@article{Welsh2019c,
title = {The association of grip strength with health outcomes does not differ if grip strength is used in absolute or relative terms: a prospective cohort study},
author = {Paul Welsh and Claire Welsh and Jana Anderson and Donald M Lyall and Daniel F Mackay and Naveed Sattar and Jason M R Gill and Jill P Pell and Stuart R Gray },
url = {https://academic.oup.com/ageing/advance-article-abstract/doi/10.1093/ageing/afz068/5519555?redirectedFrom=fulltext},
year = {2019},
date = {2019-06-17},
journal = {Age and Ageing},
abstract = {higher grip strength is associated with better health outcomes. The optimal way to report grip strength (i.e. absolute vs. relative) for prediction, however, remains to be established.
Methods
in participants (aged 37–73 at baseline) from the UK Biobank, we examined the associations of grip strength, expressed in absolute terms (kilograms) and relative to anthropometric variables, with mortality and disease incidence, after exclusion of the first 2 years of follow-up, and compared risk predictions scores of handgrip strength when differentially expressed.
Results
of the 356 721 participants included in the analysis 6,234 died (1.7%) and 4,523 developed CVD (1.3%) over a mean follow-up of 5.0 years (ranging from 3.3 to 7.8) for mortality and 4.1 years (ranging from 2.4 to 7.0) for disease incidence data. As expected, baseline higher grip strength was associated with lower risk of all-cause and cause specific mortality and incidence. These associations did not meaningfully differ when grip-strength was expressed in absolute terms, vs. relative to height, weight, fat-free mass, BMI, fat-free mass index and fat-free mass, or as z-scores. Similarly the different ways of expressing grip strength had little effect on the ability of grip strength to improve risk prediction, based on C-index change, of an office-based risk score.
Conclusions
the ability of grip strength to predict mortality is not altered by changing how it is expressed.},
keywords = {7155, grip strength, health outcomes},
pubstate = {published},
tppubtype = {article}
}

@article{Celis-Morales2018c,
title = {Associations of dietary protein intake with fat free mass and grip strength: cross-sectional study in 146,816 UK Biobank participants},
author = {Carlos A Celis-Morales and Fanny Petermann and Lewis Steell and Jana Anderson and Paul Welsh and Daniel F Mackay and Stamatina Iliodromiti and Donald Lyall Mike Lean Jill Pell Naveed Sattar Jason Gill Stuart M E P M R R Gray},
url = {https://academic.oup.com/aje/advance-article/doi/10.1093/aje/kwy134/5046854#.Wzn76llzUOM.twitter},
year = {2018},
date = {2018-06-29},
journal = {American Journal of Epidemiology},
abstract = {Adequate dietary protein intake is important for the maintenance of fat-free mass (FFM) and muscle strength: optimal requirements remain unknown. The aim of the current study was to explore the associations of protein intake with FFM and grip strength. We used baseline data from the UK Biobank (146,816 participants aged 40-69 years with data collected 2007-2010 across the UK) to examine the associations of protein intake with FFM and grip strength. Protein intake was positively associated with FFM (men 5.1% [95% CI: 5.0; 5.2] and women 7.7% [95% CI: 7.7; 7.8]) and grip strength (men 0.076 kg/kg [95% CI: 0.074; 0.078] and women 0.074 kg/kg [95% CI: 0.073; 0.076]) per 0.5 grams per kg body mass per day (g/kg/day) increment in protein intake. FFM and grip strength were higher with higher intakes across the full range of intakes, i.e. highest in those reporting consuming > 2.0 g/grams per kg/day independently of socio-demographics, other dietary measures, physical activity and comorbidities. FFM and grip strength were lower with age, but this association did not differ by protein intake categories (P > 0.05). Current recommendation for all adults (40-69 years) for protein intake (0.8 grams per kg body mass per day) may need to be increased to optimise FFM and grip strength.},
keywords = {diet, fat free mass, featured, grip strength},
pubstate = {published},
tppubtype = {article}
}

@article{Celis-Morales2018d,
title = {Associations of grip strength with cardiovascular, respiratory, and cancer outcomes and all cause mortality: prospective cohort study of half a million UK Biobank participants},
author = {Carlos A Celis-Morales and Paul Welsh and Donald M Lyall and Lewis Steell and Fanny Petermann and Jana and Anderson and Stamatina Iliodromiti and Anne Sillars and Nicholas Graham and Daniel F Mackay and Jill P Pell and Jason M R Gill and Naveed Sattar and Stuart R Gray},
url = {https://www.bmj.com/content/361/bmj.k1651},
year = {2018},
date = {2018-05-08},
journal = {BMJ},
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.},
keywords = {7155, cancer, featured, grip strength},
pubstate = {published},
tppubtype = {article}
}

