Kg For Women Research Articles

Handgrip strength weakness and asymmetry together are associated with cardiovascular outcomes in older outpatients: A prospective cohort study

AimThe evaluations of handgrip strength (HGS) weakness and asymmetry have implications for the comprehensive geriatric assessment. The aim of this study was to investigate the association of HGS weakness and asymmetry on cardiovascular outcomes in older outpatients.MethodsThis was a prospective observational cohort study of 364 Geriatrics outpatients aged ≥60 years, in which all participants carried out HGS tests at baseline. Patients with HGS <28 kg for men and <18 kg for women were diagnosed as HGS weakness, and HGS ratio <0.90 or >1.10 were diagnosed as HGS asymmetry. Primary outcomes defined as the major adverse cardiovascular event and composite end‐points were assessed during a 21‐month median follow‐up.ResultsAmong 364 participants, 155 (42.6%) showed HGS weakness, and 160 (44.0%) showed HGS asymmetry. HGS weakness was associated with major adverse cardiovascular events (HR 2.76, 95% CI 1.22–6.27) and composite end‐points (HR 2.84, 95% CI 1.40–5.77). However, no significant correlation between HGS asymmetry and cardiovascular outcomes was observed. Compared with the normal and symmetric HGS group, older adults with HGS weakness and asymmetry together had a higher risk of major adverse cardiovascular events (HR 5.23, 95% CI 1.56–17.54) and composite end‐points (HR 4.00, 95% CI 1.56–10.28).ConclusionsHGS weakness and asymmetry together might increase the risk of cardiovascular outcomes in older outpatients. HGS asymmetry offers complementary information to HGS weakness when making a comprehensive assessment of HGS. Geriatr Gerontol Int 2022; 22: 759–765.

Associations between dynapenia, cardiovascular hospitalizations, and all-cause mortality among patients on haemodialysis.

BackgroundLow muscle strength is associated with adverse clinical outcomes in patients undergoing haemodialysis (HD). No studies have reported the association between dynapenia, defined by both low handgrip strength (HGS) and quadriceps isometric strength (QIS), and long‐term clinical outcomes in patients on HD. We examined the associations between dynapenia, cardiovascular (CV) hospitalizations, and all‐cause mortality in the HD population.MethodsThis retrospective study used data from outpatients undergoing HD at two dialysis facilities between October 2002 and March 2020. We defined low muscle strength as an HGS of <28 kg for men and <18 kg for women and a QIS of <40% dry weight. Furthermore, we categorized dynapenia into three groups: robust (‘high HGS and high QIS’), either low HGS or low QIS (‘low HGS only’ or ‘low QIS only’), and dynapenia (‘low HGS and low QIS’). The outcomes were all‐cause mortality and a composite of CV hospitalizations and mortality. Cox proportional hazards and negative binomial models were used to examine these associations.ResultsA total of 616 patients (mean age, 65.4 ± 12.2 years; men, 61%) were included in the analyses. During the follow‐up (median, 3.0 years), a total of 163 deaths and 288 CV hospitalizations occurred. Patients with the either low HGS or low QIS [hazard ratio (HR), 1.75; 95% confidence intervals (CIs), 1.46–2.10] and dynapenia (HR, 2.80; 95% CIs, 2.49–3.14) had a higher risk of mortality than those in the robust group. When compared with the robust group, the either low HGS or low QIS [incidence rate ratio (IRR): 1.41, 95% CI: 1.00–1.99] and dynapenia (IRR: 2.04, 95% CI: 1.44–2.89) groups were associated with a significantly higher incident risk of CV hospitalizations.ConclusionsDynapenia (muscle weakness in both upper and lower extremities) was associated with increased risks of all‐cause mortality and CV hospitalizations among patients on HD. Screening for dynapenia using both HGS and QIS may be useful for prognostic stratification in the HD population.

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.

Reliability and validity of two hand dynamometers when used by community-dwelling adults aged over 50 years

