Association of appendicular extracellular-to-intracellular water ratio with age, muscle strength, and physical activity in 8,018 community-dwelling middle-aged and older adults

Iwasaka, Chiharu; Yamada, Yosuke; Nishida, Yuichiro; Hara, Megumi; Yasukata, Jun; Miyoshi, Nobuyuki; Shimanoe, Chisato; Nanri, Hinako; Furukawa, Toshinori; Koga, Kayoko; Horita, Mikako; Higaki, Yasuki; Tanaka, Keitaro

doi:10.1016/j.archger.2023.104931

Cited by 7 publications

(17 citation statements)

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“…Aging also affects the musculoskeletal system, causing a decrease in skeletal muscle integrity, mass, strength, and function, along with an increase in the accumulation of noncontractile and adipose tissue [ 11 12 ]. Decreases in skeletal muscle integrity can result from a diminished cross-sectional area of muscle fibers, a transition from type II to type I fibers, and a loss of innervation [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Phase Angle and Impedance Ratio as Indicators of Physical Function and Fear of Falling in Older Adult Women: Cross-Sectional Analysis

Sterner,

Stout,

Lafontant

et al. 2024

JMIR Aging

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Background Older adults experience a significant decline in muscle integrity and function with aging. Early detection of decreased muscle quality can pave the way for interventions to mitigate the progression of age-related physical declines. Phase angle (PhA) and impedance ratio (IR) are measures of muscle integrity, which can be assessed quickly via bioelectrical impedance analysis (BIA) and may be indicative of physical function. Objective This study aimed to characterize the relationships among handgrip strength (HGS), sit-to-stand (STS), BTrackS balance scores, fear of falling (evaluated using the Short Falls Efficacy Scale–International [Short FES-I]), and IR among community-dwelling older adult women classified as having a low or high PhA. Methods A cross-sectional analysis was conducted with 85 older women (mean age 75.0, SD 7.2 years; mean weight 71.0, SD 15.0 kg; mean height 162.6, SD 6.1 cm). To examine the influence of PhA on performance measures, participants were divided into 2 PhA groups: high (>4.1°; n=56) and low (≤4.1°; n=29). Data were nonnormative; hence, the Mann-Whitney U test was used to evaluate between-group differences, and Kendall τ coefficients were used to determine the partial correlations. Results The low PhA group had a significantly higher IR (mean 0.85, SD 0.03) than the high PhA group (mean 0.81, SD 0.03; r=.92; P<.001). The high PhA group had superior HGS (mean 21.4, SD 6.2 kg; P=.007; r=0.36), BTrackS balance scores (mean 26.6, SD 9.5 cm; P=.03; r=0.30), and STS scores (mean 16.0, SD 5.5; P<.001; r=0.49) than the low PhA group (mean HGS 17.6, SD 4.7 kg; mean BTrackS balance score 37.1, SD 21.1 cm; mean STS score 10.7, SD 6.2). Both PhA and IR were significantly correlated with HGS and BTrackS balance, STS, and Short FES-I scores (P<.05). However, on adjusting for the whole sample’s age, only PhA was strongly correlated with HGS (τb=0.75; P=.003) and STS scores (τb=0.76; P=.002). Short FES-I scores were moderately correlated with IR (τb=0.46; P=.07) after controlling for age. No significant between-group differences were observed for height, weight, or BMI. Conclusions PhA and IR are associated with physical function and the fear of falling in older women. However, only PhA was significantly associated with physical function (HGS and STS) independent of age. Conversely, only IR was significantly associated with the fear of falling. Diminished physical function and increased IR appear to be characteristics of older women with a PhA of ≤4.1°. These findings suggest that PhA and IR measured through BIA together may serve as a valuable tool for early identification of older women at the risk of functional decline and a heightened fear of falling.

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Section: Introductionmentioning

confidence: 99%

Phase Angle and Impedance Ratio as Indicators of Physical Function and Fear of Falling in Older Adult Women: Cross-Sectional Analysis

Sterner,

Stout,

Lafontant

et al. 2024

JMIR Aging

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“…Segmental Bioelectrical Impedance Spectroscopy (S-BIS) is a noninvasive and rapid method for assessing the water content of specific body segments such as the arms and legs ( 5 , 7 , 10 ). Because the appendicular limb regions are primarily composed of skeletal muscle tissue ( 11 ), water measurements in the appendicular limb regions are commonly used to assess the hydration status of skeletal muscle ( 6 , 12–14 ). S-BIS can distinguish between ECW and ICW contents in the appendicular limb regions ( 5 , 7 ).…”

