Aperfeiçoamento do Diagnóstico e Tratamento da Sarcopénia Através da Formação de Médicos em Portugal
DOI:
https://doi.org/10.24950/rspmi.2708Palavras-chave:
Avaliação Geriátrica, Idoso, Inquéritos sobre Cuidados de Saúde, SarcopeniaResumo
Introdução: Apesar da sarcopenia ter sido formalmente reconhecida na Classificação Internacional de Doenças da Organização Mundial da Saúde, continua a ser subdiagnosticada e subtratada na prática clínica. Este estudo teve como objetivo avaliar o conhecimento atual e a gestão da sarcopenia numa coorte de médicos portugueses e a eficácia de uma sessão de formação sobre o diagnóstico e tratamento da sarcopenia.
Métodos: Este estudo longitudinal incluiu médicos portugueses (n = 31) que preencheram um questionário sobre conhecimentos, práticas e barreiras relativamente ao rastreio, diagnóstico e tratamento da sarcopenia antes, imediatamente após (n = 29) e três meses após (n = 27) terem participado num workshop interativo sobre sarcopenia.
Resultados: Antes, imediatamente após e três meses depois do workshop, respetivamente, 66,7%, 96,6% e 81,5% dos médicos conheciam a definição de sarcopenia. Antes do workshop, 33,3% e 44,4% referiram efetuar, respetivamente, o rastreio e o diagnóstico na sua prática clínica; três meses após o workshop, este número aumentou para 70,4%. A utilização do SARC-F como instrumento de rastreio aumentou (22,2% antes vs 78,9% após três meses). No entanto, a utilização reportada de ferramentas de diagnóstico para avaliar a força muscular (ou seja, força de preensão palmar [21,1%] e o teste de elevação da cadeira [31,6%]) foi reduzida 3 meses após o workshop. A intervenção nutricional centrada na ingesta proteíca (87,0%) e o exercício de resistência (60,9%) foram as principais estratégias de tratamento registadas aos três meses. Respetivamente, 68,4% e 82,6% referiram barreiras no rastreio/diagnóstico e tratamento da sarcopenia; a falta de sensibilização ou conhecimento por parte de outros profissionais de saúde (84,6%) e a falta de reembolso do custo dos suplementos nutricionais orais (89,5%) foram as principais barreiras identificadas.
Conclusão: Após a formação, os conhecimentos sobre os princípios básicos da gestão clínica da sarcopenia melhoraram. No entanto, após três meses, os médicos reconhecem importantes constrangimentos no diagnóstico e tratamento da sarcopenia na prática clínica diária. Embora o workshop tenha aumentado efetivamente a sensibilização para a sarcopenia, a retenção de conhecimentos ao longo do tempo continua a ser um desafio.
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Referências
1. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: Revised European consensus on definition and diagnosis. Age Ageing. 2019;48:16–31.
2. ICD-10-CM Diagnosis Code M62.84 - Sarcopenia [Internet]. [cited 2023 Sep 6]. Available from: http://www.icd10data.com/ICD10CM/Codes/M00-M99/M60-M63/M62-/M62.84
3. Dent E, Morley JE, Cruz-Jentoft AJ, Arai H, Kritchevsky SB, Guralnik J, et al. International Clinical Practice Guidelines for Sarcopenia (ICFSR): Screening, Diagnosis and Management. J Nutr Health Aging. 2018;22:1148–61.
4. Cao L, Morley JE. Sarcopenia Is Recognized as an Independent Condition by an International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) Code. J Am Med Dir Assoc. 2016;17:675–7.5. Dardevet D, Rémond D, Peyron MA, Papet I, Savary-Auzeloux I, Mosoni L. Muscle wasting and resistance of muscle anabolism: The “anabolic threshold concept” for adapted nutritional strategies during sarcopenia. ScientificWorldJournal. 2012;2012:269531.
6. Dao T, Green AE, Kim YA, Bae SJ, Ha KT, Gariani K, et al. Sarcopenia and muscle aging: A brief overview. Endocrinol Metab. 2020;35:716–32.
7. dos Santos L, Cyrino ES, Antunes M, Santos DA, Sardinha LB. Sarcopenia and physical independence in older adults: the independent and synergic role of muscle mass and muscle function. J Cachexia Sarcopenia Muscle. 2017;8245–50.
