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Implications of evaluating leg muscle mass and fat mass separately for quadriceps strength in knee osteoarthritis: the SPSS-OK study

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Abstract

Objective

To examine the influence of obesity on quadriceps strength by separately analyzing body mass index (BMI) as fat mass and leg muscle mass in patients with knee osteoarthritis (KOA).

Methods

The Screening for People Suffering Sarcopenia in Orthopedic cohort of Kobe (SPSS-OK) study was a single-center cross-sectional study that recruited 906 patients with KOA. Fat mass and leg muscle mass were measured by bio-impedance. Isometric knee extension torque (Nm) was measured as quadriceps strength. A series of general linear models were fitted to estimate the continuous associations of BMI and fat mass with quadriceps strength, with adjustment of confounders. In the fitted models, both BMI and fat mass were treated as restricted cubic spline functions.

Results

A continuous, non-linear relationship between BMI and quadriceps strength was found (P = 0.008 for non-linearity). In patients with a BMI of 16–25 kg/m2, increasing quadriceps strength was observed. However, in patients with a BMI of 25–40 kg/m2, quadriceps strength seemed similar. Additionally, an inverted U-shaped relationship between fat mass and quadriceps strength was demonstrated (P = 0.04 for non-linearity). In those with a fat mass of 10–20 kg, increasing quadriceps strength was seen. However, in patients with a fat mass of 20–30 kg, quadriceps strength showed a decreasing trend. Independent of fat mass, leg muscle mass was linearly associated with greater quadriceps strength.

Conclusion

Our study suggests that there are independent associations between the leg muscle mass, fat mass, and quadriceps strength. It is difficult to easily predict quadriceps strength using only BMI.

Key Points

• An increase in body mass index (BMI) up to 25 kg/m 2 was associated with increasing quadriceps strength.

• Quadriceps strength remained almost unchanged among patients with a BMI of > 25 kg/m 2 .

• The association between fat mass and quadriceps strength had an inverted U-shaped relationship, suggesting the importance of the separate assessment of fat mass and muscle mass in patients with knee osteoarthritis, especially those who are overweight or obese.

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References

  1. Chun SW, Kim KE, Jang SN, Kim KI, Paik NJ, Kim KW, Jang HC, Lim JY (2013) Muscle strength is the main associated factor of physical performance in older adults with knee osteoarthritis regardless of radiographic severity. Arch Gerontol Geriatr 56:377–382. https://doi.org/10.1016/j.archger.2012

    Article  PubMed  Google Scholar 

  2. Wada O, Kurita N, Kamitani T, Nakano N, Mizuno K (2019) Influence of the severity of knee osteoarthritis on the association between leg muscle mass and quadriceps strength: the SPSS-OK study. Clin Rheumatol 38:719–725. https://doi.org/10.1007/s10067-018-4337-2

    Article  PubMed  Google Scholar 

  3. Radin EL, Paul IL, Rose RM (1972) Role of mechanical factors in pathogenesis of primary osteoarthritis. Lancet 1:519–522. https://doi.org/10.1016/s0140-6736(72)90179-1

    Article  CAS  PubMed  Google Scholar 

  4. Francisco V, Perez T, Pino J et al (2018) Biomechanics, obesity, and osteoarthritis The role of adipokines: when the levee breaks. J Orthop Res 36:594–604. https://doi.org/10.1002/jor.23788

    Article  CAS  PubMed  Google Scholar 

  5. Messier SP, Mihalko SL, Legault C, Miller GD, Nicklas BJ, DeVita P, Beavers DP, Hunter DJ, Lyles MF, Eckstein F, Williamson JD, Carr JJ, Guermazi A, Loeser RF (2013) Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial. JAMA 310:1263–1273. https://doi.org/10.1001/jama.2013.277669

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Messier SP, Resnik AE, Beavers DP, Mihalko SL, Miller GD, Nicklas BJ, deVita P, Hunter DJ, Lyles MF, Eckstein F, Guermazi A, Loeser RF (2018) Intentional weight loss in overweight and obese patients with knee osteoarthritis: is more better? Arthritis Care Res 70:1569–1575. https://doi.org/10.1002/acr.23608

    Article  Google Scholar 

  7. De Stefano F, Zambon S, Giacometti L et al (2015) Obesity, muscular strength, muscle composition and physical performance in an elderly population. J Nutr Health Aging 19:785–791. https://doi.org/10.1007/s12603-015-0482-3

    Article  PubMed  Google Scholar 

  8. Nuttall FQ (2015) Body mass index: obesity, BMI, and health: a critical review. Nutr Today 50:117–128. https://doi.org/10.1097/NT.0000000000000092

    Article  PubMed  PubMed Central  Google Scholar 

  9. Garn SM, Leonard WR, Hawthorne VM (1986) Three limitations of the body mass index. Am J Clin Nutr 44:996–997. https://doi.org/10.1093/ajcn/44.6.996

    Article  CAS  PubMed  Google Scholar 

  10. Prentice AM, Jebb SA (2001) Beyond body mass index. Obes Rev 2:141–147. https://doi.org/10.1046/j.1467-789x.2001.00031.x

    Article  CAS  PubMed  Google Scholar 

  11. Katoh M, Yamasaki H (2009) Comparison of reliability of isometric leg muscle strength measurements made using a hand-held dynamometer with and without a restraining belt. J Phys Ther Sci 21:37–42. https://doi.org/10.1589/jpts.21.37

    Article  Google Scholar 

  12. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502. https://doi.org/10.1136/ard.16.4.494

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Matsuo S, Imai E, Horio M et al (2009) Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis 53:982–992. https://doi.org/10.1053/j.ajkd.2008.12.034

