Orientadora : Profa. Dra. Victória Z. Cochenski Borba / Dissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Medicina Interna. Defesa : Curitiba, 02/09/2016 / Inclui referências : f. 60-72 / Resumo: A doença pulmonar obstrutiva crônica (DPOC) é uma doença altamente prevalente, prevenível e tratável. Além do comprometimento pulmonar, diversas condições associadas extrapulmonares são comumente vistas. A redução na densidade mineral óssea (DMO), a presença de fraturas vertebrais e as alterações na composição corporal (CC) que ocorrem nestes pacientes, elevam o risco de exacerbações da doença, pioram a qualidade de vida e aumentam a mortalidade. Este estudo relacionou os dados de DMO, CC, prevalência de fraturas vertebrais morfométricas (FVM), pré-sarcopenia e sarcopenia com os critérios de gravidade e prognóstico de pacientes com DPOC e comparou os resultados com dois grupos controles, além de comparar 4 critérios diagnósticos (Baumgartner, Newman, Misto e FNIH) de pré-sarcopenia e sarcopenia nos três grupos. Todos os pacientes e controles realizaram exame de densitometria óssea, CC e avaliação de FVM no SEMPR (Serviço de Endocrinologia e Metabologia da UFPR). Foram avaliados os dados de 121 pacientes (65 mulheres), média de 67,9 ± 8,6 anos com DPOC (GD), 63 indivíduos tabagistas (GT) (29 mulheres), média de 65,5 ± 8,9 anos e 81 indivíduos não tabagistas (GNT) (47 mulheres), média de 66 ± 8,5 anos. DMO alterada foi observada em 88,4% dos pacientes do GD, com maior número de pacientes com osteoporose neste grupo em relação aos controles (p<0,001). A DMO (g/cm²) nos três sítios avaliados foi menor no GD que nos controles, associado com pior grau de obstrução, estadiamento clínico e índice prognóstico da DPOC (p<0,05). A prevalência de FVM nos pacientes com DPOC foi elevada (57,85%) e maior do que em ambos os grupos controles (GT 23,8% e GNT 14,8%), p<0,001. A CC mostrou menor porcentagem de gordura corporal total no GD em relação aos controles (p=0,04). Pior DMO nos três grupos e nos três sítios avaliados foi associada com menor quantidade de massa magra total (p<0,001). A prevalência de pré-sarcopenia foi maior no GD variando de 19 a 46%, dependendo do critério utilizado, sendo mais prevalente quando utilizado o critério mais atual da literatura (FNIH). No GT a prevalência variou de 20,6 a 39,7% e no GNT de 18,5 a 29,6%. A concordância entre os critérios diagnósticos de pré-sarcopenia foi considerada baixa (kappa <0,40). O diagnóstico de sarcopenia no GD, considerando os 4 critérios, mostrou uma concordância moderada (kappa = 0,57) entre os mesmos e com alta prevalência, variando de 4,9 a 12,4%, também maior pelo FNIH. Existiu uma associação entre sarcopenia e pior prognóstico da doença (OR: 3,50 (1,06 - 11,56), p=0,035), na análise univariada. Concluímos que os pacientes com DPOC apresentaram alterações significativas na massa óssea, na CC e alta prevalência de pré-sarcopenia e sarcopenia quando comparados a controles tabagistas ou não, além de elevado número de FVM. Estas alterações podem levar a pior qualidade de vida, aumento no risco de exacerbações da doença e de mortalidade, também sugerem que a investigação de sarcopenia e de osteoporose deva ser ao diagnóstico da DPOC, para prevenção e tratamento precoces. / Abstract: Chronic obstructive pulmonary disease (COPD) is a highly prevalent, preventable and treatable disease. In addition to lung disease, COPD is commonly associated with several extra-pulmonary disorders. The reduction in bone mineral density (BMD), the presence of vertebral fractures and changes in body composition (BC) that occurs in these patients, increase the risk of disease exacerbations, worsen the quality of life and increases mortality. This study linked the BMD data, BC, prevalence of morphometric vertebral fractures (MVF), pre-sarcopenia and sarcopenia with the criteria of severity and prognosis of patients with COPD and compared the results with two control groups. In addition, did a comparison of the 4 criteria (Baumgartner, Newman, Mixed and FNIH) for diagnosis of pre-sarcopenia and sarcopenia in all groups. All patients and controls underwent bone mineral densitometry, body composition exam and evaluation of morphometric vertebral fractures at SEMPR (Serviço de Endocrinologia e Metabologia da UFPR). We evaluated the data of 121 patients (65 women), mean 67.9 ± 8.6 years with COPD (DG), 63 smokers (SG) (29 women), mean 65.5 ± 8.9 years and 81 individuals nonsmokers (NSG) (47 women) mean of 66 ± 8.5 years. Altered BMD was observed in 88.4% of DG patients