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PurposeHand grip strength (HGS) can predict physical function in next year when it is positively associated with nutritional and health status. This study aimed to determine the relationship between the healthy eating index (HEI)-2015 and hand grip strength.Methods This cross-sectional study was conducted on data from 4010 participants in the Ravansar non-communicable disease (RaNCD) cohort study. HGS was measured using a hand-held hydraulic hand grip dynamometer. HEI-2015 was calculated using data from the food frequency questionnaire.ResultsThe mean of total HEI-2015 score was significantly higher in participants with an optimal HGS than in participants with a weak HGS (P = 0.006). Higher adherence to healthy eating was associated with optimal muscle strength (OR 1.26; CI 95% 1.02–1.62). This association was remained after being adjusted for potential confounders (P = 0.01). Among the HEI-2015 components, we only found association between whole fruit, added sugar, and HGS (P = 0.01, 0.019).Conclusions Our findings indicated that adherence to HEI-2015 could promote muscle strength. Among the HEI-2015 components, higher intake of whole fruit and lower adherence to added sugar had significantly positive effects on HGS.Level of evidenceLevel V, descriptive cross-sectional study.
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Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity
https://doi.org/10.1007/s40519-020-00863-1
ORIGINAL ARTICLE
Better muscle strength withhealthy eating
YahyaPasdar1· ShimaMoradi1 · MehdiMoradinazar2· BehroozHamzeh3· FaridNaja4
Received: 12 November 2019 / Accepted: 28 January 2020
© Springer Nature Switzerland AG 2020
Abstract
Purpose Hand grip strength (HGS) can predict physical function in next year when it is positively associated with nutritional
and health status. This study aimed to determine the relationship between the healthy eating index (HEI)-2015 and hand
grip strength.
Methods This cross-sectional study was conducted on data from 4010 participants in the Ravansar non-communicable
disease (RaNCD) cohort study. HGS was measured using a hand-held hydraulic hand grip dynamometer. HEI-2015 was
calculated using data from the food frequency questionnaire.
Results The mean of total HEI-2015 score was significantly higher in participants with an optimal HGS than in participants
with a weak HGS (P = 0.006). Higher adherence to healthy eating was associated with optimal muscle strength (OR 1.26;
CI 95% 1.02–1.62). This association was remained after being adjusted for potential confounders (P = 0.01). Among the
HEI-2015 components, we only found association between whole fruit, added sugar, and HGS (P = 0.01, 0.019).
Conclusions Our findings indicated that adherence to HEI-2015 could promote muscle strength. Among the HEI-2015
components, higher intake of whole fruit and lower adherence to added sugar had significantly positive effects on HGS.
Level of evidence Level V, descriptive cross-sectional study.
Keywords Healthy eating index· Muscle strength· Non-communicable disease
Introduction
Hand grip strength (HGS) is defined as the total flexor mus-
cles strength versus palmar muscles as well as extensor mus-
cles, playing a secondary role in this contraction [1]. Evi-
dence suggests that increased muscle strength is associated
with improving health and reducing non-communicable dis-
eases (NCDs) such as cardiovascular disease, diabetes, and
overall mortality [2, 3]. In addition, poor muscle strength
can increase the risk of fall, fractures, and disability in the
years to come [4]. HGS is a simple, reliable, and noninva-
sive tool applied in many epidemiological studies to meas-
ure muscle strength [5, 6] and can predict overall muscle
strength [1]. Inappropriate lifestyle such as sedentary behav-
iors and adherence to unhealthy dietary can accelerate the
process of low muscle mass and strength [6, 7].
Healthy eating index (HEI) is developed to assess diet
quality based on the Dietary Guidelines for Americans
(DGA) that is updated every 5years [8]. HEI-2015 empha-
sizes adequacy and moderation. Components of adequacy
part include total fruits, whole fruits, total vegetables, greens
and beans, whole grains, dairy, total protein foods, seafood
* Shima Moradi
Shima.Moradi@kums.ac.ir
Yahya Pasdar
Yahya.pasdar@kums.ac.ir
Mehdi Moradinazar
M.moradinazar@kums.ac.ir
Behrooz Hamzeh
behrooz.hamzeh@kums.ac.ir
Farid Najafi
farid_n32@yahoo.com
1 Department ofNutritional Sciences, Research Center
forEnvironmental Determinants ofHealth (RCEDH), Health
Institute, Kermanshah University ofMedical Sciences,
Kermanshah, Iran
2 Behavioral Disease Research Center, Kermanshah University
ofMedical Sciences, Kermanshah, Iran
3 Environmental Determinates ofHealth Research Center,
School ofPublic Health, Kermanshah University ofMedical
Sciences, Kermanshah, Iran
4 Communing Developmental andHealth Promotion Research
Center, School ofPublic Health, Kermanshah University
ofMedical Sciences, Kermanshah, Iran
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity
1 3
and plant proteins, and fatty acids, and the other part empha-
sizes the limitation of the consumption of refined grains,
sodium, added sugars, and saturated fats [9]. Adherence to
a Mediterranean diet as a healthy diet can strengthen muscle
strength [6, 10]. This dietary pattern is associated with high
intake of whole grains, fruits, vegetables, nuts, legumes,
olive oil, low-fat dairy, moderate consumption of poultry
and fish, and low consumption of red meat, processed meat,
and sweets [6]. Additionally, a Nordic diet with low intake
of added sugar, dietary fat, and high fiber intake and sea
foods has protective effects on muscle strength and mobil-
ity [4, 10]. To the best of our knowledge, there is no any
study on HEI-2015 and muscle strength. Since recognition
and screening of the muscle status and nutritional quality of
the community are important to prevent NCDs, this study
aimed to assess HEI-2015 and muscle strength in the Ravan-
sar non-communicable diseases (RaNCDs) cohort study.
