Research progress of sarcopenic obesity and chronic liver disease / 中华肝脏病杂志

Sarcopenia has attracted increasing attention with the study of nutrition in patients with liver disease. Sarcopenia is an independent risk factor for a poor prognosis of liver disease and is becoming increasingly common in patients with liver disease. Studies have shown that patients with liver disease and sarcopenic obesity have a worse prognosis than patients with liver disease and simple sarcopenia or obesity. In clinical practice, it is easy to recognize patients with malnutrition and decreased muscle mass, but we often ignore those patients with normal body weight or even obesity who will likewise experience muscle mass loss. Simply relying on the monitoring of body mass and body mass index to assess the nutritional and muscle status of patients with liver disease is not accurate. At present, our understanding of the relationship between chronic liver disease and sarcopenic obesity is still poorly understood. In this paper, the research progress on chronic liver disease, sarcopenia, and sarcopenic obesity in recent years is reviewed so as to provide a theoretical basis for improving the clinical prognosis of patients with liver disease.

Use of Diuretics is Associated with Higher Risk of Sarcopenia in Older Adults with Hypertension

Abstract Background: Sarcopenia is a disease that involves skeletal muscle mass loss and is highly prevalent in the older adult population. Moreover, the incidence of sarcopenia is increased in patients with hypertension. Objectives: The study aimed to evaluate the association between the classes of the drugs used for arterial hypertension treatment and the presence or absence of sarcopenia. Methods: 129 older adults with hypertension were evaluated by the researchers who registered the participants medication for arterial hypertension treatment. Sarcopenia level was measured by anthropometric parameters, muscular strength, and functional capacity. The data were analyzed by one-way ANOVA followed by post-hoc test and Fisher's exact test; statistical significance was set at 0.05. Results: Age was not different between women with different levels of sarcopenia, but significant differences were observed between men with absent sarcopenia (66.8±4.2 years) and men with probable sarcopenia (77.0±10.2 years). Individuals with absent sarcopenia showed higher handgrip strength (men: 33.8±7.4, women: 23.2±4.6 Kgf) in comparison with those with sarcopenia (men with probable sarcopenia: 9.5±3.3 Kgf, women with probable, confirmed, and severe sarcopenia: 11.7±2.5, 12.2±3.0, 11.8±1.8 Kgf, respectively). The analysis showed an association between the type of medication and degree of sarcopenia; diuretics were significantly associated with probable sarcopenia, and angiotensin II receptor blockers (alone or in combination with diuretics) was associated with absence of sarcopenia. Conclusion: In conclusion, handgrip strength was a good method to diagnose sarcopenia, and diuretics were associated with increased risk of sarcopenia in older adults with hypertension.

Fuerza de prensión manual y calidad de vida en personas mayores autovalentes / Hand grip strength and quality of life in functional elderly

Introducción: Durante el envejecimiento se observa involución de algunos sistemas corporales. Entre estos cambios, los que afectan al sistema osteomuscular como la sarcopenia y la debilidad muscular, pueden alterar el desarrollo de actividades de la vida diaria, y por lo tanto, afectar la calidad de vida relacionada con la salud. Objetivo: Determinar la relación entre la fuerza de prensión manual y la calidad de vida relacionada con la salud en personas mayores. Métodos: Estudio descriptivo, correlacional. Evaluó 79 personas mayores (63 mujeres y 16 hombres) entre 65 y 78 años, de tres organizaciones sociales de la ciudad de Talca, Chile, seleccionados a través de un muestreo no probabilístico por conveniencia. Para medir la fuerza de prensión manual se utilizó un dinamómetro de mano y el cuestionario SF-36 fue usado para valorar la calidad de vida relacionada con la salud. Resultados: Se observaron relaciones significativas entre la fuerza de prensión manual y las dimensiones de la calidad de vida función física (p = 0,03; r = 0,76), dolor corporal (p = 0,01; r = 0,44) y salud general (p = 0,05; r = 0,48). Conclusiones: Existe relación entre la fuerza de prensión manual y tres dimensiones de la calidad de vida relacionada con la salud de personas mayores. Estos hallazgos corroboran la relevancia de evaluar la fuerza muscular en personas mayores como un marcador de salud y calidad de vida en estas(AU)

Introduction: During aging, involution of some body systems is observed. Among these changes, those that affect the musculoskeletal system such as sarcopenia and muscle weakness can alter the development of activities of daily life, and therefore affect health-related quality of life. Objective: to determine the relationship between hand grip strength and quality of life in elderly. Methods: Cross-sectional study. A total of 79 elderly (63 women and 13 men) between 65 and 78 years of age from three social organizations of Talca, Chile was included. A non-probabilistic convenience sample was used. To measure manual grip strength and the SF-36 questionnaire was used. Results: Significant relationships between hand grip strength and dimensions of quality of life, physical function (p = 0,03; r = 0,76), body pain (p = 0,01; r = 0,44) and general health (p = 0,05; r = 0,48) were observed. Conclusions: There is a relationship between hand grip strength and three measurements of quality of life in elderly. These findings corroborate the relevance of evaluating muscle strength in older people as a marker of health and quality of life in elderly(AU)

Effect of Sarcopenia on the Efficacy of Percutaneous Kyphoplasty in the Treatment of Osteoporotic Spinal Compression Fractures in Elderly Patients / 中国医学科学院学报

