Association Between Handgrip Strength, TNF-αlpha Levels and the Presence of Chronic Diseases Among the Elderly

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Frempong, Samuel Kekeli Agordzo, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4674200/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: There is a rapid surge in the elderly population globally and in Ghana. Ageing is frequently associated with the emergence of some chronic diseases due to a decline in physiological and physical functions. Early detection of chronic diseases or possible risk factors of disease development is critical in reducing mortality and morbidity among the elderly. This study, therefore, sought to explore the relationship between the inflammatory cytokine-tumour necrosis factor (TNF-α), handgrip strength and the presence of chronic diseases among the elderly population seeking medical care from a hospital in Ghana. Methods: This was a hospital-based cross-sectional study carried out among individuals 60 years or above. A total of 104 persons who met the inclusion criteria and consented were enrolled on the study. Handgrip strength was measured using a digital hand dynamometer and plasma TNF-α levels were determined using sandwich ELISA. Data on demographics and chronic disease conditions were collected from participants using a standardized questionnaire and from the participant’s hospital folder. Results: The study recruited 104 participants, of which 53% were females and 47% were males. The median age (median (IQR)) was 65 (62–71) years. Again, of the total participants, 63.5% had at least one chronic disease while 36.5% had no chronic disease. Whereas 12.5% of participants had low handgrip strength, 87.5% had normal hand grip strength. There was no significant association between disease status and low handgrip strength (p = 0.709). However, there was a significant association between disease status and increased plasma levels of TNF-α among participants of the study (p = 0.0435). There was also a significant association between low handgrip strength and increased plasma levels of TNF-α among participants of the study (p = 0.0001). Conclusion: In conclusion, the present study observed that low hand grip strength is significantly associated with high circulating TNF-α levels which is also associated with increased presence of chronic disease among the elderly. Low handgrip strength may not independently represent an increased risk of developing chronic diseases. Handgrip Strength Tumour Necrosis Factor-Alpha Elderly Figures Figure 1 1. Introduction Individuals who are 60 years and above experience a natural reduction in cognitive, physical, and psychological abilities [ 1 ] and are described as elderly [ 2 ]. Aging is often associated with chronic diseases, such as hypertension, diabetes mellitus, renal disease, arthritis, depression, and hypothyroidism leading to increased morbidity and mortality [ 1 ] A study conducted by Błeszyńska, Wierucki, Zdrojewski, & Renke in 2020 predicted a dramatic increase in the elderly population globally in the next four decades. Even though the current elderly population in Ghana is estimated at 5% of the national population, recent data estimates that the elderly population is increasing at an alarming rate [ 3 ]. Handgrip strength is a simple and reliable measurement of maximum voluntary muscle strength [ 4 ]. It is an important tool for diagnosing sarcopenia and is widely used as a single indicator to represent total muscle strength [ 4 ]. Aside from the usefulness of handgrip strength in predicting muscle mass and physical activity, it also predicts the incidence of chronic diseases, nutritional status, quality of life, independence of daily life, and even mortality risk [ 5 ]. Moreover, handgrip strength has also been linked with several medical conditions such as anaemia, dyslipidemia, cardiovascular diseases, metabolic disorders, and chronic renal diseases [ 6 ]. Tumour Necrosis Factor-alpha (TNF-α), is an acute-phase protein produced by macrophages/monocytes during acute inflammation and is responsible for initiating a series of signals in cells, resulting in cell death [ 7 ]. TNF-α has been shown to mediate metabolic activities with high levels observed to be associated with diabetes mellitus type 2 and decreased muscle strength and muscle mass [ 8 ]. As one ages, inflammatory factors like TNF-α increase in the body, which contributes to the pathogenesis of common chronic diseases experienced by the elderly including Alzheimer’s disease, heart-related diseases, inflammatory bowel disease, rheumatoid arthritis, and certain infections [ 9 ]. Owing to the limited knowledge of the relationship between handgrip strength, inflammation, and disease in the elderly in Ghana, we sought to ascertain the association between hand grip strength, TNF-alpha levels, and disease among the elderly. Specifically, the study; 1) investigated the relationship between TNF-α and chronic diseases among the elderly, 2) investigated the relationship between handgrip strength and the presence of chronic diseases among the elderly, and 3) ascertained the relationship between handgrip strength and inflammation as defined by the levels of TNF-α among elderly persons. 2. Results and Discussion Sociodemographic Characteristics of the Study Participants Out of the 104 participants recruited, 36.5% (n = 38) had no chronic disease, 50% (n = 52) had one chronic disease whereas 13.5% (n = 14) had more than one chronic disease. The participants were made up of 53% (n = 55) females and 47% (n = 49) males. The median age (median (IQR)) was 65 (62–71) years. Body mass index significantly differed between participants who had no chronic and those who had at least one chronic disease (Table 1.0 ). Sociodemographic Characteristics of the Study Participants Out of the 104 participants recruited, 36.5% (n = 38) had no chronic disease, 50% (n = 52) had one chronic disease whereas 13.5% (n = 14) had more than one chronic disease. The participants were made up of 53% (n = 55) females and 47% (n = 49) males. The median age (median (IQR)) was 65 (62–71) years. Body mass index significantly differed between participants who had no chronic and those who had at least one chronic disease (Table 1.0 ). Table 1.0 Sociodemographic factors of participants according to disease status Total (n = 104) No Chronic Disease (n = 38) Mono-morbidity (n = 52) Comorbidity (n = 14) Variable p-value Gender 0.316 Male 49(47.0) 18 (36.7) 27(55.1)) 10(18.2) Female 55(53.0) 20 (36.4) 25(45.5)) 4(8.2) Age (Years) 65 (62–71) 65(61–71) 65(63–71) 66(62.0–72) 0.710 Age Category 0.966 60–69 68(65.4) 24(35.3) 34(50.0) 10(14.7) 70–79 29(27.9) 12(41.4) 14(48.3) 3(10.3) 80> 7(6.7) 2(28.6) 4(57.1) 1(14.3) Education 0.747 None 18 (17.3) 8(44.4) 8(44.4) 2(11.2) Basic 52 (50.0) 19 (36.5) 24 (46.2) 9(17.3) Secondary 13(12.5) 3(23.1) 8(61.5) 2(15.4) Tertiary 21(20.2) 8(38.1) 12(57.1) 1(7.1) Marital status 0.439 Married 65(62.5) 22(33.9) 35(53.9) 8(12.3) Single 1(0.96) 1(100) 0 (0.0) 0(0.0) Cohabiting 1(0.96) 1(100) 0(0.0) 0(0.0) Divorced 12(11.5) 3(25.0) 8(66.7) 1(8.3) Widow/Widower 25(24.0) 11(44.0) 9(36.0) 5(20.0) Occupation 0.555 Formal 8(7.7) 3(37.5) 5(62.5) 0(0.0) Informal 47(45.2) 20 (42.6.0) 22 (46.8) 5(10.6) Unemployed 49(47.0) 15(30.6) 25(51.0) 9(18.4) Residence 0.373 Rural 14(13.5) 3(21.4) 8(57.2) 21.4(31.4) Urban 90(86.5) 35(38.9) 44(48.9) 11(12.2) *Results are presented as absolute figures (percentage). However, age and BMI are presented as median (interquartile range). Disease profile of participants Chronic diseases identified among participants included hypertension (50%), diabetes (18.3%), asthma (1%), and fatty liver disease (1%) (Fig. 1.0 ). The prevalence of at least one disease chronic disease among participants was 63.5% whereas 36.5% of participants had no chronic disease. Also, the prevalence of mono-morbidity and comorbidities was 50% and 13.5% respectively. Hand grip strength of participants Among participants in