Methods
Study design andpopulation
This cross-sectional study was conducted using the base-
line data from the RaNCD cohort study. Since 2014, this
study is the first Kurdish population-based study on 10,059
Kurdish participants aged 35–65years living in Ravansar
city, Kermanshah province, Western Iran. The RaNCD is
one of 18 studies developed by the PERSIAN (Prospective
Epidemiological Research Studies in Iran) mega-cohort
study that was approved by the Ethics Committees in the
Ministry of Health and Medical Education, the Digestive
Diseases Research Institute, Tehran University of Medical
Sciences, Iran. The protocol of the RaNCD cohort study
was described in previous studies [11, 12]. The cohort
study was given ethical approval by the Ethics Commit-
tee of Kermanshah University of Medical Sciences (ethics
approval number: KUMS.REC.1394.318).
In the current study, we included the participants with
an available dynamometry status at the baseline. Owing
to loss of muscle mass in CVDs [13], cancer [14], and
thyroid disorders [15, 16], we did not include participants
with these disease as well as participants with pregnancy.
Furthermore, the participants consuming energy intake
less than 800kcal/day and more than 4200kcal/day were
considered under and over energy intake reporter, respec-
tively; therefore, they were not included in this study.
Fourteen participants, who did not have complete infor-
mation to calculate the HEI, were excluded from the study
(Fig.1).
Fig. 1 Flowchart of the study
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity
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Data collection
We included the demographic data, anthropometric indices,
nutritional assessments, and HGS measurement collected
by well-trained interviewers in the study site in Ravansar.
Anthropometric indices
In the RaNCD cohort study, height was measured by the
automatic stadiometer BSM 370 (Biospace Co., Seoul,
Korea) in a standing position without shoes and with the
precision of 0.1cm. Weight was measured using the InBody
770 device (InBody Co, Seoul, Korea) with at least cloth-
ing and without shoes. Body mass index (BMI) was calcu-
lated by dividing the weight (kg) by the square of the height
(meter).
Hand grip strength
HGS was determined using a hand-held hydraulic hand grip
dynamometer (model SH5003; Saehan Corporation, Masan,
Korea). Calibration of this dynamometer was carried out
according to the manufacturers’ manual. The measurement
was taken with the dominant hand when the participant was
sitting and the elbow was at 90º of flexion. The participant
was asked to squeeze the handle with maximal effort for
10s. The measurement was repeated after 30s, and the lat-
ter was recorded as hand grip strength. Based on the guide-
lines of this device, we considered optimal and weak muscle
strength for each age group and gender [17].
Dietary assessment andHealthy eating index 2015
A total of the 130-item food frequency questionnaire was
completed to assess dietary intake in the previous year that
consisted of ten parts as follows: bread and grains, beans,
meat and its products, dairies, vegetables, fruits, oils, oil-
seeds and butter, added sugar, and spices. The validity and
reliability of this questionnaire were assessed in previous
studies [18]. We obtained the dietary information of this
questionnaire and then calculated HEI-2015, based on the
last revised HEI available in the Department of Agriculture,
Center for Nutrition Policy and Promotion [19]. This index
has two sections: adequacy and moderation. The adequacy
was related to the adequate intake of total fruits, whole
fruits, total vegetables, greens and beans, whole grains,
dairies, total protein foods, seafood and plant proteins, and
fatty acids. Moderation intake of refined grains, sodium,
added sugars, and saturated fats was evaluated using this
index (Table1).
Statistical analysis
Statistical analyses were conducted using Stata, version 14
(Stata Corp, College Station, TX). All quantitative variables
were presented as mean ± standard deviation. Qualitative vari-
ables were reported using frequency (%). Comparison of base-
line characteristics was assessed according to the HEI-2015
quartiles using ANOVA and Chi-square tests. In addition,
comparison of components of HEI-2015 between participants
with weak and optimal muscle strength was made using the
ANOVA test. Radar graphs were constructed using the Excel
software (Microsoft Office 2010) to show difference in the
obtained score of HEI-2015 components between participants
with weak and optimal muscle strength. Binary logistic regres-
sion was used in crude and adjusted models. In adjusted Model
1, we controlled the variables of age, gender, smoking, and
alcohol use. Furthermore, in adjusted Model 2, in addition
to the variables of Model 1, we controlled the variables of
physical activity and diabetes. First, the quartile of HEI-2015
was considered the reference category in all binary logistic
regression analyses. P-values were considered significant at
the level of < 0.05.
Results
In the current study, the mean of total HEI-2015 score was
significantly higher in participants with an optimal HGS
than in participants with a weak HGS (P = 0.006) (Table1).
In addition, the mean of HGS was significantly increased
with the increase in the HEI-2015 score (P < 0.001). Table2
presents the baseline characteristics according to HEI-2015
quintiles.
Our findings indicated that higher adherence to healthy
eating was associated with optimal muscle strength (OR
1.26; CI 95% 1.02–1.62). This association was remained
after being adjusted for potential confounders (P = 0.01)
(Table3).
Although totally all HEI-2015 components were higher
than in participants with an optimal HGS than in participants
with a weak HGS, this difference was only significant for
whole fruit and added sugar components.
