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De Stefano, Fabio (2015) L'obesitĂ , la forza muscolare, la composizione muscolare e la performance fisica in una popolazione anziana. [Tesi di dottorato]

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Abstract (inglese)

Objective: To evaluate the association between BMI levels, muscular strength, muscle composition and physical performance, in a follow-up of 6 years, in an elderly population.
Materials and Methods: 2911 Italians subjects aged > 65 years from the Progetto Veneto Anziani (ProVA) study were analyzed. ProVA was a population study focused on chronic diseases and functional limitations. Physical performance with the Short Physical Performance Battery (SPPB) and leg muscular strength with dynamometry were measured in all subjects both at baseline and at the end of follow-up.. Fat distribution and skeletal muscle composition were measured in an abdominal single-scan magnetic resonance (MRI) in a randomly selected sample of 348 subjects at baseline. Study population was stratified by six BMI classes: underweight (BMI<18.5 kg/m2), normal weight (BMI 18.5-24.9), overweight (BMI 25.0-29.9), obesity I level (30.0-34.9), obesity II level (35.0-39.9), and severe obesity (BMI≥40.0). Associations between BMI levels, muscular strength, muscle compositions and physical performance were analyzed in multivariable adjusted models.
Results: In the ProVA population, an association between BMI levels and SPPB was observed. Normal weight subjects showed, in a sex and age-adjusted model, the best SPPB scores (8.29±0.03), with significant differences compared to underweight (7.50±0.15; p<0.001), overweight (8.12±0.02; p<0.001), class I (7.72±0.04; p<0.001), class II (6.67±0.09; p<0.001) and class III obesity (5.88±0.24; p<0.001). This pattern was not modified by further adjustment for socio-economic status, smoke, physical activity level and comorbidities. Compared to normal weight subjects (22.9±0.1 kg), leg muscular strength was higher in overweight (23.8±0.1; p<0.001) and in class I obesity (24.5±0.1; p<0.001), but it was reduced in class II (21.4±0.3; p<0.001) and class III obesity (19.8±0.9; p<0.001). The association between BMI and impaired physical performance was not significantly affected by adjustment for leg muscular strength. In a multiple logistic analysis, performed after the exclusion of subjects with at the baseline value <3 in the SPPB test, and adjusting for age, sex, smoking, income, education, physical activity and chronic disease, a significant increased risk of a statistically significant reduction in SPPB test was observed for overweight and obese subjects.
In the subgroup of patients with abdominal MRI, at the baseline, an inverse association between SPPB scores and the degree of fat infiltration of skeletal muscle was observed.
Conclusion: A poor physical performance was observed in overweight and obese elderly subjects, whereas leg muscular strength was reduced only in subjects with more severe obesity. The physical performance was negatively influenced by the degree of fat infiltration in skeletal muscle. Moreover, an increased risk of worsening in physical performance during the years was found in overweight and obese as compared to normal weight subjects. In conclusion high BMI values affect negatively physical performance and expose the elderly to a risk of a further decline in physical performance with consequent disability

Abstract (italiano)