with a greater number of patients with osteoporosis in this group compared to controls (p <0.001). BMD (g/cm²) in the three sites evaluated was lower in DG than in controls and was associated with worse degree of obstruction, clinical staging and prognostic index of COPD (p <0.05). The prevalence of MVF in COPD patients was high (57.85%) and higher than in both control groups (SG 23.8% and 14.8% NSG), p <0.001. BC showed a lower percentage of total body fat in DG compared to controls (p = 0.04). Worse BMD in the three groups, and in the three sites was associated with lower total lean body mass (p <0.001). The prevalence of pre-sarcopenia was higher in DG ranging from 19 to 46%, depending on the criteria used, being more prevalent when using the most current criteria in the literature (FNIH). In SG the prevalence ranged from 20.6 to 39.7%, and in NSG 18.5 to 29.6%. The agreement between the pre-sarcopenia diagnostic criteria was considered poor (kappa <0.40). The diagnosis of sarcopenia in DG considering the four different criteria showed a moderate agreement between them (kappa = 0.57), with a high prevalence, ranging from 4.9 to 12.4%, also higher by FNIH. Univariate analysis showed an association between sarcopenia and worse prognosis of the disease (OR: 3.50 (1,06 - 11,56), p = 0.035). We conclude that patients with COPD have significant effects on bone mass, BC and high prevalence of pre-sarcopenia and sarcopenia compared to smokers or not smokers. Factors associated with high numbers of MVF, worse quality of life, increased risk of disease exacerbations and mortality, suggesting that initial investigation at the diagnosis of the disease should be done for precocious prevention and treatment.

Orientadora : Profª. Drª. Anna Raquel Silveira Gomes / Dissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências Biológicas, Programa de Pós-Graduação em Educação Física. Defesa: Curitiba, 11/12/2015 / Inclui referências : f. 90-106 / Área de concentração: Exercício e esporte / Resumo: Os exercícios de alongamento são frequentemente recomendados para a pessoa idosa e têm-se mostrado como uma técnica capaz de melhorar a amplitude de movimento, o equilíbrio, padrão da marcha, capacidade funcional e diminuir o risco de quedas. Porém, ainda não se sabe quais os efeitos agudos histológicos e moleculares no músculo esquelético, decorrentes dos exercícios de alongamento em idosos. Dessa forma, o objetivo da presente pesquisa foi avaliar os efeitos agudos do alongamento passivo estático na histomorfometria muscular, imunomarcação e expressão gênica no músculo sóleo de ratas idosas. Foram utilizadas 15 ratas idosas, com 26 meses, divididas em grupo alongamento e grupo controle. O protocolo de alongamento consistiu em alongamento mecânico passivo do músculo sóleo esquerdo, composto de uma série de 4 repetições de 1 minuto, com intervalo de 30 segundos entre as repetições, realizado 3 vezes por semana, durante uma semana. Para realização do protocolo, as ratas foram sedadas por via inalatória com isoflurano, inclusive as pertencentes ao grupo controle. No 6º dia do experimento, as ratas foram anestesiadas para a retirada do músculo sóleo esquerdo e posteriormente eutanasiadas. Foi realizada pesagem da massa corporal inicial e final e massa absoluta do músculo sóleo. A massa muscular relativa ao peso corporal foi estimada. A morfologia do músculo sóleo foi avaliada com microscopia de luz, em cortes histológicos transversais, corados com hematoxilina e eosina. A área de secção transversa das fibras musculares foi mensurada por meio do Programa Image J versão 1.45q. Foi realizada imunohistoquimica para análise da marcação de TNF?, TIMP-1, TGF?-1, Colágeno tipo I e tipo III no músculo sóleo. A expressão dos genes TGF?, Colágeno tipo I e tipo III foram analisados pela técnica de PCR em Tempo Real. Para a comparação entre a massa corporal inicial e final foi utilizado o teste t pareado. Para a comparação entre os grupos foi aplicada ANOVA one way para dados paramétricos e para não paramétricos o Kruskall-Wallis. Verificou-se menor área de secção transversa das fibras musculares quando se comparou o grupo alongamento com o controle (4148 ± 1568 ?m2 vs 5032 ± 2125 ?m2; p=0,001, Kruskall Wallis); menor porcentagem de imunomarcação do colágeno tipo I por área de fibra muscular (1,41±1,21% vs 1,67±1,91% p=0,01, Kruskal-wallis), maior porcentagem de imunomarcação de TNF? (0,12±0,11% vs 0,07±0,08%, p=0,04, Kruskall Wallis)e colágeno tipo III (7,06±6,88% vs 4,92±5,30%, p=0,01, Kruskal Wallis). O TGF?