Association between Grip Strength as Diagnostic Criteria of Sarcopenia and Health-Related Quality of Life in Korean Elderly

On Lee; Yeon-Soo Kim

doi:10.5763/kjsm.2018.36.1.15

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Lee and Kim: Association between Grip Strength as Diagnostic Criteria of Sarcopenia and Health-Related Quality of Life in Korean Elderly

Clinical Article

Korean J Sports Med 2018;36(1):15-23.

Published online: 10 December 2018

DOI: https://doi.org/10.5763/kjsm.2018.36.1.15

Association between Grip Strength as Diagnostic Criteria of Sarcopenia and Health-Related Quality of Life in Korean Elderly

On Lee¹, Yeon-Soo Kim^1,²

¹Department of Physical Education, College of Education, Seoul National University, Seoul, Korea

²Institute of Sport Science, Seoul National University, Seoul, Korea

Correspondence: Yeon-Soo Kim Department of Physical Education, College of Education, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Korea Tel: +82-2-889-1926, Fax: +82-2-886-7804, E-mail: kys0101@snu.ac.kr This work was supported by the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea (NRF-2015S1A5B5A07044313).

Received 24 October 2017 Revised 11 December 2017 Accepted 12 January 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study aimed to investigate the association between grip strength as diagnostic criteria of sarcopenia and health-related quality of life (HRQL) in Korean elderly.

Methods

Data were obtained through the 2014−2015 Korea National Health and Nutrition Examination Survey (6th KNHANES), targeting a total of 3,096 elderlies (over 60 years old). Grip strength was measured and divided into four quartiles, and the lower quartile was used as the muscle strength criterion for sarcopenia. The EuroQol-5 Dimension (EQ-5D) questionnaire was used to measure HRQL and classified as poor HRQL when the EQ-5D index was less than 1. Complex sample design logistic regression was used to evaluate the odds ratio (OR) and 95% confidence interval (CI) of prevalence of poor HRQL associated with sarcopenia.

Results

When confounding factors are adjusted, the OR (95% CI) of prevalence of poor HRQL for male and female elderlies in the group with the highest strength, as compared to the group with the lowest strength were 0.605 (0.413−0.893), and 0.406 (0.297−0.590), respectively.

Conclusion

Muscle strength can be considered to be more effective in assessing the health status of the elderly compared to muscle mass. In particular, this is acceptable given the cost of measurement and the clarity as a health goal.

Keywords: Hand strength, Korea National Health and Nutrition Examination Survey, Quality of life, Sarcopenia

References

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Table 1.

Demographic characteristics of participants by sex

Demographic characteristics		Male (n=1,422)		Female (n=1,764)
Demographic characteristics		No. (unweight)	% (weighted)	No. (unweight)	% (weighted)
Age (yr)	60−64	364	33.3	458	28.4
	65−69	406	24.7	418	24.4
	70−74	300	19.8	370	18.4
	75−80	352	22.2	428	28.8
Academic achievement	Elementary school	525	37.5	1,129	68.0
	Middle school	263	17.3	214	12.0
	High school	380	27.5	227	13.8
	College	254	17.7	104	6.2
Household income	1/4 Quartile	454	30.3	707	42.5
	2/4 Quartile	438	30.1	457	26.5
	3/4 Quartile	290	21.6	293	18.2
	4/4 Quartile	240	18.0	217	12.8
Spousal status	Yes	1,267	90.4	963	56.1
	No	155	9.6	711	43.9
Smoking	Current smoking	334	24.8	40	2.5
	Non	824	57.1	58	3.8
	Never	264	18.1	1,576	93.7
Alcohol consumption	Never	405	28.5	738	43.7
	＜1/wk	386	26.3	259	15.3
	≥1/wk	631	45.2	677	41.0
Weight loss in recent year	No	1,178	83.0	1,451	86.9
(3 kg)	Yes	244	17.0	223	13.1
EQ-5D index	＜1 (Problem)	517	36.2	922	55.1
	1	905	63.8	752	44.9

EQ-5D: EuroQol-5 Dimension.

Table 2.

