Among the consequences of obesity in elderly individuals are increased risk of cardiometabolic complications, physical incapacity, sexual dysfunction, urinary incontinence, depression, type 2 diabetes, arthritis, decreased cognitive function, dementia, and compromised health-related quality of life.9–12 Apart from this, the loss of muscle mass associated with the aging process results in muscle weakness, increased fall risk, and fat infiltration in the skeletal muscle.13,14

In this sense sarcopenia is defined as a decline in muscle mass associated with spinal shortening and a decrease in muscle strength and functionality.5,15 These deleterious effects seem to result from a complex interaction of innervation disturbances, decreased hormonal levels, and increased inflammatory mediators during aging.1,16,17 The reduction in muscle mass and strength is responsible for the decrease in mobility, decreased functional capacity, and increase in dependency; there are also economic and social costs.4,6,14

Inclusion criteria were age ≥ 60 years, sedentary females, and completion of all anthropometric testing. Sedentarism was determined by the International Physical Activity Questionnaire. Individuals with inflammatory, rheumatic, or autoimmune conditions or use of medications (beta blockers and metformin) that could modulate body composition were excluded. The local Ethics Committee for Human Research of the Catholic University of Brasilia approved the methodology of the present study, and all participants signed an informed consent document. The procedures were in accordance with guidelines for experimentation with human participants. Additionally, the study met the ethical standards proposed by the International Journal of Sports Medicine.18

Women between 60 to 69 years exhibited a higher body fat percentage (P = 0.004) and obesity determined by body composition (P = 0.001) measured by DXA as compared with women above 70 years, according to the classification of the National Institute of Diabetes and Digestive and Kidney Diseases.20 There was no statistically significant difference between age groups in the parameters determined by BMI (P = 0.07), sarcopenic obesity (P = 0.40), or sarcopenia (P = 0.40).

Thirty-nine percent of the eutrophic elderly women determined by BMI exhibited sarcopenic obesity, while 23.1% of those classified with mild and moderate obesity by DXA presented sarcopenic obesity (Table 3). There was no association with sarcopenic obesity independent of obesity severity determined by DXA (Table 3). However, there was a negative association between sarcopenia and sarcopenic obesity, hence most of the elderly women with sarcopenia did not present sarcopenic obesity (Table 3).

Our study indicates that a sedentary lifestyle may be an additional risk factor for both overweight and obesity, highlighting the concurrent muscular force loss as previously suggested.27 This is in accordance with previous literature.28 The diagnosis for obesity requires the utilization of various methods because BMI has been suggested to be inappropriate for this purpose in the elderly.10 Moreover, the current results suggest some discrepancies between BMI and DXA methods regarding the nutritional status of participants. Thus, eutrophic elderly women as determined by BMI were classified as obese with various severity levels with the employment of DXA, confirming the previous observations of Pahor et al.29 In this regard, BMI has demonstrated some limitations because of the concurrent lean body mass loss and fat mass gain observed in the elderly.10 Furthermore, all participants of the present study exhibited various levels of obesity, thus confirming the findings of previous studies in Brazilian populations. 30,31 Although BMI has been widely used in population studies, this method considers only height and body mass. On the other hand, DXA is considered a “gold-standard” method to estimate body composition, despite the high cost. In this sense, a higher sensitivity of DXA to estimate body composition would be expected.

Adipose tissue is currently recognized as an important metabolic and hormonal secretory organ with more than 50 product molecules identified.1 Subsequently, when there is an increase in adipose tissue, the impact of these molecules is also augmented, thus favoring the development of insulin resistance, type II diabetes, atherosclerosis, and metabolic syndrome and therefore impacting the health of older individuals.8,32,33

With the current results it was possible to verify an overestimation of muscle mass as a consequence of not taking into account the true differences in water, bone mass, and FFM, as the elderly have demonstrated an excessive extracellular fluid accumulation.29 This syndrome is associated with a progressive loss of muscle force and mass with subsequent lower physical capacity and quality of life, and hence the current results should be considered for further interventions in this population.

Newman et al34 emphasized the need to consider fat mass when diagnosing sarcopenia. The premise is based on the fact that individuals with high fat mass also demonstrate a high FFM. Therefore, individuals with high fat mass and subsequently high FFM would not be diagnosed as sarcopenic, independently of its influence on total body mass or functional capacity. In order to adjust FFM with fat mass, Newman et al34 proposed a method based on the residuals of a regression equation that predicts AFFM from fat mass and height; this was helpful in the diagnosis of sarcopenic obesity in the current study.