Sarcopenia is a generalized loss of muscle mass affecting muscle function and strength with age. The cause of sarcopenia is multifactorial and physiopathological mechanisms, including the decline of neuron numbers, changes in muscle metabolism, oxidative damage, reduced response to nutrients, and inflammation throughout proinflammatory cytokines that increase myofibrillar protein degradation and decrease protein synthesis. This chapter presents two case reports about sarcopenia and its associated multimorbidity impact on elderly patients. Sarcopenia in the elderly, when it advances to generalized muscle wasting, is mainly associated with multimorbidity which becomes a diagnostic, therapeutic, and palliative challenge to the physician; in these cases, a multidisciplinary approach is best for appropriate diagnosis and management results in a high-quality patient care setting.
TopIntroduction
Sarcopenia is defined as a generalized loss of muscle mass affecting muscle function and strength with age (Cruz-Jentoft & Sayer, 2019; Mori, et al., 2019). The Drafting Group of the European Working Group on Sarcopenia (EWGSOP2) has classified sarcopenia as acute and chronic, and has given recommendations to develop realize an algorithm to identify people with sarcopenia risk, and recommended mensuration of specific cutoff points to identify and characterize the sarcopenia (Cruz-Jentoft et al., 2019).
The cause of sarcopenia is multifactorial and physiopathological mechanisms include the decline of neuron numbers, changes in muscle metabolism, oxidative damage, reduced response to nutrients, and inflammation throughout proinflammatory cytokines that increase myofibrillar protein degradation and decreasing protein synthesis (Boirie, 2009; Walrand et al., 2011). It is well documented in the current literature that sarcopenia is present in many other chronic illnesses and infectious diseases (de Almeida et al., 2020; Dozio et al., 2021; Peterson & Mozer, 2017). Sarcopenia affects more the elderly and is related to a higher frequency of hospital admissions, as well as morbidity and mortality (Ekiz, Kara & Özçakar, 2020; Ekiz et al., 2020; Mehta et al., 2020).
Currently, there are several techniques in the evaluation of sarcopenia according to the guidelines and consensus for the diagnosis and treatment of sarcopenia (Cruz-Jentoft et al., 2019). Performing a non-invasive assessment of muscle mass is recognized as the standard, but should be performed by highly trained personnel, especially for patients with poorly defined cut-off values of muscle mass reduction (Cruz-Jentoft et al., 2019).
A method widely used in research and clinical practice to determine muscle mass because it is non-invasive and provides a reproducible estimate of appendicular skeletal muscle mass (ASM) is dual-energy X-ray absorptiometry (DXA) (Cruz-Jentoft & Sayer, 2019; Cruz-Jentoft et al., 2019). Despite this, as a disadvantage, DXA can be influenced by the degree of hydration of the patient, it is not portable, the brands available on the market still need to present more reliable results in its measurement, and may not support obese and tall people (Cruz-Jentoft et al., 2019; Martone et al., 2019; Tosato et al., 2017).
Another method considered transportable and cheaper is bioelectrical impedance analysis (BIA), which uses a DXA-mediated pattern-fitted lean mass conversion equation in a representative population (Cruz-Jentoft et al., 2019; Martone et al., 2019; Tosato et al., 2017). As a disadvantage, it can be influenced by the individual's degree of hydration, and its derivation patterns are based on older European populations (Cruz-Jentoft et al., 2019; Martone et al., 2019; Tosato et al., 2017).
According to with criteria diagnosis of EWGSOP2, sarcopenia can be identified by low muscle strength, with confirmation by the low muscle quantity or quality and low physical performance (Cruz-Jentoft et al., 2019; De Francesco, Vella & Belfiore, 2020).
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