BackgroundThe Jamar hydraulic dynamometer is a widely recognized tool for measuring grip strength. Nevertheless, the devices used most often in Asian countries are spring-type dynamometers, represented by the CAMRY dynamometer or Smedley dynamometer. We aimed to evaluate the reliability and validity of the CAMRY dynamometer compared with the Jamar dynamometer.MethodsThis was a cross-sectional study using a random crossover design in the grip strength test with two dynamometers. A total of 1064 healthy community-dwelling older adults aged 50–90 years old, which included 686 minorities and 378 Han Chinese, were recruited into the study from July to September 2021. We assessed the reliability and validity of the CAMRY EH101 dynamometer, and the Jamar dynamometer was regarded as the reference device. The order of testing with two dynamometers was randomized in a 1:1 ratio, with a 10-min gap between the two devices. Intraclass correlation coefficients (ICCs) and Bland–Altman analysis were calculated to assess reliability and validity between the two devices.ResultsThe average handgrip strength (HGS) values at six times by the Jamar and CAMRY devices were 25.0 ± 7.9 kg and 24.6 ± 7.5 kg, respectively. The ICC values between the two devices were 0.815–0.854, and the systematic bias underestimated by the CAMRY dynamometer was 0.5 kg in men and 0.6 kg in women. We carried out a linear regression equation by sex, and their relationship was found as follows: male HGS (kg)Jamar = 8.001 + 0.765 × HGS (kg)CAMRY; female HGS (kg)Jamar = 3.681 + 0.840 × HGS (kg)CAMRY.ConclusionsThe CAMRY EH101 dynamometer provides excellent reliability and validity. This device can serve as a reliable, inexpensive, and practical device to assess grip strength in geriatric clinical practice.Clinical trial registrationChinese Clinical Trial Registry: ChiCTR2100046367; Date of clinical trial reistration: 15/05/2021.

The Prevalence of Low Handgrip Strength and Its Predictors among Outpatient Older Adults in a Tertiary Care Setting: A Cross-Sectional Study.

Background: Low muscle strength is linked to several adverse health outcomes. However, there are limited data regarding its prevalence and associated factors in Thai older adults. This study aimed to fill that gap. Methods: This cross-sectional study was conducted with patients aged ≥ 60 years at the outpatient clinic of the internal medicine department of a tertiary care hospital from April 2020 to December 2021. Patient characteristics were collected, and a handgrip dynamometer was used to measure handgrip strength (HGS). Low HGS was defined according to the 2019 recommendations of the Asian Working Group for Sarcopenia. Results: In total, 198 patients were recruited. The prevalence of low HGS was 51%. Median HGS was 17.8 kg and 27.7 kg in women and men, respectively. Every age per year increase, greater number of medications of any type, and lower Montreal Cognitive Assessment (MoCA) score were independent factors associated with low HGS, with adjusted odds ratios of 1.1, 1.2, and 0.9, respectively. Conclusions: Low HGS was prevalent among older patients in this setting, indicating a high degree of possible sarcopenia. As there were some modifiable factors associated with low HGS, routine measurement, medication review, and cognitive evaluation are recommended for early diagnosis and management.

Influence of Preoperative Handgrip Strength on Length of Stay after Lumbar Fusion Surgery.

Preoperative sarcopenic status can affect length of hospital stay and patient outcomes after surgery. The aim of this study was to investigate the impacts of preoperative handgrip strength (HGS) on length of stay (LOS) and outcomes after lumbar fusion surgery. HGS was measured preoperatively, and the cut-off value for low HGS was <28 kg for men and <18 kg for women. Perioperative patient outcomes were compared between patients with low and normal HGS. A total of 225 patients, consisting of 86 and 139 patients in the low and normal HGS groups, respectively, fully satisfied the study criteria for analysis. A longer LOS (median 10 vs. 8 days, p = 0.013) and a higher incidence of serious postoperative complications (15.1 vs. 3.6%, p = 0.002) were observed in the low HGS group. In the multivariate analysis, a low HGS (odds ratio (OR) = 1.917, 95% confidence interval (CI) = 1.046–3.513, p = 0.035) was significantly associated with a longer LOS after surgery. Preoperative HGS below the reference values by sex appeared to be an independent factor associated with longer LOS after lumbar fusion surgery.

Poor Physical Capacity Combined With High Body Fat Percentage as an Independent Risk Factor for Incident Hypertension in Chinese Suburb-Dwelling Older Adults.

BackgroundThis study examined the effects of poor physical capacity and high body fat percentage (BF%) on the incidence of hypertension in Chinese suburb-dwelling older adults.MethodsThis study was conducted on 368 Chinese suburb-dwelling participants aged ≥ 60 years without hypertension (mean age: 66.74 ± 5.59 years, 48.9% men). Poor physical capacity is defined by the Asian Working Group for Sarcopenia (AWGS) criteria as grip strength < 26 kg for men and < 18 kg for women or walking speed <0.8 m/s. High BF% was defined as values that are greater than the upper tertile for BF% as stratified by sex. The outcome was the incidence of hypertension.ResultsOverall, 5.7% of subjects had both poor physical capacity and high BF%. After the average follow-up duration of 2 years, the incidence of hypertension was 39.7%, and those experiencing both poor physical capacity and high BF% had the highest incidence (81.0%). After multivariate adjustments, the incidence of hypertension was associated with the combination of poor physical capacity and high BF% [odds ratio (OR) = 6.43, 95% CI = 1.91–21.64] but not solely with poor physical capacity (OR = 1.11, 95% CI = 0.55–2.25) or only high BF% (OR = 1.37, 95% CI = 0.80–2.34).ConclusionThe combination of poor physical capacity and high BF% can significantly increase the incidence of hypertension in Chinese suburb-dwelling older adults. For hypertension prevention, ideally, we should strive toward decreasing body fat mass while simultaneously improving physical capacity.

