{"id":1901,"date":"2025-07-16T10:04:24","date_gmt":"2025-07-16T13:04:24","guid":{"rendered":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/?p=1901"},"modified":"2025-07-22T14:12:37","modified_gmt":"2025-07-22T17:12:37","slug":"sarcopenia-caquexia","status":"publish","type":"post","link":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/sarcopenia-caquexia\/","title":{"rendered":"Sarcopenia e caquexia: entenda os obst\u00e1culos da terapia nutricional nesses quadros"},"content":{"rendered":"

A manuten\u00e7\u00e3o da massa muscular desempenha papel importante em diferentes fun\u00e7\u00f5es do organismo. N\u00e3o por menos, condi\u00e7\u00f5es como sarcopenia e caquexia podem impactar desfechos cl\u00ednicos de forma significativa.<\/p>\n

Embora essenciais, interven\u00e7\u00f5es nutricionais para contornar esses quadros podem apresentar desafios. A seguir, conhe\u00e7a um pouco mais sobre essas condi\u00e7\u00f5es e quais s\u00e3o os principais obst\u00e1culos na terapia nutricional.<\/p>\n

Sarcopenia: defini\u00e7\u00e3o e diagn\u00f3stico<\/h2>\n

Atualmente, a sarcopenia \u00e9 definida como um dist\u00farbio progressivo e generalizado do m\u00fasculo esquel\u00e9tico, que satisfaz tr\u00eas crit\u00e9rios: baixa massa muscular, baixa for\u00e7a muscular e baixa for\u00e7a muscular espec\u00edfica<\/strong> \u2013 que relaciona a for\u00e7a com o tamanho do m\u00fasculo (1, 2, 3).<\/p>\n

Sua preval\u00eancia varia de acordo com a idade. Segundo pesquisa, a sarcopenia pode atingir em torno de 36.5% das pessoas com 80 anos ou mais. Entre aqueles com idades entre 60 a 70 anos, o problema alcan\u00e7a, em m\u00e9dia, 21.2% das pessoas dessa faixa et\u00e1ria (4).<\/p>\n

A sarcopenia \u00e9 classificada como prim\u00e1ria ou secund\u00e1ria, dependendo de sua etiologia. A sarcopenia prim\u00e1ria<\/strong> \u00e9 causada pela idade avan\u00e7ada. J\u00e1 a sarcopenia secund\u00e1ria <\/strong>resulta de fal\u00eancia de \u00f3rg\u00e3os, c\u00e2ncer ou outras doen\u00e7as, bem como inatividade f\u00edsica (pacientes acamados ou sedent\u00e1rios) e \u00e0 nutri\u00e7\u00e3o inadequada (problemas na alimenta\u00e7\u00e3o, na absor\u00e7\u00e3o de nutrientes ou uso de determinados medicamentos (1, 5, 6, 7).<\/p>\n

Independente do contexto, os quadros de sarcopenia est\u00e3o associados a quedas, decl\u00ednio funcional, imobilidade, incapacidade, institucionaliza\u00e7\u00e3o, doen\u00e7as sist\u00eamicas, fragilidade e mortalidade<\/a> (2, 8).<\/p>\n

O diagn\u00f3stico da sarcopenia pode ser realizado por meio de question\u00e1rios, protocolos de avalia\u00e7\u00e3o da capacidade muscular e utiliza\u00e7\u00e3o de exames de imagem. Exemplo de ferramentas incluem o Sarc-F<\/strong>, o Sarc-CalF<\/strong>, e, mais recentemente, o Sarc-Global<\/strong> (9).<\/p>\n

Caquexia: defini\u00e7\u00e3o e diagn\u00f3stico<\/h2>\n

A caquexia \u00e9 uma s\u00edndrome multifatorial caracterizada pela perda de apetite, peso e m\u00fasculo esquel\u00e9tico<\/strong>, levando \u00e0 fadiga, comprometimento funcional, aumento da toxicidade relacionada ao tratamento, baixa qualidade de vida e redu\u00e7\u00e3o da sobrevida (10).<\/p>\n

