Associação entre obesidade sarcopênica, força muscular e risco de doenças cardiovasculares e cardiometabólicas em idosos: uma revisão sistemática

SILVA NETO, Luiz Sinésio; MEDEIROS, Alessandra; TRAVASSOS, Andreia; OSÓRIO, Neila Barbosa; NUNES, Genildo Ferreira

doi:10.1590/1678-9865201932e180237

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Reviw • Rev Nutr 32 • 2019 • https://doi.org/10.1590/1678-9865201932e180237 linkcopiar

Associação entre obesidade sarcopênica, força muscular e risco de doenças cardiovasculares e cardiometabólicas em idosos: uma revisão sistemática

Autoria SCIMAGO INSTITUTIONS RANKINGS

Descrever os achados da literatura sobre a associação entre obesidade sarcopenia, força muscular e fatores de risco e/ou doenças cardiometabólicas ou doenças cardiovasculares em idosos. Foi realizada uma busca nas bases Medical Literature Analysis and Retrievel System Online, Web of Science, Literatura Latino-Americana e do Caribe em Ciências da Saúde, e Periódicos Capes, nos idiomas inglês, espanhol e português, com as seguintes chaves de busca: “obesity sarcopenic” OR “sarcopenic obesity” no título AND “cardiometabolic disease” OR “cardiovascular disease” OR “metabolic syndrome” OR insulin resistance” no título/resumo AND “aged” em todos os campos e com a variação de utilização do descritor “muscle strenght” em todos os campos do trabalho. A seleção dos artigos seguiu os seguintes critérios de exclusão: trabalhos que avaliam apenas sarcopenia e risco de doenças cardiovasculares/doenças cardiometabólicas em idosos; trabalhos que avaliam apenas obesidade e risco de doenças cardiovasculares/doenças cardiometabólicas em idosos; trabalhos que apresentam avaliações sem apresentar o método utilizado; estudos realizados em animais e outros que não estejam em português, inglês ou espanhol. A estratégia de busca identificou 235 publicações nas bases de dados e, após a utilização dos critérios de inclusão e exclusão, foram inseridos 17 artigos para análise nessa revisão. Houve heterogeneidade de métodos na identificação da obesidade sarcopênica, tendo sido utilizado o corte transversal na maioria dos estudos. Foi possível verificar a associação de obesidade sarcopênica com os fatores de risco e/ou doenças cardiovasculares ou doenças cardiometabólicas em 16 estudos. A obesidade sarcopênica está associada a fatores de risco e/ou doenças cardiometabólicas ou doenças cardiovasculares em idosos. O estabelecimento de uma definição robusta de obesidade sarcopênica em idosos é necessário para estudos e intervenções clínicas.

Palavras-chave
Doenças cardiovasculares; Idosos; Doenças metabólicas; Obesidade; Sarcopenia

Author, year Type of study and country	Population characteristics	SO definition	Cardiometabolic risk/cardiovascular disease	Muscle strength assessment	Key Findings
Stephen & Janssen, 2009 [¹²] Prospective Cohort USA	n=3.366 (M/W) Age ≥65 y.	BIA (AMM/EST²); HS (SC=HS EST-adjust-ed); Anthropometry (OB=WC).	CAD; CHF; CVA.	Grip strength dynamometer. HS adjusted by the EST.	Coronary event rate in sarcopenic obese patients increased 23% (BIA) and 33% (HS). The risk of CHF in individuals with SO, considering the BIA was 42% higher.

Lim et al., 2010 [¹⁶] Prospective Cohort Korea	n=565 (M/W) Age ≥65 y.	DXA (SC=AFFM/EST² and AFFM/BM in kgx100); CT (OB=VF >100cm²).	MS; HOMA-IR.	NA	SO (AFFM/EST²) was associ-ated with higher (HOMA-IR) and higher TGL levels. The SO group had a risk of MS 8.2 times higher than normal individuals.

Kohara et al., 2011 [⁷] Cross-sectional Japan	n=782 (M/W) Elderly individuals.	CT (SC=cross-sec-tional area of the quadriceps muscle adjusted by the BM; (OB=VF>100cm²).	Leptin; lipid profile; BP; serum insulin level; HbA1Cg; HOMA-IR.	NA	Individuals with OS have higher levels of leptin, fasting plasma glucose, serum insulin, HbA1C, HOMA-IR, and total lym-phocyte count.

Hwang et al., 2012 [¹⁷] Cross-sectional Korea	n=2.221 (M/W) Age ≥60y.	DXA (SC=AFFM/BM in kgx100); Anthro-pometry (OB=WC ?90cm for M and ?85cm for W).	HbA1C; fasting blood glucose and insulin; lipid profile; PTH; vitamin D levels.	NA	Serum insulin and vitamin D levels were associated with SO in both sexes. Serum glucose and TGL levels have been associated with SO in women and PTH levels increased the risk of SO in men.

Levine & Crimmins, 2012 [²⁷] Cross-sectional USA	n=2.287 (M/W) Age ≥60y.	DXA (SC=AFFM/BM in kg x100); Anthro-pometry (OB=WC >102cm for M and >88cm for W).	HOMA-IR; CRP.	NA	Individuals with SO have a high level of insulin resistance.