Obiettivo: valutare l'associazione tra i livelli di BMI, forza muscolare, composizione muscolare e performance fisica, in un follow-up di 4,4±1,1 anni, in una popolazione anziana.
Materiali e Metodi: Sono stati analizzati 2.911 italiani soggetti di età > 65 anni appartenenti allo studio Progetto Veneto Anziani (Prova). ProVa è uno studio di popolazione con focus sulle malattie croniche e limitazioni funzionali. In tutti i soggetti è stata misurata la performance fisica mediante la short physical performance battery (SPPB) e la forza del muscolo quadricipite mediante dinamometro. Tali misurazioni sono state eseguite sia al tempo 0 che al termine del follow-up. Inoltre, in un campione selezionato in modo random di 348 soggetti, durante le misurazioni basali è astata valutata la distribuzione del tessuto adiposo a livello addominale e la composizione del muscolo erettore spinoso della colonna mediante una singola slide di risonanza magnetica (RMN). La popolazione dello studio è stata stratificata in sei classi di BMI: sottopeso (BMI <18,5 kg / m2), normopeso (BMI 18,5-24,9), sovrappeso (BMI 25,0-29,9), obesità di I livello (30,0-34,9), l'obesità di II livello (35.0 -39,9), e l'obesità grave (BMI≥40.0). Le associazioni tra i livelli di BMI, la forza muscolare, composizioni muscolari e la performance fisica sono stati analizzati in modelli multivariati.
Risultati: Nella popolazione dello studio Prova, è stata osservata un'associazione inversa tra i livelli di BMI e i risultati nella SPPB. I soggetti normopeso hanno evidenziato, in un modello aggiusto per sesso ed età, il migliore punteggio nel SPPB test (8,29 ± 0,03), con differenze significative rispetto ai soggetti sottopeso (7,50 ± 0,15, p <0,001), sovrappeso (8.12 ± 0.02, p <0.001), I (7,72 ± 0.04, p <0.001), II (6,67 ± 0,09, p <0,001) e III livello di obesità (5,88 ± 0,24, p <0,001). Tali risultati non venivano modificati da un ulteriore aggiustamento per status socio-economico, fumo, livello di attività fisica e comorbilità. Rispetto ai soggetti normopeso (22.9 ± 0.1 kg), la forza muscolare delle gambe è risultata essere più elevata nei soggetti sovrappeso (23,8 ± 0,1; p <0.001) e nell'obesità I livello (24.5 ± 0.1, p <0.001), ma è risultata ridotta, per i soggetti con obesità di II livello (21.4 ± 0.3, p <0.001) e III livello (19,8 ± 0,9; p <0.001). L'associazione tra inversa tra BMI e performance fisica, risultava ulteriormente rafforzata dopo un ulteriore aggiustamento per la forza muscolare delle gambe. In un'analisi di regressione logistica multipla, eseguita dopo l'esclusione di soggetti con al valore basale <3 nella prova SPPB, e aggiustata per età, sesso, fumo, reddito, istruzione, attività fisica e malattie croniche, si osservava un significativo aumento del rischio di riduzione della prova SPPB per i soggetti in sovrappeso e obesi. Nel sottogruppo di pazienti con risonanza magnetica addominale, al basale, è stata osservata un'associazione inversa tra i punteggi SPPB e il grado di infiltrazione grassa del muscolo scheletrico.
Conclusione: Una scarsa performance fisica è stata osservata nei soggetti anziani in sovrappeso e obesi, mentre la forza muscolare delle gambe è risultata ridotta solo nei soggetti con obesità. La performance fisica è risultata influenzata negativamente dal grado di infiltrazione di tessuto adiposo del muscolo scheletrico. Inoltre, si è osservato, nei soggetti sovrappeso ed obesi rispetto ai normopeso, un aumento del rischio di peggiorare nella performance fisica durante gli anni. In conclusione alti valori di BMI influenzano negativamente la performance fisica della popolazione anziane ed espongono i soggetti ad un rischio ulteriore peggioramento negli anni con conseguente rischio di sviluppare disabilità.

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Tipo di EPrint:Tesi di dottorato
Relatore:Busetto, Luca
Dottorato (corsi e scuole):Ciclo 27 > scuole 27 > SCIENZE MEDICHE, CLINICHE E SPERIMENTALI > SCIENZE GERIATRICHE ED EMATOLOGICHE
Data di deposito della tesi:23 Gennaio 2015
Anno di Pubblicazione:25 Gennaio 2015
Parole chiave (italiano / inglese):Obesity, muscle composition , physical performance, elderly population
Settori scientifico-disciplinari MIUR:Area 06 - Scienze mediche > MED/09 Medicina interna
Struttura di riferimento:Dipartimenti > Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari
Codice ID:7529
Depositato il:27 Nov 2015 09:50
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