Sarcopenia is defined by the European Working Group on Sarcopenia in Older People (EWGSOP) as "a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength, carrying a risk of adverse outcomes such as physical disability, fractures, falls, impaired quality of life, and death. Obesity is classified according to the Body Mass Index (BMI), which is calculated by dividing weight in kilograms by the square of height in meters. According to the World Health Organization and most current guidelines for Western societies, obesity is defined as a BMI ≥ 30 kg/m². Sarcopenic obesity was first defined by Baumgartner as the co-occurrence of sarcopenia and obesity, measured using DEXA (10). Sarcopenic obesity is defined as the co-occurrence of high adiposity and sarcopenia; a term originally coined to describe low skeletal muscle mass, strength, and physical function, initially diagnosed in the elderly but present across the entire age spectrum. Combining the effects of both sarcopenia and obesity, sarcopenic obesity has been found to be associated with lower quality of life and greater disability, morbidity, and mortality compared to obesity or sarcopenia alone. Acupuncture is derived from the Latin words for needle (acus) and piercing (punctura). In Western languages, it is written as acupuncture. In traditional Chinese medicine, it is believed that diseases are caused by disturbances in the flow of life energy (Qi) circulating in channels called meridians in the body. Acupuncture aims to correct this disrupted energy flow by inserting needles into specific points along the meridians in the body. Numerous studies have reported that acupuncture is widely used in the treatment of obesity. Current evidence-based reviews have shown that acupuncture is effective in treating obesity. It has been suggested that acupuncture is an effective treatment for simple obesity rather than a placebo effect. The literature contains many studies on acupuncture in the treatment of obesity. However, there are no studies on acupuncture in sarcopenic obesity. Our study aimed to determine the effect of acupuncture on sarcopenia and obesity in patients with sarcopenic obesity.
Sarcopenic obesity was first defined by Baumgartner as the co-occurrence of sarcopenia and obesity, measured using DEXA (dual-energy x-ray absorptiometry). It is characterized by the simultaneous occurrence of high adiposity and sarcopenia; the term was initially coined to describe low skeletal muscle mass, strength, and physical function, initially diagnosed in the elderly but present across the entire age spectrum. Combining the effects of both sarcopenia and obesity, sarcopenic obesity has been associated with a lower quality of life and greater disability, morbidity, and mortality compared to obesity or sarcopenia alone. The lack of accurate prevalence rates for sarcopenic obesity stems from the absence of a consistent definition for sarcopenia or obesity. In a population-based cohort using National Health and Nutrition Examination Survey (NHANES) data applying FNIH criteria, sarcopenic obesity rates were found to be 12.6% in men and 33.5% in women, and these rates increased with age, reaching 27.5% in men and 48% in women over 80 years of age. The pathogenesis of sarcopenic obesity is multifactorial; the interaction between aging, sedentary lifestyle, unhealthy dietary habits, and insulin resistance, systemic inflammation, and oxidative stress leads to a quantitative and qualitative decrease in muscle mass and function, and a parallel increase in fat mass. Common etiological factors affect both muscle and fat mass. Current definitions of sarcopenic obesity are based on individual definitions of sarcopenia and obesity, but there is currently no consensus defining cut-off values for either of these conditions, making it difficult to reach an accurate diagnosis of sarcopenic obesity. In sarcopenic obesity, anthropometric measurements (weight, BMI, waist circumference) are normal or high, and imaging (DEXA, BIA, CT, MRI) shows high fat mass and low muscle mass. Acupuncture is derived from the Latin words for needle (acus) and piercing (punctura). In Western languages, it is written as acupuncture. In traditional Chinese medicine, it is believed that diseases are caused by disruptions in the flow of life energy (Qi) circulating in channels called meridians in the body. Acupuncture aims to correct the disrupted energy flow by inserting needles into specific points on the meridians in the body. The key to achieving the desired result in acupuncture is knowing where to stimulate the skin and inserting the needles appropriately. As one of the oldest medical treatments and an important part of traditional Chinese medicine, acupuncture has been widely used in the treatment of various diseases for at least 3000 years. Meanwhile, it is also one of the most popular complementary and alternative approaches, supported by the World Health Organization (WHO) and the National Institutes of Health (NIH). Numerous studies have reported that acupuncture is widely used in the treatment of obesity. Current evidence-based reviews have shown that acupuncture is effective in treating obesity. It has been suggested that acupuncture is an effective treatment for simple obesity rather than a placebo effect. In our study, the investigators aimed to reveal the effect of acupuncture on sarcopenia and obesity in patients with sarcopenic obesity.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
28
This group will receive a total of 10 sessions per week, 2 days a week consisting of aerobic exercises, resistance exercises, posture and balance exercises, and breathing exercises, as well as a diet program targeting sarcopenic obesity.
