Association between handgrip strength and the risk of new-onset metabolic syndrome: a population-based cohort study

From muscle quality to metabolic health: investigating the association between muscle quality index and metabolic syndrome in adults

OBJECTIVE

Metabolic syndrome (MetS) has a high prevalence in the United States (US); however, limited research comprehensively evaluates the relationship between muscle quality index (MQI) and MetS. This study aims to investigate the association between MQI and MetS.

METHODS

Adults aged 20-60 years from the 2011-2014 National Health and Nutrition Examination Survey were included. Handgrip strength (HGS) was measured using a dynamometer, and appendicular skeletal muscle mass (ASM) was assessed via dual-energy X-ray absorptiometry. MQI_total was calculated as the sum of HGS from both hands divided by ASM. Weighted multivariable logistic regression models and restricted cubic splines (RCS) were used to explore the association between MQI_total and MetS, and subgroup, interaction, and sensitivity analyses were conducted.

RESULTS

A total of 4,503 US residents were included in the study, with 1,165 diagnosed with MetS, yielding a prevalence of 25.9% (1,165/4,503). The weighted multivariable logistic regression model indicated that after adjusting for multiple covariates, MQI was negatively associated with the risk of MetS (odds ratio [OR] = 0.49, 95%CI: 0.32-0.73). Among the different components of MetS, MQI was negatively associated with elevated waist circumference (OR = 0.19, 95%CI: 0.12-0.28), elevated high-density lipoprotein cholesterol (OR = 0.66, 95%CI: 0.51-0.85), and elevated serum triglycerides (OR = 0.66, 95%CI: 0.51-0.85). RCS revealed a negative linear relationship between MQI and MetS (P < 0.001, Pnon-linear = 0.98).

CONCLUSION

Low MQI is associated with an increased risk of MetS, exhibiting a linear relationship. These findings suggest that improving muscle quality may be an effective strategy for the prevention of MetS.

Reversal for metabolic syndrome criteria following the CHANGE program: What are the driving forces? Results from an intervention community-based study

Objective

To examine the impact of the Canadian Health Advanced by Nutrition and Graded Exercise (CHANGE) program on the reversal of one or more metabolic syndrome (MetS) criteria among community members with MetS and define the significant predictors of upholding individual MetS criterion from 2020 to 2023.

Methods

The program enrolled 278 community members with/or at risk of MetS. Participants followed regular physical activity and a Mediterranean diet for 12 months with the assistance of a registered dietitian and a kinesiologist. A licensed practical nurse and/or registered nurse measured participants' weight, height, waist circumference, and blood pressure and withdrew blood samples for laboratory investigations. Physical activity, physical fitness, Mediterranean diet score (MDS), anthropometric measurements, and laboratory investigations were assessed at the baseline and every three months. Descriptive statistics were calculated, and binary logistic regression analysis was performed to define the significant predictors of upholding each criterion of the MetS.

Results

Participants' mean age was 60.5 ± 11.7 years, and 74.8% were females. Participants with MetS decreased by 5.04% by the end of the program. The percentage of participants with each MetS criterion showed a significant decrease at the end of the study, except for low HDL, which remained with no change. Moreover, the mean of physical activity, physical fitness tests, and MDS scores showed a significant increase after the 12 months of study. Compared to baseline, daily sedentary and screen times showed a significant decrease at the end of the program (8.6 vs. 7.2 and 3.2 vs. 2.6 hours, respectively). Logistic regression analysis revealed that age, female gender, low educational attainment, physical activity, physical fitness, and screen time were significant predictors for upholding one or more MetS criteria.

Conclusion

MetS criteria can be reversed following the CHANGE program. Sociodemographic and lifestyle features are significant predictors for upholding MetS criteria. The program is cost-effective considering its low cost and could lead to significant savings on healthcare costs. Further studies among different communities are recommended to confirm the generalizability of the results.

