Effect of sarcopenia combined with abdominal obesity on muscle strength and physical function in hospitalized elderly

doi:10.16138/j.1673-6087.2023.02.003

Abstract

Abstract:

Objective To investigate the effect of sarcopenia combined with abdominal obesity on muscle strength and somatic function in the elderly. Methods A total of 94 patients who met the admission criteria were enrolled in the ninth ward and comprehensive ward of Shanghai Fourth Rehabilitation Hospital from January to June in 2021. Bioelectrical impedance analysis(BIA) was used to measure the body composition in all subjects, and muscle strength and somatic function were evaluated, and lumbar 3 vertebral CT image analysis was used to assess the fat distribution in all patients with sarcopenia. Stepwise regression was used to analyze the influencing factors of muscle strength and somatic function in them. Results The prevalence of sarcopenia among elderly hospitalized patients was 70.7% in men and 69.8% in women, and the proportion of abdominal obesity was 39.0% in men and 40.0% in women. In patients with sarcopenia and abdominal obesity, the scores of muscle strength and somatic function in men were significantly lower than those in the non-sarcopenia group (P<0.05), and also lower than those in the sarcopeniaonly only group, in which the five-repetition-sit-to-stand test (5STS) time were significantly longer than those in the sarcopeniaonly only group (P<0.05). While the results in women were converse, in which the scores of muscle strength and somatic function significantly were lower than those in the non-sarcopenia group (P<0.05), while higher than or comparable to those in the sarcopeniaonly only group, in which the grip strength was significantly greater than that in the sarcopeniaonly only group(P<0.05). Stepwise regression analysis showed that 5STS time in male patients with sarcopenia was positively correlated with waist circumference, and negatively correlated with appendicular muscle mass index (ASMI) (P<0.05); in female patients: grip strength was negatively correlated with body mass index (BMI), and positively correlated with ASMI and subcutaneous fat area (SFA) (P<0.05). Bone mineral content(BMC) was negatively correlated with 5STS(P<0.05). Conclusions Abdominal obesity aggravated the deterioration of muscle strength and somatic function in male sarcopenia patients, and the protective effect on female sarcopenia patients could be due to a certain amount of subcutaneous fat and higher ASMI and BMC.

Key words: Elderly, Sarcopenia, Abdominal obesity, Muscle strength, Somatic function

CLC Number:

R337

ZHANG Yin, SHEN Honghua, XU Yiming, REN Lei, LI jun, WU Shunjun, LING Xiaonan. Effect of sarcopenia combined with abdominal obesity on muscle strength and physical function in hospitalized elderly[J]. Journal of Internal Medicine Concepts & Practice, 2023, 18(02): 76-82.

Figures/Tables 7

项目	男性			F/χ²	P	女性			F/χ²	P
项目	非肌少症（n=12）	单纯肌少症（n=13）	肌少症合并腹型肥胖（n=16）	F/χ²	P	非肌少症（n=16）	单纯肌少症（n=16）	肌少症合并腹型肥胖（n=21）	F/χ²	P
年龄（岁）	72.25±7.11	79.69±6.63¹⁾	82.25±7.34¹⁾	7.230	0.002	83.75±7.70	84.44±7.32	85.67±6.57	0.344	0.711
ALB（g/L）	38.99±4.15	36.68±3.72	36.18±4.12	1.822	0.176	34.87±4.71	36.68±3.72	36.90±3.93	1.328	0.274
TG（mmol/L）	1.79±0.71	1.25±0.69	1.29±0.47	2.954	0.064	1.62±1.44	1.25±0.69	1.43±0.41	0.220	0.803
合并症[n（%）]
冠心病	5 (41.7)	7 (53.8)	10 (62.5)	1.197	0.550	10 (62.5)	11 (68.7)	15 (71.4)	0.340	0.844
脑卒中	8 (66.7)	9 (69.2)	12 (75.0)	—^*	0.913	9 (56.3)	11 (68.7)	16 (76.2)	1.660	0.435
慢性气道疾病	7 (58.3)	9 (69.2)	11 (68.8)	—^*	0.841	6 (37.5)	11 (68.7)	13 (61.9)	3.580	0.167
糖尿病	5 (41.7)	6 (46.2)	9 (56.2)	0.638	0.728	7 (43.7)	8 (50.0)	15 (71.4)	3.240	0.198
身高（m）	1.73±0.04	1.70±0.06	1.71±0.05	1.122	0.336	1.57±0.05	1.57±0.05	1.56±0.05	0.390	0.679
体重（kg）	76.42±5.25	60.23±6.78¹⁾	66.00±7.98¹⁾	23.410	<0.000 1	65.63±9.43	45.69±4.94¹⁾	54.98±7.28^1),2)	30.770	<0.000 1
BMI（kg/m²）	25.63±1.89	20.96±2.85¹⁾	22.64±2.36¹⁾	13.440	0.000	26.39±3.59	18.58±1.99¹⁾	22.59±3.21^1),2)	31.810	<0.000 1
颈围（cm）	38.75±2.77	35.42±2.01¹⁾	38.09±3.23²⁾	7.096	0.004	36.53±3.09	31.19±1.52¹⁾	35.64±2.91²⁾	29.920	<0.000 1
腰围（cm）	98.04±6.61	84.85±4.79¹⁾	97.97±6.32²⁾	25.900	<0.000 1	102.00±9.70	79.03±4.72¹⁾	92.86±6.22^1),2)	50.240	<0.000 1
臀围（cm）	97.42±4.46	90.46±3.88¹⁾	98.75±7.37²⁾	11.900	0.000	102.50±9.13	86.56±4.54¹⁾	95.64±3.57^1),2)	29.450	<0.000 1
腰臀比	1.00±0.05	0.94±0.04¹⁾	0.99±0.05²⁾	8.872	0.001	1.00±0.06	0.91±0.03¹⁾	0.97±0.05²⁾	16.180	<0.000 1
小腿围（cm）	33.79±3.37	30.92±1.57¹⁾	32.75±3.64	4.411	0.025	33.31±3.79	24.94±2.90¹⁾	30.19±3.82^1),2)	26.320	<0.000 1

