Sarcopenia Pediátrica: O que Sabemos?
DOI:
https://doi.org/10.20344/amp.23301Palavras-chave:
Criança, Sarcopenia/diagnóstico, Sarcopenia/etiologia, Sarcopenia/prevenção e controloResumo
A sarcopenia pediátrica é um problema de saúde emergente que afeta o desenvolvimento muscular, a força e o bem-estar geral em crianças e adolescentes. Embora inicialmente associada ao envelhecimento, estudos recentes destacam a sua presença em populações mais jovens, especialmente entre aqueles com doença crónica. Esta condição afeta o crescimento e o neurodesenvolvimento a curto prazo, estando associada a um maior risco de complicações a longo prazo, nomeadamente doenças metabólicas e cardiovasculares. Diversos fatores contribuem para a sarcopenia pediátrica, incluindo uma nutrição pré-natal inadequada, baixo peso ao nascimento, suscetibilidade genética, ingestão insuficiente de proteínas na dieta, estilo de vida sedentário, obesidade, desequilíbrios metabólicos e doenças crónicas. A redução da massa muscular compromete a saúde óssea, atrasa o pico de crescimento e afeta o desempenho físico, o que pode levar a uma redução da qualidade de vida. Em crianças com doenças crónicas, a sarcopenia agrava o prognóstico, prolongando o internamento hospitalar e aumentando a probabilidade de complicações. O diagnóstico da sarcopenia em crianças continua a ser complexo devido aos padrões de crescimento variáveis. Os métodos de avaliação disponíveis, como as técnicas de imagem e a análise da composição corporal, carecem de valores de referência padronizados adaptados às populações pediátricas, o que dificulta a deteção precoce. As estratégias preventivas enfatizam a atividade física, especialmente os exercícios de resistência (fortalecimento muscular), juntamente com a redução do tempo de ecrã, a melhoria dos hábitos alimentares e a higiene de sono. Tratamentos inovadores estão a ser desenvolvidos, incluindo medicação dirigida ao músculo para minimizar os efeitos secundários, abordagens regenerativas utilizando nanopartículas e inibidores de miostatina para estimular o crescimento muscular. O uso da terapia com células estaminais e com biomateriais para reconstrução muscular também está a ser estudado, mas as normas de orientação clínica específicas para pediatria ainda não estão definidas. A intervenção precoce é crucial para mitigar os seus efeitos adversos e promover trajetórias de desenvolvimento mais saudáveis.
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Referências
Wolfe RR. The underappreciated role of muscle in health and disease. Am J Clin Nutr. 2006;84:475-82.
Cleasby ME, Jamieson PM, Atherton PJ. Insulin resistance and sarcopenia: mechanistic links between common co-morbidities. J Endocrinol. 2016;229:R67-81.
Guo B, Wu Q, Gong J, Xiao Z, Tang Y, Shang J, et al. Relationships between the lean mass index and bone mass and reference values of muscular status in healthy Chinese children and adolescents. J Bone Miner Metab. 2016;34:703-13.
Ramel SE, Gray HL, Christiansen E, Boys C, Georgieff MK, Demerath EW. Greater early gains in fat-free mass, but not fat mass, are associated with improved neurodevelopment at 1 year corrected age for prematurity in very low birth weight preterm infants. J Pediatrics. 2016;173:108-15.
Abera M, Tesfaye M, Girma T, Hanlon C, Andersen GS, Wells JC, et al. Relation between body composition at birth and child development at 2 years of age: a prospective cohort study among Ethiopian children. Eur J Clin Nutr. 2017;71:1411-7.
Pfister KM, Gray HL, Miller NC, Demerath EW, Georgieff MK, Ramel SE. Exploratory study of the relationship of fat-free mass to speed of brain processing in preterm infants. Pediatr Res. 2013;74:576-83.
Henriksson H, Henriksson P, Tynelius P, Ortega FB. Muscular weakness in adolescence is associated with disability 30 years later: a population-based cohort study of 1.2 million men. Br J Sports Med. 2019;53:1221-30.
Delezie J, Handschin C. Endocrine crosstalk between skeletal muscle and the brain. Front Neurol. 2018;9:698.
Ahima RS, Park HK. Connecting Myokines and metabolism. Endocrinol Metab. 2015;30:235-45.
Stump CS, Henriksen EJ, Wei Y, Sowers JR. The metabolic syndrome: role of skeletal muscle metabolism. Ann Med. 2006;38:389-402.
Crabtree NJ, Kibirige MS, Fordham JN, Banks LM, Muntoni F, Chinn D, et al. The relationship between lean body mass and bone mineral content in paediatric health and disease. Bone. 2004;35:965-72.
