Obesidade abdominal, dinapenia e obesidade dinapênica em pacientes em tratamento com hemodiálise
DOI:
https://doi.org/10.11606/issn.2176-7262.rmrp.2025.212381Palavras-chave:
Doença renal crônica, Força de preensão manual, Circunferência abdominalResumo
Introdução: A obesidade abdominal (OAD), combinação da obesidade abdominal e da baixa força muscular, é comum no envelhecimento e, consequentemente, nos pacientes com doença renal crônica (DRC) com idade avançada. Há uma lacuna a respeito da relação da OAD com a lentidão nessa população. Objetivos: i) investigar a prevalência dos fenótipos obesidade abdominal (OA), de dinapenia (D) e de OAD em pacientes com DRC em hemodiálise; ii) analisar a relação da lentidão com os fenótipos de OA, D e OAD. Métodos: Estudo transversal realizado num Centro de Nefrologia, incluindo pacientes com 50 anos ou mais, de ambos os sexos e em tratamento de hemodiálise. Informações sociodemográficas e clínicas compuseram a caracterização amostral. A dinamometria foi utilizada para determinar a baixa força muscular (<26/16kg para homens e mulheres, respectivamente). A OA foi definida pelo aumento da medida da circunferência da cintura (CC), sendo >88 cm para mulheres e >102 cm para homens. A lentidão foi avaliada pelo teste de velocidade de caminhada (VC) no ponto de corte de ≤0,8 m/s. A combinação de CC aumentada e baixa força muscular foi o critério para OAD. Análises estatísticas foram conduzidas no nível de p<0,05. Resultados: Participaram 94 pacientes (62,1±9,2 anos), predominantemente homens (73,4%) e idosos (52,1%). Pacientes caracterizados com OAD apesentaram-se mais fracos e mais lentos comparados àqueles pertencentes aos fenótipos não-OA/não-D e OA (p<0,001). A prevalência de OAD foi de 13,8% na amostra total, e a maior proporção de lentidão foi entre os pacientes com o fenótipo OAD (69,2%). Conclusão: Os pacientes que apresentam o fenótipo OAD são mais lentos e mais fracos do que aqueles com OA, bem como aqueles sem obesidade e dinapenia.
Downloads
Referências
1. Kitamura M, Takazono T, Yamaguchi K, Notomi S, Sawase K, Harada T, et al. The impact of muscle mass loss and deteriorating physical function on prognosis in patients receiving hemodialysis. Sci Rep [Internet]. 2021;11(1):1–10. Available from: https://doi.org/10.1038/s41598-021-01581-z
2. Souza VA de, Oliveira D de, Mansur HN, Fernandes NM da S, Bastos MG. Sarcopenia in chronic kidney disease. J Bras Nefrol. 2015;37(1):98–105.
3. Collins BC, Laakkonen EK, Lowe DA. Aging of the musculoskeletal system: How the loss of estrogen impacts muscle strength. Bone. 2019 Jun 1;123:137–44.
4. Sabatino A, Cuppari L, Stenvinkel P, Lindholm B, Avesani CM. Sarcopenia in chronic kidney disease: what have we learned so far? J Nephrol [Internet]. 2021;34(4):1347–72. Available from: https://doi.org/10.1007/s40620-020-00840-y
5. Li R, Xia J, Zhang XI, Gathirua-Mwangi WG, Guo J, Li Y, et al. Associations of Muscle Mass and Strength with All-Cause Mortality among US Older Adults. Med Sci Sports Exerc. 2018 Mar;50(3):458–67.
6. Hwang S-H, Lee DH, Min J, Jeon JY. Handgrip Strength as a Predictor of All-Cause Mortality in Patients With Chronic Kidney Disease Undergoing Dialysis: A Meta-Analysis of Prospective Cohort Studies. J Ren Nutr Off J Counc Ren Nutr Natl Kidney Found. 2019 Nov;29(6):471–9.
7. Yang L, He Y, Li X. Physical function and all-cause mortality in patients with chronic kidney disease and end-stage renal disease: a systematic review and meta-analysis. Int Urol Nephrol. 2023 May;55(5):1219–28.