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指标	n	非肌少症（n=28）	单纯肌少症（n=29）	肌少症合并腹型肥胖（n=37）	χ^2*	P
体重过低
男性	2	0（0.0）	2（100.0）	0（0.0）	-	1.000
女性	14	0（0.0）	11（78.6）	3（21.4）
体重正常
男性	18	3（16.7）	10（55.5）	5（27.8）	3.965	0.155
女性	20	4（20.0）	5（25.0）	11（55.0）
超重
男性	20	8（40.0）	1（5.0）	11（55.0）	-	0.830
女性	13	7（53.8）	0（0.0）	6（46.2）
肥胖
男性	1	1（100.0）	0（0.0）	0（0.0）	-	1.000
女性	6	5（83.3）	0（0.0）	1（16.7）

项目	非肌少症（n=12）	单纯肌少症（n=13）	肌少症合并腹型肥胖（n=16）	F	P
体成分
LBM（kg）	47.08±11.91	32.53±11.61¹⁾	35.68±8.53¹⁾	5.280	0.013
SMM（kg）	31.71±8.94	30.26±13.91	27.91±7.80	0.479	0.623
ASM（kg）	22.73±1.64	18.02±1.97¹⁾	17.93±1.93¹⁾	31.250	<0.000 1
ASMI（kg/m²）	7.63±0.62	6.23±0.36¹⁾	6.14±0.47¹⁾	26.660	<0.000 1
VFA（cm²）	131.4±38.7	99.62±53.59	147.70±51.71²⁾	3.508	0.040
PBF（%）	32.79±5.66	28.22±10.11	35.58±7.93	2.943	0.065
BMC（g）	2.75±0.40	2.41±0.13¹⁾	2.38±0.32¹⁾	4.073	0.032
肌肉力量指标
握力（kg）	25.74±8.24	17.89±7.26¹⁾	15.49±3.76¹⁾	7.870	0.003
伸膝肌肌力（kg）	23.84±6.37	16.48±5.01¹⁾	12.92±3.04¹⁾	15.360	<0.000 1
躯体功能指标
6 m步速（m/s）	0.71±0.21	0.48±0.17¹⁾	0.42±0.14¹⁾	8.500	0.002
SPPB	7.75±2.38	5.54±1.66¹⁾	4.63±2.13¹⁾	6.380	0.006
5次起坐时间（s）	30.79±13.49	44.76±11.67¹⁾	58.79±15.09^1),2)	12.990	0.000

项目	非肌少症（n=16）	单纯肌少症（n=16）	肌少症合并腹型肥胖（n=21）	F	P
体成分
LBM（kg）	37.11±9.65	23.99±7.02¹⁾	29.49±11.42	9.530	0.001
SMM（kg）	27.87±9.42	18.41±8.59¹⁾	23.10±9.11	4.330	0.022
ASM（kg）	17.34±2.94	10.30±2.12¹⁾	12.17±1.85^1),2)	29.970	<0.000 1
ASMI（kg/m²）	6.95±1.00	4.17±0.81¹⁾	4.97±0.58^1),2)	37.630	<0.000 1
VFA（cm²）	146.1±61.44	132.6±57.05	136.60±73.49	0.180	0.835
PBF（%）	39.39±8.52	34.69±10.64	37.03±12.64	0.740	0.483
BMC（g）	2.35±0.33	1.81±0.36	2.73±2.96	1.070	0.350
肌力指标
握力（kg）	15.66±4.18	10.21±4.01¹⁾	13.89±4.57²⁾	7.320	0.002
伸膝肌肌力（kg）	11.37±2.51	9.72±2.63	10.01±1.91	2.030	0.150
躯体功能指标
6 m步速（m/s）	0.57±0.18	0.39±0.12¹⁾	0.38±0.13¹⁾	7.250	0.003
SPPB	6.63±1.82	4.38±2.03¹⁾	3.38±1.94¹⁾	13.720	<0.000 1
5次起坐时间（s）	44.01±11.10	58.43±18.72¹⁾	53.65±18.06¹⁾	4.240	0.023

项目	单纯肌少症		t	P	肌少症合并腹型肥胖		t	P
项目	男性	女性	t	P	男性	女性	t	P
VFA	105.60±55.45	66.51±57.27	1.858	0.075	151.40±50.96	143.20±81.75	0.350	0.729
SFA	74.20±41.73	89.47±52.25	0.854	0.401	96.51±35.94	168.20±80.07	3.327	0.002
VSR	1.50±0.34	0.72±0.26	7.025	<0.000 1	1.65±0.45	0.82±0.26	7.045	<0.000 1

变量	β	调整R²	P
男性
5次起坐时间
腰围	0.45	0.34	0.007
ASMI-BIA	-0.44		0.008
女性
握力
BMI	-0.73	0.45	0.003
ASMI-BIA	0.49		0.001
SFA-CT	0.47		0.030
5次起坐时间
BMC-BIA	-0.35	0.1	0.035