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Joint Association of Relative Grip Strength and Resting Heart Rate with the Risk of Developing Diabetes in Middle-Aged Adults
Korean J Sports Med 2023;41:216-224
Published online December 1, 2023;  https://doi.org/10.5763/kjsm.2023.41.4.216
© 2023 The Korean Society of Sports Medicine.

DooYong Park1, YeonSoo Kim1, Eunkyung Kim2

1Department of Physical Education, College of Education, Seoul National University, Seoul, 2Department of Physical Education, College of Education, Chonnam National University, Gwangju, Korea
Correspondence to: Eunkyung Kim
Department of Physical Education, College of Education, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Korea
Tel: +82-2-880-7794, Fax: +82-2-880-7794, E-mail: eunkkim88@gmail.com
Received September 12, 2023; Revised October 27, 2023; Accepted October 30, 2023.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Purpose: Our primary aim was to elucidate the association between relative grip strength levels and the risk of developing diabetes, utilizing longitudinal data.
Methods: A total of 1,935 participants in this study comprised general adults aged 51 to 81 years, who had engaged in the survey both in 2013–2014 and during the subsequent follow-up in 2019–2020. The criteria for diagnosing diabetes included receiving a diabetes diagnosis and treatment. grip strength was converted into relative grip strength by dividing it by body mass index. To validate the relationship between the interaction of relative grip strength and resting heart rate and its impact on risk of developing diabetes, a proportional hazards Cox regression model was used. Subsequently, we computed the hazard ratio (HR) and 95% confidence interval (CI) for risk of developing diabetes.
Results: After adjusting for various confounding variables, we observed a significant 46% reduction in the risk of developing diabetes in the high relative grip strength group compared to the low relativegrip strength group (HR, 0.54; 95% CI, 0.36–0.80). However, upon additional adjustment for waist circumference, no significant findings could be yielded. Furthermore, we found significant differences the relationship between relative grip strength, resting heart rate, and the risk of developing diabetes among different groups.
Conclusion: This study investigates the relationship between relative grip strength and incidence of diabetes, attributed to the accumulation of body fat. Notably, both resting heart rate and relative grip strength emerge as predictive indicators for assessing the risk of diabetes development.
Keywords : Hand strength, Muscle strength, Heart rate, Diabetes mellitus, Insulin resistance
꽌 濡

젣2삎 떦눊蹂묒 떖삁愿吏덊솚쓽 쐞뿕슂냼濡, 씠瑜 愿由ы븯湲 쐞빐 援젣쟻쑝濡 떖媛곹븳 옱젙 넀떎쓣 빞湲고븯怨 엳떎1. 쁽옱 誘멸뎅쓽 寃쎌슦 떦눊蹂 쑀蹂묐쪧씠 10.5%뿉 떖븯硫, 씠 以 젣2삎 떦눊蹂묒씠 90%뿉꽌 95%瑜 李⑥븯怨 엳떎2. 援궡뿉꽌 蹂닿퀬맂 뿰援 寃곌낵뿉 뵲瑜대㈃ 떦눊蹂 쑀蹂묐쪧 궓옄 12.8%, 뿬옄 7.8%쑝硫, 留 19꽭 씠긽쓽 떦눊蹂 쑀蹂묐쪧 13.6%濡 2012뀈(9.7%)遺꽣 젏李 利앷븯怨 엳뒗 異붿꽭씠떎. 듅엳 65꽭 씠긽 끂씤쓽 寃쎌슦 3紐 以 1紐낆씠 떦눊蹂묒쓣 吏꾨떒諛쏆븯떎. 떦눊蹂묒뿉 븳 移섎즺쑉 62.4%濡, 怨쇨굅뿉 鍮꾪빐 移섎즺쑉씠 媛쒖꽑릺뿀쓬쓣 蹂닿퀬븯떎3. 씠젃벏 떦눊蹂묒 쟾 꽭怨꾩쟻쑝濡 留뚯뿰븳 긽깭씠硫, 쟾 꽭怨꾩쟻쑝濡 珥 63留 紐낆뿉 떖븯뒗 궗엺씠 떦눊蹂묒쑝濡 씤빐 愿由ш 븘슂븳 긽솴씠떎4.

떦눊蹂 愿由 諛⑸쾿 以 븯굹濡 洹쒖튃쟻씤 洹쇰젰슫룞 닔뻾 넂 洹쇰젰쓣 쑀吏떆궎뒗 寃껋쑝濡 븣젮졇 엳뒗뜲5, 洹쇰젰 굹씠, 鍮꾨쭔, 궙 떊泥댄솢룞, 떊옣吏덊솚, 뿼利앹꽦 궗씠넗移댁씤 벑怨 뿰愿븯뿬 떦눊瑜 룷븿븳 궗꽦 吏덊솚 諛쒖깮怨 諛젒븳 뿰愿꽦쓣 媛吏怨 엳쓬쓣 蹂닿퀬븯떎6. 떎젣濡 긽吏 洹쇰젰쓣 몴븯뒗 븙젰 쁽옱 泥대젰 긽깭瑜 諛섏쁺븯硫 諛섎났쟻씤 슫룞 李몄뿬 떆 떦눊蹂 쐞뿕 젙룄瑜 솗씤븷 닔 엳뒗 留덉빱濡 궗슜릺뼱 솕怨7, 젅 븙젰뿉 떊泥 鍮꾩쨷쓣 蹂댁젙븳 긽 븙젰(relative grip strength, RGS)쓽 寃쎌슦 젅 븙젰蹂대떎 吏덈퀝 긽깭瑜 삁痢≫븯뒗 뜲뿉 긽썡븯떎怨 蹂닿퀬맂 諛 엳떎8. 꽑뻾 뿰援ъ뿉 뵲瑜대㈃ 젅 븙젰 긽옄쓽 泥댁쨷怨 젙쟻 긽愿愿怨꾧 엳뼱 젅 븙젰쓽 利앷濡 씤빐 궗꽦 吏덊솚쓽 쐞뿕씠 삤엳젮 利앷븷 닔 엳怨, 諛섎㈃ 젅 븙젰쓣 泥댁쭏웾쑝濡 굹늿 RGS뒗 鍮꾨쭔怨 遺쟻 긽愿愿怨꾨 媛뽮린 븣臾몄뿉 RGS쓽 利앷媛 떦눊 媛숈 궗吏덊솚쓽 쐞뿕 媛먯냼 諛젒븳 뿰愿꽦쓣 媛吏怨 엳쓬쓣 솗씤븷 닔 엳뿀떎9.

쁽옱源뚯 洹쇰젰怨 떦눊蹂묒쓽 뿰愿꽦뿉 븳 뿰援щ뒗 떎닔 吏꾪뻾릺뼱 솕떎. 理쒓렐 援궡뿉꽌 吏꾪뻾맂 븞젙떆 떖諛뺤닔(resting heart rate, RHR), RGS 떦눊蹂 쑀蹂묐쪧쓽 뿰愿꽦쓣 솗씤븳 뿰援ъ뿉꽌 넂 RHR怨 궙 RGS媛 떦눊蹂 쐞뿕쓣 넂씤떎뒗 寃껋쓣 솗씤븯쑝굹, 뿰援ш 65꽭 씠긽 끂씤쓣 긽쑝濡 븯怨 슒떒 뿰援щ줈 吏꾪뻾릺뿀湲 븣臾몄뿉 RHR, RGS 떦눊蹂 쐞뿕 媛꾩쓽 씤怨쇨怨꾨 솗씤븷 닔 뾾뿀쓬쓣 젣븳젏쑝濡 떆궗븯떎10. 삉븳 22媛쒖쓽 떦눊蹂묎낵 떖룓泥대젰 愿젴 뿰援ъ 13媛쒖쓽 떦눊蹂묎낵 洹쇰젰 愿젴 硫뷀 遺꾩꽍뿰援 寃곌낵뿉 뵲瑜대㈃, 誘몃옒쓽 뿰援 二쇱젣濡쒖꽌 떦눊蹂 쐞뿕怨 뿰愿맂 떖룓泥대젰怨 洹쇰젰쓽 떆꼫吏 슚怨쇰 솗씤빐빞 븿쓣 媛뺤“븯떎11. 뵲씪꽌 蹂 뿰援ъ뿉꽌뒗 醫낅떒 뜲씠꽣瑜 넻빐 RGS 닔以怨 떦눊蹂 諛쒖깮쐞뿕쓽 룆由쎌쟻씤 뿰愿꽦쓣 솗씤븯怨, RGS RHR쓽 긽샇옉슜씠 떦눊蹂 諛쒖깮뿉 뼱뼚븳 뿰愿꽦쓣 媛吏뒗吏 솗씤븯怨좎옄 븳떎.

