Doença inflamatória intestinal e sarcopenia: um foco na força muscular - revisão narrativa / Inflammatory bowel disease and sarcopenia: a focus on muscle strength - narrative review

ABSTRACT Inflammation, changes in nutrient absorption and gut dysbiosis are common conditions in patients with inflammatory bowel disease. These factors may lead to variations in macro- and micronutrients and, particularly, to an imbalance of protein metabolism, loss of muscle mass and development of sarcopenia. This narrative review aims to present the set of factors with impact in muscle strength and physical performance that may potentially mediate the relation between inflammatory bowel disease and sarcopenia. Studies that associated changes in muscle strength, sarcopenia and inflammatory bowel disease were selected through a literature search in databases Medline, Pubmed and Scielo using relevant keywords: muscle strength, physical performance, sarcopenia and inflammatory bowel disease. Chronic inflammation is currently reported as a determinant factor in the development of muscle atrophy in inflammatory bowel disease. In addition, strength decline in inflammatory bowel disease patients may be also influenced by changes in body composition and by gut dysbiosis. Measures of muscle strength and physical performance should be considered in the initial identification of sarcopenia, particularly in patients with inflammatory bowel disease, for a timely intervention can be provided. Presence of proinflammatory cytokines, high adiposity, malabsorption and consequent deficits of macro and micronutrients, loss of muscle mass, and gut dysbiosis may be the main factors with impact in muscle strength, that probably mediate the relation between inflammatory bowel disease and sarcopenia.

RESUMO Inflamação, alterações na absorção de nutrientes e a disbiose intestinal são condições comuns em indivíduos com doença inflamatória intestinal. Estes fatores podem levar a variações corporais do teor de macro e micronutrientes e, em particular, a um desequilíbrio no metabolismo de proteínas com perda de massa muscular e desenvolvimento de sarcopenia. Esta revisão narrativa visa apresentar o conjunto de fatores com impacto na força e função muscular que podem potencialmente mediar a relação entre doença inflamatória intestinal e sarcopenia. Estudos que associaram as alterações de força muscular, sarcopenia e doença inflamatória intestinal foram selecionados, através de uma pesquisa bibliográfica nas bases de dados Medline, Pubmed e Scielo, usando palavras-chave relevantes: força muscular, desempenho físico, sarcopenia e doença inflamatória intestinal. A inflamação crónica é atualmente citada como um fator determinante no desenvolvimento de atrofia muscular nos casos de doença inflamatória intestinal. Além disso, o declínio de força em indivíduos com doença inflamatória intestinal, também pode ser influenciado pelas alterações na composição corporal e pela disbiose instestinal. Indicadores de força muscular e de desempenho físico devem ser considerados na identificação inicial de sarcopenia, principalmente em indivíduos com doença inflamatória intestinal, para que uma intervenção precoce possa ocorrer. A presença de citocinas pró-inflamatórias, elevada adiposidade corporal, má absorção intestinal com consequente déficit de macro e micronutrientes, perda de massa muscular e disbiose intestinal poderão ser os principais fatores com impacto na força muscular, que provavelmente medeiam a relação entre doença inflamatória intestinal e sarcopenia.

Influence of probe position in the measurement of muscle thickness and its association with lean mass: an ultrasound study / Influencia de la posición de la sonda en la medición del grosor muscular y su asociación con la masa magra: un estudio ecográfico

SUMMARY: Skeletal muscles play a fundamental role in people's lives and their evaluation provides significant information on health. Different tools have been used to evaluate muscle mass, and the evaluation of muscle thickness (MT) using ultrasound has been included as an alternative, which can be performed with the probe in different positions; however, these could present differences. The objectives of this study were to determine whether there are differences in the measurement of MT in the vastus lateralis (VL) muscle using the probe in the longitudinal or transverse position, and to determine its association with the lean mass of the lower limbs. The results indicated no significant differences between MT measurements with the probe in the longitudinal and transverse positions (p =0.084). However, when associating these measurements with lower limb lean mass, it was found that transverse measurements had a strong association (r =0.547; p < 0.001), while longitudinal measurements had a moderate association (r =0.351; p =0.007). This suggests that measurements with the probe positioned transversely to measure the MT would be the best option. Therefore, it could be useful as an indicator of lower limb lean mass in the absence of tools, such as bioelectrical bioimpedance or magnetic nuclear resonance.

