{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T02:30:13Z","timestamp":1774060213763,"version":"3.50.1"},"reference-count":40,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2021,7,15]],"date-time":"2021-07-15T00:00:00Z","timestamp":1626307200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: The combination of multiple disease statuses, muscle weakness, and sarcopenia among older adults is an important public health concern, and a health burden worldwide. This study evaluates the association between chronic disease statuses, obesity, and grip strength (GS) among older adults in Taiwan. Methods: A community-based survey was conducted every 3 years among older adults over age 65, living in Chiayi County, Taiwan. Demographic data and several diseases statuses, such as diabetes mellitus, hypertension, cerebrovascular disease, cardiovascular disease, and certain cancers, were collected using a questionnaire. Anthropometric characteristics were measured using standard methods. Grip strength was measured using a digital dynamometer (TKK5101) method. Results: A total of 3739 older individuals were recruited (1600 males and 2139 females) with the mean age of 72.9 years. The mean GS was 32.8 \u00b1 7.1 kg for males and 21.6 \u00b1 4.8 kg for females. GS significantly decreased most in males with cerebrovascular disease (from 33.0\u201429.5 kg, p &lt; 0.001) and in females with diabetes mellitus (from 21.8\u201421.0 kg, p &lt; 0.01). GS was highest in older adults with obesity (body mass index \u2265 27 kg\/m2); however, there was no significant change of GS as the disease number increased. Conclusion: Older adults who have two, rather than one or greater than three chronic diseases, have significantly lower GSs than those who are healthy. Stroke and CKD for males, and hypertension and diabetes for females, are important chronic diseases that are significantly associated with GS. Furthermore, being overweight may be a protective factor for GS in older adults of both sexes.<\/jats:p>","DOI":"10.3390\/ijerph18147540","type":"journal-article","created":{"date-parts":[[2021,7,15]],"date-time":"2021-07-15T09:32:07Z","timestamp":1626341527000},"page":"7540","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Relationship of Multimorbidity, Obesity Status, and Grip Strength among Older Adults in Taiwan"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4169-921X","authenticated-orcid":false,"given":"Ming-Hsun","family":"Lin","sequence":"first","affiliation":[{"name":"National Defense Medical Center, Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, Taipei 114, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4416-0116","authenticated-orcid":false,"given":"Chun-Yung","family":"Chang","sequence":"additional","affiliation":[{"name":"National Defense Medical Center, Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, Taipei 114, Taiwan"},{"name":"Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung City 802, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Der-Min","family":"Wu","sequence":"additional","affiliation":[{"name":"National Defense Medical Center, School of Public Health, Taipei 114, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chieh-Hua","family":"Lu","sequence":"additional","affiliation":[{"name":"National Defense Medical Center, Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, Taipei 114, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Che-Chun","family":"Kuo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan City 325, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nain-Feng","family":"Chu","sequence":"additional","affiliation":[{"name":"National Defense Medical Center, School of Public Health, Taipei 114, Taiwan"},{"name":"Department of Internal Medicine, Tri-Service General Hospital, Taipei 114, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1093\/eurpub\/cky098","article-title":"Defining and measuring multimorbidity: A systematic review of systematic reviews","volume":"29","author":"Johnston","year":"2019","journal-title":"Eur. J. Public Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"503","DOI":"10.3122\/jabfm.2018.04.180008","article-title":"Multimorbidity Trends in United States Adults, 1988\u20132014","volume":"31","author":"King","year":"2018","journal-title":"J. Am. Board Fam. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2493","DOI":"10.1001\/jama.2012.5265","article-title":"Designing health care for the most common chronic condition--multimorbidity","volume":"307","author":"Tinetti","year":"2012","journal-title":"JAMA"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e028333","DOI":"10.1136\/bmjopen-2018-028333","article-title":"Increasing age- and gender-specific burden and complexity of multimorbidity in Taiwan, 2003\u20132013: A cross-sectional study based on nationwide claims data","volume":"9","author":"Hu","year":"2019","journal-title":"BMJ Open"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1080\/13814780802436093","article-title":"Multimorbidity in primary care: Prevalence and trend over the last 20 years","volume":"14","author":"Uijen","year":"2008","journal-title":"Eur. J. Gen. Pract."