La ecografía: una nueva herramienta para el estudio de la obesidad sarcopénica

Abstract

This doctoral thesis is presented as a compilation of 3 publications in high-impact journals that follow a thematic coherence, as they explore the utility of ultrasound in the assessment of sarcopenia in patients with obesity and candidates for bariatric surgery, both in the pre-surgery phase (Simó-Servat et al. J Clin Med. 2022;11:2886) and post-surgery (Simó-Servat et al. Obes Surg 2023; 33:1211-1217), as well as in patients over 70 years of age with diabetes and frailty, most of whom also have obesity (Simó-Servat et al. Biology 2023;12:884)._x000D_ _x000D_ The findings of the thesis open new perspectives for advancing the study of body composition in patients with sarcopenic obesity. The utility of musculoskeletal ultrasound for diagnosing sarcopenic obesity is what the three articles in the thesis attempt to validate and demonstrate, providing strong correlations between the parameters provided by bioelectrical impedance (a gold standard method for studying body composition) and subcutaneous fat thickness and muscle thickness. Therefore, the main contributions of this work lie in the value of muscular ultrasound (specifically of the quadriceps) as a screening method to identify patients with sarcopenic obesity and as a tool to monitor changes in body composition after bariatric surgery. It also demonstrates its utility in informing us about the functional capacity of elderly, frail patients with diabetes, which correlates with quality of life tests._x000D_ _x000D_ From a practical application perspective, this thesis is groundbreaking, as it can change the diagnostic and monitoring procedures for an increasingly common condition such as sarcopenic obesity. It's worth noting that the simplicity and safety of ultrasound are clear advantages over other techniques for studying body composition. The strengths of the thesis lie in the comparison with BIA (the standard method), demonstrating that they are complementary methods, but further validation is needed in larger studies._x000D_ _x000D_ Based on the results obtained in this thesis, new lines of research are opening up that will ultimately lead to better diagnosis and personalized treatment:_x000D_ _x000D_ Establishing cutoff points for the diagnosis of sarcopenic obesity adapted to different populations_x000D_ Standardizing and protocolizing the ultrasound measurement method for a more precise diagnosis of sarcopenic obesity_x000D_ Working on the detection of qualitative changes in muscle structure through ultrasound that allows for earlier diagnosis and contributes to modifying the disease's prognosis._x000D_ As for weaknesses, it's worth noting that this is a pilot study, and therefore, the results need to be validated in larger cohorts. Also, the lack of standardized definitions and cutoff points, but as mentioned in the previous paragraph, this opens up new avenues for further work. On the other hand, in the final version of the thesis, the part on cognitive impairment and its relationship with sarcopenic obesity, as initially planned in the project, was omitted. This was done to focus efforts and results on the validation of ultrasound as a diagnostic method for sarcopenic obesity. Cognitive impairment is a complex entity that requires separate in-depth study._x000D_ _x000D_ The three published works in peer-reviewed journals with recognized impact factors speak to the strength of the work carried out. The future directions proposed will undoubtedly yield their results, which will translate into further publications, giving us more to work on.

Date of Award	12 Dec 2023
Original language	Spanish
Supervisor	Maria Jose Barahona Constanzo (Director)