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1Department of Physical Education, Yongin University, Yongin, Korea
2Department of Convergence, Seowon University, Cheongju, Korea
3Department of Smart Healthcare, Changwon National University, Changwon, Korea
© 2024, Korean Society of Epidemiology
This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Conflict of interest
The authors have no conflicts of interest to declare for this study.
Funding
This research was supported by Changwon National University in 2023-2024.
Author contributions
Conceptualization: Lee I, Kim M, Kim J. Data curation: Lee I, Kim M. Formal analysis: Lee I, Kim J. Funding acquisition: Lee I. Methodology: Lee I, Kim M, Kim J. Writing – original draft: Lee I, Kim M, Kim J. Writing – review & editing: Lee I, Kim M, Kim J.
Path2 |
Model 1 |
Model 2 |
||||||
---|---|---|---|---|---|---|---|---|
ß (SE) |
95% CI |
p-value | ß (SE) |
95% CI |
p-value | |||
UL | LL | UL | LL | |||||
General obesity | ||||||||
BMI→LMI, a | -0.320 (0.010) | -0.340 | -0.300 | <0.001 | -0.147 (0.010) | -0.166 | -0.127 | <0.001 |
LMI→KL, b | -0.048 (0.015) | -0.077 | -0.019 | 0.001 | -0.032 (0.016) | -0.064 | -0.001 | 0.046 |
Total effect, c | 0.107 (0.008) | 0.092 | 0.123 | <0.001 | 0.105 (0.009) | 0.088 | 0.122 | <0.001 |
Direct effect, c` | 0.092 (0.009) | 0.074 | 0.111 | <0.001 | 0.100 (0.009) | 0.082 | 0.118 | <0.001 |
Indirect effect, ab | 0.015 (0.005) | 0.006 | 0.025 | 0.005 (0.003) | 0.000 | 0.010 | ||
Indirect to total effect (%) | 14.0 | 4.8 | ||||||
Central obesity | ||||||||
WC→LMI, a | -0.100 (0.004) | -0.107 | -0.093 | <0.001 | -0.040 (0.004) | -0.047 | -0.033 | <0.001 |
LMI→KL, b | -0.049 (0.014) | -0.077 | -0.021 | 0.001 | -0.049 (0.016) | -0.081 | -0.017 | 0.002 |
Total effect, c | 0.041 (0.003) | 0.035 | 0.046 | <0.001 | 0.030 (0.003) | 0.024 | 0.036 | <0.001 |
Direct effect, c` | 0.036 (0.003) | 0.030 | 0.042 | <0.001 | 0.028 (0.003) | 0.022 | 0.034 | <0.001 |
Indirect effect, ab | 0.005 (0.001) | 0.002 | 0.008 | 0.002 (0.001) | 0.001 | 0.003 | ||
Indirect to total effect (%) | 12.2 | 6.7 |
KL, Kellgren-Lawrence grade; LMI, lower extremity muscle mass index; SE, standard error; CI, confidence interval; UL, upper limit; LL, lower limit; BMI, body mass index; WC, waist circumference.
1 Model 1: Non-adjusted; Model 2: Adjusted for age, body fat, household income, education, marital status, region, smoking, binge alcohol, inactivity, energy intake, protein intake, self-reported health status, menopause, comorbidity.
2 In the mediation model, the indirect effect is the product of path coefficients a (BMI or WC→LMI) and b (LMI→KL); The direct effect is the coefficient c`; The total effect (c) is equal to the sum of the direct and indirect (c`+ ab).