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1093\/gerona\/glr010","article-title":"Dynapenia and Aging: An Update","volume":"67A","author":"Manini","year":"2011","journal-title":"J. Gerontol. Ser. A"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/j.jamda.2013.02.001","article-title":"Muscle Strength Rather Than Muscle Mass Is Associated With Standing Balance in Elderly Outpatients","volume":"14","author":"Bijlsma","year":"2013","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1519\/00139143-200831010-00002","article-title":"Hand-grip dynamometry predicts future outcomes in aging adults","volume":"31","author":"Bohannon","year":"2008","journal-title":"J. Geriatr. Phys. Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1681","DOI":"10.2147\/CIA.S194543","article-title":"Grip Strength: An Indispensable Biomarker For Older Adults","volume":"14","author":"Bohannon","year":"2019","journal-title":"Clin. Interv. Aging"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1300","DOI":"10.1093\/gerona\/glr141","article-title":"Frailty status and altered glucose-insulin dynamics","volume":"67","author":"Kalyani","year":"2012","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1093\/gerona\/glp013","article-title":"Frailty and impaired cardiac autonomic control: New insights from principal components aggregation of traditional heart rate variability indices","volume":"64","author":"Varadhan","year":"2009","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1007\/s11357-012-9385-y","article-title":"Association of handgrip strength with chronic diseases and multimorbidity","volume":"35","author":"Cheung","year":"2013","journal-title":"AGE"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"110636","DOI":"10.1016\/j.nut.2019.110636","article-title":"Strength and multimorbidity among community-dwelling elderly from southern Brazil","volume":"71","author":"Montes","year":"2020","journal-title":"Nutrition"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.ejim.2016.04.001","article-title":"Handgrip strength is inversely and independently associated with multimorbidity among older women: Results from the KORA-Age study","volume":"31","author":"Volaklis","year":"2016","journal-title":"Eur. J. Intern. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1007\/BF03654835","article-title":"Can chronic multimorbidity explain the age-related differences in strength, speed and balance in older adults?","volume":"24","author":"Welmer","year":"2012","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.archger.2017.05.011","article-title":"The impact of multimorbidity on grip strength in adults age 50 and older: Data from the health and retirement survey (HRS)","volume":"72","author":"Yorke","year":"2017","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1002\/jcsm.12503","article-title":"Sarcopenia, long-term conditions, and multimorbidity: Findings from UK Biobank participants","volume":"11","author":"Dodds","year":"2020","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"7004300010p1","DOI":"10.5014\/ajot.2016.019117","article-title":"Reliability and Validity of Different Models of TKK Hand Dynamometers","volume":"70","author":"Ruiz","year":"2016","journal-title":"Am. J. Occup. Ther."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1519\/JSC.0b013e3181b296a5","article-title":"Elbow Position Affects Handgrip Strength in Adolescents: Validity and Reliability of Jamar, DynEx, and TKK Dynamometers","volume":"24","author":"Ortega","year":"2010","journal-title":"J. Strength Cond. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1093\/ageing\/afq022","article-title":"Handgrip strength as a predictor of functional, psychological and social health. A prospective population-based study among the oldest old","volume":"39","author":"Taekema","year":"2010","journal-title":"Age Ageing"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"773","DOI":"10.3945\/ajcn.117.156851","article-title":"Independent and joint associations of grip strength and adiposity with all-cause and cardiovascular disease mortality in 403,199 adults: The UK Biobank study","volume":"106","author":"Kim","year":"2017","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_22","first-page":"k1651","article-title":"Associations of grip strength with cardiovascular, respiratory, and cancer outcomes and all cause mortality: Prospective cohort study of half a million UK Biobank participants","volume":"361","author":"Welsh","year":"2018","journal-title":"BMJ"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1616","DOI":"10.1016\/j.amjcard.2009.01.375","article-title":"Role of frailty in patients with cardiovascular disease","volume":"11","author":"Afilalo","year":"2009","journal-title":"Am. J. