Relationship between diet quality and sarcopenia in elderly Koreans: 2008-2011 Korea National Health and Nutrition Examination Survey

  • Na, Woori (Department of Food and Nutrition, Wonkwang University) ;
  • Kim, Jiyu (Department of Food and Nutrition, Wonkwang University) ;
  • Chung, Bong Hee (Department of Food and Nutrition, Wonkwang University) ;
  • Jang, Dai-Ja (Research Group of Healthcare, Korea Food Research Institute) ;
  • Sohn, Cheongmin (Department of Food and Nutrition, Wonkwang University)
  • Received : 2020.01.08
  • Accepted : 2020.07.16
  • Published : 2020.08.01


BACKGROUND/OBJECTIVES: Given the increasing proportion of the Korean population that is aged 65 years and older, the present study analyzed the relationship between diet quality and sarcopenia in elderly persons by using data from the 2008-2011 Korea National Health and Nutrition Examination Survey (KNHANES). SUBJECTS/METHODS: Data for 3,373 persons aged 65 years and over (men: 1,455, 43.1%) were selected from the 2008-2011 KNHANES. Sarcopenia assessments are based on a formula that divides a subject's appendicular skeletal muscle mass (ASM) by their weight (wt) and multiplies that result by 100 ([ASM/wt] × 100). Sarcopenia is present if the subject's result was less than one standard deviation (SD) below the sex-specific mean for a young reference group. For evaluation of diet quality, data obtained via the 24-hour recall method were used to calculate the Diet Quality Index for Koreans (DQI-K). A general linear model was applied in order to analyze general information and nutritional intake according to sarcopenia status. For analysis of the relationship between diet quality and sarcopenia, a binominal logistic regression analysis was undertaken. RESULTS: The sarcopenia prevalence rate among the study subjects aged 65 years and over was 37.6%. The DQI-K of those without sarcopenia was 3.33 ± 0.04 points, while that of those with sarcopenia was 3.45 ± 0.04 points (P < 0.05). The relationship between diet quality and sarcopenia revealed that subjects aged 75 and older had a poor diet quality, and their odds ratio (OR) of sarcopenia presence was significantly higher (OR: 1.807, 95% confidence interval: 1.003-3.254, P < 0.05). CONCLUSIONS: This study revealed that poor diet quality was related to sarcopenia presence in Koreans aged 75 and older. In order to improve the diet quality of the elderly (aged 75 and older), it is necessary to develop dietary improvement guidelines.


  1. Statistics Korea. Statistics Korea [Internet]. Daejeon: Statistics Korea; 2019 [cited 2019 July 25]. Available from:
  2. Son KB, Shin JW, Lim EO, Lee TJ, Kim HS. Population aging and health care expenditure in South Korea: a critical review. Korean J Health Econ Policy 2015;21:51-77.
  3. Zeng Y, Gu D, Purser J, Hoenig H, Christakis N. Associations of environmental factors with elderly health and mortality in China. Am J Public Health 2010;100:298-305.
  4. Park BH, Jung M, Lee TJ. Associations of income and wealth with health status in the Korean elderly. J Prev Med Public Health 2009;42:275-82.
  5. Ethisan P, Somrongthong R, Ahmed J, Kumar R, Chapman RS. Factors related to physical activity among the elderly population in rural Thailand. J Prim Care Community Health 2017;8:71-6.
  6. Amarantos E, Martinez A, Dwyer J. Nutrition and quality of life in older adults. J Gerontol A Biol Sci Med Sci 2001;56 Spec No 2:54-64.
  7. Seo S, Cho M, Kim Y, Ahn J. The relationships among satisfaction with food-related life, depression, isolation, social support, and overall satisfaction of life in elderly South Koreans. J Korean Diet Assoc 2013;19:159-72.
  8. Patterson RE, Haines PS, Popkin BM. Diet quality index: capturing a multidimensional behavior. J Am Diet Assoc 1994;94:57-64.
  9. Haines PS, Siega-Riz AM, Popkin BM. The Diet Quality Index revised: a measurement instrument for populations. J Am Diet Assoc 1999;99:697-704.
  10. Guenther PM, Reedy J, Krebs-Smith SM. Development of the Healthy Eating Index-2005. J Am Diet Assoc 2008;108:1896-901.
