Associations between relative grip strength and type 2 diabetes mellitus: The Yangpyeong cohort of the Korean genome and epidemiology study

Grip strength, metabolic syndrome, and type 2 diabetes mellitus: a prospective study

Objectives

This study examines the impact of absolute grip strength (AGS) and relative grip strength (RGS) on the risk of developing type 2 diabetes mellitus (DM), especially in relation to metabolic syndrome (MetS).

Methods

1,935 participants were adults aged 51 to 81 years with an average observation period of 6.50 years. The diagnosis of DM was based on American Diabetes Association. The JAMA 5030J1 dynamometer was used to measure the grip strength. Multivariable extended Cox regression models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for DM incidence.

Results

The DM risk increased with the number of MetS risk factors. High AGS was associated with a reduced DM risk (HR = 0.66, 95% CI = 0.44-0.99), but association disappeared when adjusted for MetS. High RGS was significantly associated with a reduced risk of DM incidence (HR = 0.49, 95% CI = 0.33-0.72), even after adjusting for MetS (HR = 0.63, 95% CI = 0.42-0.94). With the presence of MetS, higher AGS was associated with a greater increase in the DM risk compared to lower AGS, while higher RGS was associated with a less increase in the DM risk compared to lower RGS.

Conclusion

This study demonstrates that RGS is a more reliable predictor of DM risks than AGS. Additionally, MetS significantly increases DM risk, particularly in individuals with obesity and hypertension. The study highlights the importance of assessing muscle quality in DM prevention and suggest that improving muscle quality may help mitigate DM risk.

Relative Grip Strength and Muscle-Strengthening Activity: Independent and Joint Associations with Type 2 Diabetes Mellitus

Background

Grip strength and muscle-strengthening activity (MSA) have been independently associated with type 2 diabetes mellitus (T2DM). However, analyses that consider grip strength in conjunction with MSA, while factoring in age and sex as well, are limited. Therefore, we aimed to investigate the association of relative grip strength (RGS) and MSA, separately and in combination, with T2DM, considering differences in age and sex.

Methods

A total of 27,702 participants aged 19 years and older were included from 2014 to 2021 from the Korea National Health and Nutrition Examination Survey. The association between RGS, MSA, and T2DM was assessed using logistic regression analysis. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for the independent and joint associations of RGS and MSA on T2DM prevalence.

Results

Highest (Q4) RGS levels were independently associated with lower odds of T2DM (OR, 0.39; 95% CI, 0.32 to 0.46; P for trend <0.001). Similarly, engaging in MSA 2 o 3 days per week was associated with lower odds of T2DM (OR, 0.80; 95% CI, 0.66 to 0.96), although the trend was not statistically significant (P for trend=0.775). In the joint analysis, participants with normal RGS and engaging in MSA ≥2 days per week had the lowest odds of T2DM (OR, 0.60; 95% CI, 0.51 to 0.70).

Conclusion

Higher RGS and engaging in MSA 2 to 3 days per week are independently associated with lower likelihood of T2DM. The combined association of normal RGS and MSA 2 days or more per week shows the greatest benefit for T2DM prevention.

Association of Handgrip Strength with Diabetes, Hypertension, and Comorbidities in a Korean Population: A Large-Scale Cross-Sectional Study

Background: Handgrip strength (HGS) is strongly associated with hypertension (HTN), diabetes mellitus (DM), and HTN and DM comorbidity (HDC). However, no studies have simultaneously examined anthropometric and absolute/relative HGS indices among HTN, DM, and HDC patients. The objective of this study was to examine the associations of anthropometric and HGS indices with HTN, DM, and HDC. Methods: For this large-scale cross-sectional study, we used a dataset from the Korea National Health and Nutrition Examination Survey. The study population included 15,343 participants aged 50 years and older. Complex sample binary logistic regression was used to examine the associations of each disease with the anthropometric and HGS indices in crude and adjusted models. Results: The prevalence of HTN, DM, and HDC in the study population was 35.1%, 8.6%, and 14.4% in men and 34.7%, 5%, and 11.8% in women, respectively. In men, the indices with the strongest associations with HTN, DM, and HDC were body mass index, waist circumference, and waist-to-height ratio. Among women, body mass index and waist-to-height ratio had the strongest associations with HTN. Waist circumference and waist-to-height ratio had the strongest associations with DM. Waist-to-height ratio had the strongest associations with HDC. Additionally, the relative HGS indices were more strongly associated with these diseases than the absolute HGS indices. Conclusions: HGS indices were associated with HTN, DM, and HDC, but compared with the absolute HGS index and relative HGS indices, anthropometric indices were more strongly associated with these diseases in the Korean population.

