Sarcopenic obesity and risk of new onset depressive symptoms in older adults: English Longitudinal Study of Ageing.
ABSTRACT: We examined the role of sarcopenic obesity as a risk factor for new-onset depressive symptoms over 6-year follow-up in a large sample of older adults.The sample comprised 3862 community dwelling participants (1779 men, 2083 women; mean age 64.6±8.3 years) without depressive symptoms at baseline, recruited from the English Longitudinal Study of Ageing. At baseline and 4-year follow-up, handgrip strength (kg) of the dominant hand was assessed using a hand-held dynamometer, as a measure of sarcopenia. The outcome was new onset depressive symptoms at 6-year follow-up, defined as a score of ?4 on the 8-item Centre of Epidemiological Studies Depression scale. Sarcopenic obesity was defined as obese individuals (body mass index ?30?kg?m(-)(2)) in the lowest tertile of sex-specific grip strength (<35.3?kg men; <19.6?kg women).Using a multivariable logistic regression model, the risk of depressive symptoms was greatest in obese adults in the lowest tertile of handgrip strength (odds ratio (OR), 1.79, 95% confidence interval (CI), 1.10, 2.89) compared with non-obese individuals with high handgrip strength. Participants who were obese at baseline and had a decrease of more than 1 s.d. in grip strength over 4-year follow-up were at greatest risk of depressive symptoms (OR=1.97, 95% CI, 1.22, 3.17) compared with non-obese with stable grip strength.A reduction in grip strength was associated with higher risk of depressive symptoms in obese participants only, suggesting that sarcopenic obesity is a risk factor for depressive symptoms.
Project description:Identifying children at risk of developing childhood sarcopenic obesity often requires specialized equipment and costly testing procedures, so cheaper and quicker methods would be advantageous, especially in field-based settings. The purpose of this study was to determine the relationships between the muscle-to-fat ratio (MFR) and relative handgrip strength, and to determine the ability of handgrip strength relative to body mass index (grip-to-BMI) to identify children who are at risk of developing sarcopenic obesity. Grip-to-BMI was measured in 730 Czech children (4 to 14 yrs). Bioelectrical impedance was used to estimate body fat mass and skeletal muscle mass, from which the MFR was calculated. The area under the curve (AUC) was 0.791 (95% CI 0.692-0.890, p ? 0.001) in girls 4-9; 0.789 (95% CI 0.688-0.890, p ? 0.001) in girls 10-14 years old; 0.719 (95% CI 0.607-0.831, p = 0.001) in boys 4-9; and 0.896 (95% CI 0.823-0.969, p ? 0.001) in boys 10-14 years old. Calculated using the grip-to-BMI ratio, the OR (95% CI) for girls to be at risk of sarcopenic obesity identified by MFR was 9.918 (4.243-23.186, p ? 0.001) and was 11.515 (4.280-30.982, p ? 0.001) for boys. The grip-to-BMI ratio can be used to predict the presence of sarcopenic obesity in children, which can play a role in pediatric health interventions.
Project description:BACKGROUND:Increased physical activity level is related to lower risk of depressive symptoms, and there is an inverse association between muscle strength and risk of depressive symptoms among the elderly. Although there is evidence of an inverse association between muscle strength and depressive symptoms, the relationship between these variables in a younger population is still unknown. This study aimed to examine the association between handgrip strength, a representative indicator of skeletal muscle strength, and the risk of depressive symptoms among Chinese female college freshmen. METHODS:A cross-sectional study was conducted among 867 participants aged between 16 and 23?years. Handgrip strength was measured with a handheld digital Smedley dynamometer, and handgrip strength relative to body weight (kg/kg) was calculated and was classified into tertiles as follows: low (0.32-0.50), medium (0.51-0.58), and high (0.59-0.94). Depressive symptoms were evaluated using the 20-item Zung self-rating depression scale (SDS), and three cutoff points were used to indicate different depression levels. RESULTS:We found that 10.7% of participants were classified as having severe depressive symptoms using an SDS score of 50 as the cutoff point. After adjusting for potential confounders, the adjusted odds ratios and 95% confidence intervals (CIs) for moderate-to-severe depressive symptoms across tertiles of the relative handgrip strength were 1.00 (reference) for tertile 1, 0.614 (0.353, 1.069) for tertile 2, and 0.537 (0.292, 0.988) for tertile 3 (P for trend?=?0.041). The significant associations remained when other cutoff points (SDS scores: 48 or 45) were used. Interactions between handgrip strength and potential confounders for depressive symptoms in the final models were not significant. CONCLUSIONS:Our findings indicate that handgrip strength is inversely and independently related to the risk of depressive symptoms among Chinese female college freshmen. The present findings can help develop an effective intervention strategy against depression. Further intervention studies are needed to explore the mechanisms underlying the effects of handgrip strength on depressive symptoms.
