Association Between Basal Metabolic Rate and Handgrip Strength in Older Koreans
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International Journal of Environmental Research and Public Health Article Association between Basal Metabolic Rate and Handgrip Strength in Older Koreans 1, 1, 2 3 1, Sung-Kwan Oh y, Da-Hye Son y , Yu-Jin Kwon , Hye Sun Lee and Ji-Won Lee * 1 Department of Family Medicine, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul 03722, Korea; [email protected] (S.-K.O.); [email protected] (D.-H.S.) 2 Department of Family Medicine, Yong-In Severance Hospital, 23 Yongmunno (405 Yeokbuk-dong), Gyeonggi 17046, Korea; [email protected] 3 Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul 03722, Korea; [email protected] * Correspondence: [email protected] These authors contributed equally to this paper. y Received: 16 October 2019; Accepted: 8 November 2019; Published: 9 November 2019 Abstract: We investigated the relationship between the basal metabolic rate (BMR) and muscle strength through measurement of handgrip strength. We conducted a cross-sectional study of a population representative of older Korean from the 2014–2016 Korean National Health and Nutrition Examination Survey. A total of 2512 community-dwelling men and women aged 65 years and older were included. The BMR was calculated with the Singapore equation and handgrip strength was measured using a digital dynamometer. The patients were categorized into handgrip strength quartiles and a weighted one-way analysis of variance (ANOVA) for continuous variables and a weighted chi-squared test for categorical variables were performed. Pearson, Spearman correlation analysis, univariate, and multivariate linear regression were performed. Analysis of covariance (ANCOVA) was also performed to determine the association between basal metabolic rate and handgrip strength quartiles after adjusting for confounding factors. The BMR increased according to handgrip strength quartile after adjusting for age, BMI, relative fat mass, comorbidity number, resistance exercise, aerobic physical activity, household income, educational level, smoking status, and alcohol ingestion in both sexes (p < 0.001). Handgrip strength has a positive association with the BMR in older Korean people. Therefore, muscle strength exercises should be considered for regulating the BMR in the older people. Keywords: hand strength; muscle strength dynamometer; basal metabolic rate; sarcopenia; Koreans 1. Introduction The basal metabolic rate (BMR) is defined as the energy required performing essential physical functions at rest [1]. Although an abnormally high metabolic rate is associated with some pathologic conditions or inflammatory conditions [2], BMR tends to decrease with advancing age [1], and a low BMR plays an important role in the pathogenesis of the obesity and age related chronic disease in old age [2]. Energy metabolism and body composition are closely related to fat-free mass (FFM). Although the FFM is known as a primary determinant of BMR [1], it can only account for between 50% and 70% of the BMR [3]. Apart from the FFM, several other factors such as heritable, physiological, and genetic factors could be also considered determinants of BMR [4]. Sarcopenia has been used to define the age-related loss of skeletal muscle mass and strength, which are associated with a poor quality of life and loss of independence in older people [5–7]. Muscle Int. J. Environ. Res. Public Health 2019, 16, 4377; doi:10.3390/ijerph16224377 www.mdpi.com/journal/ijerph Int.Int. J.J. Environ.Environ. Res.Res. Public Health 2019,, 16,, 4377x 2 ofof 1212 Muscle mass aside, loss of muscle strength in the elderly has been shown to increase risk of poor massphysical aside, performance. loss of muscle Additional strengthly, in previous the elderly studies has been reported shown that to increaseolder people risk of with poor decreased physical performance.muscle strength Additionally, showed higher previous risk of studies falls, frailty, reported and that mortality, older people independent with decreased of muscle muscle mass [5–7]. strength showedStudies higher have risk demonstrated of falls, frailty, decreased and mortality, BMR independent to be associated of muscle with mass sarcopenia [5–7]. or with loss of muscleStudies mass have [8–10]. demonstrated However, decreased little is known BMR to about be associated the relationship with sarcopenia between or withBMR loss and of musclemuscle massstrength. [8–10 Muscle]. However, strength little and is muscle known mass about do the not relationship necessarily betweencorrelate BMRwith or and affect muscle each strength. other, a Musclefindingstrength that again and stresses muscle the mass importance do not necessarily of muscle correlateperformance with