Effects of Sarcopenic Obesity on Metabolic Syndrome in Korean Elders: Using Data from the Korea National Health and Nutrition Examination Survey (2008-2011)

Hyun-A Choi; Kyung-Min Park

doi:10.12799/jkachn.2016.27.3.231

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Original Article
Effects of Sarcopenic Obesity on Metabolic Syndrome in Korean Elders: Using Data from the Korea National Health and Nutrition Examination Survey (2008-2011): Hyun-A Choi¹, Kyung-Min Park²; Journal of Korean Academy of Community Health Nursing 2016;27(3):231-241.
DOI: https://doi.org/10.12799/jkachn.2016.27.3.231
Published online: September 12, 2016

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¹Department of Nursing, Sunlin University, Pohang, Korea

²College of Nursing, Keimyung University, Daegu, Korea

Corresponding author: Park, Kyung-Min College of Nursing, Keimyung University, 1095 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea. Tel: +82-53-580-3900, Fax: +82-53-580-3916, E-mail: kmp@kmu.ac.kr

• Received: July 11, 2016 • Revised: September 3, 2016 • Accepted: September 3, 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
References

Abstract

Purpose
This study was conducted to examine effects of sarcopenic obesity on metabolic syndrome in Korean elders.
Methods
This study is based on the analysis of the Korea National Health and Nutrition Examination Survey (KNHANES) with 1,155 subjects (524 men, and 631 women) aged 60 or older, from 2008 to 2011. Sarcopenia was defined as an appendicular skeletal muscle (ASM), divided by weight (%) of <1 SD (standard deviation) below the sex-specific mean for young adults. Obesity was defined as a total body fat percent (men≥25%, women≥35%).
Results
The prevalence of SO (sarcopenic obesity) was 13.3% among men and 22.5% among women. Both sexes showed a higher total body fat percent, and the SMI (skeletal muscle index) was the lowest in the SO group. Metabolic syndrome was highly prevalent in the SO group (52.5% men, 60.4% women). The SO group showed a higher risk for metabolic syndrome (odds ratio men 6.57 [95% CI 5.19~7.27], women 3.89 [95% CI 2.41~6.29]) than the obese group (men 3.14 [95% CI 1.76~4.14], women 2.54 [95% CI 1.38~4.65]).
Conclusion
SO is a major risk factor for metabolic syndrome in Korean elders. Therefore, a nursing program should be given to the Korean elderly SO group to prevent metabolic syndrome.
Key Words: Sarcopenia; Obesity; Metabolism; Syndrome

Table 1.

Differences in Demographic, Health related Characteristics according to Sarcopenia & Obesity Status

Variables	Categories	Men (n=649,423)				x² or F(p)	Women (n=807,990)				x² or F(p)
		Normal (n=361,874)	Obesity (n=65,336)	Sarcopenia (n=28,623)	SO (n=193,590)		Normal (n=361,874)	Obesity (n=65,336)	Sarcopenia (n=28,623)	SO (n=193,590)
		% or M±SD	% or M±SD	% or M±SD	% or M±SD		% or M±SD	% or M±SD	% or M±SD	% or M±SD
Age (year)	60~69	67.2	66.4	66.8	58.0	11.62 (.152)	53.4	69.6	46.0	52.9	1.06(.370)
	70~79	30.6	25.0	27.6	34.2		35.3	27.5	39.0	38.5
	≥80	2.2	8.6	5.6	7.8		11.3	2.9	15.0	8.6
		67.6±0.38	67.8±0.90	67.3±1.93	68.3±0.58	0.35 (.788)	69.4±0.64	67.9±0.71	69.9±2.76	69.4±0.54	13.26(.169)
Education	≤Elementary	47.8	44.3	34.3	33.2	16.52 (.250)	82.1	84.7	88.2	79.0	3.94 (.901)
	Middle school	15.8	18.2	29.0	25.6		8.9	6.4	8.1	11.0
	High school	25.7	21.5	31.8	24.8		6.9	7.0	3.7	8.8
	≥University	10.7	16.0	4.9	16.4		2.1	1.9	−	1.2
Income	Low	21.9	17.9	43.3	13.4	17.65 (.199)	27.8	34.3	8.2	27.3	14.32 (.298)
	Middle low	24.5	33.0	24.5	27.2		22.5	23.1	50.0	20.5
	Middle high	24.7	28.4	25.2	28.4		28.6	17.2	25.1	23.9
	High	28.9	20.7	7.0	31.0		21.1	25.4	16.7	28.3
Perceived health status		2.69±0.06	2.80±0.11	2.84±0.22	2.73±0.12	0.37 (.775)	3.11±0.08	3.1±0.10	3.25±0.28	3.07±0.09	0.16 (.925)
Alcohol frequency^†	None	35.7	42.4	33.8	25.6	9.73 (.374)	76.9	83.0	90.2	79.4	14.70 (.064)
	Sometimes	22.1	13.7	19.6	29.3		13.9	15.5	9.8	17.4
	Often	42.2	43.9	46.6	45.1		9.2	1.5	−	3.2
Depression	Yes	89.8	95.9	82.7	91.5	3.86 (.350)	78.7	76.1	93.1	86.5	8.62 (.075)
	No	10.2	4.1	17.3	8.5		21.3	23.9	6.9	13.5
Smoking	Non-smoking	15.3	20.6	25.0	12.3	16.57 (.098)	88.5	97.5	90.1	93.9	11.42 (.221)
	Past-smoking	52.6	61.9	43.4	68.1		6.1	2.1	9.9	3.4
	Current-smoking	32.1	17.5	31.6	19.6		5.4	0.4	−	2.7
Exercise: strength	No	69.9	74.9	60.5	67.6	10.76 (.234)	87.5	86.9	96.3	90.4	4.77 (.620)
Exercise: strength	1~2 times/week	8.3	6.3	2.0	14.5		3.7	1.5	−	3.3
	≥3 times/week	21.8	18.8	37.5	17.9		8.8	11.6	3.7	6.3
Exercise: walking	No	53.5	47.8	42.3	56.3	2.36 (.601)	59.4	58.8	26.1	63.3	6.59 (.241)
Exercise: walking	Yes	46.5	52.2	57.7	43.7		40.6	41.2	73.9	36.7

