Dissecting the Molecular and Cellular Pathophysiology of Sarcopenic Obesity in the Elderly

Ageing is characterised by a change in body composition with a parallel decrease in muscle mass and an increase and central redistribution of fat. When drastically exacerbated, these two processes culminate in a condition known as sarcopenic obesity (SO). SO is characterised by the coexistence of obesity and sarcopenia (i.e. reduced muscle mass and function) and is a growing public health problem in the elderly. The health risks of obesity and sarcopenia act synergistically, maximising the risk of disability of OS. The molecular mechanisms underlying OS are largely unknown. Increased fat mass induces chronic systemic inflammation and alters the profiles of adipokines and hormones, promoting the development of sarcopenia. On the other hand, the reduction in muscle tissue (SM) typical of sarcopenia is characterised by an alteration in the metabolic properties of skeletal muscle with an increase in insulin resistance and a reduction in energy expenditure that favours the accumulation and dysfunction of adipose tissue (AT). The cellular alterations that would seem to underlie OS are: altered autophagy, cellular senescence, epigenetic and mitochondrial alterations and maladaptive activation of intra- and intercellular inflammatory circuits (e.g. cytokines, extracellular vesicles, dysfunctional circulating leukocytes). However, the interconnections between these mechanisms are still unclear. The impact of OS can be dramatic on the health and quality of life of those affected. Therefore, the identification of early biomarkers that can recognise overweight and obese individuals at risk of developing SO is of paramount importance. This would shed light on the heterogeneity of an otherwise homogeneous clinical condition, opening new horizons towards the conscious design of more personalised therapeutic strategies, allowing a more rational use of the limited resources available for the growing elderly population.

The study design designed to achieve this aim is a cross-sectional observational study with an additional multicentre procedure lasting two years.

Study Overview

• Status: Recruiting
• Conditions: Sarcopenic Obesity
• Intervention / Treatment: Other: clinical evaluation of sarcopenic obesity

• Study Type: Observational
• Enrollment (Estimated): 1108

Contacts and Locations

• Study Contact: Name: Patrizia Rovere Querini, PhD, MD; Phone Number: +390226436095; Email: rovere.patrizia@hsr.it
• Study Contact Backup: Name: Rebecca De Lorenzo, MD; Phone Number: +390226433065; Email: delorenzo.rebecca@hsr.it

Study Locations

• Italy
  • Milan, Italy, 20132
    • Recruiting
    • Ospedale San Raffaele
    • Contact: Rebecca De Lorenzo, MD; Phone Number: +390226433065; Email: delorenzo.rebecca@hsr.it
    • Contact: Patrizia Rovere Querini, MD, PhD; Phone Number: +390226433065; Email: rovere.patrizia@hsr.it

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Older Adult
• Accepts Healthy Volunteers: N/A

• Sampling Method: Non-Probability Sample

Study Population

patients who are candidates for hip surgery: 60 patients who are candidates for hip surgery. Specifically, we will select 15 obese and sarcopenic patients, 15 obese and non-sarcopenic patients, 15 non-obese and sarcopenic patients, and 15 non-obese and non-sarcopenic patients.

healthy subjects:subjects from a previous cohort of healthy volunteers studied in 2016-2017. In particular, we will select overweight or obese subjects who did not have sarcopenia at the time of the 2016-2017 evaluation

Description

Inclusion Criteria:

patients who are candidates for hip surgery

• patients who are candidates for hip surgery
• age ≥ 65 years
• patients able to give consent

healthy subjects

- healthy subjects from the geriatric cohort studied in 2016-2017 who at that time were: were overweight (25 ≤ BMI < 30 kg/m2) or obese (BMI ≥ 30 kg/m2) but had not yet developed sarcopenia

Exclusion Criteria:

All partecipants

• unavailability to participate in the study
• inflammatory or neurological myopathies
• acute heart failure
• active cancer

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
patients who are candidates for hip surgery; cohort of patients who are candidates for hip surgery: completion of scales and questionnaires, venous blood sampling, muscle ultrasound scan	Other: clinical evaluation of sarcopenic obesity; completion of scales and questionnaires, venous blood sampling, muscle ultrasound scan
healthy subjects; cohort of healthy subjects recruited in 2016-2017 completion of scales, questionnaires and performance of the Short Physical Performance Battery test, venous blood sampling, muscle ultrasound scan	Other: clinical evaluation of sarcopenic obesity; completion of scales and questionnaires, venous blood sampling, muscle ultrasound scan

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Identifying new molecular markers in elderly patients with sarcopenic obesity	Identifying new molecular markers in elderly patients with sarcopenic obesity	May 2023- October 2024

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Assessing the ability of new markers (identified in the pre-clinical phase of this project) to predict individual disease trajectories	Assessing the ability of new markers (identified in the pre-clinical phase of this project) to predict individual disease trajectories	May 2023- October 2024

Collaborators and Investigators

• Sponsor: IRCCS San Raffaele

Study record dates

Study Major Dates

• Study Start (Actual): May 22, 2023
• Primary Completion (Estimated): November 30, 2025
• Study Completion (Estimated): December 31, 2025

Study Registration Dates

• First Submitted: March 13, 2024
• First Submitted That Met QC Criteria: March 13, 2024
• First Posted (Actual): March 20, 2024

Study Record Updates

• Last Update Posted (Actual): June 18, 2025
• Last Update Submitted That Met QC Criteria: June 17, 2025
• Last Verified: June 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Nutrition Disorders; Overnutrition; Body Weight; Overweight; Obesity
• Other Study ID Numbers: PNRR-MAD-2022-12376672

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No