Efeitos da obesidade no equilíbrio postural e ocorrência de quedas em adultos assintomáticos

Ostolin, Thatiane Lopes Valentim Di Paschoale; Gonze, Bárbara de Barros; Jesus, Matheus Oliveira de; Arantes, Rodolfo Leite; Sperandio, Evandro Fornias; Dourado, Victor Zuniga

Resumo

Introdução:

Estudos prévios sugerem que o peso corporal é forte preditor do equilíbrio postural. Índice de Massa Corporal (IMC) apresenta associação com oscilação corporal aumentada. Contudo, isto é controverso já que estudos reportaram que não há diferença entre obesos e grupo controle em relação ao deslocamento do centro de pressão no equilíbrio postural (EP) estático. Além disso, a literatura é escassa sobre o impacto da obesidade sem o efeito confundidor do risco cardiometabólico.

Objetivo:

Avaliar os efeitos da obesidade no EP estático e na ocorrência de quedas em adultos assintomáticos acima de 40 anos.

Método:

O EP estático dos 624 indivíduos divididos segundo os quartis de IMC, relação cintura-quadril e cintura-altura e gordura corporal em porcentagem (% GC) foi avaliado com olhos abertos e fechados usando uma plataforma de força. As diferenças entre os quartis foram determinadas por meio de uma MANOVA e o papel da obesidade na ocorrência de quedas foi analisado por meio de regressão logística ajustada pelos principais confundidores.

Resultados:

Obtivemos correlações bivariadas fracas a moderadas entre a obesidade e o EP estático, que, após ajuste, não foram estatisticamente significativas. Observamos diferenças significativas entre primeiro e quarto quartis, sobretudo para quartis de %GC. A obesidade não se associou à ocorrência de quedas já que os valores de odds ratio perderam significância para todos os índices d e obesidade após o ajuste pelos confundidores.

Conclusão:

Obesidade apresenta pouca ou nenhuma influência na manutenção do EP estático e parece não determinar a ocorrência de quedas em indivíduos acima de 40 anos.

Palavras-chave:
Quedas; Equilíbrio Postural; Obesidade

[1] *TLVPO: MS, e-mail: thati.ostolin@gmail.com BBG: MS, e-mail: barbara_gonze@hotmail.com MOJ: MS, e-mail: matheus.oliveira93@hotmail.com.br RLA: PhD, e-mail: arantes.r@uol.com.br EFS: PhD, e-mail: evandrosperandio@yahoo.com VZD: PhD, e-mail: vzdourado@yahoo.com.br, victor.dourado@unifesp.br

	Quartile 1 N = 156	Quartile 2 N = 156	Quartile 3 N = 157	Quartile 4 N = 155
Age (years)	38 ± 15	42 ± 15^a	50 ± 13^ab	51 ± 12^ab
Males/females	62/94	68/88	65/92	65/90
Weight (kg)	58.3 ± 7.8	70.8 ± 9.0^a	80.5 ± 10.5^ab	97.7 ± 14.3^abc
Height (m)	1.63 ± 0.09	1.64 ± 0.09	1.62 ± 0.10	1.61 ± 0.09
Body mass index (kg/m2)	21.8 ± 1.6	25.9 ± 1.1^a	30.2 ± 1.45^ab	37.6 ± 4.4^abc
Waist (cm)	73.4 ± 7.0	84.3 ± 7.1^a	94.9 ± 9.1^ab	109.8 ± 11.5^abc
Hip (cm)	92.3 ± 4.8	99.9 ± 5.1^a	105.9 ± 7.4^ab	122.0 ± 10.8^abc
Waist-to- hip ratio	0.80 ± 0.08	0.85 ± 0.08^a	0.90 ± 0.09^ab	0.90 ± 0.08^ab
Waist-to- height ratio	0.45 ± 0.05	0.51 ± 0.04^a	0.58 ± 0.06^ab	0.68 ± 0.08^abc
Lean body mass (kg)	44.7 ± 9.2	52.1 ± 10.4^a	54.0 ± 11.2^a	57.8 ± 10.4^abc
Lean body mass (%)	75.9 ± 7.1^bcd	72.6 ± 6.9^cd	66.5 ± 7.4^d	58.7 ± 6.8
Fat body mass (kg)	13.6 ± 3.6	19.4 ± 5.6^b	26.6 ± 5.5^ab	40.2 ± 8.4^abc
Fat body mass (%)	23.8	27.4 ± 7.0^a	33.3^ab	40.9 ± 5.3^abc
Peak torque of knee extension (NM)	127 ± 51	140 ± 55	132 ± 61	123 ± 49
Peak oxygen uptake (mL/min/kg)	36.5 ± 10.7	28.9 ± 10.5^a	26.8 ± 8.6^ab	20.8 ± 5.1^abc
Number of fallers (%)	6 (3.8)	9 (5.8)	17 (10.8)	28 (18.1)^ab

