Health-related quality of life in older Koreans: a HINT-8-based cross-sectional analysis of obesity, sarcopenia, and sarcopenic obesity using the 2023 Korea National Health and Nutrition Examination Survey
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Obesity, sarcopenia, and sarcopenic obesity are increasingly prevalent in older adults and negatively affect health-related quality of life (HRQOL). While EuroQol-5 Dimension and Short Form-36 Health Survey are widely used HRQOL measures, they have limitations in sensitivity and cultural relevance. In contrast, the Health-related Quality of Life Instrument with 8 Items (HINT-8) is a preference-based instrument developed specifically for the Korean population, offering finer discrimination of physical, emotional, and social health domains.
Methods
This study analyzed data from 1,387 older adults (≥65 years) from the 2023 Korea National Health and Nutrition Examination Survey. Obesity was defined as body mass index ≥25 kg/m2, sarcopenia by Asian Working Group for Sarcopenia 2019 criteria, and sarcopenic obesity as having both conditions. Multiple linear regression was used to examine their independent effects on HRQOL, adjusting for potential confounders.
Results
Of the participants, 54.2% were classified as normal, 34.9% as obese, 9.8% with sarcopenia, and 1.1% with sarcopenic obesity. All three conditions were significantly associated with greater difficulty in stair climbing: obesity (B=0.223, P<0.001), sarcopenia (B=0.242, P<0.001), and sarcopenic obesity (B=0.338, P=0.048). Sarcopenia was also linked to impaired working ability and higher total HINT-8 scores. Sarcopenic obesity was associated with greater pain. And obesity was linked to slightly lower depression scores.
Conclusion
Obesity, sarcopenia, and sarcopenic obesity negatively impact HRQOL in older adults. Early detection and intervention are essential to improve quality of life and extend health-adjusted life expectancy.
South Korea is experiencing a rapid demographic shift toward an aging population, with individuals aged 65 years or older now accounting for more than 20% of the total population, marking the country’s transition into a super-aged society. As a result, the volume of healthcare utilization and medical expenditures among older adults has surged, posing significant challenges to the healthcare system [1].
Older adults are generally considered a vulnerable population due to age-related declines in both physical and mental function. Among the various health concerns in this population, health-related quality of life (HRQOL) is regarded as one of the most critical indicators. Identifying the factors that affect HRQOL in the elderly and developing strategies to improve it is an important and ongoing public health challenge [2].
Physiological changes associated with aging are diverse, but particular attention should be given to obesity [3], sarcopenia [4], and sarcopenic obesity [5] a condition in which both obesity and sarcopenia are present simultaneously. According to the World Health Organization and other studies, obesity has emerged as a major global public health concern. It is projected that more than half of the adult population worldwide will be overweight or obese by 2030 [6]. Obesity is not merely a matter of increased body weight, but a major risk factor for a range of chronic conditions including hypertension, type 2 diabetes, coronary artery disease, non-alcoholic fatty liver disease, and sleep apnea [7,8].
Sarcopenia was once thought to be a natural consequence of aging; however, recent studies have shown that its prevalence is increasing across all age groups [9]. This trend is attributed to a combination of factors such as poor dietary habits, reduced physical activity, sedentary lifestyle, and increased stress. Sarcopenia not only causes physical dysfunction but also raises the risk of metabolic and cardiovascular diseases including type 2 diabetes, dyslipidemia, and hypertension [10].
Sarcopenic obesity, characterized by the coexistence of obesity and sarcopenia, leads to more severe adverse outcomes such as impaired physical function, worsened cardiovascular health, elevated risk of metabolic disorders, and reduced exercise capacity. This condition is associated with higher risks of falls, fractures, and mortality than either obesity or sarcopenia alone [11,12].
Obesity, sarcopenia, and sarcopenic obesity not only involve physical changes but also contribute to overall reductions in quality of life (QoL), including negative effects on mental health. These conditions can result in secondary issues such as depression, cognitive decline, and social isolation [13], and are associated with increased medical costs and reduced productivity, placing a significant socioeconomic burden [14]. Globally, healthcare expenditures related to obesity are rising rapidly, and sarcopenic obesity in particular is associated with higher hospitalization and mortality rates [15]. Nevertheless, due to inconsistent definitions, lack of standardized diagnostic criteria, and limitations in measurement tools, the prevalence and clinical significance of sarcopenic obesity may be underestimated [16].
