Association of muscle strength with cardiovascular risk in Korean adults: Findings from the Korea National Health and Nutrition Examination Survey (KNHANES) VI to VII (2014-2016)

Association between relative grip strength and depression among U.S. middle-aged and older adults: results from the NHANES database

Background

Mental health issues among middle-aged and older adults are gaining increasing attention. Recent studies have shown that relative grip strength is associated with cardiovascular diseases and various cancers, but its relationship with depression remains unclear.

Methods

This cross-sectional study included data from adults aged 50 years and older from the 2011-2014 National Health and Nutrition Examination Survey. Relative grip strength is calculated by dividing the maximum absolute grip strength of both hands by BMI. The Patient Health Questionnaire (PHQ-9) was used to evaluate the depressive outcome. Multivariate logistic regression was performed to assess the association between relative grip strength and depression.

Results

In this study, a total of 3,639 participants (≥50 years) with a mean age of 64.3 ± 9.3 years were enrolled, of whom 48.9% were male. Compared with individuals with lower relative handgrip strength in Q1 (≤1.64 kg/BMI), the adjusted OR values for relative handgrip strength and depression in Q2 (1.64-2.17 kg/BMI), Q3 (2.17-2.84 kg/BMI), and Q4 (≥2.84 kg/BMI) were 0.69 (95% CI: 0.51, 0.93, p = 0.016), 0.36 (95% CI: 0.24, 0.55, p < 0.001), and 0.32 (95% CI: 0.20, 0.51, p < 0.001), respectively. The relationship between relative grip strength and depression presented an L-shaped curve (nonlinear, p = 0.006), with an inflection point of roughly 2.98 kg/BMI. Among participants with relative grip strength < 2.98 kg/BMI, the OR of incident depression was 0.41 (95% CI: 0.30-0.55, p < 0.001).

Conclusion

Our findings indicated that relative grip strength was inversely associated with incident depression and demonstrated an L-shaped relationship among U.S. middle-aged and older adults. Relative grip strength could be the indicator for future screening of mental health.

Association of Visceral Adiposity Index and Handgrip Strength with Cardiometabolic Multimorbidity among Middle-Aged and Older Adults: Findings from Charls 2011-2020

The visceral adiposity index (VAI) and handgrip strength (HGS) are identified as important objectives for the prevention of illness. Nevertheless, there is limited understanding regarding the impact of the VAI and HGS on cardiometabolic multimorbidity (CMM). We aimed to ascertain the impact of the VAI and HGS on CMM among middle-aged and older people. Data spanning from 2011 to 2020 were derived from the China Health and Retirement Longitudinal Study (CHARLS). In total, 7909 individuals aged 45 years and older were included. Cox proportional hazard regression was utilized to examine the correlation among the VAI, HGS, and CMM. Throughout the 10-year follow-up, we determined that both the VAI (HR = 1.330; 95%CI = 1.179-1.500) and HGS (HR = 0.745, 95%CI = 0.645-0.861) exhibited significant associations with CMM risk. Individuals exposed to both a high VAI and low HGS were found to have higher hazards of CMM (HR = 1.377, 95%CI = 1.120-1.694) in contrast to participants exposed to one or none of these conditions. The older (HR = 1.414; 95%CI = 1.053-1.899) and male (HR = 1.586; 95%CI = 1.114-2.256) groups are more likely to experience CMM risk. Our findings suggest that both the VAI and HGS have significant effects on CMM risk. Appropriate interventions focused on vulnerable groups are recommended to prevent the incidence of CMM.

Higher dietary methyl donor micronutrient consumption is associated with higher muscle strength in adults: a cross-sectional study

Methyl donor micronutrients might affect muscle strength via DNA methylation. We aimed to evaluate the combined relationship of dietary methyl donor micronutrients containing betaine, choline, methionine, vitamin B12, vitamin B6 and folate on muscle strength. This cross-sectional study was conducted on 267 subjects including 113 men and 154 women. Dietary intake of micronutrients was assessed utilising a validated 168-item semi-quantitative FFQ, and methyl donor micronutrient score (MDMS) was calculated. The muscle strength of the participants was measured using a digital handgrip dynamometer. The association was determined using linear regression analysis. The mean age of participants was 36·8 ± 13·2 years. After taking into account potential confounding variables, there was no significant association between dietary methyl donor micronutrient score (MDMS) and the mean left-hand muscle strength (β: 0·07, se: 0·05, P = 0·07); however, the changes were significant in the mean right-hand muscle strength (β: 0·09, se: 0·04, P = 0·03). There was also a significant positive relationship between mean muscle strength and methyl donors' intake after fully adjusting for potential confounders (β: 0·08, se: 0·04, P = 0·04). In conclusion, our findings revealed that higher dietary methyl donor micronutrient consumption is associated with enhanced muscle strength. As a result, advice on a higher intake of methyl donor-rich foods including grains, nuts, dairy products and seafood might be recommended by dietitians as a general guideline to adhere to. Additional prospective studies are needed to confirm the findings.

Association of sarcopenia with rapid kidney function decline and chronic kidney disease in adults with normal kidney function

The association between sarcopenia and kidney function remains poorly investigated. We aimed to evaluate the associations between sarcopenia status and kidney function (rapid kidney function decline and chronic kidney disease (CKD)) in middle-aged and older Chinese population. A total of 9375 participants from the China Health and Retirement Longitudinal Study 2011 were included in the cross-sectional analyses. A total of 5864 participants with eGFRcr-cys ≥ 60 ml/min per 1·73 m2 at baseline were included in the longitudinal analyses and were followed up in 2015. Sarcopenia status was defined according to the Asian Working Group for Sarcopenia 2019 criteria. In the cross-sectional analyses, possible sarcopenia and sarcopenia were significantly associated with an increased risk of CKD. During the 4 years of follow-up, 359 (6·12 %) participants experienced rapid decline in kidney function and 126 (2·15 %) participants developed CKD. After multivariable adjustment of baseline eGFRcr-cys level and other risk factors, possible sarcopenia (OR, 1·33; 95 % CI 1·01, 2·12) and sarcopenia (OR, 1·49; 95 % CI 1·05, 2·12) were associated with an increased risk of primary outcome (composite of rapid decline in kidney function (annualised decline in eGFRcr-cys ≥ 5 ml/min per 1·73 m2) and progression to CKD (eGFRcr-cys < 60 ml/min per 1·73 m2). Individuals with low muscle mass or low muscle strength alone also had an increased risk of rapid decline in kidney function and progression to CKD.