Orsso CE, Tibaes JR, Oliveira CL, Rubin DA, Field CJ, Heymsfield SB, et al. Low muscle mass and strength in pediatrics patients: why should we care? Clin Nutr. 2019;38:2002-15.
Kim JH, Park YS. Low muscle mass is associated with metabolic syndrome in Korean adolescents: the Korea national health and nutrition examination survey 2009-2011. Nutrition Res. 2016;36:1423-8.
Burrows R, Correa-Burrows P, Reyes M, Blanco E, Albala C, Gahagan S. Low muscle mass is associated with cardiometabolic risk regardless of nutritional status in adolescents: a cross-sectional study in a Chilean birth cohort. Pediatr Diabetes. 2017;18:895-902.
Smith JJ, Eather N, Morgan PJ, Plotnikoff RC, Faigenbaum AD, Lubans DR. The health benefits of muscular fitness for children and adolescents: a systematic review and meta-analysis. Sports Med. 2014;44:1209-23.
Garcia LA, King KK, Ferrini MG, Norris KC, Artaza JN. 1,25(OH)2Vitamin D3 stimulates myogenic differentiation by inhibiting cell proliferation and modulating the expression of promyogenic growth factors and myostatin in C2C12 skeletal muscle cells. Endocrinol. 2011;152:2976-86.
Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48:16-31.
Inoue T, Wakabayashi H, Kawase F, Kokura Y, Takamasu T, Fujiwara D, et al. Diagnostic criteria, prevalence, and clinical outcomes of pediatric sarcopenia: a scoping review. Clin Nutr. 2024;43:1825-43.
Kwon EJ, Kim YJ. What is fetal programming? a lifetime health is under the control of in utero health. Obstet Gynecol Sci. 2017;60:506-19.
Costello PM, Rowlerson A, Astaman NA, Anthony FE, Sayer AA, Cooper C, et al. Peri-implantation and late gestation maternal undernutrition differentially affect fetal sheep skeletal muscle development. J Physiol. 2008;586:2371-9.
Chomtho S, Wells JC, Williams JE, Lucas A, Fewtrell MS. Associations between birth weight and later body composition: evidence from the 4-component model. Am J Clin Nutr. 2008;88:1040-8.
Bielemann RM, Gigante DP, Horta BL. Birth weight, intrauterine growth restriction and nutritional status in childhood in relation to grip strength in adults: from the 1982 Pelotas (Brazil) birth cohort. Nutrition. 2016;32:228-35.
Dodds R, Denison HJ, Ntani G, Cooper R, Cooper C, Sayer AA, et al. Birth weight and muscle strength: a systematic review and meta-analysis. J Nutr Health Aging. 2012;16:609-15.
Narici MV, de Boer MD. Disuse of the musculo-skeletal system in space and on earth. Eur J Appl Physiol. 2011;111:403-20.
Jung HN, Jung CH, Hwang YC. Sarcopenia in youth. Metabolism. 2023;144:155557.
Benson AC, Torode ME, Fiatarone Singh MA. Muscular strength and cardiorespiratory fitness is associated with higher insulin sensitivity in children and adolescents. Int J Pediatr Obes. 2006;1:222-31.
Steene-Johannessen J, Anderssen SA, Kolle E, Andersen LB. Low muscle fitness is associated with metabolic risk in youth. Med Sci Sports Exerc. 2009;41:1361.
Nishikawa H, Asai A, Fukunishi S, Nishiguchi S, Higuchi K. Metabolic syndrome and sarcopenia. Nutrients. 2021;13:3519.
Baczek J, Silkiewicz M, Wojszel ZB. Myostatin as a biomarker of muscle wasting and other pathologies-state of the art and knowledge gaps. Nutrients. 2020;12:2401.
Phillips CM. Metabolically healthy obesity across the life course: epidemiology, determinants, and implications. Ann N Y Acad Sci. 2017;1391:85-100.
Rezende IF, Conceição-Machado ME, Souza VS, Santos EM dos, Silva LR. Sarcopenia in children and adolescents with chronic liver disease. J Pediatria. 2020;96:439-46.
Zhou J, Liu B, Liang C, Li Y, Song YH. Cytokine signaling in skeletal muscle wasting. Trends Endocrinol Metab. 2016;27:335-47.
Zhang G, Wang D, Chen J, Tong M, Wang J, Chang J, et al. Association of sleep duration and prevalence of sarcopenia: a large cross-sectional study. Prev Med Rep. 2024;42:102741.
Rubio-Arias JÁ, Rodríguez-Fernández R, Andreu L, Martínez-Aranda LM, Martínez-Rodriguez A, Ramos-Campo DJ. Effect of sleep quality on the prevalence of sarcopenia in older adults: a systematic review with meta-analysis. J Clin Med. 2019;8:2156.