Objective To investigate the effect of sarcopenia on the efficacy of percutaneous kyphoplasty(PKP)in the treatment of osteoporotic spinal compression fracture(OSCF)in elderly patients. Methods From February 2017 to June 2018,a total of 77 elderly patients who met the inclusion and exclusion criteria were included in this study.Grip strength of dominant hand was measured by an electronic grip dynamometer with cut-off values of 27 kg for males and 16 kg for females.The cross-sectional area of the pedicle level muscle of the 12th thoracic vertebra(T12)was measured by chest CT.The skeletal muscle index(SMI)was calculated by dividing the T12 pedicle level muscle cross-sectional area by the square of body height.The SMI cut-off value used to diagnose sarcopenia was 42.6 cm

Sarcopenia predicts prognosis of patients with renal cell carcinoma: A systematic review and meta-analysis

ABSTRACT Sarcopenia, a concept reflecting the loss of skeletal muscle mass, was reported to be associated with the prognosis of several tumors. However, the prognostic value of sarcopenia in patients with renal cancer remains unclear. We carried out this metaanalysis and systematic review to evaluate the prognostic value of sarcopenia in patients with renal cell carcinomas. We comprehensively searched PubMed, Embase, and Cochrane Library from inception to December 2018. Hazard ratio (HR) and 95% confidence interval (CI) were pooled together. A total of 5 studies consisting of 771 patients were enrolled in this quantitative analysis, 347 (45.0%) of which had sarcopenia. Patients with sarcopenia had a worse OS compared with those without sarcopenia (HR=1.76; 95%CI, 1.35-2.31; P <0.001). In the subgroup of patients with localized and advanced/metastatic diseases, sarcopenia was also associated with poor OS (HR=1.48, P=0.039; HR=2.14, P <0.001; respectively). With a limited sample size, we did not observe difference of PFS between two groups (HR=1.56, 95% CI, 0.69-3.50, P=0.282). In the present meta-analysis, we observed that patients with sarcopenia had a worse OS compared with those without sarcopenia in RCC. Larger, preferably prospective studies, are needed to confirm and update our findings.

Triagem da sarcopenia e fragilidade em pacientes com úlceras venosas crônicas: um estudo transversal / Screening for sarcopenia and frailty in patients with chronic ulcers: a cross-sectional study

Resumo Contexto Pacientes com úlceras venosas reportam múltiplas comorbidades e são mais propensos a ser fisicamente inativos. A sarcopenia e a fragilidade aumentam a vulnerabilidade de um indivíduo para maior dependência e/ou morte. Objetivos Verificar presença da sarcopenia e fragilidade em pacientes portadores de úlceras venosas crônicas. Métodos Estudo observacional e transversal, realizado com 9 pacientes com idade média de 67,4 ± 8,42 anos e portadores de úlcera venosa nos membros inferiores classificadas no Consenso Internacional de Doenças Venosas Crônicas (CEAP) em estágio 6. Para identificação e classificação da sarcopenia, foi avaliada a força (dinamometria manual), a velocidade da marcha (teste de caminhada de 10 metros) e a massa muscular (circunferência da panturrilha). Para triagem de fragilidade, foram utilizados os critérios de Fried: perda de peso não intencional, fadiga, redução da força e da velocidade da caminhada e baixa atividade física. Resultados O fenótipo de fragilidade foi mais frequente (n = 9; 100%) em relação à sarcopenia (n = 1; 11,1%). Entre os critérios de Fried, os mais frequentes foram a exaustão (n = 9; 100%), seguida pela baixa atividade física (n = 8; 88,8%) e fraqueza muscular (n = 5; 55%). Por fim, o critério menos frequente foi a diminuição da velocidade da marcha (n = 2; 22,2%). No diagnóstico de sarcopenia, foi observada redução da força associada à redução da massa muscular (n = 1; 11,1%). Conclusões Pacientes com úlceras venosas crônicas apresentam condição de fragilidade ou pré-fragilidade, enquanto a condição de sarcopenia foi pouco frequente.

Abstract Background Patients with venous ulcers report multiple comorbidities and are more likely to be physically inactive. Sarcopenia and frailty increase vulnerability to dependence and/or death. Objectives To investigate the occurrence of sarcopenia and frailty in patients with chronic venous ulcers. Methods Observational study with cross-sectional design. Nine patients (67.4 ± 8.42 years) with lower limb venous ulcers classified as CEAP 6 according to International Consensus on Chronic Venous Diseases criteria (open and active ulcer) were evaluated. Sarcopenia was assessed and classified by assessment of strength (manual dynamometry), gait speed (10-meter walk test), and muscle mass (calf circumference). Frailty screening was based on the Fried criteria, consisting of five components: unintentional weight loss; exhaustion; weakness; slow gait speed; and low physical activity. Results Frailty was more frequent (n=9; 100%) than sarcopenia (n=1; 11,1%). The most common Fried criterion was exhaustion (n=9; 100%), followed by low physical activity (n=8; 88,8%), muscle weakness (n=5; 55%), and unintentional weight loss. Finally, the least frequent criterion was slow walking speed (n=2; 22.2%). In the subject diagnosed with sarcopenia, both weakness and reduced muscle mass were observed (n=1; 11,1%). Conclusions Patients with chronic venous ulcers exhibit frailty or pre-frailty and the components that comprise the condition of frailty in this population are exhaustion, low physical activity, and muscle weakness. Sarcopenia was identified in a small proportion of the patients.