the study, 12.5% had low hand grip strength according to age and gender while 87.5% had normal hand grip strength. The relationship between hand grip strength and the chronic disease status of participants is demonstrated in Table 2.0 below. Table 2.0 Relationship between disease status and handgrip strength DISEASE STATUS Hand Grip Strength No Chronic Disease (n = 38) Mono-Morbidity (n = 52) Co-Morbidity (n = 14) P-Value 0.709 Normal 34(89.5) 44 (84.6) 13 (92.9) Low 4 (10.5) 8 (15.4) 1 (7.1) * Data is presented as absolute number (percentage) Relationship between TNF-α and the presence of chronic disease among study participants . Non-parametric one-way analysis of variation (Kruskal-Wallis test) indicates a significant association between disease status and plasma levels of TNF-α among participants of the study (p = 0.0435) (Table 3.0 ). Table 3.0 Relationship between plasma TNF-α levels and disease status of participants DISEASE STATUS VARIABLE No Chronic Disease (n = 38) Mono-Morbidity (n = 52) Co-Morbidity (N = 14) P-Value TNF_α (ng/mL) 7.7 (6.1–14.7) 10.2 (6.7–17.2) 6.5(6.2–8.6) 0.0435 * Data is presented as median (interquartile rang) Relationship between TNF-α and low handgrip strength among the elderly Non-parametric one-way analysis of variation (Kruskal-Wallis test) indicates a significant association between handgrip strength category and plasma levels of TNF-α among participants of the study (p = 0.0001). Table 4.0 Relationship between plasma TNF-α levels and disease status of study participants VARIABLE GRIP STRENGTH NORMAL (n = 91) GRIP STRENGTH LOW (n = 13) P-Value TNF-α(ng/mL) 7.7 (6.3–13.6) 30.5 (14.8–40.2) 0.0001 *Data is presented as median (interquartile range) DISCUSSIONS Studying the association of chronic diseases and inflammatory cytokines such as TNF-α about handgrip strength among the elderly can provide useful information on ageing-associated negative outcomes. This study, therefore, established the relationship between TNF-α, handgrip strength and the presence of chronic diseases among the elderly. The overall prevalence of a least one chronic disease among the study population was 63%. Even though this is high, it is fairly low compared to 94% reported by [ 10 ] among elderly persons in Ghana. The research by Oduro et al (2023) depended on data from the 2007 Study on Global Ageing and Adult Health (SAGE Wave1) which was based on nationally representative data. The difference in findings of the present study and that obtained by Oduro et al (2023) could have resulted from the differences in sample size, methods of obtaining information on chronic disease, the geographic location of participants, and the period during which the study was conducted as the lifestyle of people that may contribute to the development of chronic diseases may change over time. However, in Vietnam, a 43% prevalence of chronic disease was reported among the elderly population [ 11 ], which is lower than the findings of this study. Improved health and social sectors have been shown to reduce the incidence of chronic diseases [ 12 , 13 ] and this could account for the low chronic disease prevalence among the elderly population in Vietnam. Hypertension dominates the observed chronic diseases among participants of the present study which might be due to poor lifestyle and inadequate strategies for the prevention, diagnosis, and control of hypertension in an increasingly ageing population in Ghana [ 14 ]. Despite observing a low handgrip strength of 12.8% this was not significantly associated with disease status. Nevertheless, the prevalence of chronic diseases among individuals with low handgrip strength was higher compared to that of individuals with normal handgrip strength. This is consistent with studies done in China and Europe, which indicated that low handgrip strength is associated with higher odds of having multiple chronic diseases in the elderly [ 15 , 16 ]. Differences in ethnicity, age range of participants, socioeconomic status, and physical activity levels may account for the variation observed between this study and that observed in China and Europe. A strong correlation was observed between TNF-α and the presence of chronic disease among study participants. This outcome supports several studies which have linked elevated TNF-α to chronic diseases such as Alzheimer's disease, cardiovascular disease, inflammatory bowel disease, rheumatoid arthritis, and others [ 17 – 19 ]. As individuals age, inflammatory proteins like TNF-α increase in the blood, and excessive TNF-α in the blood sets the stage for developing several chronic diseases among the aged [ 19 ]. This accounted for the strong correlation between TNF-α and the presence of chronic disease among the participants Our finding of a significant association between handgrip strength and plasma levels of TNF-α is corroborated by the finding of a study in Leiden, Netherlands which revealed that elevated TNF- α levels precede muscle weakness in elderly persons [ 20 ]. It has been demonstrated that TNF-α that is discharged from diseased tissues exerts endocrine effects on skeletal muscles [ 21 ]. The direct activity of TNF-α on skeletal muscles results in the decline in muscular specific force [ 22 ]. This explains the association between higher plasma levels of TNF-α and lower hand grip strength [ 22 ]. Increased levels of pro-inflammatory proteins like TNF-α are also a precursor for several chronic diseases and muscle degeneration among the elderly [ 18 , 23 ], 2021. High levels of TNF-α and other inflammatory cytokines associated with ageing may result in low handgrip strength and chronic diseases. This may account for our finding of a significant association between handgrip strength and plasma TNF-α levels which we also observed to be significantly associated with the presence of at least one chronic disease among the elderly. 3. Conclusions The study demonstrated that low handgrip strength is significantly associated with higher levels of circulating TNF-α levels which is also significantly associated with the presence of chronic diseases among the elderly. However, handgrip strength does not have a direct relationship with the presence of diseases among the elderly. 4. Materials and Methods METHODS Study design This was a hospital-based cross-sectional study that saw the recruitment of participants from January 2020 to December 2020. Sociodemographic data was collected from each participant through the administering of a standardized questionnaire. Data on chronic diseases was retrieved from the hospital folders of the participants. Study site The study was carried out at St. Elizabeth Catholic Hospital which is located in Hwidiem in the Asutifi-South District of the Ahafo Region of Ghana. St. Elizabeth Catholic Hospital is the largest referral health facility in the Ahafo region. The hospital also has several specialized departments making it attractive to elderly clients. Study Population The study included 104 participants who were 60 years or older. The elderly have an increased risk of ageing-associated diseases due to the decline in the function of all organ systems as individuals age [ 24 ]. Handgrip strength also declines with aging impacting negatively on the ability of the elderly to perform physical activities [ 25 ]. Sample size determination With a 95% confidence level and 80% power considering the 6.6% elderly population in Ghana [ 26 ], a minimum sample size of 95 was required for this study. However, 104 participants were recruited into the study. Sources and collection of data A standardized questionnaire was administered to collect sociodemographic information from each participant. Data on chronic diseases was retrieved from the hospital folders of the participants. Specimen collection and storage Plasma was obtained from four millilitres of whole blood collected from participants into ethylenediaminetetracetic acid (EDTA) containing tubes. Centrifugation was done at 1,000 X g for 10 minutes. The