Easy-to-measure grip strength test could help predict major disease risk

Credit: University of Glasgow

Measuring grip strength – a clinical test that is both cheap and easy to perform – could be an important way to identify people who are at high risk for a wide range of diseases.

13 may 2018--New research, led by the University of Glasgow's Institute of Cardiovascular and Medical Sciences and published today in the BMJ, found that lower grip strength was strongly associated with a wide range of poorer health outcomes, including cardiovascular disease and cancer. The study also demonstrated that higher grip strength was associated with a lower risk of all causes of mortality.
The grip strength test only takes a few seconds to do and, the researchers suggest that the addition of this test within clinical practice could improve the prediction ability of an office-based risk score (which currently comprises assessment of age, sex, diabetes status, body mass index, systolic blood pressure, and smoking), by identifying people with low grip strength that might benefit from further health assessments. Researchers believe that this may be of particular use in areas where access to blood biochemical measures, such as cholesterol, is not possible.
Lower muscle strength is already known to be associated with greater mortality and morbidity. However in this study researchers were able to specifically link lower grip strength to a higher incidence of and mortality from, cardiovascular disease, respiratory disease, chronic obstructive pulmonary disease and cancer.
The study looked at 500,293 participants from the UK Biobank and the associations between lower grip strength and adverse health outcomes were consistent between men and women.
Researchers also investigated if the grip strength risk differed by age, and found that the risks associated with low grip strength were slightly stronger in younger age groups. These findings suggest that measuring grip strength could be useful over a broad range of ages.
Lead author Dr. Stuart Gray, Lecturer in Exercise and Metabolic Health, said: "Many studies have already shown that lower muscle strength is associated with greater mortality and morbidity. We wanted to investigate the association of grip strength with the incidence of specific diseases and mortality, and whether grip strength could be used in the clinic to enhance the prediction of an established office-based risk score.
"We found that not only was lower grip strength strongly associated with a broad range of adverse health outcomes, but that it predicted risk of death and cardiovascular disease even more strongly than systolic blood pressure or physical activity."
Dr. Gray said: "Our findings are important because they indicate that the addition of the measurement of grip strength may be useful in screening for risk of cardiovascular disease in community or rural settings, and in developing countries where access to measurements, such as total cholesterol, is not possible.
"Going forward, we need to perform trials which measure grip strength in clinical settings and investigate its effectiveness in risk prediction."
The UK Biobank is made up of 502, 628 participants recruited between April 2007 and December 2010, aged 40-69 years, from the general population across England, Wales, and Scotland.
The paper, "Associations of grip strength with cardiovascular, respiratory, and cancer outcomes and all cause mortality: prospective cohort study of half a million UK Biobank participants," is published in the BMJ.

More information: Yili Wu et al. Association of Grip Strength With Risk of All-Cause Mortality, Cardiovascular Diseases, and Cancer in Community-Dwelling Populations: A Meta-analysis of Prospective Cohort Studies, Journal of the American Medical Directors Association (2017). DOI: 10.1016/j.jamda.2017.03.011


Provided by University of Glasgow

High and low levels of 'good cholesterol' may cause premature death

Commonly touted as "good cholesterol" for helping to reduce risk of stroke and heart attack, both high and low levels of high-density lipoprotein (HDL) cholesterol may increase a person's risk of premature death, according to new research at Washington University School of Medicine in St. Louis and Veterans Affairs St. Louis Health Care System.

13 aug 2016--Conversely, intermediate HDL cholesterol levels may increase longevity, according to the research.
The large-scale epidemiological study is published Aug. 11 in the Clinical Journal of the American Society of Nephrology.
"The findings surprised us," said Ziyad Al-Aly, MD, an assistant professor of medicine at Washington University and the study's senior author. "Previously it was thought that raised levels of the good cholesterol were beneficial. The relationship between increased levels of HDL cholesterol and early death is unexpected and not fully clear yet. This will require further study."
Cholesterol is a fatty substance found in blood that can narrow and block heart vessels, causing cardiovascular disease and stroke. For years, HDL cholesterol has been credited with helping to remove plaque-building "bad cholesterol" from arteries.
For this study, researchers studied kidney function and HDL cholesterol levels in more than 1.7 million male veterans from October 2003 through September 2004. Researchers then followed participants until September 2013.
Patients with kidney disease frequently have lower levels of HDL cholesterol, which might explain their increased risk of early death; however, the association between elevated HDL cholesterol levels and premature death in these patients has been unclear. In the current study, the researchers showed that both high and low HDL cholesterol levels were associated with an increased risk of dying among study participants with all levels of kidney function.
"The findings may explain why clinical trials aimed at increasing HDL cholesterol levels failed to show improved outcomes," said Al-Aly, who also is the VA's associate chief of staff for research and education and co-director of the VA's Clinical Epidemiology Center in St. Louis.
Such findings regarding HDL cholesterol and premature death have not been reported in other large epidemiologic studies that have advanced understanding of the relationship between cholesterol parameters and clinical outcomes, Al-Aly said.
"However, the previous studies are limited in that the number of patients in those cohorts is relatively small compared with what a big data approach enabled us to see in our new research," he said. "Big data allow a more nuanced examination of the relationship between HDL cholesterol and risk of death across the full spectrum of HDL cholesterol levels."
Research data showed a relationship between HDL cholesterol levels and mortality as a U-shaped curve with the risk of death increased at both ends of the spectrum. "Too low and too high are both associated with higher risk of death," Al-Aly said.
Whether maintaining intermediate HDL cholesterol levels may increase longevity will need to be explored in future studies, Al-Aly said.
"A large database is critical in allowing us to research and challenge prior knowledge in our continuing efforts to create a better understanding of HDL cholesterol levels and risk of death," he said.

