Abstract
BackgroundReduced muscular strength, as measured by absolute grip strength, has been associated with increased risk of some site‐specific cancers. The ability of grip strength to predict other diseases may be affected by whether it is expressed in absolute or relative terms, but the evidence for cancer is scarce. This study compared the associations of absolute and relative grip strength with all‐cause and 15 site‐specific cancers.MethodsA prospective cohort study was undertaken using data from the UK Biobank. The exposure variable was grip strength, in absolute form (kilogrammes) and relative to weight, body mass index (BMI), height. and body fat mass. The outcome was incident cancer, at 15 sites and overall. Cox proportional hazard models were performed to study the associations.ResultsThis study included 445 552 participants, where 53.8% of the participants were women, with a mean (SD) age of 56.3 (8.11) years. During a median of 8.8 years follow‐up period, 48 886 (11.0%) patients were diagnosed with cancer. After adjusting for sociodemographic and lifestyle factors, as well as multiple testing, absolute grip strength was inversely and linearly associated with endometrial [hazard ratio (HR): 0.74, 95% confidence interval (CI): 0.69; 0.79, P value <0.001], gallbladder (HR: 0.81, 95% CI: 0.72; 0.92, P value = 0.001), liver (HR: 0.86, 95% CI: 0.79; 0.93, P value <0.001), kidney (HR: 0.93, 95% CI: 0.88; 0.99), and breast (HR: 0.93, 95% CI: 0.91; 0.96, P value = 0.031), as well as all‐cause cancer (HR: 0.97, 95% CI: 0.95; 0.98, P value <0.001). Eight cancer sites were inversely associated with HGS relative to weight and BMI: endometrium, liver, gallbladder, kidney, oesophagus, pancreas, colorectal, breast, and all‐cause cancer. Compared with absolute grip strength, grip strength relative to body fat mass had better discriminatory power for head and neck and breast cancer. Grip strength relative to BMI was marginally better than absolute grip strength in predicting stomach cancer.ConclusionsGrip strength was associated with risk of several site‐specific cancers and all‐cause cancer. Head and neck and breast cancers might be better predicted by relative grip strength.
Highlights
There were 19.3 million new cancer cases in 2020,1 and by 2040, this number is expected to increase to 27.5 million.[2]
Five representations of handgrip strength (HGS) were analysed: (1) absolute HGS in kg, (2) HGS divided by height, (3) HGS divided by weight, (4) HGS divided by body mass index (BMI), (5) HGS divided by body fat mass (BFM) in kilogramme
Analyses were adjusted for baseline age, sex, ethnicity, Townsend deprivation index, height, smoking status, dietary intake, sedentary behaviour, physical activity, and comorbidities (longstanding illness, diabetes, hypertension, cardiovascular disease (CVD), cancer, and depression), as well as height when it was not included in the exposure
Summary
There were 445 552 participants included in the analysis. The median follow-up period was 8.8 years [IQR 7.9–9.6]. The main finding of the current study was that when comparing numerous different ways to express HGS —absolute and relative to height, weight, BMI, and BFM —relative HGS only showed a modestly improvement in prediction of two groups of cancers. These findings could have important public health implications in terms of the operationalization of HGS in predicting cancer risk, which warrants further studies.[6] This study demonstrates that the most basic form of reporting grip strength, namely in absolute units (kg), is largely sufficient for predicting cancer outcomes in clinical practice and further adjustment might not be needed
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