	Unadjusted odds ratios and 95% confidence intervals			Adjusted odds ratios and 95% confidence intervals
		95% confidence interval			95% confidence interval
	OR	Lower limit	Upper limit	OR	Lower limit	Upper limit
Body mass index	3.75*	2.13	6.60	1.43	0.52	3.90
Fat body mass	4.13*	2.19	7.81	1.47	0.54	4.04
Waist-to-hip ratio	2.27*	1.23	4.17	1.57	0.59	4.19
Waist-to-height ratio	3.41*	1.40	8.25	2.09	0.64	6.80

	Fat body mass (%)		Body mass index (km/m2)		Waist-to-hip ratio		Waist-to-height ratio
	Unadjusted coefficient	Adjusted coefficient	Unadjusted coefficient	Adjusted coefficient	Unadjusted coefficient	Adjusted coefficient	Unadjusted coefficient	Adjusted coefficient
Bipedal stance with eyes open
Average Amplitude Anteroposterior (cm)	0.010*	0.005	0.020*	0.014	0.648	-0.271	1.046*	0.836
Average Amplitude Medial-Lateral (cm)	0.000	0.003	0.007	0.004	1.082	0.867	0.602	-0.655
Median Frequency Anteroposterior (cm)	0.001	-0.001	0.000	-0.003	-0.024	-0.176	0.087	-0.194
Media Frequency Medial-Lateral (cm)	-0.003*	-0.006	-0.005*	-0.007*	-0.225*	-0.464*	-0.308*	-0.486
Center of Pressure Area (cm)	0.020	-0.027	0.024	-0.009	0.697	-1,787	1.934	-1.434
Bipedal stance with eyes closed
Average Amplitude Anteroposterior (cm)	0.046*	0.026*	0.015*	0.041*	4.564	1.517	4.413*	2.891*
Average Amplitude Medial-Lateral (cm)	0.011*	0.007	0.016*	0.014	0.444	0.089	1.025*	0.989
Median Frequency Anteroposterior (cm)	0.000	-0.003	-0.003	-0.009	-0.572	-0.325	-0.332	-0.520
Media Frequency Medial-Lateral (cm)	-0.004*	-0.003	-0.005*	-0.004	-0.096	-0.117	-0.253*	-0.294
Center of Pressure Area (cm)	0.053	0.133	0.099*	0.115	2.530	-1.590	5.125	10.231
Semi-tandem stance with eyes open
Average Amplitude Anteroposterior (cm)	-0.001	0.013	0.001	0.002	0.944	0.818	0.541	0.066
Average Amplitude Medial-Lateral (cm)	0.007	0.011	0.004	-0.002	0.344	0.355	0.406	-0.422
Median Frequency Anteroposterior (cm)	-0.002*	-0.008*	-0.004*	-0.008*	0.070	-0.299	-0.119	-0.505
Media Frequency Medial-Lateral (cm)	0.000	-0.003	0.000	-0.001	0.119	-0.110	0.109	0.023
Center of Pressure Area (cm)	0.013	0.022	0.012	-0.013	0.623	0.292	1.267	-1.453
Semi-tandem stance with eyes closed
Average Amplitude Anteroposterior (cm)	0.021	0.043	0.004	-0.010	-2.212	0.021	-1.042	-0.977
Average Amplitude Medial-Lateral (cm)	0.026*	0.038*	0.044*	0.029	2.768*	1.306	2.385*	0.994
Median Frequency Anteroposterior (cm)	0.003	-0.022	-0.004	-0.013	-0.156	0.542	-0.314	-1.774
Media Frequency Medial-Lateral (cm)	0.004	-0.011	-0.001	-0.006	-0.124	0.533	-0.42	-0.734
Center of Pressure Area (cm)	0.097*	0.163*	0.167*	0.125*	10.252*	5.999	9.469*	5.354

