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European Journal of Physical and Rehabilitation Medicine 2021 Mar 24

DOI: 10.23736/S1973-9087.21.06720-4

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Sarcopenic obesity and function in women with subacute hip fracture: a short-term prospective study

Marco DI MONACO 1 , Carlotta CASTIGLIONI 1, Francesca BARDESONO 2, Edoardo MILANO 1, Giuseppe MASSAZZA 2

1 Osteoporosis Research Center, Division of Physical and Rehabilitation Medicine, Presidio Sanitario San Camillo, Fondazione Opera San Camillo, Torino, Italy; 2 Division of Physical and Rehabilitation Medicine, Department of Surgical Sciences, University, Torino, Italy


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BACKGROUND: The prognostic role exerted by the concurrent presence of sarcopenia and obesity after hip fracture has not been elucidated.
AIM: To assess the effect of sarcopenic obesity on ability to function in women with subacute hip fracture.
DESIGN: Short-term prospective study.
SETTING: Rehabilitation hospital.
POPULATION: Women with subacute hip fracture.
METHODS: 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 < 16kg and appendicular lean mass (aLM) < 15kg. Alternatively, aLM/(height)2 < 5.5kg/m2 was substituted for aLM < 15kg to confirm sarcopenia in the women with grip strength < 16kg. Obesity was diagnosed with fat mass exceeding 40% of total body mass. Function was assessed by the Barthel index.
RESULTS: 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 < 5.5kg/m2 was substituted for aLM <15kg to confirm sarcopenia in the women whose handgrip strength was < 16kg.
CONCLUSIONS: 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.
CLINICAL REHABILITATION IMPACT: In women with subacute hip fracture, sarcopenia but not obesity should be assessed to contribute to the prediction of the short-term functional outcome.


KEY WORDS: Activities of daily living; Hand strength; Obesity; Osteoporosis; Sarcopenia

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