Association between preoperative potential sarcopenia and survival of cancer patients undergoing major surgical procedures / Associação entre provável sarcopenia pré-operatória e sobrevida de pacientes oncológicos submetidos a operações de grande porte

ABSTRACT Objective: to evaluate the impact of probable sarcopenia (PS) on the survival of oncological patients submitted to major surgeries. Method: prospective cohort bicentrical study enrolling adult oncological patients submitted to major surgeries at Cancer Hospital and Santa Casa de Misericordia in Cuiabá-MT. The main endpoint was the verification of postoperative death. Demographic and clinical data was collected. PS was defined as the presence of 1) sarcopenia risk assessed by SARC-F questionnaire and 2) low muscle strength measured by dynamometry. The cumulative mortality rate was calculated for patients with either PS or non PS using Kaplan Meier curve. The univariate and multivariate Cox regression model was used to evaluate the association of mortality with various investigated confounding variables. Results: a total of 220 patients with a mean (SD) age of 58.7±14.0 years old, 60.5% males participated of the study. Patients with PS had higher risk to postoperative death (RR=5.35 95%CI 1.95-14.66; p=0,001) and for infectious complications (RR=2.45 95%CI 1.12-5.33; p=0.036). The 60 days mean survival was shorter for patients with PS: 44 (IQR=32-37) vs 58 (IQR=56-59) days (log rank <0,001). The Cox multivariate regression showed that PS was an independent risk factor (HR=5.8 95%CI 1.49-22.58; p=0.011) for mortality. Conclusion: patients bearing PS submitted to major oncological surgery have less probability of short term survival and preoperative PS is an independent risk for postoperative mortality.

RESUMO Objetivo: avaliar o impacto da provável sarcopenia (PS) pré-operatória na sobrevida de pacientes oncológicos submetidos a operações de grande porte. Métodos: estudo bicêntrico de coorte prospectivo, realizado com pacientes oncológicos adultos, submetidos a operação de grande porte no Hospital de Câncer e na Santa Casa de Misericórdia em Cuiabá-MT. A variável principal foi a ocorrência de óbito pós-operatório. Coletou-se dados demográficos, clínicos e o diagnóstico de PS, definido pela presença de: 1) risco de sarcopenia pelo questionário SARC-F e 2) baixa força muscular (Kgf) mensurada pela dinamometria. Calculou-se a taxa de sobrevida acumulada para os pacientes com e sem PS pela curva de Kaplan-Meier. Aplicou-se o modelo de regressão de Cox uni e multivariado para avaliar a associação da mortalidade com covariáveis de confundimento investigadas. Resultados: participaram do estudo 220 pacientes com idade média (DP) de 58,7±14,0 anos, sendo 60,5% do sexo masculino. Quatorze (6,4%) pacientes foram considerados com PS. Os pacientes com PS apresentaram risco aumentado para a ocorrência de óbito (RR=5,35 IC95% 1,95-14,66; p=0,001) e para complicações infecciosas (RR=2,45 IC95% 1,12-5,33; p=0,036). A sobrevida média em 60 dias, foi menor para os pacientes com PS: 44 (IIQ=32-37) vs 58 (IIQ=56-59) dias (log rank <0,001). A regressão Multivariada de Cox, mostrou que a PS foi fator de risco independente (HR=5,8 IC95% 1,49-22,58; p=0,011) para a mortalidade. Conclusão: os pacientes com PS submetidos a operações oncológicas de grande porte apresentam menor probabilidade de sobrevida a curto prazo e a PS pré-operatória, é fator de risco independente para mortalidade pós-operatória.

Evaluation of nutritional risk factors in hematopoietic stem cell transplantation-eligible patients / Avaliação dos fatores de riscos nutricionais em pacientes pré-transplante de célula-tronco hematopoiética

ABSTRACT Objective To evaluate the nutritional risk factors in patients eligible for hematopoietic stem cell transplantation. Methods A cross-sectional, descriptive study conducted with patients recruited from an hematology outpatient clinic. Study variables included demographic and clinical data, patient-generated global subjective assessment findings, anthropometric indicators, food intake and oxidative stress levels. The level of significance was set at 5% (p<0.05). Results The sample comprised 72 patients, mean age of 48.93 years (14.5%). Multiple myeloma was the most prevalent condition (51.4%) in this sample. Most patients (55.6%) were overweight according to body mass index and at risk of cardiovascular disease according to waist circumference, conicity index and percentage of body fat. Sarcopenia was associated with risk of cardiovascular disease, hip-to-waist ratio (p=0.021), muscle strength depletion (p<0.001), food intake (p=0.023), reduced functional capacity (p=0.048), self-reported well-nourished status; p=0.044) and inadequate vitamin B6 (p=0.022) and manganese (p=0.026) intake. Elevated oxidative stress, detected in 33.3% of patients in this sample, was not associated with sarcopenia. Conclusion Most patients in this sample were overweight and sarcopenic. Lean mass depletion was associated with risk of cardiovascular disease, reduced muscle strength, food intake changes, reduced functional capacity, self-reported well-nourished status and inadequate intake of vitamin B6 and manganese, but not with oxidative stress.