-1 apresentou menor porcentagem de imunomarcação (1,60±1,69% vs 1,90 ± 2,85%, p=0,04, Kruskal-wallis) e expressão gênica (0,83±0,89 vs 4,47±5,65 UA, p=0,0001,ANOVA one way) em relação ao grupo controle. Não foi encontrada diferença significativa na massa muscular absoluta e relativa, marcação imunopositiva de TIMP-1 e expressão gênica de Colágeno I e III entre os grupos. Os efeitos agudos do exercício de alongamento causaram hipotrofia muscular esquelética, no entanto, fatores envolvidos com o remodelamento da matriz extracelular indicaram efeito anti-fibrótico, no músculo esquelético de ratas idosas. Palavras-chave: Exercício de alongamento muscular, sarcopenia, envelhecimento, matriz extracelular, ratas, expressão gênica, histomorfometria. / Abstract: The muscle stretching exercises are usually recommended to elderly people, and it has been seen as able to improve the balance, gait pattern, increase range of motion and functional capacity and decrease the risk of falls. Considering that stretching exercise induces skeletal muscle and connective tissue adaptation we aimed to evaluate the effect of acute passive stretch on aged soleus muscle on muscle histomorphometry, immunohistochemistry and gene expression. Fifteen old female rats, with 26 months, were separated in stretching group and control group.The stretching protocol consisted of 4 repetitions each of 1 minute with 30 seconds interval between sets, 3 times a week during 1 week, on the left soleus muscle. The rats were anesthetized with isoflurane inhalation, including the control group. At the 6th day of the experiment, the rats were anesthetized to remove soleus muscle and then euthanized. Initial and final body weight and absolute weight of the soleus muscle were evaluated. The relative muscle mass was also identified. The soleus muscle was stained with hematoxylin and eosin and was analyzed morphologically by light microscope. The cross sectional area of muscle fiber was assessed by Image J 1.45q software. Immunohistochemistry for quantification of TNF?, TGF-?1, type I and type III collagen and TIMP-1 and gene expression by PCR Real Time for quantification of TGF?-1, type I Collagen and type III Collagen were performed. The statistical analysis was the paired t-test, ANOVA one way test for parametric and Kruskal-Wallis test for nonparametric data.The stretching group showed smallest cross-sectional area of muscle fibers when compared to the control group (4148 ± 1568 ?m2 vs 5032 ± 2125 ?m2; p=0,001, Kruskall Wallis), less type I collagen percentage of immunostain (1,41±1,21% vs 1,67±1,91% p=0,01, Kruskal-wallis), largest TNF? percentage of immunostain (0,12±0,11% vs 0,07±0,08%, p=0,04, Kruskall Wallis) and type III collagen percentage of immunostain (7,06±6,88% vs 4,92±5,30%, p=0,01, Kruskal Wallis), and lower TGF-?1 percentage of immunostain per soleus muscle fiber area (1,60±1,69% vs 1,90 ± 2,85%, p=0,04, Kruskal-wallis) and gene expression (0,83±0,89 vs 4,47±5,65 UA, p=0,0001,ANOVA one way). There was no significant difference in relative and absolute muscle mass, TIMP percentage of immunostain and gene expression of collagen I and III between groups. The acute effect of muscle stretching was muscle atrophy, however, the factors involved in the extracellular matrix remodeling showed anti-fibrotic effect in muscle of aged rats. Key words: Muscle stretching exercise, sarcopenia, aging, extracellular matrix, rats, gene expression, histo morfometry

Made available in DSpace on 2014-06-11T19:29:33Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-02-25Bitstream added on 2014-06-13T18:39:12Z : No. of bitstreams: 1 pierine_dt_me_botfm.pdf: 310490 bytes, checksum: a47108559c8dded0dfe6eea9fc1a4147 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A diminuição da massa muscular associada ao envelhecimento, atualmente, é considerada problema de saúde pública. É um processo lento e progressivo e se associa positivamente com outras doenças crônicas. Verificar a associação da massa muscular esquelética com variáveis demográficas, antropométricas, dietéticas e bioquímicas e aptidão física de adultos clinicamente selecionados para programa de mudança de estilo de vida. Estudo transversal composto por 734 indivíduos (170 homens e 564 mulheres) que foram clinicamente e eticamente selecionados. Todos foram avaliado quanto a composição corporal (IMM, IMC, GC, CA), prática habitual de atividade física (IPAQ), aptidão física (flexibilidade de tronco, FPM e VO2máx), hábito alimentar (IAS), e componentes da síndrome metabólica (CA, TG, HDL-c, PA