  11. Jankovic N, Geelen A, Streppel MT, de Groot LC, Orfanos P, van den Hooven EH, Pikhart H, Boffetta P, Trichopoulou A, Bobak M, Bueno-de-Mesquita HB, Kee F, Franco OH, Park Y, Hallmans G, Tjonneland A, May AM, Pajak A, Malyutina S, Kubinova R, Amiano P, Kampman E, Feskens EJ. Adherence to a healthy diet according to the World Health Organization guidelines and all-cause mortality in elderly adults from Europe and the United States. Am J Epidemiol 2014;180:978-88.
  12. Huijbregts P, Feskens E, Rasanen L, Fidanza F, Nissinen A, Menotti A, Kromhout D. Dietary pattern and 20 year mortality in elderly men in Finland, Italy, and The Netherlands: longitudinal cohort study. BMJ 1997;315:13-7.
  13. Lim J, Lee Y, Shin S, Lee HW, Kim CE, Lee JK, Lee SA, Kang D. An association between Diet Quality Index for Koreans (DQI-K) and total mortality in Health Examinees Gem (HEXA-G) study. Nutr Res Pract 2018;12:258-64.
  14. Kim TN, Choi KM. Sarcopenia: definition, epidemiology, and pathophysiology. J Bone Metab 2013;20:1-10.
  15. Newman AB, Kupelian V, Visser M, Simonsick EM, Goodpaster BH, Kritchevsky SB, Tylavsky FA, Rubin SM, Harris TB. Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort. J Gerontol A Biol Sci Med Sci 2006;61:72-7.
  16. Yanai H. Nutrition for sarcopenia. J Clin Med Res 2015;7:926-31.
  17. Bloom I, Shand C, Cooper C, Robinson S, Baird J. Diet quality and sarcopenia in older adults: a systematic review. Nutrients 2018;10:308.
  18. Chan R, Leung J, Woo J. A Prospective cohort study to examine the association between dietary patterns and sarcopenia in Chinese community-dwelling older people in Hong Kong. J Am Med Dir Assoc 2016;17:336-42.
  19. Brown JC, Harhay MO, Harhay MN. Physical activity, diet quality, and mortality among sarcopenic older adults. Aging Clin Exp Res 2017;29:257-63.
  20. Smee D, Pumpa K, Falchi M, Lithander FE. The Relationship between diet quality and falls risk, physical function and body composition in older adults. J Nutr Health Aging 2015;19:1037-42.
  21. Lim S, Kim JH, Yoon JW, Kang SM, Choi SH, Park YJ, Kim KW, Lim JY, Park KS, Jang HC. Sarcopenic obesity: prevalence and association with metabolic syndrome in the Korean Longitudinal Study on Health and Aging (KLoSHA). Diabetes Care 2010;33:1652-4.
  22. Chin SO, Rhee SY, Chon S, Hwang YC, Jeong IK, Oh S, Ahn KJ, Chung HY, Woo JT, Kim SW, Kim JW, Kim YS, Ahn HY. Sarcopenia is independently associated with cardiovascular disease in older Korean adults: the Korea National Health and Nutrition Examination Survey (KNHANES) from 2009. PLoS One 2013;8:e60119.
  23. Kim KM, Lim S, Choi SH, Kim JH, Shin CS, Park KS, Jang HC. Cardiometabolic implication of sarcopenia: the Korea National Health and Nutrition Examination Study (KNHANES) 2008-2010. IJC Metab Endocr 2014;4:63-9.
  24. Chung JY, Kang HT, Lee DC, Lee HR, Lee YJ. Body composition and its association with cardiometabolic risk factors in the elderly: a focus on sarcopenic obesity. Arch Gerontol Geriatr 2013;56:270-8.
  25. Newman AB, Kupelian V, Visser M, Simonsick E, Goodpaster B, Nevitt M, Kritchevsky SB, Tylavsky FA, Rubin SM, Harris TB; Health ABC Study Investigators. Sarcopenia: alternative definitions and associations with lower extremity function. J Am Geriatr Soc 2003;51:1602-9.
  26. Lee S, Lee JA, Kim JY, Zu Kim Y, Park HS. The risk factors of sarcopenia among Korean elderly men: based on 2009 Korean National Health and Nutrition Examination Survey Data. J Obes Metab Syndr 2014;23:23-31.
