Associação de marcadores musculares, endócrinos e imunológicos com a fragilidade em idosos

Abstract

The frailty syndrome has been conceptualized as a decline in spiral energy, which is based on a tripod of changes related to aging, namely sarcopenia, neuroendocrine dysregulation and immune dysfunction. The objective of this thesis was to associate muscular, endocrine and immunological markers with the frailty criteria in older people assisted by primary care in a municipality in the southern region of Brazil. This is a cross-sectional, probabilistic study, linked to the project “Comprehensive Care for the Health of the Older people”, developed in the city of Ijuí in the state of Rio Grande do Sul. The research population included individuals aged 60 years or over, both sexes, attached to the Family Health Strategies in the urban area. To obtain the variables of interest, a questionnaire prepared by the researchers was used, physical evaluations to measure and classify the levels of fragility and sarcopenia and laboratory tests to measure creatinine, serum calcium, growth factor similar to insulin-1, parathyroid hormone, 25-hydroxyvitamin D, C-reactive protein, interleukin 6 and blood count. Frailty was assessed according to Fried's criteria and sarcopenia took into account the protocol created by the European working group on sarcopenia in older people. The research protocol was applied in the home space and blood samples were previously scheduled to be collected in health units. The data obtained were compiled and analyzed using the Statistical Package for the Social Sciences (SPSS) software (version 22.0). Inferential statistics of a quantitative nature were analyzed using the means comparison test for independent samples. The dependence of qualitative variables was also analyzed using Pearson's chi-square or Fisher's exact tests. To analyze the risk between the groups, the prevalence odds ratio was used and to analyze the relationship between the dependent variables and the independent variables, the linear regression model was used. In the analysis referring to the frailty criteria, there was a relationship between creatinine in the prediction of weight loss (p<0,001), leukocytes in the prediction of handgrip strength (p=0,022), interleukin-6 in the prediction of energy expenditure (p=0,026) and 25-hydroxyvitamin D in the prediction of walking time (p=0,036). In the analysis referring to the sarcopenia criteria, it was observed that the older people with altered muscle strength had lower hematocrit (p=0,037) and higher interleukin-6 (p=0,002) values than the older people with normal muscle strength; and the older people with altered physical performance had lower values of leukocytes (p=0,024), hemoglobin (p<0,001), hematocrit (p=0,007) and 25-hydroxyvitamin D (p=0,034) and more high levels of parathyroid hormone (p=0,018) and interleukin 6 (p=0,002) when compared to the older people with normal physical performance. It is concluded that the combined use of muscle, endocrine and immunological markers can be useful for the diagnosis of frailty and sarcopenia and for proposing resolutive interventions to reduce negative outcomes for the older people.