e glicemia). Foi utilizada estatística descritiva, teste t de Student, Mann-Whitney para comparação entre grupos, correlação de Pearson e análise de regressão múltipla. Os homens apresentaram maior massa muscular do que as mulheres em todas as faixas etárias. Na correlação ajustada por gênero, idade e IMC, o IMM foi associado positivamente com FPM (r=0,16), VO2máx (r=0,20) e flexibilidade (r=0,18), e negativamente com GC (r=-0,15), CA (r=-0,12) e IAS (r=- 0,15). Os indivíduos com CA aumentada (RR: 1,92; IC: 1,02-3,60) e FPM diminuída (RR: 2,10; IC: 1,27-3,49) apresentaram risco significativamente aumentados para desenvolver sarcopenia. A obesidade abdominal e diminuição da força de preensão manual são consideradas fatores de risco para sarcopenia, independente de gênero, idade e IMC. Assim, medidas de intervenção que contemplem exercício físico e acompanhamento nutricional são necessárias, a fim de combater a obesidade abdominal e aumentar a massa muscular. / A decrease in muscle mass associated with aging, is currently considered a public health problem. It is slow and progressive and is associated positively with other chronic diseases. To investigate the association of skeletal muscle mass with demographic, anthropometric, dietary, and biochemical and physical fitness of adults clinically selected for program change of lifestyle. A survey consisting of 734 individuals (170 men and 564 women) who were clinically and ethically selected. All were assessed for body composition (MMI, BMI, BF, WC), practice of physical activity (IPAQ), fitness (trunk flexibility, HG and VO2max), dietary habits (IAS), and components of metabolic syndrome (WC, TG, HDL-C, BP and blood glucose). We used descriptive statistics, Student t test, Mann-Whitney test for comparison between groups, Pearson correlation and multiple regression analysis. Men had greater muscle mass than women in all age groups. In the correlation adjusted for gender, age and BMI, the MMI was positively associated with HG (r = 0.16), VO2max (r = 0.20) and flexibility (r = 0.18), and negatively with BF (r = -0.15), WC (r =- 0.12) and IAS (r =- 0.15). Individuals with WC increased (RR: 1.92, CI: 1,02-3,60) and HG diminished (RR: 2.10, CI: 1,27-3,49) had significantly increased risk for developing sarcopenia. Abdominal obesity and decreased hand grip strength are considered risk factors for sarcopenia, regardless of gender, age and BMI. Thus, intervention measures that include exercise and nutritional counseling are necessary to combat the abdominal obesity and increase muscle mass.

Background Sarcopenia and age-related cognitive decline (ARCD) are important age-related conditions which significantly impact upon the quality of life of older adults. ARCD is a well-established research area, whereas sarcopenia is a relatively new field. Research into the inter-relationships between them and possible common underlying mechanistic processes is lacking. Methods Several research techniques were used: a large systematic review; the development of an image analysis technique to measure neck muscle size on volumetric MR brain scans; the subsequent use of the technique in elderly cohort studies; statistical modelling to investigate the role of glucocorticoids in sarcopenia; and an invasive clinical study to develop a novel technique to measure the activity of 11beta-hydroxysteroid dehydrogenase (11βHSD1) in the human brain in vivo. Results I consistently found a relationship between: some measures of brain structure and muscle size; markers of brain structure and muscle function, mostly grip strength and gait speed; and cognition and muscle function. However, I found no relationship between current cognition and muscle size in any of the above studies. Cortisol was identified as a possible explanatory factor in the relationship between both cognition and brain volume with gait speed. I found an association between markers of immunosenescence and sarcopenia (neck muscle CSA and grip strength) and an association between expression of the cortisol amplifying enzyme 11βHSD1 and quadriceps strength. I developed a technique to measure 11βHSD1 activity across the human brain, which found that the amount of cortisol produced within the brain was not detectable and highlighted the asymmetries within the cerebrovascular venous system. Conclusions Further longitudinal studies looking at the association between sarcopenia and ARCD are now required to investigate these important relationships further and hopefully this will lead to improved therapeutic options.