    Article  CAS  PubMed  Google Scholar 

  14. Sutton AJ, Muir KR, Jones AC (1997) Two knees or one person: data analysis strategies for paired joints or organs. Ann Rheum Dis 56:401–402. https://doi.org/10.1136/ard.56.7.401

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Cameron AC, Miller DL (2015) A practitioner’s guide to cluster-robust inference. J Hum Resour 50:317–372. https://doi.org/10.3368/jhr.50.2.317

    Article  Google Scholar 

  16. Bennette C, Vickers A (2012) Against quantiles: categorization of continuous variables in epidemiologic research, and its discontents. BMC Med Res Methodol 12:21. https://doi.org/10.1186/1471-2288-12-21

    Article  PubMed  PubMed Central  Google Scholar 

  17. Frontera WR, Hughes VA, Lutz KJ, Evans WJ (1991) A cross-sectional study of muscle strength and mass in 45- to 78-yr-old men and women. J Appl Physiol (1985) 71:644–650. https://doi.org/10.1152/jappl.1991.71.2.644

    Article  CAS  Google Scholar 

  18. Wang X, You T, Yang R, Lyles MF, Demons J, Gong DW, Nicklas BJ (2010) Muscle strength is associated with adipose tissue gene expression of inflammatory adipokines in postmenopausal women. Age Ageing 39:656–659. https://doi.org/10.1093/ageing/afq024

    Article  PubMed  PubMed Central  Google Scholar 

  19. Yoshida Y, Marcus RL, Lastayo PC (2012) Intramuscular adipose tissue and central activation in older adults. Muscle Nerve 46:813–816. https://doi.org/10.1002/mus.23506

    Article  PubMed  Google Scholar 

  20. Myers A, Gibbons C, Finlayson G, Blundell J (2017) Associations among sedentary and active behaviours, body fat and appetite dysregulation: investigating the myth of physical inactivity and obesity. Br J Sports Med 51:1540–1544. https://doi.org/10.1136/bjsports-2015-095640

    Article  PubMed  Google Scholar 

  21. Pietrosimone B, Thomas AC, Saliba SA, Ingersoll CD (2014) Association between quadriceps strength and self-reported physical activity in people with knee osteoarthritis. Int J Sports Phys Ther 9:320–328

    PubMed  PubMed Central  Google Scholar 

  22. Sergi G, Coin A, Bussolotto M et al (2002) Influence of fat-free mass and functional status on resting energy expenditure in underweight elders. J Gerontol A Biol Sci Med Sci 57:M302–M307. https://doi.org/10.1093/gerona/57.5.m302

    Article  PubMed  Google Scholar 

  23. McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM, Hawker GA, Henrotin Y, Hunter DJ, Kawaguchi H, Kwoh K, Lohmander S, Rannou F, Roos EM, Underwood M (2014) OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthr Cartil 22:363–388. https://doi.org/10.1016/j.joca.2014.01.003

    Article  CAS  Google Scholar 

  24. Cruz-Jentoft AJ, Bahat G et al (2019) Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 48:16–31. https://doi.org/10.1093/ageing/afy169

    Article  PubMed  Google Scholar 

  25. Chen LK, Liu LK, Woo J, Assantachai P, Auyeung TW, Bahyah KS, Chou MY, Chen LY, Hsu PS, Krairit O, Lee JS, Lee WJ, Lee Y, Liang CK, Limpawattana P, Lin CS, Peng LN, Satake S, Suzuki T, Won CW, Wu CH, Wu SN, Zhang T, Zeng P, Akishita M, Arai H (2014) Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc 15:95–101. https://doi.org/10.1016/j.jamda.2013.11.025

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors greatly thank the following research assistant and medical staff members for their assistance in collecting the clinical information used in this study: Takehiro Kaga, Tomohiro Oka, Yoriko Tamura, Hiroshi Nishi, Yuichi Isaji, Yutaka Sato, Tomohiro Takagi, Kaho Shibata, Maho Wakai, Chisato Shindoh, Kenta Hirose, Takuma Ota, Tatsuya Arita, Yuuki Ikawa, Tsuyoshi Fukui, Riuji Nakagawa, Taisuke Hayashida, Shuto Fujii, Keisuke Yoneya, Kazuaki Mori (Anshin Hospital, Kobe-city, Hyogo), Lisa Shimokawa (Fukushima Medical University Hospital, Fukushima-city, Fukushima).

Funding

This study was supported by JSPS KAKENHI (Grant Number: JP15K16518). The JSPS had no role in this study except for funding.

Author information

Authors and Affiliations

  1. Anshin Hospital, Kobe, Japan

    Osamu Wada & Kiyonori Mizuno

  2. Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan

    Noriaki Kurita

  3. Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima City, Japan

    Noriaki Kurita

  4. Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima City, Japan

    Noriaki Kurita

  5. Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Tsukasa Kamitani

Authors
  1. Osamu Wada
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  2. Noriaki Kurita
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  3. Tsukasa Kamitani
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  4. Kiyonori Mizuno
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Corresponding author

Correspondence to Noriaki Kurita.

Ethics declarations

The study was approved by the local institutional review board (No. 57, January 26, 2017) and by the Research Ethics Committee of Fukushima Medical University School of Medicine (No. 2850, September 28, 2016). All patients provided written informed consent prior to participation.

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Wada, O., Kurita, N., Kamitani, T. et al. Implications of evaluating leg muscle mass and fat mass separately for quadriceps strength in knee osteoarthritis: the SPSS-OK study. Clin Rheumatol 39, 1655–1661 (2020). https://doi.org/10.1007/s10067-019-04879-6

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