Obese very old women have low relative hangrip strength, poor physical function, and difficulties in daily living

Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet in relation to age-associated poor muscle strength; a cross-sectional study from the Kurdish cohort study

The Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet is an eating pattern associated with multiple health benefits, including the conservation of skeletal muscle. The Hand Grip Strength (HGS) is the most frequently used indicator of muscle functional capacity and muscle strength for clinical purposes. The current study aims to investigate the association between adherence to MIND diet and prevention of age-associated decline in muscle strength among the Kurdish population in Iran. This cross-sectional study was performed using data from Ravansar non-communicable diseases (RaNCD) cohort study on 3181 adults (48.5% men) aged 35–65 years. The dietary intake of the studied participants was assessed using a 114-item food frequency questionnaire (FFQ) developed by RaNCD cohort study. The MIND diet and the major dietary patterns were identified based on the participants’ dietary intake and three dietary patterns emerged including plant-based diet, high protein diet, and unhealthy diet. Hand grip strength (HGS) was measured using a hand-held hydraulic handgrip dynamometer and poor HGS was defined as HGS less than 32.8 and 20.5 kg in men and women, respectively. Compared with participants in the lowest category of MIND diet, those in the highest category had lower odds of poor HGS (OR: 0.65; CI 95%: 0.51–0.83). Furthermore, participants who were in third tertiles of plant-based and high protein diet were more likely 37% and 33% lower odds ratio of poor HGS (OR: 0.63; CI 95%: 0.5–0.79), (OR: 0.67; CI 95%: 0.54–0.84), respectively. On the other hand, greater adherence to the unhealthy diet was increased odds of poor HGS (OR: 1.39; CI 95%: 1.11–1.74). Overall, our findings suggest that adherence to the MIND diet and high protein diet may be associated with higher HGS, while adherence to the unhealthy diet can increase the odds of age-associated poor HGS in the Kurdish population.

Relation Between Relative Handgrip Strength, Chronological Age and Physiological Age with Lower Functional Capacity in Older Women

Purpose

Relative handgrip strength (RHGS), Aged Based on Exercise Stress Testing (A-BEST), and chronological age were evaluated as predictors of impaired mobility in older women.

Methods

Participants included 88 older women (mean age 68.13±6.02 years) referred for exercise stress testing. Estimated physiological age was computed based on exercise capacity, chronotropic reserve index, heart rate recovery, and medication that could affect heart rate. RHGS was measured using a validated handgrip hydraulic dynamometer and mobility was evaluated by timed up and go test (TUG-test). A hierarchical multiple regression predicted TUG-test performance from A-BEST, chronological age and RHGS.

Results

After adjustment for diabetes, RHGS was the only variable to add significantly to the prediction model (p=0.001). An increase in RHGS of 1 kg/body mass index was associated with a decrease in TUG-test of 0.7 seconds.

Conclusion

Relative handgrip strength test was a better predictor of impaired mobility when compared with chronological and physiological age in older women. Moreover, RHGS represents an inexpensive, simple, portable, noninvasive measurement for a clinician when compared with an exercise stress testing.

Dietary Protein Intake and Overall Diet Quality Are Associated with Handgrip Strength in African American and White Adults

OBJECTIVE

To determine the association of handgrip strength (HS) with protein intake, diet quality, and nutritional and cardiovascular biomarkers in African American and White adults.

DESIGN

Cross-sectional wave 3 (2009-2013) of the cohort Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study.

PARTICIPANTS

Socioeconomically diverse urban population of 2,468 persons aged 33 to 71 years.

MEASUREMENTS

Socio-demographic correlates, dietary intakes and biomarkers, HS, physical performance measures were collected. HS was measured using a dynamometer with the dominant hand. Functional measures included chair, tandem, and single leg stands. Two 24-hour recalls were collected using the US Department of Agriculture Automated Multiple Pass Method. The total protein intake and diet quality, evaluated by adherence to the DASH eating plan and Healthy Eating Index-2010, were calculated. Biomarkers included nutritional anemia, and serum levels of albumin, cholesterol, magnesium, and glucose.