RESUMO Objetivo Avaliar os fatores de riscos nutricionais em pacientes pré-transplante de célula-tronco hematopoiética. Métodos Estudo transversal, descritivo, realizado com pacientes de um ambulatório de hematologia. As variáveis estudadas foram demográficas, dados clínicos, avaliação subjetiva global produzida pelo próprio paciente, indicadores antropométricos, ingestão alimentar e estresse oxidativo. Os dados foram considerados estatisticamente significativos quando p<0,05. Resultados A amostra do estudo foi constituída por 72 pacientes, com média de idade de 48,93 (14,5%) anos e com mieloma múltiplo (51,4%) como a patologia mais prevalente. Conforme índice de massa corporal, 55,6% dos pacientes encontravam-se com excesso de peso. De acordo com a circunferência da cintura, índice de conicidade e percentual de gordura corporal, houve prevalência de risco para doença cardiovascular. A sarcopenia foi associada ao risco de doença cardiovascular pela relação cintura/quadril (p=0,021), depleção da força muscular (p<0,001), além da ingestão alimentar (p=0,023), da capacidade funcional reduzida (p=0,048) e do diagnóstico de "bem nutrido" (p=0,044), conforme a avaliação subjetiva global, e com consumo inadequado de vitamina B6 (p=0,022) e de manganês (p=0,026). Dentre os avaliados, 33,3% apresentaram estresse oxidativo elevado sem associação com sarcopenia. Conclusão Pacientes do pré-transplante se apresentam, em sua maioria, com excesso de peso, mas com sarcopenia, estando essa ausência de massa magra associada a risco de doença cardiovascular, depleção da força muscular, alteração da ingestão alimentar, redução da capacidade funcional, classificação de "bem nutrido", segundo a avaliação subjetiva global e consumo inadequado de vitamina B6 e manganês, não estando associada a estresse oxidativo.

Sarcopenia como factor predictivo de dehiscencia de anastomosis en pacientes operados de cáncer de colon / Predictive value of sarcopenia for anastomotic dehiscense in colon cancer surgery

Resumen Introducción: Una complicación importante de la cirugía colorrectal es la dehiscencia de anastomosis (DA). El estado nutricional es uno de los factores importantes en la DA. Una forma objetiva para evaluar nutricionalmente a los pacientes es medir la sarcopenia, definida como disminución de masa muscular esquelética, que puede ser objetivada por análisis de Unidades Hounsfield (UH) y área muscular (AM) por medio de Tomografía Computarizada de Abdomen y Pelvis (TCAP). Objetivo: Evaluar si existe relación entre la DA y la presencia de sarcopenia detectada por medición de UH y AM en TCAP en pacientes sometidos a colectomía por cáncer. Materiales y Método: Estudio de casos y controles con estadística analítica. Se eligen de manera aleatoria 21 pacientes con DA y 40 sin DA. Se incluyen > 18 años, con colectomía por cáncer y anastomosis primaria. Fueron excluidos pacientes ostomizados, que no tuvieran TCAP preoperatoria o que éste no permitiera medir UH y AM. La evaluación imagenológica fue realizada por radiólogo experto. Resultados: La comparación entre grupos evidencia que son homogéneos con respecto al sexo (predomino hombres), edad (promedio 60 años) y localización. Se evidencia signos imagenológicos sugerentes de sarcopenia en el grupo de DA, puesto que existe disminución en UH con valores estadísticamente significativos y tendencia a presentar valores menores en el AM. Conclusiones: La presencia de sarcopenia evaluada por alteración de UH en estudio radiológico se correlaciona con DA, pudiendo ser un predictor de riesgo. La importancia de este hallazgo es que es un factor de riesgo potencialmente corregible.

Introduction: An important complication of colorectal surgery is anastomotic dehiscence (AD). Nutritional status is one of the important factors in AD. An objective way to evaluate the patients' nutritional status is to measure sarcopenia, which is the reduction of skeletal muscle mass. It is possible to standardize Sarcopenia using the analysis of the Hounsfield Units (HU) and the muscular area (MA) which consider Computed Tomography of Abdomen and Pelvis (CTAP). Aim: To evaluate whether there is a relationship between AD and the presence of sarcopenia detected by the measurement of HU and MA using CTAP. The situation considers patients undergoing colectomy for cancer. Materials and Method: Cases and controls were studied with analytical statistics. 21 patients with AD and 40 without AD were chosen randomly. They include > 18 years, with colectomy for cancer and primary anastomosis. Ostomized patients, who previous the surgery do not have CTAP or if it was not available to measure HU and MA, were excluded. The imaging evaluation was performed by an expert radiologist. Results: The comparison between groups shows that they are homogeneous with respect the sex (predominant men), age (average 60 years) and location. There are signs of imaging which suggest the presence of sarcopenia in the AD group. This is explained because there is an important statistical decrease in the HU values and a tendency to present lower MA values. Conclusions: The presence of sarcopenia due to alteration of HU in a radiological study is correlated with AD, and could be a predictor of risk. The importance of this finding is that this risk factor is potentially correctable.