8. Hanna RM, Ghobry L, Wassef O, Rhee CM, Kalantar-Zadeh K. A Practical Approach to Nutrition, Protein-Energy Wasting, Sarcopenia, and Cachexia in Patients with Chronic Kidney Disease. Blood Purif. 2020;49(1–2):202–11.
9. Alexandre TDS, Scholes S, Santos JLF, De Oliveira C. Dynapenic Abdominal Obesity as a Risk Factor for Worse Trajectories of ADL Disability among Older Adults: The ELSA Cohort Study. Journals Gerontol - Ser A Biol Sci Med Sci. 2019;74(7):1112–8.
10. Yang M, Jiang J, Hao Q, Luo L, Dong B. Dynapenic obesity and lower extremity function in elderly adults. J Am Med Dir Assoc. 2015 Jan;16(1):31–6.
11. Máximo R de O, Santos JLF, Perracini MR, de Oliveira C, Duarte YA de O, Alexandre T da S. Abdominal obesity, dynapenia and dynapenic-abdominal obesity as factors associated with falls. Brazilian J Phys Ther [Internet]. 2019;23(6):497–505. Available from: https://doi.org/10.1016/j.bjpt.2018.10.009
12. Corrêa H de L, Rosa T dos S, Dutra MT, Sales MM, Noll M, Deus LA, et al. Association between dynapenic abdominal obesity and inflammatory profile in diabetic older community-dwelling patients with end-stage renal disease. Exp Gerontol. 2021 Apr 1;146:111243.
13. De Oliveira Máximo R, De Oliveira DC, Ramírez PC, Luiz MM, De Souza AF, Delinocente MLB, et al. Dynapenia, abdominal obesity or both: Which accelerates the gait speed decline most? Age Ageing. 2021;50(5):1616–25.
14. Schaap LA, Koster A, Visser M. Adiposity, muscle mass, and muscle strength in relation to functional decline in older persons. Epidemiol Rev. 2013;35(1):51–65.
15. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Envelhecimento e Saúde da Pessoa Idosa. Cadernos de Atenção Básica, n. 19. Brasília, 2006. (Série A. Normas e Manuais Técnicos). Disponível em: https://aps.saude.gov.br/biblioteca/visualizar/MTE5NQ==. Acesso em: 31 de outubro de 2023.
16. Lee SM, Kim SE, Lee JY, Jeong HJ, Son YK, An WS. Serum myostatin levels are associated with abdominal aortic calcification in dialysis patients. Kidney Res Clin Pract. 2019;38(4):481–9.
17. Pilli L et al. Critério de classificação econômica Brasil, 2022. Assoc Bras Empres Pesqui. 2022;1–7.
18. Ikizler TA, Burrowes JD, Byham-Gray LD, Campbell KL, Carrero JJ, Chan W, et al. KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update. Am J Kidney Dis [Internet]. 2020;76(3):S1–107. Available from: https://doi.org/10.1053/j.ajkd.2020.05.006
19. Crooks V, Waller S, Smith T, Hahn TJ. The use of the Karnofsky Performance Scale in determining outcomes and risk in geriatric outpatients. J Gerontol. 1991 Jul;46(4):M139-44.
20. Barbosa-Silva TG, Bielemann RM, Gonzalez MC, Menezes AMB. Prevalence of sarcopenia among community-dwelling elderly of a medium-sized South American city: Results of the COMO VAI? Study. J Cachexia Sarcopenia Muscle. 2016;7(2):136–43.
21. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults--The Evidence Report. National Institutes of Health. Obes Res. 1998 Sep;6 Suppl 2:51S-209S.
22. World Health Organisation (WHO). WHO | Waist Circumference and Waist–Hip Ratio. Report of a WHO Expert Consultation. Geneva, 8-11 December 2008. 2008;(December):8–11. Available from: http://www.who.int
23. Studenski SA, Peters KW, Alley DE, Cawthon PM, McLean RR, Harris TB, et al. The FNIH sarcopenia project: Rationale, study description, conference recommendations, and final estimates. Journals Gerontol - Ser A Biol Sci Med Sci. 2014;69 A(5):547–58.
24. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: Revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16–31.