The association between handgrip strength and metabolic syndrome: A large prospective Chinese cohort study

OBJECTIVES

Many studies have explored the association between handgrip strength and metabolic syndrome; however, the findings are inconsistent due to the different types of indicators used to assess handgrip strength (absolute vs. relative handgrip strength). This prospective cohort study aimed to simultaneously investigate the associations of both absolute and relative handgrip strength with metabolic syndrome, and to compare the predictive abilities of these two measures among Chinese adults.

METHODS

Cox proportional hazards regression models were used to analyze 15,820 participants (49.7 % men) living in Tianjin, China. Handgrip strength was measured using a handheld dynamometer. Relative handgrip strength was normalized to body weight (kg).

RESULTS

During the 6-year follow-up, there were 3385 incident cases of metabolic syndrome. The fully adjusted hazards ratios (95 % confidence interval) of the incidence of metabolic syndrome for increasing quartiles of relative handgrip strength were: 1.000 (reference), 0.871(0.780, 0.973), 0.675(0.602, 0.757), 0.454(0.401, 0.513) in men and 1.000 (reference), 0.830(0.714, 0.966), 0.561(0.471, 0.668), and 0.369(0.301, 0.452) in women (both P for trend <0.0001). The optimal cut-off of relative handgrip strength to predict incident metabolic syndrome was 0.563 kg/kg in men (sensitivity = 64.3 %, specificity = 55.6 %) and 0.436 kg/kg in women (sensitivity = 57.0 %, specificity = 69.3 %).

CONCLUSIONS

This large cohort study showed that higher relative handgrip strength, but not absolute handgrip strength, was associated with a lower risk of metabolic syndrome. Although handgrip strength may not be highly sensitive in screening for metabolic syndrome, it remains a valuable predictive tool due to its convenience, ease of measurement, and cost-effectiveness.

Grip Strength, Anthropometric Indices, and Their Combination in Screening for Metabolic Syndrome in the Korean Population

Background: Metabolic syndrome (MS) is a cluster of cardiometabolic risk factors for future diabetes and cardiovascular diseases, and low grip strength (GS) is associated with an increased risk of MS. However, the index (among absolute GS, relative GS, and anthropometric indices) that is more strongly associated with MS has not been conclusively identified. Therefore, the objective of the present study was to simultaneously examine the associations of MS with relative and absolute GS and anthropometric indices in a Korean population. Methods: In this large-scale cross-sectional study, we used data from the Korean National Health and Nutrition Examination Survey (KNHANES). A total of 20,915 subjects were included in the statistical analyses. Complex sample binary logistic regression models were used to analyze the associations between MS and indices such as the waist-to-height ratio (WHtR), body mass index (BMI), and absolute and relative GS. Results: The prevalence of MS was 40.48% in men and 34.4% in women. The mean GS values in the healthy group and MS group were 38.06 ± 0.13 and 38.06 ± 0.15 years for men (p = 0.980) and 22.72 ± 0.07 and 21.19 ± 0.11 years for women (p < 0.001), respectively. Among all the indices, the WHtR was the index most strongly associated with MS in men. Among the GS indices, the GS/weight index was closely associated with MS, and the magnitude of this association was stronger than that of the absolute GS index. In women, the WHtR was the most related index to MS among all the indices. Among the GS indices, the GS/weight and GS/BMI indices were strongly associated with MS, and the magnitudes of these associations were much greater than those of the absolute GS index. Conclusions: Although absolute and relative GS indices are strongly associated with MS in the Korean population, the strongest association was observed for the simple anthropometric index (WHtR).

The combined effect of cardiorespiratory and muscular fitness on the incidence of metabolic syndrome before midlife

BACKGROUND

Cardiorespiratory fitness (CRF) could reduce the risk of metabolic syndrome (MetS) while the association between muscular endurance capacity (MEC) and incident MetS has rarely been investigated in young adults.

