Lipedema is a common disease of subcutaneous adipose tissue. The most common complaint of
patients with swelling in the affected extremity is pain. In addition, patients with
lipedema may experience conditions that can greatly affect the health and quality of life
of the individual, such as loss of muscle strength and exercise capacity, and
deterioration in activity levels of daily living. It is still unknown whether the
decrease in muscle strength in patients with lipedema is part of this condition or
whether decreased activity levels lead to decreased muscle strength.

Sarcopenia is an important health problem characterized by age-related loss of muscle
mass and muscle function. The relationship between muscle weakness and sarcopenia in
patients with lipedema has not been investigated before. Early recognition of possible
sarcopenia and functional limitations in these patients may be important to increase the
ability of patients to participate in physical activity as part of their conservative
management.

There is no study in the literature investigating sarcopenia in patients with a diagnosis
of lipedema. The aim of this study is to evaluate patients with a diagnosis of lipedema
in terms of sarcopenia. In addition, the relationship between sarcopenia and age, body
mass index, exercise frequency, lipedema type, and stage will be investigated in patients
diagnosed with lipedema.

Sarcopenia and Related Factors in Lipedema

Lipedema

Sarcopenia

Musculoskeletal Diseases

Lipedema is a chronic progressive condition in women characterized by a disproportionate
increase in subcutaneous adipose tissue, accompanied by pain in the legs and sometimes
the arms. It was first described in the 1940s and was expressed as fluid accumulation in
the wide legs and legs due to subcutaneous fat deposition in the hips and lower
extremities. Lipedema is characterized by bilateral enlargement from the hip to the
ankle, often sparing the foot, due to abnormal deposition of subcutaneous fat, often with
mild edema. The fact that many patients have pain and sensitivity has led to the use of
the term painful fat syndrome. The disease usually begins at or just after puberty.
Although some lipoedema patients are obese or overweight, the patients often have a
normal appearance from the waist up and there is a disproportionate appearance between
their trunk and lower extremities. Protection of the hands and feet is typical. This
disease, which almost always affects women, has rarely been defined in men due to
hormonal disorders or concomitant diseases such as cirrhosis. Although its prevalence is
not known exactly, it is thought to be a much more common disease than expected because
it is confused with other diseases such as obesity, venous insufficiency, and lymphedema
and is a frequently missed diagnosis. Although the results of the studies vary, it has
been reported that it is seen at a minimum rate of 1:72.000 or 11% of women affected by
this disease.

The pathophysiology of lipoedema is multifactorial, and causes such as increased
permeability and capillary fragility due to microangiopathy in adipose tissue, adipocyte
necrosis due to hypoxia, and macrophage migration are prioritized. In addition, lymphatic
drainage through HIF-1 (hypoxia-inducible factor 1), VEGF (Vascular Endothelial Growth
Factor), and FFA (Free Fatty Acid) increases and endothelial barrier function are
affected, resulting in impaired vascular circulation due to fluid extravasation and fat
accumulation. are held. Estrogen has effects on peripheral and central mechanisms and fat
metabolism. The decrease in lipolysis in the femoral region and the increase in lipedema
during periods of hormonal changes such as pregnancy, menopause, and oral contraceptive
use suggest that hormonal mechanisms are effective on the disease. Preoptic and arcuate
nuclei in the hypothalamus; It is involved in lipid mobilization and distribution of
white adipose tissue and forms a pathway through ER α (estrogen receptor alpha) and its
mediator CART (Cocaine and Amphetamine Regulatory Transcript). Disruption in this
regulation pathway also results in regional adipose tissue deposition. There is a family
history of 15-64% of the patients, and genetics is thought to be significantly effective.
Pedigree studies indicate X-dominant or autosomal-dominant inheritance.

Lipedema usually presents with bilateral extremity swelling that begins in the
post-adolescent period, is progressive, does not respond to diet and exercise, does not
improve with elevation, and is spontaneous or painful to touch. Patients describe easy
bruising with touch or minor trauma. Typically, the hands or feet are not involved,
although this may involve the hip and gluteal region. On examination, the skin is often
of normal color and texture, and oily hypertrophy may feel soft and pasty. Bruises caused
by minor traumas can be observed during the examination. It does not leave pitting after
long-term pressure is applied with the finger, and the Stemmer sign, which is observed by
compressing the skin on the dorsum of the foot, is negative. Evaluation of these two
findings is important in differentiating it from lymphedema. Lipedema consists of 5 major
types:

  -  Type 1 pelvis, gluteal region, and hips,

  -  Type 2 extending from the gluteal region to the knees and with fat folds in the
     inner parts of the knees,

  -  Type 3 extending from the gluteal region to the ankles,

  -  Type 4 located in arms,

  -  Type 5 is defined as the presence of isolated swelling in the lower part of the
     legs.

Types 1-3 are the 3 most common. Lipedema can be seen in 3 stages. In stage 1, the skin
surface is normal, the subcutaneous tissue is enlarged, and small nodules are present on
palpation. In stage 2, the skin surface is irregular, and large fat nodules are seen. In
stage 3, the skin contour is lobulated due to the increase in adipose tissue, and large
nodules and deformities are observed. Some sources state the form of lipedema accompanied
by lymphedema is stage 4, and this is called lipo lymphedema.

