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Ramírez-Vélez R, Carrera-Gil F, Dávila-Grisales AA, Izquierdo M. Handgrip strength during pregnancy: A first reference values based on nationally representative survey. Clin Nutr ESPEN 2025; 67:166-173. [PMID: 40097046 DOI: 10.1016/j.clnesp.2025.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Revised: 02/04/2025] [Accepted: 03/01/2025] [Indexed: 03/19/2025]
Abstract
BACKGROUND & AIMS Handgrip strength (HGS) using isometric dynamometry is a convenient and feasible noninvasive measure of physical strength, overall health, and nutritional status among people of all ages. While adult HGS norms have been published in many countries, no study has synthesized available data to produce representative norms during pregnancy. This study used data from an extensive national representative survey to generate gestational age-specific reference norms for HGS during pregnancy. METHODS This cross-sectional study enrolled 1016 pregnant women aged 18-48 years old. HGS was measured using a hand dynamometer with an adjustable grip. Smoothed centile curves and tables for the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles were calculated using lambda-mu-sigma (LMS) method to develop gestational age-specific norms for absolute HGS (in kilograms [kg]) and HGS normalized by height (Ht) in meters (m) squared (i.e., HGS/Ht2 in kg/m2). RESULTS We found no significant difference in absolute or normalized grip strength between trimesters and gestational weeks (p > 0.05). Median (P50), absolute and normalized HGS levels improved negligibly (equivalent to ∼0.3-1.4 kg for absolute HGS or ∼0.1-0.5 kg/m2 for normalized HGS) throughout early pregnancy (1-4 weeks to 14-17 weeks) and peaked from gestational age 23-27 weeks (at 22.97 kg [absolute HGS] or 8.74 kg/m2 [normalized HGS]) However, the gestational age-related decline in HGS levels was slightly smaller for young women than for women during middle adulthood. CONCLUSION This study provides the first national norms for pregnant women with HGS according to the gestational age. These norms are useful for health screening, monitoring, and surveillance, and for comparison with studies from other countries.
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Affiliation(s)
- Robinson Ramírez-Vélez
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Navarra, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Unidad Central del Valle del Cauca (UCEVA), Tuluá, Valle del Cauca 763022, Colombia.
| | - Frank Carrera-Gil
- Departamento de Alimentación y Nutrición, Facultad de Ciencias de la Salud, Pontificia Universidad Javeriana Seccional Cali, Cali 760021, Colombia.
| | | | - Mikel Izquierdo
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Navarra, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.
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Mialich MS, da Silva BR, Amstalden BT, Elias J, Jordao AA. Association of skeletal muscle quantity and quality with mortality in women with nonmetastatic breast cancer. Discov Oncol 2025; 16:247. [PMID: 40014176 PMCID: PMC11867992 DOI: 10.1007/s12672-025-01999-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Accepted: 02/19/2025] [Indexed: 02/28/2025] Open
Abstract
Women with breast cancer are predisposed to muscle mass loss, to compromised muscle quality, and to decreased strength, and these abnormalities may serve as important predictors of adverse outcomes, including mortality. The aim of this study was to evaluate the possible associations between muscle mass markers, assessed by computed tomography with the phase angle (PhA) obtained by Bioelectrical impedance analysis (BIA), and health outcomes in women with breast cancer. METHODS retrospective study with 54 women newly diagnosed with breast cancer, aged ≥ 18 years and < 65 years; histologically confirmed diagnosis of early breast cancer (stage I-III range), and in the first chemotherapy-cycled treatment. Measurements performed: anthropometric assessments, BIA, third lumbar vertebra by computed tomography (CT) and physical function (handgrip strength, gait speed test 4 m, fatigue assessment), and blood biochemical analysis. RESULTS Lower skeletal muscle index were correlated with reduced PhA values (R² = 0.222, p = 0.0047), suggesting a worse prognosis. Logistic regression analysis showed that individuals with low muscle mass had a significantly lower likelihood of survival compared to those with normal muscle mass regardless of age and cancer stage. CONCLUSION low muscle mass negatively affected patient survival and was associated with lower PhA values. Phase angle emerges as a promising marker of overall health and could be a valuable clinical tool in assessing prognosis.