plasma obtained was transferred into 2 millitres Eppendorf tubes and stored at a temperature of -20°C. TNF-alpha estimation TNF-α assaying was done using the Enzyme-linked immunosorbent assays (ELISA) method, (HumaReader HS ELISA plate reader, Human GmbH, Germany). A microwell ELISA plate, provided in the test kit, was coated with a specific antibody for human TNF-α. When samples or standards were added to the plate, the TNF-α in the samples or standards were combined with the pre-coated antibody. Next, a biotinylated detection antibody specific for human TNF-α and Avidin-Horseradish Peroxidase (HRP) conjugate were added to each well and incubated. After washing away free components, a substrate solution was added, resulting in blue colouration exclusively in wells containing human TNF-α, biotinylated detection antibody, and Avidin-HRP conjugate. The enzyme-substrate reaction was stopped with a stop solution, causing the colour to turn yellow. The optical density (OD) was measured at a wavelength of 450 nm ± 2 nm using a spectrophotometer. The OD value corresponded to the concentration of human TNF-α, which was calculated by comparing the OD of the samples to the standard curve. Hand grip estimation Hand grip strength was measured using a digital hand dynamometer from Changzhou Kondak Medical Rehabilitation Equipment Company Limited, China. After the process was explained to them, participants were made to squeeze the handle of the hand dynamometer using their dominant hand three times at 2-minute intervals. The highest force obtained was recorded as the grip strength of the participant. Data management and analysis Data entry and curation were carried out in Excel. The statistical analysis was done using Stata/I/C 14.0. Chi-square analysis or Fisher’s Exact test was used to test for significance between categorical variables while non-parametric analysis of variation (Kruskal-Wallis test) was used to test for significance between categorical and continuous variables. A p-value < 0.05 was considered statistically significant. 5. Recommendations Further studies into the relationship between plasma levels of TNF-α, handgrip strength, and the risk of developing chronic diseases among the elderly are needed. Measures to improve handgrip strength among the elderly should be promoted as normal handgrip strength may decrease TNF-α levels thereby controlling inflammation among the elderly. TNF-α, levels should be managed among the elderly as high levels are associated with the presence of chronic diseases. Declarations Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of Kwame Nkrumah University of Science and Technology (ref: CHRPE/AP/626/19). The Management Team of St. Elizabeth Hospital, Hwidiem also approved the protocol for the study. Before recruitment, the research was thoroughly explained to the prospective participants in the language they could understand. This allowed for informed consent to participate to be obtained from all of the participants in the study. Informed Consent Statement : Informed consent was obtained from all subjects involved in the study. Conflicts of Interest: The authors declare no conflicts of interest. Funding: This research received no external funding. Author Contribution PN, MEAA and MTF were involved in Conceptualization, Formal analysis, Investigation, Methodology, Resources, Supervision, Validation, Writing-original draft, Writing-review & editing1; Eugene Baah was involved in Investigation, Methodology, Resources, Writing-original draft2;Samuel Kekeli Agordzo took part in the Investigation, Methodology, Writing-original draft, Writing-review & editing1,6; Ivan A. Muanah provided Resources, supervision and Writing-review & editing3; Evans O. Agyapong was responsible for Investigation, Resources 3;Felix Gadzeto took part inInvestigation, Methodology, Resources3;Bright Atta-Mensah did Investigation, Resources, supervision, Writing-review & editing3;Anthony Appiah; was involved in Investigation, Resources, supervision, Writing-review & editing4;Samuel K. Boakye-Boateng too part in the supervision, Writing-review & editing and provision of Resources,5;Dennis Adu-Gyasi made Formal Analysis, Investigation, Methodology, Resources, Writing-original draft7. Acknowledgement All participants of this study as well as staff of the study sites are duely acknowledged Data Availability Statement: All data generated or analyzed during this study are included in this article and can be requested from the corresponding author. References Cao X, et al. The impact of hearing loss on cognitive impairment: the mediating role of depressive symptoms and the moderating role of social relationships. Front Public Health. 2023;11:1149769. Tadi A, Gheibizadeh M, Anjiri SGC. Death anxiety and associated factors in the hospitalized and non-hospitalized elderly with chronic diseases in ahvaz. Jundishapur J Chronic Disease Care, 2022. 11(4). Simmons SS, et al. Assessing the Determinants of the Wish to Die among the Elderly Population in Ghana. Geriatrics. 2021;6(1):32. 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(1):235–43. Lee SY, et al. Handgrip strength: Should repeated measurements be performed in both hands? Geriatr Gerontol Int. 2021;21(5):426–32. Lima TRL, et al. Handgrip strength and pulmonary disease in the elderly: what is the link? Aging disease. 2019;10(5):1109. Ribeiro D, et al. Proinflammatory pathways: the modulation by flavonoids. Med Res Rev. 2015;35(5):877–936. Premužić V et al. The association of TNF-alpha inhibitors and development of IgA nephropathy in patients with rheumatoid arthritis and diabetes. Case reports in nephrology, 2020. 2020. Mir RH, et al. Curcumin as a privileged scaffold molecule for various biological targets in drug development. Stud Nat Prod Chem. 2022;73:405–34. Oduro JK, Okyere J, Nyador JKMT. Risky health behaviours and chronic conditions among aged persons: analysis of SAGE selected countries. BMC Geriatr. 2023;23(1):145. Mwangi J, Kulane A, Van Hoi L. Chronic diseases among the elderly in a rural Vietnam: prevalence, associated socio-demographic factors and healthcare expenditures. Int J Equity Health. 2015;14(1):1–8. Egger G, Dixon J. Beyond obesity and lifestyle: a review of 21st century chronic disease determinants. BioMed research international, 2014. 2014. Senapati S, Bharti N, Bhattacharya A. Modern lifestyle diseases: chronic diseases, awareness and prevention. Int J Curr Res Acad Rev. 2015;3(3):215–23. Koduah A, et al. Health systems, population and patient challenges for achieving universal health coverage for hypertension in Ghana. Health Policy Plann. 2021;36(9):1451–8. Cheung C-L, et al. Association of handgrip strength with chronic diseases and multimorbidity: a cross-sectional study. Age. 2013;35:929–41. Mey R, et al. Handgrip strength in older adults with chronic diseases from 27 European countries and Israel. Eur J Clin Nutr. 2023;77(2):212–7. Aggarwal M, et al. Alzheimer disease occurs more frequently in patients with inflammatory bowel disease: insight from a nationwide study. J Clin Gastroenterol. 2023;57(5):501–7. Mohammad-Rezaei M, et al. Serum levels of IL-32 in patients with coronary artery disease and its relationship with the serum levels of IL-6 and TNF-α. Mol Biol Rep. 2021;48(5):4263–71. Sattui SE, et al. Incidence of dementia in patients with rheumatoid arthritis and association with disease modifying anti-rheumatic drugs–analysis of a national claims database. Seminars in Arthritis and Rheumatism. Elsevier; 2022. Taekema DG, et al. High innate production capacity of tumor necrosis factor-α and decline of handgrip strength in old age. Mech Ageing Dev. 2007;128(9):517–21. Powers SK, et al. Disease-induced skeletal muscle atrophy and fatigue. Med Sci Sports Exerc. 2016;48(11):2307. Tuttle CS, Thang LA, Maier AB. Markers of inflammation and their association with muscle strength and mass: A systematic review and meta-analysis. Ageing Res Rev. 2020;64:101185. Izzo C, et al. The role of oxidative stress in cardiovascular aging and cardiovascular diseases. Life. 2021;11(1):60. Guo J, et al. Aging and aging-related diseases: from molecular mechanisms to interventions and treatments. Signal Transduct Target Therapy. 