Handgrip Strength and Factors Associated in Poor Elderly Assisted at a Primary Care Unit in Rio de Janeiro, Brazil

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.

The Effect of Vitamin D Supplementation to Parameter of Sarcopenia in Elderly People: a Systematic Review and Meta-Analysis

Background

Vitamin D plays an essential role in promoting skeletal muscle metabolism. Several studies show that vitamin D may help the elderly prevent sarcopenia. Nevertheless, the outcome remains debatable. Our meta-analysis aimed to summarize the effect of vitamin D supplementation on sarcopenia-related parameters.

Methods

We searched PubMed, Cochrane, Springer, SAGE Journals, and Scopus abstracts on 10th December 2021 for relevant studies. We included articles that studied the effect of vitamin D on muscle mass, muscle strength, and physical performance. The aim was to measure the muscle mass, muscle strength, and physical performance both at baseline and at the end of the intervention.

Results

A total of 6,628 participants from 35 studies were included. Most of the studies used oral vitamin D, whereas only one study used intramuscular injection. The effect of vitamin D supplementation showed no effect on appendicular skeletal muscle mass (SMD = .05 [95% CI, .33 - .44], p = .79). Regarding muscle strength, vitamin D supplementation did not have a significant effect on muscle strength which is handgrip strength (p = .26). Respecting physical performance, vitamin D supplementation did not affect TUG (Timed Up and Go) (p = .45).

Conclusions

Vitamin D supplementation had minimal effect on sarcopenia-related parameters. Further research into understanding the role of Vitamin D in preventing the progressivity of sarcopenia still needs to be explored.

Examining the factors associated with functional capacity of community-dwelling older adults using the ICF framework: a cross-sectional study from the Frailty in Brazilian Older Adults Study (FIBRA)

BACKGROUND

There are many factors associated with functioning and disability in older adults and these relationships are not clear.

OBJECTIVE

To explore the factors associated with functional capacity of older adults using the framework of the International Classification of Functioning, Disability, and Health (ICF).

METHODS

This is a cross-sectional study with a dataset from a survey of 1 377 community-dwelling older adults (≥ 65 years) in a middle-income country. Three functional outcomes were selected to represent the functioning domains: 1) muscle strength for body function; 2) walking speed for activity; and 3) advanced activities of daily living (ADL) for participation. Demographic, clinical, and social information was selected to represent the domains of health conditions and contextual factors (i.e. personal and environmental factors). Multivariate models tested the impact of these factors on each outcome.

RESULTS

Depressive symptoms, age, and physical activity were associated with the three outcomes. Muscle strength was also associated with urinary incontinence, visual deficits, female sex, and employment. Walking speed was also associated with urinary incontinence, obesity, fractures due to falls, female sex, health professionals' visits, and walking aid devices. Advanced ADL were also associated with stroke, visual deficits, education, employment, health perception, social support, and walking aid devices.

CONCLUSION

Functional capacity of older adults is associated with some non-modifiable factors, such as age and sex. The modifiable factors must be addressed by health professionals and policymakers in the geriatric area, especially depression, obesity, physical inactivity, and social support.

Challenges in the Management of Sarcopenia in the Primary Care Setting: A Scoping Review

BACKGROUND

Sarcopenia is a disease associated with the loss of muscle mass, strength, and function. It affects the elderly in various ways, such as reduced mobility, compromising their daily activities, and even deteriorating metabolic health. Primary care serves as the first point of contact for patients and plays an important role in health promotion and disease prevention. Hence, this review is conducted to identify the challenges in the management of sarcopenia in the primary care setting.

METHOD

In December 2022, a scoping review was conducted using PubMed, SCOPUS, Web of Science, and a manual search, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. We used articles that have been written in English, and relevant articles were then screened, duplicates were removed, eligibility criteria were applied, and studies that met the criteria were reviewed. The keywords challenges, management, sarcopenia, and primary care were included.

RESULT

The initial search generated 280 publications, and 11 articles were included after inclusion and exclusion criteria for this review. In this review, challenges in the management of sarcopenia in a primary care setting are reviewed based on the screening and diagnosis.

CONCLUSIONS

With an increasing aging population, it is important to understand the challenges in the management of sarcopenia in a primary care setting. Identification of elderly at risk of sarcopenia, followed by referring the affected elderly for confirmation of the diagnosis, is essential to preventing the adverse health effects. The initiation of treatment that comprises resistance exercise training and nutrition should not be delayed, as they are salient in the management of sarcopenia.

Gender Differences in Determinants of the Components of the Frailty Phenotype among Older Adults in India: Findings from LASI Wave-1

This study examines the gender-specific determinants of the components of frailty in a community-dwelling setting in India. Using data from the Longitudinal Ageing Study in India (LASI) Wave-1, this study employed 30,978 (14,885 male and 16,093 female) older adults (aged 60+) to fulfil the study objective. The modified Fried frailty phenotype criteria defines frailty by the five components: exhaustion, weak grip strength, slow walking speed, unintentional weight loss, and low physical activity. The result showed grip strength (79.1%) as the most discriminant component among males, and physical activity (81.6%) as the most discriminant component among females. The results also indicated that grip strength (male: 98.0%, female: 93.5%) and physical activity (male: 94.8%, female: 96.9%) showed a sensitivity of more than 90%, which appears to be a good indicator of frailty. Combining this dual marker increased the accuracy to 99.97% among male and 99.98% among female samples. The findings suggested adding grip strength and physical activity as a proxy measure of frailty, which can increase the precision of screening without a large additional investment of time, training, or cost.

Dynapenia in all-cause mortality and its relationship with sedentary behavior in community-dwelling older adults

The aim of the present study was to investigate the relationship of dynapenia combined with sedentary behavior (SB) on the risk of mortality in older adults living in a Brazilian community. A total of 322 participants aged ≥ 60 years from the ELSIA (Longitudinal Study of Elderly Health in Alcobaça) prospective cohort were included. Dynapenia was diagnosed when the handgrip strength was < 27 ​kg for men and < 16 ​kg for women. The exposure time to SB was assessed considering the total time spent sitting during one day in the week and one day on the weekend. When combined with dynapenia, we derived the construction of four groups: best behavior (absence of dynapenia and low SB), intermediate behavior (absence of dynapenia and high SB; presence of dynapenia and low SB) and worst behavior (presence of dynapenia and high SB). Mortality was assessed by the follow-up time until death and/or censorship. During the 5-year follow-up of the study, 55 participants progressed to death. In the adjusted models, the dynapenia and the time spent exposed to SB were analyzed in a combined way, the older adults with worse behavior (high SB and dynapenia) had higher risk ratios for mortality (hazard ratio 2.46; 95% confidence interval 1.01-5.97) than the best behavior group. Older adults with dynapenia are at greater risk for all-cause mortality, which is aggravated by the addition of longer exposure to SB.

