Síndrome desnutrição sarcopenia em indivíduos hospitalizados com 50 anos ou mais

Abstract

Sarcopenia and malnutrition share similar and common etiologic factors, and thus may develop overlapping, characterizing the Malnutrition Sarcopenia Syndrome (MSS). MSS impairs treatment response and offers increased risks of negative outcomes during hospitalization. However, early screening and diagnosis are essential in hospital routine. This work proposed to know the occurrence of MSS and its association with sociodemographic, clinical, anthropometric characteristics and components of sarcopenia in individuals ≥ 50 years hospitalized, as well as to evaluate sarcopenia in two different ways, by calf circumference (CC) and by appendicular skeletal muscle mass index (ASMMI). This is a cross-sectional study with a non-probability sampling design. For the diagnosis of malnutrition we used the PatientGenerated Subjective Global Assessment (PG-SGA) and for sarcopenia the algorithm and criteria proposed by the European Working Group Sarcopenia in Older People (EWGSOP2). Low muscle mass was determined by CP ≤ 34 cm for men and ≤ 33 for women and by ASMMI at cut-off points <8.84 kg/m² and <6.67 kg/m², for men and women, respectively. Low muscle strength was determined by handgrip strength (HGS) at cut-off points <32/<21 kg for men and women, respectively. Low physical performance was determined by gait speed (GS) ≤0.8 m/s. The diagnosis of MSS was established to individuals with the presence of confirmed or severe malnutrition and sarcopenia. Pearson's chi-square (χ2) or Fisher's exact test was used to establish associations and Student's t-test was used for comparison between groups. Of 93 patients (65.2±9.8 years), the occurrence of MSS affected 30.1% and 18.3% of patients when skeletal muscle mass determined by CC and ASMMI, respectively. Regardless of the method used to estimate skeletal muscle mass, MSS had a predominance among males, elderly, with absent work activity, married, and economic level C, with <3 chronic diseases, hospitalized for clinical reasons, and without metabolic stress. When using the CC method, sarcopenia (confirmed and severe) was diagnosed in 33.4% while by ASMMI in 19.4%. MSS assessed by CC was significantly associated with the variables labor activity (p=0.028), body mass index (BMI) (p<0.001), HGS (p<0.001) and ASMMI (p<0.001). When using the ASMMI, the associations observed were work activity (p=0.018), economic level (p=0.044), BMI (p<0.001), CC (p<0.001) and HGS (p<0.001). This study found a worrisome prevalence of MSS among hospitalized patients and it was associated with low BMI, low strength and muscle mass. Furthermore, the diagnosis of MSS obtained by CC measurement was observed in approximately one-third of the patients evaluated, and was superior compared to ASMMI. The CC proved to be useful in assessing skeletal muscle mass for the diagnosis of sarcopenia and MSS, and may thus be inserted into hospital routine to facilitate the implementation of MSS screening, especially in public hospitals with low financial resources, in order to collaborate with the proper reporting of MSS.