Project description:Sarcopenic obesity portends poor outcomes, yet it is under-recognized in practice. We collected baseline clinical data including data on body composition (total and segmental muscle mass and total body fat), grip strength, and 5-times sit-to-stand. We defined sarcopenia using cut-points for appendicular lean mass (ALM) and obesity using body-fat cut-points. A total of 599 clinic patients (78.5% female; mean age was 51.3?±?14.2?years) had bioelectrical impedance analysis (BIA) data (83.8%). Mean body mass index (BMI) and waist circumference were 43.1?±?8.9?kg/m2 and 132.3?±?70.7?cm, respectively. All patients had elevated body fat. There were 284 (47.4%) individuals fulfilling criteria for ALM-defined sarcopenia. Sarcopenic obese persons had a lower BMI (38.2?±?6.4 vs 47.6?±?8.6; P?<?0.001), fat-free mass (113.0?kg?±?16.1 vs 152.1?kg?±?29.4; P?<?0.001), fat mass (48.4%?±?5.9 vs 49.5%?±?6.2; P?=?0.03), and visceral adipose tissue (216.8?±?106.3 vs 242.7?±?133.6?cm3; P?=?0.009) than those without sarcopenic obesity. Grip strength was lower in those with sarcopenic obesity (25.1?±?8.0 vs 30.5?±?11.3?kg; P?<?0.001) and sit-to-stand times were longer (12.4?±?4.4 vs 10.8?second?±?4.6; P?=?0.03). Sarcopenic obesity was highly prevalent in a rural, tertiary care weight and wellness center.
Project description:BACKGROUND:Cross-sectional evidence has shown an association between abdominal obesity and lower muscle strength in older adults. However, no longitudinal findings have confirmed this association. In addition, the impact of abdominal fat on the reduction in muscle strength is not yet fully understood. METHODS:We investigated the longitudinal associations between abdominal obesity and handgrip strength in 5,181 older adults from the English Longitudinal Study of Ageing over 8 years of follow-up. Muscular strength was measured using a manual dynamometer. Abdominal obesity was defined as a waist circumference >102 cm for men and >88 cm for women. Generalized linear mixed models were adjusted by measures of socioeconomic status, health conditions, lifestyle, cognition, depressive symptoms, biomarkers, and disability. RESULTS:At baseline, the mean age of participants was 65.8 years and their mean waist circumference and body mass index (BMI) were 95 cm and 27.7 kg/m2, respectively. Fully adjusted models showed that abdominal obese men and women had stronger muscle strength at baseline. The decline over time in muscle strength was accelerated in abdominal obese men (-0.12 kg/year, 95% confidence interval: -0.24 to -0.01) compared with nonabdominal obese. This association was not found in women. Comparative analyses showed that overweight men according to their BMI were not at greater risk of muscle strength decline. However, these men were at risk based on their waist circumference. CONCLUSIONS:Abdominal obesity is associated with accelerated muscle strength decline in men.
Project description:Sarcopenia and obesity have been independently associated with physical function decline, however little information is currently available on the relationship between sarcopenic obesity and physical performance, mainly in middle aged women. The present study aims to estimate the prevalence of sarcopenic obesity and to explore the relationship between sarcopenic obesity and physical performance in middle-aged women from Northeast Brazil.A cross-sectional study of women (40-65 years) living in Parnamirim, a city in Northeast Brazil (n = 491). Physical performance was assessed by grip strength, knee extensor and flexor strength (isometric dynamometry), gait speed, and chair stands. Using bioelectrical impedance analysis (BIA), appendicular skeletal muscle mass divided by height squared (kg / m(2)) was used to define sarcopenia. Waist circumference ≥ 88 cm was defined as abdominal obesity. Sarcopenic obesity was defined as the coexistence of obesity and sarcopenia. The physical performance outcomes were regressed in four groups defined by combinations of sarcopenia and obesity, adjusting for potential confounders (age, education and menopausal status).Prevalence rates of the four obesity-sarcopenia groups were: Sarcopenic obesity (7.1 %), obesity (67.4 %), sarcopenia (12.4 %) and normal (13 %). Women with sarcopenic obesity had significantly lower grip strength, weaker knee extension and flexion and longer time to raise from a chair compared with non-obese and non-sarcopenic women (p.values < 0.001). Except for the chair stands, these statistically significant differences were also found between sarcopenic obese and obese women. There was no significant difference for gait speed across the four groups (p = 0.50).Sarcopenic obesity was present in 7 % of this population of middle-aged women from Northeast Brazil and it was associated with poor physical performance. Sarcopenic obesity may occur in middle-aged women with performance limitations beyond pure sarcopenia-related muscle mass or obesity alone.