Sarcopenia is the age-related progressive loss of skeletal muscle (SkM) mass, function, and strength. It has been well elucidated that resistance exercise can attenuate the development of sarcopenia. A population of extracellular vesicles, termed ‘exosomes’ (EXO), can contain microRNA and facilitates intercellular communication, including within SkM, though the response to prolonged training is not well understood. Given the potential role of SkM-derived exosomes in the response to exercise, we examined older adults (n = 30, OLD) before (PRE) and after a 12-week (POST), resistance training program. Healthy, young controls (n = 12, YNG) were used for comparison of baseline measures. Exosomes were isolated from platelet-free plasma using size exclusion chromatography in combination with ultracentrifugation (SEC-UC) and characterized via western blotting, nanoparticle tracking analysis and electron microscopy. To assess exosome biogenesis and miRNA synthesis in skeletal muscle, biopsies were taken from the vastus lateralis. Circulating EXO-enclosed and SkM miRNA expression was measured using RT-PCR. In SEC-UC isolates, EXO-markers CD81 and CD9 were significantly lower in PRE compared to YNG (p<0.05) but did not change with training. At baseline, ALIX, TSG101 and CD63 (markers of exosomes) were not altered with aging as compared to YNG; however, their expression significantly increased with training (p<0.05) Circulating EXO-derived mir-1, -133, -23 and -27a were significantly lower in expression of OLD participants as compared to YNG. Following resistance training, their expression significantly increased (p<0.05), returning to a YNG phenotype. Next, we aimed to investigate the contribution of skeletal muscle in the exosome responses. Our data indicate that a small fraction of circulatory exosomes may originate from skeletal muscle. In addition, in biopsy-derived SkM tissue, expression of proteins involved in EXO and miRNA biogenesis (Alix, XPO-5, DICER) were significantly higher in PRE compared to YNG (p<0.05), and further increased with resistance training (POST, p<0.05). Expression of Rab27a, a marker of exosome trafficking, was significantly higher in PRE (p<0.05) but did not respond to training. In conclusion, here we show alterations in circulating EXO content and cargo with age and resistance training partially restores the values to a younger phenotype. / Thesis / Master of Science in Medical Sciences (MSMS) / Aging is the slow and time-dependent process that our organs, down to the cellular level, deteriorate in function reducing the biological fitness of our bodies. Aging specific to skeletal muscle, or sarcopenia, is especially important because skeletal muscle makes up 40% of our weight, is essential for posture, balance, locomotion and breathing. Sarcopenic individuals have low muscle mass, strength, and function and as a result are associated with low independence in activities of daily living and increased risks of falls and fractures. Exercise, and in particular resistance training, has been shown to be beneficial and cost-effective in treating sarcopenia and delaying aging throughout the body. Part of the underlying mechanism regarding how exercise affects us in a multi-systemic manner is not well understood. We know that skeletal muscle releases a multitude of molecular factors during exercise. Amongst them, extracellular vesicles and specifically exosomes are worth investigating because they have been shown to function in intercellular communication by delivering molecular signals, called microRNAs, from origin cells to recipient cells throughout the body. In this thesis project, we investigate exosomes in circulation of older individuals before and after a 12-week resistance training program. We found that aging alters the exosome pool in circulation as well as their miRNA content. After resistance training, many of miRNAs altered with age, return to levels comparable to young. In addition, we showed that at the skeletal muscle level, aging and resistance training affect exosome biogenesis and miRNA expressions. In conclusion, we provide evidence that aging significantly alters circulatory exosomes and miRNA and show that resistance training normalizes the miRNA profile to levels seen in exosomes derived from young plasma. How exosomes and their molecular signals change with aging and how exercise affects them gives us an insight on how exercise elicits multi-systemic benefits against aging and sarcopenia.

Yes / Background: Skeletal muscles undergo changes with ageing which can cause sarcopenia that can result in frailty. Quantitative MRI may detect the muscle-deficit component of frailty which could help improve the understanding of ageing muscles. Aims: To investigate whether quantitative MRI measures of T2, fat fraction (FF), diffusion tensor imaging and muscle volume can detect differences within the muscles between three age groups, and to assess how these measures compare with frailty index, gait speed and muscle power. Methods: 18 ‘young’ (18–30 years), 18 ‘middle-aged’ (31–68 years) and 18 ‘older’ (> 69 years) healthy participants were recruited. Participants had an MRI of their dominant thigh. Knee extension and flexion power and handgrip strength were measured. Frailty (English Longitudinal Study of Ageing frailty index) and gait speed were measured in the older participants. Results: Young participants had a lower muscle MRI T2, FF and mean diffusivity than middle-aged and older participants; middle-aged participants had lower values than older participants. Young participants had greater muscle flexion and extension power, muscle volume and stronger hand grip than middle-aged and older participants; middle-aged participants had greater values than the older participants. Quantitative MRI measurements correlated with frailty index, gait speed, grip strength and muscle power. Discussion: Quantitative MRI and strength measurements can detect muscle differences due to ageing. Older participants had raised T2, FF and mean diffusivity and lower muscle volume, grip strength and muscle power. Conclusions: Quantitative MRI measurements correlate with frailty and muscle function and could be used for identifying differences across age groups within muscle. / JDB is funded by a National Institute for Health Research (NIHR) (and Health Education England) Clinical Lectureship. This paper presents independent research funded/supported by the National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC). AC and LB are funded as part of the NIHR Collaboration for Leadership in Applied Health Research and Care, Yorkshire and Humber (NIHR CLAHRC YH).