Levine & Crimmins, 2012 [²⁷] Cross-sectional USA	n=1.127 (M/W) Age ≥60y.	DXA (SC=skeletal muscle mass; Anthro-pometry (OB=WC >102cm for M and >88cm for W).	HOMA-IR; CRP.	NA	The group of individuals with SO have high levels of CRP.

Chung et al., 2013 [²³] Cross-sectional Korea	n=2.943 (M/W) Age≥60y.	DXA (SC=AFFM ad-justed by the BM); Anthropometry (OB= BMI>25kg/m²).	BP; HOMA-IR; lipid pro-file; inflammatory mar-kers; vitamin D levels; liver function; renal function; ferritin; leukocytes; MS.	NA	Patients with SO have a higher vitamin D deficiency and chance of MS. HOMA-IR, TGL, ferritin and leukocytes levels were higher in the group with SO.

Lu et al., 2013 [²⁴] Cross-sectional Taiwan	n=600 (M/W) Age: 63.6y.	BIA (SC=AMM (kg)/ Weight (kg)×100); Anthropometry (OB=BMI ≥25 kg/m²).	MS	NA	The group of individuals with SO showed higher probability of having MS.

Atkins et al., 2014 [⁸] Cross-sectional Great Britain	n=4.252 (H) Age:≥60y.	Anthropometry (SC=average arm cir-cumference; OB=WC >102cm).	All-cause mortality and cardiovascular disease-related mortality; Car-diovascular events; CAD Events.	NA	There was no association between body composition and other factors evalu-ated. Individuals with SO had higher CRP levels.

Batsis et al., 2014 [⁵] Cross-sectional USA	n=4652 (M/W) Age: ≥60y.	BIA (SC=AFFM/EST²; OB=BF%).	Comorbidities (hyper-tension, diabetes, CHF, CAD, smoking and physical activity).	NA	In the study subjects 39.0% of deaths were from car-diovascular diseases. No association was found between SO and the risk of mortality in men. Women with SO had a higher risk of mortality.

Ohara et al., 2014 [²⁹] Cross-sectional Japan	n=1.470 (M/W) Age: 64.4y.	CT (SC=Thigh Cross-sectional Area; OB=VF >100cm²).	Arterial stiffness: pulse wave velocity of brachial wrist to ankle arteries.	NA	SO was significantly asso-ciated with arterial stiffness.

Santos et al., 2014 [²⁶] Cross-sectional Brazil	n=149 (M) Age: ≥60y.	DXA (SC=AFFM/EST²; OB=FM OS=residual value of the equation that provides for the AFFM based on height and FM).	BP; lipid profile; HOMA-IR; CRP.	NA	There was no significant difference in blood pressure, blood glucose, HOMA-IR, lipid profile and inflam-matory pattern between the SO group and other groups.

Yang et al., 2015 [²⁸] Cross-sectional USA	n=844 (M/W) Age: ≥65 y.	DXA (SC=AFFM/EST²; OB=%G).	Inflammatory process: CRP, IL-6 and TNF-?.	NA	SO is associated with in-creased CRP levels in men.

Wittmann et al., 2016 [²³] Randomized controlled trial Germany	n=75(W) Age:≥70y.	DXA (SC=MM/EST²; OB=%G).	MS	NA	The group of elderly women with SO showed a higher chance for having MS com-pared to the CG.

Sanada et al., 2017 [²²] Prospective Cohort Japan	n=2309 (M) Age:≥71y.	DXA (SC=AFFM/ EST²; OB=BMI, BF% and WC).	Comorbidities (hyper-tension and diabetes).	NA	All-cause mortality was in-creased in men with their WC-defined SO, but not their BMI and BF%.

Kang et al., 2017 [⁹] Prospective Cohort Korea	n=4.183 (W). Age: >61y.	DXA (SC=AFFM/BM; OB=BMI?25Kg/m²).	MS	NA	Women with SO had a greater chance of devel-oping MS.

Takayama et al., 2017 [¹⁰] Cross-sectional Japan	n=235 (M/W) Age: ≥65y.	DXA (SC=MLG/EST²; OB=BF%).	MS	NA	SO was more associated with risk for having MS than just obesity, regardless of the BMI and other confounding factors.

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[1] Note: Y.: Years; CVA: Cerebrovascular Accident; BIA: Bioelectrical Impedance; WC: Waist Circumference; CAD: Coronary Artery Disease; DXA: Dual Energy X-Ray Absorptiometry; EST: Stature; HS: Handgrip Strength; CG: Control Group; VF: Visceral Fat Abdominal; M: Men; Hba1c: Glycosylated Hemoglobin; HOMA-IR: Homeostasis Model Assessment of Insulin Resistance; CHF: Congestive Heart Failure; IL-6: Interleukin 6; BMI: Body Mass Index; W: Women; BM: Body Mass; FM: Fat Mass; AFFM: Appendicular Fat-Free Mass; MM: Muscle Mass; AMM: Appendicular Muscle Mass; NA: Not Assessed; OB: Obesity; SO: Sarcopenic Obesity; BP: Blood Pressure; CRP: C-Reactive Protein; PTH: Parathyroid Hormone; SC: Sarcopenia; MS: Metabolic Syndrome; CT: Computed Tomography; TGL: Triglycerides; TNF-a: Tumor Necrosis Factor Alpha; BF%: Body Fat Percentage.