HRQOL refers to an individual’s perceived impact of health status on their functioning, emotions, and daily activities. Health-related Quality of Life Instrument with 8 Items (HINT-8) is a preference-based instrument developed specifically for the general Korean population to assess HRQOL. It provides a single index value reflecting individual health preferences and allows for the calculation of quality-adjusted life years [17]. Notably, HINT-8 is a relatively recent tool that can describe up to 65,536 unique health states, offering far greater granularity compared to the EuroQol-5 Dimensions 3 Levels (EQ-5D-3L), which represents only 243 states. Furthermore, while instruments like the Short Form-36 Health Survey (SF-36) involve complex scoring for the Physical Component Summary and Mental Component Summary and may be less sensitive to subtle health changes, HINT-8 uses a four-level response scale encompassing both daily functioning and emotional well-being, making it more responsive to mild conditions and nuanced changes in QoL.
Therefore, this study aimed to systematically investigate the effects of obesity, sarcopenia, and sarcopenic obesity on health and HRQOL using the HINT-8 instrument. The goal is to raise awareness of these increasingly important public health issues and provide foundational evidence for future research and policy development.
Methods
Study population
This study analyzed data from the 2023 Korea National Health and Nutrition Examination Survey (KNHANES), including 1,836 older adults aged 65 years and above. Exclusions were made for individuals with missing body composition data (n=313), those who lacked handgrip strength measurements (n=80), and those who did not complete the HINT-8 questionnaire (n=56). As a result, a total of 1,387 participants were included in the final analysis. All survey protocols were approved by the Institutional Review Board (IRB) of the Korea Disease Control and Prevention Agency (KDCA; IRB approval no., 2022-11-16-R-A).
Measurement
Health survey and examination survey
The health survey and examination survey of the KNHANES were conducted by trained surveyors from the KDCA using mobile examination centers. Among the health interview components, items related to education and economic activity, morbidity, injury, and physical activity, as well as all items of the nutrition survey, were assessed through face-to-face interviews. Meanwhile, health behavior items such as smoking and alcohol consumption within the health survey were self-reported. Starting in 2023, an online survey was introduced, allowing participants to complete the self-reported questionnaire before visiting the mobile examination center.
Anthropometric measurements included height, weight, waist circumference and body mass index (BMI). Weight was measured using a portable scale with a precision of 0.1 kg. Laboratory tests were conducted using venous blood samples collected after a minimum fasting period of 8 hours. The analyzed parameters included fasting glucose, triglycerides, and high-density lipoprotein cholesterol levels. The collected blood samples were centrifuged, mixed, and refrigerated for storage.
Body composition and handgrip strength assessment
Body composition was measured using a bioelectrical impedance analysis (BIA) device (InBody 970; InBody Co.), which was introduced in 2022. The measured parameters included lean body mass, muscle mass (excluding bone minerals), fat mass, total body water, and phase angle. Muscle mass and fat mass were assessed separately for each limb (right arm, left arm, right leg, and left leg), while phase angle was obtained from the right-side limbs (right arm, trunk, and right leg). Appendicular skeletal muscle mass (ASM) was calculated as the sum of muscle mass in both arms and legs. Participants with implantable pacemakers, implantable cardiac pacemaker-defibrillator, or those who were pregnant were excluded from the assessment.
Handgrip strength was measured using a digital grip strength dynamometer (T.K.K 5401; Takei Scientific Instruments Co.) to evaluate muscle strength distribution, a method that has been in use since 2014. In 2023, handgrip strength was measured in participants aged 65 years and older. Each participant underwent three trials, and for statistical analysis, the maximum value from either the dominant hand or both hands was used.
Health-related Quality of Life Instrument with 8 Items
HRQOL was assessed using the HINT-8 questionnaire [17]. Developed by the KDCA in 2014, HINT-8 consists of eight items across four domains: physical health (climbing stairs, pain, vitality), social health (working), mental health (depression, memory, sleep), and positive health (happiness). Each item is rated on a four-level scale, where score 1 indicates no impairment, and score 4 represents severe impairment. For example, in the climbing stairs category, score 1 corresponds to “I had no difficulty climbing stairs,” while score 4 corresponds to “I was unable to climb stairs.” The total HINT-8 score is calculated by summing the scores of all eight items, with higher scores indicating lower HRQOL.
Definitions of obesity, sarcopenia, and sarcopenic obesity
Obesity was defined according to the criteria established by the Korean Society for the Study of Obesity [18], as a BMI ≥25 kg/m2. Sarcopenia was defined based on the Asian Working Group for Sarcopenia 2019 criteria [19]. Individuals were classified as sarcopenia if they had low handgrip strength, with a maximum value of <28 kg for male participants and <18 kg for female participants (measured twice), and low ASM, defined as ASM/height2<7.0 kg/ m2 for male participants and <5.7 kg/m2 for female participants, assessed using BIA. Sarcopenic obesity was defined as the concurrent presence of both obesity and sarcopenia.
