Imaging methods for assessing fat depot status in osteosarcopenic obesity

Aim. To analyze the incidence of osteosarcopenic obesity (OSO) using various fat depot indices in patients with multivessel coronary artery disease.

Material and methods. A total of 800 patients were included, with in­dices assessed after 12 months. Sarcopenia was diagnosed according to the criteria of the European Working Group on Sarcopenia in Older Peop­le (EWGSOP, 2019), and osteopenic syndrome was diagnosed according to World Health Organization (WHO, 2008) guidelines. Sarcopenia was screened using the SARC-F questionnaire, handgrip test, multislice computed tomography (CT) of muscle tissue, and dual-energy X-ray absorptiometry. Body mass index (BMI) was assessed. Bioimpedance analysis, computed tomography, and adipose tissue ultrasound were performed. Statistical significance was considered at p≤0,05.

Results. A BMI >30 kg/m² was more common at baseline in women (50,9%) compared to men (38,6%) (p=0,002), and in the prospective phase — 59,2% and 40,0%, respectively (p=0,001). Visceral fat values based on CT were higher in men, consistent with bioimpedance analysis and ultrasound findings. Subcutaneous fat thickness in women was higher than in men. Given the CT limitations and the inability to assess the musculoskeletal component using ultrasound, bioimpedance analysis can be used as an alternative diagnostic method for OSO.

Conclusion. The incidence of obesity depended on the diagnostic method and ranged from 38,7% to 81,2% in men and 31,0% to 91,2% in women. An analysis of the detection rate of visceral adipose tissue components revealed sex differences and variations in the studied indicator depending on the diagnostic method (from 2,0% for BMI to 16,4% for intraabdominal fat thickness).

1. Liu Y, Song Y, Hao Q. Global prevalence of osteosarcopenic obesity amongst middle aged and older adults: a systematic re­view and meta-analysis. Arch Osteoporosis. 2023;18:60. doi:10.1007/s11657-023-01247-5.

2. Cvijetić S, Keser I, Boschiero D. Osteosarcopenic adiposity and nu­tritional status in older nursing home residents during the COVID-19 pandemic. Nutrients. 2023;15:227. doi:10.3390/nu15010227.

3. Ilich JZ. Nutritional and behavioral approaches to body composition and low-grade chronic inflammation management for older adults in the ordinary and COVID-19 Times. Nutrients. 2020;12:3898. doi:10.3390/nu12123898.

4. Kubota S, Yabe D. Visceral adipose tissue quality and its impact on Metabolic health. J Clin Endocrinol Metab. 2024;109: e1665-e1666. doi:10.1210/clinem/dgae021.

5. Xue M, Zhang X, Chen K. Visceral adiposity index, premature mortality, and life expectancy in US adults. Lipids Health Dis. 2025;24(1):139. doi:10.1186/s12944-025-02560-3.

6. Di Vincenzo O, Piciocchi C, Muzzioli L, et al. Osteosarcopenic obesity: A systematic review and a call for consensus on de­finitions and diagnostic criteria. Clin Nutr. 2025;51:146-60. doi:10.1016/j.clnu.2025.06.009.

7. Gortan Cappellari G, Guillet C, Poggiogalle E, et al. Sarcopenic obesity research perspectives outlined by the sarcopenic obesity global leadership initiative (SOGLI) — proceedings from the SOGLI consortium meeting in Rome November 2022. Clin Nutr. 2023;42:687-99. doi:10.1016/j.clnu.2023.02.018.

8. Busetto L, Dicker D, Frühbeck G. A new framework for the dia­gnosis, staging and management of obesity in adults. Nat Med. 2024;30:2395-99. doi:10.1038/s41591-024-03095-3.

9. Sweatt K, Garvey WT, Martins C. Strengths and limitations of BMI in the diagnosis of obesity: what is the path forward? Curr Obes Rep. 2024;13:584-95. doi:10.1007/s13679-024-00580-1.

