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Master's Dissertation
DOI
https://doi.org/10.11606/D.109.2018.tde-06042018-150636
Document
Author
Full name
Pedro Pugliesi Abdalla
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2017
Supervisor
Committee
Machado, Dalmo Roberto Lopes (President)
Ferriolli, Eduardo
Gobbo, Luís Alberto
Moraes, Camila de
Title in Portuguese
Pontos de corte para sarcopenia em idosos a partir da força muscular de extensão do joelho absoluta, relativa e por ajustes alométricos
Keywords in Portuguese
Alometria
DXA
Idosos
Modelo preditivo
Sarcopenia
Abstract in Portuguese
Sarcopenia (Sc) é uma doença caracterizada por sintomas patológicos sem causas específicas que acomete parte dos idosos. A Sc promove reduções na massa muscular (MM) e força muscular (FM), com sérios impactos funcionais e motores. A força de preensão manual (FPM) utilizada para diagnosticar Sc não é representativa da FM global, especialmente para FM de membros inferiores (MMII), quando idosos passam por intervenção com treinamento de FM. Embora utilizada para definir a Sc, FM é considerada de forma absoluta ou relativizada pela massa corporal (MC), cuja relação nem sempre é linear. Assim, o objetivo deste estudo foi estabelecer parâmetros válidos para diagnóstico da Sc, a partir de diferentes expressões da FM de MMII em idosos. Uma amostra de 98 idosos fisicamente independentes foi medida pela absorciometria radiológia de dupla energia (DXA) para determinação do Tecido Mole Magro apendicular. Os idosos foram classificados por sexo e Sc (1=Sc; 0=não Sc), segundo os critérios do European Working Group on Sarcopenia in Older People (EWGSOP). A FM de extensão de joelhos (FMEJ) isocinética determinada a 60º/s (Biodex, System 4 Pro), foi considerada como FM referencial (FMEJTorquePico-60°/s), e a FMEJ Estimada em cadeira extensora (CMáxEstFMEJcad-ext), em protocolo de repetição máxima. Análise descritiva com medidas de tendência central foi utilizada para caracterização da amostra. A validação da FMEJ Estimada foi testada por correlação com a FMEJ de referência. Os valores de CMáxEstFMEJcad-ext foram relativizados pela massa corporal (FMEJ/MC) e por ajustes alométricos (FMEJ/MCb), onde b é o expoente gerado por regressão log-linear entre FMEJ e MC. Para determinar um modelo explicativo da Sc a partir de cada expressão da CMáxEstFMEJcad-ext (absoluta, FMEJ/MC e FMEJ/MCb) foi empregada a regressão logística simples. Os pontos de corte para Sc a partir da CMáxEstFMEJcad-ext foram definidos pela curva Característica de Operação do Receptor (ROC) e localizados pelo índice de Youden. As análises foram realizadas no Statistical Product and Service Solutions (SPSS) 20.0 e MedCalc 15.2 com níveis de significância previamente estabelecidos (?=0,05). Os resultados indicaram que a Sc esteve presente em 12,9% dos homens e 9,0% das mulheres. Houve alta correlação entre a medida de FMEJ de referência e a Estimada (r=0,81), mesmo entre idosos com Sc (r=0,72). Os expoentes b obtidos foram de 0,96 e 0,70 para homens e mulheres, respectivamente. Na regressão logística, as expressões relativas (FMEJ/MC e FMEJ/MCb) não explicaram a probabilidade para ocorrência da Sc em nenhum dos sexos. Somente a CMáxEstFMEJcad-ext absoluta explicou a chance para homens (?2=3,869; p=0,049) e mulheres (?2=4,145; p=0,042). A área abaixo da curva foi elevada (AUC>0,70), com pontos de corte de 65,0kg para homens e 34,9kg para mulheres. Conclui-se que a CMáxEstFMEJcad-ext é uma medida válida para monitorar Sc como parâmetro de FM em idosos, mesmo quando apresentam Sc. Os limiares de carga (kg) propostos como pontos de corte podem ser usados em um simples teste FMEJ da prática clínica profissional. Além disso, tem boa sensibilidade para monitorar a distância do ponto corte para Sc, o que não é possível com o modelo dicotômico do EWGSOP
Title in English
Cut-off points for sarcopenia in elderly from the absolute, relative, and allometric knee extension muscle strength
Keywords in English
Allometry
DXA
Elderly
Predictive model
Sarcopenia
Abstract in English