25. Idoso P. Bateria de Desempenho Físico Curto ( SPPB ) Avaliação do Desempenho Físico no Paciente Idoso. 2023;1–3.
26. March DS, Wilkinson TJ, Burnell T, Billany RE, Jackson K, Baker LA, et al. The Effect of Non-Pharmacological and Pharmacological Interventions on Measures Associated with Sarcopenia in End-Stage Kidney Disease: A Systematic Review and Meta-Analysis. Nutrients. 2022;14(9):1–41.
27. Kjaergaard AD, Teumer A, Witte DR, Stanzick KJ, Winkler TW, Burgess S, et al. Obesity and Kidney Function: A Two-Sample Mendelian Randomization Study. Clin Chem. 2022;68(3):461–72.
28. Borges VS, Lima-Costa MFF, de Andrade FB. A nationwide study on prevalence and factors associated with dynapenia in older adults: Elsi-Brazil. Cad Saude Publica. 2020;36(4).
29. Gonzalez MC, Mehrnezhad A, Razaviarab N, Barbosa-Silva TG, Heymsfield SB. Calf circumference: Cutoff values from the NHANES 1999-2006. Am J Clin Nutr [Internet]. 2021;113(6):1679–87. Available from: https://doi.org/10.1093/ajcn/nqab029
30. Dahl H, Rosendahl-Riise H, Marti H-P, Dierkes J. The Association of Sarcopenia and Central Obesity with Mortality Risk in Patients with Chronic Kidney Disease – a 2-Year Observational Study. Curr Dev Nutr [Internet]. 2023;7(1):100014. Available from: https://doi.org/10.1016/j.cdnut.2022.100014
31. Zamboni M, Mazzali G, Fantin F, Rossi A, Di Francesco V. Sarcopenic obesity: a new category of obesity in the elderly. Nutr Metab Cardiovasc Dis. 2008 Jun;18(5):388–95.
32. Waters DL, Baumgartner RN. Sarcopenia and obesity. Clin Geriatr Med. 2011 Aug;27(3):401–21.
33. Prado CMM, Wells JCK, Smith SR, Stephan BCM, Siervo M. Sarcopenic obesity: A Critical appraisal of the current evidence. Clin Nutr. 2012 Oct;31(5):583–601.
34. Wannamethee SG, Atkins JL. Muscle loss and obesity: The health implications of sarcopenia and sarcopenic obesity. Proc Nutr Soc. 2015;74(4):405–12.
35. Moreira PR, Barros E. Atualização em Fisiologia e Fisiopatologia Renal : Bases fisiopatológicas da miopatia na insuficiência renal crônica. 2000;22(1):40–4.
36. Chang YT, Wu HL, Guo HR, Cheng YY, Tseng CC, Wang MC, et al. Handgrip strength is an independent predictor of renal outcomes in patients with chronic kidney diseases. Nephrol Dial Transplant. 2011;26(11):3588–95.
37. Bataille S, Chauveau P, Fouque D, Aparicio M, Koppe L. Myostatin and muscle atrophy during chronic kidney disease. Nephrol Dial Transplant. 2021;36(11):1986–93.
38. Esposito P, La Porta E, Calatroni M, Grignano MA, Milanesi S, Verzola D, et al. Modulation of Myostatin/Hepatocyte Growth Factor Balance by Different Hemodialysis Modalities. Biomed Res Int. 2017;2017:7635459.
39. Koyun D, Nergizoglu G, Kir KM. Evaluation of the relationship between muscle mass and serum myostatin levels in chronic hemodialysis patients. Saudi J kidney Dis Transplant an Off Publ Saudi Cent Organ Transplantation, Saudi Arab. 2018;29(4):809–15.
40. Bouchard DR, Janssen I. Dynapenic-obesity and physical function in older adults. Journals Gerontol - Ser A Biol Sci Med Sci. 2010;65(1):71–7.
41. Stenholm S, Alley D, Bandinelli S, Griswold ME, Koskinen S, Rantanen T, et al. The effect of obesity combined with low muscle strength on decline in mobility in older persons: results from the InCHIANTI study. Int J Obes (Lond). 2009 Jun;33(6):635–44.
Downloads
Publicado
Edição
Seção
Licença
Direitos autorais (c) 2026 Letícia Colli Guzelotto, Flávia Andréia Marin, Maria Claudia Bernardes Spexot
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