Associations of indicators of sleep impairment and disorders with low muscle strength in middle-aged and older adults: The HypnoLaus cohort study

ObjectiveInvestigate associations of objective and subjective indicators of sleep impairment and disorders with low muscle strength (LMS) in different age groups and genders using data from a population-based cohort study. MethodsPolysomnographic and subjective sleep data from participants (aged 40–80 years) of the HypnoLaus study (Lausanne, Switzerland) were cross-sectionally analyzed. Indicators of sleep impairment and disorders were based on pre-defined cutoffs. LMS was defined according to the diagnosis of sarcopenia (grip strength <27 kg for men and <16 kg for women). Results obtained by multivariate logistic regression were controlled for confounders. Results1902 participants (mean [SD] age, 57.4 [10.5] years; 968 [50.9 %] female) were enrolled. Objective short (<6.2 h) and long sleep durations (>8.5 h) were associated with LMS (OR = 1.74, 95 % CI = 1.07–2.82; OR = 6.66, 95 % CI = 3.45–12.87, respectively). Increased nighttime wakefulness >90 min and severe obstructive apnea (OSA) (AHI > 30) were associated with LMS (OR = 1.60, 95 % CI = 1.01–2.56; OR = 2.36, 95 % CI = 1.29–4.31, respectively). In adults aged over 60 years, these associations persisted, and reduced sleep efficiency was associated with LMS (aOR = 1.81, 95 % CI 1.05–3.13). Objective long sleep duration was associated with LMS in both genders and severe OSA predicted LMS among women (aOR = 2.64, 95 % CI 1.11–6.24). ConclusionsMarkers of early sarcopenia are affected by long sleep duration from middle age onwards in both genders. Older adults are more susceptible to the effects of other indicators of inappropriate sleep duration and quality. The findings support a potential role of sarcopenia in age-related OSA. The intricate relationships between sleep and muscle health are potential targets of public health interventions and clinical research on preventive and therapeutic strategies against the increasing morbimortality observed with ageing.

European Working Group on Sarcopenia in Older People 2010 (EWGSOP1) and 2019 (EWGSOP2) criteria or slowness: which is the best predictor of mortality risk in older adults?

Objectivesto analyse the accuracy of grip strength and gait speed in identifying mortality; to compare the association between mortality and sarcopenia defined by the EWGSOP1 and EWGSOP2 using the best cut-off found in the present study and those recommended in the literature and to test whether slowness is better than these two definitions to identify the risk of death in older adults.Methodsa longitudinal study was conducted involving 6,182 individuals aged 60 or older who participated in the English Longitudinal Study of Ageing. Sarcopenia was defined based on the EWGSOP1 and EWGSOP2 using different cut-off for low muscle strength (LMS). Mortality was analysed in a 14-year follow-up.Resultscompared with the LMS definitions in the literature (<32, <30, <27 and < 26 kg for men; <21, <20 and < 16 kg for women), the cut-off of <36 kg for men (sensitivity = 58.59%, specificity = 72.96%, area under the curve [AUC] = 0.66) and < 23 kg for women (sensitivity = 68.90%, specificity = 59.03%, AUC = 0.64) as well as a low gait speed (LGS) ≤0.8 m/s (sensitivity = 53.72%, specificity = 74.02%, AUC = 0.64) demonstrated the best accuracy for mortality. Using the cut-off found in the present study, probable sarcopenia [HR = 1.30 (95%CI: 1.16–1.46)], sarcopenia [HR = 1.48 (95%CI: 1.24–1.78)] and severe sarcopenia [HR = 1.78 (95%CI: 1.49–2.12)] according to EWGSOP2 were better predictors of mortality risk than EWGSOP1. LGS ≤0.8 m/s was a better mortality risk predictor only when LMS was defined by low cut-off.Conclusionsusing LMS <36 kg for men and < 23 kg for women and LGS ≤ 0.8 m/s, EWGSOP2 was the best predictor for mortality risk in older adults.

