Sarcopenia en
el adulto mayor
hospitalizado
R2 Geriatría Salvador Valdez
Sesión General
Diciembre 2022
Historia
1989
• Dr Irwing 2014 2019
Rosenberg • Asia Working • EWGSOP 2
• Pérdida muscular Group for • Asian Working
asociada al Sarcopenia Group for
envejecimiento (AWGS) Sarcopenia
2010 2016
• European • Diagnóstico en
Working Group CIE-10 (M62.84)
on Sarcopenia in
Older People
(EWGSOP)
Cruz-Jentoft A.; “Nosología en el siglo XXI: Definiendo la sarcopenia”; An RANM. 2021;138(01): 10 - 15
Cesari M, et. Al; “Evidence for the Domains Supporting the Construct of Intrinsic Capacity”; J Gerontol A Biol Sci Med Sci, 2018, Vol. 73, No. 12, 1653–1660
Definición
AWS : Pérdida de masa muscular esquelética relacionada
con la edad, pérdida de fuerza muscular y/o reducción
del rendimiento físico", sin referencia a la comorbilidad.
EWGSOP2: Trastorno muscular esquelético progresivo y
generalizado que se asocia con una mayor probabilidad
de resultados adversos
Cruz-Jentoft A, et. Al.; “Sarcopenia: Revised European Consensus on Definition and Diagnosis”; Age and Ageing; 2019; No. 48; Pag 16-31
Nutricional
Baja Ingesta de proteínas
Deficiencia de micronutrientes
Síndrome de Intestino
Malabsorción y otros problemas intestinales Irritable de 27-61%
Anorexia
Asociados con inactividad
Reposo en cama, inmovilidad,
Baja actividad física, sedentarismo
Causas de la Comorbilidades
Enfermedad Oseas y articulares >20%
Sarcopenia Enfermedades cardiorrespiratorias
Enfermedades metabólicas
Falla cardiaca Estadios avanzados 20-
47%, FEVI Conservada 19% hasta 47% con
miocardiopatía dilatada
Enfermedades endocrinas
Estudio con adultos mexicanos
Enfermedades neurológicas
• Edad promedio de 69.92 años Cancer Sólidos 11-74%
• Prevalencia de pre-sarcopenia de 8.7%
Hepatopatías y nefropatías No dializados 9.8-28.7%
• Sarcopenia 13.3%, siendo mayor en Dializados 33.1%
mujeres. Iatrogénico
Admisión hospitalaria
Fármacos
Cruz-Jentoft A.; Sayer A.; “Sarcopenia”; Lancet; 2019; Vol 393; Pag 2636-46
Borba V.; et. Al.; “Sarcopenia in endocrine and non-endocrine disorders”; Europena Journal of Endocrinology; 2018; 180, R185-199
Arango VE.; et. Al.; “Prevalence of sarcopenia in México City”; European Geriatric Medicine; 2012; 157-160
Primaria o relacionada Sin causa evidente
con la edad
Condición Secundaria Otros factores causales
además del envejecimiento
Aguda <6 meses
Clasificació
n Tiempo Crónica >6 meses
Tipo Obesidad sarcopenia
Osteosarcopenia
Cruz-Jentoft A, et. Al.; “Sarcopenia: Revised European Consensus on Definition and Diagnosis”; Age and Ageing; 2019; No.