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confidence: 99%

“…The ECW in skeletal muscle reflects the extracellular space filled with plasma and interstitial fluid, whereas ICW is used as a proxy marker for muscle cell mass as it is contained within cells ( 4 , 5 , 7 ). Prior studies have used the appendicular ECW-to-ICW ratio (A-E/I) as a marker reflecting muscle quality, and A-E/I is higher with age ( 6 ). Higher A-E/I is also characterized by lower levels of muscle strength, gait speed, and habitual physical activity (PA) and higher levels of functional disability, independent of skeletal muscle mass ( 6 , 12 , 14 ).…”

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confidence: 99%

“…Prior studies have used the appendicular ECW-to-ICW ratio (A-E/I) as a marker reflecting muscle quality, and A-E/I is higher with age ( 6 ). Higher A-E/I is also characterized by lower levels of muscle strength, gait speed, and habitual physical activity (PA) and higher levels of functional disability, independent of skeletal muscle mass ( 6 , 12 , 14 ). Therefore, A-E/I has the potential to serve as a predictive marker for future adverse health outcomes associated with skeletal muscle aging.…”

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confidence: 99%

“…Handgrip strength (HGS) and walking speed are well-established predictors of mortality ( 15 ). Because A-E/I is associated with HGS and walking speed, independent of skeletal muscle mass ( 6 , 12 ), it may also serve as a valid indicator of mortality risk. In contrast to A-E/I, whole-body E/I has been reported to be associated with mortality in patients with hemodialysis, chronic kidney disease, and cancer, but this measure may differ from the hydration status in the appendicular limb regions of the general population owing to pathological edema, pleural effusions in the trunk, and ascites ( 16–18 ).…”

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confidence: 99%

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Association Between the Appendicular Extracellular-to-Intracellular Water Ratio and All-Cause Mortality: A 10-Year Longitudinal Study

Iwasaka,

Yamada,

Nishida

et al. 2023

The Journals of Gerontology: Series A

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The appendicular extracellular-to-intracellular water ratio (A-E/I) is a potential marker of skeletal muscle quality, reflecting the balance of water distribution between the extracellular and intracellular compartments of the appendicular limb regions. A-E/I has been increasingly used in recent studies; however, its association with adverse outcomes remains unclear. This study investigated the potential association between A-E/I and all-cause mortality. A prospective cohort study of 8015 middle-aged and older adults (comprised of 4755 women, aged 45–74 years) residing in a Japanese community was conducted. The baseline assessment was performed between 2010 and 2012, and the follow-up period lasted until July 2022. A-E/I and skeletal muscle mass were measured using segmental bioelectrical impedance spectroscopy. Handgrip strength (HGS) was measured using a Smedley-type dynamometer. Lifestyle, medical history, and physical activity (PA) were assessed by questionnaire and accelerometer. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) for each quartile (Q) of A-E/I were estimated using the multivariable cox regression model. During a 10.5-year median follow-up, mortality rates were 8.9 and 3.6 per 1000 person-years for men (292 deaths) and women (174 deaths), respectively. A-E/I quartiles were positively associated with all-cause mortality in both sexes (men: Q1, HR: 1.0 [95% CI: reference], Q4, HR: 1.8 [1.1–2.9], P trend <0.05; women, Q4, HR: 2.2 [1.3–3.8], P trend <0.01). This association remained significant after further adjustment for skeletal muscle mass and HGS (P trend < 0.05). Our findings suggest that A-E/I serves as an early predictive marker for mortality in middle-aged and older Japanese adults.

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Segmental extracellular-to-intracellular water resistance ratio and physical function in older adults

Asano,

Tsuji,

Okura

2023

Experimental Gerontology

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Association of appendicular extracellular-to-intracellular water ratio with age, muscle strength, and physical activity in 8,018 community-dwelling middle-aged and older adults

Cited by 7 publications

References 60 publications

Phase Angle and Impedance Ratio as Indicators of Physical Function and Fear of Falling in Older Adult Women: Cross-Sectional Analysis

Phase Angle and Impedance Ratio as Indicators of Physical Function and Fear of Falling in Older Adult Women: Cross-Sectional Analysis

Association Between the Appendicular Extracellular-to-Intracellular Water Ratio and All-Cause Mortality: A 10-Year Longitudinal Study

Segmental extracellular-to-intracellular water resistance ratio and physical function in older adults

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