PB2181: DOES SARCOPENIA INFLUENCE THE SUCCESS OF HEMATOPOIETIC STEM CELL TRANSPLANTATION?

Background: Sarcopenia has been widely studied in solid tumors. However, its presence and prognostic significance in hematological malignancies and transplantation cases are not clear enough. Aims: In this study, we aimed to evaluate the presence of sarcopenia and its effects on transplantation success in patients undergone stem cell transplantation. Methods: Twenty-four patients who had autologous or allogenic stem cell transplantation between May 2021 and January 2022 were included in this study. Patients who had a secondary non-hematological malignancy, neuropathy or paralysis, chronic liver/kidney disease, glomerular filtration rate <60 ml/min, congestive heart failure were excluded. Patients with a body mass index (BMI) <20.0 kg/m2; 20.0 - 24.9 kg/m2; 25.0 -29.9 kg/m2; > 30 kg/m2 were considered as underweight; normal weight; overweight and obese respectively. Low muscle mass was evaluated with the Bioelectrical Impedance Analysis (BIA) method. TANITA-SC-240MA device was used to measure body composition by BIA method. The low skeletal muscle mass index (SMI) was considered as ≤10.76 kg/m2 in men and ≤ 6.76 kg/m2 in women. The muscle strength was evaluated by using a handgrip dynamometer (TAKEI 5401 Hand Dynamometer, 100 kg). The average of 3 measurements were calculated and <30 kg in men and <20 kg in women were considered as low muscle strength. Patients were evaluated by bioelectrical impedance analysis (BIA), hand grip test, sit-stand test within 1 week before administration of preparative regimens for stem cell transplantation. The neutrophil and trombocyte engraftment days, presence of bacteremia, need for thrombocyte infusion and hospitalization time were analyzed due to the presence of sarcopenia. Results: 24 patients were included in our study. The median age of the patients was 48 (23-67), and 16 patients (66%) were female. Three patients (12.5%) were 65 years or older. Two patients had autologous stem cell transplantation previously and were undergone allogeneic transplantation due to the relaps. Among all patients, 5 patients (20.8%) were obese, 5 patients (20.8%) were overweight, 9 patients were (37.5%) normal weight and 5 patients were (20.8%) underweight. 4 patients (16.6%) were determined as sarcopenic. According to the BMI values of the sarcopenic patients, 3 were underweight and 1 was obese. Muscle strength and SMI were significantly lower in patients with sarcopenia (p: 0.035; p: 0.01, respectively) (Table 1). There was no significant relationship between the presence of sarcopenia and gender, age, BMI, diagnosis, neutrophil and platelet engraftment days. Although the length of hospitalization in patients with sarcopenia seemed to be longer, it was not statistically significant (p=0.83) (Table 1). The administration of parenteral nutrition was more frequent in patients with diabetes mellitus. When the patients were evaluated in terms of mortality on the 100th day, this value was found to be 50% in the group with sarcopenia. Image:Summary/Conclusion: Sarcopenia is more common in patients who are candidates for allogenic transplantation compared to autologous transplantation. However, since the number of patients included in our study was low, the effect of sarcopenia on transplantation success could not fully clarified. Prospective studies with larger number of patients are needed on this subject.

Associations of Handgrip Asymmetry With Impaired Health-Related Quality of Life Among Older Adults in South Korea: A Cross-Sectional Study Using National Survey Data.

This study aimed to examine the associations of handgrip strength (HGS) and asymmetry with health-related quality of life among South Korean older adults. We enrolled 7395 older adults from the Korea National Health and Nutrition Examination Survey. Health-related quality of life was measured using the EuroQol-5 Dimension. Weakness was defined as a HGS of <26 kg for men and <18 kg for women. Handgrip strength symmetry was defined as an HGS ratio of 0.9:1.1, and HGS asymmetry was defined as a ratio outside that range. Data were analyzed using the Rao-Scott χ2, F test, and multivariate logistic regression. Compared with those in the "symmetric HGS and not weak" group, those in the "asymmetric HGS and weak" group had impaired health-related quality of life for all variables among men (odds ratios [ORs] = 1.67-3.75). A greater risk of impaired self-care (SC; odds ratio [OR] = 2.33) and anxiety/depression (AD; OR = 1.40) was observed among women in the "asymmetric HGS and weak" group. Handgrip weakness and asymmetry are associated with impaired health-related quality of life. Handgrip asymmetry can be a clinical marker of health-related quality of life in older adults and must be measured alongside HGS.

Bio-Electrical Impedance Analysis: A Valid Assessment Tool for Diagnosis of Low Appendicular Lean Mass in Older Adults?

