Original Study
Depression is Associated With Sarcopenia Due to Low Muscle Strength: Results From the ELSA-Brasil Study

https://doi.org/10.1016/j.jamda.2018.09.020Get rights and content

Abstract

Objectives

To investigate the association of sarcopenia and its defining components with depression in Brazilian middle-aged and older adults.

Design

Cross-sectional study.

Setting and Participants

This analysis included 5927 participants from the ELSA-Brasil Study second data collection, aged 55 years and older, with complete data for exposure, outcome, and covariates.

Measures

Muscle mass was evaluated by bioelectrical impedance analysis and muscle strength by hand-grip strength. Sarcopenia was defined according to the Foundation for the National Institutes of Health (FNIH) criteria. Depression was assessed using the Clinical Interview Scheduled Revised (CIS-R). Information on sociodemographic characteristics, lifestyle, and clinical comorbidities were also obtained.

Results

The frequencies of sarcopenia, presarcopenia, low muscle mass, low muscle strength, and low muscle strength without loss of muscle mass was 1.9%, 18.8%, 20.7%, 4.8%, and 2.9%, respectively. After adjustment for sociodemographic characteristics, clinical conditions, and lifestyle factors, depression was associated with sarcopenia (odds ratio [OR] = 2.23, 95% confidence interval [CI] = 1.11-4.48, P = .024) and low muscle strength (OR = 1.94, 95% CI = 1.20-3.15, P = .007), but it was not associated with presarcopenia, low muscle mass, and low muscle strength without loss of muscle mass.

Conclusions

Depression is associated with sarcopenia defined by the FNIH criteria mainly because of its association with weakness. Future studies are needed to clarify the temporal relationship between both conditions.

Section snippets

Study Population and Design

The present study is a cross-sectional analysis of the ELSA-Brasil second data examination, which was conducted after 4 years of baseline. The ELSA-Brasil is a cohort of active and retired employees from public institutions located in different Brazilian cities, aged between 35 and 74 years at baseline, with the aim to investigate cardiovascular and chronic diseases in Brazilian adults. The study design and cohort profile have been published elsewhere.13, 14 The baseline evaluation was

Results

Among the 14,014 participants in the first follow-up evaluation of the ELSA-Brasil study, we excluded 6766 individuals younger than 55 years, 2 individuals with reported weakness in both hands due to pain and rheumatoid arthritis, and 1319 individuals with incomplete data on sarcopenia parameters, CIS-R scores, or covariates. Therefore, 5927 participants (mean age: 62.7 ± 5.9 years, 54.4% women) were included in this analysis, as seen in Figure 1. Sarcopenia was found in 114 participants

Discussion

In the present study, sarcopenia was found in 1% of middle-aged and almost 4% of older adults of a Brazilian cohort. Our study also showed that middle-aged and older adults with depression have higher odds of sarcopenia as defined by the FNIH criteria after adjustment for sociodemographic characteristics, lifestyle, and clinical conditions. This association was mainly due to low muscle strength. Moreover, depressive key symptoms such as concentration and forgetfulness, depressed mood, and

References (47)

  • A.J. Cruz-Jentoft et al.

    Sarcopenia: European consensus on definition and diagnosis: Report of the European working Group on sarcopenia in older people

    Age Ageing

    (2010)
  • C. Beaudart et al.

    Health outcomes of sarcopenia: A systematic review and meta-analysis

    PLoS One

    (2017)
  • S.A. Studenski et al.

    The FNIH sarcopenia project: Rationale, study description, conference recommendations, and final estimates

    J Gerontol A Biol Sci Med Sci

    (2014)
  • R.R. McLean et al.

    Criteria for clinically relevant weakness and low lean mass and their longitudinal association with incident mobility impairment and mortality: The Foundation for the National Institutes of Health (FNIH) sarcopenia project

    J Gerontol A Biol Sci Med Sci

    (2014)
  • V.A. Souza et al.

    Sarcopenia in patients with chronic kidney disease not yet on dialysis: Analysis of the prevalence and associated factors

    PLoS One

    (2017)
  • L.S. Eurelings et al.

    Apathy and depressive symptoms in older people and incident myocardial infarction, stroke, and mortality: A systematic review and meta-analysis of individual participant data

    Clin Epidemiol

    (2018)
  • J.E. Schillerstrom et al.

    Depression, disability and intermediate pathways: A review of longitudinal studies

    J Geriatr Psychiatry Neurol

    (2008)
  • J.A. Pasco et al.

    Sarcopenia and the common mental disorders: A potential regulatory role for skeletal muscle on brain function?

    Curr Osteoporos Rep

    (2015)
  • K.V. Chang et al.

    Is sarcopenia associated with depression? A systematic review and meta-analysis of observational studies

    Age Ageing

    (2017)
  • E.M. Aquino et al.

    Brazilian longitudinal study of adult health (ELSA-Brasil): Objectives and design

    Am J Epidemiol

    (2012)
  • M.I. Schmidt et al.

    Cohort profile: Longitudinal study of adult health (ELSA-Brasil)

    Int J Epidemiol

    (2015)
  • R. Roubenoff et al.

    Application of bioelectrical impedance analysis to elderly populations

    J Gerontol A Biol Sci Med Sci

    (1997)
  • M. Malavolti et al.

    Cross-calibration of eight-polar bioelectrical impedance analysis versus dual-energy X-ray absorptiometry for the assessment of total and appendicular body composition in healthy subjects aged 21-82 years

    Ann Hum Biol

    (2003)
  • Cited by (47)

    • A new paradigm in sarcopenia: Cognitive impairment caused by imbalanced myokine secretion and vascular dysfunction

      2022, Biomedicine and Pharmacotherapy
      Citation Excerpt :

      Sarcopenia shows multifactorial pathogenesis including neuromuscular degeneration, cognitive decline, alteration of hormone levels, inflammation, and oxidative stress [8,9]. Sarcopenia contributes broadly to various neuropathologies, including dementia [10], brain atrophy [11], and neuropsychiatric symptoms, such as depression [12]. Some studies have demonstrated the coexistence of sarcopenia and cognitive dysfunction [13–17] and the relationship between lower gait speed and cognitive impairment [18–23].

    View all citing articles on Scopus

    A.R.B. is recipient of a CAPES/Alexander von Humboldt fellowship award for experienced researchers and a consultant of the Neurocare Group GmbH (Munich, Germany).

    The ELSA-Brasil study was supported by the Brazilian Ministry of Health and CNPq (grants 01060010.00RS, 01060212.00BA, 01060300.00ES, 01060278.00MG, 01060115.00SP, 01060071.00RJ).

    View full text