Handgrip strength cut off value estimation in Indian older adults using LASI-1 dataset

INTRODUCTION

Sarcopenia can be defined as a continuous and generalised degeneration of muscle strength and skeletal muscle mass, which can be identified through the measurement of handgrip strength (HGS).^[1] Sarcopenia can be categorised as primary sarcopenia, which is associated with ageing and secondary sarcopenia, which results from chronic conditions and diseases such as cancer, arthritis and so on.^[2]

Grip strength is an easy to administer and reliable measurement of maximum voluntary muscle contraction and also serves as an indicator of the overall muscular strength of the human body.^[3] It not only helps in predicting the muscle mass in the body but also provides an indication about the state of nutrition, the occurrence of chronic diseases, quality of life and mortality.^[4-6]

Nutritional status plays a crucial role in maintaining optimum HGS by regulating the skeletal muscle mass in the body and any fluctuation in it, in terms of malnutritional state can seriously hamper the HGS and leads to early development of sarcopenia and frailty among the older adults.^[7,8]

In recent times, HGS has been widely used as a clinical indicator of deprived mobility and low muscle mass.^[9] HGS indicates the presence and function of muscle fibres in the body, which is affected by the distribution of muscle mass, and also helps to identify the early signs of sarcopenia in terms of deprived HGS, especially among older adults and the elderly.^[10]

The European Working Group on Sarcopenia in Older People (EWGSOP2) revised the older definitions (EWGSOP) and terms and set new cutoff values of HGS for indication of lower strength as <27 kg for men and <16 kg for women.^[11]As there is a disparity between European and Asian populations, in terms of ethnicity, body structure, climate and other related factors, the Asian Working Group for Sarcopenia (AWGS) proposed a HGS cutoff of <28 kg for men and <18 kg for women, which indicates lower strength.^[12] However, there is no standardised and specified cutoff values for the Indians.

In Indian context, the Longitudinal Aging Study in India (LASI), Wave 1 depicts a larger health scenario of the older adults and the elderly prevailing in the country in its report; but still there is a dearth of knowledge regarding the sarcopenia and its allied issues.^[13] Few attempts were made to specify cutoff values of HGS for Indian older adults, but most of them lack large sample sizes from the population.^[14,15] In this backdrop, the purpose of the study is to report the distribution of HGS among the Indian older adults and the elderly with age and sex specification and also generate HGS cutoff values for identification of lower muscle strength among them.

MATERIALS AND METHODS

RESULTS

Among the 40351 healthy older Indian individuals, 18833 (46.67%) were males and 21518 (53.33%) were females. The mean age of the males was 59.8 ± 10.36 years (presented in arithmetic mean ± standard deviation form) and 59.0 ± 10.15 years for females. The anthropometric profile of the healthy individuals included in the study with age and sex specifications is shown in Table 1.

The distribution of HGS (kg) in the healthy Indian individuals with age- and sex-wise categorisation is shown in Table 2.

The age- and sex-wise percentile distribution of HGS (kg) in the study population is shown in Table 3.

The age- and sex-wise generated cutoff values of HGS (kg) for the healthy Indian individuals aged 45–89 years are shown in Figure 1.

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Figure 1:

Age-specified sex-wise handgrip strength (kg) cutoff values for both Indian (a) males and (b) females (using lowest 20^th percentile). HGS: Handgrip strength.

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DISCUSSION

HGS serves as a useful indicator of muscle mass declination and helps in the early detection of sarcopenia.^[2] In the present study, on the basis of the AWGS procedure for determining HGS cutoff values, we propose, a cutoff value of HGS is <15.25 kg for both males and females, for screening, which is an early and relatively easier initial detection of muscle strength deterioration. The value proposed in the present study is similar to the study carried out on Indian older adults by Muhammad et al., where they suggested an HGS cutoff value of 19.5 kg for males and 12.5 kg for females.^[20] The trend continues with female older adults, as another study on Indian adult females reported a value of <16.7 kg; but for males, they reported a relatively higher value of <25.63kg.^[21] Looking at the findings from other countries, it is found that the value proposed in the present study has a similarity with a study carried out with older adults of Taiwan; it proposed a value of 19.73 kg.^[22] However, it should also be mentioned that the value proposed in the present study is little less compared to values reported by Chinese (28.5 for males and 18.6 kg for females), Japanese (28 kg for males and 18 kg for females) and Korean (<28.9 kg for males and <16.8 kg for females) older populations, depicted the prevailing differences in HGS among the Asian populations.^[17,23,24] Our developed cutoff value of HGS of 15.25 kg is quite less than the cutoff provided by AWGS (<28 kg for men and <18 kg for women for Asian population in general) and EWGSOP2 (<27kg for men and <16 kg for women for Europeans).

CONCLUSION

The study is able to provide a cutoff value of 15.25 kg for older Indians from a large dataset following the AWGS procedure and could be the very first such attempt for older Indians. It implies that individuals with measured HGS values of ≤15.25 kg run a risk of muscle strength deterioration that may lead to sarcopenia in the long run having serious implications. The outcome of the present work may hence facilitate a screening, that is an early, easy, and cost-effective detection of sarcopenia in terms of HGS values.