The diagnosis is made clinically, and the history and physical examination can be
supported by assistive imaging techniques. The skin and subcutaneous tissue can be
examined qualitatively and quantitatively by ultrasonography, computed tomography, or
magnetic resonance imaging.

Sarcopenia is an important health problem characterized by age-related loss of muscle
mass and muscle function. It is a harbinger of physical fragility and limitation of
movement. Muscle wasting is mainly due to the loss of type II muscle fibers, and
progressive motor neuron loss is thought to be the primary underlying factor. Anterior
thigh muscles atrophy earlier and loss of anterior thigh muscle function may therefore be
a precursor finding.

Experts in the sarcopenia special interest group (ISarcoPRM) under the umbrella of the
International Society for Physical and Rehabilitation Medicine (ISPRM) have developed a
new algorithm based on regional measurements and functional assessments of the anterior
thigh muscle, which is initially and most frequently affected in sarcopenia.

The iSarcoPRM has proposed a new measurement that uses anterior thigh muscle measurements
for early assessment and rapid diagnosis of low muscle mass and confirmation of
sarcopenia. Accordingly, STAR- (sonographic thigh adjustment ratio) sonographic thigh
adjustment ratio is found by dividing anterior thigh muscle thickness by body mass index.
Using two standard deviation values of healthy young adults, the threshold values for the
sonographic thigh fit ratio were found to be 1.4 and 1.0 for male and female subjects,
respectively.

As sarcopenia diagnostic criteria;

  -  STAR- (sonographic thigh adjustment ratio) sonographic thigh adjustment ratio below
     1.4 and 1.0 for men and women, respectively

  -  For muscle strength measurement, hand grip strength is below 32 and 19 kg for men
     and women, respectively

  -  It is recommended that the 5-repeat stand-up test (CST (chair stand test)) be longer
     than 12 seconds.

It has been suggested that walking speed (6 meters) ≤0.8 m/s or inability to get up from
a chair without support (limited movement) should be the primary outcome, not part of the
diagnostic criteria.

Although pain is the most common complaint of patients with lipoedema along with swelling
in the involved extremity, conditions such as loss of muscle strength and exercise
capacity, and deterioration in daily life activity levels, can greatly affect the health
and quality of life of the individual, can also be seen.

These patients have thickening of the lower extremities beginning in adolescence; limited
exercise, dietary changes, or swelling of the affected extremities; they have a medical
history that includes limitations in functionality such as fatigue, family history,
inability to work, and loss of activity level.

It is still unknown whether the decrease in muscle strength in patients with lipoedema is
part of this condition or whether decreased activity levels lead to decreased muscle
strength. The relationship between muscle weakness and sarcopenia in these patients has
not been investigated before. Early recognition of possible sarcopenia and functional
limitations in this patient group may be important to increase the ability of patients to
participate in physical activity as a part of conservative management. There is no study
in the literature investigating sarcopenia in patients with a diagnosis of lipedema. This
study aims to evaluate patients with a diagnosis of lipedema in terms of sarcopenia.

STAR-Sonographic Thigh Adjustment Ratio

Hand Grip Strength

Chair Stand Test

6 Meter Gait Speed

Evaluation of Sarcopenia and Associated Factors in Patients With Lipedema

With ultrasonography, anterior thigh muscle thickness on the dominant extremity side will
be measured at a 50% level between the anterior superior iliac spine and the upper pole
of the patella in the supine position. The STAR-sonographic thigh adjustment ratio will
be calculated by dividing the anterior thigh muscle thickness (mm) by the body mass
index.

Hand grip strength will be measured with a Jamar dynamometer used in the second grip
position, in a sitting position with shoulders adducted and neutrally rotated, elbows
flexed to 90°, and forearms/wrists in the neutral position. Three repetitive measurements
will be made from the dominant side and the maximum value obtained for analysis will be
taken.

For the 5-repeat stand-up test, patients will be asked to get up from a chair without an
armrest and sit (at the start) five times as fast as possible with their arms crossed
over their chest.

Assistant Professor

For walking speed measurements, patients will be asked to stand with both feet touching
the starting line and walk at their normal speed on a 6-meter track after the command.
The time between the start and end will be measured with a stopwatch and converted to
meters/second. Three consecutive measurements will be made for both and average values
will be taken for the analyses

Patients between the ages of 18-85, diagnosed with lipedema, accepted to participate in
the study, and at the appropriate sociocultural level to participate in the study are
included in this group.

Those between the ages of 18-85, in an age group similar to the lipoedema group, who
agreed to participate in the study, and who were at the appropriate sociocultural level
to participate in the study are included in this group.

Sarcopenia and Related Factors in Lipedema

About this trial

Study ID

Status

Type

Placebo

Accepting

Trial Timing

What is this trial about?

What are the participation requirements?

Locations

Location

Status