BackgroundThe diagnosis of sarcopenia is essential for early treatment of sarcopenia in older adults, for which assessment of appendicular lean mass (ALM) is needed. Multi-frequency bio-electrical impedance analysis (MF-BIA) may be a valid assessment tool to assess ALM in older adults, but the evidences are limited. Therefore, we validated the BIA to diagnose low ALM in older adults.MethodsALM was assessed by a standing-posture 8 electrode MF-BIA (Tanita MC-780) in 202 community-dwelling older adults (age ≥ 55 years), and compared with dual-energy X-ray absorptiometry (DXA) (Hologic Inc., Marlborough, MA, United States; DXA). The validity for assessing the absolute values of ALM was evaluated by: (1) bias (mean difference), (2) percentage of accurate predictions (within 5% of DXA values), (3) the mean absolute error (MAE), and (4) limits of agreement (Bland–Altman analysis). The lowest quintile of ALM by DXA was used as proxy for low ALM (< 22.8 kg for men, < 16.1 kg for women). Sensitivity and specificity of diagnosing low ALM by BIA were assessed.ResultsThe mean age of the subjects was 72.1 ± 6.4 years, with a BMI of 25.4 ± 3.6 kg/m2, and 71% were women. BIA slightly underestimated ALM compared to DXA with a mean bias of −0.6 ± 1.2 kg. The percentage of accurate predictions was 54% with a MAE of 1.1 kg, and limits of agreement were −3.0 to + 1.8 kg. The sensitivity for ALM was 80%, indicating that 80% of subjects who were diagnosed as low ALM according to DXA were also diagnosed low ALM by BIA. The specificity was 90%, indicating that 90% of subjects who were diagnosed as normal ALM by DXA were also diagnosed as normal ALM by the BIA.ConclusionThis comparison showed a poor validity of MF-BIA to assess the absolute values of ALM, but a reasonable sensitivity and specificity to recognize the community-dwelling older adults with the lowest muscle mass.

The combined effect of anemia and dynapenia on mortality risk in older adults: 10-Year evidence from the ELSA cohort study

Background/ObjectiveAnemia and dynapenia can occur simultaneously. Separately, both conditions increase the mortality risk with advancing age. However, there is no epidemiological evidence on the combined effect of these conditions on mortality in older adults. We investigated whether combined anemia and dynapenia increase the mortality risk, and whether there are gender differences. MethodsA 10-year follow-up study was conducted involving 5,310 older adults from the English Longitudinal Study of Ageing (ELSA). According to the diagnosis of anemia (hemoglobin concentration < 13.0 g/dL in men and < 12.0 g/dL in women) and dynapenia (grip strength < 26 kg for men and < 16 kg for women), individuals at baseline were categorized as “non-anemic/non-dynapenic”, “dynapenic”, “anemic” and “anemic/dynapenic”. The outcome was all-cause mortality during the follow-up period. ResultsA total of 984 deaths were computed during the follow-up (63.7% in non-anemic/non-dynapenic, 22.8% in dynapenic, 7.5% in anemic and 6.0% in anemic/dynapenic). Adjusted Cox proportional hazard models stratified by sex showed that anemia and dynapenia combined was associated with an increased mortality risk in men (HR: 1.64; 95% IC 1.08 – 2.50) and women (HR: 2.17; 95% CI 1.44 – 3.26). Anemia in men (HR: 1.68; 95% CI 1.22 – 2.32) and dynapenia in women (HR: 1.37; 95% CI 1.09 – 1.72) were also risk factors for mortality. ConclusionsThe coexistence of anemia and dynapenia increases the mortality risk, highlighting the need for early identification, prevention, and treatment of these conditions to reduce their complications and the mortality risk.

THE EFFECT OF DIETERY CHANGES ON WEIGHT AND BLOOD PRESSURE IN MIDDLE AGE PATIENTS WITH OVERWEIGHT/OBESITY AND HIGH NORMAL BLOOD PRESSURE

