Research paperDepressive symptoms, handgrip strength, and weight status in US older adults
Introduction
Decline in objective physical performance is a common feature of aging in adults (Veronese et al., 2016; Veronese et al., 2017a; Veronese et al., 2017b) and increases the risk of falls, health care use, level of dependency, admissions to residential care, and mortality (Freedman et al., 2002; Gill and Kurland, 2002). United States national statistics indicate that 20% of non-institutionalized people aged 70 years and older need help in performing at least one activity of daily living (ADL), including bathing, dressing, eating, toileting, and transferring (Kramarow et al., 1999). Indeed, for many independent older adults everyday tasks such as climbing stairs require functioning close to maximal capacity, meaning that further decline could increase their risk of becoming dependent on a carer (Rikli, 1999).
Several studies have shown that handgrip strength is a valid measure of physical function and is a non-invasive measure of physical health that has been widely used in research and clinical settings (Giampaoli et al., 1999; Rantanen et al., 1999; Rantanen et al., 2002; Onder et al., 2005). Taekema et al. (2010) found that dynamometer determined handgrip strength could be a useful instrument in geriatric practice to identify the ‘oldest old’ patients (i.e. those aged over 75 years) at risk of disability.
Depression is a leading cause of years lived with disability globally (Whiteford et al., 2015) and is associated with decreased physical activity (Vancampfort et al., 2017; Schuch et al., 2017) and objective physical performance (Stuck et al., 1999; Callahan et al., 1998; Dalle Carbonare et al., 2009). However, literature suggests that only older adults with chronic depression, not those with remitted depression are at a greater risk of physical decline than those never depressed (Penninx et al., 2000; Lenze et al., 2005). One study examined the association between different trajectories of depressive symptoms over 1 year and change in functional status over 30 months among patients undergoing coronary angiography; the study concluded that patients with persistent depressive symptoms were at greatest risk for worse functional status 30 months following coronary interventions (Wilcox et al., 2016). Moreover, a recent meta-analysis (Soysal et al., 2017) found that in participants with depression the prevalence of frailty was 40.4%. In longitudinal studies including older adults with depression at baseline the pooled OR for incident frailty was 3.72 (95% CI 1.95–7.08).
Two previous cross-sectional studies have suggested that handgrip strength is associated with depression (Gale et al., 2011; van Milligen, 2011). Another study using a large population-based adult sample from two Japanese municipalities found that lower hand-grip strength, standardised using age and gender, was both cross-sectionally and longitudinally associated with depressive symptoms (Fukumori et al., 2015). Other more recent studies have found similar results (Veronese et al., 2017b).
The presence of depression, disease and/or disability can lead to a cycle of health decline, particularly in older adults (Kelley-Moore and Ferraro, 2005). One potential consequence of depression is weight gain. In a systematic review, people with depression were found to have an 18% increased risk of being obese (de Wit et al., 2010). A meta-analysis of longitudinal studies found a bi-directional associations between obesity and depression in both men and women, suggesting that the presence of obesity increased the risk of depression – 55% increased risk – and likewise depression was predictive of developing obesity – 58% increased risk (Luppino et al., 2010). More recent systematic reviews have found similar results (Vancampfort et al., 2015). The association between depression and obesity has been shown to be strongest in severely obese persons (Onyike et al., 2003) and the odds ratio for depression increases with BMI, suggesting a dose-response gradient (Dong et al., 2004).
Overweight and obesity have been shown to be associated with depression (Luppino et al., 2010) and decline in physical function (Jensen and Friedmann, 2002 and Roberts et al., 2000) and this literature suggest that this relationship is likely to be bidirectional.
To date no paper has investigated the relationship between handgrip and depression by weight status in older US adults. Research needs to address this gap in the literature to identify whether the overweight/ obese and depressed are at the greatest presence of decline in physical function and thus inform targeted and preventive interventions.
In a large representative cohort of older US adults this paper aims to investigate the association between handgrip strength and depression by weight status. We hypothesise that those who are depressed and overweight or obese will have the lowest levels of grip strength.
Section snippets
Study population
The National Health and Nutrition Examination Survey (NHANES) was designed to provide cross-sectional estimates on the prevalence of health, nutrition, and potential risk factors among the non-institutionalized civilian U.S. population up to 85 years of age (Centres for Disease Control and Prevention, 2016). In brief, NHANES surveys a nationally representative complex, stratified, multistage, probability clustered sample of about 5,000 participants each year in 15 counties across the country.
Results
There were 2,812 adults greater than 60 years of age in the two NHANES waves who had data on handgrip strength and depressive symptoms. Participants’ mean age was 69.2 years at the time of examination, and their mean BMI was 29.2 kg/m2. We observed significant gender differences in most characteristics, except for age and race (Table 1). There were more men than women with BMI ≥ 25.0 kg/m2, had a college graduate degree or above, lived with someone, were a former or current smoker, did not have
Discussion
To our knowledge, this is the first study to investigate the association between handgrip strength and depression by weight status in older US adults. We found in a large representative sample of older US adults that, among females only, those who were categorised as having moderate to severe depression had significantly lower dynamometer determined handgrip scores than those who were categorised as having no depression. The lack of association in men is interesting, though the mechanism
Contributions
All authors collaborated on the interpretation of the data, writing the manuscript, and decision to submit the paper for publication.
Funding
None.
Conflicts of interest
None declared.
Acknowledgement
None.
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Authors contributed equally to this manuscript