Sarcopenia em receptores de transplante renal: prevalência e relação com consumo alimentar, adiposidade corporal, resistência à insulina, vitamina D e marcadores inflamatórios

Abstract

Sarcopenia is a syndrome characterized by reduced muscle mass and function, and is associated with increased risk of mortality. Renal transplant (RTx) may present reduced muscle mass. However, the prevalence of sarcopenia and the factors associated with this syndrome in these patients are notyet defubed. To evaluate the prevalence of sarcopenia in adult RTx recipients and its association with body adiposity, dietary intake, metabolic profile, vitamin D, inflammatory markers and mortality risk. Longitudinal study with adults (18-65 years) undergoing regular treatment in a specialized outpatient clinic, submitted to RTx >6 months. The mean follow-up time was 22 months. Patients on dialysis, presenting body mass index (BMI) <18.5kg/m2, AIDS, cancer or autoimmune diseases were excluded. The study was divided in two stages. In the 1st stage, the patients were evaluated for: 1) Body composition: anthropometry, electrical bioimpedance and dual energy x-ray absorptiometry (DXA); 2) Dietary intake (3 24h recalls); 3) Physical activity (Baecke questionnaire); 4) Laboratory variables: glucose, insulin, lipid profile, 25(OH)vitaminD, adiponectin, tumor necrosis factor-α, interleukin-8, high-sensitive C-reactive protein; 5) Glomerular filtration rate estimated (eGFR) by CKD-EPI equation; 6) Sarcopenia: diagnosed using the skeletal muscle mass index (SMI) evaluated with DXA, muscle strength evaluated by handgrip strength and physical performance by usual gait speed. At the end of the study (2nd stage) the occurrence of deaths was evaluated. In the 1st stage, 185 patients were evaluated (101 men), 50 (42-56) years old, 117 (32-173) months from RTx, eGFR 55.0±1.5 mL/min. Sarcopenia was observed in 32 patients (17%). The group with sarcopenia (SG) presented age, gender, time from Tx, type of graft donor, immunosuppressive drugs, eGFR, energy and protein intake, insulin resistance, lipid profile, serum levels of vitamin D and inflammatory markers similar to the non-sarcopenia group (NSG; n = 153). The total score of physical activity was significantly higher in the NSG. Total and central body adiposity assessed by anthropometry and DXA were significantly higher in the NSG. In the 2nd stage, 9 deaths occurred (5.0%) and sarcopenia was not associated with an increased risk of mortality. The present study suggests that in RTx recipients, the prevalence of sarcopenia is high and is associated with lower total and central body adiposity.