RESULTS

The mean ±SE age of the sample was 52.3±0.2 years. Approximately 61% were African American and 57% were women. The mean ±SE HS of women was 29.1±0.2kg and for men was 45.9±0.4 kg. Protein, gm, per kg body weight for the women was 0.94±0.02 compared to 1.16 ±0.02 for men. After adjusting for socio-demographic factors, hypertension, and diabetes, HS/BMI ratio was significantly associated with protein intake per kg body weight (p<0.001) and diet quality, assessed by either the DASH adherence (p=0.009) or Health Eating Index-2010 (p=0.031) scores. For both men and women, participants in the upper tertile of HS maintained a single leg and tandem stances longer and completed 5 and 10 chair stands in shorter time compared to individuals in the lower HS tertile. Of the nutritional status indicators, the percent of men in the upper HS tertile with low serum magnesium and albumin, was significantly lower than those in the lower HS tertile [magnesium,7.4% vs 16.1%; albumin, 0.4% vs 4.5%]. The only difference observed for women was a lower percent of diabetes (14.4% for the upper HS tertile compared to 20.5% for the lower HS tertile.

CONCLUSIONS

The findings confirm the role of protein and a healthful diet in the maintenance of muscle strength. In this community sample, HS was significantly associated with other physical performance measures but did not appear to be strongly associated with indicators of nutritional risk. These findings support the use of HS as a proxy for functional status and indicate the need for research to explore its role as a predictor of nutritional risk.

Association Between Physical Activity Intensity and Physical Capacity Among Individuals Awaiting Bariatric Surgery

BACKGROUND

Physical activity is a routine component of the lifestyle modification program implemented prior to bariatric surgery, and one of the goals is to improve patients' physical capacity. However, the physical activity intensity recommended to meet that goal is unknown.

OBJECTIVE

This study aimed to assess the association between time spent at different physical activity intensities and physical capacity in patients awaiting bariatric surgery.

MATERIALS AND METHODS

A total of 39 women and 13 men were recruited. The primary outcome was physical capacity measured using six objective tests: 6-min walk, chair stand, sit and reach, unipodal balance (eyes open and eyes closed), and hand grip strength tests. The primary exposure variable was physical activity intensity (i.e., sedentary, light, moderate, and vigorous) measured by accelerometers.

RESULTS

The average body mass index was 46.3 ± 5.4 kg/m². Only 6% of total time was spent at moderate to vigorous intensity, while 71% of the time was spent sedentary. When adjusted for body mass index, age, and sex, four of the six physical capacity tests were significantly associated with moderate intensity physical activity β(SE): 6-min walk 9.7 (2.7), chair stand 0.3 (0.1), balance (eyes open) 1.8 (0.7), and hand grip strength 1.2 (0.4), and only the 6-min walk was associated with sedentary activity 1.7 (0.7).

CONCLUSION

These results suggest that physical capacity is associated with time spent at moderate intensity in individuals awaiting bariatric surgery. The next step is to study if an increase in time spent at moderate intensity will translate to improvements in physical capacity.

[Obesity in old age and its importance for functionality and frailty]

In later life a high body mass index (BMI) is associated with the lowest age-related mortality rate. The BMI range used by the World Health Organization (WHO) to classify overweight, a BMI of 25-30 kg/m², can be regarded as normal weight in old age; nevertheless, obesity is associated with an increased risk of disability and of a deterioration in physical functionality, particularly among older age groups. This relationship to obesity has also been established for frailty. For this reason, a reduction in weight may be appropriate under functional aspects if BMI values exceed 30 kg/m²; however, such a decision cannot be made on the basis of an individual BMI alone. The functional status, body composition, comorbidities and, in particular the life perspectives of the patient should also be taken into consideration. If weight loss is intended, it must always be performed under strict medical supervision involving optimized protein intake, a carefully calculated moderate reduction in calories and adequate physical training. In the case of chronically ill elderly patients, weight reduction is not usually appropriate. Restrictive diets of any kind should principally be critically viewed in old age because even temporary inadequate energy intake may lead to accelerated deterioration of muscle and bone structure.