Association of muscle performance and heart rate variability in middle-aged type 2 diabetes mellitus

Background

Type 2 diabetes mellitus (T2DM) is characterized by insulin resistance, which impairs the metabolism of carbohydrates, lipids, and proteins. Recent findings indicate that skeletal muscle atrophy, decreased muscle strength, and reduced muscle performance have become prevalent complications of diabetes. Additionally, dysfunction of cardiac autonomic nerves also leads to skeletal muscle impairment. These issues further exacerbate diabetes, thereby leading to a vicious cycle. This study investigates the association between muscle performance and cardiac autonomic neuropathy in middle-aged T2DM patients.

Material and Methods

In this case-control study, we included 51 diagnosed T2DM patients aged 30-55 years, with a duration of T2DM less than 5 years and HbA1C level below 8%. We also included 51 age-, sex-, and BMI-matched healthy control subjects. Muscle performance was assessed by evaluating the core endurance through the trunk flexor endurance test (TFET), trunk lateral endurance test (TLET), trunk extensor endurance test (TEET), along with hamstring muscle flexibility through the active knee extension (AKE) test. Cardiac autonomic function was evaluated using the heart rate variability test. Statistical analyses were performed using GraphPad Prism version 9. The Mann-Whitney test was used to compare the two groups, and data were represented as median (interquartile range). Values were considered statistically significant at P value ≤ 0.05.

Results

We observed a significant decrease in core endurance (TFET, TLET, TEET) with P values < 0.001, as well as reduced hamstring muscle flexibility shown by a decrease in the degree of AKE test with P value < 0.001 in the T2DM patients when compared with the controls. Furthermore, heart rate variability in both time domain parameters (SDRR, CVRR, SDSD, RMSSD, pRR50%) and frequency domain parameters (Total power, VLF, LF, HF, LF/HF) also showed significant decreases, with P values < 0.001 in the T2DM group compared to the control group.

Conclusion

The observed decrease in muscle performance and heart rate variability parameters in middle-aged newly diagnosed T2DM patients suggests early skeletal muscle atrophy and cardiac autonomic dysfunction.

Analysis of Grip Strength Thresholds for Stroke Management and Prevention in South Korean Older Adults

BACKGROUND/OBJECTIVES

Muscle weakness in older adults is associated with cardiovascular disease and all-cause mortality. However, its association with stroke prevalence remains underexplored. This study aimed to analyze the absolute grip strength (AGS) and weight-adjusted relative grip strength (RGS) thresholds for stroke prediction in South Korean older adults and to assess their sex-specific predictive ability.

METHODS

Data from 5185 older adults (2231 men; 2954 women) from the Korea National Health and Nutrition Examination Survey (KNHNES, 2014-2018) were analyzed using complex sampling methods. Receiver operating characteristic (ROC) curve analysis was performed to determine AGS and RGS thresholds and predictive performance, while multivariate logistic regression was used to adjust for confounders and to assess independent effects.

RESULTS

In older men, both the AGS and RGS demonstrated significant predictive ability for stroke, with AUCs of 0.637 and 0.623, respectively. In women, the AGS (AUC: 0.608) and RGS (AUC: 0.615) were predictive; however, only the RGS was significant for stroke management (odds ratio (OR): 3.026; 95% confidence interval (CI), 1.541-5.943). In men, AGS (OR: 3.544, 95% CI, 2.094-5.998) and RGS (OR: 2.585, 95% CI, 1.529-4.369) were significant. The stroke prediction thresholds were AGS 28.55 kg and RGS 0.47 for men and RGS 0.36 for women.

CONCLUSIONS

The AGS and RGS provide practical indicators for stroke risk prediction based on sex-specific differences, highlighting their potential for public health and clinical applications. Future studies should investigate the stroke type, severity, and additional functional fitness indices.

Muscle quality index is correlated with insulin resistance and type 2 diabetes mellitus: a cross-sectional population-based study

BACKGROUND

Muscle quality index (MQI), an emerging health index, is calculated by dividing handgrip strength by skeletal muscle mass. Current evidence on the correlation between MQI and type 2 diabetes mellitus (T2DM), insulin resistance (IR) is limited. This work aims to study that correlation.