El músculo esquelético cumple un rol fundamental en la vida de las personas, y su evaluación entrega mucha información de la salud. Se han utilizado diferentes herramientas para evaluar la masa muscular, y el último tiempo se ha incluido la evaluación del grosor muscular (MT) a través de la ecografía como una alternativa para estimarla, las cuales se pueden realizar con la sonda en distintas posiciones, sin embargo, estas podrían presentar diferencias. Los objetivos del estudio fueron determinar si existen diferencias en la medición de MT en el músculo vasto lateral (VL) utilizando la sonda en posición longitudinal o transversal y determinar su asociación con la masa magra de los miembros inferiores. Los resultados indican que no existen diferencias significativas entre las mediciones de MT con la sonda en posición longitudinal y transversal (valor p: 0.084). Sin embargo, al asociar estas mediciones con la masa magra de los miembros inferiores, se encontró que las mediciones transversales poseen una asociación fuerte (r: 0.547; valor p < 0.001), mientras que las mediciones longitudinales presentan una asociación moderada (r: 0.351; valor p: 0.007). Esto sugiere que las mediciones con la sonda posicionada transversal para medir MT serían la mejor opción. Por lo tanto, podría ser de utilidad como un indicador de masa magra de los miembros inferiores en caso de no contar con herramientas como la bioimpedancia bioeléctrica o resonancia nuclear magnética.

Effects of eccentric exercise on muscle architecture in adults: a systematic review / Efectos del ejercicio excéntrico en la arquitectura muscular en adultos: una revisión sistemática

SUMMARY: The purpose of this systematic review was to determine the effects of eccentric training on muscle architecture in the adult population. Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statements were followed using keywords associated with architecture muscular and eccentric training. Four databases were used: PubMed, Scopus, SPORTDiscus and Web of Science. Methodological quality was assessed using the PEDro scale. A total of 1260 articles were retrieved, 18 included in this review. The parameters most frequently evaluated in the studies consulted were pennation angle (PA), fascicle length (FL), and muscle thickness (MT). These were assessed mainly in lower limb muscles such as biceps femoris long head (BFlh), vastus lateralis (VL), medial gastrocnemius (MG) and lateral gastrocnemius (LG), respectively. Eccentric training for at least four weeks generates adaptations in these parameters, mainly by increasing MT with FL and decreasing PA, determining muscle function. These results provide evidence on the effects of eccentric training on muscle architecture, which could be helpful to prevent injuries and favor muscle recovery processes.

RESUMEN: El propósito de esta revisión sistemática fue determinar los efectos del entrenamiento excéntrico sobre la arquitectura muscular en la población adulta. Se siguieron las recomendaciones del Ìtems de referencia para publicar Revisiones Sistemáticas y Metaanálisis (PRISMA) utilizando palabras clave asociadas con la arquitectura muscular y el entrenamiento excéntrico en cuatro bases de datos: PubMed, Scopus, SPORTDiscus y Web of Science. La calidad metodológica se evaluó mediante la escala PEDro. Se encontró un total de 1260 artículos, del los cuales, 18 fueron incluidos en esta revisión. Los parámetros más frecuentemente evaluados en los estudios fueron el ángulo de penación (AP), la longitud del fascículo (LF) y el grosor muscular (Gm). Estos fueron evaluados principalmente en músculos de los miembros inferiores como la cabeza larga del bíceps femoral (CLBf), el vasto lateral (VL), el gastrocnemio medial (GM) y el gastrocnemio lateral (GL), respectivamente. El entrenamiento excéntrico durante al menos cuatro semanas genera adaptaciones en estos parámetros, principalmente aumentando el GM con la LF y disminuyendo el AP, determinando de esta manera la función muscular. Estos resultados aportan evidencias sobre los efectos del entrenamiento excéntrico en la arquitectura muscular, que podrían ser útiles para prevenir lesiones y favorecer los procesos de recuperación muscular.

Body composition, muscle strength and quality of active elderly women according to the distance covered in the 6-minute walk test