Statistical analysis
All statistical analyses were conducted using weighted data. Continuous variables were presented as mean±standard error, while categorical variables were expressed as frequencies and percentages. To compare differences among the normal, obesity, sarcopenia and sarcopenic obesity groups, one-way analysis of variance was performed for continuous variables, and the chi-square test was used for categorical variables. To examine the independent effects of obesity, sarcopenia, and sarcopenic obesity on individual HINT-8 scores, multiple linear regression analysis was conducted after adjusting for sex, age, income level, education level, marital status, alcohol consumption, smoking status, and comorbidities including hypertension, hyperlipidemia, diabetes, and asthma. All statistical analyses were performed using IBM SPSS ver. 22.0 (IBM Corp.). A P-value <0.05 was considered statistically significant.
Results
Characteristics of study participants
The characteristics of the study participants are presented in Table 1. Among the total participants, 752 (54.22%) were classified as normal group, 484 (34.90%) as obesity group, 136 (9.81%) as sarcopenia group, and 15 (1.08%) as having sarcopenic obesity group. Among male participants, 364 were as the normal group, 199 as the obesity group, 67 as the sarcopenia group, and five as the sarcopenic obesity group. Among female participants, 388 were classified as normal group, 285 as obesity group, 69 as sarcopenia group, and 10 as having sarcopenic obesity group.
Statistically significant differences were noted for BMI, hand grip strength, ASM, and height, which are the key criteria for diagnosing obesity and sarcopenia. For instance, mean body weight was 57.58±7.84 kg in the normal group, 69.15±8.42 kg in the obese group, 51.85±7.58 kg in the sarcopenic group, and 59.62±4.96 kg in the sarcopenic obesity group (P<0.001). Other significantly different indicators included waist circumference (P<0.001), body fat mass (P<0.001), body fat percentage (P<0.001), fasting glucose (P=0.001), and total energy intake (P<0.001). Also, differences were observed across groups in education level (P=0.001), marital/cohabitation status (P=0.004), and alcohol intake (P=0.011).
HRQOL according to obesity, sarcopenia, and sarcopenic obesity status
The differences in HRQOL among the normal, obesity, sarcopenia and sarcopenic obesity groups were analyzed using HINT-8 scores, as presented in Table 2. The HINT-8 climbing stairs score showed a significant difference among the groups, with mean scores of 1.73±0.68 for the normal group, 1.99±0.76 for the obesity group, 2.07±0.82 for the sarcopenia group, and 2.20±0.68 for the sarcopenic obesity group (P<0.001). Similarly, the HINT-8 pain score also demonstrated a significant difference among the groups, with mean scores of 1.85±0.69 in the normal group, 1.93±0.71 in the obesity group, 1.88±0.68 in the sarcopenia group, and 2.33±0.82 in the sarcopenic obesity group (P=0.014). Additionally, significant differences were observed in the HINT-8 working score, HINT-8 memory score, and HINT-8 total score among the groups.
These mean values are visualized in Figure 1. However, since HRQOL can be affected by various other factors beyond obesity, sarcopenia, and sarcopenic obesity, it is necessary to adjust for potential confounders when analyzing these associations.
Association between HINT-8 and obesity, sarcopenia, and sarcopenic obesity
Therefore, multiple linear regression analyses were conducted to examine the independent associations between group status (normal, obesity, sarcopenia, sarcopenic obesity) and each HINT-8 item, adjusting for sex, age, income level, education level, marital status, alcohol consumption, smoking status, and comorbidities including hypertension, hyperlipidemia, diabetes, and asthma. The results are presented in Table 3.
The HINT-8 climbing stairs score was significantly positively associated with all three conditions: obesity (B=0.223, P<0.001), sarcopenia (B=0.242, P<0.001), and sarcopenic obesity (B=0.338, P=0.048). In contrast, the obesity group was significantly negatively associated with the HINT-8 depression score (B=–0.101, P=0.007). The sarcopenia group was significantly associated with higher scores in the HINT-8 working score (B=0.213, P=0.004) and total HINT-8 score (B=0.734, P=0.045). The sarcopenic obesity group showed a significant positive association with the HINT-8 pain score (B=0.382, P=0.034).
Discussion
This study examined the impact of obesity, sarcopenia, and sarcopenic obesity on HRQOL based on the HINT-8 instrument. The results demonstrated that these conditions were significantly associated with overall QoL, particularly in the domains of climbing stairs, pain, working, memory, and total HINT-8 scores. Notably, multiple linear regression analysis adjusted for sex, age, income level, educational attainment, marital status, alcohol consumption, and smoking status revealed that all three conditions were strongly associated with difficulties in climbing stairs. Additionally, obesity was negatively associated with depression, sarcopenia was associated with difficulties in working and higher total HINT-8 scores, and sarcopenic obesity was related to higher pain scores. These findings suggest that physical function decline is closely related to diminished QoL among older adults.