in or older affect people each other, [11]. a finding that againIn stresses recent the study, importance short-term of muscle resistance performance training in in older 19 peopleapparently [11]. healthy women lead to a significantIn recent increase study, short-termin BMR (p < resistance 0.001) without training any in changes 19 apparently in body healthy composition, women leadincluding to a significant body fat, increaseFFM, and in body BMR mass (p < 0.001)index (BMI) without [12], any which changes indicate in bodys that composition, change in body including composition body fat,is not FFM, the andsole bodymechanisms mass index for (BMI)change [12 in], whichBMR. indicatesIn this context, that change further in bodystudy compositionis needed to is demonstrate not the sole mechanismsassociation between for change BMR in and BMR. muscle In this strength. context, further study is needed to demonstrate association betweenMuscle BMR strength and muscle is measured strength. using hand-grip equipment (isometric strength, isokinetic power, etc.) [13].Muscle Hand-grip strength strength is measured (HGS) usingis assessed hand-grip by simple, equipment fast, (isometricand standardized strength, measurements isokinetic power, of etc.)overall [13 ].muscular Hand-grip strength strength [6,14]. (HGS) Measurement is assessed byof simple,HGS also fast, makes and standardizedit possible to measurementspredict disability of overalland frailty muscular in the strengtholder people [6,14 ].[15]. Measurement of HGS also makes it possible to predict disability and frailtyUntil in the now, older there people have [15 been]. no studies on the association between BMR and muscle strength alone.Until Our now, nationwide there have population-based been no studies onstudy the associationaims to determine between BMRthe relationship and muscle strengthbetween alone.BMR Ourand nationwideHGS in elderly population-based Koreans study aims to determine the relationship between BMR and HGS in elderly Koreans 2. Materials and Methods 2. Materials and Methods 2.1. Survey Overview and Study Population 2.1. Survey Overview and Study Population This cross-sectional study was conducted using data from the Korean National Health and NutritionThis cross-sectionalExamination Survey study (KNHANES) was conducted provided using by data the from Korea the Centers Korean for National Disease HealthControl andand NutritionPrevention Examination (KCDC) for Survey 2014–2016. (KNHANES) KNHANES provided is a na bytionwide the Korea cross-sectional Centers for Diseasesurvey that Control assesses and Preventionthe health (KCDC)and nutritional for 2014–2016. status KNHANESof Koreans. is KNHANES a nationwide reports cross-sectional and microdata survey thatare assessesreleased theannually health and and are nutritional available status to the of public Koreans. free KNHANES of charge at reports the end and of microdata the following are released year. KCDC annually also andpublished are available documents to the publicon survey free of chargemanuals at the th endrough of thethe following official year. website KCDC of also KNAHNES published documents(http://knhanes.cdc.go.kr) on survey manuals [16]. through Sampling the offi cialwas website performed of KNAHNES using (http:a stratified,//knhanes.cdc.go.kr multi-staged,)[16]. Samplingprobability-sampling was performed design using based a stratified, on the multi-staged,age, sex, and probability-samplinggeographical area of designthe participants based on thevia age,household sex, and registries. geographical In this area study, of the participantsdata from 4766 via householdindividuals registries. aged 65In years this study,and older data fromwere 4766included individuals from the aged 2014–2016 65 years KNHANES and older were (n = included23,080). Of from these the individuals, 2014–2016 KNHANESwe excluded (n those= 23,080). who Ofmet these the individuals,following criteria we excluded (n = 2254): those presence who met of theosteoarthritis, following criteriarheumatoid (n = arthritis;2254): presence history ofof osteoarthritis,stroke, or thyroid rheumatoid disease; arthritis;and those history whose of data stroke, were or unavailable thyroid disease; to evaluate and those HGS. whose After dataexcluding were unavailablethese individuals, to evaluate 2512 HGS. participants After excluding were included these individuals, in the final 2512 analysis participants (Figurewere 1). The included average in theage finalof this analysis study (Figurepopulation1). The was average 72.6 years, age of and this studythe median population age was was 72 72.6 years. years, The and oldest the median individual age waswas 7280 years.years. The oldest individual was 80 years. Figure 1. Study population flowchart diagram. KNHANES, Korea National Health and