2022;7(1):391. Vennu V. Biological ageing and the risk of decreased handgrip strength among community-dwelling older adult Indians: a cross-sectional study. BMC Geriatr. 2023;23(1):782. GSS GSS. The elderly in Ghana. 2010 Population and Housing Census Report. Ghana Statistical Service: Accra; 2013. Additional Declarations No competing interests reported. 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Agyapong","email":"","orcid":"","institution":"St. Elizabeth Catholic Hospital, Hwidiem, Ahafo Region","correspondingAuthor":false,"prefix":"","firstName":"Evans","middleName":"O.","lastName":"Agyapong","suffix":""},{"id":324060504,"identity":"21e3a664-0cca-4d0e-8e68-02515ab519d9","order_by":7,"name":"Felix Gadzeto","email":"","orcid":"","institution":"St. Elizabeth Catholic Hospital, Hwidiem, Ahafo Region","correspondingAuthor":false,"prefix":"","firstName":"Felix","middleName":"","lastName":"Gadzeto","suffix":""},{"id":324060508,"identity":"44cc69d5-eea9-4f8a-ba7e-0d4082c0f6e2","order_by":8,"name":"Bright Atta-Mensah","email":"","orcid":"","institution":"St. Elizabeth Catholic Hospital, Hwidiem, Ahafo Region","correspondingAuthor":false,"prefix":"","firstName":"Bright","middleName":"","lastName":"Atta-Mensah","suffix":""},{"id":324060509,"identity":"ae1b1871-fae7-4fef-b5dc-05bd6a0598af","order_by":9,"name":"Anthony Appiah","email":"","orcid":"","institution":"Holy Family Hospital, Techiman, Bono-East Region","correspondingAuthor":false,"prefix":"","firstName":"Anthony","middleName":"","lastName":"Appiah","suffix":""},{"id":324060510,"identity":"d20f4ced-d3fc-4f74-b946-a635b1dc4ed2","order_by":10,"name":"Samuel K. Boakye- Boateng","email":"","orcid":"","institution":"Holy Family Hospital, Techiman, Bono-East Region","correspondingAuthor":false,"prefix":"","firstName":"Samuel","middleName":"K. Boakye-","lastName":"Boateng","suffix":""},{"id":324060511,"identity":"9013f430-08ef-4bad-a7d4-3ce50469d2a2","order_by":11,"name":"Dennis Adu-Gyasi","email":"","orcid":"","institution":"Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region","correspondingAuthor":false,"prefix":"","firstName":"Dennis","middleName":"","lastName":"Adu-Gyasi","suffix":""}],"badges":[],"createdAt":"2024-07-02 12:26:59","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4674200/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4674200/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":62152025,"identity":"ae5549f6-aa1e-403a-898a-e6de875f6fb5","added_by":"auto","created_at":"2024-08-09 20:49:32","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":11986,"visible":true,"origin":"","legend":"\u003cp\u003eChronic disease profile of participants\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4674200/v1/2e43e7770c7919c47ae98e85.png"},{"id":63561129,"identity":"550ef9fb-608f-4664-a327-72c6baf664dd","added_by":"auto","created_at":"2024-08-29 14:34:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":672717,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4674200/v1/061c73ad-3833-4a9e-b235-51511c024f91.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eAssociation Between Handgrip Strength, TNF-αlpha Levels and the Presence of Chronic Diseases Among the Elderly\u003c/p\u003e","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eIndividuals who are 60 years and above experience a natural reduction in cognitive, physical, and psychological abilities [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] and are described as elderly [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Aging is often associated with chronic diseases, such as hypertension, diabetes mellitus, renal disease, arthritis, depression, and hypothyroidism leading to increased morbidity and mortality [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] A study conducted by Błeszyńska, Wierucki, Zdrojewski, \u0026amp; Renke in 2020 predicted a dramatic increase in the elderly population globally in the next four decades. Even though the current elderly population in Ghana is estimated at 5% of the national population, recent data estimates that the elderly population is increasing at an alarming rate [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHandgrip strength is a simple and reliable measurement of maximum voluntary muscle strength [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. It is an important tool for diagnosing sarcopenia and is widely used as a single indicator to represent total muscle strength [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Aside from the usefulness of handgrip strength in predicting muscle mass and physical activity, it also predicts the incidence of chronic diseases, nutritional status, quality of life, independence of daily life, and even mortality risk [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Moreover, handgrip strength has also been linked with several medical conditions such as anaemia, dyslipidemia, cardiovascular diseases, metabolic disorders, and chronic renal diseases [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTumour Necrosis Factor-alpha (TNF-α), is an acute-phase protein produced by macrophages/monocytes during acute inflammation and is responsible for initiating a series of signals in cells, resulting in cell death [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. TNF-α has been shown to mediate metabolic activities with high levels observed to be associated with diabetes mellitus type 2 and decreased muscle strength and muscle mass [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. As one ages, inflammatory factors like TNF-α increase in the body, which contributes to the pathogenesis of common chronic diseases experienced by the elderly including Alzheimer\u0026rsquo;s disease, heart-related diseases, inflammatory bowel disease, rheumatoid arthritis, and certain infections [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOwing to the limited knowledge of the relationship between handgrip strength, inflammation, and disease in the elderly in Ghana, we sought to ascertain the association between hand grip strength, TNF-alpha levels, and disease among the elderly. Specifically, the study; 1) investigated the relationship between TNF-α and chronic diseases among the elderly, 2) investigated the relationship between handgrip strength and the presence of chronic diseases among the elderly, and 3) ascertained the relationship between handgrip strength and inflammation as defined by the levels of TNF-α among elderly persons.\u003c/p\u003e"},{"header":"2. Results and Discussion","content":"\u003cp\u003e\u003cstrong\u003eSociodemographic Characteristics of the Study Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut of the 104 participants recruited, 36.5% (n\u0026thinsp;=\u0026thinsp;38) had no chronic disease, 50% (n\u0026thinsp;=\u0026thinsp;52) had one chronic disease whereas 13.5% (n\u0026thinsp;=\u0026thinsp;14) had more than one chronic disease. The participants were made up of 53% (n\u0026thinsp;=\u0026thinsp;55) females and 47% (n\u0026thinsp;=\u0026thinsp;49) males. The median age (median (IQR)) was 65 (62\u0026ndash;71) years. Body mass index significantly differed between participants who had no chronic and those who had at least one chronic disease (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1.0\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSociodemographic Characteristics of the Study Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut of the 104 participants recruited, 36.5% (n\u0026thinsp;=\u0026thinsp;38) had no chronic disease, 50% (n\u0026thinsp;=\u0026thinsp;52) had one chronic disease whereas 13.5% (n\u0026thinsp;=\u0026thinsp;14) had more than one chronic disease. The participants were made up of 53% (n\u0026thinsp;=\u0026thinsp;55) females and 47% (n\u0026thinsp;=\u0026thinsp;49) males. The median age (median (IQR)) was 65 (62\u0026ndash;71) years. Body mass index significantly differed between participants who had no chronic and those who had at least one chronic disease (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1.0\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1.0\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eSociodemographic factors of participants according to disease status\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;104)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNo Chronic Disease (n\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMono-morbidity (n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eComorbidity (n\u0026thinsp;=\u0026thinsp;14)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ep-value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.316\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e49(47.