Project description:Background & Aims:Portal hypertension contributes to the pathogenesis of malnutrition and sarcopenia in cirrhosis via multiple mechanisms. Terlipressin is a vasopressin analogue that we administer via continuous outpatient infusion, as a bridge to transplantation in patients with hepatorenal syndrome or refractory ascites. We describe, for the first time, the impact of outpatient terlipressin on nutritional and muscle parameters. Methods:Nutrition (subjective global assessment), handgrip strength, dietary intake (energy, protein), frequency of paracentesis and severity of liver disease (model for end-stage liver disease score) were prospectively recorded at terlipressin commencement and follow-up (transplantation, cessation or census date). Results:Nineteen patients were included (89% male, median age 59.6 years, median model for end-stage liver disease score 24), of whom 12 had hepatorenal syndrome and 7 had refractory ascites. All patients were malnourished at baseline, 63% (n = 12) had sarcopenic-range grip strength, and mean paracentesis frequency was 2.86 ± 1.62/month. Median duration of terlipressin was 51 days (interquartile range 29-222). Fourteen patients (74%) were transplanted, 2 delisted (10%) and 3 (16%) continued terlipressin. Energy and protein intake improved significantly following terlipressin, from 17.94 ± 5.43 kcal/kg to 27.70 ± 7.48 kcal/kg, and 0.74 ± 0.28 g/kg to 1.16 ± 0.31 g/kg, respectively (both p < 0.001). Handgrip strength increased from 25.36 ± 8.13 kg to 28.49 ± 7.63 kg (p = 0.001). Linear regression analysis demonstrated hand grip strength increased 0.075% for every 1-day of terlipressin (p = 0.005). The frequency of large-volume paracentesis reduced by 46%, to 1.57 ± 1.51/month (p = 0.001). Conclusion:Continuous terlipressin infusion reduces the complications of portal hypertension and is associated with an improvement in nutritional and muscle parameters in patients on the liver transplant waiting list, in whom such characteristics usually demonstrate progressive decline. This validates both the aetiological role of portal hypertension in malnutrition and represents a promising new anabolic therapy. Lay summary:Malnutrition and poor muscle strength are common in liver disease and often get worse while patients await liver transplant. Terlipressin is a medication used to treat portal hypertension in patients with hepatorenal syndrome. It is usually given for a few days or weeks in patients confined to hospital. Our centre provides outpatient terlipressin for weeks to months as a bridge to liver transplant. In patients treated with terlipressin at our hospital, we observed a substantial increase in their dietary intake and muscle strength, which may improve their quality of life and outcomes after liver transplant.
Project description:Objective: The aim of this research was to assess the association between periodontitis and grip strength among older American adults. METHODS:Data from the National Health and Nutrition Examination Survey 2011/2012 and 2013/2014 were used. Oral health status and hand grip strength were clinically assessed. Three outcome variables were used: (1) handgrip strength <30 kg for men, <20 kg for women; (2) handgrip strength <26 kg for men, <16 kg for women; and (3) mean maximum grip strength. The main exposure was the case definition of periodontitis. Logistic and linear regression models were constructed for grip strength definitions and the mean grip strength, respectively, adjusting for covariates. RESULTS:The study included 1953 participants. The mean age was 68.5 years, and 47.2% were males. The prevalence of low grip strength (<30 kg for men, <20 kg for women) was 7.4% in men and 13.6% in women. Periodontitis was significantly associated with grip strength (OR 1.53, 95% CI: 1.03, 2.27) in the unadjusted model. Periodontitis was also significantly associated with maximum grip strength (Coefficient 1.05, 95% CI -1.99, -0.09) in a model adjusted for age and gender. However, in all the fully adjusted models there was no statistically significant association between periodontitis and grip strength. CONCLUSION:Low grip strength appeared to be more common among persons with moderate/severe periodontitis. The observed association is probably attributed to older age and common risk factors for periodontitis and frailty.
