Grip strength, body composition, and mortality

MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, UK.
International Journal of Epidemiology (Impact Factor: 9.18). 03/2007; 36(1):228-35. DOI: 10.1093/ije/dyl224
Source: PubMed


Several studies in older people have shown that grip strength predicts all-cause mortality. The mechanisms are unclear. Muscle strength declines with age, accompanied by a loss of muscle mass and an increase in fat, but the role that body composition plays in the association between grip strength and mortality has been little explored. We investigated the relation between grip strength, body composition, and cause-specific and total mortality in 800 men and women aged 65 and over.
During 197374 the UK Department of Health and Social Security surveyed random samples of men and women aged 65 and over living in eight areas of Britain to assess the nutritional state of the elderly population. The survey included a clinical examination by a geriatrician who assessed grip strength and anthropometry. We used Cox proportional hazards models to examine mortality over 24 years of follow-up.
Poorer grip strength was associated with increased mortality from all-causes, from cardiovascular disease, and from cancer in men, though not in women. After adjustment for potential confounding factors, including arm muscle area and BMI, the relative risk of death in men was 0.81 (95% CI 0.700.95) from all-causes, 0.73 (95% CI 0.600.89) from cardiovascular disease, and 0.81 (95% CI 0.660.98) from cancer per SD increase in grip strength. These associations remained statistically significant after further adjustment for fat-free mass or % body fat.
Grip strength is a long-term predictor of mortality from all-causes, cardiovascular disease, and cancer in men. Muscle size and other indicators of body composition did not explain these associations.