Nessa condi\u00e7\u00e3o, o consumo proteico-cal\u00f3rico reduzido ocasiona um balan\u00e7o energ\u00e9tico-proteico negativo<\/strong>, associado a altera\u00e7\u00f5es metab\u00f3licas (aumento do catabolismo, resist\u00eancia anab\u00f3lica, aumento do gasto energ\u00e9tico e desregula\u00e7\u00e3o neuro-hormonal), muitas vezes n\u00e3o responsiva a terapia nutricional convencional (11).<\/p>\n

Em pacientes com c\u00e2ncer, a preval\u00eancia de caquexia varia entre 40% e 70%, dependendo do est\u00e1gio do tumor (12, 13, 14, 15). No mais, o problema tamb\u00e9m se faz presente em pacientes com doen\u00e7as como AIDS, doen\u00e7a pulmonar obstrutiva cr\u00f4nica (DPOC) e doen\u00e7as card\u00edacas e renais cr\u00f4nicas (12).<\/p>\n

O diagn\u00f3stico da caquexia ir\u00e1 depender do seu est\u00e1gio (11):<\/p>\n

1 \u2013\u00a0\u00a0 Pr\u00e9-caquexia<\/strong>: \u22645% de perda de peso nos \u00faltimos 6 meses. Cursando com anorexia e altera\u00e7\u00f5es metab\u00f3licas.<\/p>\n

2 \u2013\u00a0 Caquexia<\/strong>: >5% de perda de peso nos \u00faltimos 6 meses ou >2% de perda de peso nos \u00faltimos 6 meses e IMC<20 kg\/m\u00b2 ou >2% de perda de peso nos \u00faltimos 6 meses e sarcopenia. Ingest\u00e3o reduzida de alimentos e inflama\u00e7\u00e3o sist\u00eamica s\u00e3o comuns.<\/p>\n

3 \u2013 Caquexia refrat\u00e1ria<\/strong>: doen\u00e7a pr\u00f3-catab\u00f3lica, n\u00e3o responsiva ao tratamento anticancer\u00edgeno, baixa pontua\u00e7\u00e3o de desempenho e sobrevida esperada <3 meses.<\/p>\n

Sarcopenia e caquexia: principais obst\u00e1culos da terapia nutricional<\/h2>\n

Infelizmente, a efetividade da terapia nutricional em pacientes com sarcopenia e caquexia \u00e9 limitada por uma s\u00e9rie de barreiras.<\/p>\n

Sabe-se, por exemplo, que o apetite reduzido<\/strong> em pacientes com caquexia resulta, dentre outros motivos, do controle hipotal\u00e2mico alterado e dos sintomas descontrolados do c\u00e2ncer e seus tratamentos (dor, n\u00e1usea, v\u00f4mito, depress\u00e3o e disgeusia, etc) (10). Isso pode dificultar, por exemplo, o consumo de suplementos nutricionais orais (SNO).<\/p>\n

Ademais, quadros de altera\u00e7\u00f5es metab\u00f3licas<\/strong> s\u00e3o comuns, incluindo desregula\u00e7\u00e3o neuro-hormonal, gasto energ\u00e9tico elevado <\/strong>e aumento do catabolismo<\/strong> (10).<\/p>\n

Outras barreiras importantes incluem a interven\u00e7\u00e3o de tratamentos convencionais<\/strong> como a quimioterapia, que reduz a absor\u00e7\u00e3o de nutrientes, dificultando o manejo nutricional (16).<\/p>\n

Pacientes sarcop\u00eanicos com baixas reservas de energia s\u00e3o mais propensos ao comprometimento metab\u00f3lico, o que retarda a recupera\u00e7\u00e3o do sistema digestivo e aumenta a carga do sistema imunol\u00f3gico, causando complica\u00e7\u00f5es mais graves (1).<\/p>\n

