The Role Of Lifestyle Intervention, in Addition To Drugs, For Diabetic Kidney Disease With Sarcopenic Obesity Ⅲ

6. Discussion

Sarcopenic obesity is associated with chronic low-grade inflammation, increased insulin resistance, and adipocyte hypertrophy. To date, some proinflammatory cytokines are capable of inducing muscle dysfunction in an auto/paracrine manner, including IL-1, IL-6, IL-8, IFN-γ, TNF-α, MCP-1, and NFκB. In Vitro, studies showed insulin resistance and lipotoxic environment were characterized by intramuscular lipids accumulation with mitochondrial dysfunction, impaired β-oxidation capacity, and increased reactive oxygen species formation. While reducing obesity is effective in reducing inflammation and de-laying disease onset and progression, including diabetes, CKD, and metabolic syndrome, the metabolic effects of hyperglycemia also lead to the production of AGE, TGF-β, and protein kinase C. These toxic products have some role in nephropathy and clinical albuminuria with histological changes of thickening of the glomerular basement membrane, mesangial matrix expansion, and arteriolar hyalinosis. Moreover, other non-inflammatory factors related to kidney dysfunction include metabolic acidosis, renin-angiotensin-aldosterone system, uremic toxins, and vitamin D deficiency  

A NEW HERB FOR CURE KIDNEY DISEASE

With a rich knowledge of the pathophysiological of metabolic syndrome and diabetes, there were still suboptimal effective prevention, treatment, and intervention practices for patients with established sarcopenic obesity and CKD. Although myostatin inhibitors and AST-120 have been shown to increase muscle mass in mice studies [49,50], there were concerns about inadequate evidence of these inhibitors used in muscle wasting disorders in humans or muscle hypertrophy in athletic performance. Low serum 25(OH)D levels appear to be associated with obesity, insulin resistance, low skeletal muscle mass, and rapid decline of kidney function. Systemic L-carnitine depletion has been another causative factor for sarcopenia. The benefits and thresholds of nutritional supplements for vitamin D and Lcarnitine deficiency are highlighted with ongoing clinical trials and consensus. Fortunately, both sarcopenic obesity and physical performance, e.g., grip strength and walking speed, are positively modified by lifestyle interventions, such as nutritional modification and exercise training in renal patients [51]. A randomized controlled trial suggests that a supervised and home-based training phase is effective, adhered to, and safe in patients with kidney disease [52]. There should be many more revised standards of the effective and feasible training intensity to increase adherence in patients with CKD

7. Conclusions

Based on the adequate definition of sarcopenic obesity, awareness of these concepts and complex metabolic pathways, lifestyle modification, physical activity, and weight reduction per se lead to physical fitness and preservation of muscle mass. The most effective strategies to deal with the future debilitating complications of diabetic nephropathy are preventing hyperglycemia, the early diagnosis of kidney disease, starting treatment with antihypertensive drugs that reduce the activity of the renin-angiotensin system, and lipid-modifying therapy. The adequate analysis of body composition is also crucial to assess the effects of novel medications, nutrition, and physical exercise interventions for metabolic disturbances. However, further confirmatory evidence and research combining different approaches are required.

Funding: This research received no external funding.

Institutional Review Board Statement: Not applicable.

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