Associations of grip strength with cardiovascular, respiratory, and cancer outcomes and all cause mortality: prospective cohort study of half a million UK Biobank participants

Abstract

Objective: To investigate the association of grip strength with disease specific incidence and mortality and whether grip strength enhances the prediction ability of an established office based risk score.

Design: Prospective population based study.

Setting: UK Biobank.

Participants: 502 293 participants (54% women) aged 40-69 years.

Main outcome measures: All cause mortality as well as incidence of and mortality from cardiovascular disease, respiratory disease, chronic obstructive pulmonary disease, and cancer (all cancer, colorectal, lung, breast, and prostate).

Results: Of the participants included in analyses, 13 322 (2.7%) died over a mean of 7.1 (range 5.3-9.9) years' follow-up. In women and men, respectively, hazard ratios per 5 kg lower grip strength were higher (all at P<0.05) for all cause mortality (1.20, 95% confidence interval 1.17 to 1.23, and 1.16, 1.15 to 1.17) and cause specific mortality from cardiovascular disease (1.19, 1.13 to 1.25, and 1.22, 1.18 to 1.26), all respiratory disease (1.31, 1.22 to 1.40, and 1.24, 1.20 to 1.28), chronic obstructive pulmonary disease (1.24, 1.05 to 1.47, and 1.19, 1.09 to 1.30), all cancer (1.17, 1.13 to 1.21, 1.10, 1.07 to 1.13), colorectal cancer (1.17, 1.04 to 1.32, and 1.18, 1.09 to 1.27), lung cancer (1.17, 1.07 to 1.27, and 1.08, 1.03 to 1.13), and breast cancer (1.24, 1.10 to 1.39) but not prostate cancer (1.05, 0.96 to 1.15). Several of these relations had higher hazard ratios in the younger age group. Muscle weakness (defined as grip strength <26 kg for men and <16 kg for women) was associated with a higher hazard for all health outcomes, except colon cancer in women and prostate cancer and lung cancer in both men and women. The addition of handgrip strength improved the prediction ability, based on C index change, of an office based risk score (age, sex, diabetes diagnosed, body mass index, systolic blood pressure, and smoking) for all cause (0.013) and cardiovascular mortality (0.012) and incidence of cardiovascular disease (0.009).

Conclusion: Higher grip strength was associated with a range of health outcomes and improved prediction of an office based risk score. Further work on the use of grip strength in risk scores or risk screening is needed to establish its potential clinical utility.

Fig 1

Hazard for all cause and cause specific mortality per 5 kg lower grip strength stratified by sex. Data presented as adjusted hazard ratio and 95% CI by 5 kg decrease in grip strength. Analyses were adjusted for age, deprivation index, ethnicity, month of recruitment, comorbidities (depression, diabetes, hypertension, longstanding illness, respiratory diseases, cancer, and cardiovascular disease), height, body mass index categories, smoking, physical activity, sedentary behaviour, and dietary intake (alcohol, fruit and vegetables, oily fish, red meat, and processed meat) and excluding events in first two years after recruitment (model 4). COPD=chronic obstructive pulmonary disease

Fig 2

Hazard for cause specific incidence per 5 kg lower grip strength stratified by sex. Data presented as adjusted hazard ratio and 95% CI by 5 kg decrease in grip strength. Analyses were adjusted for age, deprivation index, ethnicity, month of recruitment, comorbidities (depression, diabetes, hypertension, longstanding illness, respiratory diseases, cancer, and cardiovascular disease), height, body mass index categories, smoking, physical activity, sedentary behaviour, and dietary intake (alcohol, fruit and vegetables, oily fish, red meat, and processed meat) and excluding events in first two years after recruitment (model 4)

Fig 3

Hazard for all cause and cause specific mortality in women and men by FNIH Sarcopenia cut-off points for muscle weakness. Data presented as adjusted hazard ratio and 95% CI by FNIH Sarcopenia cut-off points (reference groups ≥26.0 kg for men and ≥16.0 kg for women). Analyses were adjusted for age, deprivation index, ethnicity, month of recruitment, comorbidities (depression, diabetes, hypertension, longstanding illness, respiratory diseases, cancer, and cardiovascular disease), height, body mass index categories, smoking, physical activity, sedentary behaviour, and dietary intake (alcohol, fruit and vegetables, oily fish, red meat, and processed meat) and excluding events in first two years after recruitment (model 4). COPD=chronic obstructive pulmonary disease

Fig 4

Hazard for cause specific incidence in women and men by FNIH Sarcopenia cut-off points for muscle weakness. Data presented as adjusted hazard ratio and 95% CI by FNIH Sarcopenia cut-off points (reference groups ≥26.0 kg for men and ≥16.0 kg for women). Analyses were adjusted for age, deprivation index, ethnicity, month of recruitment, comorbidities (depression, diabetes, hypertension, longstanding illness, respiratory diseases, cancer, and cardiovascular disease), height, body mass index categories, smoking, physical activity, sedentary behaviour, and dietary intake (alcohol, fruit and vegetables, oily fish, red meat, and processed meat) and excluding events in first two years after recruitment (model 4)