뿰援 諛⑸쾿

1. 뿰援 긽

蹂 뿰援ъ뿉꽌뒗 븳援씤쓣 긽쑝濡 嫄닿컯 諛 깮솢뒿愿 젙蹂 벑쓣 議곗궗븯뿬 떦눊蹂 벑 留뚯꽦吏덊솚 愿由ъ移⑥쓣 닔由쏀븯怨좎옄 援ъ텞븳 洹쒕え 肄뷀샇듃 議곗궗씤 븳援씤 쑀쟾泥 뿭븰議곗궗(Korean Genome and Epidemiology Study, KoGES)뿉꽌 뼸 뜲씠꽣瑜 넗濡 遺꾩꽍뿉 솢슜븯떎12. 蹂 뿰援щ뒗 씪諛 꽦씤뱾쓣 긽쑝濡 븳 吏뿭궗쉶湲곕컲肄뷀샇듃 7湲(2013–2014뀈)瑜 湲곕컲議곗궗濡 꽕젙븯怨, 吏뿭궗쉶 湲곕컲 肄뷀샇듃 10湲(2019–2020뀈)쓽 3李 異붿쟻議곗궗源뚯 2쉶 씠긽 李몄뿬븳 寃쎄린룄 븞꽦떆 嫄곗< 51꽭遺꽣 82꽭쓽 씪諛 꽦씤뱾쓣 긽쑝濡 꽑젙븯떎. 빐떦 議곗궗뒗 쟾솕, 슦렪, 嫄곗<吏 諛⑸Ц 벑쓽 諛⑸쾿쑝濡 珥 4,814紐낆쓣 紐⑥쭛븯怨, 씪李⑥쟻쑝濡 湲곕컲議곗궗뿉꽌 떦눊蹂(n=1,056)씠굹 떖삁愿吏덊솚(n=18)씠 엳뒗 1,074紐낆쓣 젣쇅븳 3,740紐낆쓣 꽑諛쒗븯떎. 씠썑 떦눊蹂묎낵 RGS뿉 쁺뼢쓣 겮移섎뒗 蹂닔뿉 寃곗륫씠 엳뒗 긽옄 1,805紐낆쓣 젣쇅븳 룊洹 愿李곌린媛 5.12뀈(踰붿쐞, 1.58–6.50뀈)쓽 理쒖쥌 1,935紐낆쓣 遺꾩꽍뿉 솢슜븯떎. 蹂 뿰援щ뒗 KoGES 옄猷뚮 솢슜븳 씠李⑤텇꽍 뿰援щ줈 紐⑤뱺 蹂씤 KoGES瑜 넻빐 닔吏묐맂 뿭븰옄猷뚮 솢슜븯쑝硫, 吏뿭궗쉶 湲곕컲議곗궗 떎떆湲곌씤 怨좊젮븰援 쓽怨쇰븰 븞궛蹂묒썝怨 꽌슱븰援 깮紐낆쑄由ъ쐞썝쉶쓽 듅씤쓣 嫄곗퀜 吏꾪뻾븯떎(No. E2112/001-009).

2. 痢≪젙 蹂씤

1) 떦눊蹂

떦눊蹂묒쓽 吏꾨떒 2023뀈 떦눊蹂 愿由щ 쐞븳 떦눊蹂 吏꾨떒怨 遺꾨쪟瑜 떎猷 꽑뻾뿰援ъ RHR, RGS 떦눊蹂 쑀蹂묐쪧쓣 솗씤븳 꽑뻾뿰援щ 李멸퀬븯뿬 怨듬났 떆 삁떦씠 126 mg/dL 씠긽씠嫄곕굹 떦솕삁깋냼媛 6.5% 씠긽, 삉뒗 “洹븯뒗 떦눊蹂묒쓣 吏꾨떒諛쏆 쟻씠 엳뒿땲源?” “寃쎄뎄슜 떦눊蹂 빟 쁽옱 吏냽 뿬遺”쓽 꽕臾 빆紐⑹뿉 “삁” 씪怨 쓳떟븯쓣 寃쎌슦瑜 떦눊蹂묒쑝濡 洹쒖젙븯떎10.

2) 긽 븙젰怨 븞젙떆 떖諛뺤닔

븙젰寃궗(grip strength test, kg)뒗 痢≪젙諛⑸쾿씠 鍮꾧탳쟻 媛꾨떒븯怨 떒떆媛꾩뿉 寃곌낵瑜 븣 닔 엳쑝硫, 떎젣濡 떎瑜 洹쇰젰怨 긽愿꽦씠 넂떎. 븙젰 痢≪젙옣鍮꾨뒗 JAMA 5030J1 (SAEHAN)쓣 씠슜븯쑝硫, 쓽옄뿉 븠븘 뙏쓽 媛곷룄瑜 90°濡 쑀吏븳 긽깭뿉꽌 븙젰쓣 痢≪젙븯떎. 醫∙슦 3쉶뵫 痢≪젙븯뿬 룊洹좉컪쓣 湲곕줉븳떎. 蹂 뿰援ъ뿉꽌뒗 泥댁쭏웾吏닔(body mass index, BMI)瑜 蹂댁젙븳 RGS媛 젅 븙젰蹂대떎 留뚯꽦吏덊솚 삁痢≪뿉 슚怨쇱쟻씤 吏몴엫쓣 紐낆떆븳 꽑뻾뿰援ъ뿉 뵲씪, 궛異쒕맂 젅 븙젰쓣 BMI (泥댁쨷[kg]/떊옣쓽 젣怨[m2])濡 굹늿 RGS쑝濡 蹂솚븯怨13, 꽦蹂꾩뿉 뵲씪 궓꽦 3遺꾩쐞(low, 0.63–1.34 kg/BMI; middle, 1.34–1.65 kg/BMI; high, 1.65–2.69 kg/BMI), 뿬꽦 3遺꾩쐞(low, 0.20–0.73 kg/BMI; middle, 0.73–0.90 kg/BMI; high, 0.90–1.80 kg/BMI)瑜 넻빀븯뿬 遺꾩꽍뿉 솢슜븯떎.

RHR 옄룞 삁븬怨(FT-500; Jawon Medical Co. Ltd.)瑜 궗슜븯쑝硫, 삁븬쓣 痢≪젙븯뒗 룞븞쓽 떖諛뺤닔瑜 痢≪젙븯怨, 씠瑜 넻빐 遺꾨떦 RHR (beats/min)쓣 궛異쒗븯떎. 궛異쒕맂 RHR 꽦蹂 援щ텇뾾씠 2遺꾩쐞(low, 40–59 beats/min; high, 60–98 beats/min)濡 굹늿 뮘 遺꾩꽍뿉 씠슜븯떎.

異붽쟻쑝濡 RGS RHR쓽 긽샇옉슜쓣 솗씤븯湲 쐞빐 RGS뒗 꽦蹂꾨줈 援щ텇븯뿬 2遺꾩쐞濡 굹늻怨 RHR 꽦蹂꾧낵 愿怨꾩뾾씠 2遺꾩쐞濡 굹늿 뮘, RGS媛 궙怨 RHR씠 넂 寃쎌슦 “RGS low/RHR high”, RGS RHR씠 紐⑤몢 궙 寃쎌슦 “RGS low/RHR low”, RGS RHR씠 紐⑤몢 넂 寃쎌슦 “RGS high/RHR high”, RGS뒗 넂吏留 RHR씠 궙 寃쎌슦 “RGS high/RHR low”濡 援щ텇븯뿬 遺꾩꽍뿉 솢슜븯떎.

3) 삁븸 蹂씤 痢≪젙

紐⑤뱺 議곗궗 李몄뿬옄뿉寃 8떆媛 씠긽 怨듬났쓣 쑀吏븯寃 븳 썑 삁泥 梨꾩랬瑜 넻븯뿬 씪諛 삁븸寃궗瑜 떆뻾븯떎. 寃궗 떦씪 梨꾩랬맂 삁븸 깦뵆 쁽옣뿉꽌 썝떖遺꾨━湲곕줈 泥섎━ 썑, 꽌슱쓽怨쇳븰뿰援ъ냼(Seoul Clinical Laboratory)濡 蹂대궡 ADVIA 1800 auto analyzer (Siemens)瑜 씠슜븳 삁븸寃궗濡쒕꽣 뼸뼱吏 寃곌낵 以 떦눊蹂묎낵 뿰愿맂 삁떦, 怨좉컧룄 C-諛섏쓳 떒諛(high-sensitivity C-reactive protein, hs-CRP), 삁以 겕젅븘떚땶, 씤뒓由곗쓣 뿰援 옄猷뚮줈 솢슜븯떎. 寃泥 泥섎━ 諛 옣 吏덈퀝愿由щ낯遺 쑀쟾泥댁뿰援ы뿉꽌 씪愿꾩쟻쑝濡 蹂닿븯떎. 異붿젙 궗援ъ껜뿬怨쇱쑉(estimated glomerular filtration ratio, eGFR) 꽑뻾뿰援ъ뿉 洹쇨굅븯뿬 삁以 겕젅븘떚땶쓣 씠슜븳 MDRD (Modification of Diet in Renal Disease) study 怨듭떇(in mL/min per 1.73 m2=175×serum creatinine–1.154× age–0.203×[0.742 if female])쑝濡 媛믪쓣 궛異쒗븯뿬 뿰냽蹂닔濡 遺꾩꽍뿉 씠슜븯떎14.