METHODS

This study involves a cross-sectional analysis on data from the National Health and Nutrition Examination Survey (NHANES) during the period from 2011 to 2014. To explore the correlation between MQI, IR and T2DM, multivariate logistic regression, receiver operating characteristic (ROC) curve, subgroup analysis, and restricted cubic spline regression were employed.

RESULTS

A total of 2816 American adults were enrolled in this study, among whom 1264 (44.9%) had IR, and 300 (10.7%) had T2DM. Logistic regression and RCS regression analyses showed a significant negative linearly correlation between MQI and the prevalence of IR (OR = 0.708, 95%=0.514, 0.976) and T2DM (OR = 0.676, 95%CI = 0.472, 0.969). Subgroup analysis further revealed a stronger correlation between MQI and IR among individuals with obesity. ROC analysis showed that compared with skeletal muscle and grip strength, MQI (AUC = 0.679 for IR and 0.688 for T2DM) can serve as a more reliable identification factor for IR and T2DM.

CONCLUSION

This study provides evidence that decreased levels of MQI are correlated with an increased risk of IR and T2DM, indicating the potential utility as a marker for identifying IR and T2DM.

Association Between Relative Grip Strength, Insulin Resistance, and Nonalcoholic Fatty Liver Disease Among Middle-Aged and Older Adults: A Prospective Cohort Study

Introduction: This study aims to investigate the combined association between insulin resistance (IR) levels, relative grip strength (RGS), and the incidence of nonalcoholic fatty liver disease (NAFLD), stratified by sex, using longitudinal data. Methods: The study included 1702 adult participants aged 51-88 years who completed surveys in both 2013-2014 and during a subsequent follow-up in 2019-2020. NAFLD was assessed using the hepatic steatosis index, and RGS was measured using the JAMA-5030J1 equipment (SAEHAN, Korea). To assess the interaction between RGS and IR levels and their impact on NAFLD risk, we employed a proportional hazards Cox regression model. Hazard ratios (HR) and 95% confidence intervals (95% CI) were calculated for NAFLD incidence. Results: After adjusting for various confounding variables, we observed a significant decrease in NAFLD risk in the middle RGS group (HR = 0.70, 95% CI = 0.53-0.93) and high RGS group (HR = 0.31, 95% CI = 0.22-0.44) compared to the low RGS group. In addition, significant sex differences were noted in the relationship between IR, RGS levels, and NAFLD incidence across different groups. Conclusions: This study highlights that higher RGS levels are independently associated with a reduced risk of developing NAFLD. Notably, RGS emerges as a predictive indicator for assessing NAFLD risk.

Association of relative handgrip strength on the development of diabetes mellitus in elderly Koreans

BACKGROUND

Diabetes mellitus (DM) is a significant public health concern, particularly in the elderly population. Absolute handgrip strength (HGS) serves to quantify muscle strength. It is recommended that the risk of low muscle strength and increased body mass index be concurrently evaluated using relative HGS. There are currently insufficient evidence regarding the relationship between relative HGS and DM in the elderly Korean population. Therefore, the association between relative HGS and the development of DM in Korean elderly was investigated.

METHODS

Data from the Korean Longitudinal Study of Ageing were used to determine the odds ratio (OR) between relative HGS and DM during the follow-up period from 2006-2020 among Korean men and women aged ≥65 years without DM when they first participated in this survey. Analysis was conducted using the Generalized Estimating Equation method. Trend analysis was performed for DM development based on relative HGS.

RESULTS

Among elderly males, higher relative HGS groups had reduced odds of developing DM (Middle tertile: OR 0.87, 95% CI 0.61-1.23, p = 0.419.) (Upper tertile: OR 0.82, 95% CI 0.56-1.18, p = 0.281.) Among elderly females, the reductions were similar. (Middle tertile: OR 0.82, 95% CI 0.66-1.03, p = 0.087.) (Upper tertile: OR 0.79, 95% CI 0.50-1.25, p = 0.306.) However, these differences were not statistically significant. Significant predictors of new-onset DM included age, BMI (overweight/obese), household income, alcohol consumption, hypertension, and chronic liver disease. Trend tests indicated a substantial decrease in the OR as the relative HGS increased for male and total groups (p for trend < 0.05).