Liu C, Cheung W, Li J, Chow SK, Yu J, Wong SH, et al. Understanding the gut microbiota and sarcopenia: a systematic review. J Cachexia Sarcopenia Muscle. 2021;12:1393-407.
Uptodate Free. Measurement of growth in children. 2024. [cited 31 May 2024]. Available from: https://pro.uptodatefree.ir/Show/5356.
Beunen GP, Rogol AD, Malina RM. Indicators of biological maturation and secular changes in biological maturation. Food Nutr Bull. 2006;27:S244-56.
Rogol AD. Growth, body composition and hormonal axes in children and adolescents. J Endocrinol Invest. 2003;26:855-60.
Narchi H, Alblooshi A, Altunaiji M, Alali N, Alshehhi L, Alshehhi H, et al. Prevalence of thinness and its effect on height velocity in schoolchildren. BMC Research Notes. 2021;14:98.
Li Y, Gao D, Liu J, Yang Z, Wen B, Chen L, et al. Prepubertal BMI, pubertal growth patterns, and long-term BMI: results from a longitudinal analysis in Chinese children and adolescents from 2005 to 2016. Eur J Clin Nutr. 2022;76:1432-9.
Marques M, Vieira F, Teles J, Baptista F. Growth and physical development of children at apparent risk of sarcopenia. Pediatr Res. 2025;97:843-50.
Rauch F, Bailey DA, Baxter-Jones A, Mirwald R, Faulkner R. The ‘muscle-bone unit’ during the pubertal growth spurt. Bone. 2004;34:771-5.
Kâ K, Rousseau MC, Lambert M, O’Loughlin J, Henderson M, Tremblay A, et al. Association between lean and fat mass and indicators of bone health in prepubertal caucasian children. HRP. 2013;80:154-62.
Sioen I, Lust E, De Henauw S, Moreno LA, Jiménez-Pavón D. Associations between body composition and bone health in children and adolescents: a systematic review. Calcif Tissue Int. 2016;99:557-77.
Schoenau E. From mechanostat theory to development of the «functional muscle-bone-unit». J Musculoskelet Neuronal Interact. 2005;5:232-8.
Wey HE, Binkley TL, Beare TM, Wey CL, Specker BL. Cross-sectional versus longitudinal associations of lean and fat mass with pQCT bone outcomes in children. J Clin Endocrinol Metab. 2011;96:106-14.
Schoenau E, Neu CM, Beck B, Manz F, Rauch F. Bone mineral content per muscle cross-sectional area as an index of the functional muscle-bone unit. J Bone Miner Res. 2002;17:1095-101.
Matta PN, Baul TD, Loubeau K, Sikov J, Plasencia N, Sun Y, et al. Low sports participation is associated with withdrawn and depressed symptoms in urban, school-age children. J Affect Disord. 2021;280:24-9.
Bowden Davies KA, Pickles S, Sprung VS, Kemp GJ, Alam U, Moore DR, et al. Reduced physical activity in young and older adults: metabolic and musculoskeletal implications. Ther Adv Endocrinol Metab. 2019;10:2042018819888824.
DeFronzo RA, Tripathy D. Skeletal muscle insulin resistance is the primary defect in type 2 diabetes. Diabetes Care. 2009;32:S157-63.
Atlan L, Cohen S, Shiran S, Sira LB, Pratt LT, Yerushalmy-Feler A. Sarcopenia is a predictor for adverse clinical outcome in pediatric inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2021;72:883-8.
Rayar M, Webber CE, Nayiager T, Sala A, Barr RD. Sarcopenia in children with acute lymphoblastic leukemia. J Pediatr Hematol Oncol. 2013;35:98-102.
Suzuki D, Kobayashi R, Sano H, Hori D, Kobayashi K. Sarcopenia after induction therapy in childhood acute lymphoblastic leukemia: its clinical significance. Int J Hematol. 2018;107:486-9.
Van Aller C, Lara J, Stephan BC, Donini LM, Heymsfield S, Katzmarzyk PT, et al. Sarcopenic obesity and overall mortality: results from the application of novel models of body composition phenotypes to the National Health and Nutrition Examination Survey 1999-2004. Clin Nutr. 2019;38:264-70.
Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity among adults and youth: United States, 2015-2016. NCHS Data Brief. 2017;1-8.
Prado CM, Wells JC, Smith SR, Stephan BC, Siervo M. Sarcopenic obesity: a critical appraisal of the current evidence. Clin Nutr. 2012;31:583-601.