4) 꽕臾몄“궗 諛 湲고 蹂닔

떊泥 怨꾩륫 떊옣(cm), 泥댁쨷(kg)쓣 痢≪젙븯떎. 떊옣怨 泥댁쨷 븳 踰덉뵫 痢≪젙븯쑝硫, RGS瑜 援ы븯湲 쐞빐 BMI瑜 궛異쒗븯뿬 遺꾩꽍뿉 씠슜븯떎. 븙젰뿉 쁺뼢쓣 誘몄튂뒗 젣吏諛⑸웾 Zeus 9.9 (Jawon Medical Co., Ltd.)瑜 씠슜븯뿬 痢≪젙맂 媛믪쓣 遺꾩꽍뿉 씠슜븯떎. 궡옣吏諛 吏몴씤 뿀由щ몮젅뒗 痢≪젙 삤李⑤ 以꾩씠怨좎옄 議곗궗 李몄뿬옄媛 몢 뙏쓣 뱾怨 몢 떎由щ 遺숈뿬 삊諛붾줈 꽌엳뒗 긽깭뿉꽌 뒔怨④낵 옣怨 궗씠 媛옣 媛뒗 뿀由 遺쐞쓽 몮젅瑜 꽭 踰 痢≪젙븯怨, 꽭 痢≪젙移섏쓽 룊洹좎쓣 怨꾩궛븯뿬 遺꾩꽍뿉 씠슜븯떎. 꽕臾 빆紐⑹ 議곗궗슂썝뿉 쓽븳 씪씪 硫댁젒 꽕臾몄쑝濡 떎떆븯怨, 떦씪 議곗궗 썑 꽕臾몄쓣 寃넗븯怨 닔젙 蹂댁셿옉뾽쓣 넻븯뿬 꽕臾몄쓽 셿꽦룄瑜 넂떎. 쓬二 뿬遺뒗 “洹븯뒗 썝옒 닠쓣 紐 留덉떆嫄곕굹 삉뒗 泥섏쓬遺꽣 닠쓣 븞 留덉떗땲源?”씪뒗 吏덈Ц뿉 ‘삁’濡 떟븷 寃쎌슦 ‘쓬二쇨꼍뿕 뾾쓬’쑝濡 遺꾨쪟븯怨, ‘븘땲삤’濡 떟븷 寃쎌슦 “吏湲덈룄 留덉떗땲源?”씪뒗 異붽 吏덈Ц쓣 븯뿬 ‘븘땲삤’濡 떟븷 寃쎌슦 ‘怨쇨굅 쓬二’, ‘삁’濡 떟븷 寃쎌슦 ‘쁽옱 쓬二’濡 遺꾨쪟 썑 遺꾩꽍뿉 룷븿븯떎. 씉뿰 뿬遺뒗 “洹븯뒗 吏湲덇퉴吏 떞諛곕 넻뼱 5媛(100媛쒕퉬) 씠긽 뵾썱뒿땲源?”씪뒗 吏덈Ц뿉 ‘븘땲삤’濡 떟븷 寃쎌슦 ‘씉뿰 寃쏀뿕 뾾쓬’쑝濡 援щ텇븯怨, 빐떦 吏덈Ц뿉 ‘삁’濡 떟븷 寃쎌슦 “吏湲덈룄 뵾슦떗땲源?”씪怨 異붽 吏덈Ц쓣 븯뿬 ‘븘땲삤’濡 떟븷 寃쎌슦 ‘怨쇨굅 씉뿰’, ‘삁’濡 떟븷 寃쎌슦 ‘쁽옱 씉뿰’쑝濡 援щ텇븯뿬 遺꾩꽍뿉 씠슜븯떎. 슫룞 李몄뿬 뿬遺뒗 “紐몄뿉 씠 궇 젙룄쓽 슫룞쓣 洹쒖튃쟻쑝濡 븯떗땲源?”씪뒗 吏덈Ц뿉 ‘븘땲삤’濡 떟蹂븷 寃쎌슦 ‘洹쒖튃쟻씤 슫룞 誘 李몄뿬’濡, ‘삁’濡 떟蹂븷 寃쎌슦 ‘洹쒖튃쟻씤 슫룞 李몄뿬’濡 援щ텇븯뿬 遺꾩꽍뿉 씠슜븯떎. 媛議 냼뱷닔以 “洹븯 媛젙쓽 썡 룊洹 닔엯 뼱뒓 젙룄 릺떗땲源?”씪뒗 吏덈Ц뿉 ‘50留 썝 誘몃쭔’怨 ‘50留–100留 썝 誘몃쭔’쑝濡 쓳떟븳 寃쎌슦 ‘100留 썝 誘몃쭔’쑝濡, ‘100留–150留 썝 誘몃쭔’怨 ‘150留–200留 썝 誘몃쭔’쑝濡 쓳떟븳 寃쎌슦 ‘100留–200留 썝’쑝濡, ‘200留–300留 썝 誘몃쭔’씠씪怨 쓳떟븳 寃쎌슦 ‘200留–300留 썝’쑝濡, ‘300留–400留 썝 誘몃쭔’씠씪怨 쓳떟븳 寃쎌슦 ‘300留–400留 썝’쑝濡, ‘400留–600留 썝 誘몃쭔’怨 ‘600留 썝 씠긽’쑝濡 쓳떟븳 寃쎌슦 ‘400留 썝 씠긽’쑝濡 援щ텇븯뿬 遺꾩꽍뿉 씠슜븯떎.

3. 넻怨 泥섎━

蹂 뿰援ъ뿉꽌뒗 옄猷 遺꾩꽍쓣 쐞빐 STATA/IC 14.1 (STATA Corp.)쓣 궗슜븯쑝硫, 뿰援 긽옄쓽 씤援ы븰쟻 듅꽦쓣 솗씤븯湲 쐞빐 移댁씠젣怨 寃젙(chi-square test)쓣 넻븳 鍮덈룄 遺꾩꽍怨 룊洹좉컪 궛異쒖쓣 넻븳 湲곗닠 遺꾩꽍쓣 떎떆븯怨, 媛 蹂닔뒗 諛깅텇쑉 삉뒗 룊洹좉낵 몴以렪李⑤줈 몴湲고븯떎.

異붿쟻 愿李고븳 긽옄쓽 떦눊蹂 諛쒖깮諛룄(incidence density)瑜 솗씤븯湲 쐞빐 쟾泥 異붿쟻湲곌컙 룞븞 諛쒖깮븳 씤뀈(person-year)쑝濡 몴湲고븯떎. RGS 떦눊蹂 諛쒖깮쐞뿕쓽 뿰愿꽦 솗씤쓣 쐞븳 遺꾩꽍紐⑦삎쓣 李얘린 쐞빐 濡쒓렇 닚쐞 寃젙(log-rank test)쓣 떎떆븯떎(Fig. 1A). 洹 寃곌낵, RGS 닔以쓽 寃쎌슦 떦눊蹂 諛쒖깮쐞뿕 鍮꾩쑉씠 떆媛꾩씠 利앷븿뿉 뵲씪 low, middle援곌낵 high援 媛꾩쓽 룊뻾븳 怨≪꽑쓣 솗씤븯湲 븣臾몄뿉 鍮꾨쐞뿕 媛젙씠 異⑹”릺뿀쓬쓣 븣 닔 엳뿀怨, 濡쒓렇 닚쐞 寃젙 떆 쑀쓽 닔以 삉븳 넻怨꾩쟻쑝濡 쑀쓽븳 寃곌낵媛 룄異쒕릺뿀떎(p=0.007). 뵲씪꽌 蹂 뿰援ъ뿉꽌뒗 鍮꾨쐞뿕 媛젙씠 異⑹”릺뿀쑝誘濡 RGS 떦눊蹂 諛쒖깮쐞뿕쓽 룆由쎌쟻씤 뿰愿꽦쓣 솗씤븯湲 쐞빐 鍮꾨쐞뿕 Cox 쉶洹紐⑦삎쓣 씠슜븯뿬 RGS 닔以뿉 뵲瑜 떦눊蹂 諛쒖깮쓽 룆由쎌쟻씤 쐞뿕鍮(hazard ratio, HR) 95% 떊猶곌뎄媛(95% confidence interval, 95% CI)쓣 궛異쒗븯떎. 삉븳 RHR 닔以蹂 RGS 떦눊蹂 諛쒖깮쐞뿕쓽 뿰愿꽦쓣 鍮꾧탳븯湲 쐞빐 鍮꾨쐞뿕 Cox 쉶洹紐⑦삎쓣 씠슜븯뿬 떦눊蹂 諛쒖깮쐞뿕쓽 HR怨 95% CI瑜 궛異쒗븯떎. 異붽쟻쑝濡 RHR怨 RGS쓽 긽샇옉슜씠 떦눊蹂 諛쒖깮쐞뿕뿉 뼱뼡 뿰愿꽦씠 엳뒗吏 솗씤븯湲 쐞빐 鍮꾨쐞뿕 Cox 쉶洹紐⑦삎쓣 씠슜븯뿬 떦눊蹂 諛쒖깮쐞뿕쓽 HR怨 95% CI瑜 궛異쒗븯떎.