This project had its primary focus on running a campaign to recruit healthy volunteers for a test study involving the utilization of a microwave sensor and ultrasound measurements. The key system used was the Muscle Analyzer System (MAS), which consisted of the Bandstop Filter Sensor (BFS), a microwave sensor transmitting microwaves into the selected medium through transmission and a FieldFox Vector Network Analyzer which was used to transmit these microwaves. The second system utilized in the project was ultrasound imaging, which enabled the measurement of the size of the Rectus Femoris muscle in the thigh and the thickness of the fat and skin layers on the volunteer. This information served as a basis for interpreting the resonant frequency obtained from the MAS system. The goal was to compare these results to assess the muscle quality of the volunteers. A total of nine volunteers participated in the study, with data from four volunteers being suitable for follow- up data analysis and further research. The primary method used to obtain these results involved collecting measurements from the volunteers and comparing them with results from previous measurements conducted on sick patients in Maastricht. The resonant frequency observed for the volunteers in Uppsala was approximately 2.15 GHz, with the fat layer ranging from 5 to 18 mm in thickness, the skin layer measuring 2 mm thick, and the Rectus Femoris muscle having an area of 4 to 8 cm2. When these measurements were compared with the measurements from Maastricht on sick patients, a significant difference was observed. The patients' measurements showed values of approximately 1.98 GHz, even though there wasn't a substantial difference in the muscle and fat layer areas. In order to draw meaningful conclusions however, it would be necessary to conduct measurements using the same Vector Network Analyzer (VNA) for both healthy volunteers and sick patients with sarcopenia.

Introdução: Evidências epidemiológicas mostram que a obesidade sarcopênica (OS) em idosos está associada a um acelerado declínio funcional e alto risco de morbimortalidade, sendo que seu impacto tem se tornado grande preocupação dos profissionais de saúde. Objetivo: Estimar a prevalência e a incidência de obesidade sarcopênica, em coorte de idosos domiciliados no município de São Paulo/Brasil 2000 e 2010. Casuística e Métodos: Foram utilizados dados do Estudo SABE (Saúde, Bem-estar e Envelhecimento), realizado no município de São Paulo em 2000 (2.143 idosos), e em 2010 (795 idosos). A população deste estudo foi constituída por idosos ( 70 anos), de ambos os sexos, que apresentaram todos os dados necessários para este estudo e que concordaram em participar, totalizando 871 idosos analisados em 2000 e 656 idosos em 2010. As variáveis de estudo foram: 1. Dependente - obesidade sarcopênica, identificada segundo: obesidade, diagnosticada pelo valor da circunferência da cintura (CC 94 cm e CC 80 cm para homens e mulheres, respectivamente); sarcopenia, identificada por: 1- força muscular, pelo teste de preensão manual (FPM - kg) (baixa P25; normal > P25, da mesma população), 2- massa muscular (MM), obtida pelo índice de massa muscular (IMM=MM/altura²) (baixa P20; normal > P20, da mesma população) e 3- desempenho físico, identificado pelo teste (tempo dependente segundos) de sentar e levantar 5 vezes de uma cadeira (SeL) , com os braços cruzados sobre o peito (baixo P75; normal < P75); 2. Explanatórias - sexo e grupos etários (70 79 e 80). Foram classificados com OS idosos que apresentaram, simultaneamente, valores de CC adotados e baixo desempenho e baixa MM, ou então, desempenho normal, mas baixas FPM e MM. A prevalência de obesidade sarcopênica em 2000 e em 2010 foi estimada pelo número de casos de OS identificados nos dois momentos, onde foram realizadas comparações entre os intervalos de confiança, para verificar diferença estatística em