total daily energy intake) and exercise training (6 days per week) resulted in significant decreases in body weight (90.8 ± 4.9 to 85.3 ± 4.7 kg), percent total body fat (36.8 ± 3.0 to 33.2 ± 3.2 %), percent abdominal fat (39.4 ± 2.8 to 36.6 ± 3.0 %), and BMI (32.1 ± 1.0 to 30.1 ± 1.1 kg/m2) in overweight/obese men and women both with exercise (6 days/week) and without exercise. Interestingly, high-protein intake (40 %) in the non-exercising group had significant improvements over 12 weeks in body composition marked by decreases in body weight (94.5 ± 6.5 to 89.3 ± 5.9 kg), percent body fat (40.3 ± 2.4 to 38.3 ± 2.6 %), and waist circumference (102.2 ± 5.8 to 94.3 ± 4.8 cm). These improvements in body composition were made without the addition of an exercise program.\nTaken together, increased physical activity and protein intake (likely above the current recommended reference intakes) appear to be useful for reducing adiposity and maintaining muscle and bone mass in an effort to stave of osteosarcopenic obesity. This holds true for the oldest of the old and in a variety of clinical populations, although more clinical trials are needed.\nAs part of the multifactorial concept of osteosarcopenic obesity, future studies on the relationship between both psychological and physical fatigue in the development and exacerbation of this syndrome must be explored. Fatigue is a behavioral marker for reduced ability to adapt to stressors, leading to reduced physical function and poorer quality of life. Reductions in fatigue by using holistic measures may be proven beneficial as a potential countermeasure for osteosarcopenic obesity [110].\nFinally, given the novelty of the identification of osteosarcopenic obesity, the development of animal models will be helpful to identify the pathophysiology of this syndrome. Ultimately, experimental animal models may provide insight in how to apply these mechanisms to the human condition.","divisions":[{"label":"title","span":{"begin":0,"end":37}},{"label":"p","span":{"begin":38,"end":417}},{"label":"p","span":{"begin":418,"end":737}},{"label":"p","span":{"begin":738,"end":1157}},{"label":"p","span":{"begin":1158,"end":2026}},{"label":"p","span":{"begin":2027,"end":2933}},{"label":"p","span":{"begin":2934,"end":4643}},{"label":"p","span":{"begin":4644,"end":5019}},{"label":"p","span":{"begin":5020,"end":5517}}],"tracks":[]}