Fig. 1. Graph for log-minus-log survival (A) and probability of survival (B) of diabetes mellitus (DM) according to relative grip strength. BMI: body mass index, ln: logarithm naturali.

鍮꾨쐞뿕 Cox 쉶洹 紐⑦삎 遺꾩꽍 떆 떦눊蹂 諛쒖깮怨 젅 븙젰, RGS뿉 쁺뼢쓣 겮移섎뒗 뿰졊, 꽦蹂, 洹쒖튃쟻씤 슫룞 李몄뿬 뿬遺, 怨④꺽洹쇰웾, eGFR, hs-CRP, 쓬二 뿬遺, 씉뿰 뿬遺, 닔엯 닔以, homeostatic model assessment for insulin resistance (HOMA-IR), RHR쓣 룷븿븳 샎 蹂씤쓣 蹂댁젙븯뿬 遺꾩꽍븯쑝硫, 紐⑤뱺 쑀쓽닔以 p<0.05濡 꽕젙븯떎.

寃 怨

蹂 뿰援ъ뿉꽌쓽 씤援ы넻怨꾩쟻 듅꽦 Table 1뿉 젣떆븯떎. RGS媛 궙 援곗쓽 寃쎌슦 RGS媛 넂 援곗뿉 鍮꾪빐 젣吏諛⑸웾, 궗援ъ껜뿬怨쇱쑉, 쁽옱 쓬二 鍮꾩쑉, 洹쒖튃쟻씤 슫룞 李몄뿬 鍮꾩쑉, BMI媛 궙븯怨 뿰졊, hs-CRP 닔以, 냼뱷 鍮꾩쑉씠 넂 寃껋쑝濡 솗씤븷 닔 엳뿀떎. 븯吏留 쁽옱 씉뿰 鍮꾩쑉, RHR뿉 븳 援 媛 李⑥씠뒗 넻怨꾩쟻쑝濡 쑀쓽븳 寃곌낵瑜 솗씤븷 닔 뾾뿀떎.

Table 1 . Baseline characteristics of study participants

CharacteristicRGSp-value
LowMiddleHigh
No. of patients634641660
RGS range (kg/BMI)
Male0.63−1.341.34−1.651.65−2.69-
Female0.20−0.730.73−0.900.90−1.80-
Age (yr)69.53±7.5865.27±7.7060.92±6.95<0.001
Lean body mass (kg)38.88±7.4640.45±7.9341.58±8.01<0.001
Income status, <1 million KRW65.6247.2730.61<0.001
eGFR (mL/min/1.73m2)92.35±22.7296.99±20.7396.79±20.22<0.001
hs-CRP (mg/dL)1.91±3.711.30±3.391.33±4.250.007
HOMA-IR2.10±1.191.97±0.931.72±0.71<0.001
Alcohol consumption (%)
None54.1052.4249.850.011
Former9.788.274.85
Current36.1239.3145.30
Smoking status (%)
None65.9367.5567.270.204
Former24.4520.9016.82
Current9.6211.5415.91
Exercise participation (%)
None77.2970.8361.97<0.001
Regular22.7129.1738.03
Body mass index (kg/m2)25.39±3.4024.24±2.9222.89±2.67<0.001
Waist circumference (cm)91.92±8.8688.73±8.0384.98±7.77<0.001
Resting heart rate (%)61.12±7.7961.12±7.0460.96±7.300.682

Values are presented as range, mean±standard deviation, or percentage only.

RGS: relative grip strength, BMI: body mass index, KRW: Korean won, eGFR: estimated glomerularfiltration rate, hs-CRP: high-sensitivity C-reactive protein, HOMA-IR: homeostatic model assessment for insulin resistance.



RGS 닔以蹂 떦눊蹂 諛쒖깮쓽 鍮꾨쐞뿕 媛젙쓣 쐞븳 濡쒓렇 닚쐞 寃젙 寃곌낵 Kaplan-Meier 깮議 怨≪꽑 寃곌낵뒗 Fig. 1뿉 젣떆븯떎. 癒쇱 Fig. 1A뿉꽌 RGS媛 넂 援곗 떆젏뿉 긽愿뾾씠 떦눊蹂 諛쒖깮뿉 븳 怨≪꽑씠 떎瑜 援곕뱾怨 援먯감븯吏 븡뒗 寃껋쓣 솗씤븷 닔 엳뿀떎(p=0.007). Fig. 1B뿉꽌 RGS媛 以묎컙씠嫄곕굹 궙 援곗 4뀈 썑 떦눊蹂묒씠 諛쒖깮븯吏 븡뒗 鍮꾩쑉씠 90% 誘몃쭔쑝濡 뼥뼱議뚯쑝굹, RGS媛 넂 援곗 RGS媛 以묎컙씠嫄곕굹 궙 援곗뿉 鍮꾪빐 떦눊蹂묒씠 諛쒖깮븯吏 븡뒗 鍮꾩쑉씠 뿬쟾엳 넂 寃껋쓣 솗씤븷 닔 엳뿀떎.

RGS 떦눊蹂 諛쒖깮쓽 뿰愿꽦뿉 븳 寃곌낵뒗 Table 2뿉 젣떆븯떎. RGS 닔以蹂 1,000紐낅떦 諛쒖깮瑜좎 궙 RGS援곗 23.12紐, 以묎컙 RGS援곗 23.96紐, 넂 RGS援곗 14.96紐낆쑝濡, 넂 RGS 닔以 궙嫄곕굹 以묎컙 닔以뿉 鍮꾪빐 1,000紐낅떦 諛쒖깮瑜좎씠 궙쓬쓣 솗씤븷 닔 엳뿀떎. 삉븳 떦눊蹂 諛쒖깮怨 RGS뿉 쁺뼢쓣 誘몄튂뒗 떎뼇븳 샎 蹂씤쓣 蹂댁젙븳 model 1뿉꽌 RGS媛 넂 援곗 RGS媛 궙 援곗뿉 鍮꾪빐 떦눊蹂 諛쒖깮쐞뿕씠 46% 媛먯냼븯怨(HR, 0.54; 95% CI, 0.36–0.80), model 1뿉 RHR쓣 異붽 蹂댁젙븳 model 2뿉꽌룄 媛숈 寃곌낵瑜 솗씤븷 닔 엳뿀떎(HR, 0.54; 95% CI, 0.36–0.80). 븯吏留 model 2뿉 뿀由щ몮젅瑜 異붽 蹂댁젙븳 model 3뿉꽌뒗 넻怨꾩쟻쑝濡 쑀쓽븳 寃곌낵瑜 솗씤븷 닔 뾾뿀떎.

Table 2 . Incidence density and HR of DM according to RGS

CharacteristicDM (n=1,935)Person-yearIncidence density* (95% CI)HR (95% CI)
Model 1Model 2Model 3
RGS (kg/BMI)
Low713,069.9723.12 (18.32−29.18)1.00 (Reference)1.00 (Reference)1.00 (Reference)
Middle793,296.1623.96 (19.22−29.88)0.96 (0.68−1.35)0.96 (0.68−1.35)1.16 (0.81−1.65)
High533,541.8614.96 (11.43−19.58)0.54 (0.36−0.80)0.54 (0.36−0.80)0.78 (0.51−1.20)
p for trend0.0020.0020.282

Multivariable model 1: adjusted age, sex, estimated glomerular filtration rate, high-sensitivity C-reactive protein, lean body mass, alcohol intake, smoking status, income status, HOMA-IR, and exercise participation model 2: adjusted for model 1 plus resting heart rate model 3: adjusted for model 2 plus waist circumference.