Centile reference curves of the ultrasound-based characteristics of the rectus femoris muscle composition in children at 4-11 years old

Quantitative diagnostic ultrasound has been proposed as a way to characterize muscle structure, but there is a lack of normative data for children. This study aims to establish age-specific normal ranges for echo-intensity (EI), cross-sectional area (CSA), muscular thickness (MT), and subcutaneous adipose thickness (SAT) values of the rectus femoris muscle in typically developing children. The study recruited 497 children (288 boys and 209 girls) aged 4-10.9 years (mean age 7.39 years), and muscle parameters were measured using 2D B-mode ultrasound. Percentile values and reference curves were calculated using the Lambda, Mu, and Sigma method (LMS). The results showed small variation between measurements for boys compared to girls, with the most significant difference in EI, CSA, and MT values. EI decreased with age, with the most pronounced curve in boys. SAT increased in both sexes, with a slightly higher increase in girls after the age of 9.0 years. This study provides the first age-specific reference norms for the rectus femoris muscle architecture in children, and further research is needed to validate these curves and determine their clinical utility.

Physical capacity, body composition and immune-inflammatory markers are associated with risk of cardiovascular disease in sedentary people living with HIV

BACKGROUND

People living with HIV (PLHIV) are experiencing a high level of non-HIV-related disease mainly related to cardiovascular system however the factors associated with this scenario are widely discussed and indefinite so far. The purpose was to investigate the association of physical capacities, body composition, and immune-inflammatory markers with the Framingham risk score (FRS) in PLHIV.

METHODS

Volunteers were recruited and data on age, the time of HIV infection diagnosis and the time of HAART use were collected. The volunteers performed upper limb strength (ULS), lower limb strength (LLS) and cardiorespiratory fitness (VO2peak) tests, body composition evaluation, and blood collection to immune-inflammatory marker markers and the FRS was calculated. Partial age- and sex-adjusted correlation was used to verify associations between factors and multiple linear regression analysis was performed to identify an independent association of FRS and the variables.

RESULTS

113 PLHIV met the eligible criteria and were observed a negative correlation between CD4⁺ (r=-0.615), time of HIV infection diagnosis (r=-0.237), time of HAART use (r=-0.239), ULS (r=-0.274), LLS (r=-0.213), and VO<inf>2</inf>peak (r=-0.207) with FRS. There was a positive correlation between fibrinogen and FRS (r=0.363; P<0.001). The TCD4⁺ count cells were significantly associated with FRS (P=0.001).

CONCLUSIONS

Environmental and biological HIV-related factors are inversely associated with FRS while immune-inflammation markers have a positive association.

Cumulative Muscle Strength and Risk of Cardiovascular Disease and All-cause mortality: A Prospective Cohort Study

BACKGROUND

The existing literature regarding the association between muscle strength and cardiovascular disease (CVD) and all-cause mortality relies mostly on a single measurement of muscle strength but has seldomly focused on the accumulated exposure.

OBJECTIVE

This study explored the association between cumulative muscle strength and risks of CVD and all-cause mortality in middle-aged and older adults.

METHODS

A total of 6,972 patients from the China Health and Retirement Longitudinal Study, who underwent 3 repeated measurements of muscle strength over 4 years and were followed-up for another 3 years for CVD and all-cause mortality outcomes participated in this study. Muscle strength was evaluated by grip strength and chair-rising time. Cumulative muscle strength was calculated as the area under the curve. Odds ratio (OR) and 95% confidence intervals (CIs) were analyzed.

RESULTS

The odds of CVD and all-cause mortality decreased as cumulative grip strength increased or cumulative chair-rising time decreased. For each 1 standard deviation (SD) increment in cumulative grip strength, the multivariable-adjusted OR for CVD and all-cause mortality were 0.81 (95% CI 0.73-0.91) and 0.85 (95% CI 0.73-0.99), respectively. For each 1 SD decrease in cumulative chair-rising time, the corresponding OR were 0.81 (95% CI 0.75-0.88) and 0.87 (95% CI 0.77-0.98), respectively. However, neither the change-slope of grip strength nor that of chair-rising time was related to decreased OR of CVD or of all-cause mortality.

CONCLUSIONS

Cumulative muscle strength was associated with a reduced risk of CVD and all-cause mortality in middle-aged and older Chinese adults.

Longitudinal association between grip strength and the risk of heart diseases among European middle-aged and older adults

BACKGROUND

Few multi-country European studies have investigated the association between grip strength and heart diseases incidence. Thus, the aim of this study is to analyse the longitudinal relationship between grip strength and the diagnosis of heart diseases in European middle-aged and older adults.

METHOD

A prospective cohort study was conducted using data from the Survey of Health, Aging and Retirement in Europe (2004-2017). Participants were 20,829 middle-aged and older adults from 12 countries. GS was objectively measured by a dynamometer and heart diseases diagnosis was self-reported. Incidence rate of heart diseases was calculated and a Cox proportional hazard regression was performed.

RESULTS

The heart diseases incidence rate decreased from 930 per 100,000 person-years in the lowest quartile to 380 per 100,000 person-years in the highest grip strength quartile. During the 13 years of follow-up, compared to being in the lowest grip strength quartile, being in the highest quartile decreased the hazard of being diagnosed with a heart disease in 36 % (95 % confidence interval [CI]: 0.53, 0.78) for the whole sample, 35 % (95 % CI: 0.51, 0.84) for men and 46 % (95 % CI: 0.40, 0.73) for women.

CONCLUSIONS

Grip strength seems to be inversely associated with the incidence of heart diseases among European middle-aged and older adults. Scientific evidence has highlighted the potential role of grip strength as a risk stratifying measure for heart diseases, suggesting its potential to be included in the cardiovascular risk scores used in primary care. However, further research is still needed to clarify it.

Comparison of Neck Circumference, Waist Circumference, and Skinfold Thickness in Measuring the Subcutaneous Fat Distribution and Their Association with Handgrip Strength: Cross-Sectional Study

Skinfold measurement (SKF) can accurately measure abdominal obesity and is regarded as a surrogate marker to predict non-communicable diseases. The objective of the present study was to observe the degree of association between neck circumference (NC), SKF and handgrip strength (HGS). Secondly, also to know the effects of smoking on NC, HGS and SKF. The mean and standard deviations and frequencies in percentage were analyzed, respectively. The degree of association between NC, anthropometric characters and HGS was also analyzed using the Pearson correlation. Furthermore, multiple linear regression models were used to study the degree of influence of independent variables on dependent variables. Correlation assessment for neck circumference with waist circumference and HGS revealed a weak association. While with SKF for four sites, a strong association was found. A significant regression was found among the smokers in the model (F (2, 7) = 5.2, p-value of 0.04 with an R2 of 0.598). The predictor variables, like waist and NC, can produce a variation of 59.8% in the dependent variable. Whereas, among non-smokers, an insignificant regression was seen. In conclusion, neck circumference is associated with SKF. However, a small sample size of young smokers revealed that NC and waist circumference influenced HGS.