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18 (36.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27(55.1))\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10(18.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e55(53.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20 (36.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25(45.5))\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4(8.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge (Years)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e65 (62\u0026ndash;71)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e65(61\u0026ndash;71)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e65(63\u0026ndash;71)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e66(62.0\u0026ndash;72)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.710\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge Category\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.966\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e60\u0026ndash;69\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e68(65.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24(35.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34(50.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10(14.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e70\u0026ndash;79\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29(27.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12(41.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14(48.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3(10.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e80\u0026gt;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7(6.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2(28.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4(57.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1(14.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.747\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18 (17.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8(44.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8(44.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2(11.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBasic\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e52 (50.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19 (36.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24 (46.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9(17.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSecondary\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13(12.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3(23.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8(61.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2(15.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTertiary\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21(20.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8(38.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12(57.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1(7.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.439\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMarried\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e65(62.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22(33.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35(53.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8(12.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSingle\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1(0.96)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1(100)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0(0.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCohabiting\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1(0.96)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1(100)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0(0.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0(0.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDivorced\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12(11.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3(25.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8(66.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1(8.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWidow/Widower\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25(24.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11(44.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9(36.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5(20.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.555\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFormal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8(7.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3(37.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5(62.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0(0.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInformal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e47(45.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20 (42.6.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22 (46.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5(10.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUnemployed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e49(47.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15(30.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25(51.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9(18.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eResidence\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.373\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRural\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14(13.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3(21.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8(57.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e21.4(31.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUrban\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e90(86.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35(38.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44(48.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e11(12.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e*Results are presented as absolute figures (percentage). However, age and BMI are presented as median (interquartile range).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisease profile of participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChronic diseases identified among participants included hypertension (50%), diabetes (18.3%), asthma (1%), and fatty liver disease (1%) (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1.0\u003c/span\u003e). The prevalence of at least one disease chronic disease among participants was 63.5% whereas 36.5% of participants had no chronic disease. Also, the prevalence of mono-morbidity and comorbidities was 50% and 13.5% respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHand grip strength of participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong participants in the study, 12.5% had low hand grip strength according to age and gender while 87.5% had normal hand grip strength. The relationship between hand grip strength and the chronic disease status of participants is demonstrated in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2.0\u003c/span\u003e below.