Akhmedov D, Berdeaux R. The effects of obesity on skeletal muscle regeneration. Front Physiol. 2013;4:371.
Trowbridge FL, Hiner CD, Robertson AD. Arm muscle indicators and creatinine excretion in children. Am J Clin Nutr. 1982;36:691-6.
Jacobs J, Jansen M, Janssen H, Raijmann W, Van Alfen N, Pillen S. Quantitative muscle ultrasound and muscle force in healthy children: a 4-year follow-up study. Muscle Nerve. 2013;47:856-63.
McCarthy HD, Samani-Radia D, Jebb SA, Prentice AM. Skeletal muscle mass reference curves for children and adolescents. Pediatr Obes. 2014;9:249-59.
Lurz E, Patel H, Frimpong RG, Ricciuto A, Kehar M, Wales PW, et al. Sarcopenia in children with end-stage liver disease. J Pediatr Gastroenterol Nutr. 2018;66:222-6.
Ritz A, Lurz E, Berger M. Sarcopenia in children with solid organ tumors: an instrumental era. Cells. 2022;11:1278.
Mazahery H, von Hurst PR, McKinlay CJ, Cormack BE, Conlon CA. Air displacement plethysmography (pea pod) in full-term and pre-term infants: a comprehensive review of accuracy, reproducibility, and practical challenges. Maternal Health Neonatol Perinatol. 2018;4:12.
Clark RV, Walker AC, Miller RR, O’Connor-Semmes RL, Ravussin E, Cefalu WT. Creatine (methyl-d3) dilution in urine for estimation of total body skeletal muscle mass: accuracy and variability vs. MRI and DXA. J Appl Physiol. 2018;124:1-9.
Wang Z, Heshka S, Pietrobelli A, Chen Z, Silva AM, Sardinha LB, et al. A new total body potassium method to estimate total body skeletal musclemass in children. J Nutr. 2007;137:1988-91.
Arrowsmith FE, Allen JR, Gaskin KJ, Gruca MA, Clarke SL, Briody JN, et al. Reduced body protein in children with spastic quadriplegic cerebral palsy2. The American Journal of Clinical Nutrition.2006;83:613-8.
Jones G, Trajanoska K, Santanasto AJ, Stringa N, Kuo CL, Atkins JL, et al. Genome-wide meta-analysis of muscle weakness identifies 15 susceptibility loci in older men and women. Nat Commun. 2021;12:654.
Lin S, Ling M, Chen C, Cai X, Yang F, Fan Y. Screening potential diagnostic biomarkers for age-related sarcopenia in the elderly population by WGCNA and LASSO. BioMed Res Int. 2022;2022:7483911.
Valášková S, Gažová A, Vrbová P, Koller T, Šalingova B, Adamičková A, et al. The severity of muscle performance deterioration in sarcopenia correlates with circulating muscle tissue-specific miRNAs. Physiol Res. 2021;70:S91-8.
Jativa SD, Thapar N, Broyles D, Dikici E, Daftarian P, Jiménez JJ, et al. Enhanced delivery of plasmid DNA to skeletal muscle cells using a DLC8-binding peptide and ASSLNIA-modified PAMAM dendrimer. Mol Pharm. 2019;16:2376-84.
Poussard S, Decossas M, Bihan OL, Mornet S, Naudin G, Lambert O. Internalization and fate of silica nanoparticles in C2C12 skeletal muscle cells: evidence of a beneficial effect on myoblast fusion. IJN. 2015;10:1479-92.
Michiue K, Takayama K, Taniguchi A, Hayashi Y, Kogure K. Increasing skeletal muscle mass in mice by non-invasive intramuscular delivery of myostatin inhibitory peptide by iontophoresis. Pharmaceuticals. 2023;16:397.
Kenny AM, Kleppinger A, Annis K, Rathier M, Browner B, Judge JO, et al. Effects of transdermal testosterone on bone and muscle in older men with low bioavailable testosterone levels, low bone mass, and physical frailty. J Am Geriatr Soc. 2010;58:1134-43.
Rong S, Wang L, Peng Z, Liao Y, Li D, Yang X, et al. The mechanisms and treatments for sarcopenia: could exosomes be a perspective research strategy in the future? J Cachexia Sarcopenia Muscle. 2020;11:348-65.
Tian X, Pan M, Zhou M, Tang Q, Chen M, Hong W, et al. Mitochondria transplantation from stem cells for mitigating sarcopenia. Aging Dis. 2023;14:1700-13.
Najm A, Niculescu AG, Grumezescu AM, Beuran M. Emerging therapeutic strategies in sarcopenia: an updated review on pathogenesis and treatment advances. Int J Mol Sci. 2024;25:4300.
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