More information: B. Bowe et al, High Density Lipoprotein Cholesterol and the Risk of All-Cause Mortality among U.S. Veterans, Clinical Journal of the American Society of Nephrology (2016). DOI: 10.2215/CJN.00730116


Provided by Washington University School of Medicine

Watching too much TV may increase risk of early death in adults 

Adults who watch TV for three hours or more each day may double their risk of premature death compared to those who watch less, according to new research published in the Journal of the American Heart Association.

26 jun 2014--"Television viewing is a major sedentary behavior and there is an increasing trend toward all types of sedentary behaviors," said Miguel Martinez-Gonzalez, M.D., Ph.D., M.P.H., the study's lead author and professor and chair of the Department of Public Health at the University of Navarra in Pamplona, Spain. "Our findings are consistent with a range of previous studies where time spent watching television was linked to mortality."

Researchers assessed 13,284 young and healthy Spanish university graduates (average age 37, 60 percent women) to determine the association between three types of sedentary behaviors and risk of death from all causes: television viewingtime, computer time and driving time. The participants were followed for a median 8.2 years. Researchers reported 97 deaths, with 19 deaths from cardiovascular causes, 46 from cancer and 32 from other causes.

The risk of death was twofold higher for participants who reported watching three or more hours of TV a day compared to those watching one or less hours. This twofold higher risk was also apparent after accounting for a wide array of other variables related to a higher risk of death.

Researchers found no significant association between the time spent using a computer or driving and higher risk of premature death from all causes. Researchers said further studies are needed to confirm what effects may exist between computer use and driving on death rates, and to determine the biological mechanisms explaining these associations.

"As the population ages, sedentary behaviors will become more prevalent, especially watching television, and this poses an additional burden on the increased health problems related to aging," Martinez-Gonzalez said. "Our findings suggest adults may consider increasing their physical activity, avoid long sedentary periods, and reduce television watching to no longer than one to two hours each day."

The study cited previous research that suggests that half of U.S. adults are leading sedentary lives.

Provided by American Heart Association

Predicting mortality amongst older care home residents

The number of medications prescribed to a care home resident and the frequency of their contact with their GP are strong predictors of mortality in care homes shows research published today in Age & Ageing, the scientific journal of the British Geriatrics Society.

12 jan 2013--Researchers from St George's, University of London investigated predictors of mortality in older care home residents in England and Wales as compared to older people living in the community. They followed 9,772 care home and 354,306 community residents aged 65 to 104 years in 293 English and Welsh general practices in 2009. Approximately a quarter (26.2 per cent) of care home residents died within one year compared to just over 3 per cent of community residents.

The study found that in both care homes and the community, age and gender were important determinants of mortality, although the effect of increasing age was markedly attenuated in care homes. A diagnosis of dementia predicted mortality in both care homes and the community but its effect on mortality in care homes was modest compared to the community, due to the higher overall mortality in care homes. A previous cancer diagnosis was the strongest diagnostic predictor of mortality in both the community and care homes.

However, high numbers of GP consultations and prescribed medications were strong predictors of mortality in both settings. The researchers measured how many different classes of medication people had been prescribed in the last three months and the number of times they had been in contact with their GP in the last three months. This included contact, either in person or by telephone, with any GP practice clinical staff, either with the individual themselves or with a representative. It is likely that these measures of general practice use are indicators of frailty and clinical instability. Mortality was much higher in people receiving 11 or more medications compared to those receiving two or less and for people who had six or more clinical contacts compared to none.

Lead author Dr Sunil Shah said: "Care home residents are a vulnerable group. It is important to understand mortality in care homes in order to ensure that residents receive appropriate elective, preventive and palliative care. Our study shows that conventional indicators, such as diagnosis and age, are less predictive of mortality in care homes but frequency of contact with GPs and medication use are indicators of future mortality. These measures often indicate frailty and unstable health. Our findings should help GPs have timely discussions with patients and their relatives about preferences for end of life care."