DM: diabetes mellitus, RGS: relative grip strength, CI: confidence interval, HR: hazard ratio, BMI: body mass index, HOMA-IR: homeostatic model assessment for insulin resistance.

*Incidence density=case/person−year×1,000.



RHR 닔以뿉 뵲瑜 RGS 떦눊蹂 諛쒖깮쓽 뿰愿꽦뿉 븳 寃곌낵뒗 Table 3뿉 젣떆븯떎. 癒쇱 RHR씠 궙 援곗쓽 寃쎌슦 떦눊蹂 諛쒖깮怨 RGS뿉 쁺뼢쓣 誘몄튂뒗 떎뼇븳 샎 蹂씤쓣 蹂댁젙븳 寃곌낵, 넂 RGS뒗 궙 RGS뿉 鍮꾪빐 떦눊蹂 諛쒖깮쐞뿕씠 60% 媛먯냼븯뒗 寃껋쓣 솗씤븷 닔 엳뿀떎(HR, 0.40; 95% CI, 0.20–0.83). 븯吏留 RHR씠 넂 援곗쓽 寃쎌슦 RGS 떦눊蹂 諛쒖깮쐞뿕 궗씠쓽 넻怨꾩쟻쑝濡 쑀쓽븳 뿰愿꽦쓣 솗씤븷 닔 뾾뿀떎.

Table 3 . Association of RGS with DM by RHR level

CharacteristicTotalRHR (beats/min)
Low (40−59)High (60−98)
No. of patients1,9356621,273
RGS (kg/BMI)
Low1.00 (Reference)1.00 (Reference)1.00 (Reference)
Middle0.96 (0.68−1.35)1.15 (0.65−2.03)0.91 (0.59−1.39)
High0.54 (0.36−0.80)0.40 (0.20−0.83)0.62 (0.38−1.00)
p for trend0.0020.0140.050

Values are presented as hazard ratio (95% confidence interval).

Multivariable adjusted age, sex, estimated glomerular filtration rate, high-sensitivity C-reactive protein, lean body mass, alcohol intake, smoking status, income status, HOMA-IR, and exercise participation.

RGS: relative grip strength, DM: diabetes mellitus, RHR: resting heart rate, BMI: body mass index, HOMA-IR: homeostatic model assessment for insulin resistance.



RGS RHR쓽 긽샇옉슜뿉 븳 떦눊蹂 諛쒖깮쐞뿕怨쇱쓽 뿰愿꽦 Fig. 2뿉 젣떆븯떎. RHR씠 넂怨 RGS媛 궙 援곌낵 鍮꾧탳뻽쓣 븣, RHR씠 궙怨 RGS媛 궙 援곌낵 RHR씠 궙怨 RGS媛 넂 援곗뿉꽌 떦눊蹂 諛쒖깮쐞뿕씠 媛곴컖 36% (HR, 0.64; 95% CI, 0.45–0.92), 40% (HR, 0.60; 95% CI, 0.39–0.94) 媛먯냼븯뒗 寃곌낵瑜 솗씤븷 닔 엳뿀떎. 듅엳 RHR씠 궙 援곗뿉꽌 넂 RGS뒗 궙 RGS蹂대떎 떦눊蹂 諛쒖깮쐞뿕씠 뜑 겕寃 媛먯냼븯떎.

Fig. 2. Multivariable-adjusted hazard ratios (HRs) for developing diabetes mellitus (DM) for joint association between relative grip strength (RGS) and resting heart rate (RHR). Multivariable adjusted age, sex, estimated glomerular filtration rate, high-sensitivity C-reactive protein, lean body mass, alcohol intake, smoking status, income status, HOMA-IR, and exercise participation. HOMA-IR, homeostatic model assessment for insulin resistance.
*p<0.05.
怨 李

蹂 뿰援ъ뿉꽌뒗 RGS 떦눊蹂 諛쒖깮뿉 誘몄튂뒗 뿬윭 슂씤뱾怨 RHR쓣 蹂댁젙뻽쓬뿉룄 遺덇뎄븯怨, 넂 RGS뒗 떦눊蹂 諛쒖깮쐞뿕쓣 媛먯냼떆耳곗쑝굹, 異붽쟻쑝濡 뿀由щ몮젅瑜 蹂댁젙뻽쓣 븣 RGS 떦눊蹂 諛쒖깮쐞뿕쓽 쑀쓽븳 뿰愿꽦씠 굹굹吏 븡뒗 寃껋쓣 솗씤븯떎. RHR씠 궙 援곗뿉꽌 넂 RGS뒗 떦눊蹂 諛쒖깮쐞뿕쓣 媛먯냼떆耳곌퀬, 異붽쟻쑝濡 RGS 닔以怨 愿怨꾩뾾씠 궙 RHR 떦눊蹂 諛쒖깮쐞뿕 媛먯냼 諛젒븯寃 뿰愿릺뼱 엳뿀쑝硫, RHR씠 궙 援 궡뿉꽌 넂 RGS뒗 궙 RGS蹂대떎 떦눊蹂 諛쒖깮쐞뿕쓣 뜑 겕寃 媛먯냼떆궎뒗 寃껋쓣 솗씤븷 닔 엳뿀떎.

洹쇱쑁웾怨 룆由쎌쟻쑝濡, 洹쇰젰 씠룞꽦, 湲곕뒫쟻 긽깭, 궗留앸쪧怨 諛젒븳 뿰愿씠 엳쓬쓣 蹂닿퀬븳 諛 엳쑝硫 뵲씪꽌 긽 洹쇰젰怨 媛숈 洹쇱쑁쓽 湲곕뒫쟻 뒫젰씠 끂솕濡 씤븳 洹쇨컧냼利앹쓣 삁痢≫븷 닔 엳뒗 吏몴濡 怨좊젮릺怨 엳떎15. 듅엳 洹쇰젰쓽 媛먯냼뒗 끂씤뿉 엳뼱꽌 以묒슂븳 嫄닿컯吏몴濡 洹쇨컧냼利, 愿긽룞留μ쭏솚, 굺긽, 궗留앸쪧쓣 利앷떆궎硫, 굹씠媛 利앷븿뿉 뵲씪 怨꾩냽 媛먯냼븯湲 븣臾몄뿉 끂씤쓣 쐞븳 몴以솕맂 洹쇰젰 痢≪젙쓣 沅뚭퀬븯怨 엳떎16. 넂 븙젰 닔以 뿀由щ몮젅, 泥댁諛⑸웾, 떖옣吏덊솚쑝濡 씤븳 궗留앹쐞뿕쓣 以꾩씠뒗 寃껋쑝濡 蹂닿퀬븳 諛 엳떎. 듅엳 떊泥 諛룄瑜 蹂댁젙븳 RGS뒗 궗吏덊솚怨 뿰愿릺뼱 엳뿀쑝硫17, 씠윭븳 RGS쓽 利앷뒗 삁떦 議곗젅怨 뿰愿맂 씤뒓由 빆꽦쓣 以꾩뿬, 젣2삎 떦눊蹂, 궗利앺썑援, 떖삁愿吏덊솚쓽 諛쒖깮쓣 媛먯냼떆궗 닔 엳쓬쓣 떆궗븯떎18. 쁽옱源뚯 吏꾪뻾맂 洹쇰젰怨 떦눊蹂묒쓽 뿰愿꽦뿉 븳 뿰援 寃곌낵뿉 뵲瑜대㈃, 諛섎났쟻씤 빆슫룞쓣 넻븳 洹쇱쑁쓽 吏(muscle quality, MQ) 媛쒖꽑 洹쇱쑁궡 삁떦 궗瑜 뼢긽떆궎硫19, 5媛쒖쓽 떦눊蹂 愿젴 뿰援щ 硫뷀 遺꾩꽍븳 꽑뻾뿰援ъ뿉꽌뒗 洹쇰젰쓣 利앹쭊븯뒗 솢룞뿉 二 2쉶 씠긽 李몄뿬븷 寃쎌슦 쟾 李몄뿬븯吏 븡븯쓣 븣蹂대떎 떦눊蹂 諛쒖깮瑜좎씠 17% 媛먯냼븯뒗 寃껋쓣 솗씤븷 닔 엳뿀떎(relative risk, 0.83; 95% CI, 0.77–0.89; p<0.001). 삉 떎瑜 뿰援ъ뿉꽌뒗 洹쇰젰쓣 利앹쭊븯뒗 솢룞씠 二쇰떦 10遺 利앷븷 븣留덈떎 떦눊蹂 諛쒖깮쐞뿕씠 젏李 媛먯냼븯쑝硫, 二쇰떦 60遺 씠썑遺꽣 議곌툑 뜑뵖 媛먯냼瑜 솗씤븷 닔 엳뿀떎20. RGS, RHR怨 떦눊蹂묎낵쓽 뿰愿꽦뿉 븳 꽑뻾뿰援ъ뿉꽌뒗 RHR씠 媛옣 넂怨 RGS媛 媛옣 궙 援곗씠 RHR씠 媛옣 궙怨 RGS媛 媛옣 넂 援곕낫떎 떦눊蹂 쑀蹂 쐞뿕씠 궓꽦쓽 寃쎌슦 4.23諛(odds ratio [OR], 4.23; 95% CI, 2.74–6.54), 뿬꽦쓽 寃쎌슦 2.90諛(OR, 2.90; 95% CI, 1.98–4.23) 利앷븳 寃껋쓣 솗씤븷 닔 엳뿀떎10.