Sarcopenia and mortality risk in community-dwelling Brazilian older adults

We estimated the impact of sarcopenia parameters on mortality risk and assessed its prevalence and associated factors in the older adults according to the European Working Group on Sarcopenia in Older People's 2010 (EWGSOP1) and 2018 (EWGSOP2) criteria. This was a 10-year follow-up cohort study. Low muscle mass (MM) was defined as low skeletal muscle mass index (SMI) using dual-energy X-ray absorptiometry (DXA), and low calf circumference (CC). Cox regression and the Kaplan-Meier method were performed. The prevalence of sarcopenia and associated factors were influenced by the MM measurement method and diagnostic criteria used [6.8% (SMI and EWGSOP2), 12.8% (CC and EWGSOP2; and SMI and EWGSOP1) and 17.4% (CC and EWGSOP1)]. While a low BMI was associated with sarcopenia regardless of the sarcopenia definitions, diabetes, and high TGs were associated with sarcopenia only when using the EWGSOP1 criteria. Low SMI increased mortality risk (EWGSOP1: HR = 2.01, 95% CI 1.03-3.92; EWGSOP2: HR = 2.07, 95% CI 1.05-4.06). The prevalence of sarcopenia was higher according to EWGSOP1 than EWGSOP2. A low BMI, diabetes, and high TGs were associated with sarcopenia. A low SMI doubled the risk of mortality in community-dwelling older adults.

Relationship between handgrip strength, depression and cognitive functioning among older adults: Evidence from longitudinal ageing study in India

BACKGROUND

Handgrip strength (HGS) is a frequent and general indicator of muscle strength and it may affect several aspects of mental health among older people. This study explored the association of HGS with depression and cognitive impairment among community-dwelling older adults in resource-constrained setting of India.

METHOD

Data were drawn from the Longitudinal Ageing Study in India (LASI), and the analysis was conducted on 27,707 older adults aged 60 years and above. Outcome measures included depression (assessed by the Short Form Composite International Diagnostic Interview (CIDI-SF) and the Center for Epidemiological Studies-Depression (CES-D) scales) and cognitive impairment. Descriptive statistics and mean scores of HGS were reported and multivariable linear regression analyses were conducted to test the research hypotheses of the study.

RESULTS

Mean score of HGS was 24.33 (SD: 7.22) for males and 15.94 (SD: 5.14) for females. Mean age was 68.86 (SD: 7.19) and 68.40 (SD: 7.31) years among males and females respectively. Older participants who had weak HGS were significantly more likely to be depressed in CIDI-SF scale (B: 0.06, CI: 0.01-0.13) and CES-D scale (B: 0.02, CI: 0.01-0.03) in comparison to those who had strong HGS after adjusting for a large number of confounders. Older participants who had weak HGS were significantly more likely (B: 0.92, CI: 0.76-1.07) to have cognitive impairment compared to those who had strong HGS.

CONCLUSION

The findings highlight the independent association of HGS with major depression, depressive symptoms and cognitive impairment that have implications on promoting resistance-training programs among aged population.

Adverse childhood experiences and handgrip strength among middle-aged and older adults: a cross-sectional study in China

BACKGROUND

Evidence on the association between adverse childhood experiences (ACEs) and handgrip strength (HGS) in later life was limited and inconclusive. We aimed to explore the impact of ACEs on HGS among middle-aged and older Chinese adults.

METHODS

We conducted a cross-sectional study with data extracted from the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey with respondents recruited from 450 villages/urban communities of 28 provinces. Participants aged 45 years or older were drawn from the CHARLS 2014 life history survey and the 2015 health survey. Twelve ACE indicators before the age of 17 years were collected. HGS was measured with a dynamometer and the maximum value of HGS obtained from both hands was used in the analyses. Low muscle strength (LMS) was defined according to the recommendation of European Working Group on Sarcopenia in Older People (EWGSOP). Multivariate linear and logistic regression models were constructed to evaluate the association of ACEs with continuous HGS and LMS, with adjustment for age, sex, marital status, ethnicity, area of residence, smoking and drinking status, body mass index, hypertension, dyslipidaemia, diabetes mellitus, cardiovascular disease, arthritis, hip fracture, and memory-related disease.

RESULTS

Of the 7209 eligible participants, 2258 (31.3%) had experienced three or more ACEs. Compared to individuals without ACEs, exposure to ≥ 3 ACEs was negatively associated with continuous HGS in kilogram (β = -0.93, 95% CI: -1.37, -0.49) and positively associated with the risk of LMS (OR = 1.34, 95% CI: 1.12, 1.61). Such associations were consistently found both in men and women who had experienced three or more ACEs. Significant dose-response relationship between the number of ACEs and outcomes was also observed in the overall population and different sex groups.

CONCLUSION

Exposure to ACEs was associated with lower HGS and increased risk of LMS among middle-aged and older Chinese adults, indicating the importance of intervention in individuals with experience of ACEs in order to mitigate its detrimental impact on HGS and promote healthy ageing.

Cognitive impairment and World Trade Centre-related exposures

On 11 September 2001 the World Trade Center (WTC) in New York was attacked by terrorists, causing the collapse of multiple buildings including the iconic 110-story 'Twin Towers'. Thousands of people died that day from the collapse of the buildings, fires, falling from the buildings, falling debris, or other related accidents. Survivors of the attacks, those who worked in search and rescue during and after the buildings collapsed, and those working in recovery and clean-up operations were exposed to severe psychological stressors. Concurrently, these 'WTC-affected' individuals breathed and ingested a mixture of organic and particulate neurotoxins and pro-inflammogens generated as a result of the attack and building collapse. Twenty years later, researchers have documented neurocognitive and motor dysfunctions that resemble the typical features of neurodegenerative disease in some WTC responders at midlife. Cortical atrophy, which usually manifests later in life, has also been observed in this population. Evidence indicates that neurocognitive symptoms and corresponding brain atrophy are associated with both physical exposures at the WTC and chronic post-traumatic stress disorder, including regularly re-experiencing traumatic memories of the events while awake or during sleep. Despite these findings, little is understood about the long-term effects of these physical and mental exposures on the brain health of WTC-affected individuals, and the potential for neurocognitive disorders. Here, we review the existing evidence concerning neurological outcomes in WTC-affected individuals, with the aim of contextualizing this research for policymakers, researchers and clinicians and educating WTC-affected individuals and their friends and families. We conclude by providing a rationale and recommendations for monitoring the neurological health of WTC-affected individuals.

Validity and Test-Retest Reliability of a Novel Push Low-Cost Hand-Held Dynamometer for Knee Strength Assessment during Different Force Ranges

The objective was to assess the instrumental validity and the test–retest reliability of a low-cost hand-held push dynamometer adapted from a load-cell based hanging scale (tHHD) to collect compressive forces in different ranges of compressive forces. Three independent raters applied 50 pre-established compressions each on the tHHD centered on a force platform in three distinct ranges: ~70 N, ~160 N, ~250 N. Knee isometric strength was also assessed on 19 subjects in two sessions (48 h apart) using the tHHD anchored by an inelastic adjustable strap. Knee extension and flexion were assessed with the participant seated on a chair with the feet resting on the floor, knees, and hips flexed at 90°. The isometric force peaks were recorded and compared. The ICC and the Cronbach’s α showed excellent consistency and agreement for both instrumental validity and test–retest reliability (range: 0.89–0.99), as the correlation and determination coefficients (range: 0.80–0.99). The SEM and the MDC analysis returned adequate low values with a coefficient of variation less than 5%. The Bland–Altman results showed consistency and high levels of agreement. The tHHD is a valid method to assess the knee isometric strength, showing portability, cost-effectiveness, and user-friendly interface to provide an effective form to assess the knee isometric strength.