CONCLUSION

Relative HGS did not achieve statistical significance. Our findings indicate that BMI, particularly overweight and obesity, significantly predicts new-onset DM. However, trend tests indicated a substantial decrease in the OR as the relative HGS increased for male and total groups (p for trend < 0.05), even after adjusting for BMI categories. Despite the lack of statistical significance in some cases, the trend suggests that promoting resistance exercises to enhance HGS could be beneficial in DM prevention. Comprehensive DM prevention strategies should include managing obesity and chronic conditions for elderly.

Prevalence of mild cognitive impairment and modifiable risk factors: A cross-sectional study in rural older adults with diabetes

To determine the prevalence and modifiable risk factors for MCI in older adults with T2DM in rural China. This cross-sectional study encompassed 96 villages, employing a cluster sampling approach to recruit eligible older adults with T2DM as study participants. Logistic regression analysis was utilized to identify modifiable risk factors associated with MCI. Average marginal effects were calculated. The discriminatory performance of these risk factors in identifying MCI was evaluated by plotting the receiver operating curve and calculating the value of the area under the curve. A total of 898 older adults with T2DM in our study. The overall prevalence of MCI was 50.22 %. Independent associations with MCI were found in poor self-management ability of diabetes (OR = 0.808, 95 % CI: 0.808, 0.766), depressive symptoms (OR = 3.500, 95 % CI: 1.933, 6.337), moderate (OR = 0.936, 95 % CI: 0.017, 0.075) and high (OR = 0.939, 95 % CI: 0.016, 0.100) levels of physical activity, poorer oral health (OR = 2.660, 95 % CI: 2.226, 3.179), and lower grip strength (OR = 0.913, 95 % CI: 0.870, 0.958). The AUC was 0.967 (95 % CI 0.508-0.470). The prevalence of MCI was high among older adults with T2DM in rural areas of China. The self-management ability of diabetes, depressive symptoms, physical activity, oral health and grip strength were modifiable risk factors of MCI. Targeted interventions should be developed and implemented to address these modifiable risk factors, aiming to enhance cognitive function and mitigate the incidence of MCI in older adults with T2DM.

Comparison of Absolute and Relative Grip Strength to Predict Incidence of Diabetes Mellitus in Korea: A Prospective Cohort Study

Background: This study aimed to investigate the association between absolute grip strength (AGS), relative grip strength (RGS) levels, and the risk of developing diabetes in middle-aged adults, utilizing longitudinal data. Methods: A total of 1935 participants, 51-81 years of age, were engaged in surveys both in 2017-2018 and during the subsequent follow-up survey in 2019-2020. Diabetes diagnosis and treatment were the criteria for categorizing individuals as "diabetic." Grip strength was measured using the JAMA-5030J1 equipment (SAEHAN, Korea), and AGS and RGS were also categorized into tertiles by gender. A proportional hazards Cox regression model was used to evaluate the relationship among AGS, RGS, and the risk of developing diabetes. Subsequently, we computed the hazard ratio (HR) and 95% confidence interval (95% CI) for the risk of developing diabetes. Results: After adjusting for various confounding variables, a significant reduction in diabetes risk was observed in the high grip strength group, adjusted for body mass index (RGS1) and body weight (RGS2), compared with the low RGS1 and RGS2 groups (RGS1 HR = 0.54, 95% CI = 0.36-0.80; RGS2 HR = 0.50, 95% CI = 0.34-0.73). However, there were no significant associations between AGS and diabetes risk. Furthermore, significant differences in the relationship among AGS, RGS levels, and the risk of developing diabetes were found across gender and insulin resistance levels. Conclusion: This study underscores the importance of RGS levels in predicting the incidence of diabetes, with AGS, RGS1, and RGS2 emerging as significant predictive indicators for assessing diabetes risk.

The Impact of Hand Strength on HbA1c, Body Mass Index and Body Composition by Group According to Sedentary Behaviour: Cross-Sectional Study in Japanese Patients with Type 2 Diabetes Mellitus

Background

The impact of hand strength in consideration of sedentary behaviour on diabetes management in patients with type 2 diabetes mellitus (T2DM) is unclear. The purpose of this study was to examine the impact of hand strength on HbA1c, body mass index (BMI) and body composition by group according to the duration of sedentary behaviour in Japanese patients with T2DM.

Methods

In this retrospective, cross-sectional, single-centre study, hand strength standardised by bodyweight (GS) and sedentary time (ST), were obtained and analysed in a total of 270 Japanese T2DM outpatients in 2021. After dividing the patients into four categories of median values (high and low GS, and long and short ST), odds ratios (ORs) for good control of HbA1c, BMI, waist circumference (WC) and intra-abdominal fat (IAF) were investigated using logistic regression models.

