Endocrine Abstracts

Background: Handgrip strength (HGS) and skeletal muscle mass (SMM) are associated with all-cause and cardiovascular disease (CVD)-specific mortality risk in type 2 diabetes (T2DM) patients. However, the pattern of this association was unclear. We aimed to explore the pattern of associations between HGS and SMM with all-cause and CVD mortality risk in a diabetic population.

Method: Data were obtained from the UK Biobank (application number 92014), a large prospective cohort study. HGS was measured using a Jamar J00105 hydraulic hand dynamometer, and the mean values of left and right HGS were expressed in absolute units ( kg). SMM was measured using bioelectrical impedance method. Considering the influence of individual body size, SMM/height² was used for subsequent analysis. Death data are available via links to the National Health Service Information Centre.

Results: The mean age of the 13392 T2DM patients was 60.39 ± 6.76 years and 8350 (52.35) were male. With a mean follow-up of 12.52 years, there were 3006 (22.45%) deaths, including 746 (5.57%) CVD deaths. Cox proportional risk model showed that compared with the highest quartile of HGS (Q4), the all-cause and CVD mortality risk increased progressively with decreasing muscle strength (P-trend<0.05). As a continuous variable, a 1 SD decrease in HGS was found to increase the risk of all-cause mortality by 30.9% in men (HR: 1.309, 95% CI: 1.241-1.381) and 25.6% in women (HR: 1.256, 95% CI: 1.112-1.420); the risk of CVD mortality increased by 35.0% in men (HR: 1.350, 95% CI: 1.219-1.496) and 43.4% in women (HR: 1.434, 95% CI: 1.087-1.894). Decreased SMM/height² was not associated with increased mortality risk when SMM/height² was quartile divided and when used as a continuous variable. However, when the third quartile (Q3) of SMM/height² was used as a reference, an increased mortality risk was found in men for Q1 and in women for both Q1 and Q4 . The multivariable restricted cubic regression splines with 4 knots showed that there was no non-linear evidence between HGS with all-cause mortality and CVD mortality risk (Pnon-linear>0.05), while SMM/height² showed a U-shaped non-linear relationship with all-cause mortality and CVD mortality risk (Pnon-linear<0.05).

Conclusion: HGS showed a linear downward trend with mortality risk, whereas SMM/height² showed a U-shaped relationship, and either too low or too high muscle mass was associated with increased risk of CVD and all-cause mortality. Because HGS is a simple, non-invasive, and inexpensive measure, it could be used to predict mortality risk.