Socioeconomic differences in handgrip strength and its association with measures of intrinsic capacity among older adults in six middle-income countries

Handgrip strength, a measure of muscular strength is a powerful predictor of declines in intrinsic capacity, functional abilities, the onset of morbidity and mortality among older adults. This study documents socioeconomic (SES) differences in handgrip strength among older adults aged 50 years and over in six middle-income countries and investigates the association of handgrip strength with measures of intrinsic capacity-a composite of all the physical and mental capacities of an individual. Secondary data analysis of cross-sectional population-based data from six countries from the WHO's Study on global AGEing and adult health (SAGE) Wave 1 were conducted. Three-level linear hierarchical models examine the association of demographic, socioeconomic status and multimorbidity variables with handgrip strength. Regression-based Relative Index of Inequality (RII) examines socioeconomic inequalities in handgrip strength; and multilevel linear and logistic hierarchical regression models document the association between handgrip strength and five domains of intrinsic capacity: locomotion, psychological, cognitive capacity, vitality and sensory. Wealth quintiles are positively associated with handgrip strength among men across all countries except South Africa while the differences by education were notable for China and India. Work and nutritional status are positively associated with handgrip strength. Our findings provide new evidence of robust association between handgrip strength and other measures of intrinsic capacity and confirms that handgrip strength is a single most important measure of capacity among older persons.

Utility of fragility fracture prediction tools in a group of postmenopausal women

Objectives

Fractures are a common complication of osteoporosis. The main aim of our study was to assess the relation between fractures identified as low energy fractures (fragility), bone mineral density (BMD), trabecular bone score (TBS), and handgrip in a group of postmenopausal women. An additional aim was to determine the relation between fragility fractures and age, height loss, and falls (reported in the last 12 months and 5 years).

Material and methods

The study was conducted in a group of 120 (mean age 69 years; 59-81, SD 5.3) postmenopausal patients who were referred to the Medical Centre for an osteoporosis screening appointment by their general practitioner. All patients were interviewed (with a questionnaire containing questions on fracture risk factors and highest height), had their anthropometric measures taken (current height and weight) as well as TBS analysis following their DXA (dual-energy X-ray absorptiometry) scan and handgrip measure.

Results

Sixty patients from the study group had a history of fractures (with a total of 92 fractures), of whom 39 women (76 fractures) were identified as those with a low-energy fracture. Fragility fractures were more likely to be reported in older patients (Me 71 vs. 68 years, p < 0.05). Differences observed between TBS, handgrip and BMD in reference to fragility fractures were not statistically significant. Analysis showed significant correlations between BMD (neck and L1-L4) and TBS fracture risk categories. Falls reported in the last 5 years and height loss were factors which correlated with fragility fractures (p < 0.05).

Conclusions

Risk of fragility fractures increases with age. Bone mineral density is insufficient as a fracture risk assessment tool. Information on falls and height loss may provide additional data on fracture risk assessment.

Dynapenia in middle-aged and older persons with and without abdominal obesity and the complex relationship with behavioral, physical-health and mental-health variables: Learning Bayesian network structures

BACKGROUND

Few studies have analyzed the relationship between dynapenia and lifestyle, physical-health and mental-health variables in middle-aged and older persons classified according to their waist circumference. The aim of this study was to identify the relationships between dynapenia and behavioral, physical-health and mental-health variables in middle-aged and older persons with and without abdominal obesity using Bayesian networks, a graphical analysis technique that allows simultaneous associations between variables to be identified.

METHODS

A cross-sectional study of 2526 participants without abdominal obesity and 2729 with abdominal obesity (waist circumference > 102 cm in men and >88 cm in women) aged 50 years or older who took part in the Brazilian Longitudinal Study of Aging. Two network structures including behavioral, physical-health and mental-health variables and dynapenia (grip strength < 26 kg for men and <16 kg for women) were learnt with the hill-climbing score-based algorithm for a sample of individuals with and without abdominal obesity. Statistical resampling tests were performed to quantify the strength of the relationships between factors associated with dynapenia.

RESULTS

In middle-aged and older persons without abdominal obesity, dynapenia was strongly associated with and influenced by at-risk alcohol consumption while in middle-aged and older persons with abdominal obesity the condition was strongly associated with and influenced by diabetes and depression. In the latter group, dynapenia was also strongly associated with and influenced the disability.

CONCLUSIONS

The use of Bayesian networks allowed different factors associated with dynapenia in middle-aged and older persons classified according to the presence or absence of abdominal obesity to be identified.

High-Frequency External Muscle Stimulation Reduces Depressive Symptoms in Older Male Veterans: A Pilot Study

OBJECTIVE

Late-life depression (LLD) is a severe public health problem. Given that pharmacological treatments for LLD are limited by their side effects, development of efficient and tolerable nonpharmacological treatment for LLD is urgently required. This study investigated whether high-frequency external muscle stimulation could reduce depressive symptoms in LLD.

METHODS

Twenty-two older male veterans with major depression were recruited and randomized into a treatment (n = 9) or sham control group (n = 13). The groups received high-frequency external muscle stimulation or sham intervention 3 times per week for 12 weeks. Clinical symptoms and muscle strength were evaluated at baseline and every 2 weeks.

RESULTS

The 2 groups were homogeneous in age, baseline clinical symptoms, and muscle strength. The treatment group showed significant improvement in depression and anxiety scores and muscle strength (all P < .01), whereas the control group showed no significant change after the 12-week follow-up. Compared to the control group, the treatment group showed significant improvements in depression (Geriatric Depression Scale, P = .009; Hamilton Depression Rating Scale, P = .007) and anxiety scores (HAMA, P = .008) and muscle strength (all P < .001). Changes in depression and anxiety levels were significantly correlated with changes in muscle strength after the study. In the treatment group, we observed a trend of correlation between the reduction in depression and muscle strength gains.

CONCLUSION

High-frequency external muscle stimulation appears to be an effective treatment for older patients with LLD. Large studies with more tests and/or conducted in different populations are warranted to validate these preliminary findings.

Grip Strength and Depression Symptoms Among Middle-Age and Older Adults

OBJECTIVE

To analyze the relationship between grip strength and symptoms of depression, considering sex and age, in adults from 18 countries.

METHODS

Cross-sectional data for adults 50 years and older from the Survey of Health, Aging, and Retirement in Europe wave 6 (collected in 2015) were analyzed. Grip strength was measured twice on each hand using a handgrip dynamometer. The EURO-D 12-item scale was used to measure depression symptoms. Multivariable logistic regression analysis was conducted. Data analyses were conducted between November 5, 2019, and February 7, 2020.

RESULTS

Men and women who were in quartiles 2, 3, and 4 of grip strength were less likely to have depression symptoms than those in the first quartile of grip strength. Having more grip strength decreased the odds of depression symptoms by 30% (odds ratio 0.70; 95% CI, 0.65 to 0.77) and 47% (odds ratio, 0.53; 95% CI, 0.49 to 0.57) for adults aged 50 to 64 years and 65 years and older, respectively, when compared with those with the lowest grip strength. The negative relationship between strong grip strength and depression symptoms was observed among men and women younger and older than 65 years.

CONCLUSION

There was an association between grip strength and depression symptoms. For clinical practice and geriatric health professionals, assessing adults' grip strength can be used as a signal to screen for physical and mental health.