	Body mass index (kg/m2)				Waist-to-hip ratio				Waist-to-height ratio
	Quartile 1 N = 156	Quartile 2 N = 155	Quartile 3 N = 157	Quartile 4 N = 155	Quartile 1 N = 104	Quartile 2 N = 154	Quartile 3 N = 200	Quartile 4 N = 165	Quartile 1 N = 138	Quartile 2 N = 161	Quartile 3 N = 159	Quartile 4 N = 165
Bipedal stance with eyes open
Average Amplitude Anteroposterior (cm)	1.96(1.82-2.09)	1.96(1.77-2.14)	2.12(1.96-2.27)	2.26(2.10-2.42)	2.06(1.88-2.23)	1.95(1.81-2.10)	2.07(1,91-2.23)	2.20(2.04-2.36)	1.94(1.81-2.07)	2.04(1.86-2.23)	1,97(1.84-2.10)	2,31(2.14-2.49)
Average Amplitude Medial-Lateral (cm)	1.17(1.04-1.31)	1.20(0.98-1.41)	1.41(1.13-1.70)	1.16(0.98-1.34)	1.17(0.95-1.35)	1.15(1.01-1.28)	1.18(1,00-1.36)	1.43(1.14-1.72)	1.11(0.98-1.24)	1.28(1.06-1.50)	1,06(0.96-1.16)	1,46(1.16-0.77)^c
Median Frequency Anteroposterior (cm)	0.26(0.24-0.27)	0.29(0.23-0.35)	0.25(0.23-0.27)	0.28(0.22-0.34)	0.29(0.20-0.37)	0.25(0.23-0.27)	0.28(0,23-0.33)	0.26(0.24-0.28)	0.26(0.24-0.27)	0.27(0.22-0.33)	0,27(0.24-0.29)	0,28(0.22-0.34)
Media Frequency Medial-Lateral (cm)	0.46(0.43-0.49)	0.45(0.38-0.52)	0.40(0.38-0.43)	0.38(0.32-0.45)	0.49(0.38-0.59)	0.41(0.38-0.44)	0.43(0,38-0.49)	0.38(0.36-0.41)^a	0.47(0.44-0.51)	0.43(0.37-0.50)	0,41(0.38-0.43)	0,39(0.32-0.45)
Center of Pressure Area (cm)	1.73(1.17-2.28)	1.56(1.18-1.93)	2.21(0.94-3.47)	1.86(1.36-2.36)	1.61(1.20-2.02)	1.76(1.19-2.33)	1.66(1,23-2.09)	2.27(1.07-3.48)	1.66(1.06-2.27)	1.68(1.30-2.06)	1,45(1.20-1.69)	2,52(1.25-3.79)
Bipedal stance with eyes closed
Average Amplitude Anteroposterior (cm)	2.89(1.35-4.43)	2.14(2.02-2.25)	3.72(1.25-6.19)	2.80(2.62-2.99)	2.11(1.96-2.25)	2.15(1.99-2.32)	3.02(1.82-4.22)	3.91(1.57-6.26)	2.02(1.90-2.14)	2.95(1.46-4.44)	3,60(1.17-6.04)	2,87(2.64-3.10)
Average Amplitude Medial-Lateral (cm)	0.99(0.91-1.07)	0.94(0.87-1.02)	1.04(0.93-1.15)	1.18(1.01-1.35)	1.01(0.91-1.11)	1.02(0.91-1.14)	1.01(0.90-1.13)	1.10(0.99-1.22)	0.97(0.88-1.05)	0.99(0.92-1.07)	1,00(0.89-1.10)	1,19(1.03-1.35)
Median Frequency Anteroposterior (cm)	0.29(0.27-0.30)	0.51(0.09-0.93)	0.31(0.29-0.34)	0.33(0.27-0.39)	0.59(0.03-1.21)	0.29(0.27-0.32)	0.33(0.28-0.37)	0.31(0.29-0.34)	0.53(0.06-1.00)	0.29(0.27-0.31)	0,30(0.28-0.32)	0,34(0.28-0.39)
Media Frequency Medial-Lateral (cm)	0.50(0.47-0.53)	0.49(0.46-0.52)	0.45(0.42-0.47)	0.42(0.37-0.48)	0.46(0.42-0.50)	0.48(0.45-0.51)	0.48(0.43-0.53)	0.43(0.41-0.46)	0.51(0.47-0.54)	0.48(0.45-0.51)	0,44(0.42-0.47)	0,44(0.38-0.49)