Variables | Total (n=2,843) | Normal (n=1,477) | KOA (n=1,366) | p-value |
---|---|---|---|---|
KL grade | 1.67±1.44 | 0.42±0.49 | 3.02±0.75 | <0.001 |
Age (yr) | 63.8±9.0 | 60.4±8.3 | 67.4±8.3 | <0.001 |
Body weight (kg) | 57.0±8.7 | 56.0±8.1 | 58.1±9.3 | <0.001 |
Height (cm) | 153.2±5.8 | 154.2±5.6 | 152.2±5.9 | <0.001 |
LMM (kg) | 11.3±1.6 | 11.2±1.6 | 11.3±1.7 | 0.621 |
LMI (%) | 20.0±2.0 | 20.3±2.0 | 19.7±2.0 | <0.001 |
BMI (kg/m2) | 24.3±3.3 | 23.6±3.0 | 25.0±3.3 | <0.001 |
WC (cm) | 82.3±9.3 | 80.2±8.7 | 84.7±9.3 | <0.001 |
Body fat (%) | 34.7±5.5 | 34.0±5.4 | 35.4±5.5 | <0.001 |
Socioeconomic status | ||||
Household income (10,000 KRW/mo) | 140.7±246.4 | 164.5±270.4 | 115.0±214.6 | <0.001 |
Education | <0.001 | |||
Lower than elementary school | 1,822 (64.1) | 785 (53.1) | 1,037 (75.9) | |
Middle/high school | 886 (31.2) | 588 (39.8) | 298 (21.8) | |
Over than college | 135 (4.7) | 104 (7.1) | 31 (2.3) | |
Marital status | <0.001 | |||
Married | 1,923 (67.6) | 1,123 (76.0) | 800 (58.6) | |
Widowed/divorced/unmarried | 920 (32.4) | 354 (24.0) | 566 (41.4) | |
Region of residence | <0.001 | |||
Urban | 1,947 (68.5) | 1,089 (73.7) | 858 (62.8) | |
Rural | 896 (31.5) | 388 (26.3) | 508 (37.2) | |
Health-related parameters | ||||
Smoking | 195 (6.9) | 100 (6.8) | 95 (7.0) | 0.846 |
Binge alcohol | 106 (3.7) | 54 (3.7) | 52 (3.8) | 0.832 |
Inactivity | 2,265 (79.7) | 1,166 (78.9) | 1,099 (80.5) | 0.318 |
Energy intake (g/day) | 1,591.1±615.2 | 1,640.5±615.4 | 1,537.7±610.7 | <0.001 |
Protein intake (g/day) | 53.0±27.6 | 56.1±29.3 | 49.6±25.1 | <0.001 |
Self-reported health status | <0.001 | |||
Good or very good | 765 (26.9) | 410 (27.8) | 355 (26.0) | |
Fair | 1,074 (37.8) | 607 (41.1) | 467 (34.2) | |
Poor or very poor | 1,004 (35.3) | 460 (31.1) | 544 (39.8) | |
Menopause | 2,684 (94.4) | 1,353 (91.6) | 1,331 (97.4) | <0.001 |
Comorbidity | <0.001 | |||
0 | 1,305 (45.9) | 797 (54.0) | 508 (37.2) | |
1 | 932 (32.8) | 419 (28.4) | 513 (37.6) | |
≥2 | 606 (21.3) | 261 (17.6) | 345 (25.3) |
Variables | BMI (kg/m2) |
p-value | WC (cm) |
p-value | ||
---|---|---|---|---|---|---|
<25 (n=1,763) | ≥25 (n=1,080) | <85 (n=1,759) | ≥85 (n=1,084) | |||
BMI (kg/m2) | 22.3±1.9 | 27.5±2.2 | <0.001 | 22.6±2.3 | 27.0±2.7 | <0.001 |
WC (cm) | 77.5±6.8 | 90.2±7.0 | <0.001 | 76.6±5.8 | 91.6±5.6 | <0.001 |
Age (yr) | 63.8±9.4 | 63.7±8.4 | 0.646 | 63.1±9.3 | 64.8±8.4 | <0.001 |
Body weight (kg) | 52.5±6.1 | 64.5±7.0 | <0.001 | 52.9±6.5 | 63.8±7.6 | <0.001 |
Height (cm) | 153.4±6.0 | 153.0±5.6 | 0.115 | 152.9±5.9 | 153.8±5.7 | <0.001 |
LMM (kg) | 10.7±1.4 | 12.1±1.6 | <0.001 | 10.7±1.4 | 12.1±1.6 | <0.001 |
LMI (%) | 20.6±2.0 | 19.0±1.7 | <0.001 | 20.5±2.0 | 19.1±1.8 | <0.001 |
Body fat (%) | 32.6±5.2 | 38.1±4.0 | <0.001 | 32.8±5.3 | 37.7±4.2 | <0.001 |
Socioeconomic status | ||||||
Household income (10,000 KRW/mo) | 148.3±256.5 | 128.4±228.5 | 0.016 | 149.2±255.8 | 126.9±229.8 | 0.016 |
Education | <0.001 | <0.001 | ||||
Lower than elementary school | 1,082 (61.3) | 740 (68.5) | 1,040 (59.1) | 782 (72.1) | ||
Middle/high school | 581 (33.0) | 305 (28.3) | 611 (34.8) | 275 (25.4) | ||
Over than college | 100 (5.7) | 35 (3.2) | 108 (6.1) | 27 (2.5) | ||