The Relationship between Muscular Strength and Depression in Older Adults with Chronic Disease Comorbidity

Older adults with disease and disability are particularly vulnerable to experiencing more severe consequences of depression. The purpose of the present study is to investigate the relationship between disease comorbidities (number of disease: ND0, 1 disease: ND1 and 2 or more diseases: ND ≥ 2), hand grip strength (low HGS and high HGS), and the prevalence of depression in Korean older adults. Data from the living profiles of older people survey that was conducted by the ministry of health and welfare in Korea were utilized. Data for 6107 females and 4347 males were appropriate for statistical tests. The results demonstrated that depression was more prevalent as ND increased (p < 0.01). In addition, HGS appeared lower as ND increased in both male (p < 0.01) and female subjects (p < 0.01). Furthermore, relative to ND0 and low HGS, ND0 and high HGS showed a ~65% reduction in the prevalence of depression (p < 0.01). After adjusting for age, the prevalence of depression was reduced by ~60% in the subgroup with ND0 and high HGS relative to ND0 and low HGS (p < 0.01). These data demonstrate that muscular strength indices such as HGS may be useful when assessing depression in older adults. Further research in this area is warranted.

Get a Grip on Factors Related to Grip Strength in Persons With Hand Osteoarthritis: Results From an Observational Cohort Study

OBJECTIVE

To compare levels of grip strength in individuals with hand osteoarthritis (OA) with normative values, and to examine how hand OA severity and other biopsychosocial factors are associated with grip strength.

METHODS

Levels of grip strength across age groups were compared with normative values from the general population in sex-stratified analyses using 2-sample t-tests. Associations between radiographic hand OA severity (Kellgren/Lawrence sum score) in different joint groups and grip strength of the same hand were examined in 300 individuals from the Nor-Hand study using linear regression. Analyses were repeated using markers of pain, demographic factors, comorbidities, and psychological and social factors as independent variables. We adjusted for age, sex, and body mass index.

RESULTS

Individuals with hand OA had lower grip strength than the general population, especially in individuals age <60 years. In thumb base joints, increasing radiographic severity (range 0-8) and the presence of pain were associated with lower grip strength (β = -0.83 [95% confidence interval (95% CI) -1.12, -0.53] and β = -2.15 [95% CI -3.15, -1.16], respectively). Negative associations with grip strength were also found for women, low education, higher comorbidity index, and higher resting heart rate.

CONCLUSION

Individuals with hand OA have lower grip strength than the general population. Our results support the idea that studies on thumb base OA should include grip strength as an outcome measure. However, other biopsychosocial factors should also be considered when the grip strength is being interpreted, because other factors such as sex, socioeconomic factors, physical fitness, and comorbidities are negatively associated with grip strength.

Independent and combined effect of home-based progressive resistance training and nutritional supplementation on muscle strength, muscle mass and physical function in dynapenic older adults with low protein intake: A randomized controlled trial

BACKGROUND

With the aging phenomenon, there is growing interest in developing effective strategies to counteract dynapenia, the age-related loss of muscle strength. The positive effect of progressive resistance training on muscle strength is well known, however, the effect of nutritional supplementation or its synergistic effect along with exercise on muscle strength is not a consensus in the literature, especially in populations with low protein intake.

METHODS

We analyzed the muscle strength (handgrip strength and sit-to-stand test), muscle mass, body mass index, insulin resistance, and physical function (gait speed, timed up & go test, and single-leg-stance test) of 69 dynapenic older adults with low protein intake, before and after the intervention period of three months. The participants were randomly allocated into four groups: resistance training, supplementation, resistance training plus supplementation, and control.

RESULTS

There was a significant group x time interaction on the following outcome measures: handgrip strength (p <  0.001), gait speed (p =  0.023), and sit-to-stand test (p <  0.001). Considering the outcomes that showed a significant difference between and within groups, only the resistance training group and the resistance training plus supplementation group showed a large effect size in handgrip strength, gait speed, and sit-to-stand test, whereas the supplementation group showed a moderate effect size in gait speed. After the intervention period, there was no difference between the resistance training and the resistance training plus supplementation groups.

CONCLUSION

This study reinforces the value of resistance training in improving muscle strength. The nutritional supplementation added no further benefits in this specific population. Registration number at the Brazilian registry of clinical trials: RBR-4HRQJF.

Development of Taiwan Risk Score for Sarcopenia (TRSS) for Sarcopenia Screening among Community-Dwelling Older Adults

The SARC-F questionnaire has been suggested by the European Working Group on Sarcopenia in Older People (EWGSOP) as a first-step screening tool for sarcopenia. However, the sensitivity to SARC-F is low among community-dwelling older adults. Therefore, this study aimed to develop a new prediction model for sarcopenia screening in the community setting. We conducted a cross-sectional analysis of data from the Taiwan Integration of Health and Welfare (TIHW) study. Covariates including comorbidities, socioeconomic status, social support, health behaviors, body composition, and serum biomarkers were collected for analysis. Sarcopenia was defined using handgrip strength and gait speed cut-off values suggested by the Asian Working Group for Sarcopenia. Risk scores for sarcopenia were estimated by stepwise logistic regression. Among 1025 participants (mean age, 71.95 ± 6.89 years), 179 (17.5%) had sarcopenia. Seven items, including age, female sex, receiving social assistance pension, absence of exercise, being underweight, abnormal fasting glucose levels, and abnormal creatinine levels were selected for the Taiwan Risk Scores for Sarcopenia (TRSS) with a cutoff value of 76 (sensitivity, 71.8%; specificity, 71.1%) and area under the curve (AUC) of 0.757. Our results suggested that the TRSS model could be applied cost-effectively in the community for early detection of sarcopenia.

Normative data and associated factors of hand grip strength among elderly individuals: The Yilan Study, Taiwan

Weak grip strength is associated with subsequent mortality in elderly populations. The normative data and associated factors of HGS in community-dwelling elderly Taiwanese populations require further evaluation. From February 2012 until the end of 2016, all residents of Yilan City, Taiwan aged 65 years or older were randomly selected for a population-based community health survey. A total of 2,470 older adults were enrolled in this study. The relationships between HGS and various anthropometric and sociodemographic correlates were examined. The results showed that HGS was higher in men than in women. The mean HGS exhibited a decreasing trend with advanced age in both men and women. HGS was significantly associated with height, weight, and exercise habits. The physical as well as the mental component summary measures of health-related quality of life (HRQoL) were positively associated with HGS. After HRQoL was integrated into the regression model, female sex, age, waist circumference, and diabetes mellitus were significantly negatively associated with HGS. In conclusion, HGS significantly decreased with advanced age. among community-dwelling Taiwanese elderly people, Various factors had different effects on HGS.

Factors associated with low handgrip strength in older people: data of the Study of Chronic Diseases (Edoc-I)

BACKGROUND

Handgrip strength (HGS) is an important health biomarker whose low scores have been shown to be associated with the morbimortality. This study aimed to analyze the factors associated with low HGS in older people in Rio Branco, Acre, Brazil.

METHODS

The study was carried out with data from the Study of Chronic Diseases (EDOC-I) - Older People, a cross-sectional household PAPI probability sample survey performed with 1016 people aged over 60 residing in Rio Branco in 2014. The low HGS was defined by the 20th percentile of the maximum HGS by sex and age group. Associations between variables of health status (psychological and physical) and low HGS, by sex, were estimated using logistic regression, expressed by adjusted ORs (aOR).

