La sarcopenia: dall'epidemiologia all'impatto clinico - SIGG Società Italiana di Gerontologia e ...
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Roma, 27-29 novembre 2019
SIMPOSIO
MIGLIORARE LA PROGNOSI DEI PAZIENTI CON SARCOPENIA:
NUOVE EVIDENZE SCIENTIFICHE SULL’IMPORTANZA DELLA
NUTRIZIONE
La sarcopenia:
dall’epidemiologia all’impatto clinico
Prof. P. Abete
Dipartimento di Scienze Mediche Traslazionali
Università di Napoli Federico II
no-SARCOPENIA SARCOPENIA Hand-Grip = 23.7 kg Hand-Grip = 3.75 kg
The first phenotypic description of the
"sarcopenia" phenomenon
….the sixth ages shifts into the lean ans slipper pantaloon…
As you like it, act II, scene VII
William Shakespeare
1564-1616
La sarcopenia:
dall’epidemiologia
all’impatto clinico
Roma, 27-29 novembre 2019
What is “sarcopenia”
Anthropometric modifications
Definitions
Epidemiology
Risk factors
Physical frailty
Prevalence/incidence
Clinical consequences
Disability, hospitalization and mortality
Functional recovery
Relazione tra età e modificazione della composizione
muscolare
Lexell J. JGMS 1995
Relazione tra età, area muscolare della
gamba e forza muscolare (InCHIANTI)
Age, years Age, years
Lauretani F. et al. J Appl Physiol, 2003
Skeletal muscle attenuation determined by computed
tomography is associated to skeletal muscle lipid content
SARCOPENIC OBESITY
Goodpaster B et al, J Apll Physiol; 2000
La sarcopenia:
dall’epidemiologia
all’impatto clinico
Roma, 27-29 novembre 2019
What is “sarcopenia”
Anthropometric modifications
Definitions
Epidemiology
Risk factors
Physical frailty
Prevalence/incidence
Clinical consequences
Disability, hospitalization and mortality
Functional recovery
SARCOPENIA
age-related reduction of strength and
mass muscle associated with adverse
events
DYNAPENIA CACHEXIA
age-related muscle strength Multifactorial syndrome
loss characterized by loss of body
weight, lean mass and muscle2018 operational definition of sarcopenia
Sarcopenia: revised European consensus on definition and diagnosis,
Age & Ageing 2018Muscle strenght at dynamometer
men < 27 kg
The total score range is from 0 to 10, with
scores of ≥4Women < 16 kg
points indicative of the risk of
sarcopenia
Start
intervention!
Sarcopenia: revised European consensus on definition and diagnosis,
Age & Ageing 2018Sarcopenia: revised European consensus on definition and diagnosis,
Age & Ageing 2018La sarcopenia:
dall’epidemiologia
all’impatto clinico
Roma, 27-29 novembre 2019
What is “sarcopenia”
Anthropometric modifications
Definitions
Epidemiology
Risk factors
Physical frailty
Prevalence/incidence
Clinical consequences
Disability, hospitalization and mortality
Functional recoverySarcopenia “pathogenesis”
Age-related changes Age-related changes
in neuro-muscular to the systemic
function environment
↓ PROTEIN-SYNTHESIS
↑ APOPTOSIS SARCOPENIA ↓ AUTOPHAGY
↑ PROTEIN-LYSIS
Behavior- Alterations in Disease-
mediated muscle protein mediated
pathways turnover pathwaysMalnutrition and sarcopenia
MALNUTRITION
SARCOPENIA
Cederholm T et al. Curr Pharmaceut design 2014Malnutrition, Mini Nutritional Assessment (MNA) and
SARCOPENIA in non-institutionalized elderly patients
*p < 0.05 forPhysical inactivity and sarcopenia
DISABILITY
SARCOPENIA
Cederholm T et al. Curr Pharmaceut design 2014SARCOPENIA and hospital length stay
“Studio Glisten”
Martone AM, et al. J Cachexia Sarcopenia Muscle. 2017Physical Activity Score in the Elderly (PASE) and
SARCOPENIA in non-institutionalized elderly patients
Abete P et al., J Geriatric Physical Therapy 2017La sarcopenia:
dall’epidemiologia
all’impatto clinico
Roma, 27-29 novembre 2019
What is “sarcopenia”
Anthropometric modifications
Definitions
Epidemiology
Risk factors
Physical frailty
Prevalence/incidence
Clinical consequences
Disability, hospitalization and mortality
Functional recoveryPhysical Nutritional
Multidimensional
FRAILTY
Mental Social
ADVERSE OUTCOMES
disability, health care utilization,
deathFrailty according to
“multidimensional hypothesis”
SARCOPENIA
Cruz-Jentoft AJ et al., Aging Clin Exp Res 2017Abete P et al., Aging Exp Clin Res 2017
Mortality predictors
Italian Frailty index (IFi)
n. ITEMS RR CI 95% p
1 Affaticarsi per qualsiasi cosa 4.83 1.33-17.5 0.02
2 Aiuto nel salire o scendere le scale 4.12 1.21-14.0 0.02
3 Cancro 2.93 1.61-5.35 0.00
4 Aiuto nel sedersi o alzarsi dalla sedia 2.82 1.20-6.62 0.02
5 Forza muscolare 2.56 1.13-5.82 0.02
6 A letto 1/2 giornata per motivi di salute 2.38 1.29-4.41 0.01
7 Supporto sociale 2.30 1.00-5.31 0.05
8 Perdita di più di 4.5 kg di peso nell’ultimo anno 2.28 1.31-3.94 0.00
9 Insufficienza cardiaca 2.25 1.17-4.33 0.02
10 Aiuto nel mangiare 2.02 1.00-4.08 0.05
11 Test del cammino 2.00 1.06-3.80 0.03
13 Ti senti depresso 1.17 1.05-2.24 0.04
14 MMSE (Mini Mental State Examination) 1.02 1.01-1.99 0.02
Abete P et al., Aging Exp Clin Res 2017Linear relationship between grip strenght
and multidimensional frailty
Grip strenght (kg)
Italian Frailty Index
Abete P et al., 2019 ongoingLa sarcopenia:
dall’epidemiologia
all’impatto clinico
Roma, 27-29 novembre 2019
What is “sarcopenia”
Anthropometric modifications
Definitions
Epidemiology
Risk factors
Physical frailty
Prevalence/incidence
Clinical consequences
Disability, hospitalization and mortality
Functional recoverySkeletal muscle mass accordig to age and sex
NHANES III
Normali
SARCOPENIA
Classe I
Classe II
≈40% SMI = skeletal muscle mass/body
mass*100.