Association between Grip Strength, Obesity, and Cardiometabolic Risk Factors among the Community-Dwelling Elderly Population in Taiwan

The aim of this study was to evaluate the association between grip strength, obesity, and cardiometabolic risk factors among elderly individuals with different grip strength statuses and weight statuses in Taiwan. We conducted a series of community-based health surveys among the elderly population in Chiayi County, Taiwan from 2017 to 2019. This is a cross-sectionally designed health check-up program that was conducted by the local public health bureau. Anthropometric characteristics, handgrip strength, diabetes, and cardiometabolic risk profiles were measured using standard methods. This study recruited 3739 subjects (1600 males and 2139 females). The non-obese subjects had lower blood glucose (BG) levels compared to the obese subjects. The BG levels of non-obese and obese subjects were 102.7 ± 25.6 mg/dL vs. 109.1 ± 34.3 mg/dL for males; and 102.8 ± 30.1 mg/dL vs. 112.5 ± 40.3 mg/dL for females (both p < 0.001). The grip strength was negatively associated with BG in both sexes (β = -0.357, p < 0.001 for males and β = -0.385, p < 0.05 for females). The relationship between the grip strength and the risk of diabetes showed that for every 1 kg increase in the grip strength, there was a 4.1% and 4.5% decrease in the risk for developing diabetes for males and females, respectively (OR = 0.959, 95% CI = 0.940-0.979 for males and OR = 0.955, 95% CI = 0.932-0.978 for females). A higher handgrip strength is associated with a lower BG level and a lower risk for diabetes mellitus in the elderly Taiwanese subjects. Additional health promotion should focus on the obese and sarcopenic population to prevent cardiometabolic comorbidities in later life.

Dietary Essential Amino Acid Intake Is Associated with High Muscle Strength in Korean Older Adults

The relationship between daily dietary intake of an individual or all essential amino acids (EAAs) and muscle strength in older adults is still inadequately characterized. This population-based cross-sectional study included 5971 participants aged ≥65 years from the 2014–2019 Korea National Health and Nutrition Examination Survey. Dietary information was derived from the 24 h recall data. Total essential amino acid score (EAAS) was calculated with an intake that satisfied the recommended nutrient intake (RNI) in each essential amino acid (EAA). The mean handgrip strength was estimated from triplicate measurements obtained using the dominant hand, and high muscle strength was defined as handgrip strength ≥28 kg for men and ≥18 kg for women. Multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression models. After multivariable adjustment, we found that a high total EAAS was associated with high muscle strength in Korean older adults (OR: 1.38, 95% CI: 1.07–1.79). High muscle strength was significantly enhanced with increased total EAA intake from animal sources (OR: 1.27, 95% CI: 1.02–1.58), but there was no significant association with total EAA intake from non-animal sources. EAA intake and high muscle strength are associated based on a positive dose-response relationship in which high muscle strength is further increased when the overall EAA intake meets the RNI. Thus, Korean older adults should ensure an adequate intake of all EAAs from various food sources (especially animal sources) to meet the RNI as a prerequisite for achieving high muscle strength.

Assessment of Muscle Quantity, Quality and Function

Sarcopenia is a syndrome characterized by loss of skeletal muscle mass and strength that can increase the risk of physical disability, chronic conditions such as diabetes mellitus and cardiovascular diseases, and long-term mortality. Sarcopenia adversely affects not only the elderly population, but also young adults. This review provides updated definitions of sarcopenia and recommendations for the assessment of muscle quantity and quality.

Mediation of Grip Strength on the Association Between Self-Rated Health and Estimated Cardiovascular Disease Risk

Background: Grip strength and self-rated health (SRH) have been reciprocally related, and each has been associated with cardiovascular disease (CVD) risk. However, the pathway between SRH and grip strength in the association with CVD risk remains uncertain. This cross-sectional study evaluated whether grip strength mediates the association between SRH and estimated CVD risk. Methods: In 15,930 Koreans 40-79 years of age without CVD history from the 2014 to 2018 Korea National Health and Nutrition Examination Survey, the risk of 10-year atherosclerotic cardiovascular disease (ASCVD) was calculated using Pooled Cohort Equations. Relative grip strength (RGS) was defined as measured grip strength divided by body mass index. SRH was assessed using a single questionnaire. Results: After adjusting for the covariates, males in the non-highest RGS tertiles, the fair/poor/very poor SRH groups, or the other joined categories of RGS tertiles and SRH groups (except the highest RGS tertile and good SRH group) had higher odds for 10-year ASCVD risk ≥7.5% than the reference group. The ASCVD risk was higher in females in the lowest RGS tertile, the poor/very poor SRH group, or the combined category of lowest RGS tertile and poor SRH group than the reference group. RGS significantly mediated the relationship between better SRH and the lower ASCVD risk (indirect effect: β = -0.078, 95% CI [-0.097 to -0.060], P < 0.05) and reduced the total effect of SRH on the ASCVD risk (direct effect: β = -0.225, t = -3.203, P = 0.001). RGS mediated 26% of the association between SRH and ASCVD risk. Conclusion: Grip strength may have a mediating role in the relationship between SRH and the estimated 10-year risk of ASCVD.

Machine learning-based diagnosis and risk factor analysis of cardiocerebrovascular disease based on KNHANES

The prevalence of cardiocerebrovascular disease (CVD) is continuously increasing, and it is the leading cause of human death. Since it is difficult for physicians to screen thousands of people, high-accuracy and interpretable methods need to be presented. We developed four machine learning-based CVD classifiers (i.e., multi-layer perceptron, support vector machine, random forest, and light gradient boosting) based on the Korea National Health and Nutrition Examination Survey. We resampled and rebalanced KNHANES data using complex sampling weights such that the rebalanced dataset mimics a uniformly sampled dataset from overall population. For clear risk factor analysis, we removed multicollinearity and CVD-irrelevant variables using VIF-based filtering and the Boruta algorithm. We applied synthetic minority oversampling technique and random undersampling before ML training. We demonstrated that the proposed classifiers achieved excellent performance with AUCs over 0.853. Using Shapley value-based risk factor analysis, we identified that the most significant risk factors of CVD were age, sex, and the prevalence of hypertension. Additionally, we identified that age, hypertension, and BMI were positively correlated with CVD prevalence, while sex (female), alcohol consumption and, monthly income were negative. The results showed that the feature selection and the class balancing technique effectively improve the interpretability of models.

Calf Circumference and All-Cause Mortality: A Systematic Review and Meta-Analysis Based on Trend Estimation Approaches

OBJECTIVES

To perform a systematic review and meta-analysis and quantify the associations of total mortality with calf circumference (CC) in adults 18 years and older via combining various analyses based on empirical dichotomic CC, continuous CC, and dose-response CC.

METHODS

We conducted a systematic search of relevant studies in PubMed, EMBASE, Cochrane Library, and Web of Science published through April 12, 2022. This systematic review includes longitudinal observational studies reporting the relationships of total mortality with CC. We calculated the pooled relative risk (RR) and 95% confidence interval (CI) of total mortality with CC per 1 cm for each study and combined the values using standard meta-analysis approaches. Newcastle-Ottawa scale (NOS), Grading of Recommendations, Assessment, Development and Evaluations approach (GRADE), and the Instrument for assessing the Credibility of Effect Modification Analyses (ICEMAN) were assessed for meta-analyses.