Sarcopenia (Sc) is a disease characterized by pathological symptoms without specific causes that affects part of the elderly. Sc promotes reductions in muscle mass (MM) and muscle strength (MS), with serious functional and motor impacts. The handgrip strength (HS) used to diagnose Sc is not representative of global MS, especially for lower limb (LL) MS, when the elderly go through an intervention with MS training. Although used to define Sc, MS is considered absolutely or relativized by body mass (BM), whose relationship is not always linear. Thus, the objective of this study was to establish valid parameters for the diagnosis of Sc, from different MS expressions of LL in the elderly. A sample of 98 physically independent elderly subjects was measured by dual energy absorptiometry (DXA) to determine appendicular lean soft tissue. The elderly were classified by sex and Sc (1=Sc; 0=not Sc), according to the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP). The isokinetic knee extension MS (KEMS) determined at 60º/s (Biodex, System 4 Pro) was considered as referential (KEMSPeakTork-60°/s), and KEMS Estimated in extensor chair (EstMaxLoadKEMSext-ch), in maximal repetition protocol. Descriptive analysis with measures of central tendency was used to characterize the sample. Validation of the estimated KEMS was tested by correlation with the reference KEMS. The values of EstMaxLoadKEMSext-ch were relativized by body mass (KEMS/BM) and by allometric adjustments (KEMS/BMb), where b is the allometric exponent generated from the log-linear regression between KEMS and BM. To determine an explanatory model of Sc from each expression of EstMaxLoadKEMSext-ch (absolute, KEMS/BM and KEMS/BMb), simple logistic regression was used. The cutoff points for Sc from the EstMaxLoadKEMSext-ch were defined by the Receiver Operating Characteristic (ROC) curve and located by the Youden index. The analyzes were performed in Statistical Product and Service Solutions (SPSS) 20.0 and MedCalc 15.2 with previously established levels of significance (? = 0.05). The results indicated that Sc was present in 12.9% of men and 9.0% of women. There was a high correlation between the reference KEMS and the estimated (r=0.81), even among the elderly with Sc (r=0.72). The exponent b obtained was 0.96 and 0.70 for men and women, respectively. In the logistic regression, the relative expressions (KEMS/BM and KEMS/BMb) did not explain the probability for occurrence of Sc in any of the sexes. Only absolute EstMaxLoadKEMSext-ch explained the chance for males (?2=3,869, p=0.049) and females (?2=4.145, p=0.042). The area below the curve was elevated (AUC>0.70), with cutoff points of 65.0kg for men and 34.9kg for women. It is concluded that the EstMaxLoadKEMSext-ch is a valid measure to monitor Sc as MS parameter in the elderly, even when they present Sc. Load thresholds (kg) proposed as cutoff points can be used in a simple clinical practice test. In addition, it has good sensitivity to monitor the distance from the cut point to MS, which is not possible with the dichotomous model of the EWGSOP
 
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Publishing Date
2018-06-05
 
WARNING: The material described below relates to works resulting from this thesis or dissertation. The contents of these works are the author's responsibility.
  • ABDALLA, P. P.; CARVALHO, A. S.; SANTOS, A. P.; VENTURINI, A. C. R.; ALVES, T. C.; MOTA, J.; OLIVEIRA, A. S.; RAMOS, N. C.; MARINI, J. A. G.; MACHADO, D. R. L. Cut- off points of knee extension strength allometrically adjusted to identify sarcopenia risk in older adults: A cross-sectional study. Arch Gerontol Geriatr, v. 89, n., p. 104100, 2020.
  • ABDALLA, P. P.; CARVALHO, A. S.; SANTOS, A. P.; VENTURINI, A. C. R.; ALVES, T. C.; MOTA, J.; MACHADO, D. R. L. One-repetition submaximal protocol to measure knee extensor muscle strength among older adults with and without sarcopenia: a validation study. BMC Sports Science, Medicine and Rehabilitation, v. 12, n. 1, p. 29, 2020.
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