RESULTS

Older individuals had lower median HGS than younger individuals (- 6.0 kg among men and - 2.6 kg among women). Women aged over 80 had, on average, the lower quintile of HGS compared to women of the previous age groups. Factors independently associated with low HGS in men and women, respectively, were low weigh in body mass index [(aOR = 2.80; 95%CI: 1.19, 6.61) and (aOR = 2.61; 95%CI: 1.46, 4.66)], anemia [(aOR = 4.15; 95%CI: 2.09, 8.21) and (aOR = 1.80; 95%CI: 1.06, 3.06)] and diabetes as a risk factor in men (aOR 1.95; 95%CI: 1.00, 3.81). There was a higher chance of low HGS in men with partners (aOR = 2.44; 95%CI: 1.32, 4.51), smokers or former smokers (aOR = 3.25; 95%CI: 1.25, 8.44), with current self-assessment of health worse than the 12 previous months (aOR = 2.21; 95%CI: 1.14, 4.30) and dependence in activities of daily living (aOR = 2.92; 95%CI: 1.35, 6.30). Only among women, there was an increased chance of low HGS associated with altered waist-to-hip ratio (aOR = 1.79; 95%CI: 1.02, 3.12), insomnia (aOR = 1.83; 95%CI: 1.10, 3.03) and physical activity from displacement/occupation (aOR = 1.75; 95%CI: 1.08, 2.84).

CONCLUSION

Factors associated with low HGS are not the same between sexes, and the inclusion of HGS as a component of health assessment seems to be a promising strategy for disease prevention and health promotion.

Normative reference values on handgrip strength among healthy adults of Dhulikhel, Nepal: A cross-sectional study

Context

Handgrip strength (HGS) is the amount of static force that the hand can generate around the dynamometer and can be defined as the ability of the hand to hold the objects between the thumb and fingers. Handgrip measurement is simple but also a valid measure of overall muscle strength and also provides an objective index of functional integrity of upper extremity.

Aims

To provide population-based HGS reference values for Nepalese adults from 19 to 70 years of age.

Settings and Design

A cross-sectional study was conducted in Dhulikhel community among 526 participants.

Methods and Materials

Jamar Dynamometer was used for measuring HGS based on the recommendation provided by the American Society of Hand Therapists.

Statistical Analysis Used

Data were analyzed using STATA version 14.

Results

Men exhibited higher HGS compared to women with maximum grip strength observed in age group of 19-29 which were 47.24 kg and 32.51 kg for men and women, respectively. HGS decreases with increasing age in both dominant and nondominant hands.

Conclusions

The normative reference values provided in this study may serve as a guide for interpreting grip-strength measurements obtained from tested individuals.

Indices calculated by serum creatinine and cystatin C as predictors of liver damage, muscle strength and sarcopenia in liver disease

Serum creatinine (Cr)-based glomerular filtration rate (CrGFR) is overestimated in liver disease. The present study evaluated whether the difference in CrGFR and cystatin C (CysC) GFR (dGFR) is significant in liver disease. The Cr-to-CysC ratio and sarcopenia index (SI) have been reported to correlate with muscle volume. An estimated total body muscle mass with Cr, CysC and calculated body muscle mass (CBMM) has also been reported to correlate with muscle mass. The applicability of dGFR, SI and CBMM for liver disease were evaluated. A total of 313 patients with liver damage were evaluated for Child-Pugh score, albumin-bilirubin (ALBI) score, model for end-stage liver disease, fibrosis-4, Cr, CysC, Cr-based estimated GFR (CreGFR), CysCGFR and grip strength. Of the 313 patients, 199 were evaluated using cross-sectional computed tomography (CT) of the third lumbar vertebra to determine the skeletal muscle (SM) mass. dGFR, CBMM and SI were compared to liver damage, muscle strength and muscle mass. In the 313 patients, dGFR was correlated with age, ALBI and grip strength; CBMM was correlated with body mass index (BMI) and grip strength; and SI was correlated with BMI and grip strength. In patients evaluated with CT, the correlation coefficients for CBMM and SI with SM were 0.804 and 0.293, respectively. Thus, CBMM and SI were associated with sarcopenia. The relationship between dGFR and ALBI does not differ with different grades of CrGFR-based chronic kidney disease (CKD). dGFR is a marker of liver damage and muscle strength regardless of CKD. CBMM and SI are markers for sarcopenia in liver disease.

Association between Handgrip Strength, Mobility, Leg Strength, Flexibility, and Postural Balance in Older Adults under Long-Term Care Facilities

INTRODUCTION

Low muscle strength is common and important in geriatric syndromes including frailty and sarcopenia. The epidemiology of grip strength of older people under long-term care facilities has been little explored.

PURPOSE

The aim of this study was to assess handgrip strength of older women and men covered by institutional care and to analyse the associations between HGS and mobility, leg strength, flexibility, and postural balance.

MATERIALS AND METHODS

This is a cross-sectional study carried out at care homes in southeastern Poland. After considering the inclusion criteria, 209 older people aged 65 to 85 were included in the study. Sociodemographic data were collected, and tests of muscular strength, mobility, flexibility, and postural balance were carried out by the use of the stabilometric platform CQ Stab 2P.

RESULTS

The average handgrip strength in the study group amounted to 19.8 kg, including 14.8 kg in women and 25.9 kg in men. Low grip strength was found in 67.83% women and 52.13% men in institutional care. A negative correlation between handgrip strength (HGS) and the Timed Up and Go (TUG) test was demonstrated, both with and without cognitive task and strength of lower limbs. Gait speed and dynamic balance were positively correlated with HGS. A negative correlation was found between the total length of the centre of pressure (COP) path, the length of the COP path in the lateral-medial direction, and the sway area delimited by the COP and HGS for the dominant hand. Speaking of women, gait speed was most strongly associated with HGS, while among men, it was upper limb flexibility.

CONCLUSION

Regardless of gender, HGS is associated with mobility, strength of the lower limbs, and dynamic balance. By means of simple tools, early diagnosis will facilitate the planning of appropriate interventions in order to prevent disability and mortality in long-term care facilities.

Sarcopenia is Associated with Malnutrition but Not with Systemic Inflammation in Older Persons with Advanced CKD

Background: In patients with chronic kidney disease (CKD), sarcopenia can be determined by a wide spectrum of risk factors. We evaluated the association of sarcopenia with nutritional, behavioral and inflammatory patterns in older patients with advanced CKD. Methods: we cross-sectionally evaluated 113 patients with CKD stages 3b-5. Sarcopenia was defined according to the EWGSOP2 criteria. We assessed: anthropometry, bioelectrical impedance analysis, physical, and psychological performance. Nutritional status was assessed using the Malnutrition Inflammation Score (MIS) and by verifying the eventual presence Protein Energy Wasting syndrome (PEW). Systemic inflammation was assessed by dosing: CRP, IL6, TNFα, MCP1, IL10, IL17, fetuin, IL12. Results: 24% of patients were sarcopenic. Sarcopenic individuals had lower creatinine clearance (18 ± 11 vs. 23 ± 19 mL/min; p = 0.0087) as well as lower BMI (24.8 ± 3.0 vs. 28.4 ± 5.5 Kg/m²; p < 0.0001) and a lower FTI (11.6 ± 3.9 vs. 14.4 ± 5.1 kg/m², p = 0.023). Sarcopenic persons had higher prevalence of PEW (52 vs. 20%, p < 0.0001) and a tendency to have higher MIS (6.6 ± 6.5 vs. 4.5 ± 4.0, p = 0.09); however, they did not show any difference in systemic inflammation compared to non-sarcopenic individuals. Conclusions: CKD sarcopenic patients were more malnourished than non-sarcopenic ones, but the two groups did not show any difference in systemic inflammation.

