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Impacto da cirurgia bariátrica e o potencial papel da metformina na sarcopenia
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Abstract(s)
A obesidade é uma doença que resulta de vários fatores e assola um grande número de pessoas, sendo considerada uma epidemia a nível mundial, com repercussões na qualidade de vida e comorbilidades associadas. Um dos tratamentos com eficácia comprovada no tratamento da obesidade é a cirurgia bariátrica. A redução da massa gorda após a cirurgia aporta grandes benefícios para o indivíduo, incluindo a remissão de comorbilidades como a diabetes mellitus tipo 2. Por outro lado, após a cirurgia bariátrica há também a perda de massa magra. A sarcopenia é uma doença associada à perda de função da massa muscular e à perda de massa magra, sendo a obesidade sarcopénica a junção desta perda de massa com a massa gorda aumentada. Assim, os objetivos deste trabalho são responder às seguintes três questões:
• Em pacientes adultos obesos sujeitos à cirurgia bariátrica, poderá surgir a sarcopenia como resultado da intervenção cirúrgica?
• Os obesos sarcopénicos sujeitos a esta cirurgia terão uma recuperação diferente dos que não apresentam a sarcopenia previamente?
• Há evidências científicas de que a metformina poderá prevenir e/ou tratar a sarcopenia?
O método utilizado para responder a estas questões foi a realização de uma revisão sistemática, dividida em duas questões de investigação: 1) relação entre a cirurgia bariátrica e a sarcopenia; 2) relação entre a metformina e a sarcopenia, visto que não foi possível encontrar resultados que englobassem as respostas aos objetivos de investigação.
Nos resultados apresentados não parece existir relação entre a cirurgia bariátrica e o desenvolvimento de sarcopenia, nem a obesidade sarcopénica parece influenciar o resultado da cirurgia bariátrica, no entanto, os trabalhos selecionados apresentam várias limitações. Quanto à metformina, é consensual o seu papel como um agente protetor da sarcopenia e outras doenças relacionadas com a idade, mas será também necessária mais investigação neste campo.
Conclui-se que este tema carece de mais investigação, com grupos de estudo com um maior número de indivíduos e com protocolos bem definidos relativamente à sarcopenia, para assim se auferir a relação entre a sarcopenia e cirurgia bariátrica, e o efeito farmacológico da metformina na prevenção e/ou tratamento da sarcopenia.
Obesity is a disease that results from several factors and affects many people, being considered a worldwide epidemic, with repercussions on quality of life and associated comorbidities. One of the treatments with proven effectiveness in the treatment of obesity is bariatric surgery. The reduction in fat mass after surgery brings great benefits to the individual, including the remission of comorbidities such as type 2 diabetes. On the other hand, after bariatric surgery there is also a loss of lean mass. Sarcopenia is a disease associated with loss of muscle mass function and loss of lean mass, and sarcopenic obesity is the combination of this loss of mass with increased fat mass. Thus, the objectives of this work are to answer the following three questions: • In obese adult patients undergoing bariatric surgery, can sarcopenia develop because of the surgical intervention? • Will sarcopenic obese patients who undergo this surgery have a different recovery than those who do not previously have sarcopenia? • Is there scientific evidence that metformin can prevent and/or treat sarcopenia? The method used to answer these questions was to do a systematic review, divided into two research questions: 1) relationship between bariatric surgery and sarcopenia; 2) relationship between metformin and sarcopenia, because it was not possible to find results that incorporate the responses to the research objectives. In the results presented, there seems to be no relationship between bariatric surgery and the development of sarcopenia, even does sarcopenic obesity seem to influence the outcome of bariatric surgery, however, the selected studies have several limitations. As for metformin, there is consensus on its role as a protective agent against sarcopenia and other age-related diseases, but more research is also needed in this field. It is concluded that this topic needs further investigation, with study groups with a greater number of individuals and with well-defined protocols regarding sarcopenia, to obtain the relationship between sarcopenia and bariatric surgery, and the pharmacological effect of metformin on prevention and/or treatment of sarcopenia.
Obesity is a disease that results from several factors and affects many people, being considered a worldwide epidemic, with repercussions on quality of life and associated comorbidities. One of the treatments with proven effectiveness in the treatment of obesity is bariatric surgery. The reduction in fat mass after surgery brings great benefits to the individual, including the remission of comorbidities such as type 2 diabetes. On the other hand, after bariatric surgery there is also a loss of lean mass. Sarcopenia is a disease associated with loss of muscle mass function and loss of lean mass, and sarcopenic obesity is the combination of this loss of mass with increased fat mass. Thus, the objectives of this work are to answer the following three questions: • In obese adult patients undergoing bariatric surgery, can sarcopenia develop because of the surgical intervention? • Will sarcopenic obese patients who undergo this surgery have a different recovery than those who do not previously have sarcopenia? • Is there scientific evidence that metformin can prevent and/or treat sarcopenia? The method used to answer these questions was to do a systematic review, divided into two research questions: 1) relationship between bariatric surgery and sarcopenia; 2) relationship between metformin and sarcopenia, because it was not possible to find results that incorporate the responses to the research objectives. In the results presented, there seems to be no relationship between bariatric surgery and the development of sarcopenia, even does sarcopenic obesity seem to influence the outcome of bariatric surgery, however, the selected studies have several limitations. As for metformin, there is consensus on its role as a protective agent against sarcopenia and other age-related diseases, but more research is also needed in this field. It is concluded that this topic needs further investigation, with study groups with a greater number of individuals and with well-defined protocols regarding sarcopenia, to obtain the relationship between sarcopenia and bariatric surgery, and the pharmacological effect of metformin on prevention and/or treatment of sarcopenia.
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Keywords
Obesidade Cirurgia bariátrica Sarcopenia Obesidade sarcopénica Diabetes mellitus tipo 2 Metformina