Objective: To evaluate the effects of dietary weight loss intervention in middle age with high normal blood pressure and overweight/obesity. Design and method: Men and women aged 25–54 was from working population were observed within the prospective epidemiological study: in subjects with BMI more than 25 kg/m2and BP 130–139/85–89 mm Hg. Was found a strong correlation of systolic BP and BMI was revealed: p = 0.0001 in women and p = 0.0045 in men. The same was true for diastolic BP: p = 0.0001 in women and p = 0.0001 in men. Two groups were formed and followed for 3 years: Intervention and Control groups consisted of 455 subjects (203 and 252 respectively). Dietician’s consultations were used in intervention group. Results: An increase of BMI by 1 kg/m2was associated with increase of systolic BP in women and men (by 1.3 and 0.7 mmHg respectively), (p &lt; 0.05). For diastolic BP increase of BMI by 1 kg/m2was associated with increase in men and women (by 0.7 and 0.9 mm Hg respectively). In stepwise regression analysis body mass explains 27% of systolic BP variability and 11% of diastolic BP variability in men. In women it was 19% and 17% respectively. Last follow up visit attended more than 76% of the participants. After 3 years of intervention a weight loss was noted in the intervention group on an average at 1.17 kg in women (p &lt; 0.05) and 0.63 kg (p &lt; 0.05) in men. In controls body weight increased in women and in men (at 3.08 and 2.89 kg respectively) (all p &lt; 0.05). BP decreased in the intervention group - 3.27 for systolic BP and – 2.09 mm Hg for diastolic BP in women; - 1.92 and – 1.91 mm Hg in men respectively. In control group BP increased: 2.97 mm Hg systolic BP and 1.29 mm Hg for diastolic Bp in women and 2.56 mm Hg and 2.39 mm Hg in men respectively (all p &lt; 0.05). Conclusions: Dietary approach to weight loss is effective tool in middle age men and women with high normal BP and overweight/obesity for prevention of hypertension.

Prevalence of Anemia and Factors Associated With Handgrip Strength in Indonesian Elderly Population.

Introduction: Anemia is a common blood disorder in the elderly which is associated with numerous poor medical outcomes. However, there is currently no study that assesses anemia prevalence of the Indonesian elderly population aged ≥60 years old in multiple provinces and analyzes its association with handgrip muscle strength using a large sample size.Aim: We aimed to elucidate the prevalence of anemia and analyze factors associated with handgrip strength in elderly.Method: This was a cross-sectional study using data from the Indonesian Family Life Survey-5 (IFLS-5). All participants aged ≥60 years old were included in this study. Exclusion criteria were: (1) respondents who refused to take health measurements (hemoglobin (Hb) level, handgrip strength, weight, stature, and waist circumference); (2) respondents with incomplete or missing data; (3) respondents with history of stroke; and (4) respondents with history of pain, swelling, inflammation, injury, and surgery on one or both hands within the last 6 months. The dependent variable for this study was handgrip strength. Subjects were classified as weak if the handgrip strength was <28 kg for men and <18 kg for women based on classification from the Asian Working Group for Sarcopenia (AWGS) 2019. The independent variables were Hb level, gender, age, body mass index (BMI), waist circumference, smoking history, comorbidities, and current use of drug therapies. Based on WHO standard, male and female participants with Hb less than 13 g/dL and 12 g/dL, respectively, are defined as anemic. Statistical analyses used included correlation, bivariate logistic regression, and multivariate logistic regression.Result: A total of 3192 individuals were selected for analysis. Overall, 38.8% of participants had anemia, and the prevalence of anemia increases with age. A total of 56.30% of participants aged ≥80 years had anemia. There was a positive correlation between Hb level and handgrip strength in the Indonesian elderly population (r: 0.349; p value: <0.001). Multivariate analysis showed that anemia was significantly associated with weak handgrip strength (OR: 1.557; 95% CI: 1.314-1.846; p value: <0.001). Age ≥ 80 years (OR: 5.234), age 70-79 years (OR: 3.152), low BMI (OR: 1.827), and hypertension (OR: 1.340) were associated with weak handgrip strength in multivariate analysis.Conclusion: The prevalence of anemia in the Indonesian elderly was 38.8% and anemia was associated with weak handgrip strength. The association of anemia with weak handgrip strength is more pronounced in males and the elderly aged ≥80 years.

How Well Do Low Population-Specific Values for Muscle Parameters Associate with Indices of Poor Physical Health? Cross-Sectional Data from the Geelong Osteoporosis Study.