In this study, we found that higher intake of whole
fruits was associated with an optimal HGS (OR 1.01; CI
95% 1.02–1.18). In addition, participants who consumed
less added sugar had an optimal HGS (OR 1.06; CI 95%
1.01–1.12) (Table4).
Discussion
This study highlights that higher adherence to healthy eat-
ing is associated with an optimal HGS. Epidemiological
studies have indicated that proper nutrition can prevent the
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity
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progression of frailty during aging, which is characterized
by a low HGS [6, 7]. Since low muscle strength is associated
with decreased physical function [20], increased fractures
[21], worsening cardiometabolic status [3], and all-cause
mortality [22], identification of dietary components is an
effective strategy to prevent low muscle strength. To the best
of our knowledge, this study is the first study evaluating
HEI-2015 and its components using HGS.
Stress oxidative and inflammation contribute to develop-
ment of low muscle strength and its subsequence frailty [23,
24]. The HEI-2015 confirms an adequate intake of fruits,
vegetables, whole grain, seafood, plant protein, dairy, and
essential fatty acid. In addition, consumption of refined
grain, added sugar, sodium, and saturated fatty acid should
be moderate [8]. Fruits and vegetables are high in antioxi-
dants and play a key role in systemic inflammation [25].
Furthermore, omega-3 fatty acid had beneficial effects on
decreasing inflammation [26]. Dairy products, sea food,
and plant protein spatially soy protein can promote muscle
strength and muscle mass [2729]. Moreover, dairy products
are rich in high biological value protein and important min-
erals, including calcium and phosphorus [30]. In addition to
high biological value protein, seafood can provide omega-3
fatty acid, contributing to reduction in inflammation [31,
32].
Among the HEI-2015 components, higher adherence to
whole fruits intake was related to better muscle strength. In
the components, all fruits were considered without fruits
Table 1 Healthy eating index—2015
Intakes between the minimum and maximum standards are scored proportionately
*P value was obtained independent samples T test
a 100% fruit juice
b All forms except juice
c Legumes (beans and peas)
d All milk products, such as fluid milk, yogurt, and cheese, and fortified soy beverages
e Seafood, nuts, seeds, soy products (other than beverages), and legumes (beans and peas)
d Ratio of poly- and monounsaturated fatty acids (PUFAs and MUFAs) to saturated fatty acids (SFAs)
Component Standard for maximum
score
Standard for minimum
score of zero
Maxi-
mum
points
Weak muscle strength Optimum
muscle
strength
P value*
Adequacy
Total fruitsa0.8 cup equivalent per
1000kcal
No fruit 5 2.59 ± 1.25 2.69 ± 1.26 0.881
Whole fruitsb≥ 0.4 cup equivalent per
1000kcal
No whole fruit 5 3.78 ± 1.3 3.93 ± 1.24 0.004
Total vegetablesc1.1 cup equivalent per
1000kcal
No vegetables 5 3.43 ± 1.1 3.46 ± 1.1 0.837
Greens and beansc0.2 cup equivalent per
1000kcal
No dark green vegetables
or legumes
53.19 ± 1.25 3.23 ± 1.27 0.432
Whole grains 1.5 cup equivalent per
1000kcal
No whole grains 10 1.37 ± 0.97 1.35 ± 0.92 0.476
Dairyd1.3 cup equivalent per
1000kcal
No dairy 10 4.95 ± 2.81 4.99 ± 2.74 0.291
Total protein foodsc2.5 cup equivalent per
1000kcal
No protein foods 5 3.02 ± 1.09 3.1 ± 1.08 0.736
Seafood and plant
proteinsc,e
0.8 cup equivalent per
1000kcal
No seafood or plant
Proteins
54.13 ± 0.67 4.17 ± 0.69 0.136
Fatty acidsf(PUFAs + MUFAs)/
SFAs ≥ 2.5
(PUFAs + MUFAs)/
SFAs ≤ 1.2
10 4.69 ± 3.04 4.85 ± 3 0.512
Moderation
Refined grains 1.8oz equivalent per
1000kcal
4.3oz equivalent per
1000kcal
10 0.09 ± 0.6 0.07 ± 0.62 0.199
Sodium 1.1 grams per 1000kcal ≥ 2.0 grams per 1000kcal 10 2.11 ± 2.59 2.15 ± 2.62 0. 809
Added sugars 6.5% of energy 26% of energy 10 8.72 ± 1.97 8.92 ± 1.76 0.001
Saturated fats 8% of energy 16% of energy 10 7.47 ± 2.54 7.54 ± 2.54 0.784
Total score 100 49.54 ± 6.97 52.46 ± 6.89 0.006
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity
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juice. In one study by Barrea etal. [6], fruits consumption
more than three times per day in women was associated with
a better HGS. The higher intake of fruits as a component
of the Mediterranean diet had positive effects on muscle
strength and fat-free mass [3335]. Lima Ribeiro etal. [36]
indicated that intake of the fruits juice worsened muscle
strength. Fruits are rich in vitamins having anti-oxidative
and anti-inflammatory effects. They can also prevent muscle
atrophy owing to the effect of fruits on the gut microbiota in
animal models [33, 37].