8. Chen X, Cao M, Liu M, Liu S, Zhao Z, Chen H. Association between sarcopenia and cognitive impairment in the older people: a meta-analysis. Eur Geriatr Med. 2022;13:771–87.
9. Beaudart C, Demonceau C, Reginster JY, Locquet M, Cesari M, Cruz Jentoft AJ, et al. Sarcopenia and health-related quality of life: A systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. 2023;14:1228–43.
10. Cawthon PM, Lui LY, Taylor BC, McCulloch CE, Cauley JA, Lapidus J, et al. Clinical Definitions of Sarcopenia and Risk of Hospitalization in Community-Dwelling Older Men: The Osteoporotic Fractures in Men Study. J Gerontol A Biol Sci Med Sci. 2017;72:1383–9.
11. Westbury LD, Beaudart C, Bruyère O, Cauley JA, Cawthon P, Cruz-Jentoft AJ, et al. Recent sarcopenia definitions—prevalence, agreement and mortality associations among men: Findings from population-based cohorts. J Cachexia Sarcopenia Muscle. 2023;14:565–75.
12. Bauer J, Morley JE, Schols AMWJ, Ferrucci L, Cruz-Jentoft AJ, Dent E, et al. Sarcopenia: A Time for Action. An SCWD Position Paper. J Cachexia Sarcopenia Muscle. 2019;10:956–61.
13. Sousa-Santos AR, Afonso C, Afonso C, Borges N, Borges N, Santos A, et al. Sarcopenia, physical frailty, undernutrition and obesity cooccurrence among Portuguese community-dwelling older adults: Results from Nutrition up 65 cross-sectional study. BMJ Open. 2020;10:e033661.
14. Sousa AS, Guerra RS, Fonseca I, Pichel F, Amaral TF. Sarcopenia among hospitalized patients - A cross-sectional study. Clin Nutr. 2015;34:1239–44.
15. Bertschi D, Kiss CM, Beerli N, Kressig RW. Sarcopenia in hospitalized geriatric patients: insights into prevalence and associated parameters using new EWGSOP2 guidelines. Eur J Clin Nutr. 2021;75:653–60.
16. Roller-Wirnsberger R, Masud T, Vassallo M, Zöbl M, Reiter R, Van Den Noortgate N, et al. European postgraduate curriculum in geriatric medicine developed using an international modified Delphi technique. Age Ageing. 2019;48:291–9.
17. Bauer J, Biolo G, Cederholm T, Cesari M, Cruz-Jentoft AJ, Morley JE, et al. Evidence-based recommendations for optimal dietary protein intake in older people: A position paper from the PROT-AGE study group. J Am Med Dir Assoc. 2013;14:542–59.
18. Volkert D, Beck AM, Cederholm T, Cruz-Jentoft A, Hooper L, Kiesswetter E, et al. ESPEN practical guideline: Clinical nutrition and hydration in geriatrics. Clin Nutr. 2022;41:958–89.
19. Yeung SSY, Reijnierse EM, Trappenburg MC, Meskers CGM, Maier AB. Current knowledge and practice of Australian and New Zealand health-care professionals in sarcopenia diagnosis and treatment: Time to move forward! Australas J Ageing. 2020;39:e185–93.
20. Reijnierse EM, De Van Der Schueren MAE, Trappenburg MC, Doves M, Meskers CGM, Maier AB. Lack of knowledge and availability of diagnostic equipment could hinder the diagnosis of sarcopenia and its management. PLoS One. 2017;12:e0185837.
21. Meza-Valderrama D, Marco E, Dávalos-Yerovi V, Muns MD, Tejero-Sánchez M, Duarte E, et al. Sarcopenia, malnutrition, and cachexia: Adapting definitions and terminology of nutritional disorders in older people with cancer.
Nutrients. 2021;13:761.
22. Gingrich A, Volkert D, Kiesswetter E, Thomanek M, Bach S, Sieber CC, et al. Prevalence and overlap of sarcopenia, frailty, cachexia and malnutrition in older medical inpatients. BMC Geriatr. 2019;19:120.
23. Yoshimura Y, Wakabayashi H, Yamada M, Kim H, Harada A, Arai H. Interventions for Treating Sarcopenia: A Systematic Review and Meta-Analysis of Randomized Controlled Studies. J Am Med Dir Assoc. 2017;18:553.e1-553.e16.