Note. Values are presented as M±SD or %. All data are weighted to the residential population of Korea.

SO=sarcopenic-obesity; ^†Alcohol frequency: none ≤1 time/month, sometimes 1~4 times/month, often 2~4 times/weeks.

Table 2.

Differences in Body Composition and Metabolic Component according to Sarcopenia & Obesity Status

Variables	Men (n=649,423)				x² or F(p)	Women (n=807,990)				x² or F(p))
	Normal (n=361,874)	Obesity (n=65,336)	Sarcopenia (n=28,623)	SO (n=193,590)		Normal (n=334,112)	Obesity (n=131,586)	Sarcopenia (n=14,236)	SO (n=328,056)
	M±SD	M±SD	M±SD	M±SD		M±SD	M±SD	M±SD	M±SD
Height (cm)	165.6	165.8	167.0	165.1	0.78	151.9	152.7	148.7	151.7	1.47
	±0.35	±0.90	±1.35	±0.52	(.509)	±0.44	±0.51	±2.16	±0.44	(.227)
Weight (kg)	61.0^a	69.3^b	63.3^a	69.2^b	24.69	50.8^a	58.2^b	50.4^a	60.2^b	59.62
	±0.57	±1.42	±1.98	±0.75	(＜.001)	±0.50	±0.76	±2.27	±0.61	(＜.001)
Waist	81.28^a	89.31^b	84.48^a	89.85^b	30.51	77.10^a	84.94^b	80.03^a	87.64^c	65.92
circumference (cm)	±0.59	±1.17	±1.60	±0.75	(＜.001)	±0.57	±0.78	±2.93	±0.55	(＜.001)
Body mass index	22.17^a	25.13^b	22.65^a	25.38^b	39.53	21.97^a	24.95^b	22.74^a	26.12^c	86.05
(BMI, kg/m²)	±0.18	±0.35	±0.53	±0.27	(＜.001)	±0.16	±0.30	±0.70	±0.24	(＜.001)
ASM (kg)	20.24^b	21.52^c	18.74^a	19.53^a	8.31	13.65^c	14.27^d	11.69^a	13.16^b	13.56
	±0.21	±0.44	±0.67	±0.20	(＜.001)	±0.15	±0.20	±0.55	±0.14	(＜.001)
Skeletal muscle	33.52^d	31.23^c	29.81^b	28.44^a	213.10	27.17^d	24.74^c	23.40^b	22.05^a	234.61
index (SMI%)	±0.14	±0.08	±0.23	±0.15	(＜.001)	±0.18	±0.08	±0.12	±0.12	(＜.001)
Total body fat	19.33^a	26.61^c	23.43^b	29.22^d	343.80	29.92^a	37.02^c	33.00^b	40.27^d	181.07
(%)	±0.24	±0.14	±0.25	±0.29	(＜.001)	±0.36	±0.12	±0.55	±0.26	(＜.001)
Systolic BP	126.22	128.85	136.11	129.80	1.53	129.88^a	132.59^ab	138.90^ab	134.11^b	2.87
(mmHg)	±1.50	±2.98	±6.18	±1.49	(.210)	±1.43	±2.72	±8.15	±1.02	(＜.05)
Diastolic BP	74.42^a	78.58^b	83.82^ab	76.21^ab	3.23	74.29	75.75	77.07	76.85	2.51
(mmHg)	±0.73	±1.40	±5.33	±1.11	(＜.05)	±0.77	±1.30	±3.50	±0.62	(.062)
FPG (mg/dL)	97.41	98.39	99.46	103.46	1.83	94.11^a	96.67^b	99.56^ab	97.86^b	3.04
	±1.31	±1.60	±2.50	±2.23	(.146)	±0.81	±1.09	±4.27	±1.21	(＜.05)
Total cholesterol	184.35	184.34	188.41	186.84	0.22	198.48^a	198.40^a	184.96^a	209.14^b	3.58
(mg/dL)	±2.40	±3.88	±6.39	±3.57	(.881)	±2.61	±3.78	±10.66	±2.66	(＜.05)
HDL-cholesterol	48.31^b	44.89^ab	48.18^ab	42.48^a	4.33	48.26^b	48.47^b	52.41^ab	45.77^a	2.93
(mg/dL)	±0.70	±1.87	±4.02	±1.35	(＜.01)	±0.65	±1.08	±5.78	±0.75	(＜.05)
Triglyceride	125.30^a	155.83^b	153.59^ab	157.24^b	4.04	126.59^a	133.71^a	120.10^a	157.41^b	3.58
(mg/dL)	±5.42	±11.14	±24.01	±8.48	(＜.01)	±6.04	±9.40	±15.36	±7.78	(＜.05)