Handgrip Strength Cutoff Points to Identify Mobility Limitation in Community-dwelling Older People and Associated Factors

BACKGROUND

Sarcopenia is defined as a progressive and generalized loss of skeletal muscle mass and strength. The specific threshold of muscle weakness that leads to mobility limitations has not been identified.

OBJECTIVES

To determine the best cutoff point of handgrip strength for identifying mobility limitation and to investigate the factors associated with muscle weakness and mobility limitation in community-dwelling older people.

DESIGN

Transversal study.

SETTING

Cities of Belo Horizonte, Barueri and Santa Cruz in Brazil.

PARTICIPANTS

1374 community-dwelling older people from the Frailty study in Brazilian older people (FIBRA Study).

MEASUREMENTS

Outcomes included muscle weakness determined according to gender-specific handgrip strength cutoff points generated by Receiver Operating Characteristic curves, mobility limitation defined as a gait speed ≤ 0.8 m/s; and a combination of both muscle weakness and mobility limitation. Associated factors included socio-demographic variables, lifestyle, anthropometrics, health conditions, use of health services and disability.

RESULTS

The cutoff points of handgrip strength with the best balancing between sensitivity and specificity for mobility limitation were 25.8 kgf for men (sensitivity 69%, specificity 73%) and 17.4 kgf (sensitivity 60%, specificity 66%) for women. Age and disability in instrumental activities of daily living were associated with all outcomes. Women had greater odds of mobility limitation than men. Physical inactivity, body fat, diabetes, depression, sleeping disturbances, number of medications and occurrence of falls remained as significant associated factors in the final model.

CONCLUSIONS

Handgrip strength can be a useful tool to identify mobility limitation in clinical practice. Interventions to prevent or minimize impacts of sarcopenia should stimulate physical activity and improvement of body composition in addition to the management of chronic diseases and disabilities.

Muscle Mass Index and Animal Source of Dietary Protein Are Positively Associated with Insulin Resistance in Participants of the NuAge Study

OBJECTIVES

Contribute evidence towards the complex interrelationships of body composition, insulin sensitivity and protein intake independently from adiposity in an older population.

DESIGN

This is a cross-sectional analysis of an existing dataset in which a literature-supported model linking together the variables of interest is tested using path analysis.

SETTING

The loss of muscle mass has been implicated in the development of insulin resistance. We propose to test associations of muscle mass with insulin sensitivity and their respective associations with animal and vegetable sources of protein intake, independently from adiposity.

PARTICIPANTS

Non-diabetic participants aged 68-82 years from the NuAge study with all available measures (n=441) were included.

MEASUREMENTS

A model considering age, sex, chronic diseases, physical activity; smoking and sources of protein intake influencing body composition components and insulin sensitivity was created and tested with Path Analysis for their independent associations. Muscle mass index (MMI; kg/height in m2) and % body fat were derived from DXA and BIA. Insulin resistance was estimated by the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) score and physical activity by the Physical Activity Scale for the Elderly (PASE) questionnaire. Protein intakes were obtained from three non-consecutive 24h-diet recalls.

RESULTS

In the final model, direct positive associations were observed between HOMA-IR score and MMI (ß=0.42; 95%CI: 0.24; 0.6) and % body fat (ß=0.094; 95%CI: 0.07; 0.11). There were no direct associations between animal protein intake and MMI or with HOMA-IR. There was a significant direct negative association between plant protein intake and MMI (ß= -0.068; 95%CI: -0.13; -0.003) and significant indirect associations mediated through MMI and % body fat between HOMA-IR and animal protein intake (ß=0.0321; 95%CI: 0.01; 0.05), as well as plant protein intake (ß= -0.07; 95%CI: -0.1; 0.0).

CONCLUSIONS

Our final model indicated that MMI and HOMA score were significantly positively associated. Protein intake sources were related to HOMA-IR score differently through MMI and % body fat, respectively.