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2.0\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eRelationship between disease status and handgrip strength\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eDISEASE STATUS\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHand Grip Strength\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo Chronic Disease (n\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMono-Morbidity (n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCo-Morbidity (n\u0026thinsp;=\u0026thinsp;14)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP-Value\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.709\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNormal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34(89.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44 (84.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13 (92.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLow\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (10.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8 (15.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (7.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003e\u003cstrong\u003e*\u003c/strong\u003eData is presented as absolute number (percentage)\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eRelationship between TNF-\u0026alpha; and the presence of chronic disease among study participants\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eNon-parametric one-way analysis of variation (Kruskal-Wallis test) indicates a significant association between disease status and plasma levels of TNF-\u0026alpha; among participants of the study (p\u0026thinsp;=\u0026thinsp;0.0435) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3.0\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3.0\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eRelationship between plasma TNF-\u0026alpha; levels and disease status of participants\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eDISEASE STATUS\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVARIABLE\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo Chronic Disease (n\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMono-Morbidity\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCo-Morbidity (N\u0026thinsp;=\u0026thinsp;14)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eP-Value\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTNF_\u0026alpha; (ng/mL)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.7 (6.1\u0026ndash;14.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10.2 (6.7\u0026ndash;17.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.5(6.2\u0026ndash;8.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.0435\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003e*\u003cstrong\u003eData is presented as median (interquartile rang)\u003c/strong\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eRelationship between TNF-\u0026alpha; and low handgrip strength among the elderly\u003c/p\u003e\n\u003cp\u003eNon-parametric one-way analysis of variation (Kruskal-Wallis test) indicates a significant association between handgrip strength category and plasma levels of TNF-\u0026alpha; among participants of the study (p\u0026thinsp;=\u0026thinsp;0.0001).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4.0\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eRelationship between plasma TNF-\u0026alpha; levels and disease status of study participants\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVARIABLE\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGRIP STRENGTH NORMAL\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;91)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGRIP STRENGTH LOW\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP-Value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTNF-\u0026alpha;(ng/mL)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.7 (6.3\u0026ndash;13.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30.5 (14.8\u0026ndash;40.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.0001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\"\u003e*Data is presented as median (interquartile range)\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eDISCUSSIONS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudying the association of chronic diseases and inflammatory cytokines such as TNF-\u0026alpha; about handgrip strength among the elderly can provide useful information on ageing-associated negative outcomes. This study, therefore, established the relationship between TNF-\u0026alpha;, handgrip strength and the presence of chronic diseases among the elderly.\u003c/p\u003e\n\u003cp\u003eThe overall prevalence of a least one chronic disease among the study population was 63%. Even though this is high, it is fairly low compared to 94% reported by [\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e] among elderly persons in Ghana. The research by Oduro et al (2023) depended on data from the 2007 Study on Global Ageing and Adult Health (SAGE Wave1) which was based on nationally representative data. The difference in findings of the present study and that obtained by Oduro et al (2023) could have resulted from the differences in sample size, methods of obtaining information on chronic disease, the geographic location of participants, and the period during which the study was conducted as the lifestyle of people that may contribute to the development of chronic diseases may change over time. However, in Vietnam, a 43% prevalence of chronic disease was reported among the elderly population [\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e], which is lower than the findings of this study. Improved health and social sectors have been shown to reduce the incidence of chronic diseases [\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e] and this could account for the low chronic disease prevalence among the elderly population in Vietnam.\u003c/p\u003e\n\u003cp\u003eHypertension dominates the observed chronic diseases among participants of the present study which might be due to poor lifestyle and inadequate strategies for the prevention, diagnosis, and control of hypertension in an increasingly ageing population in Ghana [\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eDespite observing a low handgrip strength of 12.8% this was not significantly associated with disease status. Nevertheless, the prevalence of chronic diseases among individuals with low handgrip strength was higher compared to that of individuals with normal handgrip strength. This is consistent with studies done in China and Europe, which indicated that low handgrip strength is associated with higher odds of having multiple chronic diseases in the elderly [\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e]. Differences in ethnicity, age range of participants, socioeconomic status, and physical activity levels may account for the variation observed between this study and that observed in China and Europe.