This study confirmed that individuals with obesity had more difficulty climbing stairs but showed a somewhat improved status in depression. It is not surprising that stair climbing becomes more challenging in individuals with obesity due to increased mechanical loading on joints and greater cardiorespiratory burden [8]. Previous studies have reported that individuals with moderate obesity (BMI ≥30 kg/m2) had a 1.18-fold increased risk of experiencing depression [20]. However, other studies have reported different findings. In contrast, the present study found that older adults with a BMI ≥25 kg/m2 showed a tendency toward improved depressive symptoms [21]. This suggests that the relationship between obesity and mental health in older adults may vary depending on age and other contributing factors [22]. Future studies should further analyze these associations across age groups and BMI categories to better understand these dynamics.
Furthermore, this study showed that individuals with sarcopenia experienced greater difficulty in climbing stairs and working, along with higher total HINT-8 scores. These findings imply that muscle loss negatively affects mobility, work ability, and overall QoL. Prior research has reported that sarcopenia leads to decreased physical function, reduced strength, and increased fatigue [23], which in turn impair work productivity and the ability to maintain independent living [24]. In a study using EQ-5D, Sun et al. [25] reported that male participants with sarcopenia experienced greater impairments in mobility, self-care, and usual activities, along with more pain/discomfort, while female participants with sarcopenia showed greater mobility and self-care limitations as well as more anxiety/depression. The findings of this study are consistent with those prior studies, indicating that sarcopenia significantly impacts occupational and social functioning in older adults.
Moreover, the present study found that individuals with sarcopenic obesity had lower QoL scores in the domains of climbing stairs and pain. According to Ozturk et al. [26], individuals with sarcopenic obesity showed the lowest average gait speed and handgrip strength, the highest risk of falls, and an overall negative correlation with SF-36 QoL scores. Similar to these findings, the present study also found that the sarcopenic obesity group had the lowest handgrip strength. Although not statistically significant, this group also showed higher total HINT-8 scores.
This study confirmed that obesity, sarcopenia, and sarcopenic obesity may negatively affect HRQOL, including physical and social domains. Sarcopenic obesity, in particular, contributes to more complex health problems than either obesity or sarcopenia alone. As a multifactorial condition involving chronic inflammation, age-related physiological changes, insulin resistance, anabolic resistance, hormonal alterations, decreased physical activity, and nutritional imbalances, sarcopenic obesity deserves greater attention in both research and clinical practice [27].
To improve QoL in the elderly, effective management and treatment strategies for sarcopenic obesity are essential. Lifestyle modification is critical, and combined aerobic and resistance exercise has been shown to effectively reduce visceral fat and increase muscle mass [28]. Nutritional management also plays an important role in the prevention and treatment of sarcopenic obesity. Adequate intake of high-quality protein and micronutrient supplementation can help preserve muscle mass and improve physical function [29]. Therefore, individualized nutrition strategies and exercise programs should be implemented in patients with sarcopenic obesity, with the goal of improving metabolic health and maintaining physical function.
This study has several strengths. It utilized data from the KNHANES, a large-scale, nationally representative cohort, which lends reliability to the findings. In particular, the study comprehensively evaluated the effects of obesity, sarcopenia, and sarcopenic obesity on QoL using the HINT-8 instrument and assessed the independent effects of each variable using multiple linear regression analysis.
However, this study also has limitations. First, as a cross-sectional study, it is unable to establish causal relationships between obesity, sarcopenia, sarcopenic obesity, and HRQOL. Future longitudinal studies are needed to investigate the long-term impact of changes in body composition on HRQOL. Second, as the study relied on self-reported health questionnaires, there is potential for subjective bias. To enhance reliability, future research should incorporate objective HRQOL assessments and physiological biomarker analyses. Lastly, here are limitations related to the variability in the definitions, diagnostic criteria, and assessment tools for sarcopenic obesity, which may lead to substantial differences in prevalence estimates. In this study, the prevalence of sarcopenic obesity based on the proposed definition was only 1.08% (n=15), which limited the statistical power and interpretability of the results. In 2022, the European Society for Clinical Nutrition and Metabolism and the European Association for the Study of Obesity proposed standardized definitions, diagnostic criteria, and staging systems for sarcopenic obesity. Developing standardized criteria in Korea and applying them in clinical and research settings would improve the identification and management of high-risk patients.
