O envelhecimento está associado a profundas alterações fisiológicas, como modificações no sistema metabólico e na composição corporal, com aumento da massa de gordura e diminuição da massa muscular. A obesidade está associada a uma resposta inflamatória crônica, caracterizada por uma produção anormal de citocinas e ativação de certas vias de sinalização pró-inflamatórias, resultando na indução de vários marcadores biológicos da inflamação. Evidências sugerem que a presença de uma inflamação de baixo grau, com concentrações alteradas de vários fatores circulantes, tais como um aumento de proteína C reativa, TNF-α, IL-6, entre outros marcadores biológicos da inflamação, capazes de diminuir a ação da insulina. Portanto, além do agravamento do risco cardiovascular associado à inflamação, sendo que o aumento crônico das concentrações circulantes de citocinas pode contribuir para uma resistência à insulina, está parece modificar as respostas bioquímicas de uma maneira que predispõe para os fatores de risco metabólicos, podendo levar a SM e assim proporcionar um risco maior para o desenvolvimento de doença cardiovascular e diabetes. Considerando que a insulina é um sinal anabólico dominante da proteína muscular, a resistência à insulina em indivíduos obesos pode promover o catabolismo muscular, levando assim ao aparecimento da obesidade sarcopênica.
Sendo os três artigos apresentados estudos transversais e de caráter exploratórios, não temos a intenção explorar as vias moleculares subjacentes à obesidade, resistência à insulina, síndrome metabólica e obesidade sarcopênica, nem tampouco determinar uma relação entre causa e efeito das variáveis pesquisadas nos estudos. Nossa discussão de forma alguma é exaustiva, sendo que outras hipóteses sobre os mecanismos da obesidade sarcopênica, síndrome metabólica e resistência à insulina poderão surgir, além disso, nossa amostra foi composta por indivíduos do sexo feminino, desta forma os resultados não podem ser extrapolados diretamente para a população masculina. Entretanto, pesquisas com essas características se tornam relevantes, sobretudo quando a literatura não elucida e não contempla informações suficientes para direcionar aplicações práticas clinicas e politicas públicas no combate de tais patologias. Consequentemente, a identificação de pacientes idosos com resistência insulínica, síndrome metabólica e
obesidade sarcopênica, é de suma importância para atenuar o impacto clínico destas patologias nesta população.
Devemos ressaltar que futuras pesquisas com intervenções longitudinais com aplicação do exercício físico, que ajudem a minimizar essas enfermidades relacionadas ao envelhecimento, são de suma importância para saúde pública.
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