Handgrip Strength and Trajectories of Preclinical Obesity Progression: A Multistate Model Analysis Using the UK Biobank

TL;DR

Stronger handgrip is linked to slower obesity progression and lower mortality risk in preclinical obesity.

Contribution

This study reveals grip strength as a protective factor against obesity-related dysfunction and death using multistate modeling.

Findings

Each SD increase in grip strength reduced preclinical obesity progression risk at all stages.

Strongest protection was observed from baseline to first dysfunction (HR: 0.86).

Highest grip strength showed strongest protection against death from double dysfunctions (HR: 0.77).

Abstract

Grip strength has been increasingly recognized as a predictor of chronic disease risk and mortality. The aim of our study was to investigate the association of grip strength and the trajectories of preclinical obesity progression.

Data were collected from 93 275 participants in the UK Biobank. Preclinical obesity was diagnosed based on an excess of anthropometric parameters, defined as elevated body mass index combined with at least 1 abnormal measure among waist circumference, waist-to-hip ratio, waist-to-height ratio, or percentage body fat, in the absence of obesity-induced dysfunctions. Three models captured different trajectories from baseline to dysfunctions and death, with or without intermediate progression. A multistate model was used to investigate the association between grip strength and the preclinical obesity progression and multiple-cause mortality risk. Sensitivity analyses were performed using free muscle volume, total lean mass, and muscle-to-weight ratio as exposures.

Among 8163 death events over a mean follow-up of 13.4 years, each SD increase in grip strength was associated with a significantly reduced risk of preclinical obesity progression at each stage, with the strongest inverse association observed in baseline to first dysfunction [fully adjusted hazard ratio (HR): 0.86, 95% confidence interval (CI): 0.85–0.88]. Compared to the lowest tertile, the highest grip strength significantly showed protective effects across all trajectory models, with double dysfunctions to all-cause death yielding the most pronounced associations (fully adjusted HR: 0.77, 95% CI: 0.70–0.84). Further subgroup and sensitivity analysis showed consistent results.

Increased grip strength was significantly associated with a decreased risk of obesity-induced dysfunctions progression and multiple-cause mortality. These findings underscore the importance of improving muscle mass and strength in preclinical obesity.

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