48; Pag 16-31
Cruz-Jentoft A, et. Al.; “Sarcopenia: Revised European Consensus on Definition and Diagnosis”; Age and Ageing; 2019; No. 48; Pag 16-31
Zamboni M., Rubele S., Rossi A.; “Sarcopenia and Obesity”; Curr Opin Clin Nutr Metab Care 2019, 22:13 – 19
Definición Operativa de Sarcopenia de la EWGSOP2
Sarcopenia probable: Criterio 1
Diagnóstico confirmatorio: Criterio 2
Sarcopenia grave: todos los Criterios 1, 2 y 3
(1)Baja fuerza muscular
(2)Baja cantidad o calidad muscular
(3)Bajo rendimiento físico
Chen, L, et. Al.; “Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment”; JAMDA; March 2020; Volume 21, Issue 3, P300-307.E2
Cruz-Jentoft A, et. Al.; “Sarcopenia: Revised European Consensus on Definition and Diagnosis”; Age and Ageing; 2019; No. 48; Pag 16-31
Chen, L, et. Al.; “Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment”; JAMDA; March 2020; Volume 21, Issue 3, P300-307.E2
Cruz-Jentoft A, et. Al.; “Sarcopenia: Revised European Consensus on Definition and Diagnosis”; Age and Ageing; 2019; No. 48; Pag 16-31
Diagnóstico
• Medición de la fuerza muscular
• Medición de la masa muscular
• Medición del rendimiento físico
Cruz-Jentoft A, et. Al.; “Sarcopenia: Revised European Consensus on Definition and Diagnosis”; Age and Ageing; 2019; No. 48; Pag 16-31
Cruz-Jentoft A.; Sayer A.; “Sarcopenia”; Lancet; 2019; Vol 393; Pag 2636-46
RMN y TAC
• Gold standard
Diagnóstico Absorciometría de rayos X de energía dual (DXA)
por imagen
Análisis de impedancia bioeléctrica
Ultrasonido
Borba V.; et. Al.; “Sarcopenia in endocrine and non-endocrine disorders”; Europena Journal of Endocrinology; 2018; 180, R185-199
Shrestha A; et. Al.; “Acute Sarcopenia after Elective and
Emergency Surgery”; Aging nd Disease; 2022; Vol 14; No 6;
Pag 1759-1769
Shi Y., et. Al; “Sarcopenia and perioperative
management of elderly surgical patients”; Front.
Biosci. (Landmark Ed) 2021, 26(10), 882–894
Shi Y., et. Al; “Sarcopenia and perioperative
management of elderly surgical patients”; Front.
Biosci. (Landmark Ed) 2021, 26(10), 882–894
• Kouw IWK, Groen BBL, Smeets JSJ, Kramer IF, van Kranenburg JMX, et al. (2019). One Week of Hospitalization Following Elective Hip Surgery Induces
Substantial Muscle Atrophy in Older Patients. J Am Med Dir Assoc, 1: 35-42
• Mak D, Chisholm C, Davies AM, Botchu R, James SL. (2020). Psoas muscle atrophy following unilateral hip arthroplasty. Skeletal Radiol, 10: 1539-1545.
• Miller RR, Eastlack M, Hicks GE, Alley DE, Shardell MD, et al. (2014). Asymmetry in CT Scan Measures of Thigh Muscle 2 Months after Hip Fracture: The
Baltimore Hip Studies. Journals Gerontol - Ser A Biol Sci Med Sci, 10: 1276-1280.
• Mikkola T, Sipilä S, Portegijs E, Kallinen M, Alén M, et al. (2007). Impaired geometric properties of tibia in older women with hip fracture history.
Osteoporos Int, 8: 1083-1090.
• Shachar SS, Williams GR, Muss HB, Nishijima TF. (2016). Prognostic value of sarcopenia in adults with solid tumours: A meta-analysis and systematic
review. Eur J Cancer, 58-67
• Burden ST, Gibson DJ, Lal S, Hill J, Pilling M, et al. (2017). Pre-operative oral nutritional supplementation with dietary advice versus dietary advice alone
in weight-losing patients with colorectal cancer: singleblind randomized controlled trial. J Cachexia Sarcopenia Muscle, 3: 437-446.
• Becker C, Lord SR, Studenski SA, Warden SJ, Fielding RA, et al. (2015). Myostatin antibody (LY2495655) in older weak fallers: A proof-ofconcept,
randomised, phase 2 trial. Lancet Diabetes Endocrinol, 12: 948-957
• Fukuda Y, Yamamoto K, Hirao M, Nishikawa K, Nagatsuma Y, Nakayama T, et al. Sarcopenia is associated with severe postoperative complications in
elderly gastric cancer patients undergoing gastrectomy. Gastric Cancer: Official Journal of the International Gastric Cancer Association and the Japanese
Gastric Cancer Association. 2016; 19: 986–993.