10. Gažarová M, Galšneiderová M, Mečiarová L. Obesity diagnosis and mortality risk based on a body shape index (ABSI) and other indices and anthropometric parameters in university students. Rocz Panstw Zakl Hig. 2019;70(3):267-75. doi:10.32394/rpzh.2019.0077.

11. Donini LM, Pinto A, Giusti AM. Obesity or BMI paradox? Beneath the tip of the iceberg. Front Nutr. 2020;7:53. doi:10.3389/fnut.2020.00053.

12. Drapkina OM, Angarsky RK, Rogozhkina EA, et al. Ultrasound-as­sis­ted assessment of visceral and subcutaneous adipose tissue thick­ness. Methodological guidelines. Cardiovascular The­rapy and Pre­ven­tion. 2023;22(3):3552. (In Russ.) doi:10.15829/1728-8800-2023-3552.

13. Inoue T, Maeda K, Nagano A. Related factors and clinical out­comes of Osteosarcopenia: a narrative review. Nutrients. 2021; 13:291. doi:10.3390/nu13020291.

14. Conforto R, Rizzo V, Russo R, et al. Advances in body composition and gender differences in susceptibility to frailty syndrome: Role of osteosarcopenic obesity. Metabolism. 2024;161:156052. doi:10.1016/j.metabol.2024.156052.

15. Perna S, Spadaccini D, Nichetti M, et al. Osteosarcopenic Visceral Obesity and Osteosarcopenic Subcutaneous Obesity, Two New Phenotypes of Sarcopenia: Prevalence, Metabolic Pro­file, and Risk Factors. J Aging Res. 2018;2018:6147426. doi:10.1155/2018/6147426.

16. Cvijetić S, Keser I, Boschiero D, et al. Prevalence of Osteo­sarcopenic Adiposity in Apparently Healthy Adults and Appraisal of Age, Sex, and Ethnic Differences. J Pers Med. 2024;14(8):782. doi:10.3390/jpm14080782.

17. Gavin KM, Bessesen DH. Sex differences in adipose tissue function. Endocrinol Metab Clin N Am. 2020;49:215-28. doi:10.1016/j.ecl.2020.02.008.

18. Biagetti B, Puig-Domingo M. Age-related hormones changes and its impact on health status and lifespan. Aging Dis. 2023;14:605-20. doi:10.14336/AD.2022.1109.

19. Gutin I. Body mass index is just a number: conflating riskiness and unhealthiness in discourse on Body size. Sociol Health Illn. 2021; 43:1437-53. doi:10.1111/1467-9566.13309.

20. Taylor JA, Greenhaff PL, Bartlett DB. Multisystem physiological perspective of human frailty and its modulation by physical activity. Physiol Rev. 2023;103:1137-91. doi:10.1152/physrev.00037.2021.

21. Lee K. Association of osteosarcopenic obesity and its compo­nents: Osteoporosis, sarcopenia and obesity with insulin resis­tance. J Bone Miner Metab. 2020;38:695-701. doi:10.1007/s00774-020-01104-2.

22. Tsygankov DA, Polikutina OM. Features of the lipid profile and adi­pose tissue in patients with carotid artery stenosis on the back­ground of coronary artery disease. Complex Issues of Car­dio­vascular Diseases. 2023;12(4):20-8. (In Russ.) doi:10.17802/2306-1278-2023-12-4-20-28.

23. Nuti R, Brandi ML, Checchia G. Guidelines for the management of osteoporosis and fragility fractures. Intern Emerg Med. 2019; 14:85-102. doi:10.1007/s11739-018-1874-2.

24. Hernlund E, Svedbom A, Ivergård M. Osteoporosis in the Euro­pean Union: medical management, epidemiology and economic burden. Arch Osteoporos [Internet]. 2013;8:136. doi:10.1007/s11657-013-0136-1.