Nationwide handgrip strength values and factors associated with muscle weakness in older adults: findings from the Brazilian Longitudinal Study of Aging (ELSI-Brazil)

Abstract

Background Handgrip strength (HGS) is a simple, quick, inexpensive, and highly reliable method for the assessment of muscle strength in clinical practice and epidemiological studies. This study aimed at describing the HGS values by age group and sex in Brazilians aged 50 years and over, determining age group- and sex-specific cutoff points for muscle weakness, and investigating sociodemographic and anthropometric variables associated with muscle weakness for each sex. Methods Data from the second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) were analyzed. HGS was measured in the dominant hand using a hydraulic hand dynamometer. Fractional polynomial regression models were fitted to estimate the percentiles (P5, P10, P20, P25, P50, P75, P90, and P95) of HGS by age group and sex. The P20 of the maximum HGS by age group and sex was used to define muscle weakness. Associations between sociodemographic (racial self-classification, place of residence, schooling, and monthly household income per capita in tertiles) and anthropometric variables (body mass index and waist circumference) and muscle weakness, by sex, were evaluated using logistic regression. Results The analytical sample included 7905 participants (63.1 ± 9.1 years; 60% women). HGS reduced with increasing age in both sexes. Men presented higher HGS than women in all age groups. The cutoff points for muscle weakness ranged from 28 to 15 kg for men and from 17 to 9 kg for women. In the adjusted analyses, low schooling (0–4 years) was positively associated with muscle weakness in both sexes (in men, odds ratio (OR) 2.45, 95% confidence interval (CI) 1.46–4.12; in women, OR 1.90, 95%CI 1.18–3.06). Low and middle monthly household income per capita also had a positive association with muscle weakness among women (OR 1.78, 95%CI 1.37–2.32; OR 1.32, 95%CI 1.01–1.73, respectively). Overweight had a negative association with muscle weakness among men (OR 0.66, 95%CI 0.52–0.83), and obesity was inversely associated with muscle weakness in both sexes (in men, OR 0.49, 95%CI 0.31–0.78; in women, OR 0.69, 95%CI 0.52–0.92). Conclusions This study provides HGS values and cutoff points for muscle weakness by age group and sex from a nationally representative sample of older Brazilian adults. The variables associated with muscle weakness slightly differed between men and women. HGS values and cutoff points generated can be used as benchmarks in clinical settings and foster future epidemiological research.

Associations between Body Mass Index and Probable Sarcopenia in Community-Dwelling Older Adults

“…An analysis of the Irish Longitudinal Study on Ageing, which employed hand grip strength only, found that overweight and obesity were associated with lower odds of probable sarcopenia [ 9 ]. Consistent with this, in the Brazilian Longitudinal Study of Ageing, obesity was inversely associated with hand grip strength [ 19 ]. Others similarly observed that a larger overall body mass, indicated by higher BMI, was associated with stronger hand grip strength [ 38 ].…”

“…Previously, we reported that overweight and obesity were associated with lower odds of probable sarcopenia, which was assessed by hand grip strength only [ 9 ]. Similarly, an analysis from the Brazilian Longitudinal Study of Ageing (ELSI-Brazil) showed that BMI was inversely associated with muscle weakness measured by hand grip strength [ 19 ]. In contrast, others report an increased risk of sarcopenia/probable sarcopenia in older adults with obesity [ 20 ].…”

Socioeconomic, Disease Burden, Physical Functioning, Psychosocial, and Environmental Factors Associated With Mortality Among Older Adults: The Brazilian Longitudinal Study of Ageing (ELSI-Brazil)

“…ELSI-Brazil therefore provides an opportunity to understand better the contribution of factors such as educational attainment, the household economic situation, health behaviors, and a range of health conditions-separately and in combination, on mortality, longevity, disability, and inequalities in each of these outcomes for a nationally representative sample of older adults. Future research can further advance the state-of-the-art by incorporating ELSI's mortality data (including specific causes of death) with measures of physical functioning, cognitive performance, metabolic and other biomarkers, and genomic analyses (Lima-Costa et al, 2022). The study's ultimate objective is to harness such research for promoting healthy aging among older Brazilians and to inform the overall provision and continuous quality improvement of health and social services essential to reaching this goal.…”

“…The baseline sample comprised 10, 000 older adults (9412 participated), residing in 70 municipalities from all five Brazilian geographic regions. Details of the ELSI study (See http://elsi.cpqrr.fiocruz.br) have been described elsewhere (Lima-Costa et al, 2022).…”

“…Health status measures included fair/poor self-rated health, measured Body Mass Index (in categories), cognitive health (late memory word recall), and chronic conditions (self-reported prior medical diagnosis of cardiovascular disease—heart attack, angina or congestive heart failure, diabetes, stroke, cancer, depression, and measured hypertension (>140/90). Functional ability includes Activities of Daily Living (ADL) limitations, Instrumental Activities of Daily Living (IADL) limitations, and measured grip strength (average of two highest values) (de Souza Moreira et al, 2022). We also assessed behavioral factors (current or ever smoker vs. never), social support (partnered vs. single), and the physical environment (geographic region, and urban vs. rural residence).…”