In conclusion, this study demonstrates that obesity, sarcopenia, and sarcopenic obesity are all associated with decreased HRQOL in older adults. These findings underscore the importance of lifestyle interventions that include a balanced diet and regular physical activity, as well as early diagnosis and proactive management. Future research should focus on developing and validating effective intervention strategies and clarifying the causal relationships through long-term follow-up.
Article Information
Conflict of interest
No potential conflict of interest relevant to this article was reported.
Funding
None.
Data availability
The data used in this study are available from the Korea National Health and Nutrition Examination Survey 2023.
Author contribution
All the work was done by Gee Youn Song.
Figure. 1.
Comparison of quality of life (HINT-8) among normal, obese, sarcopenic, and sarcopenic obese groups. HINT-8: (A) climbing stairs, (B) pain, (C) vitality, (D) working, (E) depression, (F) memory, sleep (G), happiness (H), and total (I).
Table 1.
Demographic and lifestyle characteristics of normal, obese, sarcopenic, and sarcopenic obese groups
Characteristic
Normal
Obesity
Sarcopenia
Sarcopenic obesity
P-value
Total
752 (54.22)
484 (34.90)
136 (9.81)
15 (1.08)
Sex
0.047
Male
364 (48.40)
199 (41.12)
67 (49.26)
5 (33.33)
Female
388 (51.60)
285 (58.88)
69 (50.74)
10 (66.67)
Age (y)
71.71±4.79
71.77±4.95
75.46±4.66
74.87±4.16
<0.001
Height (cm)
160.19±8.53
159.07±8.54
156.04±8.06
150.97±6.00
<0.001
Weight (kg)
57.58±7.84
69.15±8.42
51.85±7.58
59.62±4.96
<0.001
Waist circumference (cm)
82.23±7.24
94.07±6.36
80.02±7.82
91.49±6.49
<0.001
Body mass index (kg/m2)
22.38±1.88
27.29±2.08
21.24±2.16
26.14±1.39
<0.001
Body fat mass (kg)
15.99±3.77
24.25±4.75
15.34±4.24
23.81±3.53
<0.001
Body fat percentage (%)
27.96±6.33
35.29±6.24
29.42±6.55
40.01±5.39
<0.001
ASM (kg)
16.82±3.85
18.11±4.01
14.11±3.10
13.44±2.35
<0.001
ASM/weight (%)
28.98±3.90
25.99±3.52
27.09±3.65
22.46±2.70
<0.001
ASM/height2 (kg/m2)
6.46±0.88
7.06±0.88
5.72±0.77
5.85±0.60
<0.001
Hand grip strength (kg)
28.53±7.72
27.45±8.54
19.49±5.31
18.57±5.17
<0.001
Energy intake (kcal/d)
1,678±652.40
1,674±714.03
1,415±552.53
1,404±536.13
<0.001
Income level
0.360
Low
166 (22.16)
117 (24.22)
33 (24.26)
4 (26.67)
Low mid
175 (23.36)
128 (26.50)
33 (24.26)
5 (33.33)
High mid
183 (24.43)
125 (25.88)
39 (28.68)
2 (13.33)
High
225 (30.04)
113 (23.40)
31 (22.79)
4 (26.67)
Education level
0.001
Elementary
295 (39.28)
231 (47.73)
73 (53.68)
9 (60.00)
Middle
157 (20.91)
104 (21.49)
33 (24.26)
4 (26.67)
High
185 (24.63)
101 (20.87)
20 (14.71)
2 (13.33)
Collage
114 (15.18)
48 (9.92)
10 (7.35)
0 (0.00)
Marital status
0.004
Married, living together
556 (73.94)
330 (68.18)
86 (63.24)
7 (46.67)
Other
196 (26.06)
154 (31.82)
50 (36.76)
8 (53.33)
Alcohol intake
0.011
None
360 (47.87)
232 (47.93)
91 (66.91)
7 (46.67)
≤1 time/mo
185 (24.60)
118 (24.38)
20 (14.71)
4 (26.67)
≤1 time/wk
105 (13.96)
64 (13.22)
7 (5.15)
2 (13.33)
≥2 time/wk
102 (13.56)
70 (14.46)
18 (13.24)
2 (13.33)
Smoking status
0.529
Never
448 (59.57)
307 (63.43)
82 (60.29)
11 (73.33)
Ex-smoker
223 (29.65)
138 (28.51)
39 (28.68)
2 (13.33)
Current smoker
81 (10.77)
39 (8.06)
15 (11.03)
2 (13.33)
Moderate intensity exercise or activity
0.257
Yes
180 (23.94)
108 (22.31)
23 (16.91)
2 (13.33)
No
572 (76.06)
379 (77.69)
113 (83.09)
13 (86.67)
Discomfort in past 2 wk
0.875
Yes
203 (26.99)
123 (25.41)
36 (26.47)
3 (20.00)
No
549 (73.01)
361 (74.59)
100 (73.53)
12 (80.00)
Restrictions on activity
0.047
Yes
100 (13.30)
67 (13.84)
29 (21.32)
4 (26.67)
No
652 (86.70)
417 (86.16)
107 (28.68)
11 (73.33)
Comorbidity
Hypertension
341 (45.30)
311 (64.30)
70 (51.50)
14 (93.30)
<0.001
Hyperlipidemia
288 (38.30)
228 (47.10)
49 (36.00)
8 (53.30)
0.007
Diabetes
148 (19.70)
117 (24.20)
38 (27.90)
6 (40.00)
0.027
Asthma
21 (2.80)
21 (4.30)
6 (4.40)
3 (20.00)
0.003
Kidney disease
29 (3.90)
14 (2.90)
7 (5.10)
2 (13.30)
0.135
Values are presented as number (%) or mean±standard error. P-values were obtained by the chi-square test for categorical variables and one-way analysis of variance for continuous variables.