Marital status | 0.482 | <0.001 | ||||
Married | 1,201 (68.1) | 772 (66.9) | 1,233 (70.1) | 690 (63.7) | ||
Widowed/divorced/unmarried | 562 (31.9) | 358 (33.1) | 526 (29.9) | 394 (36.3) | ||
Region of residence | 0.975 | 0.090 | ||||
Urban | 1,207 (68.5) | 740 (68.5) | 1,225 (69.6) | 722 (66.6) | ||
Rural | 556 (31.5) | 340 (31.5) | 534 (30.4) | 362 (33.4) | ||
Health-related parameters | ||||||
Smoking | 137 (7.8) | 58 (5.4) | 0.014 | 125 (7.1) | 70 (6.5) | 0.506 |
Binge alcohol | 55 (3.1) | 51 (4.7) | 0.029 | 53 (3.0) | 53 (4.9) | 0.010 |
Inactivity | 1,436 (81.5) | 829 (76.8) | 0.003 | 1,406 (79.9) | 859 (79.2) | 0.658 |
Energy intake (g/day) | 1,586.1±638.9 | 1,599.2±574.5 | 0.582 | 1,598.8±637.9 | 1,578.7±576.4 | 0.398 |
Protein intake (g/day) | 53.1±27.9 | 52.8±27.0 | 0.830 | 54.0±28.9 | 51.4±25.2 | 0.011 |
Self-reported health status | 0.125 | <0.001 | ||||
Good or very good | 480 (27.2) | 285 (26.4) | 501 (28.5) | 264 (24.4) | ||
Fair | 685 (38.9) | 389 (36.0) | 697 (39.6) | 377 (34.8) | ||
Poor or very poor | 598 (33.9) | 406 (37.6) | 561 (31.9) | 443 (40.8) | ||
Menopause | 1,670 (94.7) | 1,014 (93.9) | 0.346 | 1,650 (93.8) | 1,034 (95.4) | 0.074 |
Comorbidity | <0.001 | <0.001 | ||||
0 | 921 (52.2) | 384 (35.5) | 948 (53.9) | 357 (32.9) | ||
1 | 549 (31.1) | 383 (35.5) | 541 (30.8) | 391 (36.1) | ||
≥2 | 293 (16.7) | 313 (29.0) | 270 (15.3) | 336 (31.0) | ||
KL grade | 1.43±1.40 | 2.06±1.44 | <0.001 | 1.41±1.39 | 2.08±1.43 | <0.001 |
Radiographic KOA | 712 (40.4) | 654 (60.6) | <0.001 | 700 (39.8) | 666 (61.4) | <0.001 |
Variables | Lower LMI (n=711, 25.0%) | Middle LMI (n=1,421, 50.0%) | Upper LMI (n=711, 25.0%) | p for trend |
---|---|---|---|---|
LMI (%) | 17.5±0.9 | 19.9±0.7 | 22.7±1.2 | <0.001 |
Age (yr) | 65.5±8.8 | 63.2±8.8 | 63.4±9.4 | <0.001 |
Body weight (kg) | 60.7±9.1 | 57.4±8.0 | 52.7±7.8 | <0.001 |
Height (cm) | 151.8±5.5 | 153.5±5.7 | 154.1±6.3 | <0.001 |
LMM (kg) | 10.6±1.6 | 11.3±1.6 | 11.8±1.6 | <0.001 |
BMI (kg/m2) | 26.3±3.4 | 24.3±2.8 | 22.1±2.6 | <0.001 |
WC (cm) | 87.5±9.4 | 82.4±8.2 | 76.9±8.0 | <0.001 |
Body fat (%) | 40.2±3.4 | 34.9±3.2 | 28.7±4.6 | <0.001 |
Socioeconomic status | ||||
Household income (10,000 KRW/mo) | 240.1±9.0 | 230.1±6.1 | 281.3±10.5 | 0.238 |
Education | <0.001 | |||
Lower than elementary school | 504 (70.9) | 890 (62.6) | 428 (60.2) | |
Middle/high school | 185 (26.0) | 462 (32.5) | 239 (33.6) | |
Over than college | 22 (3.1) | 69 (4.9) | 44 (6.2) | |
Marital status | 0.007 | |||
Married | 438 (61.6) | 999 (70.3) | 486 (68.4) | |
Widowed/divorced/unmarried | 273 (38.4) | 422 (29.7) | 225 (31.6) | |
Region of residence | 0.017 | |||
Urban | 489 (68.8) | 1,011 (71.1) | 447 (62.9) | |
Rural | 222 (31.2) | 410 (28.9) | 264 (37.1) | |
Health-related parameters | ||||
Smoking | 42 (5.9) | 98 (6.9) | 55 (7.7) | 0.173 |
Binge alcohol | 28 (3.9) | 54 (3.8) | 24 (3.4) | 0.576 |
Inactivity | 572 (80.5) | 1,141 (80.3) | 552 (77.6) | 0.188 |
Energy intake (g/day) | 1,508.7±556.2 | 1,607.2±631.5 | 1,641.4±630.9 | <0.001 |
Protein intake (g/day) | 51.0±28.1 | 53.7±26.9 | 53.6±28.2 | 0.075 |
Self-reported health status | 0.008 | |||
Good or very good | 171 (24.1) | 397 (27.9) | 197 (27.7) | |