Is rectus abdominis thickness associated with survival among patients with liver cirrhosis? A prospective cohort study

ABSTRACT BACKGROUND: Sarcopenia may affect patients with liver cirrhosis and worsen disease outcomes. OBJECTIVES: To evaluate ultrasound-measured psoas major (PM) and rectus abdominis (RA) thickness for predicting survival among patients with liver cirrhosis. DESIGN AND SETTING: Prospective cohort study in a tertiary-level hospital. METHODS: 61 patients with liver cirrhosis were prospectively included during a 15-month period and followed up for at least six months. Cirrhosis was classified using the Child-Pugh score. Sarcopenia was assessed using surrogate parameters: handgrip strength (HGS), mid-arm muscle circumference (MAMC) and SGA (subjective global assessment). We used ultrasound to measure RA and PM thickness at admission. RESULTS: There were 41 men. The patients' mean age was 58.03 ± 10.8 years. 26.22% of them were Child-Pugh A, 45.9% B and 27.86% C. The patients were followed up for 11.9 ± 5.63 months. RA thickness correlated moderately with MAMC (r = 0. 596; P < 0.0001) and HGS (r = 0.515; P < 0.0001) and decreased with increasing SGA class (A, 10.6 ± 2.8 mm; B, 8.3 ± 1.9 mm; C, 6.5 ± 1.9 mm; P < 0.0001). Survival at six months was independently predicted by using the model for end-stage liver disease-serum sodium score (odds ratio, OR 1.305; 95% OR confidence interval 1.083-1.572; P = 0.005). Survival during follow-up was independently predicted by RA thickness (hazard ratio, HR 0.701; 95% HR confidence interval 0.533-0.922; P = 0.011) and ascites (HR 1.876; 95% HR confidence interval 1.078-3.267; P = 0.026). PM thickness did not have any predictive value. CONCLUSIONS: As a surrogate marker of sarcopenia, RA thickness may predict survival among patients with liver cirrhosis.

Sarcopenia and sarcopenic obesity as prognostic predictors in hospitalized elderly patients with acute myocardial infarction / Relação entre sarcopenia e obesidade sarcopênica como preditores de prognóstico em pacientes idosos hospitalizados com infarto agudo do miocárdio

ABSTRACT Objective: To investigate the potential value of sarcopenia and sarcopenic obesity as prognostic predictors in hospitalized elderly patients with acute myocardial infarction. Methods: A cross-sectional study based on data collected from elderly patients with acute myocardial infarction, admitted to a public hospital located in the Northeastern region of Brazil, from April to July 2015. The diagnosis of sarcopenia was based on muscle mass, muscle strength and physical performance measurements. Cardiovascular risk and prognostic markers, such as troponin and creatine kynase MB isoenzyme values, acute myocardial infarction classification according to ST segment elevation, and thrombolysis in myocardial infarction score were used. Results: The sample comprised 99 patients with mean age of 71.6 (±7.4) years. Prevalence of sarcopenia and sarcopenic obesity was 64.6% and 35.4%, respectively. Sarcopenia was more prevalent among males (p=0.017) aged >80 years (p=0.008). Thrombolysis in myocardial infarction was the only marker of cardiovascular risk significantly associated with sarcopenia (p=0.002). Conclusion: Prevalence of sarcopenia was high and associated with thrombolysis in myocardial infarction risk score. Sarcopenic obesity affected approximately one-third of patients and was not associated with any of the prognostic predictors.

RESUMO Objetivo: Verificar a relação entre sarcopenia e obesidade sarcopênica como preditores de prognóstico em pacientes idosos com infarto agudo do miocárdio internados. Métodos: Estudo transversal envolvendo pacientes idosos com infarto agudo do miocárdio, hospitalizados no período de abril a julho de 2015, em serviço público, no Nordeste brasileiro. A sarcopenia foi determinada por meio das medidas de massa muscular, força muscular e desempenho físico. Foram utilizados os marcadores de risco cardiovascular e de prognóstico, como os valores de troponina e da isoenzima MB da creatinina quinase, classificação do infarto agudo do miocárdio de acordo com a elevação do segmento ST e o escore de risco de trombólise em infarto do miocárdio. Resultados: Foram avaliados 99 pacientes, com média de idade de 71,6 (±7,4) anos. Verificou-se prevalência de sarcopenia de 64,6% e 35,4% de obesidade sarcopênica. A sarcopenia foi mais prevalente no sexo masculino (p=0,017), na faixa etária >80 anos (p=0,008). Dentre os marcadores de risco cardiovascular, apenas o escore de risco trombólise em infarto do miocárdio esteve estatisticamente associado à sarcopenia (p=0,002). Conclusão: A prevalência da sarcopenia foi elevada e se associou com o escore de risco de trombólise em infarto do miocárdio. A obesidade sarcopênica acometeu cerca de um terço dos pacientes e não se associou a nenhum parâmetro preditor prognóstico.