RESULTS

Our analysis included a total of 37 cohort studies involving 62,736 participants, across which moderate heterogeneity was observed (I2=75.7%, P<0.001), but no publication bias was found. Study quality scores ranged from 6 to 9 (mean 7.7), with only three studies awarded a score of 6 (fair quality). We observed an inverse trend between total death risk and CC per 1 cm increase (RR, 0.95, 95% CI, 0.94-0.96; P<0.001; GRADE quality=high). Only a very slight difference was found among residents of nursing homes (6.9% mortality risk reduction per one cm CC increase), community-dwellers (5.4%), and those living in hospitals (4.8%), respectively (P for meta-regression=0.617). Low credible subgroup difference was found based on the ICEMAN tool.

CONCLUSIONS

Calf circumference is a valid anthropometric measure for mortality risk prediction in a community, nursing home, or hospital.

Dietary Calcium Intake and Fat Mass in Spanish Young Adults: The Role of Muscle Strength

Obesity is declared as a chronic multifaceted health problem, and young adults may be particularly vulnerable to weight gain. This study aims to identify the role of dietary calcium intake and the muscle strength index in handling excess of fat mass in young adults and to examine if the relationship between dietary calcium intake and fat mass percentage is mediated by muscle strength. A cross-sectional study including 355 Spanish college students (aged 21.05 ± 3.11) was performed during the 2017–2018 academic year. Pearson correlation coefficients were estimated to determine the relationship between dietary calcium intake, fat mass percentage, body mass index, muscle strength components, and total energy intake. ANCOVA models were used to analyze the differences in the muscle strength index by total dietary calcium intake categories, as well as the differences in % fat mass by total dietary calcium intake and muscle strength index categories, controlling for different sets of confounders. A mediator analysis was conducted to test if the relationship between dietary calcium intake and fat mass percentage was explained by muscle strength. Data on the fat mass percentage, dietary calcium intake, and muscle strength index as the sum of the standardized z-score of the standing long jump and z-score of handgrip/weight were collected. The muscle strength index was significantly better in young adults with higher dietary calcium intake. Moreover, the fat mass percentage was significantly lower in those with a higher dietary calcium intake and a better muscle strength index. Finally, the relationship between dietary calcium intake and fat mass percentage was fully mediated by muscle strength (z = −1.90; p < 0.05), explaining 33.33% of this relationship. This study suggests that both a major dietary calcium intake and muscle strength are associated with fat mass percentage. Moreover, muscle strength mediates the link between dietary calcium intake and fat mass percentage. Therefore, both high dietary calcium intake and exercise activities aimed at improving muscle strength levels may help to prevent the cardiometabolic risk associated with an excess of fat mass in young people.

Association of skeletal muscle and cardiovascular risk factors in patients with lower extremity arterial disease

BACKGROUND

Sarcopenia is defined as low muscle mass, with low muscle strength or low physical performance. The skeletal muscle mass (or density) and strength are inversely associated with cardiovascular risk factors. We aim to determine the relationship between skeletal muscle characteristics (strength, mass, area), and cardiovascular risk factors in a population with lower extremity artery disease (LEAD) METHODS: : An observational, prospective study including patients with LEAD was conducted from January 2018 to December 2020. The cardiovascular risk factors and anthropometric measurements were prospectively registered. The skeletal muscle characteristics (area, density/mass and strength) were analysed. The skeletal muscle area and density were quantified with a CT scan. The strength was determined with a Jamar® hydraulic hand dynamometer.

RESULTS

96 patients with LEAD with 67.70± 10.11 years-old were enrolled in the study. The most prevalent cardiovascular risk factor was hypertension, followed by dyslipidemia and diabetes. Patients with diabetes had a lower handgrip strength and skeletal muscle density, when compared with patients without diabetes (strength: 19.67± 9.98 kgf versus 26.79 ± 11.80 kgf, p=0.002 and skeletal muscle density: 10.58 ± 17.61 HU versus 18.17 ± 15.33 HU, p=0.032). There was a trend for the association between the presence of cardiovascular risk factors (hypertension and dyslipidemia) and a decrease in skeletal muscle density and strength (density: hypertension: 13.46 ± 16.74 HU versus 20.38 ± 11.63 HU p=0.055; dyslipidemia: 13.57 ± 17.16 HU versus 17.74 ± 13.00 HU p=0.315; strength- hypertension: 22.55 ± 10.08 kgf versus 27.58 ± 15.11 p= 0.073; dyslipidemia: 22.80 ± 10.52 kgf versus 25.28 ± 13.14 kgf p=0.315). Interestingly, we found that smokers had a favorable skeletal muscle characteristic, which could be explained by the higher prevalence of diabetes in non-smokers.

CONCLUSIONS

The indicators of skeletal muscle dysfunction (strength and density) are associated to the presence of diabetes in patients with LEAD. Therapeutic strategies to improve the skeletal muscle characteristics could have a role in improving LEAD risk factors, particularly diabetes.

The triglyceride-glucose index is a more powerful surrogate marker for predicting the prevalence and incidence of type 2 diabetes mellitus than the homeostatic model assessment of insulin resistance

AIMS

Insulin resistance is an independent risk factor for developing type 2 diabetes. Therefore, this study compared the predictability of the triglyceride-glucose (TyG) index and the homeostatic model assessment of insulin resistance (HOMA-IR) for the prevalence and incidence of type 2 diabetes.

METHODS

We analyzed data from 9730 adults aged 40-69 years at baseline and 7783 participants without diabetes who were followed up in the Korean Genome and Epidemiology Study survey. From 2001 to 2002 (baseline survey) to 2013-2014, this survey was conducted biennially (six follow-ups). The average follow-up period was 9.0 years.

RESULTS

The TyG index showed better predictability for the prevalence of type 2 diabetes than HOMA-IR (TyG index: 0.784, HOMA-IR: 0.728, p < 0.001). The area under the time-dependent receiver operating characteristic curve of the TyG index for incident type 2 diabetes was 0.640 (0.628-0.652), which was significantly higher than that of HOMA-IR [0.531 (0.521-0.541)] (p < 0.001).

CONCLUSIONS

The TyG index is superior to HOMA-IR for predicting type 2 diabetes. The TyG index could, therefore, be more useful for the early detection and prevention of type 2 diabetes.

Mediation and Moderation of Adiposity Indicators for the Association Between Grip Strength and Cardiovascular Disease Risk Scores

Background: This cross-sectional study evaluated mediation or moderation of adiposity indicators on the association between handgrip strength (HGS) and the 10-year cardiovascular disease risk scores (CVDR). Methods: In data of 15,206 Korean adults (6961 men and 8245 women) aged ≥30 years using the Korea National Health and Nutrition Examination Survey, HGS, body mass index (BMI), height, waist circumference, the components of Framingham CVDR, and covariates (sociodemographic factors, health behaviors, perceived stress, health, functional status, and nutritional status) were used. BMI, waist circumference, and waist-to-height ratio were used as adiposity indicators. Gender-specific general linear model and PROCESS Macro were applied. Results: HGS had an inverse association with the CVDR after adjusting for the covariates and BMI (or waist circumference), while adiposity indicators had positive associations with the CVDR after adjusting for the covariates and HGS. Mediation analysis shows indirect effects of adiposity indicators (0.010-0.019, P < 0.05) and direct effect of HGS on the CVDR (-0.08 to -0.09, P < 0.05) after adjusting for the covariates. Moderation analysis reveals positive interactions between HGS and adiposity indicators in the relationship with the CVDR after adjusting for the covariates (P < 0.05). The inverse association between the HGS and the CVDR tended to be stronger with decrease in adiposity levels. Conclusions: Adiposity indicators mediated and moderated the association between HGS and the CVDR in Koreans. The moderating effects indicate that the lower the levels of the adiposity indicators, the stronger the CVDR improvement effect of HGS.

