Table 1 shows the patient characteristics among the three study groups. The patients in the S group were significantly older than those in the C and D groups, and the patients in the D group were significantly older than those in the C group. The BMI in the D group was not significantly different from that in the C group, but the BMI in the S group was significantly lower than that in the C group. Importantly, the BMI in the D group was significantly higher than that in the S group.
Table 1
|
Control (C)
|
Dynapenia(D)
|
D vs. C
|
Sarcopenia (S)
|
S vs.C
|
D vs. S
|
Total N
|
77
|
61
|
|
129
|
|
|
Sex(M/F)
|
M 32/F 45
|
M 24/F 37
|
n.s.
|
M 55/ F 74
|
n.s.
|
|
Age (y.o)
|
72.0 (69.0–77.0)
|
76.0 (70.0-81.5)
|
< 0.05
|
82.0 (76.0–85.0)
|
< 0.01
|
< 0.01
|
BMI (kg/m2)
|
23.6 (21.4–26.3)
|
25.2 (23.3–28.2)
|
n.s.
|
21.2 (18.8–23.0)
|
< 0.01
|
< 0.01
|
SysBP (mmHg)
|
125.0 (118.0-136.5)
|
129.0 (117.8–140.0)
|
n.s.
|
130.0 (120.0-142.0)
|
n.s.
|
n.s.
|
DiaBP (mmHg)
|
70.0 (65.0–78.0)
|
70.0 (63.8–76.5)
|
n.s.
|
68.5 (60.0-76.3)
|
n.s.
|
n.s.
|
Hand Grip(kg)
|
M 33.0 (30.4–35.3)/
F 21.6 (20.0-23.1)
|
M 26.1 (21.5–33.0)/
F 15.4 (13.6–19.1)
|
n.a
|
M 22.5 (18.6–25.5)/
F14.6 (11.7–17.0)
|
n.a
|
n.a
|
Walking Speed (m/s)
|
1.2 (1.1–1.4)
|
0.7(0.5–0.9)
|
< 0.01
|
0.8(0.5-1.0)
|
< 0.01
|
n.s.
|
SMI (kg/m2)
|
M 7.0 (6.4–7.5)/
F 5.9 (5.4–6.4)
|
M 7.7 (7.2–8.1)/
F 6.1 (5.9–6.7)
|
n.a
|
M 6.2 (5.5–6.5)/
F 4.9 (4.7–5.3)
|
n.a
|
n.a
|
Hb (g/dl)
|
13.7 ± 1.6
|
12.6 ± 1.8
|
< 0.01
|
12.0 ± 1.8
|
< 0.01
|
n.s.
|
Alb (g/dl)
|
4.2 (4.0-4.5)
|
4.0 (3.7–4.3)
|
< 0.01
|
3.8 (3.5–4.1)
|
< 0.01
|
n.s.
|
AST (U/L)
|
22.0 (18.0-27.5)
|
22.0 (18.0–28.0)
|
n.s.
|
20.0 (16.0–25.0)
|
n.s.
|
n.s.
|
ALT (U/L)
|
17.0 (14.0–24.0)
|
17.0 (13.0-27.5)
|
n.s.
|
13.0 (10.0-19.5)
|
n.s.
|
n.s.
|
chE (U/L)
|
316.2 ± 70.9
|
296.3 ± 95.4
|
n.s.
|
266.5 ± 82.7
|
< 0.01
|
n.s.
|
BUN (mg/dl)
|
14. 3(13.1–18.4)
|
16.5 (13.2–21.3)
|
n.s.
|
16.6 (12.8–20.6)
|
n.s.
|
n.s.
|
Cr (mg/dl)
|
0.7 (0.6–0.9)
|
0.8 (0.6-1.0)
|
n.s.
|
0.8 (0.6-1.0)
|
n.s.
|
n.s.
|
TC (mg/dl)
|
193.8 ± 33.7
|
175.1 ± 46.7
|
< 0.05
|
174.4 ± 39.3
|
< 0.01
|
n.s.
|
TG (mg/dl)
|
109.5 (78.3-169.8)
|
114.0 (81.5–154.0)
|
n.s.
|
110.0 (71.0-162.0)
|
n.s.
|
n.s.
|
LDL-C (mg/dl)
|
111.4 ± 30.2
|
101.4 ± 37.5
|
n.s.
|
96.4 ± 31.5
|
< 0.01
|
n.s.
|
HDL-C (mg/dl)
|
60.0 (47.3–66.0)
|
47.0 (40.0-57.5)
|
< 0.01
|
52.0 (44.0–66.0)
|
n.s.