@article{Firth2018b,
title = {Grip Strength Is Associated With Cognitive Performance in Schizophrenia and the General Population: A UK Biobank Study of 476559 Participants},
author = {Joseph Firth and Brendon Stubbs and Davy Vancampfort and Josh A Firth and Matthew Large and Simon Rosenbaum and Mats Hallgren and Philip B Ward and Jerome Sarris and Alison R Yung},
url = {https://academic.oup.com/schizophreniabulletin/advance-article/doi/10.1093/schbul/sby034/4942313},
year = {2018},
date = {2018-04-19},
journal = {Schizophrenia Bulletin},
abstract = {Background

Handgrip strength may provide an easily-administered marker of cognitive functional status. However, further population-scale research examining relationships between grip strength and cognitive performance across multiple domains is needed. Additionally, relationships between grip strength and cognitive functioning in people with schizophrenia, who frequently experience cognitive deficits, has yet to be explored.

Methods

Baseline data from the UK Biobank (2007–2010) was analyzed; including 475397 individuals from the general population, and 1162 individuals with schizophrenia. Linear mixed models and generalized linear mixed models were used to assess the relationship between grip strength and 5 cognitive domains (visual memory, reaction time, reasoning, prospective memory, and number memory), controlling for age, gender, bodyweight, education, and geographical region.

Results
In the general population, maximal grip strength was positively and significantly related to visual memory (coefficient [coeff] = −0.1601, standard error [SE] = 0.003), reaction time (coeff = −0.0346},
keywords = {22125, featured, grip strength, schizophrenia},
pubstate = {published},
tppubtype = {article}
}

@article{Beyer2018,
title = {Prospective association between handgrip strength and cardiac structure and function in UK adults},
author = {Sebastian E Beyer and Mihir M Sanghvi and Nay Aung and Alice Hosking and Jackie A Cooper and José Miguel Paiva and Aaron M Lee and Kenneth Fung and Elena Lukaschuk and Valentina Carapella and Murray A Mittleman and Soren Brage and Stefan K Piechnik and Stefan Neubauer and Steffen E Petersen},
url = {http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0193124},
year = {2018},
date = {2018-03-14},
journal = {PLoS One},
abstract = {Handgrip strength, a measure of muscular fitness, is associated with cardiovascular (CV) events and CV mortality but its association with cardiac structure and function is unknown. The goal of this study was to determine if handgrip strength is associated with changes in cardiac structure and function in UK adults.
Methods and results
Left ventricular (LV) ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), mass (M), and mass-to-volume ratio (MVR) were measured in a sample of 4,654 participants of the UK Biobank Study 6.3 ± 1 years after baseline using cardiovascular magnetic resonance (CMR). Handgrip strength was measured at baseline and at the imaging follow-up examination. We determined the association between handgrip strength at baseline as well as its change over time and each of the cardiac outcome parameters. After adjustment, higher level of handgrip strength at baseline was associated with higher LVEDV (difference per SD increase in handgrip strength: 1.3ml, 95% CI 0.1–2.4; p = 0.034), higher LVSV (1.0ml, 0.3–1.8; p = 0.006), lower LVM (-1.0g, -1.8 –-0.3; p = 0.007), and lower LVMVR (-0.013g/ml, -0.018 –-0.007; p<0.001). The association between handgrip strength and LVEDV and LVSV was strongest among younger individuals, while the association with LVM and LVMVR was strongest among older individuals.

Conclusions

Better handgrip strength was associated with cardiac structure and function in a pattern indicative of less cardiac hypertrophy and remodeling. These characteristics are known to be associated with a lower risk of cardiovascular events.},
keywords = {2964, cardiac function, genetics, grip strength},
pubstate = {published},
tppubtype = {article}
}