In this study, the other component contributing to cal-
culation of HEI-2015 was added sugar in which its lower
Table 2 Demographic and baseline characteristics according to the healthy eating index-2015 quintiles
BMI body mass index
P value was obtained ANOVA and Chi-square tests
Determinants Total (n = 4010) HEI quintiles P value
Q1
(n = 1121)
Q2
(n = 903)
Q3
(n = 1011)
Q4
(n = 975)
Age (years), mean ± SD 47.77 ± 8.36 49.25 ± 8.38 48.33 ± 8.31 46.84 ± 8.25 46.55 ± 8.21 < 0.001
Weight (kg), mean ± SD 70.96 ± 13.6 67.96 ± 13.53 70.22 ± 13.13 72.35 ± 13.76 73.68 ± 13.25 < 0.001
BMI (kg/m2), mean ± SD 27 ± 4.68 26.13 ± 4.77 26.71 ± 4.50 27.41 ± 4.75 27.89 ± 4.48 < 0.001
Muscle strength (kg), mean ± SD 31.47 ± 11.16 30.23 ± 10.81 30.96 ± 10.84 32.24 ± 10.99 32.59 ± 11.86 < 0.001
Physical activity (MET hour/ day),
Mean ± SD
41.19 ± 7.47 42.32 ± 7.61 41.47 ± 7.29 40.68 ± 7.55 40.19 ± 7.25 < 0.001
Gender (%)
Male 44.5 43.9 46 44.7 43.8 0.763
Education year (%)
Illiterate 29.5 40.8 33.8 22.3 20.1 < 0.001
1–5years 38.6 38.4 39.3 41.6 35.0
6–12years 26.8 19.6 24.3 30.8 33.3
≥ 13years 5.1 1.2 2.7 5.3 11.6
Income status (%)
Very poor 24.7 36.4 27 22 12.7 < 0.001
Poor 22.5 24.4 25.2 20.5 19.8
Normal 20.9 22.1 20.8 22.3 18.9
Rich 18.4 12.2 18.2 20.5 22.8
Wealthy 13.5 5 8.8 14.9 25.7
Smoking (%)
No 80.2 73.8 78.2 83.3 86.4 < 0.001
Yes 19.8 26.2 21.8 16.7 13.6
Alcohol consumption (%)
No 94.2 94.5 94.4 94.3 93.7 0.904
Yes 5.8 5.5 5.6 5.7 6.3
Diabetic (%)
No 93.2 94.5 94.1 93 90.8 0.006
Yes 6.8 5.5 5.9 7 9.2
Table 3 Relationship between
HEI-2015 and muscle strength
Model 1 adjusted with age, gender, smoking, and use alcohol
Model 2 adjusted with variable in Model 1, physical activity, and diabetes
Muscle strength Quartiles of HEI—2015, OR (CI 95%) P-trend
Q1 Q2 Q3 Q4
Crude 1 0.96 (0.73–1.26) 1.39 (1.09–1.78) 1.26 (1.02–1.62) 0.009
Model 1 1 0.95 (0.73–1.25) 1.38 (1.07–1.76) 1.24 (1.01–1.6) 0.015
Model 2 1 0.96 (0.73–1.26) 1.36 (1.09–1.79) 1.26 (1.02–1.64) 0.01
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity
1 3
intake was associated with optimal muscle strength. In
animal models, no change in strength was shown after
drinking sugar-sweetened beverages [38]. Cameron etal.
[39] did not observe any association between dietary
carbohydrates and fat-free mass; however, high pro-
tein intake can predict high fat-free mass. Additionally,
Hashemi etal. did not find any association between adher-
ence Western diet and sarcopenia; in this case, Western
diet was introduced by high sugar, fat, desserts, and fast
food [40]. Since reduction in simple carbohydrates intake
is accompanied by an increase in the intake of complex
carbohydrates and proteins to provide energy, it seems
that this relationship was owing to an increase in intake
of complex carbohydrates, not necessarily a decrease in
added sugar intake.
This study had several limitations; HEI-2015 was
calculated based on FFQ. Although it is considered an
appropriate nutritional assessment tool in large epidemio-
logical studies, it can be affected by the recall bias. Fur-
thermore, this study design was cross sectional in which
a causal relationship maybe is inferred.
In conclusion, our findings indicated that adherence
to HEI-2015 could enhance muscle strength. Although
the score of all HEI-2015 components was higher in par-
ticipants with an optimal HGS than in participants with
a weak HGS, these associations were significant only
between two HEI-2015 components (including whole
fruits and added sugar) and HGS. Therefore, these results
reflect that higher adherence to HEI-2015, especially
adequate intake of whole fruits and moderation intake of
added sugar, is an appropriate strategy to improve muscle
strength.
What isalready known onthis subject?
Over 80% of the study participants had poor muscle
strength. Previous studies have shown that weak muscle
strength is associated with decreased mobility, increased
fractures, and increased risk of cardiometabolic diseases.
Identification and screening of nutritional factors affecting
muscle strength can play a crucial role in muscle strength
improvement.
What does this study add?
The study findings indicated that adherence to the HEI-2015
guidelines enhanced HGS, especially an adequate intake of
whole fruits and a moderation intake of added sugar.
Acknowledgments RaNCD is part of PERSIAN national cohort,
and we would like to thank Professor Reza Malekzadeh, Deputy of
Research and Technology at the Ministry of Health and Medical Educa-
tion of Iran and Director of the PERSIAN cohort, and also Dr. Hossein
Poustchi Executive Director of PERSIAN cohort for all their supports
during design and running of RaNCD.
Funding This study was supported by Ministry of Health and Medi-
cal Education of Iran and Kermanshah University of Medical Science
(Grant No: 92472).