Note. Values are presented as M±SD. All data are weighted to the residential population of Korea.

SO=sarcopenic-obesity; ASM (kg)=appendicular skeletal muscle mass; FPG=fasting plasma glucose; HDL=high-density lipoprotein; post-hocanalysis: a＜b＜c＜d.

Table 3.

Frequency of Metabolic Component and Metabolic Syndrome according to Sarcopenia & Obesity Status

Variables	Men (n=649,423)				x² (p)	Women (n=807,990)				x² (p)
	Normal (n=361,874)	Obesity (n=65,336)	Sarcopenia (n=28,623)	SO (n=193,590)		Normal (n=334,112)	Obesity (n=131,586)	Sarcopenia (n=14,236)	SO (n=328,056)
	%	%	%	%		%	%	%	%
Abdominal obesity	14.9	47.8	20.3	51.1	75.84 (＜.001)	14.6	47.1	32.5	61.8	123.88 (＜.001)
High blood pressure	51.7	73.0	62.6	68.7	17.04 (＜.01)	61.4	68.3	82.5	76.4	14.59 (＜.05)
Hypertriglyceridemia	28.3	46.8	48.1	46.8	19.29 (＜.01)	31.9	45.2	35.9	47.1	13.75 (＜.05)
Low HDL cholesterolemia	28.9	45.8	40.6	53.5	27.36 (＜.01)	64.5	61.6	47.4	66.5	2.24 (.679)
High fasting plasma glucose	31.8	36.9	46.0	44.0	7.39 (.188)	22.2	29.8	39.2	35.9	12.30 (.054)
Metabolic syndrome	24.2	45.1	39.9	52.5	38.26 (＜.001)	31.1	48.4	57.3	60.4	45.52 (＜.001)

Note. Values are presented as %. All data are weighted to the residential population of Korea. SO=sarcopenic-obesity; HDL=high-density lipoprotein.

Table 4.

Adjusted Odds Ratio Metabolic Syndrome according to Sarcopenia & Obesity Status

Variables	Men				Women
	Normal OR (95%CI)	Obesity OR (95%CI)	Sarcopenia OR (95%CI)	SO OR (95%CI)	Normal OR (95%CI)	Obesity OR (95%CI)	Sarcopenia OR (95%CI)	SO OR (95%CI)
	p	p	p	p	p	p	p	p
Unadjusted	1.00	2.57	2.07	3.46	1.00	2.08	2.98	3.38
		(1.22~5.38)	(0.61~6.98)	(2.11~5.65)		(1.12~3.88)	(0.62~14.34)	(2.19~5.21)
		＜.05	.238	＜.001		＜.05	.171	＜.001
Model 1^†	1.00	2.70	2.13	3.80	1.00	2.39	2.91	3.52
		(1.29~5.62)	(0.67~6.82)	(2.24~6.45)		(1.30~4.38)	(0.49~17.16)	(2.24~5.54)
		＜.01	.201	＜.001		＜.01	.236	＜.001
Model 2^‡	1.00	3.05	2.02	4.07	1.00	2.67	3.13	3.84
		(1.47~6.35)	(0.61~6.64)	(2.35~7.04)		(1.46~4.89)	(0.51~19.18)	(2.39~6.17)
		＜.01	.247	＜.001		＜.01	.216	＜.001
Model 3^§	1.00	3.14	1.50	6.57	1.00	2.54	3.40	3.89
		(1.76~4.14)	(0.60~2.35)	(5.19~7.27)		(1.38~4.65)	(0.60~19.46)	(2.41~6.29)
		＜.01	.302	＜.001		＜.01	.168	＜.001

SO=sarcopenic-obesity; OR (95% CI)=odds ratio (95% confidential interval).

^† Model 1: adjusted age;

^‡ Model 2: adjusted age, smoking, alcohol, exercise;

^§ Model 3: Model 2＋education, income.

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