Avaliação da osteosarcopenia em adultos jovens e de meia-idade com obesidade severa

Abstract

Osteosarcopenic obesity (OSO) is a term recently introduced to describe a multifactorial musculoskeletal syndrome that simultaneously includes excess adipose tissue, decline in muscle mass and function, and decreased bone mineral density due to fat redistribution and infiltration in these tissues. The primary concern regarding the coexistence of sarcopenia and osteopenia in obese individuals is functional impairment, which can lead to reduced quality of life, increased risk of fractures, and higher mortality rates. Therefore, the aim of this study is to assess the presence of osteosarcopenic obesity in young and middle-aged adults. A cross-sectional analytical study was conducted with adults aged 20 to 59 years who had severe obesity (Body Mass Index ≥ 35 kg/m² with comorbidities and ≥ 40 kg/m² regardless of comorbidities). Body composition was assessed using dual-energy X-ray absorptiometry (DXA). The parameters for assessing sarcopenia included handgrip strength (HGS), the 5x sit-to-stand test (5STS), and appendicular muscle mass (ALM) adjusted for body size (ALM/weight × 100). For osteopenia, a T-score of the spine and femur was considered low if it was < -1.0 and > -2.5, while osteoporosis was defined as a T-score ≤ -2.5. Osteosarcopenia was diagnosed when there was a simultaneous presence of low strength, low muscle mass, and low bone mineral density. Seventy adults were evaluated, with an average age of 43 ± 10 years and with a predominance of female. Low strength was found in 71.4% of those assessed by the 5x sit-to-stand test (5STS) and in 7.1% assessed by handgrip strength (HGS). The frequencies of sarcopenic, osteopenic, and osteosarcopenic obesity were 46%, 3%, and 1.4%, respectively. For all obesity phenotypes, no significant differences were found between sexes. A negative correlation was observed between body fat percentage and bone mineral density, which became more significant as body mass index (BMI) increased: (BMI 35-39.9 Kg/m2: rfemur= -0.114, p = 0,769; rspine= -0.011, p= 0,976); (BMI 40-49.9 kg/m2: rfemur= -0.494, p= 0,001; rspine= -0.460, p= 0,001); (BMI ≥ 50 Kg/m2:rfemur= -0.853, p = 0,001; rspine= -0.697, p= 0,006). Young and middle-aged adults with severe obesity exhibit musculoskeletal alterations. The reduction in muscle function and mass is evident, while the decrease in bone mineral content appears to be gradual and subclinical.