METHODS

A total of 2890 military men and women, aged 18-39 years, free of baseline MetS in Taiwan, were followed for incident MetS from baseline (2014) until the end of 2020. All subjects received annual health examinations for assessment of MetS. Physical fitness was assessed by CRF (estimated maximal oxygen uptake, VO2 max [mL/kg/min], in a 3000-m run) and MEC (numbers of 2-min push-ups). MetS was defined according to the International Diabetes Federation (IDF) criteria. Multiple Cox regression analysis was conducted with adjustments for baseline age, sex, substance use status and physical activity to determine the associations of CRF and MEC with incidences of new-onset MetS and related features, for example, central obesity, hypertension, dyslipidaemia and prediabetes or diabetes. To examine the combined effects of CRF and MEC status on incidence of MetS, high and low levels of CRF and MEC were separately defined by over and under the sex-specific median in each exercise test.

RESULTS

During a median follow-up of 5.8 years, there were 673 (23.3%) new-onset MetS. Higher CRF was associated with a lower incidence of MetS (hazard ratio [HR] and 95% confidence interval: 0.905 [0.877-0.933]), and its components separately, except hypertension. No association was observed between MEC and incident MetS, and its components separately, except hypertension. When evaluating the combined effects of MEC and CRF status on the incidence of MetS, it was observed that compared with the low CRF/low MEC, the high CRF/high MEC (HR: 0.553 [0.439-0.697]) and the high CRF/low MEC (HR: 0.730 [0.580-0.918]) had a lower incidence of new-onset MetS (P value for the intergroup difference = 0.04). There was no significant result for the low CRF/high MEC.

CONCLUSIONS

This study highlights that although the protective effects of MEC to reduce the incidence of MetS and most of its related features were mainly driven by CRF in young adults, there was an addictive effect of greater MEC on CRF to prevent the development of new-onset MetS before midlife.

Correlation between low handgrip strength and metabolic syndrome in older adults: a systematic review

Muscle weakness has been associated to insulin resistance and metabolic syndrome in the general population. However, it is still unclear whether this association is maintained in older adults. This study investigated correlations between low handgrip strength (HGS) and metabolic syndrome, or some of its components, in older adults through a systematic review of the literature. Searches were conducted in the Virtual Health Library Regional Portal, Scopus, Cochrane, Embase, MEDLINE/ PubMed, SciELO, and Web of Science databases for relevant studiesinvestigating muscle weakness (measured by hand dynamometer) and metabolic syndrome or its components in older adult populations, published up to September 2023. From the 2050 references initially identified, 20 studies, comprising a total of 31,264 older adults of both genders, completely met the inclusion/exclusion criteria. Eighteen studies showed that lower HGS was associated with metabolic syndrome or some of its risk factors, such as abdominal obesity, hyperglycemia, insulin resistance, dyslipidemia, or high blood pressure. Two studies found that older men with high blood pressure had increased HGS. Most studies included in this systematic review revealed a significant correlation between reduced HGS and metabolic syndrome or some of its components, especially abdominal obesity and insulin resistance. We conclude that below-average HGS can be associated with metabolic syndrome in older adults.

Handgrip Strength and Clinical Evolution of People Living with HIV: A Mini Narrative Review

HIV infection is a worldwide epidemic. Antiretroviral therapy allows people living with HIV (PLHIV) increased longevity and a better quality of life. Among the various ways of monitoring the clinical evolution of PLHIV, handgrip strength (HGS) is a promising strategy, as this test can be used to assess the health condition quickly and at a low cost. In this sense, the present study aims to describe, through a literature review, the relationship between HGS and the clinical evolution of PLHIV, especially with morbimortality. Initially, it is highlighted that aging, HIV infection, and excess body fat are related to the loss of HGS in PLHIV. Furthermore, PLHIV is more likely to present cardiometabolic diseases that can be aggravated by reduced HGS. Thus, in people without positive HIV serology, low HGS indirectly, through the presence of risk factors or cardiometabolic diseases, or directly increases the chance of mortality. In conclusion, the lack of studies on this topic for PLHIV is highlighted, and more longitudinal studies, including control groups, are needed.