Em um estudo envolvendo pacientes com c\u00e2ncer g\u00e1strico e sarcopenia, apesar da nutri\u00e7\u00e3o parenteral pr\u00e9-operat\u00f3ria de curto prazo promover uma menor infec\u00e7\u00e3o intra-abdominal, o suporte n\u00e3o se associou a uma redu\u00e7\u00e3o da taxa geral de complica\u00e7\u00f5es (1).<\/p>\n

Entretanto, em outra pesquisa com pacientes com c\u00e2ncer avan\u00e7ado e caquexia, as diferen\u00e7as nas taxas de sobreviv\u00eancia entre grupos de nutri\u00e7\u00e3o enteral (n = 730), parenteral (n = 190) e controle (n = 533) foram significativas, com o menor risco de mortalidade no grupo de nutri\u00e7\u00e3o enteral (17).<\/p>\n

Em todo caso, vale refor\u00e7ar que o preju\u00edzo dessas condi\u00e7\u00f5es dificilmente \u00e9 contido ou compensado apenas por meio de abordagens convencionais de suporte nutricional.<\/p>\n

Sarcopenia e caquexia: quais as op\u00e7\u00f5es terap\u00eauticas?<\/h2>\n

O tratamento atualmente recomendado para perda de massa e fun\u00e7\u00e3o muscular consiste em (2):<\/p>\n

1) Treinamento de exerc\u00edcios de resist\u00eancia.<\/strong><\/p>\n

2) Otimiza\u00e7\u00e3o da ingest\u00e3o proteica<\/strong>:\u00a0 para uma popula\u00e7\u00e3o adulta mais velha (> 65 anos), prop\u00f5e-se um aumento na ingest\u00e3o di\u00e1ria de prote\u00ednas (1 a 1,2 g\/kg\/dia; 1,2 a 1,5 g\/kg\/dia em caso de doen\u00e7a inflamat\u00f3ria), preferencialmente de prote\u00ednas de alta qualidade (prote\u00edna de soro de leite), contendo grandes quantidades de amino\u00e1cidos essenciais, como a leucina. Mais especificamente, 25 a 30 g de prote\u00edna de alta qualidade e at\u00e9 3 g de leucina devem ser administrados em cada refei\u00e7\u00e3o.<\/p>\n

3) Considerar suplementa\u00e7\u00e3o nutricional oral (SNO)<\/strong> na presen\u00e7a de ingest\u00e3o alimentar inadequada.<\/p>\n

4) Tratamento da defici\u00eancia\/insufici\u00eancia de vitamina D<\/strong>: a suplementa\u00e7\u00e3o pode ser considerada (pelo menos 800 a 1.000 UI\/dia), em caso de sarcopenia.<\/p>\n

Principalmente na caquexia, a combina\u00e7\u00e3o adequada de nutrientes e agentes anti-inflamat\u00f3rios <\/strong>\u00e9 essencial (18). A utiliza\u00e7\u00e3o de suplementos enriquecidos com \u00e1cidos graxos \u00f4mega-3<\/strong> est\u00e1 associada ao aumento do peso corporal e redu\u00e7\u00e3o da perda muscular (11).<\/p>\n

De qualquer forma, cabe ressaltar que o aumento no consumo nutricional, por si s\u00f3, n\u00e3o reverte o desequil\u00edbrio metab\u00f3lico (19).<\/p>\n

Em rela\u00e7\u00e3o \u00e0 terapia nutricional<\/strong>, a sarcopenia e a caquexia, isoladamente, n\u00e3o justificam a necessidade de suporte enteral ou parenteral. \u00c9 necess\u00e1rio realizar uma avalia\u00e7\u00e3o do alcance das metas nutricionais, estado cl\u00ednico e possibilidade de uso do trato gastrointestinal para indicar estas op\u00e7\u00f5es terap\u00eauticas.<\/p>\n