Associations Between Vision, Hearing, and Olfactory Impairment With Handgrip Strength

Objectives: We aimed to assess the cross-sectional associations between sensory impairments (vision, hearing, and/or olfactory loss) and handgrip strength. Method: In the Blue Mountains Eye Study, 947 participants aged 65+ years had handgrip strength measured using a dynamometer. Visual impairment was defined as visual acuity <20/40 (better eye), and hearing impairment as average pure-tone air conduction threshold >25 dBHL (500-4,000 Hz). Olfaction was measured using the San Diego Odor Identification Test. Results: Marginally significant associations between sensory impairment and handgrip strength were observed after multivariable adjustment. For example, women with two or three sensory impairments had lower adjusted mean handgrip strength (17.47 ± 0.5 kg) versus women who had no sensory loss (18.59 ± 0.3 kg; p = .06) or only one sensory impairment (18.58 ± 0.3 kg; p = .05), respectively. No significant associations were observed in men. Discussion: Women who had multiple sensory impairments had reduced muscle strength as indicated by ~1.1 kg lower mean handgrip strength.

Handgrip Strength of World Trade Center (WTC) Responders: The Role of Re-Experiencing Posttraumatic Stress Disorder (PTSD) Symptoms

Background: This study sought to examine whether handgrip strength (HGS), a measure of muscle strength and a biomarker of aging, was associated with post-traumatic stress disorder (PTSD) in a cohort of World Trade Center (WTC) responders at midlife. Methods: HGS was assessed utilizing a computer-assisted hand dynamometer administered to a consecutive sample of men and women (n = 2016) who participated in rescue and recovery efforts following the World Trade Center (WTC) attacks and subsequently attended monitoring appointments in Long Island, NY. PTSD symptom severity and depressive symptoms were assessed using the PTSD specific-trauma checklist (PCL-S) and the Patient Health Questionnaire (PHQ-9). General linear models were used to examine the association of WTC-related PTSD with HGS after adjusting for confounders. Results: The sample was at midlife (mean age = 53.3) when assessed, and 91.3% were men. Nearly 10% of the sample had probable PTSD (PCL ≥ 44) with concomitant depression (PHQ ≥ 10), while 5.1% had probable PTSD without depression. Average HGS was 57.4 lbs. (95% confidence interval (95% CI): 56.6⁻58.1) among men and 36.1 lbs. (95% CI = 33.8⁻38.5) among women. Mean HGS of those with probable PTSD with concomitant depression was lower (45.9 lbs., 95% CI = 43.6⁻48.2) than responders with only PTSD (49.1 lbs., 95% CI = 46.0⁻52.4) and those without PTSD or depression (57.5 lbs., 95% CI = 56.2⁻57.8). Subdomain analyses of PTSD symptoms revealed that re-experiencing symptoms at enrollment (p = 0.003) was associated with lower HGS after adjusting for depressive symptoms and other confounders. Discussion: Results suggested that higher WTC-related PTSD symptom severity was associated with lower HGS. Results support ongoing work suggesting that PTSD may be associated with more rapid physical aging. The potential for developing interventions that might simultaneously improve physical and mental health in the aftermath of trauma may be considered.

Risk factors associated with low handgrip strength in the older Korean population

Hand grip strength (HGS) is a means to assess health status and physical abilities indirectly. Various factors are known to be related to HGS, but data on the factors influencing HGS in the Korean population are lacking. Recently, the Korea National Health and Nutrition Examination Survey (KNHANES) conducted by the Korea Centers for Disease Control and Prevention surveyed social status, nutrition, physical status, and other medical history including HGS. This study aimed to investigate the social, physical, and individual health behavior factors associated with low HGS in the elderly Korean population. This population-based cross-sectional study was based on the 2014-2016 KNHANES. Community-dwelling Korean elderly (aged ≥65 years) were included in this survey. The relationship between HGS and socioeconomic status, nutrition, exercise, and other clinical characteristics were analyzed using multivariate logistic regression. The sample size was 3,634 (weighted: 6,006,406). Elderly men and women with low HGS showed lower body mass index, reduced physical activity and lower education level. Among elderly men, excessive carbohydrate and inadequate protein intake were observed in the low HGS group. Meanwhile, older women who did not drink alcohol and had diabetes were at higher risk of low HGS. In conclusion, various physical, nutritional, socioeconomic and comorbidity statuses were seemed to be the factors associated with HGS in Korean elderly. However, further cohort or case-control study will be necessary to determine the causal relationship of those factors and HGS.

Handgrip Strength is Associated with Psychological Functioning, Mood and Sleep in Women over 65 Years

Background: The predictive nature of handgrip strength (HGS) was analyzed, showing a direct association with the functional domains of health, cognitive and social levels, and some inverse association with depressive values. Aim: To analyze the relationship between HGS and the psychological functioning of older people, such as depression, mood and sleep. Method: A total of 38 women, participated in this study (age = 72.29 ± 5.21 year). As measurement instruments a hand dynamometer was used for HGS, Profile of Mood Status (POMS) 29 was used for mood, the geriatric depression scale was used for depression, and the Oviedo questionnaire was used for sleep. A cluster analysis was performed taking into account the performance in the HGS. Results: The group that obtained a high HGS result showed a better total score for vigor, depression, insomnia and sleep. Pearson correlation analysis showed significant correlations between HGS and vigor, depression, insomnia and sleep total score. Conclusion: HGS in women over 65 years was associated with psychological functioning and sleep quality.

Physical function assessment of older adults with lower body fractures at 3 months post-discharge from hospital

Background and purpose

Physical function assessment can be performed to assess functional mobility among older adults, especially after a traumatic incident such as lower body fracture (LBF). The objective of this study was to evaluate physical function of older patients with LBF after 3 months of discharge from the hospital.

Patients and methods

A total of 89 patients were followed up at the discharge phase. Four independent variables were tested: age, sex, type of fracture, and use of a walking aid before fracture. Mobility and strength were assessed with the Timed Up and Go (TUG) test and hand-grip strength (HGS) test, respectively.

Results

The majority of the patients were ≥65 years old (64%), female (61.8%), of Chinese ethnicity (50.6%), and had a hip fracture (51.7%). The mean time for TUG test was 26.11 seconds, while mean HGS was 19.02 kg. We found significant differences in TUG test scores with respect to all independent variables tested: age (P=0.026), sex (P=0.011), fracture type (P<0.001), and use of a walking aid before fracture (P=0.004). Significant differences were also detected in HGS test scores with respect to all independent variables tested: age (P<0.001), sex (P<0.001), fracture type (P<0.001), and use of a walking aid before fracture (P=0.035).

Conclusion

Increasing age, female sex, having a hip fracture, and use of a walking aid before fracture predicted reduction in the physical function and strength among older adults with LBF.

Handgrip strength and depression among 34,129 adults aged 50 years and older in six low- and middle-income countries

INTRODUCTION

Handgrip strength is a simple and inexpensive marker of health and mortality risk. It presents an ideal risk-stratifying method for use in low and middle-income countries (LMICs). There are, however, no population-based studies investigating the associations between handgrip strength and depression in LMICs. We aimed to assess these associations among community-dwelling middle-aged and older adults using nationally representative data from six LMICs.

METHOD

Cross-sectional data on individuals aged ≥ 50 years from the World Health Organization's Study on Global Ageing and Adult Health were analyzed. Depression was based on the Composite International Diagnostic Interview. Weak handgrip strength was defined as < 30 kg for men and < 20 kg for women using the average value of two handgrip measurements of the dominant hand. Multivariable logistic regression analysis was conducted.

