Avaliação da massa e força muscular, desempenho físico e indicadores de qualidade de vida de pacientes submetidos à cirurgia bariátrica

Abstract

Background: Roux-en-Y gastric bypass (RYGB) is a widely performed bariatric procedure that promotes substantial fat mass loss, significantly improves obesity-related comorbidities, and reduces all-cause mortality. However, the loss of muscle mass post-surgery is a notable concern. Loss of muscle mass can negatively impact muscle strength and physical function, which in turn can affect the quality of life (QoL). Objectives: To compare muscle mass and strength, physical function, and QoL indicators in patients undergoing RYGB with body mass index (BMI)-, age- and gender-matched non-surgical controls (CON). Associations were tested between percent excess weight loss (EWL), percent total weight loss (TWL), and time since surgery vs. muscle health parameters. Methods: This cross-sectional study included 39 patients submitted to laparoscopic RYGB [92.3% females, aged 39±5 years, with a preoperative weight of 111.4±12.9kg, and a BMI of 42.2±3.8kg/m2]. They had an EWL of 104.8±20.5%, a TWL of 35.7±6.8%, a ratio of weight regains (RWR) of 14.1±9.5%, and a time since surgery of 3 [3–4] years. The CON consisted of 21 BMI, age- and gender-matched controls. Between-group comparisons were performed for appendicular skeletal muscle mass index (ASM index), handgrip strength (HGS), timed Up and Go Test (TUG), anthropometric and biochemical parameters, and 36-Item Short-Form Health Survey (SF-36). Results: RYGB exhibited similar ASM index, HGS, and TUG to controls (p≥0.18), and worse scores in the majority of QoL indicators (physical functioning, physical/emotional role limitations, bodily pain, social functioning, and mental health) (p≤0.01). EWL and TWL were negatively correlated to the ASM index (r=-0.55 and r=-0.48, p<0.001) and HGS (r=-0.32 and r=-0.34, p≤0.04), but not to TUG (r=-0.04 and r=0.05; p≥0.72). On the other hand, the time since surgery was positively correlated to the TUG (rho=0.43, p<0.001), but not to ASM index (rho=-0.07, p=0.66) and HGS (rho=-0.14, p=0.39). RYGB presented lower values of waist circumference, systolic blood pressure, fasting glucose, glycated hemoglobin type A1c (HbA1c), total cholesterol, low-density lipoprotein cholesterol (LDL-c), triglycerides, uric acid, urea, and creatinine vs. control (p≤0.04). Conclusion: RYGB showed similar muscle mass/strength and physical function to CON. On the other hand, the majority of physical and mental components of QoL were worse in RYGB compared with CON. A better cardiometabolic/renal profile and fat distribution were detected in RYGB compared to CON.