Sex effects on the association between sarcopenia EWGSOP and osteoporosis in outpatient older adults: data from the SARCOS study

ABSTRACT Objective: The objective was to evaluate the association between sarcopenia (EWGSOP) and osteoporosis in older adults. Subjects and methods: This is a cross sectional analysis of a baseline evaluation of the SARCopenia and OSteoporosis in Older Adults with Cardiovascular Diseases Study (SARCOS). Three hundred and thirty-two subjects over 65 years of age were evaluated. Sarcopenia was determined by EWGSOP flowchart and Osteoporosis was established by WHO's criteria. Physical function, comorbidities and medications were evaluated. Results: Women were older (79.8 ± 7.2 years) than men (78.21 ± 6.7 years) (p = 0.042). Osteoporosis occurred in 24.8% of men, and in 42.7% of women (p < 0.001); sarcopenia occurred in 25.5% of men and in 17.7%, of women (p = 0.103). Osteoporosis was diagnosed in 68% of sarcopenic women, however only 20.7% (p = 0.009) of women with osteoporosis had sarcopenia; in older men, 44.7% of individuals with sarcopenia presented osteoporosis and 42.9% (p = 0.013) of men with osteoporosis showed sarcopenia. In an adjusted logistic regression analyses for sarcopenia, osteoporosis presented a statistically significant association with sarcopenia in men [OR: 2.930 (95% CI: 1.044-8.237; p = 0.041)] but not in women [OR: 2.081 (0.787-5.5; p = 0.142)]; in the adjusted logistic regression analyses for osteoporosis, a statistically significant association occurred in men [OR: 2.984 (95% CI: 1.144-7.809; p = 0.025)], but not in women [OR: 2.093 (0.962-3.714; p = 0.137)]. Conclusion: According to sex, there are significant differences in the association between sarcopenia EWGSOP and osteoporosis in outpatient older adults. It is strong and significant in males; in females, despite showing a positive trend, it was not statistically significant.

Rectus femoris muscle mass evaluation by ultrasound: facilitating sarcopenia diagnosis in pre-dialysis chronic kidney disease stages

OBJECTIVES: We evaluated the validity and reliability of ultrasonography measurement of rectus femoris cross-sectional area compared to computed tomography in patients in pre-dialysis chronic kidney disease and analyzed the association between these measurements and the diagnosis of sarcopenia. METHODS: One hundred patients with nondialysis chronic kidney disease were evaluated. Sarcopenia was defined using the criteria of the Foundation for the National Institutes of Health Sarcopenia Project (FNIH). The rectus femoris cross-sectional area was evaluated using ultrasonography and computed tomography. RESULTS: The prevalence of sarcopenia was 29% according to the FNIH criteria. The difference in mean rectus femoris cross-sectional area by ultrasonography and computed tomography was 3.97 mm, with a strong correlation between the two methods (p<0.001). Bland-Altman plot analysis showed good agreement between computed tomography and ultrasonography. Rectus femoris cross-sectional area was significantly correlated with muscle strength (r=0.300, p=0.002), lean body mass in the upper limbs (r=0.286, p=0.004), and lean body mass in the lower limbs (r=0.271, p=0.006). The prevalence of sarcopenia was 12% (n=12) based on the definition of low muscle mass according to ultrasonography of the rectus femoris cross-sectional area. CONCLUSION: Ultrasonography was demonstrated to be a valid and reliable method for evaluating the rectus femoris cross-sectional area in patients in pre-dialysis chronic kidney disease.

Phase angle is associated with the length of ICU stay in patients with non-ST elevation acute coronary syndrome

Background: The aim of this study was to evaluate the associations between phase angle (PhA), sarcopenia, and the length of stay (LOS) in the coronary intensive care unit (ICU) in patients with non-ST acute coronary syndrome(NSTE-ACS).Methods: This was a prospective observational study that evaluated 80 patients with NSTE-ACS over the age of18 years, admitted to the ICU from January to June 2014. Upon admission, the patients'demographic information was recorded. Handgrip strength and bioelectrical impedance analysis (BIA) were performed, and blood samples were taken within the first 72 h of admission. All of the patients were followed during their ICU stays. Results: We evaluated 80 patients, five were excluded due to impossibility of assessing handgrip strength, and seven patients were not subjected to BIA. Thus, 68 patients with a mean age of 63.3 ± 13.1 years were included in the analysis. Among these patients, 60.1% were male, 27.9% of the patients had sarcopenia, 8.8% had LOSs≥8 days, and median phase angle was 6.5 (6.1­7.3)°. Multiple logistic regression adjusted for age and gender revealed tha PhA was not associated with the presence of sarcopenia. Additionally, PhA (OR 0.337; CI 95% 0.118­0.961;p= 0.04)but not sarcopenia (OR 0.517; CI 95% 0.055­4.879;p= 0.56) was associated with an increased LOS. Conclusions: PhA is associated with LOS in patients with NSTE-ACS. Additionally, there was no association between PhA and sarcopenia.