RESULTS

The sample included 34,129 individuals (62.4 ± 16.0 years; 52.1% female). The prevalence of weak handgrip strength and depression were 47.4% and 6.2%, respectively. Individuals with weak handgrip strength had a higher prevalence of depression than those without this condition (8.8% vs. 3.8%; p < 0.001). Across all countries, after adjustment for potential confounders, weak handgrip strength was associated with a 1.45 (95%CI = 1.12-1.88) times higher odds for depression, although some between-country differences were noted.

DISCUSSION

Weaker handgrip strength is associated with higher odds for depression in LMICs. Future research should seek to establish the predictive value of this inexpensive measure for clinical use. Furthermore, interventional studies should examine if muscular strength can be a target of resistance-training interventions to address depressive symptoms in low-resourced settings.

Prevalence of sarcopenia in patients with geriatric depression diagnosis

AIM

In this study, the aim was to identify the prevalence of sarcopenia among patients with geriatric depression (GD) diagnosis and to collect data to illuminate precautions to reduce disease load.

METHOD

The study was completed with 116 patients (GD group) aged 65 years or older with possible or definite depression diagnosis according to the Geriatric Depression Scale (GDS) criteria and 301 volunteers aged from 18 to 39 years (control 1) and above 65 years (control 2). Our prospective and cross-sectional study applied the Hamilton Depression Rating Scale (HDRS) to control 1 group and the GDS and Mini Mental Test (MMSE) to control 2 and GD groups. All groups had skeletal muscle mass index (SMMI), muscle strength, and physical performance assessed with sarcopenia diagnosis according to the European Working Group on Sarcopenia in Older People (EWGSOP) diagnostic criteria.

RESULTS

In our study, in parallel with the severity of disease in patients with GD diagnosis, the prevalence of sarcopenia (led by severe sarcopenia) was observed to be high compared to the control group. The prevalence of sarcopenia was 12.7%/24.2% among women and 13.8%/44.0% among men and 13.4%/32.8% in total in the control 2 and GD groups, respectively. There was a significant increase observed in the prevalence of sarcopenia, led by severe sarcopenia with a definite depression diagnosis.

CONCLUSION

For GD patients, diagnosis of sarcopenia in the early stages and precautions like improving muscle functions with protein support in diet and resistance exercises will make it possible to contribute to improving clinical results of the disease.

Postural control and balance in a cohort of healthy people living in Europe: An observational study

In the past 20 years, posturography has been widely used in the medical field. This observational study aimed to report the values derived from posturography of a wide set of healthy subjects from various European countries using a plantar pressure platform and a standardized method of measurement.A random cluster sampling of 914 healthy subjects aged between 7.0 and 85.99 years, stratified by age, was carried out. To provide percentile values of our cohort, data were processed to obtain 3 curves corresponding to the following percentiles: 25th, 50th, 75th, and the interquartile range. Distance-weighted least squares method was used to represent the percentile on appropriate graphs.In our sample, the balance to improve with age, up to approximately 45 years, but the trend to reverse with older age. The data show that the oscillations on the sagittal plane (y-mean) change with advancing age. Young people had more retro-podalic support than older people; the balance shifted forward in elderly people.As the study included a relatively large quantity of data collected using a standardized protocol, these results could be used as normative values of posturography for similar populations. On the basis of this data, correct diagnostic clues will be available to clinicians and professionals in the field. However, further studies are needed to confirm our findings.

The effects of selected lifestyle components on the risk of developing dynapenia in women – a pilot study

Aging processes in a body inevitably lead to changes which may decrease the quality of life of the elderly. Dynapenia is a phenomenon which is still not well known and needs to be studied in the population. The aim of the research was to determine the effects of lifestyle on the risk of developing dynapenia in post-menopausal women. The study included 46 females aged 71.4 ±5.6 living in the town of Wysokie Mazowieckie. Basic body dimensions and body composition elements were assessed with the use of anthropometry and bioelectrical impedance analysis (BIA). A direct interview method with the use of the modified Sedentary Behavior Questionnaire (SBQ) was applied. In order to assess the prevalence of dynapenia, handgrip strength was measured with the use of hydraulic dynamometer. Physical activity was assessed with the use of a pedometer. The respondents’ nutrition was examined in an interview concerning their diet from the 24 hours preceding the examination according to the methodology of Food and Nutrition Institute (FNI). The intake of energy and nutritional elements in a diet was calculated with using DIETA 5.0 computer software. Dynapenia was diagnosed in 21.7% of the examined women. The women with dynapenia had significantly bigger waist and hip circumferences and higher BMI (p<0.05) as well as significantly weaker hand muscles than healthy women (p<0.001). Females with dynapenia spent significantly more time in a sedentary position, i.e. talking on the phone, participating in religious rituals or watching TV (p<0.05) compared to women without dynapenia. No significant differences concerning the diet of women with and without dynapenia were revealed. Physical activity may significantly decrease the risk of dynapenia among women over 60 years of age. Furher research is needed to assess the risk of dynapenia and methods of its prevention.

The association between muscular strength and depression in Korean adults: a cross-sectional analysis of the sixth Korea National Health and Nutrition Examination Survey (KNHANES VI) 2014

Background

There are conflicting researches on the relationship between muscular strength and depression, the most common mental illness. There is no study of relationship between muscular strength and depression using national data from young adults to seniors. For example, there has not been a study done explaining mediating pathways among the influences of handgrip strength on depression. Here, we conducted survey for the association between relative handgrip strength and depression and explain mediated pathways for quality of life.

Methods

A cross-sectional study was administered to 4298 Korean adult subjects, aged 19–80 years, based on the 6th Korean National Health and Nutrition Examination Survey (KNHANES VI) of 2014. Handgrip strength reported as the average with each hand. The relative handgrip strength is defined as the handgrip strength divided by the body mass index (BMI). We performed analysis for all subjects and age groups (young adult, middle-aged, and elderly). We analyzed the association using multivariate linear regression and logistic regression. We also conducted mediation analysis for quality of life, which was measured by the EuroQol Five-Dimension Questionnaire (EQ5D).

Results

After adjusting for covariates, handgrip strength was inversely associated with the PHQ-9 score (P < 0.05). The odds ratios (OR) of depression symptoms were statistically significant for participants in the first and second quartile of handgrip strength compared to those with the highest quartile in entire sample, young adult, middle-aged, and elderly. There was about a 50% mediation effect of EQ5D in the relationship between handgrip strength and depression.

Conclusions

Using a large national sample, our results found that lower handgrip strength is associated with an increased risk of depression in Korean adult (young adult, middle-aged, and elderly). Our results suggest that increasing muscular strength may prevent depression in Korean adults.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6030-4) contains supplementary material, which is available to authorized users.

Relationship between muscle strength and fall episodes among the elderly: the Yilan study, Taiwan

Background

Fall episodes are not unusual among community residents, especially the elderly, and lower muscle strength is an important issue to address in order to prevent falls.

Methods

A community health survey was conducted in a suburban area of Taiwan, and 1067 older adults were selected for enrollment in the present study. All the enrolled subjects had been visited at their homes; the subjects’ strength of both hands and muscle mass of both legs were measured and well-established questionnaires were finished by certificated paramedic staffs.

Results

The incidence of fall episodes in the previous 1 year in the Yilan elderly population was 15.1%, and the female predominance was significant. A significantly higher prevalence of cataracts was found in group who experienced a fall in the past year (64% vs. 54.9% in the non-fall group). Mild or more severe dementia was much more prevalent in the group who experienced a recent fall (33.8% vs. 25.7% in the non-fall group). The strength of both hands tested as the physical function was 17.6 ± 8.0 kg in the recent fall group, significantly weaker than that in the non-fall group (20.7 ± 8.7 kg). Multivariate regression analysis revealed a greater weekly exercise duration and greater strength of both hands reduced the occurrence of falls among the whole and the female population. The standardized effect sizes of hand grip strength between both groups, not trivial, were 0.29 and 0.37 for the total population and the female subpopulation respectively.