Segundo a ASCO (American Society of Clinical Oncology<\/em>), n\u00e3o se deve oferecer rotineiramente terapia nutricional para controle da caquexia. Um teste de curto prazo de nutri\u00e7\u00e3o parenteral pode ser oferecido a pacientes com obstru\u00e7\u00e3o intestinal revers\u00edvel, s\u00edndrome do intestino curto ou outros problemas que contribuem para m\u00e1 absor\u00e7\u00e3o. No entanto, mesmo nestes casos, os riscos, benef\u00edcios e custos devem ser discutidos (10).<\/p>\n

Leia mais: O que voc\u00ea precisa saber sobre a indica\u00e7\u00e3o de nutri\u00e7\u00e3o parenteral<\/em><\/p>\n

O que podemos concluir?<\/h2>\n

Muitas vezes negligenciadas, sarcopenia e caquexia s\u00e3o quest\u00f5es que precisam ser abordadas durante o acompanhamento de pacientes, em diversos quadros e faixas et\u00e1rias.<\/p>\n

Com isso, \u00e9 poss\u00edvel reduzir o preju\u00edzo \u00e0 qualidade de vida e desfechos negativos provocados por essas condi\u00e7\u00f5es. Ainda assim, \u00e9 essencial considerar os desafios apresentados para estabelecer as melhores abordagens poss\u00edveis.<\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

Refer\u00eancias:<\/p>\n

1 – Becerril-Alarc\u00f3n Y, Campos-G\u00f3mez S, Valdez-Andrade JJ, Campos-G\u00f3mez KA, Reyes-Barretero DY, Ben\u00edtez-Arciniega AD, Vald\u00e9s-Ramos R, Soto-Pi\u00f1a AE. Inulin Supplementation Reduces Systolic Blood Pressure in Women with Breast Cancer Undergoing Neoadjuvant Chemotherapy. Cardiovasc Ther. 2019 Jul 1;2019:5707150.<\/p>\n

2 – Cereda E, Pisati R, Rondanelli M, Caccialanza R. Whey Protein, Leucine- and Vitamin-D-Enriched Oral Nutritional Supplementation for the Treatment of Sarcopenia. Nutrients. 2022 Apr 6;14(7):1524.<\/p>\n

3 – Kirk B, Cawthon PM, Arai H, \u00c1vila-Funes JA, Barazzoni R, Bhasin S, Binder EF, Bruyere O, Cederholm T, Chen LK, Cooper C, Duque G, Fielding RA, Guralnik J, Kiel DP, Landi F, Reginster JY, Sayer AA, Visser M, von Haehling S, Woo J, Cruz-Jentoft AJ; Global Leadership Initiative in Sarcopenia (GLIS) group. The Conceptual Definition of Sarcopenia: Delphi Consensus from the Global Leadership Initiative in Sarcopenia (GLIS). Age Ageing. 2024 Mar 1;53(3):afae052.<\/p>\n

4 – Yazar T, Yazar HO. Prevalence of sarcopenia according to decade. Clin Nutr ESPEN. 2019;29:137-141.<\/p>\n

5 – Parra BFCS, de Matos LBN, Ferrer R, Toledo DO. SARCPRO: Proposta de protocolo para sarcopenia em pacientes internados. BRASPEN J. 2019;34(1):58-63.<\/p>\n

6 – Beaudart C, McCloskey E, Bruy\u00e8re O, Cesari M, Rolland Y, Rizzoli R, et al. Sarcopenia in daily practice: assessment and management. BMC Geriatr. 2016;16(1):170.<\/p>\n

7 – Shiozu H, Higashijima M, Koga T. Association of sarcopenia with swallowing problems, related to nutrition and activities of daily living of elderly individuals. J Phys Ther Sci. 2015;27(2):393-6.<\/p>\n