RGS 떦눊蹂 諛쒖깮 뼲젣뿉 愿븳 湲곗쟾 紐낇솗븯吏 븡쑝굹, 넂 洹쇰젰 닔以쓣 媛吏 궗엺 떊泥댁쟻쑝濡 솢룞쟻씤 긽깭瑜 媛吏怨 엳湲 븣臾몄뿉21 넂 솢룞 닔以뿉 뵲瑜 洹쇱닔異 鍮덈룄 利앷뒗 떦눊蹂묎낵 諛젒븳 뿰愿꽦쓣 媛吏 씤뒓由 빆꽦쓣 媛쒖꽑븯怨, 삁떦 슫諛 뒫젰 뼢긽뿉 以묒슂븳 뿭븷쓣 떞떦븯怨 엳뒗 寃껋쑝濡 蹂닿퀬븳 諛 엳떎22. 蹂 뿰援ъ뿉꽌룄 넂 RGS援곗 궙 RGS援곗뿉 鍮꾪빐 洹쒖튃쟻씤 슫룞뿉 15.32% 뜑 留롮씠 李몄뿬븯怨, 씠뒗 넂 RGS 닔以씠 넂 솢룞닔以쓣 쓽誘명븯뒗 꽑뻾뿰援ъ쓽 寃곌낵 씪移섑븳떎22.

Table 2뿉꽌 넂 RGS 닔以씠 RHR怨 룆由쎌쟻쑝濡 떦눊蹂 諛쒖깮쐞뿕쓣 媛먯냼떆耳곗쑝굹, 뿀由щ몮젅瑜 蹂댁젙뻽쓣 븣 RGS 떦눊蹂 諛쒖깮쐞뿕쓽 뿰愿꽦씠 궗씪吏뒗 씠쑀뒗 洹쇱쑁궡 吏諛 媛먯냼뿉 留ㅺ컻븯뿬 넂 MQ媛 씤뒓由 빆꽦쓣 媛쒖꽑븷 닔 엳湲 븣臾몄쑝濡 깮媛곷맂떎. MQ뒗 洹쇱쑁웾 떒쐞떦 洹쇰젰쓣 쓽誘명븯硫, 二쇰줈 긽 洹쇰젰쓣 넻빐 痢≪젙븯뿬 뒪룷痢 쁽옣씠굹 떎뿕떎 궡뿉꽌 닔뻾쓣 룊媛븯湲곗뿉 쟻빀븿쓣 떆궗븯떎23. 꽑뻾뿰援ъ뿉 뵲瑜대㈃ 醫뗭 MQ瑜 媛吏 援곗 洹쇱쑁웾씠 쟻뼱룄 醫뗭 洹쇰젰쓣 깮궛븷 닔 엳뒗 뒫젰쓣 媛吏怨 엳쓬쓣 蹂닿퀬븳 諛 엳怨, 諛섎濡 궙 MQ瑜 媛吏 援곗쓽 寃쎌슦 긽쟻쑝濡 臾닿굅슫 泥댁쨷쑝濡 씤빐 넂 젣吏諛⑸웾쓣 媛吏怨 엳쓬뿉룄 洹쇱쑁 궡 吏諛⑹씠 怨쇰떎븯寃 異뺤쟻릺뼱 엳湲 븣臾몄뿉 궙 洹쇰젰 諛 씤뒓由 빆꽦 利앷 뿰愿릺뼱 엳쓬쓣 떆궗븯떎23. 떎젣濡 떦눊蹂 솚옄瑜 긽쑝濡 16二쇨컙 怨좉컯룄 긽븯吏 洹쇰젰 듃젅씠떇쓣 떎떆뻽쓣 븣 뼢긽맂 洹쇱쑁웾怨 MQ媛 愿李곕릺뿀쑝硫, 씠뒗 씤뒓由 誘쇨컧꽦뿉 湲띿젙쟻씤 쁺뼢쓣 젣怨듯뻽쓬쓣 蹂닿퀬븯떎24. 뿀由щ몮젅뒗 BMI굹 泥댁諛⑸쪧怨 媛숈 鍮꾨쭔슂냼뱾蹂대떎 怨좏삁븬, 떦눊蹂, 怨좎삁利 벑쓽 떖삁愿吏덊솚 쐞뿕슂냼 삁痢≪뿉 뜑 슚怨쇱쟻씠硫, 洹쇨컧냼꽦 鍮꾨쭔怨 諛젒븳 뿰愿꽦씠 엳쓬쓣 蹂닿퀬븯떎25.

蹂 뿰援ъ뿉꽌쓽 RGS 닔以蹂 HOMA-IR 꽑뻾뿰援 寃곌낵 媛숈씠 궙 RGS援(2.10±1.19)蹂대떎 넂 RGS援(1.72±0.71)뿉꽌 뜑 궙 寃껋쓣 솗씤븷 닔 엳뿀怨23, RHR RGS 닔以蹂 쑀쓽븳 李⑥씠媛 굹굹吏 븡븯쑝굹(p=0.682) 뿀由щ몮젅뿉꽌뒗 넻怨꾩쟻쑝濡 쑀쓽븳 李⑥씠(p<0.001)媛 엳뿀湲 븣臾몄뿉, RGS 닔以怨 뿀由щ몮젅뒗 洹쇨컧냼꽦 鍮꾨쭔(sarcopenic obesity) 痢〓㈃뿉꽌 諛젒븳 뿰愿꽦씠 엳뒗 寃껋쓣 솗씤븷 닔 엳뿀떎. 뵲씪꽌 넂 MQ濡 씤븳 RGS 利앷뒗 洹쇱쑁궡 吏諛 異뺤쟻씠 媛먯냼맂 긽깭濡쒖꽌23, 넂 MQ媛 씤뒓由 빆꽦쓣 媛쒖꽑븯뿬24 삁떦 媛먯냼뿉 湲띿젙쟻씤 쁺뼢쓣 誘몄튌 寃껋쑝濡 깮媛곷맂떎19.

Table 3뿉꽌 RHR씠 궙 援곗뿉꽌 RGS媛 넂쑝硫 떦눊蹂 諛쒖깮쐞뿕씠 쑀쓽븯寃 媛먯냼뻽쑝굹 RHR씠 넂 援곗뿉꽌뒗 쑀쓽븳 寃곌낵瑜 솗씤븷 닔 뾾뿀뜕 씠쑀뒗 援먭컧떊寃쎄퀎쓽 솢꽦솕媛 RGS 利앷蹂대떎 떦눊蹂 諛쒖깮쐞뿕뿉 뜑 겙 쁺뼢쓣 젣怨듯븯湲 븣臾몄쑝濡 깮媛곷맂떎. 꽑뻾뿰援ъ뿉 뵲瑜대㈃ RHR 援먭컧떊寃쎄퀎 솢룞뿉 븳 吏몴濡 솢슜릺怨 엳쑝硫26, 利앷맂 援먭컧떊寃쎄퀎 솢룞 씤뒓由 빆꽦쓣 利앷븯뒗 썝씤씠 맂떎怨 븯떎27. 씠뒗 援먭컧떊寃 옄洹뱀쑝濡 씤븳 삁愿 닔異뺤씠 洹쇱쑁 삁瑜섎웾 媛먯냼瑜 쑀諛쒗븯硫 洹 寃곌낵 洹쇱쑁 궡 삁떦 쑀엯 寃곗넀씠 굹굹뒗 寃껋쑝濡 蹂닿퀬븯떎28. 삉븳 떎瑜 꽑뻾뿰援ъ뿉 뵲瑜대㈃ 援먭컧떊寃쎄퀎쓽 솢꽦솕뒗 떦눊蹂 쐞뿕쓣 利앷떆궎뒗 寃껋쑝濡 蹂닿퀬븯쑝硫, 寃곌뎅 넂 RHR 援먭컧떊寃쎄퀎 솢꽦솕뿉 븳 吏몴濡쒖꽌 떦눊蹂 諛쒖깮쐞뿕怨 뿰愿릺뼱 엳쓬쓣 떆궗븯떎27. 뵲씪꽌 넂 RGS쑝濡 씤븳 떦눊蹂 諛쒖깮쐞뿕 媛먯냼 슚怨쇰낫떎 援먭컧떊寃쎄퀎 솢꽦솕뿉 븳 吏몴濡26 넂 RHR씠 떦눊蹂 諛쒖깮쐞뿕 利앷뿉 뜑 겕寃 옉슜븯湲 븣臾몄쑝濡 깮媛곷맂떎27.

