Evaluation of sarcopenia in long-lived elderly patients: comparison between the Muscle Mass Index and the Calf Circumference

The increase in life expectancy, observed in several countries, including Brazil, is due to improvements in living and health conditions and the epidemiological transition from the causes of morbidity and mortality, from infectious and parasitic diseases to chronic diseases. Furthermore, an increase in longevity, in addition to advances in science, with the improvement of diagnoses and the search for new treatments contributed to the increase in years lived1,2. However, the aging process is associated with a decrease in organic functions over the years. Sarcopenia is considered a complex geriatric syndrome and is defined as an age-related decline in skeletal muscle mass and function2. It is a major public health concern because it can result in functional decline, disability, falls, increased hospitalization costs, poor quality of life, and even deaths3. Although Dual-energy X-ray Absorptiometry (DXA) is the most used method to estimate the loss of muscle mass4 the high cost and low viability hinder its use in Primary Health Care (PHC). Methods such as Muscle Mass Index (MMI) and Calf Circumference (CC) can be used replacing DXA due to ease of access and application as well as low cost5. The Academic League of Geriatrics and Gerontology, Três Lagoas Campus, Federal Univeristy of Mato Grosso do Sul designed and executed a research intending to evaluate several aspects in elderly people with extreme longevity. One of the variables analyzed was sarcopenia, which was evaluated and compared using MMI and CC. For this purpose, a cross-sectional and quantitative study was performed in 2019/2020, with n = 69 individuals aged ≥ 90 years, of both genders, users of the Unified Health System in the town of Três Lagoas – MS. A sociodemographic questionnaire containing gender, age, and years of schooling was applied. Anthropometric data (CC and MMI) were collected in triplicate. The skeletal muscle mass was determined using the formula of Lee and collaborators which considers age, body mass, gender, ethnicity and height5. The values of MMI ​​of Janssen and collaborators were used as a reference to classify whether the nonagenarian or centenarians were sarcopenic or not6. For CC, a cutoff score ≤ 31 centimeters was adopted as a sign of sarcopenia7. The interviewed elderly had an average age of 93.5 years old, 1.3 years of schooling and 52.2% of the participants were women. The average CC was 31.2 centimeters, with 46.1% being considered sarcopenic patients according to this parameter. The average MMI was 5.1 kg/m2, with 100% of the elderly patients being considered sarcopenic through this method. There was no relationship between CC and MMI (p = 0.213). The high rates of sarcopenia found, especially using MMI and the absence of a relationship between the CC and MMI highlights the need to use more reliable methods to evaluate sarcopenia in long-lived elderly people, since the identification from CC, despite being easy and fast, may not be sensitive in this age group. These findings also lead to considering the use of more specific methods or those associated with other variables, such as Timed up and Go (TUG), for the evaluation of sarcopenia in the elderly aged 90 years or over. Future investigations should  consider the importance of validating specific instruments for elderly people in extreme longevity, as they constitute a group that has unique characteristics. The screening, monitoring, and health promotion carried out by PHC teams can promote the improvement in the quality of life of elderly people in extreme longevity

Negative self-perceived health in mothers of children and adolescents during the COVID-19 pandemic