Dynamics of Serum Retinol and Alpha-Tocopherol Levels According to Non-Alcoholic Fatty Liver Disease Status

The available data on the association between micronutrients in the blood and non-alcoholic fatty liver disease (NAFLD) are limited. To investigate the clinical implications of this relationship, we sought to identify the difference in the serum levels of vitamins A and E according to NAFLD status using data from the seventh Korea National Health and Nutrition Examination Survey. In this cross-sectional study of the Korean population, NAFLD and its severity were defined using prediction models. Differences in the prevalence and severity of NAFLD were analyzed according to serum retinol (vitamin A) and alpha (α)-tocopherol (vitamin E) levels. Serum levels of retinol and α-tocopherol were positively correlated with the prevalence of NAFLD. In most prediction models of the NAFLD subjects, serum retinol deficiency was significantly correlated with advanced fibrosis, while serum α-tocopherol levels did not differ between individuals with or without advanced fibrosis. Similar trends were also noted with cholesterol-adjusted levels of α-tocopherol. In summary, while circulating concentrations of retinol and α-tocopherol were positively associated with the presence of NAFLD, advanced liver fibrosis was only correlated with serum retinol levels. Our findings could provide insight into NAFLD patient care at a micronutrient level.

Relationship Between Sarcopenia and Electrocardiographic Abnormalities in Older People: The Bushehr Elderly Health Program

Background: Sarcopenia is characterized by low skeletal muscle mass and function, which is associated with cardiovascular risk factors and may even be related to adverse cardiovascular events and mortality. This study aimed to evaluate whether sarcopenia is related to electrocardiographic (ECG) abnormalities in a large sample of older adults.

Methods: We performed a cross-sectional study based on the data collected during the Bushehr Elderly Health (BEH) cohort study. Body composition was measured by dual X-ray absorptiometry (DXA) and muscle strength was measured using a digital dynamometer for each hand of every participant. A person who had low muscle strength, as well as low muscle mass was identified as having sarcopenia. The subjects were classified into three groups according to the Minnesota Code (MC) as major, minor ECG abnormalities and participants with no abnormalities ECG.

Results: Of the 2,426 participants, 354 (14.6%) had major ECG abnormalities and 193 (8%) had minor ECG abnormalities. Sarcopenia was associated with an increased risk of major ECG abnormality in all models. After adjustment for confounders of CHD in full model, the OR for major ECG abnormality was 1.47 (95% CI 1.11–1.95) in those with sarcopenia. Low muscle strength and low muscle performance were both with an increased risk of major ECG abnormality in all models. Sarcopenia and low muscle strength increased 28% and 62% risk of any ECG abnormality in the full models [sarcopenia: 1.28(1.01–1.63), low muscle strength: 1.62(1.30–2.03)], respectively.

Conclusions: This study showed that sarcopenia and its components are associated with ECG abnormalities in Iranian older people. Although some older adults have higher cardiovascular risk factors, these data showed that further factors such as sarcopenia may be identified as a particular risk factor for future cardiovascular events. Therefore, sarcopenia could be added to the screening of the older population to reduce the risk of cardiovascular events.

Cancer Survivors with Low Hand Grip Strength Have Decreased Quality of Life Compared with Healthy Controls: The Korea National Health and Nutrition Examination Survey 2014-2017

BACKGROUND

Cancer survivors experience decreased physical function and reduced muscle strength, which leads to lower quality of life (QOL). The hand grip strength (HGS) can be a predictor of poor health-related QOL as a parameter of sarcopenia. The purpose of this study was to investigate the relationship between low HGS and QOL in cancer survivors and healthy controls.

METHODS

We analyzed 392 cancer survivors and 1,176 healthy controls from the Korea National Health and Nutrition Examination Survey, 2014-2017. We defined low HGS as 2 standard deviation values for healthy young Korean adults from a previous study. QOL was evaluated using the European Quality of Life Scale-Five Dimensions. A complex sample logistic regression model was used to assess the relationship between each dimension of low HGS and QOL.

RESULTS

The odds ratios (ORs) for decreased QOL were significantly higher in male cancer survivors with low HGS on self-care (OR, 8.51; 95% confidence interval [CI], 1.69-42.83) and usual activities (OR, 6.63; 95% CI, 1.22-36.03). The ORs for problems in mobility (OR, 5.87; 95% CI, 2.04-16.91), usual activities (OR, 14.46; 95% CI, 3.84-54.44), pain/discomfort (OR, 4.90; 95% CI, 2.00-12.01), and anxiety/depression (OR, 6.43; 95% CI, 2.16-19.12) were significantly high in female cancer survivors with low HGS. However, healthy controls showed no significant relationship between low HGS and QOL.

CONCLUSION

For cancer survivors, low HGS was associated with poor QOL in some domains. Strategies to increase muscle strength must be considered to improve the QOL of cancer survivors.

Relative Handgrip Strength as Marker of Cardiometabolic Risk in Women with Systemic Lupus Erythematosus

This study aimed to examine the association of relative handgrip strength (rHGS) with cardiometabolic disease risk factors in women with systemic lupus erythematosus (SLE). Methods: Seventy-seven women with SLE (mean age 43.2, SD 13.8) and clinical stability during the previous six months were included. Handgrip strength was assessed with a digital dynamometer and rHGS was defined as absolute handgrip strength (aHGS) divided by body mass index (BMI). We measured blood pressure, markers of lipid and glucose metabolism, inflammation (high sensitivity C-reactive protein [hs-CRP]), arterial stiffness (pulse wave velocity [PWV]), and renal function. A clustered cardiometabolic risk index (z-score) was computed. Results: Pearson′s bivariate correlations revealed that higher rHGS was associated with lower systolic blood pressure (SBP), triglycerides, hs-CRP, PWV, and lower clustered cardiometabolic risk (r_range = from −0.43 to −0.23; all p < 0.05). Multivariable linear regression analyses adjusted for age, disease activity (SLEDAI), and accrual damage (SDI) confirmed these results (all p < 0.05) except for triglycerides. Conclusions: The findings suggest that higher rHGS is significantly associated with lower cardiometabolic risk in women with SLE.