|
< 0.05
|
NT-proBNP (pg/ml)
|
62.0 (31.5–93.5)
|
147.0 (54.0-330.0)
|
n.s.
|
165.0 (92.0-545.0)
|
n.s.
|
n.s.
|
Lumbar
YAM (%)
|
98.5 (80.0-118.0)
|
88.0 (77.8-107.3)
|
n.s.
|
84.5 (74.0–91.0)
|
< 0.01
|
n.s.
|
Femoral neck
YAM (%)
|
88.5 (78.8-106.3)
|
83.0 (72.0-103.0)
|
n.s.
|
76.0 (64.0–86.0)
|
< 0.01
|
< 0.05
|
T2DM
|
50/77 (64.9%)
|
51/59 (86.4%)
|
< 0.01
|
82/125 (65.6%)
|
n.s.
|
n.a
|
History of Fractures
|
1/76 (1.3%)
|
8/59 (13.6%)
|
< 0.05
|
25/126 (19.8%)
|
< 0.05
|
n.a
|
History of Strokes
|
6/77 (7.8%)
|
19/59 (32.2%)
|
< 0.01
|
32/126 (25.4%)
|
< 0.01
|
n.a
|
History of Heart Diseases
|
12/76 (15.8%)
|
11/56 (19.6%)
|
n.s.
|
24/126 (19.0%)
|
n.s.
|
n.a
|
Data are shown as mean ± standard deviation or median (25th–75th percentile). |
D vs. C and S vs. C and D vs. S were compared by Dunnett’s T3 test or the χ2 test with p value. |
n.s., not significant (p ≥ 0.05); n.a; not analyzed |
C, control; D, dynapenia; S, sarcopenia; M, male; F, female; Alb, albumin; BMI, body mass index; SysBP, systolic blood pressure; DiaBP, diastolic blood pressure; SMI, skeletal muscle mass index; Hb, hemoglobin; Alb, albumin; AST, aspartate transaminase; ALT, alanine transaminase; chE, cholinesterase; BUN, blood urea nitrogen; Cr, creatinine; TC, total cholesterol; TG, triglycerides; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; NT-proBNP, N-terminal pro-brain natriuretic peptide; YAM, young adult mean; T2DM, type 2 diabetes mellitus; |
Compared with the C group, both the D and S groups had significantly lower Hb, albumin, and total cholesterol concentrations. The cholinesterase and LDL-C concentrations were also significantly lower in the S than C group. The HDL-C concentration was significantly lower in the D group than in the C and S groups. BMD designated by the percentage of the YAM in the lumbar and femoral neck bone was significantly lower in the S than C group. However, no difference in BMD was found between the D and C groups. In the comparison between the D and S groups, only femoral neck BMD was significantly lower in the S than D group. The complication of T2DM was more frequent in the D than C group, but no such difference was observed between the S and C groups. A history of bone fracture and stroke was significantly more frequent in the D and S groups than in the C group, respectively.
Next, factors contributing to the diagnosis of dynapenia and sarcopenia were investigated by binomial logistic analysis (Table 2). The values below and above the median of the blood sampling items or the presence or absence of T2DM, history of stroke, and history of bone fracture were set as explanatory variables. The results showed that lower Hb and HDL-C concentrations were risk factors in both the D group (Table 2-I) and S group (Table 2-III) compared with the C group and that T2DM, a history of stroke, and a history of bone fracture were also risk factors for both dynapenia (Table 2-II) and sarcopenia (Table 2-IV).
Table 2. Factors contributing to dynapenia (I, II) and sarcopenia (III, IV) as determined by binomial logistic regression analysis adjusted for sex, age, and body mass index.
(I)
variables
|
adjusted OR (95% CI)
|
p value
|
Sex
|
1.53 (0.59-0.91)
|
n.s.
|
Age
|
2.48 (0.91-6.78)
|
n.s.
|
BMI
|
2.42 (0.77-7.57)
|
n.s.
|
Hb
|
0.14 (0.05-0.40)
|
<0.01
|
Alb
|
1.02 (0.39-2.68)
|
n.s.
|
HDL-C
|
0.21 (0.07-0.57)
|
<0.01
|
(II)
variables
|
adjusted OR (95% CI)
|
p value
|
Sex
|
1.44 (0.60-3.48)
|
n.s.
