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Clinical Manifestations and Factors Associated with Osteosarcopenic Obesity Syndrome: A Cross-Sectional Study in Koreans with Obesity

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Abstract

Demonstrating the clinical consequences of osteosarcopenic obesity (OSO) is complex. This study evaluated clinical manifestations and factors associated with bone and muscle loss in Koreans with obesity. This cross-sectional observational study enrolled Koreans with obesity aged ≥ 50 years from the Korea National Health and Nutrition Examination Survey. Clinical manifestations were compared among four groups: obesity (O), sarcopenic obesity (SO), osteopenic obesity (OO), and OSO. Factors associated with appendicular skeletal muscle mass (ASM) or bone mineral density (BMD) were evaluated. OSO increases with age in both sexes. Men with SO and OSO had increased cardiometabolic diseases and markers, percentages of body fat (BF %), and trunk fat (TF %), and decreased limb fat percentage (LF %). Women with SO and OSO had increased metabolic markers, BF %, and TF % but those with OSO had increased cardiometabolic diseases and lower LF %. Both sexes with OSO had decreased ASM and vitamin D, and higher vitamin D deficiency. BF % was negatively associated with ASM and femur BMD in both sexes. TF % was negatively and LF % was positively associated with ASM in both sexes and with femur BMD in women. Vitamin D was positively associated with femur BMD in men and with ASM and BMD at all sites in women. ASM and BMD were positively associated with each other. Appendicular muscle loss is metabolically significant regardless of bone loss in men; however, appendicular muscle loss with bone loss is metabolically more significant in women. Regional body composition, fat distribution, and vitamin D deficiency were associated with OSO phenotype in both sexes.

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Abbreviations

ALT:

Alanine aminotransferase

ASM:

Appendicular skeletal muscle mass

AST:

Aspartate aminotransferase

BF %:

Body fat percentage

BMD:

Bone mineral density

BMI:

Body mass index

CI:

Confidence interval

Cr:

Creatinine

CVA:

Cerebrovascular accident

DBP:

Diastolic blood pressure

DXA:

Dual-energy X-ray absorptiometry

FM:

Fat mass

H:

Hours

HbA1c:

Glycated hemoglobin

HDL-C:

High-density lipoprotein cholesterol

HL:

Hyperlipidemia

HOMA-IR:

Homeostasis model assessment of insulin resistance

Ht:

Height

HTN:

Hypertension

iPTH:

Intact parathyroid hormone

KNHANES:

Korea National Health and Nutrition Examination Surveys

LDL-C:

Low-density lipoprotein cholesterol

LF %:

Limb fat percentage

LM:

Lean mass

MetS:

Metabolic syndrome

MI:

Myocardial infarction

Min:

Minutes

O:

Obesity

OA:

Osteoarthritis

OO:

Osteopenic obesity

OSO:

Osteosarcopenic obesity

SBP:

Systolic blood pressure

SD:

Standard deviation

SO:

Sarcopenic obesity

T-C:

Total cholesterol

TF %:

Trunk fat percentage

TG:

Triglycerides

T2D:

Type 2 diabetes

WC:

Waist circumference

Wt:

Weight

25OHD:

25-hydroxyvitamin D

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Acknowledgements

We wish to acknowledge the Korea Centers for Disease Control and Prevention who performed the KNHANES. This work was supported by research fund of Catholic Kwandong University (CKURF-201805490001).

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Author notes

  1. Yoo Mee Kim and Sunghoon Kim have contributed equally to this work.

Authors and Affiliations

  1. Division of Endocrinology and Metabolism, Department of Internal Medicine, Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, Simgokro 100Gil 25, Seo-gu, Incheon, 22711, South Korea

    Yoo Mee Kim, Young Jun Won & Se Hwa Kim

  2. Institute for Translational and Clinical Research, Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, Incheon, South Korea

    Yoo Mee Kim & Se Hwa Kim

  3. Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, South Korea

    Sunghoon Kim

  4. Institute for Bio-Medical Convergence, Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, Incheon, South Korea

    Young Jun Won

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Contributions

YMK and SK set up the study, analyzed the data, and wrote the manuscript. YJW and SHK contributed to the data analysis and reviewed/edited the manuscript. All authors contributed to the interpretation of results, critically revised the manuscript, and approved the final manuscript. SHK was the guarantor.

Corresponding author

Correspondence to Se Hwa Kim.

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Conflict of interest

Yoo Mee Kim, Sunghoon Kim, Young Jun Won, and Se Hwa Kim confirm that they have no conflict of interest related to this study.

Human and Animal Rights and Informed Consent

All procedures on participants were performed in accordance with ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Each participant gave written informed consent.

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Kim, Y.M., Kim, S., Won, Y.J. et al. Clinical Manifestations and Factors Associated with Osteosarcopenic Obesity Syndrome: A Cross-Sectional Study in Koreans with Obesity. Calcif Tissue Int 105, 77–88 (2019). https://doi.org/10.1007/s00223-019-00551-y

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