8 – Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31.<\/p>\n

9 – Lopes NC, et al. Sarc-Global: A New Sarcopenia Screening Tool in Older Adults. Nutrition. 2025.<\/p>\n

10 – Roeland EJ, et al. Management of Cancer Cachexia: ASCO Guideline. J Clin Oncol. 2020;38(24):2438-2453.<\/p>\n

11 – Arends J, Muscaritoli M, Anker S, Audisio R, Barazzoni R, Bosnjak S, Bossi P, Bowman J, Gijssels S, Krznari\u0107 \u017d, Strasser F, Aapro M. Overcoming barriers to timely recognition and treatment of cancer cachexia: Sharing Progress in Cancer Care Task Force Position Paper and Call to Action. Crit Rev Oncol Hematol. 2023;185:103965.<\/p>\n

12 – Yakovenko A, Cameron M, Trevino JG. Molecular therapeutic strategies targeting pancreatic cancer-induced cachexia. World J Gastrointest Surg. 2018 Dec 27;10(9):95-106.<\/p>\n

13 – Park B, You S, Cho WCS, Choi JY, Lee MS. A systematic review of herbal medicines for the treatment of cancer cachexia in animal models. J Zhejiang Univ Sci B. 2019 Jan;20(1):9-22.<\/p>\n

14 – Hendifar AE, Petzel MQB, Zimmers TA, Denlinger CS, Matrisian LM, Picozzi VJ, Rahib L. Precision Promise Consortium. Pancreas Cancer-Associated Weight Loss. Oncologist. 2019 May;24(5):691-701.<\/p>\n

15 – Suzuki T, Palus S, Springer J. Skeletal muscle wasting in chronic heart failure. ESC Heart Fail. 2018 Dec;5(6):1099-1107.<\/p>\n

16 – Marchiori MC, Genaro S. Altera\u00e7\u00f5es nutricionais associadas ao tratamento quimioter\u00e1pico em pacientes com c\u00e2ncer. Colloquium Vitae. 2017 Jul;9(1):8-12.<\/p>\n

17 – Amano K, Inoue S, et al. Effects of enteral nutrition and parenteral nutrition on survival in patients with advanced cancer cachexia: Analysis of a multicenter prospective cohort study. Clin Nutr. 2021;40(3):1168-1175.<\/p>\n

18 – Tanaka K, Nakamura S, Narimatsu H. Nutritional Approach to Cancer Cachexia: A Proposal for Dietitians. Nutrients. 2022;14(2):345. Dispon\u00edvel em: https:\/\/www.mdpi.com\/2072-6643\/14\/2\/345. Acesso jan. 2023.<\/p>\n

19 – Baker Rogers J, Syed K, Minteer JF. Cachexia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Atualizado em 2022 Aug 8.<\/p>\n","protected":false},"excerpt":{"rendered":"

A manuten\u00e7\u00e3o da massa muscular desempenha papel importante em diferentes fun\u00e7\u00f5es do organismo. N\u00e3o por menos, condi\u00e7\u00f5es como sarcopenia e caquexia podem impactar desfechos cl\u00ednicos de forma significativa. Embora essenciais, interven\u00e7\u00f5es nutricionais para contornar esses quadros podem apresentar desafios. A seguir, conhe\u00e7a um pouco mais sobre essas condi\u00e7\u00f5es e quais s\u00e3o os principais obst\u00e1culos na […]<\/p>\n","protected":false},"author":5902,"featured_media":2066,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[47],"tags":[207,150,66,104,143],"class_list":["post-1901","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-artigo-4","tag-caquexia","tag-massa-muscular","tag-nutricao","tag-sarcopenia","tag-terapia-nutricional"],"acf":[],"yoast_head":"\nSarcopenia e Caquexia na Terapia Nutricional: Veja os Desafios<\/title>\n<meta name=\"description\" content=\"Sarcopenia e caquexia s\u00e3o condi\u00e7\u00f5es relativamente comuns associadas a desfechos cl\u00ednicos piores. 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