Xiong Lijiao, Zeng Zhaohao, Wang Shuojia, Liao Tingfeng, Wang Xiaohao, Wang Xinyu, Yang Guangyan, Li Yanchun, Li Lixing, Zhu Jing, Zhao Pengfei, Yang Shu, Kang Lin, Liang Zhen
Department of Geriatrics, The Second Clinical Medical College, Jinan University (Shenzhen People's Hospital), Shenzhen, China.
Guangdong Provincial Clinical Research Center for Geriatrics, Shenzhen Clinical Research Center for Geriatrics, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China.
Front Nutr. 2023 Sep 15;10:1183973. doi: 10.3389/fnut.2023.1183973. eCollection 2023.
To investigate the association between handgrip strength (HGS) with all-cause and cardiovascular disease (CVD) mortality in US adults.
We analyzed data from the National Health and Nutrition Examination Survey (NHANES) prospective cohort study (2011-2014) with 10,470 participants. The cox regression analysis, Kaplan-Meier survival curves, fitted curves, ROC curves, and propensity score-matched analysis (PSM) with inverse probability of treatment weighting (IPTW), SMRW (PSM with repeated weights), PA (pairwise algorithm), and OW (overlap weighting) regression analysis were performed to assess the relationship between HGS and all-cause and CVD mortality.
The low HGSs (men <37.4 kg, women <24 kg), was found to be associated with higher all-cause and CVD mortality in a reverse J-shaped curve ( < 0.05). Adjusting for multiple covariates including age, BMI, race, education level, marriage status, smoking and alcohol use, and various comorbidities, the hazard ratio (HR) for all-cause mortality in the lowest HGS quintile 1 (Q1) was 3.45 (2.14-5.58) for men and 3.3 (1.88-5.79) for women. For CVD mortality, the HR was 2.99 (1.07-8.37) for men and 10.35 (2.29-46.78) for women. The area under the curve (AUC) for HGS alone as a predictor of all-cause mortality was 0.791 (0.768-0.814) for men and 0.780 (0.752-0.807) for women ( < 0.05), while the AUC for HGS and age was 0.851 (0.830-0.871) for men and 0.848 (0.826-0.869) for women ( < 0.05). For CVD mortality, the AUC for HGS alone was 0.785 (95% CI 0.738-0.833) for men and 0.821 (95% CI 0.777-0.865) for women ( < 0.05), while the AUC for HGS and age as predictors of all-cause mortality was 0.853 (0.861-0.891) for men and 0.859 (0.821-0.896) for women ( < 0.05). The HGS Q1 (men <37.4 kg and women <24 kg) was matched separately for PSM. After univariate, multivariate Cox regression models, PSM, IPTW, SMRW, PA, and OW analyses, women had 2.37-3.12 and 2.92-5.12 HRs with low HGS for all-cause and CVD mortality, while men had 2.21-2.82 and 2.33-2.85 for all-cause and CVD mortality, respectively ( < 0.05).
Adults with low HGS exhibited a significantly increased risk of both all-cause and CVD mortality, regardless of gender. Additionally, low HGS served as an independent risk factor and predictor for both all-cause and CVD mortality.
研究美国成年人握力（HGS）与全因死亡率和心血管疾病（CVD）死亡率之间的关联。
我们分析了来自国家健康与营养检查调查（NHANES）前瞻性队列研究（2011 - 2014年）的10470名参与者的数据。进行了Cox回归分析、Kaplan - Meier生存曲线分析、拟合曲线分析、ROC曲线分析以及倾向评分匹配分析（PSM），包括逆概率处理加权法（IPTW）、重复加权PSM（SMRW）、成对算法（PA）和重叠加权（OW）回归分析，以评估HGS与全因死亡率和CVD死亡率之间的关系。
发现低握力（男性<37.4千克，女性<24千克）与全因死亡率和CVD死亡率呈反向J形曲线相关（P<0.05）。在调整了包括年龄、体重指数、种族、教育水平、婚姻状况、吸烟和饮酒以及各种合并症等多个协变量后，最低握力五分位数1（Q1）的男性全因死亡率风险比（HR）为3.45（2.14 - 5.58），女性为3.3（1.88 - 5.79）。对于CVD死亡率，男性HR为2.99（1.07 - 8.37），女性为10.35（2.29 - 46.78）。仅将握力作为全因死亡率预测指标时，男性的曲线下面积（AUC）为0.791（0.768 - 0.814），女性为0.780（0.752 - 0.807）（P<0.05），而握力和年龄作为预测指标时，男性AUC为0.851（0.830 - 0.871），女性为0.848（0.826 - 0.869）（P<0.05）。对于CVD死亡率，仅握力的AUC男性为0.785（95%CI 0.738 - 0.833），女性为0.821（95%CI 0.777 - 0.865）（P<0.05），而握力和年龄作为全因死亡率预测指标时，男性AUC为0.853（0.861 - 0.891），女性为0.859（0.821 - 0.896）（P<0.05）。对握力Q1（男性<37.4千克且女性<24千克）分别进行PSM匹配。经过单变量、多变量Cox回归模型、PSM、IPTW、SMRW、PA和OW分析后，低握力的女性全因死亡率和CVD死亡率的HR分别为2.37 - 3.12和2.92 - 5.12，而男性全因死亡率和CVD死亡率的HR分别为2.21 - 2.82和2.33 - 2.85（P<0.05）。
无论性别，低握力的成年人全因死亡率和CVD死亡率风险均显著增加。此外，低握力是全因死亡率和CVD死亡率的独立危险因素和预测指标。