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Affiliation(s)
- Mirele Savegnago Mialich
- Department of Health Sciences, Faculty of Medicine of Ribeirão Preto, University of São Paulo (USP), Rua Miguel Covian, 120, Ribeirão Preto, SP, 14049-900, Brazil.
- Barão de Maua University Center, Ribeirão Preto, Brazil.
| | - Bruna Ramos da Silva
- Department of Health Sciences, Faculty of Medicine of Ribeirão Preto, University of São Paulo (USP), Rua Miguel Covian, 120, Ribeirão Preto, SP, 14049-900, Brazil
- Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada
| | - Barbara Toledo Amstalden
- Department of Health Sciences, Faculty of Medicine of Ribeirão Preto, University of São Paulo (USP), Rua Miguel Covian, 120, Ribeirão Preto, SP, 14049-900, Brazil
| | - Jorge Elias
- Department of Medical, Imaging, Hematology and Oncology at Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Alceu Afonso Jordao
- Department of Health Sciences, Faculty of Medicine of Ribeirão Preto, University of São Paulo (USP), Rua Miguel Covian, 120, Ribeirão Preto, SP, 14049-900, Brazil
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Tomkinson GR, Lang JJ, Rubín L, McGrath R, Gower B, Boyle T, Klug MG, Mayhew AJ, Blake HT, Ortega FB, Cadenas-Sanchez C, Magnussen CG, Fraser BJ, Kidokoro T, Liu Y, Christensen K, Leong DP. International norms for adult handgrip strength: A systematic review of data on 2.4 million adults aged 20 to 100+ years from 69 countries and regions. JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 14:101014. [PMID: 39647778 PMCID: PMC11863340 DOI: 10.1016/j.jshs.2024.101014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 09/23/2024] [Accepted: 10/08/2024] [Indexed: 12/10/2024]
Abstract
BACKGROUND Muscular strength is a powerful marker of current health status and robust predictor of age-related disease and disability. Handgrip strength (HGS) using isometric dynamometry is a convenient, feasible, and widely used method of assessing muscular strength among people of all ages. While adult HGS norms have been published for many countries, no study has yet synthesized available data to produce international norms. The objective of this study was to generate international sex- and age-specific norms for absolute and body size-normalized HGS across the adult lifespan. METHODS Systematic searches were conducted in 6 databases/web search engines (MEDLINE, SPORTDiscus, Embase, Web of Science, CINAHL, and Google Scholar) up to December 1, 2023. We included full-text peer-reviewed observational studies that reported normative HGS data for adults aged ≥20 years by sex and age. Pseudo data were generated using Monte Carlo simulation following harmonization for methodological variation. Population-weighted Generalized Additive Models for Location, Scale, and Shape were used to develop sex- and age-specific norms for absolute HGS (kg) and HGS normalized by height (Ht, m) squared (i.e., HGS/Ht2 in kg/m2). Norms were tabulated as percentile values (5th to 95th) and visualized as smoothed percentile curves. RESULTS We included data from 100 unique observational studies representing 2,405,863 adults (51.9% female) aged 20 to 100+ years from 69 countries and regions tested from the year 2000 onward. On average, absolute and normalized HGS values negligibly improved throughout early adulthood, peaked from age 30-39 years (at 49.7 kg (males) and 29.7 kg (females) for absolute HGS or 16.3 kg/m2 (males) and 11.3 kg/m2 (females) for HGS/Ht2), and declined afterwards. The age-related decline in HGS accelerated from middle to late adulthood and was slightly larger for males than for females during middle adulthood. CONCLUSION This study provides the world's largest and most geographically comprehensive international norms for adult HGS by sex and age. These norms have utility for global peer-comparisons, health screening, and surveillance.