Fig. 2뿉꽌 넂 RHR怨 궙 븙젰쓣 媛吏 援곌낵 鍮꾧탳뻽쓣 븣, 궙 RHR怨 궙 RGS瑜 媛吏 援곕낫떎 궙 RHR怨 넂 RGS瑜 媛吏 援곗뿉꽌 뜑 겙 媛먯냼媛 굹굹뒗 씠쑀뒗 떖룓泥대젰怨 洹쇰젰 利앷쓽 긽샇옉슜 슚怨 븣臾몄쑝濡 깮媛곷맂떎. 꽑뻾뿰援ъ뿉꽌 젣2삎 떦눊蹂 솚옄瑜 긽쑝濡 12二쇨컙 쑀궛냼 듃젅씠떇, 빆꽦 듃젅씠떇, 蹂듯빀(쑀궛냼竊뗭빆) 듃젅씠떇쓣 吏꾪뻾뻽쓣 븣, 씤뒓由 誘쇨컧꽦쓣 議곗젅븯뒗 omentin-1 닔以 蹂듯빀 듃젅씠떇쓣 吏꾪뻾뻽쓣 븣뿉留 利앷븳 寃껋쓣 솗씤븯뿬, 쑀궛냼 듃젅씠떇怨 빆 듃젅씠떇쓣 븿猿 吏꾪뻾븯뒗 寃껋씠 떒룆 듃젅씠떇蹂대떎 뜑 슚쑉쟻쑝濡 씤뒓由 誘쇨컧꽦쓣 뼢긽븷 닔 엳쓬쓣 蹂닿퀬븳 諛 엳떎29. 씠윭븳 寃곌낵뒗 蹂듯빀 듃젅씠떇쓽 泥댁諛 媛먯냼濡 씤븳 슚怨쇨 떒룆쑝濡 듃젅씠떇쓣 吏꾪뻾븳 寃껊낫떎 뜑 겕湲 븣臾몄쑝濡 蹂닿퀬븯쑝硫29, 떎瑜 꽑뻾뿰援ъ뿉꽌뒗 듃젅씠떇 떆 떦눊蹂묒쓣 쑀諛쒗븯뒗 씤뒓由 빆꽦 媛먯냼뿉 궡옣吏諛⑹쓽 媛먯냼媛 留ㅺ컻릺뼱 엳쓬쓣 떆궗븯떎30. 뵲씪꽌 洹쇰젰쓽 吏몴濡쒖꽌 RGS 利앷7 떖룓泥대젰쓽 吏몴濡쒖꽌 RHR쓽 媛먯냼10뒗 媛 泥대젰 슂냼쓽 떒룆쟻씤 利앷蹂대떎 궡옣吏諛 媛먯냼 留ㅺ컻맂 씤뒓由 빆꽦 媛먯냼뿉 슚怨쇱쟻씠湲 븣臾몄뿉 떦눊蹂 諛쒖깮쐞뿕쓣 媛먯냼떆궗 寃껋쑝濡 깮媛곷맂떎29.

蹂 뿰援щ뒗 RGS 닔以怨 떦눊蹂 諛쒖깮쐞뿕쓽 룆由쎌쟻씤 뿰愿꽦쓣 솗씤븯怨, RGS RHR쓽 긽샇옉슜뿉 븳 떦눊蹂 諛쒖깮쐞뿕쓽 뿰愿꽦쓣 鍮꾧탳 솗씤븳 醫낅떒뿰援щ줈꽌 쓽誘멸 엳쑝굹 紐 媛吏 븳怨꾩젏씠 議댁옱븳떎. 泥 踰덉㎏, 떦눊蹂묒뿉 쁺뼢쓣 誘몄튂뒗 떇씠 蹂닔瑜 蹂댁젙븷 닔 뾾뿀떎. 븯吏留 떦눊蹂묒뿉 쁺뼢쓣 誘몄튂뒗 씉뿰, 쓬二, 떊泥댄솢룞怨 媛숈 깮솢뒿愿怨 HOMA-IR, hs-CRP, eGFR怨 媛숈 삁븸 蹂닔瑜 蹂댁젙븿쑝濡쒖뜥 蹂 뿰援ъ쓽 떊猶곗꽦쓣 넂씠怨좎옄 븯떎. 異뷀썑 뿰援ъ뿉꽌뒗 씪씪 쓬떇꽠痍⑤웾, 떊泥댄솢룞 닔以, 洹쇱쑁웾 벑 떦눊 諛쒖깮뿉 썝씤씠 릺뒗 뿬윭 샎 蹂씤뱾씠 룆由쎌쟻쑝濡 RGS 떦눊蹂 諛쒖깮뿉 븳 뿰愿꽦뿉 뼱뼚븳 쁺뼢쓣 誘몄튂뒗吏 솗씤씠 븘슂븯떎. 몢 踰덉㎏, 蹂 뿰援ъ뿉꽌뒗 븳誘쇨뎅 궡 씪遺 吏뿭뿉 嫄곗<븯뒗 40꽭 씠긽쓽 꽦씤쓣 긽옄濡 꽑젙븯湲 븣臾몄뿉, 蹂 뿰援ъ쓽 寃곌낵濡 븳誘쇨뎅쓣 몴븯뒗 뜲뿉뒗 씪諛섑솕쓽 삤瑜섍 議댁옱븳떎. 異뷀썑 뿰援ъ뿉꽌뒗 쟾 援誘쇱쓣 긽쑝濡 븳 肄뷀샇듃 뿰援ъ뿉꽌 떦눊蹂묎낵 RGS쓽 뿰愿꽦쓣 鍮꾧탳 솗씤븷 븘슂꽦씠 엳떎. 꽭 踰덉㎏, 긽吏 洹쇰젰쓽 吏몴씤 븙젰留뚯쑝濡 떦눊蹂묎낵쓽 뿰愿꽦쓣 솗씤뻽湲 븣臾몄뿉 븯吏, 蹂듬 벑 떎瑜 遺쐞쓽 洹쇰젰 닔以怨 떦눊蹂묒쓽 뿰愿꽦쓣 솗씤븷 닔 뾾뿀떎. 븙젰씠 떦눊 諛쒖깮뿉 쁺뼢쓣 二쇰뒗 쟾泥 怨④꺽洹쇰웾쓣 몴븯吏뒗 紐삵븯湲 븣臾몄뿉, 異뷀썑 뿰援ъ뿉꽌뒗 븯吏, 긽吏, 紐명넻 洹쇱쑁 닔以蹂꾨줈 떦눊蹂묒뿉 誘몄튂뒗 쁺뼢쓣 솗씤빐 蹂 븘슂媛 엳떎. 꽕 踰덉㎏, 떦눊蹂 諛쒖깮쐞뿕쓣 솗씤븯湲 쐞븳 湲곕컲議곗궗뿉꽌 떦눊蹂 솚옄瑜 紐⑤몢 젣嫄고븯湲 븣臾몄뿉 긽옄 꽑젙뿉 렪뼢꽦쓣 媛吏怨 엳怨, RGS 닔以蹂 떦눊 諛쒖깮뿉 쁺뼢쓣 誘몄튂뒗 glucose, 떦솕삁깋냼쓽 뿰냽쟻씤 蹂솕瑜 솗씤븷 닔 뾾뿀떎. 뵲씪꽌 異뷀썑 뿰援ъ뿉꽌뒗 RGS 닔以蹂 삁떦, 떦솕삁깋냼 媛숈 떦눊蹂 吏몴뱾쓽 떆媛꾩뿉 뵲瑜 蹂솕瑜 솗씤븯뒗 寃껋씠 븘슂븯떎.

