Prevalence of sarcopenia in women at stable weight phase after Roux-en-Y gastric bypass

Abstract

Objective: Evaluating the prevalence of sarcopenia in women submitted to bariatric surgery -Rouxen-Y gastric bypass. Design: Observational, cross-sectional study. Subjects and methods: Women (18-65 years old) who underwent bariatric surgery (BG) ≥ 2 years and reached stable weight ≥ 6 months, were investigated. Control group (CG) comprised non-operated matched women with obesity. Body composition was determined through dual-energy X-ray absorptiometry. Low lean mass (LLM) was defined as appendicular lean mass index (ALM kg/height m²) < 5.5 kg/m². Physical strength was assessed through dynamometer and sit-to-stand test (SST), whereas performance was assessed through 4-m gait speed and Short Physical Performance Battery Tests (SPPB). Sarcopenia was diagnosed in the presence of LLM and low strength. Results: One-hundred and twenty women (60 in each group, 50 ± 9.7 years old) were investigated. All anthropometric and body composition parameters were lower in BG than in CG, whereas strength and performance were similar between groups. Women with reduced strength presented high total fat mass and low physical activity level (p < 0.005). LLM was observed in 35% of BG and in 18.3% of CG (p = 0.04), whereas sarcopenia was diagnosed in 28.3% of BG and in 16.6% of CG (p = 0.12). Sarcopenic women in BG had better performance both in SST (p = 0.001) and SPPB (p = 0.004). Total lean mass (OR:1.41, 95% CI [1.18; 1.69], p < 0.001) and obesity (OR: 38.2 [2.27; 644.12], p < 0.001) were associated with sarcopenia in the multivariate analysis. Conclusion: Despite great weight loss, sarcopenia prevalence did not increase in BG and its presence was influenced by total lean mass and obesity.

Existe vantagem na unificação dos conceitos de sarcopenia e dinapenia em pacientes com obesidade sarcopênica eletivos à cirurgia bariátrica? Uma revisão conceitual

“…Dynamic obesity, however, refers to the initial idea of dynapenia -the loss of muscle strength in obese patients -and perhaps it would be more effective to define obesity as leading to decreased muscle strength [19]. While sarcopenic obesity would be defined as obesity only with a decrease in lean mass, without negative repercussions on strength or even with improvement, as seen in studies [5,6].…”

“…However, in the context of sarcopenic obesity, this may not apply [3,4]. Studies with patients that undergo bariatric surgery have demonstrated that despite the decrease in lean mass, it is possible to obtain gains in muscle strength [5,6].…”

Existe relação de causalidade entre sarcopenia e dinapenia em pacientes submetidos à cirurgia bariátrica?

“…In a recent study, women undergoing bariatric surgery in a period of weight stability, when compared with women with SO who did not undergo the same surgery, performed better on the SST and SPPB [3]. In another study, it was estimated that the prevalence of SO in the elderly (≥ 60 years) in the world was 15% when the diagnosis of sarcopenia was based only on the volume of lean mass and decreased to 4% when muscle strength and physical functionality were considered [4].…”

“…Obesity is a global epidemic condition of significant social and economic impact that can lead to chronic diseases, functional limitations, high risk of mortality, and, when associated with the diagnosis of sarcopenia, is called sarcopenic obesity [3]. Obese patients have a greater amount of muscle mass and strength compared to non-obese individuals and morphological changes such as weight loss generally have repercussions on the decrease in lean mass, causing sarcopenia (SO) [3].…”

“…The muscular strength with the handgrip test, the volume of lean mass with the study of bioimpedance, and the gait speed in the walking test, also applied in the Short Physical Performance Battery (SPPB), are the evaluated parameters, being possible to grade the sarcopenia in pre -sarcopenia, sarcopenia and severe sarcopenia [1,2]. The guideline EWGSOP2, an updated version of EWGSOP, uses the sit-to-stand test (SST) as a muscle strength parameter, evaluating the speed of the individual in getting up from a chair [3].…”