Association of circulating C-reactive protein and high-sensitivity C-reactive protein with components of sarcopenia: A systematic review and meta-analysis of observational studies

BACKGROUND

Sarcopenia, a multi-faceted skeletal muscle disorder in the older population, has poor health outcomes. Some previous observational studies investigated the association between circulating inflammatory markers and sarcopenia components to evaluate chronic inflammation as a risk factor for sarcopenia in the elderly population. Nevertheless, the association between circulating C-reactive protein (CRP) and hs-CRP, as the recognized markers of systemic inflammation and components of sarcopenia, is unclear. This meta-analysis aimed to investigate the association of muscle strength, muscle mass, and muscle function with two serum inflammatory markers, circulating C-reactive protein (CRP) and high-sensitive CRP (hs-CRP).

METHODS

We assessed all observational studies across different electronic databases including PubMed, Scopus, and Google Scholar using keywords such as "muscle strength", "muscle mass", "muscle function", CRP and hs-CRP from inception until the 30th of July 2019. Only studies that investigated the association between components of sarcopenia and CRP or hs-CRP levels were included. Participants' country, age, sex, BMI, and screening tool for sarcopenia were retrieved. The correlations between muscle strength, muscle mass, and muscle function with CRP, and hs-CRP were expressed as the correlation coefficient (r) with 95% confidence intervals (CIs). Begg's test and Egger's test were conducted to evaluate risk of publication bias in this study.

RESULTS

Initially, we found fifty-nine studies for the qualitative synthesis. Ultimately, nineteen adult cross-sectional studies comprising 14,650 subjects were included in the meta-analysis. Of them, fourteen studies measured the correlation between CRP or hs-CRP and muscle strength. There were significant inverse correlation between CRP and hs-CRP concentrations with muscle strength (ES (z) = -0.22; 95% CI = -0.34 to -0.09; P < 0.001), (ES (z) = -0.22; 95% CI = -0.34 to -0.09; P < 0.001), respectively. No publication bias was found between muscle strength and CRP (P = 0.53) or hs-CRP (P = 0.62) respectively.

CONCLUSION

Among diagnostic components of sarcopenia, impairment of muscle strength was independently associated with both inflammatory biomarkers. However, future cohort studies are essential to clarify the causal correlation.

A cross-sectional study investigating the relationship between handgrip strength with multimorbidity in Korean adults: Findings from the Korea National Health and Nutrition Examination Survey VI-VII (2014-2017)

To date research investigating the associations between handgrip strength and multimorbidity when stratifying by age and sex is limited. Furthermore, this is the first study in a Korean population, and the first to include adults ≥ 19 years of age. Here we investigated the associations between handgrip strength and multimorbidity in Korean adults aged ≥ 19 years.In this cross-sectional study data from the Korean National Health and Nutrition Examination Survey were used. Multimorbidity was defined as having 2 or more chronic diseases. A total of 19,779 participants were eligible for the study (8730 male and 11,049 female). We grouped and analysed participants based on age and sex (men and women aged 19-49 years, men and women aged 50-80 years) and examined the associations between handgrip strength and multimorbidity using multivariate logistic regressions using stratification by age, sex and body mass index (BMI).Multivariate logistic regressions revealed a significant inverse association irrespective of sex, between relative handgrip strength and multimorbidity. Participants with the lowest handgrip strength had a significantly higher odds ratio (OR) of multimorbidity (men aged 19-49 years: 3.76 and aged 50 years to 80 years: 2.11; women aged 19 years to 49 years: 1.52 and aged 50-80 years: 2.15) when compared to those with highest handgrip strength after adjusting for confounding variables. The highest OR was observed in men aged 19 years to 49 years with a BMI ≥ 25 kg/m2.In the current study we observed a significant inverse relationship between handgrip strength and multimorbidity in males and females with 2 or more chronic diseases. Male participants with a low handgrip strength aged between 19 years to 49 years with a BMI ≥25 kg/m2 may be at greater risk of multimorbidity. This study highlights the need for further longitudinal studies to investigate the effects of increasing handgrip strength combined with weight loss, as an effective strategy to reduce the incidence of multimorbidity.

Socioeconomic and behavioral determinants of cardiovascular diseases among older adults in Belgium and France: A longitudinal analysis from the SHARE study

Despite advances in the healthcare system, cardiovascular diseases (CVDs) are still an important public health problem with disparities in the burden within and between countries. Studies among the adult population documented that socioeconomic and environmental factors play a role in the incidence and progression of CVDs. However, evidence is scarce on the socioeconomic determinants and the interplay with behavioral risks among older adults. Therefore, we identified socioeconomic and behavioral determinants of CVDs among older adults. Our sample consisted of 14,322 people aged 50 years and above from Belgium and France who responded to the waves 4, 5, 6 and/or 7 of the Survey of Health Ageing and Retirement in Europe. The effect of determinants on the occurrence of CVD was examined using a Generalized Estimating Equation (GEE) approach for binary longitudinal data. The overall rate of heart attack was 8.3%, which is 7.6% in Belgium and 9.1% in France. Whereas, 2.6% and 2.3% in Belgium and France, respectively, had experienced stroke. In the multivariable GEE model, older age [AOR: 1.057, 95%CI: 1.055-1.060], living in large cities [AOR: 1.14, 95%CI: 1.07-1.18], and retirement [AOR: 1.21, 95%CI: 1.16-1.31] were associated with higher risk of CVD. Furthermore, higher level of education [AOR: 0.82, 95%CI: 0.79-0.90], upper wealth quantile [AOR: 0.82, 95%CI: 0.76-0.86] and having social support [AOR: 0.81, 95%CI: 0.77-0.84] significantly lowers the odds of having CVD. A higher hand grip strength was also significantly associated with lower risk of CVD [AOR: 0.987, 95%CI: 0.984-0.990]. This study demonstrated that older adults who do not have social support, live in big cities, belong to the lowest wealth quantile, and have a low level of education have a higher likelihood of CVD. Therefore, community-based interventions aimed at reducing cardiovascular risks need to give more emphasis to high-risk retired older adults with lower education, no social support and those who live in large cities.

Associations between Health-Related Physical Fitness and Cardiovascular Disease Risk Factors in Overweight and Obese University Staff

PURPOSE

This cross-sectional study examined the associations between health-related physical fitness (HPF) and cardiovascular disease (CVD) risk factors in overweight and obese university staff.

METHODS

A total of 340 university staff (109 women, mean age 43.1 ± 9.7 years) with overweight (n = 284) and obesity (n = 56) were included. The HPF indicators included skeletal muscle mass index (SMI), body fat percentage (BFP), grip strength (GS), sit-and-reach test (SRT), and vital capacity index (VCI). CVD risk factors were measured, including uric acid (UA), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and glucose (GLU).

RESULTS

BFP, SMI, and GS were positively associated with UA level (β = 0.239, β = 0.159, β = 0.139, p < 0.05). BFP was positively associated with TG and TG/HDL-C levels (β = 0.421, β = 0.259, p < 0.05). GS was positively associated with HDL-C level (β = 0.244, p < 0.05). SRT was negatively associated with GLU level (β = -0.130, p < 0.05).