We aimed to examine associations between skeletal muscle deficits and indices of poor health. Cut-points for skeletal muscle deficits were derived using data from the Geelong Osteoporosis Study and definitions from the revised European Consensus on Definition and Diagnosis and the Foundation for the National Institutes of Health. Participants (n = 665; 323 women) aged 60–96 year had handgrip strength measured by dynamometry and appendicular lean mass by whole-body dual-energy X-ray absorptiometry. Physical performance was assessed using the Timed Up and Go test. Sex-specific cut-points were equivalent to two standard deviations below the mean young reference range from the Geelong Osteoporosis Study. Indices of poor health included fractures, falls, and hospitalisations. Low trauma fractures since age 50 year (excluding skull, face, digits) were self-reported and confirmed using radiological reports. Falls (≥1 in the past 12 months) and hospitalisations (past month) were self-reported. Logistic regression models (age- and sex-adjusted) were used to examine associations. Receiver Operating Characteristic curves were applied to determine optimal cut-points for handgrip strength, Timed Up and Go, appendicular lean mass/height2, and appendicular lean mass/body mass index that discriminated poor health outcomes. There were 48 participants (6.9%) with hospitalisations, 94 (13.4%) with fractures, and 177 (25.3%) with at least one fall (≥1). For all cut-points, low handgrip strength was consistently associated with falls. There was little evidence to support an association between low appendicular lean mass, using any cut-point, and indices of poor health. Optimal cut-offs for predicting falls (≥1) were: handgrip strength 17.5 kg for women and 33.5 kg for men; Timed Up and Go 8.6 s for women and 9.9 s for men; appendicular lean mass/height2 6.2 kg/m2 for women and 7.46 kg/m2 for men; and appendicular lean mass/body mass index 0.6 m2 for women and 0.9 m2 for men. In conclusion, muscle strength and function performed better than lean mass to indicate poor health. These findings add to the growing evidence base to inform decisions regarding the selection of skeletal muscle parameters and their optimal cut-points for identifying sarcopenia.

Predictive ability of hand-grip strength and muscle mass on functional prognosis in patients rehabilitating from stroke

ObjectivesThis study aimed to investigate the association between muscle strength and adjusted appendicular skeletal muscle mass (ASM) in patients who have had strokes with the Functional Independence Measure (FIM) and the probability of being discharged. MethodsA retrospective cohort study was conducted for older patients who have had strokes admitted to convalescent rehabilitation wards between January 2017 and October 2020. Hand-grip strength (HGS) was used to assess muscle strength. ASM was measured with a bioelectrical impedance analysis, and then divided by height-squared, body weight, body mass index (BMI), body fat mass (BFM), and body fat percentage (BFP) to calculate the adjusted ASM. The primary outcome was FIM at the time of discharge, and the secondary outcome was the probability of being discharged to their home. Multivariate analyses were conducted to adjust for confounding effects. ResultsThe data of 699 participants (female: 47%; median age, 79 y) were analyzed. HGS was independently associated with FIM at the time of discharge in men (partial regression coefficient [B] = 0.482; 95% confidence interval [CI], 0.225–0.740) and women (B = 0.664; 95% CI, 0.263–1.065) and also was independently associated with being discharged to their home in men (odds ratio [OR]: 1.070; 95% CI, 1.030–1.100) and women (OR: 1.070; 95% CI, 1.000–1.130). Conversely, none of the adjusted ASM indices were associated with the outcomes. The cutoff value of HGS for discharge to home was 15.1 kg for men and 9.5 kg for women. ConclusionsIn patients who have had strokes, HGS independently predicted FIM at the time of discharge and the probability of being discharged to their home. The adjusted ASM methods had less predictive value for functional and discharge outcomes.

Prediction of Probable Sarcopenia with an Alternative Method: Plantar Flexion Strength

Objective : Sarcopenia is a geriatric syndrome characterized by age-related reduction in muscle mass and strength. Assessment of handgrip strength (HGS) is an essential measurement for the diagnosis of sarcopenia; however, disorders affecting upper limb muscles and joints may pose challenges in assessing handgrip strength. Therefore, the present study aimed to show the validity of plantar flexion strength (PFS) in diagnosing probable sarcopenia and investigating the relations between comprehensive geriatric assessment (CGA) and PFS while determining appropriate cutoff values for PFS. Methods : A total of 304 older participants who underwent CGA were included. The revised criteria of the European Working Group on Sarcopenia in Older People (EWGSOP) were used to determine PFS cutoff values for gender groups. Associations between probable sarcopenia and CGA parameters were investigated using PFS cutoffs. Results : The mean age was 74.50±7.10, and 170 of the participants (55.9%) were women. The mean HGS was 14.40±5.63 kg in women and 25.08±8.07 kg in men. The mean PFS were 13.17±3.62 and 14.92±3.86 kg respectively. In females, PFS cutoff with sensitivity/specificity; 0.81/0.60 was set at 14.95 kg (AUC 0.69, 95%CI: 0.611-0.772, p<0.001). In males, PFS cutoff with sensitivity/specificity; 0.80/0.55 was set at 16.80 kg (AUC 0.68, 95%CI: 0.593-0.772, p<0.001). Probable sarcopenia identified by GMS was associated with basic living activities, mobility, and frailty after adjusting for age and sex (p<0.001, p=0.021, and p=0.011 respectively). Conclusions : Probable sarcopenia identified by PFS could be associated with CGA. PFS may be useful for evaluating probable sarcopenia in older whose HGS cannot be estimated accurately.