Results

The high GS/short ST group was found to have a significantly higher (OR = 2.01; 95% CI: 1.00, 4.03; P = 0.049) for controlled HbA1c compared with that of the low GS/long ST group. The high GS/short ST and the high GS/long ST groups had significantly higher ORs for controlled BMI, WC and IAF compared with the OR of the low GS/long ST group. In addition, the ORs were significantly increased with a positive trend in order from low GS/long ST, low GS/short ST, high GS/long ST, to high GS/short ST in all models (P < 0.001 for trend).

Conclusion

Hand strength, with modest effects from sedentary behaviour, could be helpful for diabetes management in T2DM patients.

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 and upper limb functional performance measures in people over 18 years old: Analysis of relationships and influencing factors

BACKGROUND

Handgrip strength is a common, simple, and inexpensive method to measure muscle strength. On the other hand, the functional performance measurement involves a usual task which implies repeating elements between the individuals' interaction and the environment. This is fundamental for projecting their results to daily life situation.

PURPOSE

To explore the relationship between grip strength and measures of functional performance of the upper limbs (ULs) in people over 18 years of age, and to determine the influence of sociodemographic and anthropometric variables on the relationship.

STUDY DESIGN

A cross-sectional study was conducted under the analytical empirical approach, using linear associations between handgrip strength and functional performance measurement tests (correspondence analysis).

METHODS

Three hundred sixty-two male and female individuals between 18 and 91 years of age from 4 Colombian cities participated. The grip strength of both ULs measured with a digital dynamometry was associated with the Box and Block Test (BBT, manual dexterity), Nine-Hole Peg Test (NHPT, daily living tasks), and Jebsen-Taylor Hand Function Test (JJT, ability to grasp, pick up, and place). Multiple linear regression analyzes were performed to assess possible explanatory factors of a sociodemographic and anthropometric order.

RESULTS

A significant association was found between the grip strength of dominant and non-dominant ULs with all functional performance tests (ρ > 0.27 and p < .001), except for the writing and simulated feeding subtests of the JJT (ρ ≤ 0.16). An interactive effect of age was found in the relationship between grip strength and the 3 functional performance tests.

CONCLUSIONS

These results support the association between grip strength with the NHPT, JJT, and BBT measures and the interactive effect of age on the performance of all tests.

Low relative hand grip strength is associated with a higher risk for diabetes and impaired fasting glucose among the Korean population

OBJECTIVE

This study investigated the association between relative hand grip strength (HGS) and glycemic status, such as impaired fasting glucose (IFG) and diabetes, using data from the Korea National Health and Nutrition Examination Survey (KNHANES).

METHODS

We performed a cross-sectional study using the data from the KNHANES of 27,894 individuals from 2014 to 2019. Relative HGS was defined as the absolute HGS divided by body mass index and divided into quartiles in men and women. Odds ratios (OR) for diabetes and IFG were calculated using multivariate logistic regression analysis. All analyses were stratified by sex, and subgroup analysis was age-stratified.

RESULTS

The lowest relative HGS quartile had a significant increase in the risk for diabetes (men: OR 2.72, 95% confidence interval [CI] 2.12-3.50; women: OR 3.38, 95% CI 2.70-4.24) and IFG (men: OR 1.35, 95% CI 1.15-1.59; women: OR 1.60, 95% CI 1.40-1.84). The ORs for diabetes and IFG according to the decreasing quartiles of relative HGS gradually increased in both sexes (P for trend <0.001). ORs and 95% CI of the lowest relative HGS quartile for diabetes were higher in the younger age group than that of the older age group (men: 4.47 and 2.80-7.14 for young adults; 2.41 and 1.37-4.25 for older adults; women: 5.91 and 3.06-9.38 for young adults; 1.47 and 0.92-2.33 for older adults). ORs and 95% CI for IFG was similar with the trend of ORs for diabetes (men: 1.80 and 1.43-2.26 for young adults; 1.17 and 0.75-1.84 for older adults; women: 2.20 and 1.77-2.72 for young adults; 1.33 and 0.86-2.07 for older adults).

CONCLUSION

Lower relative HGS was associated with a higher risk of not only diabetes but also IFG in both sexes. These trends were stronger in younger adults than in older adults.