ASM, appendicular skeletal muscle mass.
Table 2.
Comparison of quality of life (HINT-8) among normal, obese, sarcopenic, and sarcopenic obese groups
Variable
Normal
Obesity
Sarcopenia
Sarcopenic obesity
P-value
Climbing stairs
1.73±0.68
1.99±0.76
2.07±0.82
2.20±0.68
<0.001
Pain
1.85±0.69
1.93±0.71
1.88±0.68
2.33±0.82
0.014
Vitality
2.11±0.94
2.06±0.98
2.30±1.06
2.27±1.03
0.077
Working
1.78±0.76
1.81±0.83
2.10±0.93
2.20±1.01
<0.001
Depression
1.53±0.66
1.44±0.64
1.53±0.64
1.73±0.80
0.056
Memory
1.80±0.58
1.76±0.61
1.91±0.65
2.07±0.70
0.017
Sleep
1.73±0.68
1.74±0.79
1.80±0.74
2.00±0.65
0.407
Happiness
2.26±0.92
2.20±0.95
2.36±1.01
2.47±1.06
0.269
HINT-8 total
14.79±3.90
14.94±4.14
15.96±4.16
17.27±3.69
0.002
Values are presented as mean±standard error. P-values were obtained by one-way analysis of variance.
HINT-8, Health-related Quality of Life Instrument with 8 Items.
Table 3.
Association between normal, obese, sarcopenic, sarcopenic obese groups and HINT-8
Variable
Normal
Obesity
Sarcopenia
Sarcopenic obesity
Adjusted R2
DW
F (P-value)
B
SE
t-value
P-value
B
SE
t-value
P-value
B
SE
t-value
P-value
Climbing stairs
-
0.223
0.041
5.478
<0.001
0.242
0.066
3.678
<0.001
0.338
0.181
1.864
0.048
0.112
1.912
18.376 (≤0.001)
Pain
-
0.053
0.040
1.326
0.185
–0.010
0.065
–0.148
0.883
0.382
0.180
2.126
0.034
0.043
1.928
7.216 (≤0.001)
Vitality
-
–0.110
0.055
–1.998
0.062
0.074
0.089
0.831
0.406
–0.008
0.246
–0.031
0.975
0.065
2.006
10.674 (≤0.001)
Working
-
0.002
0.046
0.033
0.973
0.213
0.075
2.859
0.004
0.276
0.205
1.343
0.179
0.070
1.843
11.474 (≤0.001)
Depression
-
–0.101
0.038
–2.701
0.007
0.008
0.061
0.128
0.898
0.138
0.167
0.825
0.409
0.041
1.938
6.909 (≤0.001)
Memory
-
–0.054
0.035
–1.545
0.123
0.080
0.057
1.398
0.162
0.211
0.157
1.345
0.179
0.018
1.989
3.582 (≤0.001)
Sleep
-
–0.016
0.042
–0.381
0.703
0.057
0.068
0.836
0.403
0.201
0.187
1.074
0.283
0.029
1.952
5.054 (≤0.001)
Happiness
-
–0.086
0.054
–1.586
0.113
0.069
0.088
0.792
0.428
0.069
0.241
0.284
0.776
0.041
2.003
6.978 (≤0.001)
HINT-8 total
-
–0.090
0.226
–0.397
0.691
0.734
0.366
2.006
0.045
1.607
1.007
1.595
0.111
0.089
1.858
14.538 (≤0.001)
P-values are obtained by multiple linear regression analysis.
HINT-8, Health-related Quality of Life Instrument with 8 Items; B, unstandardized coefficient; SE, standard error; DW, Durbin-Watson.