\u003c/p\u003e\n\u003cp\u003eA strong correlation was observed between TNF-\u0026alpha; and the presence of chronic disease among study participants. This outcome supports several studies which have linked elevated TNF-\u0026alpha; to chronic diseases such as Alzheimer's disease, cardiovascular disease, inflammatory bowel disease, rheumatoid arthritis, and others [\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e]. As individuals age, inflammatory proteins like TNF-\u0026alpha; increase in the blood, and excessive TNF-\u0026alpha; in the blood sets the stage for developing several chronic diseases among the aged [\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e]. This accounted for the strong correlation between TNF-\u0026alpha; and the presence of chronic disease among the participants\u003c/p\u003e\n\u003cp\u003eOur finding of a significant association between handgrip strength and plasma levels of TNF-\u0026alpha; is corroborated by the finding of a study in Leiden, Netherlands which revealed that elevated TNF- \u0026alpha; levels precede muscle weakness in elderly persons [\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eIt has been demonstrated that TNF-\u0026alpha; that is discharged from diseased tissues exerts endocrine effects on skeletal muscles [\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e]. The direct activity of TNF-\u0026alpha; on skeletal muscles results in the decline in muscular specific force [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e]. This explains the association between higher plasma levels of TNF-\u0026alpha; and lower hand grip strength [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e]. Increased levels of pro-inflammatory proteins like TNF-\u0026alpha; are also a precursor for several chronic diseases and muscle degeneration among the elderly [\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e], 2021.\u003c/p\u003e\n\u003cp\u003eHigh levels of TNF-\u0026alpha; and other inflammatory cytokines associated with ageing may result in low handgrip strength and chronic diseases. This may account for our finding of a significant association between handgrip strength and plasma TNF-\u0026alpha; levels which we also observed to be significantly associated with the presence of at least one chronic disease among the elderly.\u003c/p\u003e"},{"header":"3. Conclusions","content":"\u003cp\u003eThe study demonstrated that low handgrip strength is significantly associated with higher levels of circulating TNF-α levels which is also significantly associated with the presence of chronic diseases among the elderly. However, handgrip strength does not have a direct relationship with the presence of diseases among the elderly.\u003c/p\u003e"},{"header":"4. Materials and Methods","content":"\u003cp\u003eMETHODS\u003c/p\u003e \u003cp\u003e \u003cem\u003eStudy design\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThis was a hospital-based cross-sectional study that saw the recruitment of participants from January 2020 to December 2020. Sociodemographic data was collected from each participant through the administering of a standardized questionnaire. Data on chronic diseases was retrieved from the hospital folders of the participants.\u003c/p\u003e \u003cp\u003e \u003cem\u003eStudy site\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe study was carried out at St. Elizabeth Catholic Hospital which is located in Hwidiem in the Asutifi-South District of the Ahafo Region of Ghana. St. Elizabeth Catholic Hospital is the largest referral health facility in the Ahafo region. The hospital also has several specialized departments making it attractive to elderly clients.\u003c/p\u003e \u003cp\u003e \u003cem\u003eStudy Population\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe study included 104 participants who were 60 years or older. The elderly have an increased risk of ageing-associated diseases due to the decline in the function of all organ systems as individuals age [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Handgrip strength also declines with aging impacting negatively on the ability of the elderly to perform physical activities [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cem\u003eSample size determination\u003c/em\u003e \u003c/p\u003e \u003cp\u003eWith a 95% confidence level and 80% power considering the 6.6% elderly population in Ghana [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], a minimum sample size of 95 was required for this study. However, 104 participants were recruited into the study.\u003c/p\u003e \u003cp\u003e \u003cem\u003eSources and collection of data\u003c/em\u003e \u003c/p\u003e \u003cp\u003eA standardized questionnaire was administered to collect sociodemographic information from each participant. Data on chronic diseases was retrieved from the hospital folders of the participants.\u003c/p\u003e \u003cp\u003e \u003cem\u003eSpecimen collection and storage\u003c/em\u003e \u003c/p\u003e \u003cp\u003ePlasma was obtained from four millilitres of whole blood collected from participants into ethylenediaminetetracetic acid (EDTA) containing tubes. Centrifugation was done at 1,000 X g for 10 minutes. The plasma obtained was transferred into 2 millitres Eppendorf tubes and stored at a temperature of -20\u0026deg;C.\u003c/p\u003e \u003cp\u003e \u003cem\u003eTNF-alpha estimation\u003c/em\u003e \u003c/p\u003e \u003cp\u003eTNF-α assaying was done using the Enzyme-linked immunosorbent assays (ELISA) method, (HumaReader HS ELISA plate reader, Human GmbH, Germany). A microwell ELISA plate, provided in the test kit, was coated with a specific antibody for human TNF-α. When samples or standards were added to the plate, the TNF-α in the samples or standards were combined with the pre-coated antibody. Next, a biotinylated detection antibody specific for human TNF-α and Avidin-Horseradish Peroxidase (HRP) conjugate were added to each well and incubated. After washing away free components, a substrate solution was added, resulting in blue colouration exclusively in wells containing human TNF-α, biotinylated detection antibody, and Avidin-HRP conjugate. The enzyme-substrate reaction was stopped with a stop solution, causing the colour to turn yellow. The optical density (OD) was measured at a wavelength of 450 nm\u0026thinsp;\u0026plusmn;\u0026thinsp;2 nm using a spectrophotometer. The OD value corresponded to the concentration of human TNF-α, which was calculated by comparing the OD of the samples to the standard curve.\u003c/p\u003e \u003cp\u003e \u003cem\u003eHand grip estimation\u003c/em\u003e \u003c/p\u003e \u003cp\u003eHand grip strength was measured using a digital hand dynamometer from Changzhou Kondak Medical Rehabilitation Equipment Company Limited, China. After the process was explained to them, participants were made to squeeze the handle of the hand dynamometer using their dominant hand three times at 2-minute intervals. The highest force obtained was recorded as the grip strength of the participant.\u003c/p\u003e \u003cp\u003e \u003cem\u003eData management and analysis\u003c/em\u003e \u003c/p\u003e \u003cp\u003eData entry and curation were carried out in Excel. The statistical analysis was done using Stata/I/C 14.0. Chi-square analysis or Fisher\u0026rsquo;s Exact test was used to test for significance between categorical variables while non-parametric analysis of variation (Kruskal-Wallis test) was used to test for significance between categorical and continuous variables. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"5. Recommendations","content":"\u003cp\u003eFurther studies into the relationship between plasma levels of TNF-α, handgrip strength, and the risk of developing chronic diseases among the elderly are needed. Measures to improve handgrip strength among the elderly should be promoted as normal handgrip strength may decrease TNF-α levels thereby controlling inflammation among the elderly.\u003c/p\u003e \u003cp\u003eTNF-α, levels should be managed among the elderly as high levels are associated with the presence of chronic diseases.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics approval and consent to participate:\u003c/h2\u003e \u003cp\u003e The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of Kwame Nkrumah University of Science and Technology (ref: CHRPE/AP/626/19). The Management Team of St. Elizabeth Hospital, Hwidiem also approved the protocol for the study. Before recruitment, the research was thoroughly explained to the prospective participants in the language they could understand. This allowed for informed consent to participate to be obtained from all of the participants in the study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eInformed Consent Statement\u003c/strong\u003e : Informed consent was obtained from all subjects involved in the study.