MO924: Association Between Dynapenia, Cardiovascular Hospitalizations and All-Cause Mortality Among Patients on Hemodialysis

Abstract BACKGROUND AND AIMS Low muscle strength is associated with adverse clinical outcomes in patients on hemodialysis (HD). However, the association between dynapenia, characterized by both low handgrip strength (HGS) and leg strength (LS) and long-term clinical outcomes in patients on HD has not yet been reported. Therefore, this study investigated whether dynapenia was associated with higher cardiovascular (CV) hospitalization risk and all-cause mortality in patients on HD. METHOD This retrospective study used the data of outpatients on HD from two dialysis facilities between October 2002 and March 2020. This study was approved by the Institutional Review Board/Ethics Committee of Kitasato University of Allied Health Sciences and was conducted in accordance with the principles of the Declaration of Helsinki. All participants provided written informed consent before inclusion in the study. Low muscle strength was defined as an HGS of &amp;lt; 28 kg for men and &amp;lt; 18 kg for women and an LS of &amp;lt; 40% dry weight. Furthermore, dynapenia was categorized into three groups: robust (‘high HGS and high LS’), either low HGS or low LS (‘low HGS only’ or ‘low LS only’) and dynapenia (‘low HGS and low LS’). The outcomes were all-cause mortality and a composite of CV hospitalizations and mortality. These associations were examined using Cox proportional hazards and negative binomial models. RESULTS Data from 616 patients (mean age, 65.4 ± 12.2 years; men, 61%) were analyzed. During the follow-up (median, 3.0 years), 163 deaths and 288 CV hospitalizations occurred. Figure 1 shows the results of the Kaplan–Meier survival analyses of the robust, either low HGS or low LS, and dynapenia groups. The log-rank test showed significantly worse survival in the either low HGS or low LS and dynapenia groups than in the robust group (P &amp;lt; 0.001). After adjusting for age, sex, body mass index, HD vintage, comorbidity index, serum albumin, serum hemoglobin, serum creatinine and C-reactive protein levels, patients with either low HGS or low LS [hazard ratio (HR), 1.81; 95% confidence intervals (95% CIs), 1.51–2.17] and dynapenia (HR 2.77, 95% CI 2.48–3.08) were found to have a higher mortality risk than those in the robust group. Similarly, compared with the robust group, either the low HGS or low LS [incidence rate ratio (IRR) 1.45, 95% CI 1.04–2.03] and dynapenia (IRR 2.06, 95% CI 1.48–2.89) groups had higher multiple CV hospitalization and all-cause mortality risks. CONCLUSION Dynapenia, characterized by both low HGS and LS, was significantly associated with increased CV hospitalization and mortality risk in patients on HD. Clinical assessments of muscle strength and screening patients with low muscle strength are crucial for disease management in this population. Measuring the muscle strength of the entire extremity, and not only the upper or lower extremities, may be necessary for accurate prognostic stratification.

Associations of handgrip strength with all-cause and cancer mortality in older adults: a prospective cohort study in 28 countries.

Backgroundmixed evidence exists on the association between muscle strength and mortality in older adults, in particular for cancer mortality.Aimto examine the dose–response association of objectively handgrip strength with all-cause and cancer mortality.Study Design and Settingdata from consecutive waves from the Survey of Health, Ageing and Retirement in Europe comprising 27 European countries and Israel were retrieved. Overall, 54,807 men (45.2%; 128,753 observations) and 66,576 women (54.8%; 159,591 observations) aged 64.0 (SD 9.6) and 63.9 (SD 10.2) years, respectively, were included. Cox regression and Fine-Grey sub-distribution method were conducted.Resultsduring the follow-up period (896,836 person-year), the fully adjusted model showed the lowest significant risk estimates for the highest third of handgrip strength when compared with the first third (reference) in men (hazard ratio [HR], 0.41; 95% confidence interval [CI], 0.34–0.50) and women (HR, 0.38; 95% CI, 0.30–0.49) for all-cause mortality. We identified a maximal threshold for reducing the risk of all-cause mortality for men (42 kg) and women (25 kg), as well as a linear dose–response association in participants aged 65 or over. No robust association for cancer mortality was observed.Conclusionthese results indicate an inverse dose–response association between incremental levels of handgrip and all-cause mortality in older adults up to 42 kg for men and 25 kg for women, and a full linear association for participants aged 65 years or over. These findings warrant preventive strategies for older adults with low levels of handgrip strength.