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1161\/STROKEAHA.117.018417","article-title":"Focused Update of Sex Differences in Patient Reported Outcome Measures After Stroke","volume":"49","author":"Gall","year":"2018","journal-title":"Stroke"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1038\/nrneurol.2017.95","article-title":"Stroke in women\u2014From evidence to inequalities","volume":"13","author":"Cordonnier","year":"2017","journal-title":"Nat. Rev. Neurol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1710","DOI":"10.2337\/dc17-0921","article-title":"Associations between diabetes and both cardiovascular disease and all-cause mortality are modified by grip strength: Evidence from UK Biobank, a prospective population-based cohort study","volume":"40","author":"Petermann","year":"2017","journal-title":"Diabetes Care"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.2147\/DMSO.S186600","article-title":"Sarcopenia and type 2 diabetes mellitus: A bidirectional relationship","volume":"12","author":"Mesinovic","year":"2019","journal-title":"Diabetes Metab. Syndr. Obes. Targets Ther."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1111\/j.1469-7793.2000.t01-1-00203.x","article-title":"Oxidative capacity and ageing in human muscle","volume":"526","author":"Conley","year":"2000","journal-title":"J. Physiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1007\/s11357-009-9097-0","article-title":"Association of C-reactive protein and muscle strength in the English Longitudinal Study of Ageing","volume":"31","author":"Hamer","year":"2009","journal-title":"AGE"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1332","DOI":"10.1111\/jdi.13014","article-title":"Association of accumulated advanced glycation end-products with a high prevalence of sarcopenia and dynapenia in patients with type 2 diabetes","volume":"10","author":"Mori","year":"2019","journal-title":"J. Diabetes Investig."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Kuo, C.K., Lin, L.Y., Yu, Y.H., Wu, K.H., and Kuo, H.K. (2009). Inverse association between insulin resistance and gait speed in nondiabetic older men: Results from the U.S. National Health and Nutrition Examination Survey (NHANES) 1999\u20132002. BMC Geriatr., 9.","DOI":"10.1186\/1471-2318-9-49"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1111\/j.1532-5415.2011.03472.x","article-title":"Association between insulin resistance and lean mass loss and fat mass gain in older men without diabetes mellitus","volume":"59","author":"Lee","year":"2011","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1038\/nrneph.2014.112","article-title":"Mechanisms of muscle wasting in chronic kidney disease","volume":"10","author":"Wang","year":"2014","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1688","DOI":"10.1046\/j.1523-1755.2000.00014.x","article-title":"Relationship between nutritional status and the glomerular filtration rate: Results from the MDRD study","volume":"57","author":"Kopple","year":"2000","journal-title":"Kidney Int."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Moon, S.J., Kim, T.H., Yoon, S.Y., Chung, J.H., and Hwang, H.-J. (2015). Relationship between stage of chronic kidney disease and sarcopenia in Korean aged 40 years and older using the Korea National Health and Nutrition Examination Surveys (KNHANES IV-2, 3, and V-1, 2), 2008\u20132011. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0130740"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/S0140-6736(14)62000-6","article-title":"Prognostic value of grip strength: Findings from the Prospective Urban Rural Epidemiology (PURE) study","volume":"386","author":"Leong","year":"2015","journal-title":"Lancet"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1046\/j.1532-5415.2001.49189.x","article-title":"High Body Mass Index Does Not Predict Mortality in Older People: Analysis of the Longitudinal Study of Aging","volume":"49","author":"Grabowski","year":"2001","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1046\/j.1467-789x.2001.00034.x","article-title":"Obesity in the elderly\u2014A future matter of concern?","volume":"2","year":"2001","journal-title":"Obes. Rev."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Pes, G.M., Licheri, G., Soro, S., Longo, N.P., Salis, R., Tomassini, G., Niolu, C., Errigo, A., and Dore, M.P. (2019). Overweight: A Protective Factor against Comorbidity in the Elderly. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16193656"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1016\/j.jamda.2020.08.003","article-title":"Grip Strength and Demographic Variables Estimate Appendicular Muscle Mass Better Than Bioelectrical Impedance in Taiwanese Older Persons","volume":"22","author":"Hsiao","year":"2021","journal-title":"J. Am. Med. Dir. Assoc."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/14\/7540\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:31:02Z","timestamp":1760164262000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/14\/7540"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,15]]},"references-count":40,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2021,7]]}},"alternative-id":["ijerph18147540"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18147540","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,15]]}}}