|
Age
|
3.42 (1.41-8.29)
|
<0.01
|
BMI
|
2.89 (1.05-7.96)
|
<0.05
|
T2DM
|
3.75 (1.26-11.13)
|
<0.05
|
History of stroke
|
4.82 (1.60-14.58)
|
<0.01
|
History of bone fracture
|
12.68 (1.30-123.25)
|
<0.05
|
(III)
variables
|
adjusted OR (95% CI)
|
p value
|
Sex
|
2.66 (1.07-6.60)
|
<0.05
|
Age
|
5.04 (2.14-11.91)
|
<0.01
|
BMI
|
0.18 (0.08-0.43)
|
<0.01
|
Hb
|
0.35 (0.14-0.90)
|
<0.05
|
Alb
|
0.50 (0.21-1.20)
|
n.s.
|
LDL-C
|
0.99 (0.97-1.00)
|
n.s.
|
HDL-C
|
0.31 (0.12-0.77)
|
<0.05
|
(IV)
variables
|
adjusted OR (95% CI)
|
p value
|
Sex
|
1.20 (0.56-2.60)
|
n.s.
|
Age
|
8.91 (4.07-19.47)
|
<0.01
|
BMI
|
0.25(0.12-0.54)
|
<0.01
|
T2DM
|
2.95 (1.25-6.95)
|
<0.05
|
History of stroke
|
5.71 (1.81-18.09)
|
<0.01
|
History of bone fracture
|
10.09 (1.20-85.19)
|
<0.05
|
The satatistical analysis was based on the comparison with control group.
When the value was less than the median value, the number 1 was entered.
When the value was more than the median value, the number 2 was entered.
Variables: sex (male = 1, female = 2), age (<77 years = 1, ≥77 years = 2), body mass index (<median value 22.6 kg/m2 = 1, ≥22.6 kg/m2 = 2), type 2 diabetes mellitus (no = 0, yes = 1), history of stroke (no = 0, yes = 1), history of bone fracture (no = 0, yes = 1)
p*; vs control group
OR, odds ratio; CI, confidence interval; Hb, hemoglobin; Alb, albumin; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol
Next, the explanatory variables were changed from a history of fracture to the femoral BMD and reanalyzed (Table 3). Compared with the C group, we again found that a history of stroke was a risk factor in the D group (Table 3-I) and S group (Table 3-II). Femoral neck BMD of < 70% of the YAM (corresponding to the diagnosis of osteoporosis) was a risk factor only in the S group (Table 3-I and II). When lumbar BMD < 70% of the YAM was analyzed as the explanatory variable, it was also a risk factor only in the S group (adjusted OR 0.244, p < 0.05) but not in the D group.
Table 3. Factors contributing to dynapenia (I) and sarcopenia (II) as determined by binomial logistic regression analysis adjusted for sex, age, and body mass index
(I)
variables
|
adjusted OR (95% CI)
|
p value
|
Sex
|
1.11(0.42-2.93)
|
n.s.
|
Age
|
1.86 (0.73-4.75)
|
n.s.
|
BMI
|
3.76(1.22-11.65)
|
<0.05
|
T2DM
|
2.03 (0.70-5.91)
|
n.s.
|
History of stroke
|
5.46 (1.52-19.59)
|
<0.01
|
Femoral BMD
|
0.24 (0.04-1.34)
|
n.s.
|
(II)
variables
|
adjusted OR (95% CI)
|
p value
|
Sex
|
1.56 (0.64-3.77)
|
n.s.
|
Age
|
5.25 (2.27-12.16)
|
<0.01
|
BMI
|
0.23(0.10-0.55)
|
<0.01
|
T2DM
|
4.89 (1.76-13.64)
|
<0.01
|
History of stroke
|
7.05 (1.81-27.50)
|
<0.01
|
Femoral BMD
|
0.14 (0.03-0.55)
|
<0.01
|
The satatistical analysis was based on the comparison with control group.
Variables: sex (male = 1, female = 2), age (<77 years = 1, ≥77 years = 2), body mass index (<median value 22.6 kg/m2 = 1, ≥22.6 kg/m2 = 2), T2DM (no = 0, yes = 1), history of stroke (no = 0, yes = 1), young adult mean of femoral BMD (<70% = 1, ≥70% = 2)
OR, odds ratio; CI, confidence interval; T2DM, type 2 diabetes mellitus; BMD, bone mineral density
The mean PhA was 4.6 ± 0.6 degrees in the C group, 4.1 ± 0.8 degrees in the D group, and 3.7 ± 0.7 degrees in the S group. When the PhA was compared among the three groups by Kruskal–Wallis analysis, significant differences were found. The PhA was significantly lower in the D and S groups than in the C group and significantly lower in the S group than in the D group (Fig. 1). Similar significant differences were obtained between D/S and C and between D and S, respectively even after adjusting for age and sex (data not shown).