Provided by St. George's University of London

Cardiorespiratory Fitness Outdoes BMI as Mortality Predictor


COLUMBIA, S.C., Dec. 4 -- Fitness level, not body fat, may be a stronger predictor of longevity for older adults, according to investigators here.During a mean 12-year follow-up of those older than 60, low cardiorespiratory fitness at baseline was a significant predictor of all-cause mortality independent of overall or abdominal adiposity, Xuemei Sui, M.D., of the University of South Carolina, and colleagues reported in the Dec. 5 issue of the Journal of the American Medical Association. They found that fit individuals who were obese (those with a BMI of 30.0 to 34.9, abdominal obesity, or an excessive percent of body fat) had a lower risk of all-cause mortality than did unfit, normal-weight, or lean individuals.
Action Points --->
Explain to interested patients that among older individuals, fitness (brisk walking at least 30 minutes or more on most days) was a major predictor of longer life, even if the person was overweight.
Death rates for those with higher fitness were often less than half the rates for those who were unfit, per stratum of adiposity, they added.
Prospective studies provide convincing evidence that obesity and physical inactivity each can produce excess mortality in middle-age patients. However, there had been little data for whether this is also true for older adults, Dr. Sui said.
So to examine the independent and joint associations among fitness, adiposity, and mortality in men and women 60 or older, the researchers studied a cohort of 2,603 participants (mean age 64.4, 20% women) enrolled in the Aerobics Center Longitudinal Study who completed a baseline health examination a some point from 1979 through 2001.
Fitness was measured by a maximal exercise test, and adiposity was assessed by BMI, waist circumference, and percent body fat.
Low fitness was defined as the lowest fifth of the sex-specific distribution of maximum duration on an exercise treadmill.
The distributions of BMI, waist circumference, and percent body fat were grouped for analysis according to clinical guidelines.
All-cause mortality through Dec. 31, 2003 included 450 deaths during a mean follow-up of 12 years and 31,236 person-years of exposure. Those who died were older, had lower fitness levels, and had more cardiovascular risk factors than survivors.
Members of the higher fitness groups were for the most part less likely to have risk factors for cardiovascular disease, such as hypertension, diabetes, or high cholesterol levels. However, the researchers found no significant differences in adiposity measures.
Fit participants had lower death rates than unfit participants within each stratum of adiposity -- overweight, waist circumference, and percent body fat, for example -- except for two of the obesity groups.
In most instances, death rates for those with higher fitness were less than half the rates for those who were unfit, the researchers said.
Fitness had a strong inverse association with mortality, and this pattern was changed little by adjustment for adiposity or fat distribution. Thus, the researchers said, their primary finding is that both fitness and BMI were strong and independent predictors of all-cause mortality.
Significantly, upon analyzing the combination of fitness and BMI, they found that higher levels of fitness were inversely related to all-cause mortality in both normal weight and overweight BMI subgroups.
These individuals included those with a normal waist circumference and those with abdominal obesity, and those with a normal percentage of body fat and those with an excessive percentage of body fat.
These data, they wrote, suggest that fitness levels in older individuals influence the association of obesity with mortality.
In reviewing the findings, the researchers reported that death rates per 1,000 person-years, adjusted for age, sex, and examination year were:
13.9, 13.3, 18.3, and 31.8 across BMI groups of 18.5-24.9, 25.0-29.9, 30.0-34.9, and ≥35.0, respectively (P=0.01 for trend);
13.3 and 18.2 for normal and high waist circumference (≥88 cm in women; ≥102 cm in men) (P=0.004);
13.7 and 14.6 for normal and high percent body fat ( ≥30% in women; ≥25% in men) (P=0.51);
32.6, 16.6, 12.8, 12.3, and 8.1 across incremental fifths of fitness (P=<0.001 for trend).
The association between waist circumference and mortality persisted after further adjustment for smoking, baseline health status, and BMI (P=0.02) but not after additional adjustment for fitness (P=0.86).
Fitness predicted mortality risk after further adjustment for smoking, baseline health, and either BMI, waist circumference, or percent body fat (P<0.001 for trend).
Study limitations included a focus on individuals who were primarily white and well-educated, had middle to upper socioeconomic status, and were physically able to complete a maximal exercise test. Thus the results may not apply to other groups, they said.
Adequate information about diet was lacking, and because of the limited number of women who participated in the study, the groups were combined, with adjustment made for sex.
In addition, the study focused primarily on all-cause mortality because of the relatively small number of cause-specific deaths. However, some exploratory cause-specific analyses were done suggesting that cardiovascular disease and cancer accounted for 74% of all the deaths.
These data provide further evidence regarding the complex long-term relationship among fitness, body size, and survival. It may be possible to reduce all-cause death rates among older adults, including those who are obese, by promoting regular physical activity, such as brisk walking for 30 minutes or more on most days of the week, which would help most individuals enjoy longer life in better health, the researchers said.
The Aerobics Center Longitudinal Study was supported by National Institutes of Health grants.
Dr. Sui reported no financial conflicts.
Book royalties, honoraria, research grants, and lecture fees for co-authors included those from Human Kinetics, Jenny Craig, Magellan Health Services, Matria Health Care, BodyMedia, and the University of North Texas. Some of these fees were donated to the South Carolina Educational Foundation or to other nonprofit groups.
Primary source: Journal of the American Medical AssociationSource reference:Sui X, et al "Cardiorespiratory fitness and adiposity as mortality predictors in older adults" JAMA 2007; 298: 2507-2516.