Handgrip Strength Is Associated with Specific Aspects of Vascular Function in Individuals with Metabolic Syndrome

BACKGROUND

Metabolic syndrome (MetS) is a disorder associated with an increased risk for the development of diabetes mellitus and its complications. Lower isometric handgrip strength (HGS) is associated with an increased risk of cardiometabolic diseases. However, the association between HGS and arterial stiffness parameters, which are considered the predictors of morbidity and mortality in individuals with MetS, is not well defined.

OBJECTIVE

To determine the association between HGS and HGS asymmetry on components of vascular function in adults with MetS.

METHODS

We measured handgrip strength normalized to bodyweight (HGS/kg), HGS asymmetry, body composition, blood glucose, lipid profile, blood pressure, pulse wave velocity (PWV), reflection coefficient (RC), augmentation index @75 bpm (AIx@75) and peripheral vascular resistance (PVR) in 55 adults with a diagnosis of MetS between 25 and 54 years old.

RESULTS

Mean age was 43.1 ± 7.0 years, 56.3% were females. HGS/kg was negatively correlated with AIx@75 (r = -0.440), p < 0.05, but these associations were not significant after adjusting for age and sex. However, when interaction effects between sex, HGS/kg and age were examined, we observed an inverse relationship between HGS/kg and AIx@75 in the older adults in the sample, whereas in the younger adults, a weak direct association was found. We also found a significant association between HGS asymmetry and PVR (beta = 30, 95% CI = 7.02; 54.2; p <0.012).

CONCLUSIONS

Our findings suggest that in people with MetS, maintaining muscle strength may have an increasingly important role in older age in the attenuation of age-related increases in AIx@75-a marker of vascular stiffness-and that a higher HGS asymmetry could be associated with a greater vascular resistance.

Association between handgrip strength and metabolic syndrome: A meta-analysis and systematic review

BACKGROUND

Although muscle strength has been reported to be associated with metabolic syndrome (MetS), the association is still controversial. Therefore, the purpose of this meta-analysis was to identify the association between handgrip strength (HGS) and MetS.

METHODS

Original research studies involving HGS and MetS from database inception to 20 May 2022 were selected from PubMed, Web of Science, Embase, China National Knowledge Infrastructure, Wanfang databases, and Chinese Biomedical Document Service System. The odds ratios (ORs) with 95% confidence intervals (CIs) of MetS for HGS were calculated using a random-effects model. A dose-response analysis was performed. Subgroup analysis and meta-regression were also conducted.

RESULTS

Thirty effect sizes (reported in 19 articles) with a total of 43,396 participants were included in this meta-analysis. All studies were considered to be of moderate-to-good quality. An inverse association between HGS (low vs. high) with MetS was shown (OR: 2.59, 95% CI: 2.06-3.25). Subgroup analyses demonstrated the pooled ORs of relative HGS (HGS/weight), relative HGS (HGS/BMI), and absolute HGS were 2.97 (95% CI: 2.37-3.71), 2.47 (95% CI: 1.08-5.63), and 1.34 (95% CI: 1.06-1.68), respectively. Dose-response analysis revealed a significant linear dose-response relationship between relative HGS (HGS/weight) and MetS in observational studies (0.1 HGS/weight: OR, 0.68; 95% CI: 0.62-0.75). Univariate meta-regression analysis indicated that country status, measuring tools of HGS, components of MetS, and diagnosed criteria of MetS explained 16.7%, 26.2%, 30.1%, and 42.3% of the tau-squared in the meta-regression, respectively.

CONCLUSION

The results of the current meta-analysis indicated that lower HGS is associated with a higher risk of MetS. A linear dose-response association between lower relative HGS (HGS/weight) and increased prevalence of MetS was found. Accordingly, a lower HGS is a significant predictor of MetS.

SYSTEMATIC REVIEW REGISTRATION

[https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021276730].