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Health-related quality of life in older Koreans: a HINT-8-based cross-sectional analysis of obesity, sarcopenia, and sarcopenic obesity using the 2023 Korea National Health and Nutrition Examination Survey
Figure. 1. Comparison of quality of life (HINT-8) among normal, obese, sarcopenic, and sarcopenic obese groups. HINT-8: (A) climbing stairs, (B) pain, (C) vitality, (D) working, (E) depression, (F) memory, sleep (G), happiness (H), and total (I).
Graphical abstract
Figure. 1.
Graphical abstract
Health-related quality of life in older Koreans: a HINT-8-based cross-sectional analysis of obesity, sarcopenia, and sarcopenic obesity using the 2023 Korea National Health and Nutrition Examination Survey
Characteristic
Normal
Obesity
Sarcopenia
Sarcopenic obesity
P-value
Total
752 (54.22)
484 (34.90)
136 (9.81)
15 (1.08)
Sex
0.047
Male
364 (48.40)
199 (41.12)
67 (49.26)
5 (33.33)
Female
388 (51.60)
285 (58.88)
69 (50.74)
10 (66.67)
Age (y)
71.71±4.79
71.77±4.95
75.46±4.66
74.87±4.16
<0.001
Height (cm)
160.19±8.53
159.07±8.54
156.04±8.06
150.97±6.00
<0.001
Weight (kg)
57.58±7.84
69.15±8.42
51.85±7.58
59.62±4.96
<0.001
Waist circumference (cm)
82.23±7.24
94.07±6.36
80.02±7.82
91.49±6.49
<0.001
Body mass index (kg/m2)
22.38±1.88
27.29±2.08
21.24±2.16
26.14±1.39
<0.001
Body fat mass (kg)
15.99±3.77
24.25±4.75
15.34±4.24
23.81±3.53
<0.001
Body fat percentage (%)
27.96±6.33
35.29±6.24
29.42±6.55
40.01±5.39
<0.001
ASM (kg)
16.82±3.85
18.11±4.01
14.11±3.10
13.44±2.35
<0.001
ASM/weight (%)
28.98±3.90
25.99±3.52
27.09±3.65
22.46±2.70
<0.001
ASM/height2 (kg/m2)
6.46±0.88
7.06±0.88
5.72±0.77
5.85±0.60
<0.001
Hand grip strength (kg)
28.53±7.72
27.45±8.54
19.49±5.31
18.57±5.17
<0.001
Energy intake (kcal/d)
1,678±652.40
1,674±714.03
1,415±552.53
1,404±536.13
<0.001
Income level
0.360
Low
166 (22.16)
117 (24.22)
33 (24.26)
4 (26.67)
Low mid
175 (23.36)
128 (26.50)
33 (24.26)
5 (33.33)
High mid
183 (24.43)
125 (25.88)
39 (28.68)
2 (13.33)
High
225 (30.04)
113 (23.40)
31 (22.79)
4 (26.67)
Education level
0.001
Elementary
295 (39.28)
231 (47.73)
73 (53.68)
9 (60.00)
Middle
157 (20.91)
104 (21.49)
33 (24.26)
4 (26.67)
High
185 (24.63)
101 (20.87)
20 (14.71)
2 (13.33)
Collage
114 (15.18)
48 (9.92)
10 (7.35)
0 (0.00)
Marital status
0.004
Married, living together
556 (73.94)
330 (68.18)
86 (63.24)
7 (46.67)
Other
196 (26.06)
154 (31.82)
50 (36.76)
8 (53.33)
Alcohol intake
0.011
None
360 (47.87)
232 (47.93)
91 (66.91)
7 (46.67)
≤1 time/mo
185 (24.60)
118 (24.38)
20 (14.71)
4 (26.67)
≤1 time/wk
105 (13.96)
64 (13.22)
7 (5.15)
2 (13.33)
≥2 time/wk
102 (13.56)
70 (14.46)
18 (13.24)
2 (13.33)
Smoking status
0.529
Never
448 (59.57)
307 (63.43)
82 (60.29)
11 (73.33)
Ex-smoker
223 (29.65)
138 (28.51)
39 (28.68)
2 (13.33)
Current smoker
81 (10.77)
39 (8.06)
15 (11.03)
2 (13.33)
Moderate intensity exercise or activity
0.257
Yes
180 (23.94)
108 (22.31)
23 (16.91)
2 (13.33)
No
572 (76.06)
379 (77.69)
113 (83.09)
13 (86.67)
Discomfort in past 2 wk
0.875
Yes
203 (26.99)
123 (25.41)
36 (26.47)
3 (20.00)
No
549 (73.01)
361 (74.59)