Center of Pressure Area (cm)	1.40(1.10-1.70)	1.23(1.09-1.38)	2.84(0.74-4.94)	2.64(1.71-3.57)	1.32(1.13-1.52)	1.75(0.95-2.55)	2.46(0.83-4.09)	2.22(1.592.84)	1.20(1.04-1.37)	1.44(1.16-1.73)	2,80(0.69-4.91)	2,55(1.77-3.33)
Semi-tandem stance with eyes open
Average Amplitude Anteroposterior (cm)	1.88(1.72-2.04)	1.90(1.74-2.06)	2.15(1.87-2.43)	1.88(1.73-2.03)	2.00(1.71-2.29)	1.82(1.66-1.97)	1.93(1.80-2.06)	2.08(1.84-2.32)	1.80(1.67-1.93)	1.98(1.76-2.19)	1.96(1.80-2.11)	2.06(1.82-2.29)
Average Amplitude Medial-Lateral (cm)	2.67(2.45-2.90)	2.66(2.53-2.79)	2.89(2.63-3.15)	2.72(2.2-2.83)	2.82(2.47-3.18)	2.66(2.43-2.88)	2.69(2.58-2.80)	2.81(2.67-2.95)	2.63(2.39-2.88)	2.71(2.46-2.95)	2.76(2.64-2.89)	2.83(2.69-2.96)^a
Median Frequency Anteroposterior (cm)	0.61(0.56-0.67)	0.61(0.57-0.65)	0.58(0.54-0.62)	0.53(0.50-0.56)	0.56(0.49-0.63)	0.57(0.53-0.60)	0.62(0.58-0.65)	0.58(0.54-0.62)	0.59(0.54-0.65)	0.59(0.54-0.63)	0.60(0.56-0.64)	0.55(0.52-0.59)
Media Frequency Medial-Lateral (cm)	0.35(0.33-0.38)	0.37(0.34-0.39)	0.39(0.36-0.42)	0.36(0.33-0.39)^c	0.34(0.32-0.37)	0.36(0.33-0.38)	0.38(0.35-0.40)	0.38(0.36-0.41)	0.36(0.33-0.38)	0.36(0.34-0.38)	0.38(0.36-0.41)	0.37(0.34-0.40)^ac
Center of Pressure Area (cm)	3.11(2.54-3.68)	3.01(2.68-3.35)	3.86(2.90-4.83)	3.14(2.81-3.46)	3.59(2.44-4.74)	3.01(2.45-3.56)	3.11(2.81-3.40)	3.56(2.92-4.21)	2.84(2.38-3.31)	3.46(2.63-4.29)	3.27(2.89-3.65)	3.49(2.87-4.11)
Semi-tandem stance with eyes closed
Average Amplitude Anteroposterior (cm)	2.73(2.40-3.06)	4.33(1.57-7.08)^a	3.41(2.98-3.83)	3.15(2.79-3.52)	4.73(0.63-8.83)	2.93(2.53-3.33)	3.15(2.81-3.50)	3.31(2.88-3.73)	4.12(1.04-7.20)	2.99(2.59-3.40)	3.27(2.84-3.70)	3.33(2.93-3.73)
Average Amplitude Medial-Lateral (cm)	4.39(4.16-4.62)	4.79(4.47-5.12)	5.07(4.73-5.41)	5.03(4.73-5.32)	4.27(4.06-4.47)	4.67(4.38-4.96)	5.05(4.78-5.33)	5.04(4.69-5.38)	4.25(4.07-4.42)	4.82(4.48-5.15)	5.02(4.71-5.32)	5.12(4.80-5.43)
Median Frequency Anteroposterior (cm)	0.70(0.66-0.74)	0.69(0.63-0.74)	1.25(0.16-2.33)^a	0.62(0.58-0.67)^a	0.62(0.57-0.66)	1.25(0.14-2.36)	0.66(0.63-0.70)	0.72(0.65-0.78)	0.66(0.62-0.70)	1.24(0.18-2.30)	0.66(0.62-0.71)	0.68(0.62-0.74)
Media Frequency Medial-Lateral (cm)	0.38(0.36-0.40)	0.38(0.33-0.43)	0.74(0.08-1.41)	0.37(0.32-0.42)	0.37(0.34-0.39)	0.73(0.05-1.41)	0.35(0.33-0.37)	0.44(0.36-0.51)	0.36(0.34-0.38)	0.73(0.08-1.38)	0.36(0.33-0.39)	0.41(0.33-0.48)
Center of Pressure Area (cm)	6.55(5.67-7.44)	7.52(6.49-8.55)	9.15(7.95-10.3)	8.68(7.50-9.86)	6.57(5.70-7.43)	7.16(6.18-8.14)	8.45(7.51-9.39)	9.06(7.73-0.39)	5.98(5.41-6.55)	7.66(6.57-8.76)	8.52(7.49-9.55)^a	9.43(8.10-0.76)^ac

Brasil