Normal SMI = > 1-SD above the sex-
specific mean for young adults (aged
18–39).
Class I = SMI was within 1 to 2-SD of
young adult values;
≈60%
Class II = SMI was below 2-SD
standard deviations of young adult
values.
Janssen I et al., JAGS 2002Appendicular Skeletal muscle Mass (ASM) Definition ratio men women EWGSOP2 ASM/height2
Prevalence of sarcopenia
in “COMMUNITY DWELLING” elderly subjects
The International Sarcopenia Initiative
Male from 2.6% to 27.1%
Female from 5.2% to 30.1%
Cruz-Jentoft A J et al. Age Ageing 2014Prevalence of sarcopenia
in “COMMUNITY DWELLING” elderly subjects
studio InCHIANTI
Men Women
100% 100%
90% 90%
80% 80%
70% 70%
60% 60%
50% ≈10% 50% ≈30%
40% 40%
30% 30%
20% 20%
10% 10%
0% 0%Prevalence of sarcopenia
in “NURSING HOME” elderly subjects
The International Sarcopenia Initiative
Male = 67.7%
Female = 20.8%
Cruz-Jentoft A J et al. Age Ageing 2014Sarcopenia in hospitalized elderly subjects
GLISTEN study
Multicentre Italian Study
conducted in 12 Acute
Care Wards of University
Hospitals across Italy.
Prevalence = 34.7%
(95% CI 28-37)
Among those without sarcopenia at hospital
admission, 14.7% of the study sample met
the EWGSOP sarcopenia diagnostic criteria
at discharge!
Martone AM, et al. J Cachexia Sarcopenia Muscle. 2017La sarcopenia:
dall’epidemiologia
all’impatto clinico
Roma, 27-29 novembre 2019
What is “sarcopenia”
Anthropometric modifications
Definitions
Epidemiology
Risk factors
Physical frailty
Prevalence/incidence
Clinical consequences
Disability, hospitalization and mortality
Functional recoverySARCOPENIA and DISABILITY
in “COMMUNITY DWELLING” elderly subjects
meta-analysis
DISABILITY ≈ 3 times
Beudart C et al. PloSONE 2017SARCOPENIA and MORTALITY
in “COMMUNITY DWELLING” elderly subjects
meta-analysis
MORTALITY ≈ 1.5 times
Liù P. et al. Maturitas 2017SARCOPENIA and 3-YEAR HOSPITAL RE-ADMISSIONS
in “HOSPITALIZED” elderly subjects
RE-ADMISSIONS ≈ 1.8 times
Yang M., et al. J Cachexia Sarcopenia Muscle. 2017SARCOPENIA and 3-YEAR SURVIVAL
in “HOSPITALIZED” elderly subjects
GLISTEN study
EWGSOP2 FNIH
European Working Group Foundation for the National
on Sarcopenia Institutes of Health
in Older People 2
HR*=1.87 (95% CI 1.32-2.59) HR*=1.54 (95% CI 1.11-2.15)
*adjusted for age and gender Bianchi L et al., J Gerontol A Biol Sci Med Sci, 2019La sarcopenia:
dall’epidemiologia
all’impatto clinico
Roma, 27-29 novembre 2019
What is “sarcopenia”
Anthropometric modifications
Definitions
Epidemiology
Risk factors
Physical frailty
Prevalence/incidence
Clinical consequences
Disability, hospitalization and mortality
Functional recoveryPrognostic role of SARCOPENIA in patients underwent
transcatheter aortic valve implantation (TAVI)
Mok M. et al. Am J Cardiology 2016SARCOPENIA is associated with post-operative
infections and delayed functional recovery in elderly
patients undergoing colon cancer resection
Infections 4.4 times
Delay in functional
recovery 2.6 times
Lieffers JR British Journal of Cancer 2012TAKE HOME MESSAGE • Sarcopenia is defined as an age-related reduction of mass and muscle strength. • The pathogenesis is multifactorial but nutrition and exercise play a key role. • Sarcopenia is the main feature of physical frailty. • The different prevalence and incidence of sarcopenia depends on definition adopted (i.e . EWGSOP2 or FNIH). • Sarcopenia is associated with short and long term negative clinical events in all care settings. • Sarcopenia influences the functional recovery of frequent therapeutic procedure in advancing age (i.e TAVI and colon cancer resection).
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