100 (73.53)
12 (80.00)
Restrictions on activity
0.047
Yes
100 (13.30)
67 (13.84)
29 (21.32)
4 (26.67)
No
652 (86.70)
417 (86.16)
107 (28.68)
11 (73.33)
Comorbidity
Hypertension
341 (45.30)
311 (64.30)
70 (51.50)
14 (93.30)
<0.001
Hyperlipidemia
288 (38.30)
228 (47.10)
49 (36.00)
8 (53.30)
0.007
Diabetes
148 (19.70)
117 (24.20)
38 (27.90)
6 (40.00)
0.027
Asthma
21 (2.80)
21 (4.30)
6 (4.40)
3 (20.00)
0.003
Kidney disease
29 (3.90)
14 (2.90)
7 (5.10)
2 (13.30)
0.135
Variable
Normal
Obesity
Sarcopenia
Sarcopenic obesity
P-value
Climbing stairs
1.73±0.68
1.99±0.76
2.07±0.82
2.20±0.68
<0.001
Pain
1.85±0.69
1.93±0.71
1.88±0.68
2.33±0.82
0.014
Vitality
2.11±0.94
2.06±0.98
2.30±1.06
2.27±1.03
0.077
Working
1.78±0.76
1.81±0.83
2.10±0.93
2.20±1.01
<0.001
Depression
1.53±0.66
1.44±0.64
1.53±0.64
1.73±0.80
0.056
Memory
1.80±0.58
1.76±0.61
1.91±0.65
2.07±0.70
0.017
Sleep
1.73±0.68
1.74±0.79
1.80±0.74
2.00±0.65
0.407
Happiness
2.26±0.92
2.20±0.95
2.36±1.01
2.47±1.06
0.269
HINT-8 total
14.79±3.90
14.94±4.14
15.96±4.16
17.27±3.69
0.002
Variable
Normal
Obesity
Sarcopenia
Sarcopenic obesity
Adjusted R2
DW
F (P-value)
B
SE
t-value
P-value
B
SE
t-value
P-value
B
SE
t-value
P-value
Climbing stairs
-
0.223
0.041
5.478
<0.001
0.242
0.066
3.678
<0.001
0.338
0.181
1.864
0.048
0.112
1.912
18.376 (≤0.001)
Pain
-
0.053
0.040
1.326
0.185
–0.010
0.065
–0.148
0.883
0.382
0.180
2.126
0.034
0.043
1.928
7.216 (≤0.001)
Vitality
-
–0.110
0.055
–1.998
0.062
0.074
0.089
0.831
0.406
–0.008
0.246
–0.031
0.975
0.065
2.006
10.674 (≤0.001)
Working
-
0.002
0.046
0.033
0.973
0.213
0.075
2.859
0.004
0.276
0.205
1.343
0.179
0.070
1.843
11.474 (≤0.001)
Depression
-
–0.101
0.038
–2.701
0.007
0.008
0.061
0.128
0.898
0.138
0.167
0.825
0.409
0.041
1.938
6.909 (≤0.001)
Memory
-
–0.054
0.035
–1.545
0.123
0.080
0.057
1.398
0.162
0.211
0.157
1.345
0.179
0.018
1.989
3.582 (≤0.001)
Sleep
-
–0.016
0.042
–0.381
0.703
0.057
0.068
0.836
0.403
0.201
0.187
1.074
0.283
0.029
1.952
5.054 (≤0.001)
Happiness
-
–0.086
0.054
–1.586
0.113
0.069
0.088
0.792
0.428
0.069
0.241
0.284
0.776
0.041
2.003
6.978 (≤0.001)
HINT-8 total
-
–0.090
0.226
–0.397
0.691
0.734
0.366
2.006
0.045
1.607
1.007
1.595
0.111
0.089
1.858
14.538 (≤0.001)
Table 1. Demographic and lifestyle characteristics of normal, obese, sarcopenic, and sarcopenic obese groups
Values are presented as number (%) or mean±standard error. P-values were obtained by the chi-square test for categorical variables and one-way analysis of variance for continuous variables.
ASM, appendicular skeletal muscle mass.
Table 2. Comparison of quality of life (HINT-8) among normal, obese, sarcopenic, and sarcopenic obese groups
Values are presented as mean±standard error. P-values were obtained by one-way analysis of variance.
HINT-8, Health-related Quality of Life Instrument with 8 Items.
Table 3. Association between normal, obese, sarcopenic, sarcopenic obese groups and HINT-8
P-values are obtained by multiple linear regression analysis.
HINT-8, Health-related Quality of Life Instrument with 8 Items; B, unstandardized coefficient; SE, standard error; DW, Durbin-Watson.