Cutoff values for appendicular skeletal muscle mass and strength in relation to fear of falling among Brazilian older adults: cross-sectional study

ABSTRACT CONTEXT AND OBJECTIVE: Sarcopenia is an emerging public health issue in Brazil. Because of its high prevalence and the lack of national data, the objective here was to identify cutoff points for appendicular skeletal muscle (ASM) and handgrip strength in relation to fear of falling among Brazilian older adults. DESIGN AND SETTING: Cross-sectional study; in the community. METHODS: Participants underwent morphological and functional evaluations; and were asked about previous falls and fear of falling. Different adjustments to ASM and handgrip strength were used. Slow walking speed was defined as < 0.8 m/s or 1.0 m/s. Gender and age groups were compared using t tests, analysis of variance (ANOVA), chi-square test or Fisher's exact test. Receiver operating characteristic curves were used to identify cutoffs for ASM and handgrip strength in relation to fear of falling. RESULTS: 578 older adults participated in this study. Function levels decreased with increasing age, and body composition differed between the sexes. In relation to fear of falling, the cutoffs for ASM adjusted for body mass index (BMI) were < 0.85 for men and < 0.53 for women; the cutoffs for absolute handgrip strength and relative handgrip strength (adjusted for BMI) were 30.0 kgf and 21.7 kgf, and 1.07 and 0.66, for men and women, respectively. CONCLUSION: The values presented can be used as references in clinical practice and research. We recommend use of ASM adjusted for BMI and choosing between absolute and relative handgrip strength for men and women, according to study needs.

Osteosarcopenia: un factor de riesgo para fracturas osteoporoticas / Osteosarcopenia: a risk factor for osteoporotic fractures / Osteo-sarcopenia: um fator de risco para fraturas osteoporóticas

La sarcopenia asociada a la edad es una condicion caracterizada por una disminucion de la masa y fuerza muscular de causa multifactorial. El hueso y el musculo son dos tejidos que se encuentran interrelacionados entre si. Las fuerzas mecanicas aplicadas sobre el hueso son aquellas originadas por la contraccion muscular, lo cual condiciona las propiedades del hueso como masa, tamano, forma y arquitectura. Por la tanto, la disminucion de la masa y fuerza muscular conduciran a una disminucion de la cantidad y calidad osea. De esta manera, la sarcopenia es una condicion que en adultos mayores incrementa el riesgo de caidas y fracturas por fragilidad osea, por lo que se propone el termino de osteosarcopenia para identificar aquellos adultos mayores con mayor riesgo de fracturas por fragilidad osea. En la actualidad, el desarrollo de un consenso sobre los criterios diagnosticos de osteosarcopenia son demandados por la comunidad medica ya que estos permitirian identificar a los pacientes con mayor riesgo de desarrollar fracturas osteoporoticas, realizar intervenciones terapeuticas adecuadas y mejorar la calidad de vida de los adultos mayores.

Age-related sarcopenia is a condition which typically shows a decline in muscle mass and strength due to multifactorial causes. Bones and muscles are two interrelated tissues. The mechanical forces applied on bones are those derived from muscle contraction, conditioning bone properties, such as mass, size, shape and architecture. Therefore, the decline of muscle mass and strength would lead to a decrease in bone quality and quantity resulting in bone frailty. For this reason, sarcopenia is a condition that increases the risk of suffering falls and fractures in older adults. Currently, osteosarcopenia is the term used to identify those older adults with a greater risk of fractures due to bone frailty; however, a consensus of the medical community is needed for developing diagnostic criteria which makes it possible to identify patients with a high risk of developing osteoporotic fractures, to perform adequate therapeutic interventions and to improve the quality of life of older adults.

A sarcopenia associada à idade é uma condição caracterizada por uma diminuição da massa e da força muscular derivada de uma série de causas. O osso e o músculo são dois tecidos que se encontram inter-relacionados entre si. As forças mecânicas aplicadas sobre o osso são aquelas originadas pela contração muscular, que condiciona as propriedades do osso, tais como a massa, o tamanho, a forma e a arquitetura. Portanto, a diminuição da massa e da força muscular conduzirão à uma diminuição da quantidade e da qualidade ósseas. Desta maneira, a sarcopenia é uma condição que em adultos idosos incrementa o risco de quedas e fraturas em razão da fragilidade óssea, razão pela qual se propõe o termo osteo-sarcopenia para identificar a aqueles idosos com maior risco de fraturas por fragilidade óssea. Na atualidade, o desenvolvimento de um consenso sobre os critérios diagnósticos da osteo-sarcopenia é demanda da comunidade médica, na medida em que permitiria identificar os pacientes com maior risco de desenvolver fraturas osteoporóticas, realizar intervenções terapêuticas adequadas e melhorar a qualidade de vida dos idosos.

Associations of Sarcopenia and Sarcopenic Obesity With Metabolic Syndrome Considering Both Muscle Mass and Muscle Strength / 예방의학회지