Availability of data and materials Data will be available upon request
from the corresponding author.
Compliance with ethical standards
Conflict of interest The authors have no conflict of interest to disclose.
Ethical approval All procedures performed in studies involving human
participants were in accordance with the ethical standards of the insti-
tutional and/or national research committee and with the 1964 Helsinki
Declaration and its later amendments or comparable ethical standards.
This study was approved by the Ethics Committee of Kermanshah
University of Medical Sciences (ethics approval number: KUMS.
REC.1394.318).
Informed consent Written informed consent was obtained from each
studied subject after explaining the purpose of the study. The right of
subjects to withdraw from the study at any time and subjects informa-
tion is reserved and will not be published.
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... Both prospective studies included older adults [46,47]. The studies predominantly included participants who were of normal weight, with six studies [38,[40][41][42][43]47] having a greater proportion of overweight and obese participants. Table 1 presents the summary characteristics of the included studies. ...
... Sixof the studies were conducted in South Korea [19,[34][35][36][37][38], in which four articles [34][35][36]38] presented data obtained from the Korea National Health and Nutrition Examination Survey (KNHANES), a national surveillance system, while two articles [19,37] presented data obtained from the National Fitness Award. Three studies were conducted in Iran [39][40][41], followed by two studies in Brazil [42,43]. Chile [44], Hong Kong [45], Taiwan [46], and Israel [47] reported one study each. ...
... Chile [44], Hong Kong [45], Taiwan [46], and Israel [47] reported one study each. Most of the studies were published within the last 5 years (80%) [19,34,[36][37][38][39][40][41][42][43]46,47], cross-sectional in design (86.7%) [19,[34][35][36][37][38][39][40][41][42][43][44]47], and had a sample size larger than 2,000 respondents (40%) [34][35][36]38,39,44].While the majority of the studies (53.3%) were conducted among older adults [19,[35][36][37]41,[45][46][47], only two reported on respondents with specific health conditions [42,47]. Both prospective studies included older adults [46,47]. ...
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Sarcopenia refers to common age-related changes characterised by loss of muscle mass, strength, and physical performance that results in physical disability, poorer health status, and higher mortality in older adults. Diet quality is indicated as a potentially modifiable risk factor for sarcopenia. However, the association between diet quality and sarcopenia in developing economies appears to be conflicting. Hence, we conducted a systematic review of the literature from developing economies examining the relationship between diet quality and at least one of the three components of sarcopenia, including muscle mass, muscle strength, and physical performance, and the overall risk of sarcopenia. No restrictions on age and study design were employed. We identified 15 studies that met review inclusion criteria. There was heterogeneity among the studies in the diet quality metric used and sarcopenia-related outcomes evaluated. Longitudinal evidence and studies relating diet quality to a holistic definition of sarcopenia were lacking. Although limited and predominantly cross-sectional, the evidence consistently showed that diet quality defined by diversity and nutrient adequacy was positively associated with sarcopenia components, such as muscle mass, muscle strength, and physical performance
... Dietary patterns can be determined from the study populations (e.g., healthy diet vs. unhealthy diet) or be a predefined eating pattern (e.g., Mediterranean diet and healthy eating index) [26]. Predefined dietary patterns were previously examined in relation to weak muscle strength and sarcopenia and showed similar results [20,23,27]. The healthy Nordic diet, for instance, is based on healthy, common local Nordic foods, which include high consumption of fruits, vegetables, whole-grain products, fish, and rapeseed oil, and low consumption of red meat and alcohol [20]. ...
... and added sugar (OR = 1.06; 95%CI: 1.01-1.12) [23]. ...
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The Healthy Eating Index-2015 (HEI-2015) was designed to reflect adherence to the 2015–2020 Dietary Guidelines for Americans (DGA). The study aims to examine the association between HEI-2015 and grip strength in a nationally representative sample of the U.S. adult population. This cross-sectional study used data from the National Health and Nutrition Examination Surveys of 2011–2014. Low grip strength was defined as <35.5 kg for men and <20 kg for women. HEI-2015 was computed from two days of 24-h dietary recalls and comprised 13 components. Each component was scored on the density out of 1000 calories and summed to a total score divided into quartiles. Weighted logistic regressions examined the study aim while controlling for associated covariates. The sample included 9006 eligible participants, of those, 14.4% (aged 20+ years), and 24.8% (aged ≥50 years) had low grip strength. Mean (±SD) HEI-2015 total score was 54.2 ± 13.6 and in the lowest and highest quartiles 37.3 ± 5.1 and 72.0 ± 6.5, respectively. In the multivariable model, participants in the highest vs. lowest HEI-2015 quartile had 24% lower odds of having low grip strength (Odds Ratio (OR) = 0.76; 95% CI: 0.60–0.96). Specifically, participants who met the DGA for protein intakes, whole grains, greens and beans, vegetables, or whole fruits had 20–35% lower odds of having low grip strength than those who did not. Higher compliance to the DGA might reduce the risk for low grip strength as a proxy measure for sarcopenia among U.S. adults, particularly adequate intakes of proteins, whole grains, greens and beans, vegetables, and whole fruits.
... En la presente investigación, el consumo de ags se encontró por encima de los valores reportados en los adultos de Estados Unidos (11 % del amdr) [39,40], considerando que es uno de los países con mayores prevalencias de emc y ecv a nivel mundial. Lo anterior puede repercutir en los valores de fp, puesto que en otro estudio [41] se encontró asociación positiva con un patrón alimentario saludable y mayores niveles de fp, proponiendo que puede relacionarse con el aporte abundante de fitonutrientes y antioxidantes. Adicionalmente, se ha reportado que quienes consumen menos azúcar adicionado tienen una óptima fp [41]. ...
