ArticlesPrognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study
Section snippets
introduction
Physical fitness is an important predictor of mortality and morbidity.1, 2 Physical fitness consists of cardiorespiratory fitness and muscular fitness. Both muscular endurance and muscle strength are indicators of muscular fitness. Reduced muscle strength, as measured by grip strength, has been associated with an increased risk of mortality in many studies.2, 3, 4, 5, 6, 7, 8, 9, 10, 11 However, the mechanism by which low muscle strength might predispose to death is uncertain. Grip strength
Study Design and participants
The design of the PURE study has been described previously.12 In brief, we selected countries to achieve substantial socioeconomic heterogeneity. For reasons of feasibility, we did not undertake proportionate sampling of all countries worldwide, or of regions within countries. At the start of the study, we classified selected countries according to the World Bank scheme as high-income (Canada, Sweden, and United Arab Emirates), upper middle-income (Argentina, Brazil, Chile, Malaysia, Poland,
Results
Participant characteristics were stratified by sex and grip-strength tertile (table 1). Baseline grip strength and vital status were recorded for 139 691 participants. Increased grip strength was associated with young age, male sex, high level of education, employment, high level of physical activity, high dietary calorie intake, of which a high proportion came from protein, and with increasing height, weight, and upper arm circumference. Previous use of alcohol or tobacco was associated with
Discussion
In people of diverse economic and sociocultural backgrounds, grip strength is a strong predictor of cardiovascular mortality and a moderately strong predictor of incident cardiovascular disease. Grip strength is also predictive for non-cardiovascular mortality, but is not predictive of incident non-cardiovascular disease. Low grip strength is associated with higher case-fatality rates in people who develop cardiovascular or non-cardiovascular disease. These findings suggest that muscle strength
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