Associations of Relative Handgrip Strength and Aerobic and Strength Exercises with Metabolic Syndrome Prevalence

BACKGROUND

The purpose of this study was to investigate associations of relative handgrip strength and participation in aerobic and strength exercises with metabolic syndrome prevalence. Moreover, level of handgrip strength, exercise frequency, and types of participation in aerobic and strength exercises associated with reductions in metabolic syndrome prevalence were explored.

METHODS

This study relied on data from the Korean National Health and Nutrition Examination Survey, 2018, specifically data on handgrip strength level, aerobic and strength exercise levels, and metabolic syndrome prevalence. Aerobic exercise level was categorized as either moderate physical activity (>150 min/week) or vigorous physical activity (>75 min/week) or not engaging in those levels of exercise. Frequency of strength exercise was also recorded. Multivariate logistic regression analyses were used for data analysis.

RESULTS

A total 4836 adults were included in this study. Greater relative handgrip strength in both female and male adults was significantly associated with reduced metabolic syndrome prevalence. Levels of aerobic and strength exercise participation were higher in adults with greater relative handgrip strength. Aerobic and strength exercise participation was significantly associated with decreased metabolic syndrome prevalence in males, but the association was not significant in females.

CONCLUSIONS

The relative handgrip strength may instead be a marker of lower metabolic syndrome risk, and an increased participation in aerobic and strength exercise helps to reduce the risk of metabolic syndrome. Suggested exercises for female adults include light aerobic exercise such as walking and strength exercise including weight-bearing exercise and stair climbing.

Sex and Diet-Related Disparities in Low Handgrip Strength among Young and Middle-Aged Koreans: Findings Based on the Korea National Health and Nutrition Examination Survey (KNHANES) from 2014 to 2017

“Possible sarcopenia” may be defined as a low muscle strength assessed by handgrip strength (HGS) by sex. We examined the sex-specific association between low handgrip strength (LGS) and dietary factors for the prevention of sarcopenia in young and middle-aged Koreans. We used data from the 2014–2017 Korea National Health and Nutrition Examination Survey of 11,635 Korean adults with LGS and normal handgrip strength (NGS). The relationship between dietary factors, e.g., nutrients, foods, and dietary patterns, and HGS was evaluated by multivariate logistic regression analyses. In men, the LGS group had a higher proportion of energy from carbohydrates and a lower proportion of energy from proteins than the NGS group. The LGS group had lower protein, niacin, phosphorus, and iron densities in their diet than the NGS group. The odds of having LGS increased as intake of vitamin B1 (odds ratio (OR) 2.916, 95% confidence interval (CI) 1.265–6.719), niacin (OR 2.286, 95% CI 1.095–4.774), phosphorus (OR 2.731, 95% CI 1.036–7.199), and iron (OR 2.591, 95% CI 1.102–6.088) decreased. In women with LGS, the odds of insufficient protein intake (OR 1.976, 95% CI 1.248–3.127) was significantly higher. This study suggests that adequate intake of protein, vitamin B1, niacin, phosphorus, and iron is beneficial for maintaining HGS.

Definition and Diagnostic Criteria for Sarcopenic Obesity: ESPEN and EASO Consensus Statement

INTRODUCTION

Loss of skeletal muscle mass and function (sarcopenia) is common in individuals with obesity due to metabolic changes associated with a sedentary lifestyle, adipose tissue derangements, comorbidities (acute and chronic diseases) and during the ageing process. Co-existence of excess adiposity and low muscle mass/function is referred to as sarcopenic obesity (SO), a condition increasingly recognized for its clinical and functional features that negatively influence important patient-centred outcomes. Effective prevention and treatment strategies for SO are urgently needed, but efforts are hampered by the lack of a universally established SO definition and diagnostic criteria. Resulting inconsistencies in the literature also negatively affect the ability to define prevalence as well as clinical relevance of SO for negative health outcomes.