... Lo anterior puede repercutir en los valores de fp, puesto que en otro estudio [41] se encontró asociación positiva con un patrón alimentario saludable y mayores niveles de fp, proponiendo que puede relacionarse con el aporte abundante de fitonutrientes y antioxidantes. Adicionalmente, se ha reportado que quienes consumen menos azúcar adicionado tienen una óptima fp [41]. ...
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Objetivo: Determinar los niveles de actividad física, composición corporal, fuerza prensil, consumo de alimentos, y sus posibles asociaciones, en trabajadores de una institución de educación superior. Métodos: Estudio transversal en el que participaron 141 empleados administrativos y docentes (56 % mujeres y 44 % hombres), seleccionados mediante muestreo probabilístico estratificado. Se incluyó un modelo lineal generalizado, con regresión de Poisson para la asociación de las variables con la fuerza prensil de mano dominante. Resultados: El 51,6 % de los hombres y el 46,8 % de las mujeres presentaron sobrepeso u obesidad, según el índice de masa corporal; el 39,7 % de la población se encontró clasificada con riesgo de enfermedad cardiovascular por índice cintura / estatura; el 68,8 % cumplió con el requerimiento de actividad física; el 45,7 % clasificó con bajo nivel de fuerza prensil. De acuerdo con el modelo lineal generalizado, se encontró asociación significativa entre el bajo nivel de fuerza prensil con tener mayor masa adiposa y ser hombre. En consumo de alimentos, se observaron patrones inadecuados, con elevado consumo de ácidos grasos saturados, colesterol, azúcares añadidos y baja ingesta de fibra. Conclusión: Se identificaron factores de riesgo para el desarrollo de enfermedades no transmisibles, como alto comportamiento sedentario, exceso de masa corporal y bajo nivel de fuerza prensil; esta última se asoció de forma inversa con el porcentaje de masa adiposa. Se proponen planes de intervención para promover cambios en la conducta sedentaria, la actividad física y el consumo de alimentos.
... Another study was shown that higher adherence to sugary foods was decreased muscle strength (OR: 1.06 CI 95%: 1.01-1.12) [39]. Other studies also found that low-protein, high-sugar, high-fat diets were associated with more chronic LBP and higher CRP levels [9,[40][41][42]. ...
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Background Chronic low back pain (LBP) is the most common musculoskeletal pain that affects a person’s daily activities. This present study aimed at evaluating the relationship between major dietary pattern and Chronic LBP. Methods This cross-sectional analysis was examined 7686 Kurdish adults. The RaNCD cohort study physician diagnosed chronic LBP. Dietary patterns were derived using principal component analysis. The three identified dietary patterns derived were named: 1) the vegetarian diet included vegetables, whole grain, legumes, nuts, olive, vegetable oil, fruits, and fruit juice; 2) high protein diet related to higher adherence to red and white meat, legumes, nuts, and egg; and 3) energy-dense diet characterized with higher intake of salt, sweet, dessert, hydrogenated fat, soft drink, refined grain, tea, and coffee. Dietary pattern scores were divided into tertiles. Binary logistic regression in crude, adjusted odds ratios (OR) and 95% confidence intervals (CI) were used to determine this association. Results Twenty-two per cent of participants had chronic LBP. Higher adherence to high protein dietary pattern was inversely associated with chronic LBP in crude (OR: 0.79, 95% CI: 0.69–0.9) and adjusted model (for age, sex, smoking, drinking, diabetes, physical activity, body mass index, and waist circumference) (OR: 0.84, 95% CI: 0.72–0.97). In addition, after controlling for the mentioned potential confounders, participants in the highest category of energy dense diet were positively associated with chronic LBP compared with those in the lowest category (OR: 1.13, 95% CI: 1.01–1.32). Conclusions Higher adherence to the high protein diet was inversely related to chronic LBP prevalence. In addition, we found that following energy dense diet was positively associated with chronic LBP.
... Since 1995 the healthy eating index (HEI) has been a dietary index developed to evaluate the diet's quality in accordance with Dietary Guidelines for Americans (DGA). The HEI is updated every five years by the evidence-based recommendations of the United States Department of Agriculture (USDA) and Health and Human Services (HHS) [14,15]. The latest version of this index is the HEI 2015 index noting two essential features in nutrition guidelines, adequacy moderation for dietary intakes. ...
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Background Since hypertension (HTN) is responsible for more than half of all deaths from cardiovascular disease, it is vital to understand the nutritional factors that reduce its risk. Little information, however, is known about it in the Kurdish population. This study was aimed to evaluate the healthy eating index (HEI) 2015 and major dietary patterns concerning incident HTN. Methods This case-cohort study was designed using Ravansar non-communicable diseases (RaNCD) cohort study data (294 participants with incident HTN and 1295 participants as representative random sub-cohort). HEI 2015 and major dietary patterns were extracted using data from their dietary intake, and three major dietary patterns were identified, including plant-based, high protein, and unhealthy dietary patterns. To analyses the association between HEI 2015 and major dietary patterns with incident HTN Cox proportional hazards regression models were applied. Results There was a significant positive correlation between HEI 2015 and plant-based diet (r = 0.492). The participants in the highest quartile of HEI-2015 had a 39% and 30% lower risk of incident HTN, compared to participants in the first quartile in both crude and adjusted model (HR: 0.61; 95% CI: 0.46–0.82) and (HR: 0.70; 95% CI: 0.51–0.97), respectively. Furthermore, participants with the highest tertile of the plant-based dietary pattern were at lower risk of incident HTN in both crude and adjusted models (HR: 0.69; 95% CI: 0.54–0.9) and (HR: 0.70; 95% CI: 0.53–0.94), respectively. However, the other two identified dietary patterns showed no significant association with incident HTN. Conclusions We found evidence indicating higher adherence to HEI 2015 and plant- based diet had protective effects on incident HTN. The HEI 2015 emphasizes limited sodium intake and adequate intake of vegetables and fruits.
