Division of Physical and Rehabilitation Medicine, Osteoporosis Research Center, Presidio Sanitario San Camillo, Opera San Camillo Foundation, Turin, Italy -
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Eur J Phys Rehabil Med. 2021 Dec;57(6):940-947. doi: 10.23736/S1973-9087.21.06720-4. Epub 2021 Mar 24.
The prognostic role exerted by the concurrent presence of sarcopenia and obesity after hip fracture has not been elucidated.
To assess the effect of sarcopenic obesity on ability to function in women with subacute hip fracture.
Short-term prospective study.
Rehabilitation hospital.
Women with subacute hip fracture.
At admission, grip strength, by a Jamar dynamometer, and body composition by dual-energy x-ray absorptiometry were assessed. Sarcopenia was defined according to the criteria released by the European Working Group for Sarcopenia in Older People in 2019, with both grip strength <16 kg and appendicular lean mass (aLM)<15 kg. Alternatively, aLM/(height)<5.5 kg/m was substituted for aLM<15 kg to confirm sarcopenia in the women with grip strength <16 kg. Obesity was diagnosed with fat mass exceeding 40% of total body mass. Function was assessed by the Barthel index.
We assessed 183 of 200 women. Sarcopenic women had lower Barthel index scores assessed at the end of subacute inpatient rehabilitation (U=300,0; z=-4.3; P<0.001) and lower Batrhel index effectiveness (U=310,0; z=-4.2; P<0.001) than non-sarcopenic women. Conversely, we found no significant differences in function between obese and non-obese women. The concurrent presence of sarcopenia and obesity did not worsen the functional prognosis versus the presence of isolated sarcopenia. After adjustment for Barthel index scores before rehabilitation, age, hip-fracture type and cognitive impairment, sarcopenia was significantly associated with Barthel index scores (P=0.001) and Barthel index effectiveness (P<0.001), whereas obesity was not. The results did not materially change when aLM/(height)2<5.5 kg/m2 was substituted for aLM <15 kg to confirm sarcopenia in the women whose handgrip strength was <16 kg.
The concurrent presence of obesity did not worsen the negative prognostic role of sarcopenia in the short-term recovery of ability to function after hip fracture in women.
In women with subacute hip fracture, sarcopenia but not obesity should be assessed to contribute to the prediction of the short-term functional outcome.
髋部骨折后同时存在肌肉减少症和肥胖的预后作用尚未阐明。
评估肌少症性肥胖对亚急性髋部骨折女性功能能力的影响。
短期前瞻性研究。
康复医院。
亚急性髋部骨折的女性。
入院时，使用 Jamar 测力计评估握力，通过双能 X 射线吸收法评估身体成分。根据欧洲老年人肌肉减少症工作组 2019 年发布的标准定义肌肉减少症，握力<16kg 和四肢瘦质量（aLM）<15kg。或者，用 aLM/（身高）<5.5kg/m 代替 aLM<15kg 来确认握力<16kg 的女性存在肌肉减少症。肥胖定义为体脂超过总体重的 40%。功能通过巴氏指数评估。
我们评估了 200 名女性中的 183 名。在亚急性住院康复结束时，肌肉减少症女性的巴氏指数评分较低（U=300.0；z=-4.3；P<0.001），巴氏指数有效性较低（U=310.0；z=-4.2；P<0.001）比非肌肉减少症女性。相反，我们发现肥胖女性与非肥胖女性的功能无显著差异。与单纯肌肉减少症相比，肌肉减少症和肥胖症同时存在并未使功能预后恶化。在调整康复前巴氏指数评分、年龄、髋部骨折类型和认知障碍后，肌肉减少症与巴氏指数评分（P=0.001）和巴氏指数有效性（P<0.001）显著相关，而肥胖症则没有。当用 aLM/（身高）2<5.5kg/m2 代替 aLM<15kg 来确认握力<16kg 的女性存在肌肉减少症时，结果没有实质性变化。
在女性髋部骨折后短期恢复功能能力方面，肥胖症的同时存在并没有加重肌肉减少症的负面预后作用。
在亚急性髋部骨折的女性中，应评估肌肉减少症而不是肥胖症，以预测短期功能结局。
