Clinical research study
Grip Strength Predicts Cause-Specific Mortality in Middle-Aged and Elderly Persons

https://doi.org/10.1016/j.amjmed.2006.04.018Get rights and content

Abstract

Purpose

Handgrip strength is a simple measurement used to estimate overall muscle strength but might also serve as a predictor of health-related prognosis. We investigated grip strength-mortality association in a longitudinal study.

Methods

A total of 4912 persons (1695 men and 3217 women), 35 to 74 years old at baseline, were the subjects of this study. Members of the Adult Health Study (AHS) cohort in Hiroshima, Japan, these individuals underwent a battery of physiological tests, including handgrip-strength testing, between July 1970 and June 1972. Mortality was followed until the end of 1999. Estimates of relative risk (RR) of mortality associated with grip strength were adjusted for potentially confounding factors by Cox proportional hazard analysis.

Results

Multivariate-adjusted RR of all causes of death, except for external causes, for the highest quintile of grip strength in men was 0.52 (95% confidence interval [CI], 0.33-0.80) for the age group 35-54 years, 0.72 (95% CI, 0.53-0.98) for the ages 55-64 years, and 0.67 (95% CI, 0.49-0.91) for the ages 65-74 years. These figures were significantly lower than the RR for the reference group (the third quintile). Similar trends were observed in women. Multivariate-adjusted RR of all causes of death except external causes for each 5-kg increment of grip strength was significantly low (RR: 0.89, 95% CI, 0.86-0.92 for men, RR: 0.87, 95% CI, 0.83-0.92 for women). Multivariate-adjusted RR for heart disease, stroke, and pneumonia in men was 0.85 (95% CI, 0.79-0.93), 0.90 (95% CI, 0.83-0.99), and 0.85 (95% CI, 0.75-0.98), respectively. RR for each 5-kg increment of grip strength remained 0.92 (95% CI, 0.87-0.96), even after more than 20 years of follow-up.

Conclusion

Grip strength is an accurate and consistent predictor of all causes of mortality in middle-aged and elderly persons.

Section snippets

Methods

Subjects were members of the AHS cohort of RERF. The AHS was begun in 1958 by RERF’s predecessor, the Atomic Bomb Casualty Commission (ABCC), as a clinical cohort study to investigate the long-term medical and biological effects of exposure to atomic-bomb radiation among the survivors and unexposed controls in Hiroshima and Nagasaki. Approximately 20,000 persons were invited to participate in biennial health examinations conducted by ABCC (and later, RERF) clinical physicians. A detailed

Results

Average age at examination was 55.5 years in men and 53.9 years in women. Average grip strength was 46.4 kg in men and 29.2 kg in women. According to average grip strength by age- and sex-specific categories, a gradual decrease was apparent in both sexes. Decrease of grip strength from 35-44 years to 65-74 years was 11.1 kg in men and 8.8 kg in women (Figure 1). Other clinical characteristics are shown in Table 1. Men tend to have higher systolic and diastolic blood pressure, and are more

Discussion

Grip strength was a strong and consistent predictor of all causes of mortality in middle-aged and elderly persons in Japan at more than 20 years of follow-up from baseline. This association was observed in all age categories from 35 to 74 years and in both sexes. It predicted not only all causes of mortality, but also heart disease and stroke mortality.

Grip strength may be representative of overall muscular strength because it is highly correlated with other muscular strength measures,

Conclusion

Grip strength is a strong and consistent predictor of all causes of mortality in middle-aged and elderly persons, even at more than 20 years of follow-up from baseline. In accordance with the present findings, regular exercise for improvement of physical and musculoskeletal fitness is eagerly recommended to improve prognosis.

Acknowledgment

This publication is based on research performed at the Radiation Effects Research Foundation (RERF), Hiroshima and Nagasaki, Japan. RERF is a private nonprofit foundation funded equally by the Japanese Ministry of Health, Labour and Welfare (MHLW) and the US Department of Energy (DOE), the latter through the National Academy of Sciences. This publication was supported by RERF Research Protocol RP2-75.

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