Mean value among age group and quartile and lowest cut-off value of grip strength by sex

Variable		Male	Female
Variable		Mean (95% CI)	Mean (95% CI)
Grip strength	60−64	39.99 (39.26−40.71)	24.94 (24.49−25.40)
	65−69	37.57 (36.89−38.25)	23.44 (22.97−23.91)
	70−74	34.48 (33.79−35.18)	21.93 (21.45−22.41)
	75−80	31.33 (30.56−32.09)	19.54 (19.01−20.06)
	1/4 Quartile	27.27 (26.83−27.70)	16.11 (15.84−16.38)
	2/4 Quartile	33.66 (33.48−33.84)	21.01 (20.90−21.11)
	3/4 Quartile	38.18 (38.03−38.32)	24.09 (23.99−24.18)
	4/4 Quartile	44.54 (44.13−44.96)	28.18 (27.96−28.39)
	1/4 Quartile cut value	＞31.3	＞19.2
Relative grip strength^*	60−64	59.78 (58.80−60.78)	43.37 (42.51−44.22)
	65−69	57.35 (56.18−58.52)	41.05 (40.11−41.99)
	70−74	53.40 (52.08−54.72)	39.10 (38.21−39.99)
	75−80	51.28 (49.98−52.59)	36.71 (35.71−37.70)
	1/4 Quartile	42.40 (41.70−43.09)	29.16 (28.68−29.64)
	2/4 Quartile	52.84 (52.65−53.03)	37.25 (37.06−37.43)
	3/4 Quartile	59.02 (58.79−59.23)	43.00 (42.82−43.18)
	4/4 Quartile	68.78 (68.09−69.47)	50.88 (50.88−51.28)
	1/4 Quartile cut value	＞49.3	＞34.1

CI: confidence interval.

^* Relative grip strength: grip strength (kg)/body weight (kg)×100.

Table 3.

Estimated probability of sarcopenia and poor quality of life according to sex and demographic variables with weighting

Variable	Sarcopenia (1/4 quartile in grip strength)		Poor quality of life (EQ-5D score ＞1)
Variable	Male	Female	Male	Female
Age (yr)	^*	^*	^*	^{*, †}
60−64	7.1 (4.7−10.5)	7.6 (5.3−10.8)	28.4 (23.5−33.8)	39.5 (34.4−44.8)
65−69	12.9 (10.0−16.5)	15.3 (1.7−19.7)	38.2 (33.0−43.6)	55.3 (50.2−60.4)
70−74	28.0 (23.0−33.5)	24.1 (19.4−29.5)	36.4 (30.9−42.3)	56.7 (51.1−62.1)
75−80	52.7 (46.7−58.6)	46.6 (41.1−52.2)	45.4 (39.9−50.9)	69.1 (63.6−74.0)
Academic achievement	^*	^{*, †}	^*	^{*, †}
Elementary school	29.9 (25.7−34.5)	30.1 (26.9−33.5)	45.6 (40.9−50.4)	61.6 (58.2−64.9)
Middle school	21.7 (16.7−27.7)	2.3 (8.3−17.9)	34.1 (27.9−40.9)	32.4 (35.5−49.6)
High school	16.3 (12.5−21.0)	8.0 (5.2−12.2)	34.4 (29.1−40.1)	44.5 (37.2−52.1)
College	18.7 (13.3−25.7)	11.3 (6.5−18.9)	20.9 (15.8−27.0)	31.1 (21.8−42.2)
House income	^*	^*	^*	^{*, †}
1/4	36.8 (31.8−42.2)	32.1 (28.3−36.1)	44.1 (38.9−49.4)	64.5 (60.2−68.6)
2/4	19.3 (15.6−23.7)	20.0 (16.1−24.5)	37.4 (32.5−42.7)	52.6 (47.0−58.2)
3/4	17.3 (13.1−22.3)	19.2 (14.5−25.1)	32.6 (26.8−39.0)	49.3 (42.8−55.7)
4/4	11.6 (7.7−17.2)	10.5 (6.7−16.0)	25.1 (19.3−31.9)	37.0 (30.2−44.3)
Spousal status	^*	^{*, †}	^*	^{*, †}
Living together	21.3 (18.8−24.1)	17.5 (14.8−20.6)	33.7 (30.7−36.8)	49.5 (45.7−53.3)
Separated	36.4 (28.5−45.0)	31.7 (27.6−35.9)	59.3 (50.5−67.6)	62.1 (57.5−66.5)
Smoking	–	–	–	^{*, †}
Current	18.2 (13.9−23.5)	39.5 (23.5−58.0)	37.3 (31.4−43.6)	71.8 (53.4−85.0)
Non	24.5 (21.2−28.1)	38.9 (23.8−56.4)	38.0 (34.3−41.9)	77.4 (62.9−87.4)
Never	23.6 (18.3−29.9)	22.7 (20.2−25.5)	28.8 (22.7−35.7)	53.7 (50.8−56.6)
Alcohol	^*	^{*, †}	–	^†
Never	26.5 (22.0−31.5)	20.5 (17.4−24.0)	38.6 (33.4−44.1)	57.1 (52.9−61.1)
＞1/wk	18.1 (14.0−23.0)	15.1 (11.0−20.3)	37.5 (32.4−42.8)	47.2 (40.3−54.1)
1/wk	23.2 (19.5−27.3)	30.4 (26.3−35.0)	33.9 (29.7−38.3)	55.8 (51.2−60.4)
Weight loss in recent year	^*	^{*, †}	^*	^†
No	20.5 (18.0−23.3)	22.7 (20.1−25.5)	33.8 (30.8−36.9)	55.0 (51.7−58.1)
Yes	33.8 (27.5−40.8)	30.9 (23.6−39.3)	47.8 (40.6−55.0)	55.7 (49.1−62.1)
Body mass index	^*	^{*, †}	–	^†
Under	47.1 (31.4−63.4)	49.0 (30.0−68.2)	44.1 (28.3−61.1)	64.3 (43.3−81.0)
Normal	24.0 (21.0−27.3)	24.0 (20.8−27.5)	35.4 (31.9−39.1)	51.5 (47.6−55.4)
Overweight	18.4 (14.7−22.8)	22.4 (18.8−26.5)	36.9 (31.8−42.2)	59.8 (55.2−64.2)