Project description:BACKGROUND:The association between handgrip strength combined with body mass index (BMI) and cognitive impairment has not been thoroughly examined. We aimed to investigate whether the relationship between handgrip strength and risk of cognitive impairment is altered by the presence of obesity in older women. METHODS:A total of 544 older women aged over 65 years without cognitive impairment from the Korean Longitudinal Study of Aging (KLoSA) were included in the study. Handgrip strength was classified in a binary manner (weak or strong) or in tertiles and obesity was defined as a BMI???25 kg/m2, in accordance with the Asia-Pacific World Health Organization criteria. Incident cognitive impairment was defined as a Korean Mini-mental State Examination (K-MMSE) score of less than 24 after eight years of follow-up. RESULTS:Strong handgrip strength was associated with reduced likelihood of developing cognitive impairment compared to weak handgrip strength in obese women (adjusted odds ratio, aOR 0.23, 95% confidence interval, CI 0.08-0.66). The highest tertile of handgrip strength was associated with reduced risk of incident cognitive impairment (aOR 0.16, 95% CI 0.04-0.70), compared to the lowest tertile of handgrip strength in obese women, with a significant linear trend (p for trend?=?0.016). Furthermore, the highest tertile of handgrip strength was significantly associated with smaller decline in K-MMSE scores compared to the lowest tertile of handgrip strength in obese women (p value?=?0.009). There was no association between handgrip strength and incident cognitive impairment in non-obese women. CONCLUSIONS:Strong handgrip strength was associated with reduced risk of cognitive impairment among obese women, but not in non-obese women. Handgrip strength may be a simple and useful marker for predicting future cognitive impairment among obese women.
Project description:The health correlates of the metabolically healthy obese (MHO) phenotype, particularly in relation to depressive symptoms remains unclear. Accordingly, we examined the risk of depressive symptoms in this phenotype using a 16-year follow-up prospective study.A sample of 14 475 participants (75% men), aged 44-59 years in 1996, was drawn from the Gazel cohort. Obesity was defined as body mass index (BMI) ? 30 kg/m2 and metabolic health as having none of the self-reported following cardiovascular risk factors: hypertension, type 2 diabetes and dyslipidemia. Depressive symptoms were assessed by the Center for Epidemiologic Studies Depression (CES-D) scale in 1996, 1999, 2002, 2005, 2008 and 2012. Generalized Estimating Equations (GEE) were used to estimate the risk of depressive symptoms during a follow-up of 16 years.In multivariate analyses, metabolically unhealthy normal weight [Odds Ratio (OR) = 1.37; 95% Confidence Interval (CI): 1.25-1.51], overweight [1.44 (1.31-1.59)] and obese [1.30 (1.10-1.54)] but not MHO participants [1.04 (0.81-1.32)] had higher risk of depressive symptoms at the start of follow-up compared to metabolically healthy normal weight individuals. Depressive symptoms decreased over time in metabolically healthy normal weight individuals [0.52 (0.50-0.55)], this decrease was less marked only in metabolically unhealthy obese participants [1.22 (1.07-1.40)]. Compared to MHO participants, metabolically unhealthy obese individuals were at increased risk of depression at the start of follow-up, but with a similar reduction of this risk over time.Poor metabolic health, irrespective of BMI was associated with greater depressive symptoms at the start of follow-up, whereas a poorer course of depressive symptoms over time was observed only in those with both obesity and poor metabolic health.
Project description:To examine the independent and combined associations of obesity and muscle strength with mortality in adult men and women.Follow-up study with 33 years of mortality follow-up.A total of 3594 men and women aged 50-91 years at baseline with 3043 deaths during the follow-up.Body mass index (BMI) and handgrip strength were measured at baseline.Based on Cox models adjusted for age, sex, education, smoking, alcohol use, physical activity and chronic conditions, baseline obesity (BMI ?30?kg?m(-2)) was associated with mortality among participants aged 50-69 years (hazard ratio (HR) 1.14, 95% confidence interval (CI), 1.01-1.28). Among participants aged 70 years and older, overweight and obesity were protective (HR 0.77, 95% CI, 0.66-0.89 and HR 0.76, 95% CI, 0.62-0.92). High handgrip strength was inversely associated with mortality among participants aged 50-69 (HR 0.89, 95% CI, 0.80-1.00) and 70 years and older (HR 0.78, 95% CI, 0.66-0.93). Compared to normal-weight participants with high handgrip strength, the highest mortality risk was observed among obese participants with low handgrip strength (HR 1.23, 95% CI, 1.04-1.46) in the 50-69 age group and among normal-weight participants with low handgrip strength (HR 1.30, 95% CI, 1.09-1.54) among participants aged 70+ years. In addition, in the old age group, overweight and obese participants with high handgrip strength had significantly lower mortality than normal-weight participants with high handgrip strength (HR 0.79, 95% CI, 0.67-0.92 and HR 0.77, 95% CI, 0.63-0.94).Both obesity and low handgrip strength, independent of each other, predict the risk of death in adult men and women with additive pattern. The predictive value of obesity varies by age, whereas low muscle strength predicts mortality in all age groups aged>50 years and across all BMI categories. When promoting health among older adults, more attention should be paid to physical fitness in addition to body weight and adiposity.