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eConflicts of Interest:\u003c/h2\u003e \u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThis research received no external funding.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003ePN, MEAA and MTF were involved in Conceptualization, Formal analysis, Investigation, Methodology, Resources, Supervision, Validation, Writing-original draft, Writing-review \u0026amp; editing1; Eugene Baah was involved in Investigation, Methodology, Resources, Writing-original draft2;Samuel Kekeli Agordzo took part in the Investigation, Methodology, Writing-original draft, Writing-review \u0026amp; editing1,6; Ivan A. Muanah provided Resources, supervision and Writing-review \u0026amp; editing3; Evans O. Agyapong was responsible for Investigation, Resources 3;Felix Gadzeto took part inInvestigation, Methodology, Resources3;Bright Atta-Mensah did Investigation, Resources, supervision, Writing-review \u0026amp; editing3;Anthony Appiah; was involved in Investigation, Resources, supervision, Writing-review \u0026amp; editing4;Samuel K. Boakye-Boateng too part in the supervision, Writing-review \u0026amp; editing and provision of Resources,5;Dennis Adu-Gyasi made Formal Analysis, Investigation, Methodology, Resources, Writing-original draft7.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eAll participants of this study as well as staff of the study sites are duely acknowledged\u003c/p\u003e\u003ch2\u003eData Availability Statement:\u003c/h2\u003e \u003cp\u003eAll data generated or analyzed during this study are included in this article and can be requested from the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCao X, et al. The impact of hearing loss on cognitive impairment: the mediating role of depressive symptoms and the moderating role of social relationships. Front Public Health. 2023;11:1149769.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTadi A, Gheibizadeh M, Anjiri SGC. 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Health Policy Plann. 2021;36(9):1451\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheung C-L, et al. Association of handgrip strength with chronic diseases and multimorbidity: a cross-sectional study. Age. 2013;35:929\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMey R, et al. Handgrip strength in older adults with chronic diseases from 27 European countries and Israel. Eur J Clin Nutr. 2023;77(2):212\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAggarwal M, et al. Alzheimer disease occurs more frequently in patients with inflammatory bowel disease: insight from a nationwide study. J Clin Gastroenterol. 2023;57(5):501\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMohammad-Rezaei M, et al. Serum levels of IL-32 in patients with coronary artery disease and its relationship with the serum levels of IL-6 and TNF-α. Mol Biol Rep. 2021;48(5):4263\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSattui SE, et al. Incidence of dementia in patients with rheumatoid arthritis and association with disease modifying anti-rheumatic drugs\u0026ndash;analysis of a national claims database. Seminars in Arthritis and Rheumatism. Elsevier; 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTaekema DG, et al. High innate production capacity of tumor necrosis factor-α and decline of handgrip strength in old age. Mech Ageing Dev. 2007;128(9):517\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePowers SK, et al. Disease-induced skeletal muscle atrophy and fatigue. Med Sci Sports Exerc. 2016;48(11):2307.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTuttle CS, Thang LA, Maier AB. Markers of inflammation and their association with muscle strength and mass: A systematic review and meta-analysis. Ageing Res Rev. 2020;64:101185.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIzzo C, et al. The role of oxidative stress in cardiovascular aging and cardiovascular diseases. Life. 2021;11(1):60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuo J, et al. Aging and aging-related diseases: from molecular mechanisms to interventions and treatments. Signal Transduct Target Therapy. 2022;7(1):391.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVennu V. Biological ageing and the risk of decreased handgrip strength among community-dwelling older adult Indians: a cross-sectional study. BMC Geriatr. 2023;23(1):782.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGSS GSS. The elderly in Ghana. 2010 Population and Housing Census Report. Ghana Statistical Service: Accra; 2013.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Handgrip Strength, Tumour Necrosis Factor-Alpha, Elderly","lastPublishedDoi":"10.21203/rs.3.rs-4674200/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4674200/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThere is a rapid surge in the elderly population globally and in Ghana. Ageing is frequently associated with the emergence of some chronic diseases due to a decline in physiological and physical functions. Early detection of chronic diseases or possible risk factors of disease development is critical in reducing mortality and morbidity among the elderly. This study, therefore, sought to explore the relationship between the inflammatory cytokine-tumour necrosis factor (TNF-α), handgrip strength and the presence of chronic diseases among the elderly population seeking medical care from a hospital in Ghana.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This was a hospital-based cross-sectional study carried out among individuals 60 years or above. A total of 104 persons who met the inclusion criteria and consented were enrolled on the study. Handgrip strength was measured using a digital hand dynamometer and plasma TNF-α levels were determined using sandwich ELISA. Data on demographics and chronic disease conditions were collected from participants using a standardized questionnaire and from the participant’s hospital folder.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The study recruited 104 participants, of which 53% were females and 47% were males. The median age (median (IQR)) was 65 (62–71) years. Again, of the total participants, 63.5% had at least one chronic disease while 36.5% had no chronic disease. Whereas 12.5% of participants had low handgrip strength, 87.5% had normal hand grip strength. There was no significant association between disease status and low handgrip strength (p = 0.709). However, there was a significant association between disease status and increased plasma levels of TNF-α among participants of the study (p = 0.0435). There was also a significant association between low handgrip strength and increased plasma levels of TNF-α among participants of the study (p = 0.0001).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e In conclusion, the present study observed that low hand grip strength is significantly associated with high circulating TNF-α levels which is also associated with increased presence of chronic disease among the elderly. Low handgrip strength may not independently represent an increased risk of developing chronic diseases.\u003c/p\u003e","manuscriptTitle":"Association Between Handgrip Strength, TNF-αlpha Levels and the Presence of Chronic Diseases Among the Elderly","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-09 20:49:28","doi":"10.21203/rs.3.rs-4674200/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9d1342e7-cf22-4fba-aede-1f6ba8250850","owner":[],"postedDate":"August 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-29T14:26:36+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-09 20:49:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4674200","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4674200","identity":"rs-4674200","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}