CONCLUSIONS

In overweight and obese university staff, body composition, muscle strength, and flexibility were associated with CVD risk factors. An HPF test may be a practical nonmedical method to assess CVD risk.

The Generality of Strength: Relationship between Different Measures of Muscular Strength in Older Women

The aims of this study were: (i) to analyze the relationship between the performance of different measures of muscular strength, and (ii) to identify which measurements present a greater relationship with an overall strength score. Sixty older women (aged 69 ± 6 years) were submitted to muscular strength measurements from isotonic, isokinetic, and isometric tests. An overall-strength score was generated with z-scores of the values obtained in all tests. Interquartile intervals were created for each measure and the overall-strength score. Pearson's r (0.463-0.951, p < 0.05) and Cronbach's α (0.500-0.966) suggested that subjects had relatively similar strength performance compared to their peers in the different tests. Greater associations were observed between tests for similar tasks. In addition, strong-magnitude associations were revealed between all the tests and the overall-strength score (r = 0.710-0.806; α = 0.760-0.846). Factor analysis identified that only two principal components may be sufficient to explain the strength of the sample. All strength measures had high loadings (0.716-0.916) on a common factor with 1 component. The associated eigenvalue with 2 components was 6.8 (84% of the variance). The present results support the phenomenon of the generality of strength in older women. Although greater correlations were observed for tests performed at the same joint, movement, or type of muscular action, the eight tests satisfactorily represented a measure of general muscular strength cross-sectionally.

Association between tooth loss and handgrip strength in a general adult population

Tooth loss is a prevailing condition in China due to the high prevalence of oral diseases. Since previous studies explored the association between tooth loss and handgrip strength showed incongruous results, the aim of this study was to investigate the association between tooth loss and handgrip strength in Tianjin, China. Cross-sectional data in the present study used baseline data of Tianjin Chronic Low-grade Systemic Inflammation and Health (TCLSIH) Cohort Study during 2013–2016. Eligible adults (n = 26275) were classified into four groups depending on the number of missing teeth (excluding third molars): 0, 1–2, 3–5 and ≥6. Handgrip strength was measured using a handheld type dynamometer. Analysis of covariance was used to examine the relationships between tooth loss and handgrip strength and handgrip strength per body weight according to gender. After adjustment for potential confounders, the relationships existed between increasing categories of tooth loss and handgrip strength, as well as handgrip strength per weight. The data of stratified analysis showed that there was a trending association between decreased handgrip strength and fewer retained teeth both in males and females less than 60 years of age (P for trend <0.01); whereas no significant association 60 years of age or older. Moreover, loss of more than 3 teeth was significantly associated with reduced muscle strength (P <0.01). Tooth loss is independently associated with handgrip strength in Chinese adults less than 60 years of age.

Physical Fitness and Dyslipidemia Among Japanese: A Cohort Study From the Niigata Wellness Study

BACKGROUND

Grip strength reflects systemic muscle strength and mass and is reportedly associated with various metabolic variables. However, its prognostic association with dyslipidemia is unknown. We examined the association of grip strength and other physical fitness markers with the incidence of dyslipidemia among Japanese adults.

METHODS

A total of 16,149 Japanese (6,208 women) individuals aged 20-92 years who underwent a physical fitness test between April 2001 and March 2002 were included in this cohort study. Grip strength, vertical jump, single-leg balance with eyes closed, forward bending, and whole-body reaction time were evaluated at baseline. Dyslipidemia was annually determined based on fasting serum lipid profiles and self-reported dyslipidemia from April 2001 to March 2008.

RESULTS

During the follow-up period, 4,458 (44.9%) men and 2,461 (39.6%) women developed dyslipidemia. A higher relative grip strength (grip strength/body mass index) was associated with a lower incidence of dyslipidemia among both men and women (P for trend <0.001). Compared with those for the first septile, the hazards ratios and 95% confidence intervals (CIs) for the seventh septile were 0.56 (95% CI, 0.50-0.63) for men and 0.69 (95% CI, 0.58-0.81) for women. Moreover, relative vertical jump (vertical jump strength/body mass index) was also inversely associated with the incidence of dyslipidemia among both men and women (P for trend <0.001). There was no association between other physical fitness and dyslipidemia among both men and women.

CONCLUSION

Relative grip strength and vertical jump may be useful risk markers of the incidence of dyslipidemia.

Metabolic syndrome and weight status may modify the inverse association between handgrip strength and C-reactive protein in Korean adults

Metabolic and weight phenotype-specific relationships between high-sensitivity C-reactive protein (hsCRP) and handgrip strength (HGS) may compare the phenotypes that can potentially influence association between HGS and hsCRP risk. However, these phenotype-related differences remain unclear. The present study investigated the associations between HGS assessed using raw HGS of each hand and relative HGS (HGS/body mass index [BMI]) and hsCRP status according to metabolic and weight phenotypes. In 15 061 Korean adults (50.8 ± 16.6 years) with complete data from the Korea National Health and Nutrition Examination Survey from 2015 to 2017, hsCRP levels were classified into high risk (>3 mg/L) vs low to average risk. Metabolic and weight phenotypes were categorized into 6 groups according to the number of metabolic syndrome (MetS) components (0/1-2/3-4) and the absence/presence of obesity (BMI ≥ 25 kg/m²). After adjusting for confounding factors (demographics, treatment of concurrent illnesses, and health-related behaviors), high-risk hsCRP had inverse associations with HGS values, whereas it had positive associations with phenotypes having higher number of MetS components and higher BMI in both sexes. In both men and women, increases of all HGS were not associated with high-risk hsCRP in the nonobese phenotype without MetS components after adjusting for confounding factors. However, those increases in HGS had inverse associations with high-risk hsCRP in either men or women with at least 1 MetS component, regardless of coexistent weight status, and those with obesity, regardless of coexistent MetS components. In conclusion, strong HGS may be more favorable for individuals with high-risk hsCRP when they have obesity or metabolically unhealthy phenotypes.

The Differential Association between Muscle Strength and Diabetes Mellitus According to the Presence or Absence of Obesity

Background

Muscle strength can be affected by body mass index. In the present study, we compared the association between the diabetes mellitus (DM) and muscle strength according to obesity.

Methods

We analyzed the association between DM and muscle strength using the Korea National Health and Nutrition Examination Survey 2014 to 2016 data weighted to represent the Korean population aged between 30 and 79 years old. Muscle strength was classified into age- and sex-specific quartiles (Qs) of handgrip strength, with the lowest Q defined as “low muscle strength (LMS).”

Results

Muscle strength was positively associated with body mass index in both sexes (P<0.001); the prevalence of obesity increased by 30% in male (odds ratio [OR], 1.300; 95% confidence interval [CI], 1.231–1.373) and 12% in female (OR, 1.122; 95% CI, 1.062–1.185), respectively, per one Q of muscle strength. In contrast, the prevalence of DM decreased as muscle strength increased (OR per one Q, 0.926; 95% CI, 0.862–0.996 in male and OR per one Q, 0.917; 95% CI, 0.854–0.986 in female). LMS was significantly associated with DM even following adjustment for age, sex, family history of DM, abdominal obesity, dyslipidemia, and hypertension (OR, 1.328; 95% CI, 1.133–1.558). Stratified analysis according to obesity status showed that it remained significant only in nonobese populations (OR, 1.513; 95% CI, 1.224–1.870 in nonobese participants and OR, 1.124; 95% CI, 0.879–1.437 in obese participants).

