Fatores preditivos de sarcopenia em pessoas idosas e em indivíduos com câncer de cabeça e pescoço

Abstract

This thesis presents the development of research aimed at identifying predictive factors of sarcopenia in elderly individuals and patients with head and neck squamous cell carcinoma (HNSCC), based on demographic variables, whole-body and appendicular anthropometric measurements, nutritional and sarcopenia risk, and participants’ physical performance. In the elderly group, in addition to these independent variables, oral health status was also evaluated. In the HNSCC patient group, clinical tumor characteristics, functional capacity, and serum levels of C-reactive protein (CRP) and albumin were also assessed. In the first group, elderly individuals (n = 511, male/female ratio of 1:1.62) were diagnosed with probable sarcopenia in the exclusive presence of low skeletal muscle strength (SMS). The diagnosis of sarcopenia was established with the occurrence of low SMS and low skeletal muscle mass (SMM). In the occurrence of low physical performance, the diagnosis was severe sarcopenia. Weight loss and comorbidity diagnosis were also measured. The risks of malnutrition and sarcopenia were investigated through questionnaires. The number of decayed, missing, and restored teeth, diagnosis of edentulism, dental occlusion condition, and use of dental prosthesis were evaluated. The risk of oropharyngeal dysphagia was investigated. In the sample of elderly individuals, multinomial logistic regression analysis demonstrated that probable sarcopenia was significantly predicted by greater height (OR = 1.06, 95% CI = 1.03-1.08), smaller arm muscle area (OR = 1.74, 95% CI = 1.04-2.89), and diagnosis of edentulism (OR = 2.03, 95% CI = 1.32-3.14). In turn, the diagnosis of sarcopenia was predicted by arm muscle circumference (OR = 0.69, 95% CI = 0.58-0.81), higher risks of malnutrition (OR = 3.24, 95% CI = 1.25-8.40) and sarcopenia (OR = 7.98, 95% CI = 3.04-20.99), and reduced number of occlusal contacts (OR = 0.92, 95% CI = 0.86-0.99). Advanced age predicted diagnoses of probable sarcopenia (OR = 1.05, 95% CI = 1.02-1.08) and sarcopenia (OR = 1.05, 95% CI = 1.01-1.11). In the group of individuals with HNSCC (n = 125, male/female ratio: 3.8:1), the diagnosis of sarcopenia was defined according to findings of low SMS and low physical performance. The association between sarcopenia and the independent variables was analyzed using binary logistic regression models. The diagnosis of sarcopenia was identified in 28 (22.4%) individuals with HNSCC. Being older increased the chances of predicting sarcopenia (OR = 1.05, 95% CI = 1.01–1.10). Increases in arm circumference measurement reduced the chances of association with sarcopenia (OR = 0.69, 95% CI = 0.55–0.86), while increases in arm fat area measurement increased the chance of predicting sarcopenia (OR = 1.33, 95% CI = 1.01–1.27). Low ECOG-PS scores increased the prediction of sarcopenia (OR = 5.54, 95% CI = 1.85–16.54). We can conclude that appendicular anthropometric measurements and oral health examination can contribute to the screening of high-risk elderly individuals for sarcopenia in outpatient care. Thus, the early identification of sarcopenia predictors through easy-to-perform and cost-effective tests tends to favor the implementation of personalized therapeutic and support interventions for elderly individuals and those with HNSCC.