BACKGROUND: Changes arising from the aging process, particularly changes in body composition, contribute to the functional decline of the elderly. OBJECTIVE: To compare the body composition and muscle strength, mobility and quality in active elderly women according to the distance walked during the 6-minute walk test (6MWT). METHOD: The study included 77 active elderly women aged 65 to 80 years, who were divided into tertiles (A, B and C) according to the distance covered in the 6MWT. We performed anthropometric and clinical evaluations. Body composition was determined by dual energy X-ray absorptiometry (DXA). Handgrip strength (HGS) was measured with a portable dynamometer (Saehan), and knee extension strength (KES) was measured with the one repetition maximum test (1-RM). Functional mobility was assessed by the Timed Up and Go (TUG) test, and body balance was assessed by the Berg Balance Scale (BBS). Muscle quality was defined by the ratio between muscle strength (kgf) and muscle mass (kg). RESULTS: The group that walked the shortest distance in the 6MWT had a higher BMI (A=30.8±7.0, B=27.2±4.2 and C=25.9±3.5 kg/m2), greater amount of fat mass (A=31.3±10.7, B=25.9±6.7 and C=23.81±6.46 kg) lower HGS (A=21.8±5.1, B=22.1±3.5 and C=25.5±5.1 kgf), lower knee extension strength (A=30.6±10.9, B=40.4±12.5 and C=47.2±10.1 kgf), lower arm muscle quality (A=10.1±3.7, B=11.6±2 and C=12.7±2.2 kg) and lower leg muscle quality (A=1.78±1, B=2.84±0.98 and C=3.31±0.77 kg). There was no significant difference between muscle mass (p=0.25) and lean mass (p=0.26). CONCLUSION: Body fat has a negative influence on functional performance, even among active elderly women. .

Espessura e qualidade musculares medidas a partir de ultrassonografia: influência de diferentes locais de mensuração / Muscle thickness and muscle quality measured by ultrasound: influence of different sites of measurement

Os objetivos do presente estudo foram: a) observar se há diferença entre os valores de espessura muscular (EM) medidos por ultrassonografia e qualidade muscular (QM) de três diferentes pontos nos músculos flexores de cotovelo e extensores de joelho, b) analisar a correlação das medidas de EM e força isométrica de flexão de cotovelo e extensão de joelho. Sessenta e nove sujeitos homens, fisicamente ativos, participaram do estudo. Os valores de produção de força isométrica de flexão de cotovelo e extensão de joelho foram obtidos nos ângulos de 90° e 60°, respectivamente. A medida de EM foi realizada em três pontos nos flexores de cotovelo (proximal ? BB1, médio - BB2, e distal ? BB3) e extensores de joelho (proximal ? RI1, medial - RI2, e distal ? RI3). As diferenças entre as três medidas de EM e QM foram avaliadas por meio da one-way ANOVA para medidas repetidas, e a correlação entre EM e produção de força foi testada utilizando correlação de Pearson. O nível de significância utilizado foi de p<0,05. A EM e a QM diferiram estatisticamente nos três pontos de medidas, tanto nos flexores do cotovelo quanto nos extensores do joelho (p<0,001). As correlações entre as medidas de EM dos flexores de cotovelo nos pontos BB1, BB2 e BB3 e a produção de força isométrica foram r=0,57, r=0,52 e r=0,59 (p<0,05), respectivamente. Já nos extensores de joelho, estas foram de r=0,47, r=0,51 e r=0,53 (p<0,01), nos pontos RI1, RI2, e RI3, respectivamente. Os resultados do presente estudo demonstraram que o ponto de medida exerce influência significativa na EM e QM. Os valores de EM relacionam-se com os de produção de força isométrica dos flexores de cotovelo e extensores de joelho.

The aims of this study were: a) to investigate differences in muscle thickness (MT) measured by ultrasound and muscle quality (MQ) at three sites in the elbow flexors and knee extensors, and b) to correlate MT with isometric force production of the elbow flexors and knee extensors. Sixty-nine young male subjects participated in this study. The isometric force production values of the elbow flexors and knee extensors were obtained at 90° and 60°, respectively. MT was assessed at three sites in the elbow flexors (proximal ? BB1, middle ? BB2, and distal ? BB3) and knee extensors (proximal ? RI1, middle ? RI2, and distal ? RI3). Differences between the three measurements of MT and MQ were evaluated by one-way repeated measures ANOVA. Pearson?s correlation test was used to assess the correlation between MT and isometric force. The level of significance was set at p<0.05. The results showed significant differences (p<0.001) between the three MT and MQ sites in the elbow flexors (BB1, BB2, BB3) and in the knee extensors (RI1, RI2, RI3). The correlation between BB1, BB2 and BB3 and force production was r=0.57, r=0.52 and r=0.59, respectively (p<0.05). In the knee extensors, the correlation between RI1, RI2 and RI3 and force production was r=0.47, r=0.51 and r=0.53, respectively (p<0.01). There were significant differences in MQ between elbow flexors (p<0.001) and knee extensors (p<0.001The present results showed that the site of measurement has a significant influence on MT and MQ. Furthermore, MT was positively correlated with isometric force production in the elbow flexors and knee extensors.