Does Low Body Mass Index Matter? Relationship between Body Mass Index and Subjective Well-Being among Long-Lived Women over 95 Years of Age

OBJECTIVES

To examine the relationship between body mass index (BMI) and subjective well-being (SWB) among long-lived women over 95 years of age and evaluate whether this relationship is mediated by functional ability.

DESIGN

Retrospective cohort study.

SETTING

Data from the Rugao longevity cohort, a population-based study in Rugao, China.

PARTICIPANTS

A sample of 342 long-lived women (mean age 97.4 ± 2.1, range 95-107) whose SWB and other covariates were available were included in this study.

MEASUREMENTS

BMI was calculated as weight in kilograms divided by height in meters-squared (kg/m(2)). SWB was measured by life satisfaction (LS), positive affect (PA), negative affect (NA) and affect balance (AB). Functional ability was assessed by the Katz Index of Activities of Daily Living (ADL).

RESULTS

According to BMI classification standards for China, the underweight group had lower levels of LS than the normal and overweight groups (28.62 vs. 30.51 and 31.57, respectively; p<.05). Correlation analysis showed that BMI was significantly related to LS (r = 0.166, p<.01). The strength of the BMI and LS association was diminished when ADL was included in the general linear regression models. Mediation analysis revealed that ADL mediated this relationship (effect size = 22.6%). We did not observe significant associations of BMI with other SWB components (PA, NA, and AB).

CONCLUSION

For long-lived women, low BMI, rather than elevated BMI, is an indicator of poor psychological well-being. The findings call for public health awareness about low body weight in long-lived women, especially in those with physical disabilities when focusing on quality of life.

[Obesity in elderly]

The prevalence of obesity is increasing also in the elderly population. The European Euronut-Seneca study described an obesity prevalence of 12-41% in elderly women and of 8-24% in elderly men. Obesity in the elderly is related to the cardiometabolic risk, but also to degenerative joint diseases and impaired physical functions. Some discrepancies are caused by the description of a so-called obesity paradox with a more favourable prognosis for certain diseases in the presence of overweight compared to normal or reduced body weight. The so-called sarcopenic obesity is associated with the worst prognosis.Preventive and therapeutic regimens should consider the increased risk of malnutrition in elderly. The combinations of individually tailored nutritional recommendations and physical exercise is of advantage for the prognosis of comorbidities and the quality of life.

Association of Grip Strength, Upper Arm Circumference, and Waist Circumference with Dementia in Older Adults of the WiSE Study: A Cross-Sectional Analysis

OBJECTIVE

We examined the associations of handgrip strength, upper arm circumference, and waist circumference with dementia among Singapore older adults.

DESIGN

Cross-sectional epidemiological study.

SETTING

Residential homes, day care centres, nursing homes and institutions.

PARTICIPANTS

2,565 men and women aged 60 years and above who participated in the Well-being of the Singapore Elderly (WiSE) study in 2013.

MEASUREMENTS

Socio-demographic correlates, dietary habits, health behaviours, grip strength, upper arm circumference, and waist circumference were collected. Grip strength was measured using a hand dynamometer with the dominant hand. Upper arm circumference was measured using a measuring tape around the thickest part of the upper arm while waist circumference measured in centimetres was measured at the narrowest part of the body between the chest and hips for women, and measured at the level of the umbilicus for men. Dementia was diagnosed using the 10/66 dementia diagnostic criteria.

RESULTS

Mean grip strength was 13.07 kg (SE=0.60) for people with dementia and 21.98 kg (SE=0.26) for people without dementia. After adjusting for all factors, grip strength remained significantly associated with dementia (p <0.0001). Upper arm circumference was associated with dementia (p <0.0001) but this association was only significant in the univariate analysis. Waist circumference was not significantly associated with dementia.

CONCLUSIONS

Lower grip strength was independently associated with dementia in the older adult population in Singapore. Further research needs to be done to ascertain whether this association exists for specific types of dementia and look into the relationship of other anthropometric measurements with dementia in Singapore.