... Gatineau et al. found that feeding aging rats sucrose causes a reduction in muscle mass (35) . Similar to the present study, others also found that the simultaneous effect of aging and added sugar consumption may be a cause of low HGS (36) . ...
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Full-text available
Sarcopenia is associated with frailty and disability in older adults. Adherence to current dietary guidelines in addition to physical activity could prevent muscle wasting and weakness. The Healthy Eating Index-2015 (HEI) is a tool to assess diet quality. We aimed to investigate the association between HEI scores and probable sarcopenia (PS) among older adults in Tehran. 201 randomly selected older adults were included in this cross-sectional study between May and October 2019 in Tehran, Iran. A previously validated semi-quantitative food frequency questionnaire was used to estimate HEI scores and dietary intake. Handgrip strength (HGS) was measured to evaluate the PS. Statistical evaluation included descriptive analysis, logistic and linear regression. Those probably suffering from sarcopenia had significantly lower HEI scores ( P =0⋅02). After adjusting for confounders, HEI scores and HGS were still significantly associated (adjusted R ² =0⋅56, slope β =0⋅03, P =0⋅09). Older adults with a low PS had a higher ratio of monounsaturated and polyunsaturated to saturated fatty acids ( P= 0⋅06) and ingested less added sugars and saturated fats ( P =0⋅01 and P =0⋅02, respectively). Furthermore, consuming more total protein foods correlated positively with muscle strength ( P =0⋅01, R =0⋅18). To sum up, HEI scores were associated with PS, measured by HGS, indicating that adhering to the HEI might improve muscle strength in aging individuals.
... This reliable method can reflect overall muscle strength and nutritional status [13]. Optimal muscle strength is associated with a lower risk of noncommunicable diseases (NCDs), such as cardiovascular and diabetes, and overall mortality [11,14]. According to the high prevalence of musculoskeletal pain, we hypothesize that the recognition of the association between muscle strength and the risk of low back pain and arthralgia could provide suggestions for modifying and improving lifestyle to reduce these pains. ...
Article
Full-text available
Background Musculoskeletal disorders can reduce the quality of life and work capacity. The study assessed handgrip strength (HGS) in relation to low back pain and arthralgia in Kurdish men. Methods This cross-sectional study was conducted using data from Ravansar non-communicable diseases (RaNCD) cohort study on 2164 men aged 35–65 years. HGS was measured using a hand-held hydraulic handgrip dynamometer. Low back pain, arthralgia, and joint stiffness were evaluated by the RaNCD cohort study physician using a standard questionnaire. Results The results showed that 21.39 and 24.58% of studied participants had low back pain and arthralgia, respectively. Among the participants with low back pain, 14.5% had back stiffness, and among those with arthralgia, 12.8% had joint stiffness. The mean of HGS in participants with arthralgia and back & joint stiffness was significantly less than those without these disorders ( P < 0.001, P = 0.05, and P = 0.005, respectively). Multiple-adjusted OR and 95% confidence intervals (CI) for arthralgia and back and joint stiffness across muscle strength showed the HGS increase to be associated with a lower risk of arthralgia and back &joint stiffness, but not low back pain. Conclusions Higher HGS was associated with a lower risk of arthralgia and back & joint stiffness. However, there was no association between HGS and low back pain. Exercise and adherence to proper nutrition are suggested to enhance muscle strength in order to reduce musculoskeletal pain.
... Handgrip strength (HGS) is a convenient and practical method in clinical and epidemiological studies to re ect musculoskeletal function, and its physical and nutritional status [11,12]. This reliable method can re ect overall muscle strength and nutritional status [13].Optimal muscle strength is associated with a lower risk of noncommunicable diseases (NCDs), such as cardiovascular and diabetes, and overall mortality [11,14]. According to the high prevalence of musculoskeletal pain, we hypothesize that the recognition of the association between muscle strength and the risk of low back pain and arthralgia could provide suggestions for modifying and improving lifestyle to reduce these pains. ...
Preprint
Full-text available
Background: Musculoskeletal disorders can reduce the quality of life and work capacity. The study assessed handgrip strength (HGS) in relation to low back pain and arthralgia in Kurdish men. Methods: This cross-sectional study was conducted using data from Ravansar non-communicable diseases (RaNCD) cohort study on 2164 men aged 35-65 years. HGS was measured using a hand-held hydraulic handgrip dynamometer. Low back pain, arthralgia, and joint stiffness were evaluated by the RaNCD cohort study physician using a standard questionnaire. Results: The results showed that 21.39% and 24.58% of studied participants had low back pain and arthralgia, respectively. Among the participants with low back pain, 14.5% had back stiffness, and among those with arthralgia, 12.8% had joint stiffness. The mean of HGS in participants with arthralgia and back & joint stiffness was significantly less than those without these disorders (P<0.001, P=0.05, and P= 0.005, respectively). Multiple-adjusted OR and 95% confidence intervals (CI) for arthralgia and back and joint stiffness across muscle strength showed the HGS increase to be associated with a lower risk of arthralgia and back &joint stiffness, but not low back pain. Conclusions: Higher HGS was associated with a lower risk of arthralgia and back & joint stiffness. However, there was no association between HGS and low back pain. Exercise and adherence to proper nutrition are suggested to enhance muscle strength in order to reduce musculoskeletal pain.