The second group will receive acupuncture treatment in addition to diet and exercise. Acupuncture treatment will be applied twice a week for a total of 10 sessions, with each session lasting at least 20 minutes. The acupuncture points the investigators will use in the treatment have been determined based on previous research and are as follows: body acupuncture points ST25, ST36, SP15, LI4, Ren12, Ren6, Ki3, GB34, SP3, SP6, Liv8, SJ-6, Du 20, Yin Tang, Tai Yin; ear acupuncture points are shenmen, large intestine, hunger, and mouth points.
Ankara Bilkent City Hospital
Ankara, çankaya, Turkey (Türkiye)
Appendicular skeletal muscle mass
Body composition was assessed using a DEXA scanner (Lunar iDXA; GE Healthcare, 3030 Ohmeda Drive, Madison, WI 53718, USA). Participants' weight, muscle mass and lean mass values were recorded. ASM was calculated as the sum of the bone-free lean mass of the four limbs.
Time frame: baseline-Week 6-Week 12
weight
The weight was measured with a standardized weight scale.
Time frame: baseline-week 6-week 12
body mass index
BMI was calculated as weight in kilograms divided by height in meters squared (kg/m²).
Time frame: baseline-week 6-week 12
hand grip strength
Muscle strength was evaluated by measuring handgrip strength with a validated and reliable Baseline hydraulic hand dynamometer (Inc., White Plains, NY 10602, USA)8. Grip strength was assessed with the participant seated in a chair, the shoulder in a neutral position, and the elbow flexed at 90°; three maximal grip efforts were performed with each hand, both right and left. The highest value obtained was taken as the grip strength. A rest interval of at least 30 seconds was allowed between measurements.
Time frame: baseline-week 6-week 12
waist circumference and hip circumference measurement
Waist and hip circumference were measured with a tape measure.
Time frame: baseline-week 6-week 12
Sit-Up and Stand-Up Test (from a Chair)
Participants were seated in a standard-height, armless chair with their feet flat on the floor, approximately shoulder-width apart. They were instructed to cross their arms over their chest and, upon the command "start," to stand up and sit down fully five times as quickly as possible without using their arms for support. The timer started with the "start" command and stopped at the end of the fifth repetition when the participant reached a fully upright position. The total time taken to complete all five repetitions was recorded in seconds. A shorter completion time was considered to indicate better lower extremity functional performance.
Time frame: baseline-week 6-week 12
Walking speed of 4 meters
For the gait speed test, participants were asked to walk 4 meters at their usual pace and the elapsed time was measured with a stopwatch. Gait speed was calculated in meters per second (m/s).
Time frame: baseline-week 6-week 12
Sarcopenia Quality of Life Scale (SarQoL)
Sarcopenia-related quality of life was assessed using the validated Turkish version of the Sarcopenia Quality of Life questionnaire (SarQoL®). The SarQoL® is a self-administered, sarcopenia-specific questionnaire consisting of 22 questions and 55 items covering seven domains of health-related quality of life. The total score ranges from 0 to 100, with higher scores indicating better quality of life.
Time frame: baseline-week 6-week 12
Obesity-Weight Loss Quality of Life Scale (OWLQOL)
Obesity- and weight-loss-related quality of life was assessed using the validated Turkish version of the Obesity and Weight-Loss Quality of Life Questionnaire (OWLQOL). The OWLQOL is a disease-specific, self-administered questionnaire consisting of 17 items rated on a seven-point Likert scale. The total score is standardized to a range of 0-100, with higher scores indicating better obesity- and weight-loss-related quality of life.
Time frame: baseline-week 6-week 12
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