蹂 뿰援ъ뿉꽌뒗 RGS媛 泥댁諛 異뺤쟻뿉 留ㅺ컻븯뿬 떦눊蹂 諛쒖깮쐞뿕怨 諛젒븳 뿰愿꽦쓣 媛吏怨 엳쑝硫, 궙 RHR씠 넂 RGS蹂대떎 떦눊蹂 諛쒖깮쐞뿕 媛먯냼뿉 뜑 겙 쁺뼢쓣 誘몄튂뒗 寃껋쓣 솗씤븷 닔 엳뿀떎. RGS뒗 젅 븙젰蹂대떎 吏덊솚쓣 뜑 옒 삁痢≫븷 닔 엳뒗 吏몴濡쒖꽌, RHR怨 븿猿 떦눊蹂 諛쒖깮쐞뿕 삁痢≪뿉 쑀슜븳 泥숇룄뱾 以 븯굹媛 맆 닔 엳쓣 寃껋쑝濡 깮媛곷맂떎. 뵲씪꽌 떦눊蹂 諛쒖깮쐞뿕쓣 以꾩씠湲 쐞빐 洹쒖튃쟻씤 슫룞 李몄뿬瑜 넻븳 洹쇰젰, 떖룓泥대젰쓽 利앹쭊쓣 룆젮븯뒗 寃껋씠 以묒슂븯硫, RGS 利앷 RHR 媛먯냼瑜 쐞븳 援媛 李⑥썝뿉꽌쓽 떊泥댄솢룞 봽濡쒓렇옩쓣 옣젮븷 븘슂꽦씠 엳떎.

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Author Contributions

Conceptualization: DYP, YSK. Data curation, Formal analysis, Investigation, Resources: DYP. Methodology: all authors. Project administration: DYP, EK. Supervision: YSK, EK. Writing–original draft: DYP. Writing–review & editing: all authors.

References
  1. Madden KM. Evidence for the benefit of exercise therapy in patients with type 2 diabetes. Diabetes Metab Syndr Obes 2013;6:233-9.
    Pubmed KoreaMed CrossRef
  2. Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services. National diabetes statistics report, 2020. CDC; 2021.
  3. Korea Disease Control and Prevention Agency (KDCA). 2021 National Health and Nutrition Statistics: National Health and Nutrition Examination Survey-8th round, 3rd year. KDCA; 2021.
  4. Zeyfang A, Wernecke J, Bahrmann A. Diabetes mellitus at an elderly age. Exp Clin Endocrinol Diabetes 2021;129(Suppl 1):S20-6.
    Pubmed CrossRef
  5. U.S. Department of Health and Human Services (HHS). Physical activity guidelines for Americans. 2nd ed. HHS; 2018.
  6. Chen CN, Chen TC, Tsai SC, Hwu CM. Factors associated with relative muscle strength in patients with type 2 diabetes mellitus. Arch Gerontol Geriatr 2021;95:104384.
    Pubmed CrossRef
  7. Jeon CY, Lokken RP, Hu FB, van Dam RM. Physical activity of moderate intensity and risk of type 2 diabetes: a systematic review. Diabetes Care 2007;30:744-52.
    Pubmed CrossRef
  8. Slemenda C, Heilman DK, Brandt KD, et al. Reduced quadriceps strength relative to body weight: a risk factor for knee osteoarthritis in women? Arthritis Rheum 1998;41:1951-9.
    Pubmed CrossRef
  9. Byeon JY, Lee MK, Yu MS, et al. Lower relative handgrip strength is significantly associated with a higher prevalence of the metabolic syndrome in adults. Metab Syndr Relat Disord 2019;17:280-8.
    Pubmed CrossRef
  10. Park DH, Hong SH, Cho W, Jeon JY. Higher resting heart rate and lower relative grip strength is associated with increased risk of diabetes in Korean elderly population: Korean National Health and Nutrition Examination Survey 2015-2018. Exerc Sci 2020;29:416-26.
    CrossRef
  11. Tarp J, Støle AP, Blond K, Grøntved A. Cardiorespiratory fitness, muscular strength and risk of type 2 diabetes: a systematic review and meta-analysis. Diabetologia 2019;62:1129-42.
    Pubmed KoreaMed CrossRef
  12. Korea Centers for Disease Control and Prevention (KCDC). Korean genome epidemiology study project survey guidelines: population-based surveys and examinations. KCDC; 2011.
  13. Yi DW, Khang AR, Lee HW, Son SM, Kang YH. Relative handgrip strength as a marker of metabolic syndrome: the Korea National Health and Nutrition Examination Survey (KNHANES) VI (2014-2015). Diabetes Metab Syndr Obes 2018;11:227-40.
    Pubmed KoreaMed CrossRef
  14. Andrassy KM. Comments on 'KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease'. Kidney Int 2013;84:622-3.
    Pubmed CrossRef
  15. Fragala MS, Kenny AM, Kuchel GA. Muscle quality in aging: a multi-dimensional approach to muscle functioning with applications for treatment. Sports Med 2015;45:641-58.
    Pubmed CrossRef
  16. Mehmet H, Yang AW, Robinson SR. Measurement of hand grip strength in the elderly: a scoping review with recommendations. J Bodyw Mov Ther 2020;24:235-43.
    Pubmed CrossRef
  17. Chun SW, Kim W, Choi KH. Comparison between grip strength and grip strength divided by body weight in their relationship with metabolic syndrome and quality of life in the elderly. PLoS One 2019;14:e0222040.
    Pubmed KoreaMed CrossRef
  18. Lawman HG, Troiano RP, Perna FM, Wang CY, Fryar CD, Ogden CL. Associations of relative handgrip strength and cardiovascular disease biomarkers in U.S. adults, 2011-2012. Am J Prev Med 2016;50:677-83.
    Pubmed KoreaMed CrossRef
  19. Pesta DH, Goncalves RL, Madiraju AK, Strasser B, Sparks LM. Resistance training to improve type 2 diabetes: working toward a prescription for the future. Nutr Metab (Lond) 2017;14:24.
    Pubmed KoreaMed CrossRef
  20. Momma H, Kawakami R, Honda T, Sawada SS. Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies. Br J Sports Med 2022;56:755-63.
    Pubmed KoreaMed CrossRef
  21. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 2013;3:1-150.
  22. Kalyani RR, Corriere M, Ferrucci L. Age-related and disease-related muscle loss: the effect of diabetes, obesity, and other diseases. Lancet Diabetes Endocrinol 2014;2:819-29.
    Pubmed CrossRef
  23. Barbat-Artigas S, Filion ME, Plouffe S, Aubertin-Leheudre M. Muscle quality as a potential explanation of the metabolically healthy but obese and sarcopenic obese paradoxes. Metab Syndr Relat Disord 2012;10:117-22.
    Pubmed CrossRef
  24. Brooks N, Layne JE, Gordon PL, Roubenoff R, Nelson ME, Castaneda-Sceppa C. Strength training improves muscle quality and insulin sensitivity in Hispanic older adults with type 2 diabetes. Int J Med Sci 2006;4:19-27.
    Pubmed KoreaMed CrossRef
  25. Ikeue K, Kusakabe T, Muranaka K, et al. A combined index of waist circumference and muscle quality is associated with cardiovascular disease risk factor accumulation in Japanese obese patients: across-sectional study. Endocrine 2022;77:30-40.
    Pubmed KoreaMed CrossRef
  26. Grassi G, Vailati S, Bertinieri G, et al. Heart rate as marker of sympathetic activity. J Hypertens 1998;16:1635-9.
    Pubmed CrossRef
  27. Wang L, Cui L, Wang Y, et al. Resting heart rate and the risk of developing impaired fasting glucose and diabetes: the Kailuan prospective study. Int J Epidemiol 2015;44:689-99.
    Pubmed KoreaMed CrossRef
  28. Julius S, Gudbrandsson T, Jamerson K, Andersson O. The inter-connection between sympathetics, microcirculation, and insulin resistance in hypertension. Blood Press 1992;1:9-19.
    Pubmed CrossRef
  29. AminiLari Z, Fararouei M, Amanat S, et al. The effect of 12 weeks aerobic, resistance, and combined exercises on omentin- 1 levels and insulin resistance among type 2 diabetic middle-aged women. Diabetes Metab J 2017;41:205-12.
    Pubmed KoreaMed CrossRef
  30. O'Leary VB, Marchetti CM, Krishnan RK, Stetzer BP, Gonzalez F, Kirwan JP. Exercise-induced reversal of insulin resistance in obese elderly is associated with reduced visceral fat. J Appl Physiol (1985) 2006;100:1584-9.
    Pubmed KoreaMed CrossRef