@article{Kim2017b,
title = {Independent and joint associations of grip strength and adiposity with all-cause and cardiovascular disease mortality in 403,199 adults: the UK Biobank study.},
author = {Y Kim and K Wijndaele and DC Lee and SJ Sharp and Wareham N S Brage},
url = {https://www.ncbi.nlm.nih.gov/pubmed/28793990},
year = {2017},
date = {2017-08-09},
journal = {American Journal of Clinical Nutrition},
abstract = {Background: Higher grip strength (GS) is associated with lower mortality risk. However, whether this association is independent of adiposity is uncertain.Objective: The purpose of this study was to examine the associations between GS, adiposity, and mortality.Design: The UK Biobank study is an ongoing prospective cohort of >0.5 million UK adults aged 40-69 y. Baseline data collection (2006-2010) included measurements of GS and adiposity indicators, including body mass index (BMI; in kg/m2). Age- and sex-specific GS quintiles were used. BMI was classified according to clinical cutoffs.Results: Data from 403,199 participants were included in analyses. Over a median 7.0-y of follow-up, 8287 all-cause deaths occurred. The highest GS quintile had 32% (95% CI: 26%, 38%) and 25% (95% CI: 16%, 33%) lower all-cause mortality risks for men and women, respectively, compared with the lowest GS quintile, after adjustment for confounders and BMI. Obesity class II (BMI ≥35) was associated with a greater all-cause mortality risk. The highest GS quintile and obesity class II category showed relatively higher all-cause mortality hazards (not statistically significant in men) than the highest GS quintile and the normal weight category; however, the increased risk was relatively lower than the risk for the lowest GS quintile and obesity class II category. All-cause mortality risks were generally lower for obese but stronger individuals than for nonobese but weaker individuals. Similar patterns of associations were observed for cardiovascular mortality.Conclusions: Lower grip strength and excess adiposity are both independent predictors of higher mortality risk. The higher mortality risk associated with excess adiposity is attenuated, although not completely attenuated, by greater GS. Interventions and policies should focus on improving the muscular strength of the population regardless of their degree of adiposity.},
keywords = {adiposity, grip strength},
pubstate = {published},
tppubtype = {article}
}

@article{Kim2017c,
title = {Adiposity and grip strength as long-term predictors of objectively measured physical activity in 93,015 adults: The UK Biobank study.},
author = {Wijndaele SJ Sharp NJ Wareham Brage K S Y Kim T White T},
url = {https://www.ncbi.nlm.nih.gov/pubmed/28529332},
year = {2017},
date = {2017-05-22},
journal = {International Journal of Obesity},
abstract = {BACKGROUND/OBJECTIVES:

Fatness and fitness are associated with physical activity (PA) but less is known about the prospective associations of adiposity and muscle strength with PA. This study aimed to determine longitudinal associations of body mass index (BMI), waist circumference (WC) and grip strength (GS) with objectively measured PA.

SUBJECTS/METHODS:

Data are from the UK Biobank study. At baseline (2006-2010), BMI, WC and GS were objectively measured. At follow-up (2013-2015), a sub-sample of 93 015 participants (52 161 women) wore a tri-axial accelerometer on the dominant wrist for 7 days. Linear regression was performed to investigate longitudinal associations of standardised BMI, WC and GS at baseline with moderate-to-vigorous PA (MVPA) and acceleration after a median 5.7-years follow-up (interquartile range: 4.9‒6.5 years).

RESULTS:

Linear regression revealed strong inverse associations for BMI and WC, and positive associations for GS with follow-up PA; in women, MVPA ranges from lowest to highest quintiles of GS were 42‒48 min/day in severely obese (BMI⩾35 kg/m2), 52‒57 min/day in obese (30⩽BMI<35 kg/m2), 61‒65 min/day in overweight (25⩽BMI<30 kg/m2), and 69‒75 min/day in normal-weight (18.5⩽BMI<25 kg/m2). Follow-up MVPA was also lower in the lowest GS quintile (42‒69 min/day) compared with the highest GS quintile (48‒75 min/day) across BMI categories in women. The pattern of these associations was generally consistent for men, and in analyses using WC and mean acceleration as exposure and outcome, respectively.

CONCLUSIONS:

More pronounced obesity and poor strength at baseline independently predict lower activity levels at follow-up. Interventions and policies should aim to improve body composition and muscle strength to promote active living.International Journal of Obesity accepted article preview online, 22 May 2017. doi:10.1038/ijo.2017.122.},
keywords = {408, grip strength, obesity},
pubstate = {published},
tppubtype = {article}
}

@article{Ntuk2017,
title = {Association between grip strength and diabetes prevalence in black, South-Asian, and white European ethnic groups: a cross-sectional analysis of 418 656 participants in the UK Biobank study.},
author = {DF Mackay Sattar JP Pell JM N UE Ntuk CA Celis-Morales},
year = {2017},
date = {2017-02-01},
journal = {Diabetic Medicine},
abstract = {AIMS:

To quantify the extent to which ethnic differences in muscular strength might account for the substantially higher prevalence of diabetes in black and South-Asian compared with white European adults.
METHODS:

This cross-sectional study used baseline data from the UK Biobank study on 418 656 white European, black and South-Asian participants, aged 40-69 years, who had complete data on diabetes status and hand-grip strength. Associations between hand-grip strength and diabetes were assessed using logistic regression and were adjusted for potential confounding factors.
RESULTS:

Lower grip strength was associated with higher prevalence of diabetes, independent of confounding factors, across all ethnicities in both men and women. Diabetes prevalence was approximately three- to fourfold higher in South-Asian and two- to threefold higher in black participants compared with white European participants across all levels of grip strength, but grip strength in South-Asian men and women was ~ 5-6 kg lower than in the other ethnic groups. Thus, the attributable risk for diabetes associated with low grip strength was substantially higher in South-Asian participants (3.9 and 4.2 cases per 100 men and women, respectively) than in white participants (2.0 and 0.6 cases per 100 men and women, respectively). Attributable risk associated with low grip strength was also high in black men (4.3 cases) but not in black women (0.4 cases).
CONCLUSIONS:

Low strength is associated with a disproportionately large number of diabetes cases in South-Asian men and women and in black men. Trials are needed to determine whether interventions to improve strength in these groups could help reduce ethnic inequalities in diabetes prevalence.},
keywords = {7155, diabetes, grip strength},
pubstate = {published},
tppubtype = {article}
}

@article{Celis-Morales2016,
title = {The association between physical activity and risk of mortality is modulated by grip strength and cardiorespiratory fitness: evidence from 498 135 UK-Biobank participants},
author = {Jana Anderson Stamatina Iliodromiti Yu Fan Uduakobong Ntuk Daniel Mackay Jill Pell Naveed Sattar Jason Gill Carlos Celis-Morales Donald Lyall},
url = {http://m.eurheartj.oxfordjournals.org/content/early/2016/06/29/eurheartj.ehw249},
year = {2016},
date = {2016-05-30},
journal = {European Heart Journal},
abstract = {Aims It is unclear whether the potential benefits of physical activity differ according to level of cardiorespiratory fitness (CRF) or strength. The aim of this study was to determine whether the association between physical activity and mortality is moderated by CRF and grip strength sufficiently to inform health promotion strategies.

Methods and results 498 135 participants (54.7% women) from the UK Biobank were included (CRF data available in 67 702 participants). Exposure variables were grip strength, CRF, and physical activity. All-cause mortality and cardiovascular disease (CVD) events were the outcomes. 8591 died over median 4.9 years [IQR 4.3–5.5] follow-up. There was a significant interaction between total physical activity and grip strength (P < 0.0001) whereby the higher hazard of mortality associated with lower physical activity was greatest among participants in the lowest tertile for grip strength (hazard ratio, HR:1.11 [95% CI 1.09–1.14]) and lowest among those in the highest grip strength tertile (HR:1.04 [1.01–1.08]). The interaction with CRF did not reach statistical significance but the pattern was similar. The association between physical activity and mortality was larger among those in the lowest tertile of CRF (HR:1.13 [1.02–1.26]) than those in the highest (HR:1.03 [0.91–1.16]). The pattern for CVD events was similar.

Conclusions These data provide novel evidence that strength, and possibly CRF, moderate the association between physical activity and mortality. The association between physical activity and mortality is strongest in those with the lowest strength (which is easily measured), and the lowest CRF, suggesting that these sub-groups could benefit most from interventions to increase physical activity.},
keywords = {7155, cardiorespiratory fitness, grip strength},
pubstate = {published},
tppubtype = {article}
}

@article{Cooper2016,
title = {Bidirectional association between physical activity and muscular strength in older adults: Results from the UK Biobank study},
author = {Sharp Simmons S J R K A.J.M. Cooper M.J.E. Lamb and S J Griffin},
url = {http://ije.oxfordjournals.org/content/early/2016/05/20/ije.dyw054.full},
year = {2016},
date = {2016-05-21},
journal = {International Journal of Epidemiology},
abstract = {Background: The relationship between physical activity and muscular strength has not been examined in detail among older adults. The objective of this study was to examine the associations between physical activity and hand grip strength among adults aged ≥ 60 years.

Methods: Using data from the UK Biobank study, we included 66 582 men and women with complete baseline data and 6599 with 4.5 years of follow-up data. We used multiple linear regression models to examine the cross-sectional, longitudinal and bidirectional associations between moderate-to-vigorous physical activity (MVPA) and grip strength, adjusting for potential confounding by age, sex, height, weight, health status, education level, smoking status, Townsend deprivation index and retirement status.
Results: In cross-sectional analyses, grip strength and MVPA were linearly and positively associated with each other. Longitudinally, baseline MVPA was not associated with grip strength at follow-up difference between quintile [Q] 5 and Q1 = 0.40 [95% confidence interval (CI): -0.14, 0.94]kg, whereas baseline grip strength was associated with MVPA at follow-up [Q5 vs Q1 = 7.15 (1.18, 13.12) min/day]. People who maintained/increased time spent in MVPA did not experience any benefit in grip strength [0.08 (−0.20, 0.37) kg] whereas those who increased their grip strength spent 3.69 (0.20, 7.17) min/day extra in MVPA.

Conclusion: Promotion of strength-training activities may enable and maintain participation in regular physical activity among older adults.},
keywords = {5180, grip strength, physical activity},
pubstate = {published},
tppubtype = {article}
}