Background: Sarcopenic obesity (SO) is defined as a relatively low muscle mass in
combination with obesity. Individuals with SO have an increased risk of disability,
cardiovascular mortality, and all-cause mortality compared to those with only obesity or
sarcopenia. Lifestyle factors are thought to influence the pathogenesis of SO, but the
association between diet and SO are unknown.
Aim: To determine clinical and dietary determinants of sarcopenia and SO.
Methods: We included 102,106 participants from the LifeLines cohort. Participants were
included if they were ≥18 years old and did not have missing or unreliable BMI, 24-hour
urine creatinine excretion, or nutrition data. First, we split the LifeLines cohort into standard
deviations (SD) of 24-hour urine creatinine excretion from the mean (<-1.0SD, -1.0-0.0SD,
0.0-1.0SD, >1.0SD). This allowed us to compare variables such as age, physical activity,
macronutrient consumption, and comorbidities between the groups. Within the overweight
and obese population (BMI ≥25 kg/m2; n=53,406) we then compared the same variables
between the group with obesity and low muscle mass or SO (<-1.0SD) with those with
obesity and normal muscle mass (ONMM; ≥-1.0SD). To determine if dietary patterns differ
in those with SO and ONMM we used a plant-based diet score (PBDS). Also, using a logistic
regression we evaluated if there was an association between score and SO prevalence. This
was also done with a healthy plant-based dietary score (H-PBDS) and individual
Results: We found a SO prevalence of 5.37% for males and 4.83% for females. Those with
SO were found to be older, have a higher prevalence of co-morbidities (diabetes, kidney
disease, high blood pressure, and high cholesterol), be less active, and overall consume less
calories and macronutrients. Those with SO had a greater PBDS (50.71 vs. 50.24 in males
and 51.28 vs. 50.62 in females) compared to those with ONMM. We also found a positive
association between PBDS and SO (Odds ratio (OR) 1.014, P value <0.001 in males; OR
1.020, P value <0.001 in females). A similar trend was seen for the H-PBDS, plant protein
intake, and fruit and vegetable consumption, while total and animal protein and fat
consumption were inversely associated with SO.
Conclusion: Overall, we found those with SO to be older, have more co-morbidities, be less
active, and eat less calories and macronutrients. Additionally, those with SO had a higher
PBDS than those with ONMM, indicating they eat a more plant-based diet.
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