AIMS AND METHODS

The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) launched an initiative to reach expert consensus on a definition and diagnostic criteria for SO. The jointly appointed international expert panel proposes that SO is defined as the co-existence of excess adiposity and low muscle mass/function. The diagnosis of SO should be considered in at-risk individuals who screen positive for a co-occurring elevated body mass index or waist circumference, and markers of low skeletal muscle mass and function (risk factors, clinical symptoms, or validated questionnaires). Diagnostic procedures should initially include assessment of skeletal muscle function, followed by assessment of body composition where presence of excess adiposity and low skeletal muscle mass or related body compartments confirm the diagnosis of SO. Individuals with SO should be further stratified into stage I in the absence of clinical complications or stage II if cases are associated with complications linked to altered body composition or skeletal muscle dysfunction.

CONCLUSIONS

ESPEN and EASO, as well as the expert international panel, advocate that the proposed SO definition and diagnostic criteria be implemented into routine clinical practice. The panel also encourages prospective studies in addition to secondary analysis of existing data sets, to study the predictive value, treatment efficacy and clinical impact of this SO definition.

Metabolic Syndrome and Sarcopenia

Skeletal muscle is a major organ of insulin-induced glucose metabolism. In addition, loss of muscle mass is closely linked to insulin resistance (IR) and metabolic syndrome (Met-S). Skeletal muscle loss and accumulation of intramuscular fat are associated with a variety of pathologies through a combination of factors, including oxidative stress, inflammatory cytokines, mitochondrial dysfunction, IR, and inactivity. Sarcopenia, defined by a loss of muscle mass and a decline in muscle quality and muscle function, is common in the elderly and is also often seen in patients with acute or chronic muscle-wasting diseases. The relationship between Met-S and sarcopenia has been attracting a great deal of attention these days. Persistent inflammation, fat deposition, and IR are thought to play a complex role in the association between Met-S and sarcopenia. Met-S and sarcopenia adversely affect QOL and contribute to increased frailty, weakness, dependence, and morbidity and mortality. Patients with Met-S and sarcopenia at the same time have a higher risk of several adverse health events than those with either Met-S or sarcopenia. Met-S can also be associated with sarcopenic obesity. In this review, the relationship between Met-S and sarcopenia will be outlined from the viewpoints of molecular mechanism and clinical impact.

The prediction of Metabolic Syndrome alterations is improved by combining waist circumference and handgrip strength measurements compared to either alone

Background

Adiposity is a major component of the metabolic syndrome (MetS), low muscle strength has also been identified as a risk factor for MetS and for cardiovascular disease. We describe the prevalence of MetS and evaluate the relationship between muscle strength, anthropometric measures of adiposity, and associations with the cluster of the components of MetS, in a middle-income country.

Methods

MetS was defined by the International Diabetes Federation criteria. To assess the association between anthropometric variables (waist circumference (WC), waist-to-hip ratio (W/H), body mass index (BMI)), strength (handgrip/kg bodyweight (HGS/BW)) and the cluster of MetS, we created a MetS score. For each alteration (high triglycerides, low HDLc, dysglycemia, or high blood pressure) one point was conferred. To evaluate the association an index of fat:muscle and MetS score, participants were divided into 9 groups based on combinations of sex-specific tertiles of WC and HGS/BW.

Results

The overall prevalence of MetS in the 5,026 participants (64% women; mean age 51.2 years) was 42%. Lower HGS/BW, and higher WC, BMI, and W/H were associated with a higher MetS score. Amongst the 9 HGS/BW:WC groups, participants in the lowest tertile of HGS/BW and the highest tertile of WC had a higher MetS score (OR = 4.69 in women and OR = 8.25 in men;p < 0.01) compared to those in the highest tertile of HGS/BW and in the lowest tertile of WC.

Conclusion

WC was the principal risk factor for a high MetS score and an inverse association between HGS/BW and MetS score was found. Combining these anthropometric measures improved the prediction of metabolic alterations over either alone.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12933-021-01256-z.