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Available from: Avan Aihie Sayer, Jul 03, 2014
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    • "Importantly, reduced weight at birth is correlated with reduced grip strength and decreased muscle size (Funai et al. 2006; Gale et al. 2007; Inskip et al. 2006; Patel et al. 2010, 2011, 2014, 2012; Sayer et al.1998). These factors are associated with increased risk of disability, morbidity and mortality later in life (Gale et al. 2007; Laukkanen et al. 1995; Rantanen 2003; Rantanen et al. 1999, 2002). The molecular mechanisms of such a phenomenon and the concept of skeletal muscle programming/memory, particularly in the regulation of adult skeletal muscle mass growth and loss following changes in anabolic/ catabolic environments throughout the lifespan have not been directly investigated. "
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    ABSTRACT: Sufficient quantity and quality of skeletal muscle is required to maintain lifespan and healthspan into older age. The concept of skeletal muscle programming or memory has been suggested to contribute to accelerated muscle decline in the elderly in association with early life stress such as fetal malnutrition. Further, muscle cells in vitro appear to remember the in vivo environments from which they are derived (e.g. cancer, obesity, type II diabetes, physical inactivity and nutrient restriction). Tumour-necrosis factor alpha (TNF-α) is a pleiotropic cytokine that is chronically elevated in sarcopenia and cancer cachexia. Higher TNF-α levels are strongly correlated with muscle loss, reduced strength and therefore morbidity and earlier mortality. We have extensively shown that TNF-α impairs regenerative capacity in mouse and human muscle derived stem cells (Meadows 2000; Foulstone 2001, 2004; Stewart 2004; Al-Shanti 2008; Saini 2008; Sharples 2010). We have also recently established an epigenetically mediated mechanism (SIRT1-histone deacetylase) regulating survival of myoblasts in the presence of TNF-α (Saini 2012). We therefore wished to extend this work in relation to muscle memory of catabolic stimuli and the potential underlying epigenetic modulation of muscle loss. To enable this aim; C2C12 myoblasts were cultured in the absence or presence of early TNF-α (early proliferative lifespan) followed by 30 population doublings in the absence of TNF-α, prior to the induction of differentiation in low serum media (LSM) in the absence or presence of late TNF-α (late proliferative lifespan). The cells that received an early plus late lifespan dose of TNF-α exhibited reduced morphological (myotube number) and biochemical (creatine kinase activity) differentiation vs. control cells that underwent the same number of proliferative divisions but only a later life encounter with TNF-α. This suggested that muscle cells had a morphological memory of the acute early lifespan TNF-α encounter. Importantly, methylation of myoD CpG islands were increased in the early TNF-α cells, 30 population doublings later, suggesting that even after an acute encounter with TNF-α, the cells have the capability of retaining elevated methylation for at least 30 cellular divisions. Despite these fascinating findings, there were no further increases in myoD methylation or changes in its gene expression when these cells were exposed to a later TNF-α dose suggesting that this was not directly responsible for the decline in differentiation observed. In conclusion, data suggest that elevated myoD methylation is retained throughout muscle cells proliferative lifespan as result of early life TNF-α treatment and has implications for the epigenetic control of muscle loss.
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    • "The health benefits of enhancing physical fitness (i.e., cardiorespiratory fitness (CRF), muscular fitness, and flexibility) have become well established during the past decades. Higher levels of CRF and muscular fitness are associated with significantly lower risk of developing metabolic syndrome [1] [2] and all-cause and cardiovascular mortality [3] [4] [5] [6] [7]. Although physical fitness declines as part of the physiological changes with age [8] [9] [10], the rate of decrease and possible reversibility might be amendable by intervention. "
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    ABSTRACT: Objective. To examine the effects of a 12-week Hatha yoga intervention on cardiorespiratory endurance, muscular strength and endurance, and flexibility in Chinese adults. Methods. 173 adults (aged 52.0 ± 7.5 years) were assigned to either the yoga intervention group () or the waitlist control group (). 19 dropped out from the study. Primary outcomes were changes in cardiorespiratory endurance (resting heart rate (HR) and maximal oxygen uptake ()), muscular strength and endurance (curl-up and push-up tests), and lower back and hamstring flexibility (the modified back-saver sit-and-reach (MBS) test). Results. Compared to controls, the yoga group achieved significant improvements in (), curl-up () and push-up () tests, and the MBS left and right leg tests (both ) in both genders. Significant change was also found for resting HR between groups in women () but not in men. Further analysis comparing participants between younger and older subgroups yielded similar findings, except that the older participants in the yoga group failed to improve resting HR or the curl-up test versus control. Adherence (89%) and attendance (94%) were high. No serious adverse events occurred. Conclusion. A 12-week Hatha yoga intervention has favorable effects on cardiorespiratory endurance, muscular strength and endurance, and flexibility in Chinese adults.
    Full-text · Article · Jul 2015 · Evidence-based Complementary and Alternative Medicine
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    • "Taken as a whole, there is a consistent finding in the epidemiological literature that muscular strength is inversely associated with cardiovascular mortality but only for men. The very few studies conducted with women [15] [25] reported conflicting results; thus more research is required to elucidate if higher levels of muscular strength in women are associated with substantial reductions in cardiovascular mortality. "
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    ABSTRACT: Muscular strength, an important component of physical fitness, has an independent role in the prevention of chronic diseases whereas muscular weakness is strongly related to functional limitations and physical disability. Our purpose was to investigate the role of muscular strength as a predictor of mortality in health and disease. We conducted a systematic search in EMBASE and MEDLINE (1980-2014) looking for the association between muscular strength and mortality risk (all-cause and cause-specific mortality). Selected publications included 23 papers (15 epidemiological and 8 clinical studies). Muscular strength was inversely and independently associated with all-cause mortality even after adjusting for several confounders including the levels of physical activity or even cardiorespiratory fitness. The same pattern was observed for cardiovascular mortality; however more research is needed due to the few available data. The existed studies failed to show that low muscular strength is predictive of cancer mortality. Furthermore, a strong and inverse association of muscular strength with all-cause mortality has also been confirmed in several clinical populations such as cardiovascular disease, peripheral artery disease, cancer, renal failure, chronic obstructive pulmonary disease, rheumatoid arthritis and patients with critical illness. However, future studies are needed to further establish the current evidence and to explore the exact independent mechanisms of muscular strength in relation to mortality. Muscular strength as a modifiable risk factor would be of great interest from a public health perspective. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
    Full-text · Article · Apr 2015 · European Journal of Internal Medicine
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