... Handgrip strength (HGS) is a convenient and practical method in clinical and epidemiological studies to re ect musculoskeletal function, and its physical and nutritional status [11,12]. Optimal muscle strength is associated with a lower risk of non-communicable diseases (NCDs), such as cardiovascular and diabetes, and overall mortality [11,13]. According to the high prevalence of musculoskeletal pain, we hypothesize that the recognition of the association between muscle strength and the risk of low back pain and arthralgia could provide suggestions for modifying and improving lifestyle to reduce these pains. ...
Preprint
Full-text available
Background Musculoskeletal disorders can reduce the quality of life and work capacity. In this study, we found that better muscle strength could prevent musculoskeletal pain, including arthralgia and back & joint stiffness. The study assessed handgrip strength (HGS) in relation to low back pain and arthralgia in Kurdish men. Methods This cross-sectional study was conducted using data from Ravansar non-communicable diseases (RaNCD) cohort study on 2164 men aged 35-65 years. HGS was measured using a hand-held hydraulic hand grip dynamometer. Low back pain, arthralgia, and joint stiffness were evaluated by the RaNCD cohort study physician using a standard questionnaire. Results The results showed that 21.39% and 24.58% of studied participants had low back pain and arthralgia, respectively. Among the participants with low back pain, 14.5% had back stiffness, and among those with arthralgia, 12.8% had joint stiffness. The mean of HGS in participants with arthralgia and back & joint stiffness was significantly less than those without these disorders (P<0.001, P=0.05, and P= 0.005, respectively). Multiple-adjusted OR and 95% confidence intervals (CI) for arthralgia and back and joint stiffness across muscle strength showed the HGS increase to be associated with a lower risk of arthralgia and back &joint stiffness, but not low back pain. Conclusions Our results highlighted that higher HGS was associated with a lower risk of arthralgia and back & joint stiffness. However, there was no association between HGS and low back pain. Exercise and adherence to proper nutrition are suggested to enhance muscle strength in order to reduce musculoskeletal pain.
Preprint
Full-text available
Background Chronic low back pain (LBP) is the most common musculoskeletal pain that affects a person's daily activities. This present study aimed at evaluating the relationship between major dietary pattern and Chronic LBP. Methods This cross- sectional study was applied using data from Ravansar non- communicable diseases (RaNCD) cohort study. Chronic LBP was diagnosed by the RaNCD cohort study physician. Dietary patterns were evaluated by principal component analysis. The three identified dietary patterns included: 1) vegetarian dietary pattern which included vegetables, whole grain, legumes, nuts, olive, vegetable oil, fruits, and fruit juice; 2) high protein diet related to higher adherence to red and white meat, legumes, nuts, and egg; and 3) unhealthy dietary pattern characterized with higher intake of salt, sweet, dessert, hydrogenated fat, soft drink, refined grain, tea, and coffee. Results 22.5% of participants had chronic LBP Higher following high protein dietary pattern was associated with lower risk of chronic LBP in crude (OR: 0.79, 95% CI: 0.69–0.9) and adjusted model (for age, sex, smoking, drinking, diabetes, physical activity, and body mass index) (OR: 0.84, 95% CI: 0.72–0.97). In addition, after controlling for the mentioned potential confounders, participants in the highest category of unhealthy dietary pattern were higher at risk of chronic LBP compared with those in the lowest category (OR: 1.13, 95% CI: 1.01–1.32). Conclusions Higher adherence to high protein diet significantly the decreased risk of chronic LBP prevalence. In addition, we found that following unhealthy dietary pattern was associated with higher risk of chronic LBP.
Article
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Purpose: This study aimed to determine the indirect effect of risk factors associated with obesity and overweight through physical activity (PA) and dietary pattern (DP), using structural equation model (SEM) in the dults’ population. Methods: This cross-sectional study was conducted on 10000 adults from baseline data of Ravansar Non Communicable Disease (RaNCD) cohort study, in the west region of Iran in 2018. Structural equation modeling was used to assess the causal effects of associated factors on Obesity and overweight as the outcome. Results: In general, the population at higher economic level was significantly more dependent on the healthy DP. The direct effect of SES on obesity and overweight was -0.070, the indirect effect was 0.127, and the total effect was 0.057. When stratified by gender, in women, SES had a weak direct effect (b=0.024) on the outcome, but indirectly and through the variables of PA and DP, had a significant effect (b=0.088) on the outcome. In men, the same situation has been observed and the direct effect of SES (b=0.070) was weak, but indirectly and through three variables such as PA, DP, and smoking status significantly contribute to the expected outcome. Conclusion: Factors associated with obesity and overweight not only by direct effect but also can indirectly and through mediators (such as DP and PA as two important mediation variables) cause this outcome. Keywords: obesity, overweight, physical activity, dietary pattern, Structural Equation Modeling
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