Association of lifestyle factors and inflammation with sarcopenic obesity: data from the PREDIMED-Plus trial

Background Sarcopenia is a progressive age-related skeletal muscle disorder associated with increased likelihood of adverse outcomes. Muscle wasting is often accompanied by an increase in body fat, leading to 'sarcopenic obesity'. The aim of the present study was to analyse the association of lifestyle variables such as diet, dietary components, physical activity (PA), body composition, and inflammatory markers, with the risk of sarcopenic obesity. Methods A cross-sectional analysis based on baseline data from the PREDIMED-Plus study was performed. A total of 1535 participants (48% women) with overweight/obesity (body mass index: 32.5 +/- 3.3 kg/m(2); age: 65.2 +/- 4.9 years old) and metabolic syndrome were categorized according to sex-specific tertiles (T) of the sarcopenic index (SI) as assessed by dual-energy X-ray absorptiometry scanning. Anthropometrical measurements, biochemical markers, dietary intake, and PA information were collected. Linear regression analyses were carried out to evaluate the association between variables. Results Subjects in the first SI tertile were older, less physically active, showed higher frequency of abdominal obesity and diabetes, and consumed higher saturated fat and less vitamin C than subjects from the other two tertiles (all P < 0.05). Multiple adjusted linear regression models evidenced significant positive associations across tertiles of SI with adherence to the Mediterranean dietary score (P-trend < 0.05), PA (P-trend < 0.0001), and the 30 s chair stand test (P-trend < 0.0001), whereas significant negative associations were found with an inadequate vitamin C consumption (P-trend < 0.05), visceral fat and leucocyte count (all P-trend < 0.0001), and some white cell subtypes (neutrophils and monocytes), neutrophil-to-lymphocyte ratio, and platelet count (all P-trend < 0.05). When models were additionally adjusted by potential mediators (inflammatory markers, diabetes, and waist circumference), no relevant changes were observed, only dietary variables lost significance. Conclusions Diet and PA are important regulatory mediators of systemic inflammation, which is directly involved in the sarcopenic process. A healthy dietary pattern combined with exercise is a promising strategy to limit age-related sarcopenia.This work was supported by the official Spanish institutions for funding scientific biomedical research, CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn) and Instituto de Salud Carlos III (ISCIII), through the Fondo de Investigación para la Salud (FIS), co‐funded by the European Regional Development Fund (ERDF) (four coordinated FIS projects leaded by J.S.‐S. and J.V., including the following projects: PI13/00462, PI13/01090, PI13/02184, PI14/00853, PI14/00728, PI14/01919, PI16/00501, PI16/00381, PI16/01522, PI17/00525, PI17/00532, PI17/00215, and PI17/00926), and through specific grants: the Astra Zeneca Young Investigators Award in Category of Obesity and Diabetes 2017 (D.R.); Juan de la Cierva‐formación research grant (FJCI‐2015‐24058) of the Spanish Ministry of Economy, Industry and Competitiveness and European Social Funds (J.K.), the ‘FOLIUM’ programme within the FUTURMed project; and talent for the medicine within the future from the Fundación Instituto de Investigación Sanitaria Illes Balears (financed by 2017 annual plan of the sustainable tourism tax and at 50% with charge to the ESF Operational Program 2014–2020 of the Balearic Islands) (J.K.). None of the funding sources took part in the design, collection, analysis, or interpretation of the data or in the decision to submit the manuscript for publication. This work is supported by the European Research Council (Advanced Research Grant 2014–2019; agreement #340918 granted to MAM‐G)