title: Combined association of chronic disease and low skeletal muscle mass with physical performance in older adults in the Sarcopenia and Translational Aging Research in Taiwan (START) study.
abstract: BACKGROUND
  Multiple chronic conditions and low skeletal muscle mass are common features of aging that are detrimental to physical performance. This study evaluates the simultaneous impact of these conditions on physical performance in older adults.
  
  
  METHODS
  Five studies from 2003 to 2012 were pooled to include 2,398 adults aged ≥65 years with diagnosed chronic diseases measured by self-administered questionnaire. Low muscle mass was defined as an appendicular skeletal muscle mass index less than that of the sex-specific lowest quintile in the population of older adults. Poor physical performances were defined as the lowest quintile of grip strength and gait speed in the population of older adults and the slowest sex-specific 20% of Timed Up and Go (TUG) test at each study site. Chi-squared and logistic regression tests were applied for data analysis.
  
  
  RESULTS
  Mean age of the study participants, of whom approximately 50% were men, was 74.3 years. Slow gait speed was nearly three times more likely to occur in the presence of low muscle mass coupled with chronic disease than in the absence of both factors after adjustment for study site, age, sex, education, marital status, body mass index, tobacco and alcohol use, and comorbidities. The independent effect of low muscle mass was generally stronger than that of each disease. Participants with more than two chronic diseases and low muscle mass were significantly more likely to perform poorly than those with no risk factors (odds ratio [OR] = 2.51 in patients with low grip strength, OR = 3.89 in patients with low gait speed, and OR = 3.67 in patients with poor TUG test scores, all P < 0 .05) after adjustment.
  
  
  CONCLUSIONS
  The combined association of chronic disease and low skeletal mass with physical performance was stronger than the effect of either factor alone.
authors: Department of Medical Research, China Medical University Hospital, Taichung, Taiwan. a6446@mail.cmuh.org.tw.|School of Medicine, China Medical University, 91 Hsueh-Shih Road, Taichung, 40421, Taiwan. a6446@mail.cmuh.org.tw.
authors: Chia-Ing
authors: CI
authors: Li
authors: Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan. tcli@mail.cmu.edu.tw.
authors: Tsai-Chung
authors: TC
authors: Li
authors: School of Medicine, China Medical University, 91 Hsueh-Shih Road, Taichung, 40421, Taiwan. wylin@mail.cmu.edu.tw.|Department of Family Medicine, China Medical University Hospital, Taipei, Taiwan. wylin@mail.cmu.edu.tw.
authors: Wen-Yuan
authors: WY
authors: Lin
authors: School of Medicine, China Medical University, 91 Hsueh-Shih Road, Taichung, 40421, Taiwan. liucs@ms14.hinet.net.|Department of Family Medicine, China Medical University Hospital, Taipei, Taiwan. liucs@ms14.hinet.net.
authors: Chiu-Shong
authors: CS
authors: Liu
authors: Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan. cch@nhri.org.tw.|Department of Health Services Administration, China Medical University, Taichung, Taiwan. cch@nhri.org.tw.
authors: Chih-Cheng
authors: CC
authors: Hsu
authors: Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan. hsiung@nhri.org.tw.
authors: Chao A
authors: CA
authors: Hsiung
authors: Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan. cycchen@ntu.edu.tw.|Department of Family Medicine, National Taiwan University, Taipei, Taiwan. cycchen@ntu.edu.tw.
authors: Ching-Yu
authors: CY
authors: Chen
authors: Department of Family Medicine, National Taiwan University, Taipei, Taiwan. bretthuang@ntu.edu.tw.
authors: Kuo-Chin
authors: KC
authors: Huang
authors: Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan. paulo@mail.ncku.edu.tw.
authors: Chih-Hsing
authors: CH
authors: Wu
authors: School of Physical Therapy & Center for Education and Research on Geriatrics and Gerontology, Chung Shan Medical University, Taichung, Taiwan. cywang@csmu.edu.tw.
authors: Ching-Yi
authors: CY
authors: Wang
authors: School of Medicine, China Medical University, 91 Hsueh-Shih Road, Taichung, 40421, Taiwan. cclin@mail.cmuh.org.tw.|Department of Family Medicine, China Medical University Hospital, Taipei, Taiwan. cclin@mail.cmuh.org.tw.|Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan. cclin@mail.cmuh.org.tw.
authors: Cheng-Chieh
authors: CC
authors: Lin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D015992:Body Mass Index; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D005684:Gait / Q000502:physiology; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000503:physiopathology; D016017:Odds Ratio; D012307:Risk Factors; D055948:Sarcopenia / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D011795:Surveys and Questionnaires; D013624:Taiwan; D057170:Translational Research, Biomedical