Estado nutricional e inflamatório durante a pandemia de COVID-19, em idosos institucionalizados, com dinapenia e sarcopenia

Abstract

Introduction: aging is characterized by physiological changes that predispose to muscle wasting, which can be potentiated by poor nutritional status and a chronic, systemic, low-grade inflammatory state characteristic of aging named inflammaging. These are associated with dynapenia and sarcopenia in the elderly, especially those residents in long-term care facility. Objective: to investigate, during the COVID-19 pandemic, the association between nutritional and inflammatory status with dynapenia and sarcopenia in institutionalized elderly. Methods: this is a cross-sectional study carried out with elderly residents at a referral center for geriatrics and gerontology in the city of Salvador-BA. Sociodemographic and clinical data were collected. The diagnoses of dynapenia and sarcopenia were based on the European Consensus on Sarcopenia (EWGSOP2): dynapenia was assessed by hand dynamometer, muscle mass was assessed by calf circumference (CC) and physical performance was assessed by the Short Physical Performance Balance. Nutritional status was assessed using the Mini Nutritional Assessment (MNA) and inflammatory status by laboratory tests of C-reactive protein (CRP), neutrophil/lymphocyte (RNL) and platelet/lymphocyte (RPL) ratios, and by the immune-inflammation index (SII). Descriptive statistics were used to characterize the population. To assess associations between nominal variables, the Chi-Square or Fisher's Exact test was used, and to assess quantitative variables, the Student's t test or the nonparametric Mann-Whitney test was used. For associations between nominal variables, the chi-square test or Fisher's exact test was used. For quantitative variables, Student's t test or nonparametric Mann-Whitney test was used. Results: the population consisted of 46 elderly people with a mean age of 80.6 ± 7.5 years and a predominance of females (67.4%). The prevalence of dynapenia was 100% and sarcopenia was confirmed in 82.6%, being 97.4% severe sarcopenia, and 17.4% had isolated dynapenia. The prevalence of malnutrition or nutritional risk was significantly higher among sarcopenic patients (78.9%). There were no significant differences in inflammatory markers between the dynapenic and sarcopenic groups. Conclusion: there was a significant association between sarcopenia and worse nutritional status, but not with inflammatory status. Worse health outcomes were found in the sarcopenic elderly, indicating the potential combined impact of reduced strength, muscle mass and physical performance. The high prevalence of dynapenia, severe sarcopenia and malnutrition or nutritional risk point to the need for greater attention to institutionalized elderly people, especially in the context of the pandemic and its long-term effects.