Conclusions

Less weekly exercise duration and weaker muscle strength were f ound to be independent risk factors of fall episode(s) in an elderly Taiwanese population, especially in the female sub-population. Muscle strength, measured by average of both hands grip strength, was the most significantly factor of one-year fall episode(s) accessed retrospectively.

Reference values of hand-grip dynamometry and the relationship between low strength and mortality in older Chileans

Aim

This study was aimed to set reference values of hand-grip strength by age and sex and validate cut points for risk of functional limitation and mortality in older Chileans.

Methods

This was a pooled analysis of four studies including 6,426 people ≥60 years of nondependent community-dwelling Chileans. After exclusion criteria, the final sample included 5,250 subjects, from whom 2,193 were followed to study all-cause mortality associated with low hand-grip strength. Face-to-face interviews registering sociodemographic characteristics, self-reported chronic diseases, and functional limitations were conducted. Anthropometric measurements and observed mobility were performed by trained professionals. Hand-grip strength was measured with a hand dynamometer T-18 (Country Technology, Inc.) before 2008 or with JAMAR brand from 2008 onwards. Percentiles were calculated through descriptive analysis and quantile regression models for specific groups of age and sex. Adjusted Cox regression hazard models for mortality risk according to low dynamometry condition and covariates were developed.

Results

We deliver reference values of hand-grip strength for older Chileans proposing the 25th percentile as the cut-off point for low dynamometry risk: men ≤27 kg, women ≤15 kg. Low hand-grip strength was associated with Instrumental Activities of Daily Living limitations (p=0.001), and altered physical performance evaluated through the Timed Up and Go test (p=0.0001), grasping (p=0.001), bending (p<0.0001), and lifting (p<0.0001). After Cox proportional hazard regression models were assessed with a median follow-up of 9.2 years, the adjusted risk of all-cause mortality associated with a hand-grip strength lower than the 25th percentile in older Chileans showed a hazard ratio of 1.39 (95% confidence interval: 1.13–1.71).

Conclusion

The cut-off points of dynamometry validated for the older Chileans allow the incorporation in the geriatric evaluation in primary health care of an easy-to-use, inexpensive indicator to identify older adults at risk of sarcopenia, frailty, and dismobility. In addition this also helps to optimize the evaluation of intervention strategies focused on the maintenance of functionality.

Handgrip strength and its association with functional independence, depressive symptoms and quality of life in older adults

We assessed the associations between handgrip strength and functional independence, quality of life and depressive symptoms in 947 participants aged 65 years or over. Handgrip strength was measured with a dynamometer. Use of formal support and family/friend support was self-reported. Activities of daily living (ADL), quality of life and depressive symptoms were assessed using validated scales. Mean handgrip strength was 27.1kg (±10.3). Each 10kg increase in handgrip strength was associated with 39% reduced odds of impaired instrumental ADL. Handgrip strength was inversely associated with use of both formal and family/friend support. Handgrip strength was independently associated with functional independence.

Grip strength as a frailty diagnostic component in geriatric inpatients

BACKGROUND

Frailty has emerged as a key medical syndrome predictive of comorbidity, disability, institutionalization and death. As a component of the five frailty phenotype diagnostic criteria, patient grip strength deserves attention as a simple and objective measure of the frailty syndrome. The aim of this study was to assess conditions that influence grip strength in geriatric inpatients.

PATIENTS AND METHODS

The study group consisted of 80 patients aged 78.6±7.0 years [Formula: see text], with 68.8% women, admitted to the Department of Geriatrics. A comprehensive geriatric assessment was complemented with assessment for the frailty phenotype as described by Fried et al for all patients in the study group. Functional assessment included Barthel Index of Activities of Daily Living (Barthel Index), Instrumental Activities of Daily Living Scale and Mini-Mental State Examination.

RESULTS

Three or more frailty criteria were positive in 32 patients (40%), while 56 subjects (70%) fulfilled the frailty criterion of weakness (grip strength test). Multivariate linear regression analysis revealed that two independent measures showed positive association with grip strength - Mini-Mental State Examination score (β=0.239; P=0.001) and statin use (β=0.213; P=0.002) - and four independent measures were negatively associated with grip strength - female sex (β=-0.671; P<0.001), C-reactive protein (β=-0.253; P<0.001), prior myocardial infarction (β=-0.190; P=0.006) and use of an antidepressant (β=-0.163; P=0.018). Low physical activity was identified as the only independent qualitative frailty component associated with 2-year mortality in multivariate logistic regression analysis after adjustment for age and sex (odds ratio =6.000; 95% CI =1.357-26.536; P=0.018).

CONCLUSION

Cognitive function, somatic comorbidity and medical treatment affect grip strength as a measure of physical frailty in geriatric inpatients. Grip strength was not predictive of 2-year mortality in this group.

Sarcopenia in patients with chronic kidney disease not yet on dialysis: Analysis of the prevalence and associated factors

INTRODUCTION

Sarcopenia is a chronic condition that is associated with aging and characterized by a reduction of muscle mass, strength, and function. Sarcopenia is prevalent in patients with chronic kidney disease (CKD) and associated with increased morbidity and mortality, as well as cardiovascular complications.

OBJECTIVES

To investigate the prevalence of sarcopenia in patients with CKD not yet on dialysis and its correlation with clinical and laboratory variables and inflammatory markers.

METHODS

A total of 100 patients of both sexes aged over 18 were evaluated. Sarcopenia was defined using the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP) and of the Foundation for the National Institutes of Health (FNIH) Sarcopenia Project. Sociodemographic and clinical data, activities of daily living, functional capacity, and physical activity were also evaluated. Inflammation was assessed by the serum levels of high-sensitivity C-reactive protein (hsCRP) and interleukin (IL) 4 and 6.

RESULTS

The prevalence of sarcopenia was 11.9% and 28.7% using the EWGSOP and FNIH criteria, respectively. Sarcopenia was more prevalent in the more advanced stages of CKD (34.5% in stages 2 and 3A; and 65.5% in stages 3B, 4, and 5) and associated with worse performance in activities of daily living (p = 0.049), lower walking speeds (p < 0.001), and higher body mass indexes (BMIs) (p = 0.001) in the non-adjusted model. In addition, patients with sarcopenia had lower functional capacity (p = 0.012) and higher prevalence of physical inactivity (p = 0.041) compared with patients without sarcopenia. After adjustment for confounding variables, sarcopenia was still significantly correlated with walking speed (p = 0.004) and BMI (p = 0.002). HsCRP levels were inversely correlated with appendicular lean mass adjusted for BMI (p = 0.007) and were also positively associated with BMI (p = 0.001). IL4 levels were positively correlated with walking speed (p = 0.007) and lean mass in the lower limbs (p = 0.022).

CONCLUSIONS

Sarcopenia is common in patients with CKD, particularly in the most advanced stages of the disease. We observed an association between the levels of inflammatory markers and peripheral lean body mass, physical performance, and BMI. This association between sarcopenia and modifiable factors highlights the importance of early diagnosis and the implementation of therapeutic measures to minimize adverse outcomes in patients with CKD not yet on dialysis.