• Simonsen C, de Heer P, Bjerre ED, Suetta C, Hojman P, Pedersen BK, et al. Sarcopenia and Postoperative Complication Risk in Gastrointestinal Surgical
Oncology. Annals of Surgery. 2018; 268: 58–69
• Carey EJ, Lai JC, Sonnenday C, Tapper EB, Tandon P, DuarteRojo A, et al. A North American Expert Opinion Statement on Sarcopenia in Liver
Transplantation. Hepatology. 2019; 70: 1816–1829.
Sarcopenia: Masa muscular reducida +
Diagnóstico
Función muscular alterada
diferencial
Masa muscular reducida +
Fuerza muscular normal
Desnutrició
Catabolismo e inflamación,
n cambios neuroendocrinos
diferentes a la sarcopenia
Fragilidad Caquexia
Cruz-Jentoft A.; Sayer A.; “Sarcopenia”; Lancet; 2019; Vol 393; Pag
2636-46
Tratamiento Sanos. 1-1.2 g/kg/día
Crónicos. 1.2-1.5 g/kg/día
1000-4000 UI
5 g/día
American College of Sports
Medicine (ACSM) FITT-VP
• Frecuencia
• Intensidad
• Tiempo
• Tipo de Ejercicio Bimagrumab
• Volumen
• Progreso
Chen, L, et. Al.; “Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and
Treatment”; JAMDA; March 2020; Volume 21, Issue 3, P300-307.E2
Cruz-Jentoft A, et. Al.; “Sarcopenia: Revised European Consensus on Definition and Diagnosis”; Age and Ageing; 2019;
No. 48; Pag 16-31
Borba V.; et. Al.; “Sarcopenia in endocrine and non-endocrine disorders”; Europena Journal of Endocrinology; 2018;
180, R185-199
Impacto del entrenamiento y nutrición
Papadopoulou S.; “Sarcopenia: A Contemporary Health Problem among Older Adult Populations”; Nutrients; 2020, 12, 1293
Conclusiones
La sarcopenia se ha asociado durante mucho tiempo con el
envejecimiento y las personas mayores, pero ahora se reconoce que el
desarrollo de la sarcopenia comienza antes en la vida
La sarcopenia ahora se considera una enfermedad muscular
(insuficiencia muscular)
Se ha pasado por alto y se ha tratado de forma insuficiente en la práctica
habitual, aparentemente debido a la complejidad de determinar qué
variables medir, cómo medirlas, qué puntos de corte guían mejor el
diagnóstico y el tratamiento, y cómo evaluar mejor los efectos de las
intervenciones terapéuticas
Bibliografía
• Cruz-Jentoft A.; “Nosología en el siglo XXI: Definiendo la sarcopenia”; An RANM. 2021;138(01): 10 - 15
• Chen, L, et. Al.; “Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment”; JAMDA; March 2020;
Volume 21, Issue 3, P300-307.E2
• Cruz-Jentoft A, et. Al.; “Sarcopenia: Revised European Consensus on Definition and Diagnosis”; Age and Ageing; 2019; No. 48; Pag 16-31
• Shrestha A; et. Al.; “Acute Sarcopenia after Elective and Emergency Surgery”; Aging nd Disease; 2022; Vol 14; No 6; Pag 1759-1769
• Zamboni M., Rubele S., Rossi A.; “Sarcopenia and Obesity”; Curr Opin Clin Nutr Metab Care 2019, 22:13 – 19
• Cruz-Jentoft A.; Sayer A.; “Sarcopenia”; Lancet; 2019; Vol 393; Pag 2636-46
• Cesari M, et. Al; “Evidence for the Domains Supporting the Construct of Intrinsic Capacity”; J Gerontol A Biol Sci Med Sci, 2018, Vol. 73, No. 12,
1653–1660
• Borba V.; et. Al.; “Sarcopenia in endocrine and non-endocrine disorders”; Europena Journal of Endocrinology; 2018; 180, R185-199
• Arango VE.; et. Al.; “Prevalence of sarcopenia in Mexico City”; European Geriatric Medicine; 2012; 157-160
• Papadopoulou S.; “Sarcopenia: A Contemporary Health Problem among Older Adult Populations”; Nutrients; 2020, 12, 1293
• Shi Y., et. Al; “Sarcopenia and perioperative management of elderly surgical patients”; Front. Biosci. (Landmark Ed) 2021, 26(10), 882–894
