Handgrip strength and cause-specific and total mortality in older disabled women: Exploring the mechanism
Handgrip strength and cause-specific and total mortality in older disabled women: Exploring the mechanism
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DOI：
10.1034/j.1600-0579.2003.00207.x
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发表时间：
2003-05-01
影响因子：
6.3
通讯作者：
Guralnik, JM
中科院分区：
文献类型：
--
作者：
Rantanen, T;Volpato, S;Guralnik, JM
目的：研究肌肉力量与总死亡率和死因特异性死亡率之间的关系，以及这种关系的可能影响因素，如常见的潜在死亡疾病、炎症、营养缺乏、缺乏运动、吸烟和抑郁症。设计：前瞻性人群队列研究，死亡率监测超过5年。居住在马里兰州巴尔的摩东半部和部分巴尔的摩县的老年妇女。参与者：919名年龄在65岁至101岁之间的中度至重度残疾妇女参加了基线握力测试，作为妇女健康和老龄化研究的一部分。研究测量：心血管疾病（CVD）、癌症、呼吸系统疾病、其他测量（非CVD、呼吸系统疾病或癌症）、总死亡率、握力和白细胞介素-6。结果：在5年的随访中，336例死亡：149例死于CVD，59例死于癌症，38例死于呼吸系统疾病，90例死于其他疾病。与握力最高三分位数相比，未校正的CVD死亡相对危险度（RR）最低为3.21（95% CI = 2.00-5.14），居中为1.88（95% CI = 1.11-3.21）。在最低与最高握力三分位数中，呼吸死亡率的未校正RR为2.38（95%CI = 1.09-5.20），其他死亡率为2.59（95%CI = 1.59-4.20）。癌症死亡率与握力无关。调整年龄、种族、身高和体重后，以最高握力三分位数为参考，CVD死亡率的RR最低为2.17（95%CI = 1.26-3.73），中间为1.56（95%CI = 0.89-2.71）。对多种疾病、缺乏运动、吸烟、白细胞介素-6、C反应蛋白、血清白蛋白、意外体重减轻和抑郁症状的进一步调整没有实质性改变风险估计。类似的结果观察到的全因mortals.CONCLUSION：在老年残疾妇女，握力是一个强大的预测的原因特异性和总死亡率。慢性疾病的存在通常导致死亡或慢性疾病中肌肉力量下降的机制，如炎症，营养状况差，废用和抑郁症，所有这些都是死亡率的独立预测因素，并不能解释这种关联。握力是整体肌肉力量的一个指标，可能通过疾病导致肌肉损伤以外的机制预测死亡率。握力测试可能有助于识别健康恶化风险增加的患者。
OBJECTIVES: To examine the association between muscle strength and total and cause-specific mortality and the plausible contributing factors to this association, such as presence of diseases commonly underlying mortality, inflammation, nutritional deficiency, physical inactivity, smoking, and depression.DESIGN: Prospective population-based cohort study with mortality surveillance over 5 years.SETTING: Elderly women residing in the eastern half of Baltimore, Maryland, and part of Baltimore County.PARTICIPANTS: Nine hundred nineteen moderately to severely disabled women aged 65 to 101 who participated in handgrip strength testing at baseline as part of the Women's Health and Aging Study.MEASUREMENTS: Cardiovascular disease (CVD), cancer, respiratory disease, other measures (not CVD, respiratory, or cancer), total mortality, handgrip strength, and interleukin-6.RESULTS: Over the 5-year follow-up, 336 deaths occurred: 149 due to CVD, 59 due to cancer, 38 due to respiratory disease, and 90 due to other diseases. The unadjusted relative risk (RR) of CVD mortality was 3.21 (95% confidence interval (CI) = 2.00-5.14) in the lowest and 1.88 (95% CI = 1.11-3.21) in the middle compared with the highest tertile of handgrip strength. The unadjusted RR of respiratory mortality was 2.38 (95% CI = 1.09-5.20) and other mortality 2.59 (95% CI = 1.59-4.20) in the lowest versus the highest grip-strength tertile. Cancer mortality was not associated with grip strength. After adjusting for age, race, body height, and weight, the RR of CVD mortality decreased to 2.17 (95% CI = 1.26-3.73) in the lowest and 1.56 (95% CI = 0.89-2.71) in the middle, with the highest grip-strength tertile as the reference. Further adjustments for multiple diseases, physical inactivity, smoking, interleukin-6, C-reactive protein, serum albumin, unintentional weight loss, and depressive symptoms did not materially change the risk estimates. Similar results were observed for all-cause mortality.CONCLUSION: In older disabled women, handgrip strength was a powerful predictor of cause-specific and total mortality. Presence of chronic diseases commonly underlying death or the mechanisms behind decline in muscle strength in chronic disease, such as inflammation, poor nutritional status, disuse, and depression, all of which are independent predictors of mortality, did not explain the association. Handgrip strength, an indicator of overall muscle strength, may predict mortality through mechanisms other than those leading from disease to muscle impairment. Grip strength tests may help identify patients at increased risk of deterioration of health.