idosos ( por cento ) com OS, segundo variáveis explanatórias, com nível de significância de 5 por cento . Para o cálculo do coeficiente de incidência de OS, em 2010, foi considerado o tempo de observação de cada indivíduo, determinado de maneira específica para cada caso. Para os cálculos foi utilizado o programa: Stata/SE ® 10.0 for Windows. Resultados: Dos 871 idosos analisados em 2000, 85 (7,4 por cento ) foram identificados com OS [6,5 por cento mulheres (IC 5,08,4) e 4,8 por cento 80 anos (IC 3,6-6,4)] (p 5 por cento ), e, em 2010, (n=656), 73 (9,2 por cento ) foram identificados com OS [7,2 por cento mulheres (IC 5,5-9,4) e 5,3 por cento 80 anos (IC 4,0-7,0)] (p 5 por cento ). Em 10 anos, foram identificados 43 novos casos de OS. O coeficiente de incidência foi 15,29/1000 pessoas/ano entre 2000 e 2010. Conclusões: A prevalência de OS em 2000 e 2010 foi maior nas mulheres e nos idosos mais longevos, sendo que, em ambos os casos, foi maior em 2010, quando comparada a 2000. Não houve diferença significativa entre os coeficientes de incidência, segundo as variáveis explanatórias. / Background: Epidemiological evidence shows that sarcopenic obesity (SO) is associated with accelerated functional decline and high risk of morbidity and mortality, and its impact has become major concern of health professionals. Objective: To estimate the prevalence and incidence of sarcopenic obesity in the elderly cohort domiciled in São Paulo / Brazil - 2000 and 2010. Methods: We used data from the SABE Survey (Health, Well-being and Aging), held in São Paulo in 2000 (2.143) and 2010 (795). The study population consisted of elderly ( 70 years) of both sexes, who had all the necessary data for this study and who agreed to participate, totaling 871 elderly analyzed in 2000 and 656 elderly in 2010. The variables of study were: 1.Dependent sarcopenic obesity, identified according to: obesity, diagnosed by the value of the waist circumference (WC 94 cm and WC 80 cm for men and women, respectively); sarcopenia, identified by: 1-muscle strength, by handgrip test (kg) (low P25; normal > P25, of the same population), 2-muscle mass (MM), obtained by muscle mass index (MMI = MM/height ²) (low P20; normal > P20, of the same population) and 3-physical performance, identified by the test (time-dependent seconds) to sit down and get up 5 times a chair (S&L), with their arms crossed on the chest (low P75; normal < P75); 2. Explanatory: sex and age groups (70-79 and 80).They were classified with SO elderly who presented, simultaneously, WC values adopted and low performance and low MM, or, normal performance but low muscle strength and MM. The prevalence of obesity sarcopênica in 2000 and in 2010 was estimated by the number of the cases identified in two moments, where comparisons were made between confidence intervals, to check statistical difference in the elderly ( per cent ) with the second explanatory variables, with a significance level of 5 per cent . For the calculation of the incidence coefficient, in 2010, it was considered the each individual observation time, determined specifically for each case. For the calculations we used the program: Stata / SE ® 10.0 for Windows. Results: Of the 871 analyzed elderly in 2000, 85 (7.4 per cent ) were diagnosed with SO [6.5 per cent women (CI 5.0-8.4) and 4.8 per cent 80 years (CI 3,6-6.4) ] (p 5 per cent ), and, in 2010 (656), 73 (9.2 per cent ) were identified with SO [7.2 per cent women (CI 5.5- 9.4) and 5.3 per cent 80 years (CI 4.0-7, 0) ] (p 5 per cent ). In 10 years, were identified 43 new cases of SO. Incidence coefficient of SO was 15.29/1000 people/year between 2000 and 2010. Conclusion: The prevalence of SO in 2000 and 2010 was higher in women and the oldest old, and, in both cases, was higher in 2010, compared to 2000. There was no significant difference between the incidence coefficient, according to the explanatory variables.