OBJECTIVES: We investigated the associations of sarcopenia-defined both in terms of muscle mass and muscle strength-and sarcopenic obesity with metabolic syndrome. METHODS: Secondary data pertaining to 309 subjects (85 men and 224 women) were collected from participants in exercise programs at a health center in a suburban area. Muscle mass was measured using bioelectrical impedance analysis, and muscle strength was measured via handgrip strength. Sarcopenia based on muscle mass alone was defined as a weight-adjusted skeletal muscle mass index more than two standard deviations below the mean of a sex-specific young reference group (class II sarcopenia). Two cut-off values for low handgrip strength were used: the first criteria were <26 kg for men and <18 kg for women, and the second criteria were the lowest quintile of handgrip strength among the study subjects. Sarcopenic obesity was defined as the combination of class II sarcopenia and being in the two highest quintiles of total body fat percentage among the subjects. The associations of sarcopenia and sarcopenic obesity with metabolic syndrome were evaluated using logistic regression models. RESULTS: The age-adjusted risk ratios (RRs) of metabolic syndrome being compared in people with or without sarcopenia defined in terms of muscle mass were 1.25 (95% confidence interval [CI], 1.06 to 1.47, p=0.008) in men and 1.12 (95% CI, 1.06 to 1.19, p<0.001) in women, which were found to be statistically significant relationships. The RRs of metabolic syndrome being compared in people with or without sarcopenic obesity were 1.31 in men (95% CI, 1.10 to 1.56, p=0.003) and 1.17 in women (95% CI, 1.10 to 1.25, p<0.001), which were likewise found to be statistically significant relationships. CONCLUSIONS: The associations of sarcopenia defined in terms of muscle mass and sarcopenic obesity with metabolic syndrome were statistically significant in both men and women. Therefore, sarcopenia and sarcopenic obesity must be considered as part of the community-based management of non-communicable diseases.

Linfoma de Burkitt en pacientes HIV positivo tratados con quimioterapia intensiva en el Hospital del Salvador entre 2011 y 2014: Protocolo Nacional de Cáncer del Adulto, Chile / Intensive chemotherapy for Burkitt lymphoma in HIV positive patients

Background: Burkitt lymphoma has a low incidence, is highly aggressive, may be endemic, sporadic or associated with immunodeficiency and it has a high frequency of extranodal involvement. Overall and relapse free survival in HIV patients is 72 and 71% respectively. However, the current protocol in Chile considers a positive HIV serology as an exclusion criterion for intensive chemotherapy. Aim: To analyze the response to Burkitt lymphoma treatment among HIV positive patients. Material and Methods: All HIV positive patients with a Burkitt lymphoma treated using PANDA protocol in a public hospital were analyzed. Results: Eight male patients aged between 25 and 43 years, 63% in stage IV, were analyzed. All patients received an intensified chemotherapy regime, three of them without Rituximab. Complete remission was achieved in 87%. One patient was refractory to treatment and one patient relapsed at 5 months and died. Overall and relapse free survival were 58 and 60% respectively. All patients had episodes of high risk febrile neutropenia, but it did not cause deaths. Conclusions: In this group of HIV patients, intensive chemotherapy for Burkitt lymphoma had a high degree of effectiveness with a low relapse rate and high cure rate.

Comparação da força muscular respiratória entre idosos após acidente vascular cerebral / Comparison of respiratory muscle strength between elderly subjects after a stroke

A diminuição do recolhimento elástico dos pulmões e da complacência da caixa torácica são uma das principais mudanças no sistema respiratório com o avançar da idade, quando essas alterações estão associadas às manifestações clínicas subjacentes ao Acidente Vascular Cerebral (AVC), a força muscular respiratória dos idosos pode ser gravemente afetada, portanto, faz-se necessário investigar as condições da força muscular respiratória de hemiparéticos idosos tanto em fase aguda como crônica. Objetivo: comparar a força muscular respiratória de idosos hemiparéticos em fase aguda e crônica após AVC, avaliadas por meio dos valores das pressões respiratórias máximas, para que assim, a reabilitação desses indivíduos seja mais orientada. Método: Foram avaliados 29 indivíduos hemiparéticos, 17 em fase aguda e 12 em fase crônica, os valores da pressão inspiratória máxima (PImáx) e pressão expiratória máxima (PEmáx) coletados por meio de um manovacuômetro. Resultados: não houve diferença entre a fase aguda e crônica, no entanto, as medidas de PImáx e PEmáx apresentaram diminuição estatisticamente significante quando comparadas ao valores preditos. Conclusão: não houve diferença da força muscular respiratória entre as fases aguda e crônica, no entanto, a PImáx e PEmáx apresentou-se diminuída em todos os indivíduos avaliados, isto sugere fraqueza semelhante da musculatura respiratória em ambas as fases após AVC, e este quadro pode ser agravado pelo processo de senescência. Sugere-se que seja abordado um programa de treinamento da musculatura respiratória desses indivíduos para melhor reabilitação após AVC.

The decrease in elastic recoil of the lungs and chest cavity compliance is a major change in the respiratory system with advancing age, when these changes are associated with clinical manifestations of under lying cerebral vascular accident (stroke), respiratory muscle strength of the elderly may be seriously affected, therefore it is necessary to investigate the conditions of respiratory muscle strength in older hemiparetic patients in both the acute and chronic phases.Objective: to compare respiratory muscle strength in elderly hemiparetic patients in both the acute and chronic phases after stroke, evaluated by the values of maximal respiratory pressures, so that the rehabilitation of these individuals will be more targeted. Method: twenty-nine hemiparetic individuals were evaluated-seventeen in acute and twelve in chronic phases, the values of maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) being measured by means of a manometer. Results: There was no difference between acute and chronic patients, however, measurements of MIP and MEP after the stroke showed statistically significant decreases when compared with predicted values. Conclusion: There was no difference in respiratory muscle strength between the acute and chronic phases, however, the fact that the MIP and MEP were also reduced in all subjects, suggests similar weakness in the respiratory musculature in both phases after stroke, and this condition can be worsened when coupled with the aging process. It is suggested that a program include muscle training for these individuals to have better rehabilitation after their strokes.