THE RELATIONSHIP OF SARCOPENIA, SARCOPENIC-OBESITY AND SARCO-OSTEOPOROSIS WITH HANDGRIP STRENGTH IN COMMUNITY DWELLING ELDERLY MEN Asta Mastaviciute*, Vidmantas Alekna, Vaidile Strazdiene, Marija Tamulaitiene
1,3
1,2
2,3
1,3
1 Vilnius University, Faculty of Medicine; 2 State Research Institute Centre For Innovative Medicine; 3 National Osteoporosis Center; Vilnius, Lithuania
BACKGROUND
Aging is associated with alterations in body composition: body fat percentage increases and fat mass redistributes, bone mineral density decreases, fat-free mass decreases1. A progressive and generalized loss of skeletal muscle mass and strength, and/or low physical performance, is called sarcopenia2. A combination of excess weight with reduced muscle mass and strength is called as sarcopenic obesity3 and a combination of sarcopenia
and osteoporosis is called sarco-osteoporosis4. The decreased muscle strength is closely correlated with functional limitation, poor quality of life and mortality5. There are not sufficient data about sarcopenic-obesity, sarco-osteoporosis and handgrip strength in elderly men.
OBJECTIVE
This study was designed to investigate relationship of sarcopenia, sarcopenic-obesity and sarco-osteoporosis with handgrip strength in community dwelling elderly men.
MATERIAL AND METHODS
This cross-sectional study included 58 men aged 65 years and older. Exclusion criteria were metabolic or endocrine disorders known to affect musculoskeletal system and restriction of movement in the upper extremities. All participants answered face-to-face questionnaires addressing medical history, lifestyle habits and medications use. Written informed consent was obtained from each participant. Physical examination was performed. Dual-energy X-ray absorptiometry (iDXA, GE Lunar) was used to measure lean mass, fat mass, body fat percentage (% BF), bone mineral content (BMC), total body bone mineral density (BMD). Sarcopenia was defined when appendicular lean mass (ALM) divided to squared height was less than 7.26 kg/m2. Obesity was based on the relative fat mass, and it was defined as percentage of body fat greater than 27%. Osteoporosis was defined using World Health (WHO) definition, when T-score was
≤ -2.5 at the lumbar spine or total hip. In case of the combination of sarcopenia and obesity subjects were classified as sarcopenic-obese. Subjects with sarcopenia and osteoporosis were called sarco-osteoporotic. Handgrip strength as a surrogate measurement of total body strength was used. All subjects performed three maximum attempts for dominant handgrip strength measurements with handle dynamometer (Presision Druck, Germany) and the mean value of these trials was recorded in kilograms (kg). Statistical analysis was carried out using SPSS version 18.0 for Windows. Differences between groups at the 5% significance level (p < 0.05) were assessed by LSD post hoc probability test for multiple comparisons. Simple correlations were determined using Pearson’s correlation coefficient.
RESULTS
Of all men investigated, 31 subjects were sarcopenic, 16 - sarcopenic-obese and 11 men had sarco-osteoporosis. Distribution of body composition types in percentage is shown in figure 1.
Coefficients of correlations between body composition components and handgrip strength in men with sarcopenia, sarcopenic-obesity and sarco-osteoporosis were calculated for further analysis (Table 2). Table 2. Correlations between body composition components and handgrip strength in men according to type of body composition
19%
Type of body composition
sarcopenic men sarcopenic-obese men
Sarcopenic (n = 31)
Characteristic, units of measurements
53.4%
Figure 1. Distribution of body composition types in the study population
Descriptive data of the study subjects are shown in table 1. The smallest handgrip strength was determined in sarco-osteoporosis group (p=0.03). Using one-way ANOVA test the statistically significant handgrip strength difference was found between sarcopenic, sarcopenic-obese, and sarco-osteoporotic men (p=0.04). Post hoc analysis revealed the statistically significant difference of handgrip strength between sarcopenic and sarco-osteoporotic men (Table 1).
Sarco-osteoporotic (n = 11)
r
p value
r
p value
r
p value
Lean mass (kg)
0.5
0.001
0.9
0.03
0.8
0.001
Fat mass (kg)
0.2
0.6
0.4
0.3
-0.2
0.5
BMC (kg)
0.4
0.001
0.3
0.4
0.5
0.2
sarco-osteoporotic men
27.6%
Sarcopenic-obese (n = 16)
r – correlation coefficient; BMC – bone mineral content.
There were positive significant correlations between lean mass and handgrip strength in sarcopenic, sarcopenic-obese and sarco-osteoporotic men. This study revealed postive correlation between bone mineral content and handgrip strength in sarcopenic men.
Table 1. Descriptive basic characteristics of the study subjects Characteristic, units of measurements
Sarcopenic men (n =31)
Sarcopenic-obese Sarco-osteoporotic men men (n=16) (n=11)
p value
Age (year)
75.8 ± 7.6
80.6 ± 4.1
76.8 ± 8.1
0.18
BMI (kg/m2)
25.2 ± 3.9
26.1 ± 3.5
22.1 ±4.2
0.001
Fat mass (kg)
20.9 ± 9.7
23.7 ± 4.5
19.1 ± 8.5
0.001
BF (%)
27.4 ± 9.6
33.8 ± 3.7
28.4 ± 9.4
0.002
BMC (kg)
2.7 ± 0.5
2.4 ± 0.2
2.3 ± 0.3
0.001
1.088 ± 0.209
1.033 ±0.574
1.033 ± 0.117
0.001
Total body BMD (g/cm2) Handgrip strength (kg)
26.9 ± 9.9
28.5 ± 9.6
26.4 ± 11.1
0.001
Data are presented as mean ± SD; SD – standard deviation; BMI – body mass index; BF – body fat; BMD – bone mineral density.
CONCLUSION
This study showed higher handgrip strength in men with sarcopenia comparing to sarco-osteoporotic men. There was found the relationship between lean mass and handgrip strength in all body composition types. Bone mineral content positively associated with handgrip strength only in sarcopenic men.
ACNOWLEDGMENTS We would like to thank Audrone Misiunaite, Edita Merkeliuniene for the skillful performing of the body composition measurements, and Elvyra Stapcinskiene for valuable assistance in coordination of this study.
REFERENCES: 1. Morley JE. Family Practice 2012; 29: i44–i48 2. Cruz-Jentoft AJ, et al. Age Ageing 2010; 39(4): 412–423 3. Roubenoff R. Obes Res 2004; 12: 887–88 4. Buehring B, et al. J Cachexia Sarcopenia Muscle 2012; DOI 10.1007/s13539-012-0080-8 5. Gale Catharine R, et al. International Journal of Epidemiology 2007; 36(1): 228–235
*Contact address: asta.mastaviciute@osteo.lt IOF Regionals – 2nd Middle East & Africa Osteoporosis Meeting & 6th Pan Arab Osteoporosis Congress, PAOC’6