INTRODUÇÃO: Os efeitos do envelhecimento no sistema respiratório iniciam-se aproximadamente aos 25 anos de idade e leva a diminuição da função máxima deste sistema. Esta diminuição de função é perceptível sobre os volumes e capacidades pulmonar, sobre a força dos músculos respiratórios e do fluxo aéreo, predispondo o idoso a complicações que podem resultar em internações e até em morte. A massa e a força muscular reduzida já é bem estudada nesta população, porém com poucos estudos investigando a relação com a função respiratória. OBJETIVO: Avaliar a relação entre força muscular respiratória e força de preensão palmar em idosos institucionalizados e da comunidade. MÉTODO: Caracteriza-se por um estudo transversal com 64 voluntários, sendo 33 institucionalizado (GI) e 31 da comunidade (GC). Foram avaliados a pressão inspiratória máxima (PImax), pressão expiratória máxima (PEmax), pico de fluxo expiratório (PF), força de preensão palmar dominante (FPP D) e não dominante (FPP ND), dados antropométricos e nível de atividade física (IPAQ curto). Os dados foram submetidos a análise estatística através do teste t student para amostras independentes para comparação entre os grupos, análise de covariância (ANCOVA) controlada pela covariável idade para as variáveis respiratórias e para a força de preensão palmar, teste de Pearson para avaliação da correlação das variáveis e a análise de regressão linear para identificação da influência das variáveis respiratórias sobre a FPP, além da correção de Bonferroni para excluir o erro do tipo I. RESULTADOS: Os valores encontrados nos testes respiratórios e de força entre os grupos, diferiram estatisticamente mesmo controlado pela covariável idade, sendo que o GI apresentou valores inferiores ao GC. No GI não encontramos correlação entre as variáveis respiratórias e as de FPP, porém o preditor respiratório mais fortemente associado à FPP D foi a PEmax (p=0,04). No GC verificou-se correlação entre PImax e FPP D (r=0,539), PEmax e FPP D / ND (r=0,62 / 0,6), PF e FPP D / ND (r=0,64 / 0,43) e o preditor respiratório mais fortemente associado à FPP D foi PF (p=0,009) e PEmax (p=0,028) e para FPP ND foi a PEmax (p=0,021). Na análise conjunta dos grupos verificou-se associação entre PImax e FPP D / ND (r=0,40 / 0,41), PEmax e FPP D / ND (r=0,57 / 0,54), PF e FPP D / ND (r=0,57 / 0,47) e o preditor respiratório mais fortemente associado à FPP D foi PF (p=0,01) e PEmax (p=0,03) e para FPP ND foi a PEmax (p=0,008) e PF (p=0,041). CONCLUSÃO: O GI apresenta maior fraqueza da musculatura respiratória e estas variáveis não se relacionam bem com a FPP. Em idosos da comunidade o PF e a PEmax parecem ser um bom preditor para a FPP / INTRODUCTION: The effects of aging on the respiratory system begin at approximately 25 years of age and lead to a decrease in the maximum function of this system. This diminished function is noticeable on lung volumes and capacities, on respiratory muscle strength and airflow, predisposing the elderly to complications that may result in hospitalization and even death. The mass and reduced muscle strength is already well studied in this population, but with few studies investigating the relation with the respiratory function. OBJECTIVE: To evaluate the relationship between respiratory muscle strength and palmar grip strength in institutionalized and community aged individuals. METHOD: It is characterized by a cross-sectional study with 64 volunteers, being institutionalized 33 (GI) and 31 from the community (GC). The maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), peak expiratory flow (PF), dominant palmar grip strength (FPP D) and non-dominant (FPP ND), anthropometric data and level of physical activity (short IPAQ). The data were submitted to statistical analysis through t Student test for independent samples for comparison between groups, covariance analysis (ANCOVA) controlled by covariate age for respiratory variables and for palmar grip strength, Pearson test for correlation evaluation of the variables and the linear regression analysis to identify the influence of the respiratory variables on the FPP, besides the Bonferroni correction to exclude the type I error. RESULTS: The values found in the respiratory and strength tests between the groups, differed statistically even by the covariable age, and the GI presented values lower than the GC. In GI, we found no correlation between respiratory and FPP variables, but the respiratory predictor most strongly associated with FPP D was the PEmax (p = 0.04). In the CG, correlation was found between PImax and FPP D (r = 0.539), PEmax and FPP D / ND (r = 0.62 / 0.6), PF and FPP D / ND (r = 0.64 / 0, 43) and the respiratory predictor most strongly associated with FPP D was PF (p = 0.009) and PEmax (p = 0.028) and for FPP ND was PEmax (p = 0.021). In the joint analysis of the groups, an association between PImax and FPP D / ND (r = 0.40 / 0,41), PEmax and FPP D / ND (r = 0.57 / 0.54), FP and FPP D (P = 0.01) and PEmax (p = 0.03) and for FPP ND it was the PEmax (p = 0.07) and ND (r = 0.57 / 0.47) and the respiratory predictor most strongly associated with FPP D = 0.008) and PF (p = 0.041). CONCLUSION: GI shows greater respiratory muscle weakness and these variables do not correlate well with PPF. In the elderly in the community, PF and PEmax appear to be a good predictor of PPF

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 / 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