Journal of Obesity & Metabolic Syndrome



J Obes Metab Syndr 2019; 28(4): 295-296

Published online December 30, 2019

Copyright © Korean Society for the Study of Obesity.

Letter: The Differential Association between Muscle Strength and Diabetes Mellitus According to the Presence or Absence of Obesity (J Obes Metab Syndr 2019;28:46-52)

Ji A Seo *

Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea

Correspondence to:
Ji A Seo
Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan 15355, Korea
Tel: +82-31-412-4275 Fax: +82-31-412-5984 E-mail:

Received: August 26, 2019; Reviewed : October 1, 2019; Accepted: October 13, 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Recent consensus reports are emphasizing that reduced muscle strength (dynapenia) and poor physical performance are key diagnostic criteria of sarcopenia, as much as loss of muscle mass is, although definitions vary.1,2 Aging is a universal cause of decreased muscle mass and strength. However, in addition to aging, many chronic diseases including diabetes mellitus (DM) can accelerate loss of muscle mass and strength. Dynapenia was found to be associated with an increased risk of all-cause and cardiovascular mortality in many studies3,4 but somewhat controversial in a prospective study of diabetics.4

In the issue of the Journal of Obesity & Metabolic Syndrome, Koo5 analyzed the association between DM and absolute handgrip strength in Korean adults aged 30–79 years. Low handgrip strength was associated with the presence of DM only in nonobese subjects. The author5 used absolute handgrip strength in contrast to the use of relative (body mass index [BMI]- or weight-normalized) handgrip strength used in some previous reports6 and performed obesity-stratified analyses instead. There are no standardized indices for the definition of low muscle strength. Using absolute handgrip strength for this analysis could be a useful alternative. However, I have some concerns about the results showing differences between obese and nonobese subjects and additional points that need further clarification.

First, comparative data are needed to confirm that the characteristics of obese and nonobese people were similar. A longer duration of diabetes and higher concentrations of glucose and insulin are associated with accelerated muscle loss7 and disability.8 If nonobese DM subjects had more severe hyperglycemia than obese DM subjects, a more pronounced association with DM could be seen in nonobese subjects. In addition to the severity of DM, insufficient protein intake could also be an important factor. Second, to confirm the results, a stratified analysis of obesity based on a non-BMI basis (e.g., body fat percent, waist circumference, etc.) would be useful. In addition, the percentage of blue-collar workers and socioeconomic status distribution could be considered confounding.

Nevertheless, this study added another piece of evidence to our understanding of the relationship between low muscle strength and DM using a nationally representative sample of adults in Korea. Low muscle mass increases the risk of developing type 2 DM in Koreans.9 Future prospective studies will be needed to assess the effects of body components, including muscle mass and fat deposition, and changes in the quality and function of muscles on the occurrence of DM and the development of diabetic complications.

The author declares no conflict of interest.

  1. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019;48:16-31.
    Pubmed KoreaMed CrossRef
  2. Chen LK, Liu LK, Woo J, Assantachai P, Auyeung TW, Bahyah KS, et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc 2014;15:95-101.
    Pubmed CrossRef
  3. Ruiz JR, Sui X, Lobelo F, Morrow JR, Jackson AW, Sjöström M, et al. Association between muscular strength and mortality in men: prospective cohort study. BMJ 2008;337:a439.
    Pubmed KoreaMed CrossRef
  4. Leong DP, Teo KK, Rangarajan S, Lopez-Jaramillo P, Avezum A, Orlandini A, et al. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet 2015;386:266-73.
    Pubmed CrossRef
  5. Koo BK. The differential association between muscle strength and diabetes mellitus according to the presence or absence of obesity. J Obes Metab Syndr 2019;28:46-52.
    Pubmed KoreaMed CrossRef
  6. Lee WJ, Peng LN, Chiou ST, Chen LK. Relative handgrip strength is a simple indicator of cardiometabolic risk among middle-aged and older people: a nationwide population-based study in Taiwan. PLoS One 2016;11:e0160876.
    Pubmed KoreaMed CrossRef
  7. Park SW, Goodpaster BH, Strotmeyer ES, Kuller LH, Broudeau R, Kammerer C, et al. Accelerated loss of skeletal muscle strength in older adults with type 2 diabetes: the health, aging, and body composition study. Diabetes Care 2007;30:1507-12.
    Pubmed CrossRef
  8. Kalyani RR, Tian J, Xue QL, Walston J, Cappola AR, Fried LP, et al. Hyperglycemia and incidence of frailty and lower extremity mobility limitations in older women. J Am Geriatr Soc 2012;60:1701-7.
    Pubmed KoreaMed CrossRef
  9. Son JW, Lee SS, Kim SR, Yoo SJ, Cha BY, Son HY, et al. Low muscle mass and risk of type 2 diabetes in middle-aged and older adults: findings from the KoGES. Diabetologia 2017;60:865-72.
    Pubmed CrossRef