Conclusion

LMS was independently associated with DM in the Korean population aged between 30 and 79 years. However, obesity-stratified analysis revealed that it was significant only in the nonobese population.

Handgrip strength, depression, and all-cause mortality in Korean older adults

Background

Decreased muscle strength and/or depression with aging are emerging as important public health concerns in both developed and developing countries. This study investigated the effects of low handgrip strength (HGS) and depression on the risk of all-cause mortality in Korean older adults.

Methods

Data from 13,901 Korean adults (57% women) who participated in the 2008 baseline survey and completed the 2011 follow-up assessments were used.

Results

In total, the current findings showed that individuals with depression only and individuals with low HGS plus depression had significantly higher risks of all-cause mortality (hazard ratio (HR) = 1.366, 95% confidence interval (CI) = 1.033–1.807, p = 0.029 and HR = 1.961, 95% CI = 1.409–2.736, p < 0.001, respectively) even after adjustments for all the measured covariates, compared with individuals with high HGS plus no depression (HR = 1). Gender-stratified analysis showed that men with depression only and men with depression plus low HGS had significantly higher risks of all-cause mortality (HR = 1.376, 95% CI =1.029–1.841, p = 0.031 and HR = 1.861, 95% CI = 1.306–2.651, p = 0.001, respectively) even after adjustments for all the measured covariates, compared with individuals with no depression plus high HGS (HR = 1). In women, however, the joint effect of depression and low HGS only remained significant at borderline (HR = 2.603, 95% CI = 0.981–6.908, p = 0.055) when adjusted for all the confounders.

Conclusion

The current finding suggested that depression and low HGS were significantly and synergistically associated with the increased risk of premature death from all causes in the Korean geriatric population.

Handgrip strength, chronic physical conditions and physical multimorbidity in middle-aged and older adults in six low- and middle income countries

PURPOSE

Handgrip strength provides a clinically validated marker of overall health and mortality risk. There are however, no multi-national population-based studies investigating the associations between handgrip strength, chronic physical conditions, and physical multimorbidity (i.e., ≥2 chronic conditions). We aimed to assess these associations among community-dwelling middle-aged and older adults using nationally representative data from six in low- and middle-income countries (LMICs).

METHODS

Cross-sectional, community-based data on individuals aged ≥50 years from the World Health Organization's Study on Global Ageing and Adult Health were analyzed. Eleven chronic physical conditions (angina, arthritis, asthma, chronic back pain, chronic lung disease, diabetes, edentulism, hearing problems, hypertension, stroke, visual impairment) were assessed. Weak handgrip strength was defined as <30 kg for men and <20 kg for women. Multivariable logistic regression analysis was conducted.

RESULTS

The final sample included 34,129 individuals (62.4 ± 16.0 years; 52.1% female). After adjustment for potential confounders, when compared to those with no chronic physical conditions, having 1, 2, 3, and ≥4 physical chronic conditions was associated with 1.22 (95%CI = 1.08-1.37), 1.29 (95%CI = 1.11-1.50), 1.41 (95%CI = 1.18-1.68), and 1.78 (95%CI = 1.46-2.18) times higher odds for weak handgrip strength. Similar associations were observed in the analyses stratified by age and sex. There was a moderate level of between-country heterogeneity in the association between weak handgrip strength and physical multimorbidity (Higgin's I² = 67.8%) with the pooled estimate being 1.26 (95%CI = 1.06-1.50).

CONCLUSION

Weaker handgrip strength is associated with a range of chronic physical conditions and multimorbidity. Future research should seek to establish the predictive value of this inexpensive measure for clinical use.

Handgrip Strength and All-Cause Mortality in Middle-Aged and Older Koreans

Aging-related decline in handgrip strength has been associated with adverse functional and metabolic morbidity and mortality. Korea is one of the fastest aging countries, and the prospective relationship of handgrip strength with all-cause mortality in Korean adults has not been studied. We conducted a prospective observation study to examine whether baseline handgrip strength predicted mortality over eight years of follow-ups in Korean adults aged 45 years or older. We analyzed the nationwide survey data based on 9393 Korean adults (mean age of 61 ± 10.7 years) from the 2006–2014 Korean Longitudinal Study of Aging. The mean handgrip strength values measured using a dynamometer, and were divided into quartiles for each gender. Cox models were conducted in order to estimate the hazard ratios (HRs) of all-cause mortality with 95% confidence intervals (CIs) in relation to handgrip strength adjusting for covariates. There was a robust independent relationship between a weaker handgrip strength and higher all-cause mortality in both women and men, adjusting for selected covariates (e.g., age, income, smoking, exercise, and comorbidities). Compared to the strongest quartile (i.e., reference), women and men in the weakest group had higher HRs of mortality, 2.5 (95% CI: 1.7–3.8) vs. 2.6 (95% CI: 1.8–3.9), respectively. The robust independent relationships between weaker handgrip strength and higher all-cause mortality found in the study suggest that simply assessing and monitoring the handgrip strength during adulthood demonstrates great potentials for the public health of aging populations, and protects against premature death in Korean adults.

Association of Relative Handgrip Strength and Metabolic Syndrome in Korean Older Adults: Korea National Health and Nutrition Examination Survey VII-1

BACKGROUND

The prevalence of metabolic syndrome (MetS) is rapidly increasing with advanced age. Since aging affects sarcopenia and muscle strength, which could, in turns, affect MetS, it is critical to examine the association between MetS and muscle strength in this population. Handgrip strength (HGS) has been introduced as a simple assessment tool for muscular strength. Several studies investigating the association between HGS and the risk of MetS have yield conflicting results. Therefore, this study aimed to investigate the association of MetS and relative handgrip strength (RHGS) in elderly Koreans.

METHODS

A total of 1,244 (male, 589; female, 655) elderly subjects (age ≥65 years), who participated in the Seventh Korea National Health and Nutrition Examination Survey VII-1 (2016) were analyzed. Participant's HGS, body mass index (BMI), MetS, and its five criteria were measured. Subjects were categorized into four groups based on their RHGS, which was defined as absolute HGS divided by BMI.

RESULTS

The highest quartile RHGS group has a significantly lower prevalence of MetS in both men and women (F=35.16, P<0.001 vs. F=31.78, P<0.001, respectively). Moreover, the odds ratio of MetS was 0.52 times lower (0.52; 95% confidence interval [CI], 0.31-0.85) in the third quartile RHGS than that of the lowest RHGS, and 0.28 times lower (0.28; 95% CI, 0.17-0.47) in the highest RHGS group in women than that of the lowest RHGS group.

CONCLUSION

Maintaining a high level of HGS may reduce the incidence rate of MetS in elderly Koreans.