Fair | 246 (34.6) | 556 (39.1) | 272 (38.3) | |
Poor or very poor | 294 (41.3) | 468 (33.0) | 242 (34.0) | |
Menopause | 687 (96.6) | 1,325 (93.2) | 672 (94.5) | 0.083 |
Comorbidity | <0.001 | |||
0 | 249 (35.0) | 630 (44.3) | 426 (59.9) | |
1 | 249 (35.0) | 487 (34.3) | 196 (27.6) | |
≥2 | 213 (30.0) | 304 (21.4) | 89 (12.5) | |
KL grade | 1.52±0.06 | 1.41±0.04 | 1.34±0.05 | <0.001 |
Radiographic KOA | 423 (59.5) | 660 (46.4) | 283 (39.8) | <0.001 |
Path |
Model 1 |
Model 2 |
||||||
---|---|---|---|---|---|---|---|---|
ß (SE) | 95% CI |
p-value | ß (SE) | 95% CI |
p-value | |||
UL | LL | UL | LL | |||||
General obesity | ||||||||
BMI→LMI, a | -0.320 (0.010) | -0.340 | -0.300 | <0.001 | -0.147 (0.010) | -0.166 | -0.127 | <0.001 |
LMI→KL, b | -0.048 (0.015) | -0.077 | -0.019 | 0.001 | -0.032 (0.016) | -0.064 | -0.001 | 0.046 |
Total effect, c | 0.107 (0.008) | 0.092 | 0.123 | <0.001 | 0.105 (0.009) | 0.088 | 0.122 | <0.001 |
Direct effect, c` | 0.092 (0.009) | 0.074 | 0.111 | <0.001 | 0.100 (0.009) | 0.082 | 0.118 | <0.001 |
Indirect effect, ab | 0.015 (0.005) | 0.006 | 0.025 | 0.005 (0.003) | 0.000 | 0.010 | ||
Indirect to total effect (%) | 14.0 | 4.8 | ||||||
Central obesity | ||||||||
WC→LMI, a | -0.100 (0.004) | -0.107 | -0.093 | <0.001 | -0.040 (0.004) | -0.047 | -0.033 | <0.001 |
LMI→KL, b | -0.049 (0.014) | -0.077 | -0.021 | 0.001 | -0.049 (0.016) | -0.081 | -0.017 | 0.002 |
Total effect, c | 0.041 (0.003) | 0.035 | 0.046 | <0.001 | 0.030 (0.003) | 0.024 | 0.036 | <0.001 |
Direct effect, c` | 0.036 (0.003) | 0.030 | 0.042 | <0.001 | 0.028 (0.003) | 0.022 | 0.034 | <0.001 |
Indirect effect, ab | 0.005 (0.001) | 0.002 | 0.008 | 0.002 (0.001) | 0.001 | 0.003 | ||
Indirect to total effect (%) | 12.2 | 6.7 |
Values are presented as mean±standard deviation or number (%). KOA, knee osteoarthritis; KL, Kellgren-Lawrence; LMM, lower extremity muscle mass; LMI, lower extremity muscle mass index; BMI, body mass index; WC, waist circumference; KRW, Korean won.
Values are presented as mean±standard deviation or number (%). GOB, general obesity; COB, central obesity; BMI, body mass index; WC, waist circumference; LMM, lower extremity muscle mass; LMI, lower extremity muscle mass index; KRW, Korean won; KL, Kellgren-Lawrence; KOA, knee osteoarthritis.
Values are presented as mean±standard deviation or number (%). LMI, lower extremity muscle mass index; LMM, lower extremity muscle mass; BMI, body mass index; WC, waist circumference; KRW, Korean won; KL, Kellgren-Lawrence; KOA, knee osteoarthritis.
KL, Kellgren-Lawrence grade; LMI, lower extremity muscle mass index; SE, standard error; CI, confidence interval; UL, upper limit; LL, lower limit; BMI, body mass index; WC, waist circumference. Model 1: Non-adjusted; Model 2: Adjusted for age, body fat, household income, education, marital status, region, smoking, binge alcohol, inactivity, energy intake, protein intake, self-reported health status, menopause, comorbidity. In the mediation model, the indirect effect is the product of path coefficients a (BMI or WC→LMI) and b (LMI→KL); The direct effect is the coefficient c`; The total effect (c) is equal to the sum of the direct and indirect (c`+ ab).