  27. Kim SH, Kim TH, Hwang HJ. The relationship of physical activity (PA) and walking with sarcopenia in Korean males aged 60 years and older using the Fourth Korean National Health and Nutrition Examination Survey (KNHANES IV-2, 3), 2008-2009. Arch Gerontol Geriatr 2013;56:472-7.
  28. Paddon-Jones D, Rasmussen BB. Dietary protein recommendations and the prevention of sarcopenia. Curr Opin Clin Nutr Metab Care 2009;12:86-90.
  29. Geirsdottir OG, Arnarson A, Ramel A, Jonsson PV, Thorsdottir I. Dietary protein intake is associated with lean body mass in community-dwelling older adults. Nutr Res 2013;33:608-12.
  30. Morley JE, Argiles JM, Evans WJ, Bhasin S, Cella D, Deutz NE, Doehner W, Fearon KC, Ferrucci L, Hellerstein MK, Kalantar-Zadeh K, Lochs H, MacDonald N, Mulligan K, Muscaritoli M, Ponikowski P, Posthauer ME, Rossi Fanelli F, Schambelan M, Schols AM, Schuster MW, Anker SD; Society for Sarcopenia, Cachexia, and Wasting Disease. Nutritional recommendations for the management of sarcopenia. J Am Med Dir Assoc 2010;11:391-6.
  31. Deutz NE, Bauer JM, Barazzoni R, Biolo G, Boirie Y, Bosy-Westphal A, Cederholm T, Cruz-Jentoft A, Krznaric Z, Nair KS, Singer P, Teta D, Tipton K, Calder PC. Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN expert group. Clin Nutr 2014;33:929-36.
  32. Zeng FF, Xue WQ, Cao WT, Wu BH, Xie HL, Fan F, Zhu HL, Chen YM. Diet-quality scores and risk of hip fractures in elderly urban Chinese in Guangdong, China: a case-control study. Osteoporos Int 2014;25:2131-41.
  33. Chan R, Leung J, Woo J. Dietary patterns and risk of frailty in Chinese community-dwelling older people in Hong Kong: a prospective cohort study. Nutrients 2015;7:7070-84.
  34. Jahangir A, Mirza M, Shahreyar M, Mengesha T, Shearer R, Sultan S, Jahangir A, Choudhuri I, Nangia V, Dhala A, Bhatia A, Niazi I, Sra J, Tajik AJ. Presence of obesity is associated with lower mortality in elderly patients with implantable cardioverter defibrillator. Int J Obes 2018;42:169-74.
  35. Alkerwi A, Vernier C, Crichton GE, Sauvageot N, Shivappa N, Hebert JR. Cross-comparison of diet quality indices for predicting chronic disease risk: findings from the Observation of Cardiovascular Risk Factors in Luxembourg (ORISCAV-LUX) study. Br J Nutr 2015;113:259-69.
  36. Ramirez-Vargas E, Arnaud-Vinas MR, Delisle H. Prevalence of the metabolic syndrome and associated lifestyles in adult males from Oaxaca, Mexico. Salud Publica Mex 2007;49:94-102.
  37. Milajerdi A, Namazi N, Larijani B, Azadbakht L. The Association of dietary quality indices and cancer mortality: a systematic review and meta-analysis of cohort studies. Nutr Cancer 2018;70:1091-105.
  38. Zarrin R, Ibiebele TI, Marks GC. Development and validity assessment of a diet quality index for Australians. Asia Pac J Clin Nutr 2013;22:177-87.
  39. Chen LW, Fung SM, Fok D, Leong LP, Toh JY, Lim HX, Pang WW, Tan KH, Chong YS, Yap F, Godfrey KM, Lee YS, Chong MF. The development and evaluation of a diet quality index for Asian toddlers and its perinatal correlates: the GUSTO cohort study. Nutrients 2019;11:535.
  40. Granic A, Mendonca N, Sayer AA, Hill TR, Davies K, Siervo M, Mathers JC, Jagger C. Effects of dietary patterns and low protein intake on sarcopenia risk in the very old: the Newcastle 85+ study. Clin Nutr 2020;39:166-73.