Depression Severity as a Risk Factor of Sarcopenic Obesity in Morbidly Obese Patients.

SETTING: Etiopathogenic factors of physical disability in obesity are numerous, underestimated and not sought in the non-geriatric population. Amongst these factors, depression may favor the development of sarcopenic obesity by reducing strength and physical performance even in the absence of overt muscle loss. Objectives and participants: To study the link between depression status and muscle functional disorders (dynapenia) in a population of adult subjects with severe and morbid obesity. MEASUREMENTS: Patients were assessed for body composition, grip strength, the Short Physical Performances Battery test (SPPB), for depression according to the Beck II score as well as for metabolic parameters through biological tests. RESULTS: In 373 obese subjects (mean age 44 ± 13y and BMI 43 ± 6 kg/m²), the prevalence of depression was 53% with 18% having mild depression, 18% moderate depression and 16% severe depression. Depression was significantly related to dynapenia: 62% of dynapenic (D) patients suffered from depression compared to 50% of non-dynapenic (ND) patients (p = 0.036). The Beck questionnaire score for D patients was 20 ± 13 and 15 ± 10 for ND patients (p = 0.001). The depression intensity was significantly correlated with dynapenia with D patients having a higher severe depression degree than ND patients (30% versus 11%; p < 0.0001). Fat-free to fat mass ratio was also significantly correlated with dynapenia (p = 0.01). In multivariate analysis, the presence of depression was twice as likely to be associated with dynapenia. CONCLUSIONS: Depression is associated with a reduction of muscle function in severe obesity in relation to its severity and to changes in fat to fat-free mass, suggesting that screening and prevention of sarcopenic obesity should be considered in adult obese patients with depression.

Low socio-economic status is a newly identified independent risk factor for poor vitamin D status in severely obese adults.

BACKGROUND: Hypovitaminosis D is very prevalent, especially in the obese population. However, the degree of severity and the parameters involved in vitamin D deficiency in this population are still unclear. The present study aimed to identify, from among the factors known to influence vitamin D status in a healthy population, those impacting the same parameter in obese population. METHODS: Serum 25-OH-D concentration was measured in 564 patients with class III obesity [i.e. severe and morbid obesity; mean (SD) body mass index (BMI) 42.04 (6.92) kg m-2 ] and their demographic, clinical, biological, anthropometric, dietary and socio-economic data were collected. RESULTS: We observed that 96% of the obese patients had serum 25-OH-D lower than 30 ng mL-1 . Severe vitamin D deficiency (serum 25-OH-D concentration <10 ng mL-1 ) affected 35% of this population. We found an inverse relationship between 25-OH-D levels and BMI (P = 0.012), fat mass (P = 0.041), metabolic syndrome (P < 0.0001), fasting blood glucose (P = 0.023), homeostasis model assessment for insulin resistance (P = 0.008), waist circumference (P = 0.001), and fasting blood triglycerides (P = 0.002) and C-reactive protein (P = 0.005). Low socio-economic status independently increased the risk of severe vitamin D deficiency [odds ratio (OR) = 1.98; 95% confidence interval (CI) 1.25-3.13], especially in the autumn-winter season (OR = 2.94; 95% CI 1.98-4.36), morbid obesity (OR = 3.19; 95% CI 1.49-6.82), metabolic syndrome (OR = 1.6; 95% CI 1.06-2.42) and inflammation (OR = 1.03; 95% CI 1.01-1.06). CONCLUSIONS: Vitamin D deficiency is extremely common among obese patients, and the prevalence of severe deficiency is high. The association of adiposity, high body mass index, metabolic syndrome and inflammation with vitamin D status is marked, whereas low socio-economic status appears to be a major risk factor for severe vitamin D deficiency, suggesting that vitamin D deficiency may at least in part be responsible for the greater health vulnerability of populations with low socio-economic status.