Handgrip strength in older adults from Antioquia-Colombia and comparison of cutoff points for dynapenia

The first objective of this study was to describe handgrip characteristics in the older population from Antioquia, Colombia. In this population, handgrip strength significantly decreases with aging, in both men and women. Handgrip strength has shown a positive and strong association with functional and health parameters. These findings corroborate the potential value of manual dynamometry in medical and nutritional assessments of older population. In relation to the second objective, dynapenia prevalence was below 1% when applying the original Colombian cutoffs¹⁷. The prevalence increased up to 5.5% using the alternative Colombian borderline values. While applying the international criteria, prevalence was around 20%. Regarding the third objective, dynapenia classification using the cutoffs proposed for Colombians did not show any significant association with physical inactivity, presence of multimorbidity, or malnutrition risk. This suggests that the handgrip cutoff points proposed for Colombians seems to underestimate the prevalence of dynapenia in the older population of Antioquia.

Handgrip strength was higher in subjects that were physically active, morbidity free, and free of malnutrition risk, which is in line with previous studies^18,19,20,21. Likewise, older adults with adequate handgrip strength showed normal gait speed, thus supporting this measurement’s utility to identify older people with locomotion impairments^22,23. These results endorse handgrip strength as a screening and monitoring tool for nutrition and health status in older population^3,4,8.

Using the original cutoff points proposed for Colombians, the prevalence of dynapenia in the older population of Antioquia was rather low (0.8%); this percentage shows a slight agreement with the international criteria (kappa < 0.06). Probably, the prevalence of dynapenia is higher in Antioquia´s population, as it is suggested by the international cutoff points (between 18.4 and 26.1%) and the health conditions found of multimorbidity (45.9%), risk of malnutrition (36.2%), physical inactivity (36.7%) and slow gait speed (45.0%). Accordingly, the application of the original Colombian cutoffs seem to underestimate the prevalence of sarcopenia, frailty, and malnutrition in this population, which may delay the treatments of these conditions, and then affecting the general wellbeing of the older adult Colombian population.

The low performance of the original handgrip cutoffs proposed for Colombians is probably due to several factors. One factor might relate to the sociodemographic characteristics of the population used for deriving the cutoff points. However, the Colombian older population was similar in terms of age, gender, and educational levels as to the population from Chile, and other developing countries of South America wherein cutoffs were higher^13,14. Therefore, the methodology used to derive the cutoffs may have played a major role. The proposed handgrip cutoff points were derived from the SABE-Colombia study, which included population aged between 60 and 108¹⁷. Since handgrip strength decreases with aging and its reduction is related to functional impairment, considering older adults as reference population to derive cutoff points may be inappropriate. EWGSOP2 cutoffs for dynapenia, proposed in 2019 (< 27 kg for men and < 16 kg for women), were derived from British adult population⁵. These cutoff points correspond to a < 2.5 T-score value of the maximum handgrip strength found in adult men (29–39 years old) and women (26–42 years old)⁵. Cutoff points for the older population developed in adults have shown to be helpful in monitoring health parameters like bone mass density²⁴.

Using values below one standard deviation for establishing cutoff points could be another factor that contributed to the low performance of the original handgrip thresholds proposed for Colombians. One standard deviation is close to 15th and 16th percentiles on a normal sample distribution, and this could be a low value for handgrip cutoff points in older people. Lera et al.¹³, using a sample of older adult Chilean population, established handgrip cutoffs using the 25th percentile. Lera’s thresholds seem to be more appropriate for the older population of Antioquia, as shown in the results of this study. Similarly, the Asian handgrip cutoff points¹¹, developed with older population using the 20th percentile, showed results in accordance with the multimorbidity states and functionality status found in the population of Antioquia.

The alternative Colombian borderlines yielded higher dynapenia prevalence (5.5%) than the cutoffs originally proposed for Colombians in 2019 (0.8%). Dynapenia classification with the alternative Colombian borderlines showed additional associations with physical inactivity, presence of multimorbidity, and nutritional risk evaluated by MNA; such associations were missing when the cutoff points proposed for Colombians were used. From a clinical viewpoint, the application of the alternative Colombian borderlines appears to be more reasonable for diagnosing dynapenia in older people from Antioquia. However, these borderline values generate lower dynapenia prevalence than the international criteria. Therefore, it seems reasonable to continue using the international handgrip cutoff points, especially when using manual dynamometry in health promotion and disease prevention among older population of Antioquia.

A strength of this study was its representative sample of older people from Antioquia, which included people from urban and rural areas. Moreover, this study used a handgrip device and measurement protocol resembling the Colombian SABE survey. One limitation of this study is its cross-sectional design that limits establishing causal conclusions. However, the analysis in this study does not claim this type of association. Rather, the analysis focuses on reporting the characteristics of handgrip strength and the concordance between the different classifications for dynapenia.