Values are presented as mean (95% confidence interval). EQ-5D: EuroQol-5 Dimension.

^* There is a significant difference in group;

^† There is a significant difference between sex.

Table 4.

Association between grip and health-related quality of life by sex

Variable		Male		Female
Variable		Grip strength	Relative grip strength	Grip strength	Relative grip strength
Grip strength	1/4 Quartile	Reference	Reference	Reference	Reference
	2/4 Quartile	0.478 (0.346−0.661)	0.546 (0.383−0.777)	0.709 (0.512−0.981)	0.571 (0.409−0.797)
	3/4 Quartile	0.475 (0.337−0.669)	0.590 (0.408−0.854)	0.510 (0.360−0.724)	0.397 (0.275−0.573)
	4/4 Quartile	0.473 (0.335−0.666)	0.553 (0.385−0.793)	0.305 (0.216−0.433)	0.339 (0.238−0.483)
	p-trend	0.027	0.022	＜0.001	＜0.001

Values are presented as crude model odds ratio (95% confidence interval).

Table 5.

Association between sarcopenia and health-related quality of life by sex

Variable	Male		Female
Variable	Crude model OR (95% CI)	Adjusted model OR (95% CI)	Crude model OR (95% CI)	Adjusted model OR (95% CI)
Quality of life	2.104 (1.616−2.740)	1.740 (1.308−2.315)	2.097 (1.575−2.793)	1.591 (1.178−2.150)
Problem of mobility	2.732 (2.011−3.711)	2.096 (1.509−2.912)	2.235 (1.694−2.950)	1.543 (1.149−2.071)
Problem of self-care	4.169 (2.505−6.939)	3.172 (1.771−5.680)	2.904 (1.966−4.290)	2.002 (1.340−2.992)
Problem of usual activity	3.010 (2.117−4.279)	2.330 (1.597−3.398)	2.214 (1.661−2.952)	1.774 (1.314−2.396)
Problem of pain/discomfort	1.738 (1.300−2.325)	1.695 (1.249−2.301)	1.521 (1.174−1.969)	1.303 (0.992−1.713)
Problem of anxiety/depression	1.699 (1.084−2.664)	1.282 (0.739−2.224)	1.142 (0.845−1.545)	1.069 (0.768−1.488)

OR: odds ratio, CI: confidence interval.

Adjusted model used age, academic achievement, family income, spousal state, smoking, alcohol consumption, and body mass index, especially as weight loss in recent year as adjust variables.

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