Introduction: The COVID-19 pandemic represents a major stressful event, drastically affecting the population's quality of life. In this context, self-perception of health stands out as an indicator of health itself, and is increasingly used in epidemiological studies given its validity and reliability. It is strongly associated with the real state of people's health, incorporating their physical, cognitive and emotional aspects, as well as a sense of well-being and satisfaction with life. The individual's perception of feeling sick does not come only from the physical sensations of pain and discomfort, but, above all, from the social and psychological consequences of ill health. Thus, women in particular, due to their social roles and the intensification of their workload, which has been accentuated in the pandemic context, have a higher prevalence of negative self-perception of health, justifying the importance of the study. Objectives: To assess the prevalence of negative self-perception of health in mothers during the pandemic and to relate it to sociodemographic and health variables. Methodology: Cross-sectional study, carried out in the second half of 2020, with 822 mothers (aged ≥ 18 years) of children and adolescents, who answered an online questionnaire containing sociodemographic and health variables. Self-perceived health was classified as positive (very good and good) or negative (regular, bad, and very bad). Chi-square and Mann-Whitney tests were used for the analyses. Results: The mothers' mean age was 37.1 years, with 46.8% showing negative self-perception of health. Women who identified with a number of factors (had no partner; had completed ≤ 11years of schooling; were younger; slept fewer hours a night; were unemployed; felt overwhelmed in caring for their children; and suffered violence during the pandemic) had a significantly higher proportion of negative self-perception of health. Discussion and conclusion: The results of our study suggest worrying evidence of mothers' negative psychological response to the COVID-19 pandemic, since the high prevalence of negative self-perceived health may be associated with higher levels of depression, stress and anxiety. Thus, throughout the care process, attention should be paid to the biopsychosocial nature of the phenomena that make up the illness process, especially among the vulnerable population in question. Understanding and monitoring the health and quality of life of mothers during and after the pandemic is essential for carrying out preventive care and health promotion interventions and actions in primary healthcare settings in order to create and optimize policies aimed at managing the effects of this public health issue

Evaluation of sarcopenia in long-lived elderly patients: comparison between the muscle mass index and the calf circumference

Introduction: With population aging, many elderly citizens have been achieving extreme longevity (≥ 90 years). Sarcopenia is related to several adverse outcomes, such as disability, falls, hospitalization and death; hence, its early identification is important. Several methods can be used for its evaluation, with dual-energy x-ray absorptiometry (DXA) being the most accurate. Nevertheless, due to low availability and high cost, other methods are routinely adopted for screening in Primary Health Care (PHC), such as the evaluation of the Muscle Mass Index (MMI) and the Calf Circumference (CC).Objective: To evaluate sarcopenia in elderly people with extreme longevity, and then compare it by means of MMI and CC.Methodology: Cross-sectional and quantitative study, performed in 2019/2020, with n = 69 individuals aged ≥ 90 years, of both genders, users of the Unified Health System in the town of Três Lagoas – MS. We collected sociodemographic and anthropometric data in triplicate. For CC, we used a cutoff score ≤ 31 centimeters as a sign of sarcopenia. We determined MMI based on the calculation of skeletal muscle mass, using the formula of Lee and collaborators, which considers height, body mass, gender, age and ethnicity. The classification of sarcopenia adopted was that of Janssen and collaborators (women: ≤ 5.75 kg/m2 = severe sarcopenia; 5.76 – 6.75 kg/m2 = moderate sarcopenia; and ≥ 6.76 kg/m2 = normal muscle mass. Men: ≤ 8.50 kg/m2 = severe sarcopenia; 8.51 – 10.75 kg/m2 = moderate sarcopenia; and ≥ 10.76 kg/ m2 = normal muscle mass). In order to relate the variables, we applied the Spearman’s correlation test. Results: A total of 52.2% of the participants were women, with an average age of 93.5 years old and 1.3 years of schooling. The average CC was 31.2 centimeters, with 46.1% being considered sarcopenic patients according to this parameter. The average MMI was 5.1 kg/m2, with 100% of the elderly patients being considered sarcopenic through this method. There was no relationship between CC and MMI (p = 0.213).Discussion: We found a high prevalence of sarcopenia in the long-lived elderly patients, mainly using MMI. This data is worrying, since these elderly people may have several limitations due to sarcopenia. The absence of a relationship between the CC and MMI variables highlights the need to use more reliable methods to evaluate sarcopenia in long-lived elderly people, since the identification from CC, despite being easy and fast, may not be sensitive in this age group. Conclusion: We should highlight the need for personalization of public policies and evaluation recommendations for elderly people with extreme longevity in PHC, as they constitute a group that has unique characteristics