24. Lu L, Mao L, Feng Y, Ainsworth BE, Liu Y, Chen N. Effects of different exercise training modes on muscle strength and physical performance in older people with sarcopenia: a systematic review and meta-analysis. BMC Geriatr. 2021;21:708.
25. Yoo SZ, No MH, Heo JW, Park DH, Kang JH, Kim SH, et al. Role of exercise in age-related sarcopenia. J Exerc Rehabil. 2018;14:551–8.
26. Hengeveld LM, Boer JMA, Gaudreau P, Heymans MW, Jagger C, Mendonça N, et al. Prevalence of protein intake below recommended in community-dwelling older adults: a meta-analysis across cohorts from the PROMISS consortium. J Cachexia Sarcopenia Muscle. 2020;11:1212–22.
27. Visser M, Hung Y, Verbeke W. Protein knowledge of older adults and identification of subgroups with poor knowledge. Nutrients. 2021;13:1006.
28. Lee SY, Lee HJ, Lim JY. Effects of leucine-rich protein supplements in older adults with sarcopenia: A systematic review and meta-analysis of randomized controlled trials. Arch Gerontol Geriatr. 2022;102:104758.
29. Uchitomi R, Oyabu M, Kamei Y. Vitamin d and sarcopenia: Potential of vitamin D supplementation in sarcopenia prevention and treatment. Nutrients. 2020;12:3189.
30. Bollen SE, Bass JJ, Fujita S, Wilkinson D, Hewison M, Atherton PJ. The Vitamin D/Vitamin D receptor (VDR) axis in muscle atrophy and sarcopenia. Cell Signal. 2022;96:110355.
31. Duarte C, Carvalheiro H, Rodrigues AM, Dias SS, Marques A, Santiago T, et al. Prevalence of vitamin D deficiency and its predictors in the Portuguese population: a nationwide population-based study. Arch Osteoporos. 2020;15:36.
32. Wicherts IS, Van Schoor NM, Boeke AJP, Visser M, Deeg DJH, Smit J, et al. Vitamin D status predicts physical performance and its decline in older persons. J Clin Endocrinol Metab. 2007;92:2058–65.
33. Pachołek K, Sobieszczanska M. Sarcopenia identification during comprehensive geriatric assessment. Int J Environ Res Public Health. 2022;19:32.
34. Ellis G, Sevdalis N. Understanding and improving multidisciplinary team working in geriatric medicine. Age Ageing. 2019;48:498–505.
35. Kokura Y, Wakabayashi H, Maeda K, Nishioka S, Nakahara S. Impact of a multidisciplinary rehabilitation nutrition team on evaluating sarcopenia, cachexia and practice of rehabilitation nutrition. J Med Invest. 2017;64:140–5.
36. Soulis G, Kotovskaya Y, Bahat G, Duque S, Gouiaa R, Ekdahl AW, et al. Geriatric care in European countries where geriatric medicine is still emerging. Eur Geriatr Med. 2021;12:205–11.
37. Cawood AL, Elia M, Stratton RJ. Systematic review and meta-analysis of the effects of high protein oral nutritional supplements. Ageing Res Rev. 2012;11:278–96.
38. Neelemaat F, Bosmans JE, Thijs A, Seidell JC, van Bokhorst-de van der Schueren MAE. Oral nutritional support in malnourished elderly decreases functional limitations with no extra costs. Clin Nutr. 2012;31:183–90.
39. Kim CO, Lee KR. Preventive effect of protein-energy supplementation on the functional decline of frail older adults with low socioeconomic status: A community-based randomized controlled study. J Gerontol A Biol Sci Med Sci. 2013;68:309–16.
40. Schuetz P, Sulo S, Walzer S, Vollmer L, Brunton C, Kaegi-Braun N, et al. Cost savings associated with nutritional support in medical inpatients: An economic model based on data from a systematic review of randomised trials. BMJ Open. 2021;11:e046402.
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Direitos de Autor (c) 2025 Medicina Interna
Este trabalho encontra-se publicado com a Licença Internacional Creative Commons Atribuição 4.0.
Direitos de Autor (c) 2023 Medicina Interna
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