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Affiliation(s)
- Grant R Tomkinson
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia.
| | - Justin J Lang
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia; Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON K1A 0K9, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Lukáš Rubín
- Department of Physical Education and Sport, Faculty of Science, Humanities and Education, Technical University of Liberec, Liberec 461 17, Czech Republic; Institute of Active Lifestyle, Faculty of Physical Culture, Palacký University Olomouc, Olomouc 779 00, Czech Republic
| | - Ryan McGrath
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia; Healthy Aging North Dakota (HAND), North Dakota State University, Fargo, ND 58102, USA; Department of Health, Nutrition and Exercise Sciences, North Dakota State University, Fargo, ND 58108, USA; Fargo VA Healthcare System, Fargo, ND 58102, USA; Department of Geriatrics, University of North Dakota, Grand Forks, ND 58202, USA
| | - Bethany Gower
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia
| | - Terry Boyle
- Australian Centre for Precision Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia
| | - Marilyn G Klug
- Department of Population Health, University of North Dakota, Grand Forks, ND 58202, USA
| | - Alexandra J Mayhew
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada; Labarge Centre for Mobility in Aging, McMaster University, Hamilton, ON L8P 0A1, Canada; McMaster Institute for Research on Aging, McMaster University, Hamilton, ON L8P 0A1, Canada
| | - Henry T Blake
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia
| | - Francisco B Ortega
- Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, ES 18071, Spain; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Granada, ES 18071, Spain; Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä 40014, Finland
| | - Cristina Cadenas-Sanchez
- Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, ES 18071, Spain; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Granada, ES 18071, Spain; Department of Cardiology, Stanford University, Stanford, CA 94305, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Costan G Magnussen
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia; Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku 20520, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku 20520, Finland
| | - Brooklyn J Fraser
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia; Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia
| | - Tetsuhiro Kidokoro
- Faculty of Sport Science, Nippon Sport Science University, Tokyo 158-8508, Japan
| | - Yang Liu
- School of Physical Education, Shanghai University of Sport, Shanghai 200438, China; Shanghai Research Center for Physical Fitness and Health of Children and Adolescents, Shanghai 200438, China
| | - Kaare Christensen
- Department of Public Health, Epidemiology Biostatistics and Biodemography, University of Southern Denmark, Odense 5230, Denmark
| | - Darryl P Leong
- The Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada
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Liang W, Liu Y, Guo X, Ma X, Yang X, Zhou J. Grip strength predicts postoperative ileus among patients undergoing abdominal minimally invasive surgery: a prospective multicenter cohort study. Surg Endosc 2024; 38:7217-7226. [PMID: 39384653 DOI: 10.1007/s00464-024-11296-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 09/13/2024] [Indexed: 10/11/2024]
Abstract
BACKGROUND Postoperative ileus (POI) is a prevalent complication following abdominal surgery, leading to extended hospitalization and escalated medical expenses. Few studies have investigated the association between grip strength and POI after abdominal minimally invasive surgery (MIS). METHODS A prospective multicenter cohort study was conducted using data from a prospectively registered database of patients undergoing abdominal MIS from March to December 2022. Grip strength levels were categorized and analyzed for their association with POI using multiple regression analysis with demographic adjustments. A smooth curve was generated to visualize the linear relationship. RESULTS Out of 501 eligible patients, 393 were analyzed, with 67 (17.05%) developing POI. Grip strength was significantly and independently associated with POI, with each 1 kg and 8.57 kg (SD) increase in grip strength resulting in ORs of 0.94 and 0.61, respectively. Grip strength categories specific to sex and age were significantly associated with POI incidence, with individuals in the high grip strength group having a lower risk. Subgroup analysis showed grip strength as a significant predictor of POI risk, especially for males and older individuals. Higher grip strength was associated with a significantly lower risk of POI in males (OR = 0.29, 95% CI 0.09-0.90, p = 0.031) and older adults over 60 years old (OR = 0.31, 95% CI 0.10-0.98, p = 0.046). CONCLUSION Grip strength can predict the occurrence of POI in patients undergoing abdominal MIS. This can help identify high-risk individuals and improve perioperative management for better outcomes.
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Affiliation(s)
- Wenquan Liang
- Department of General Surgery of the First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Yuhua Liu
- Institute of Army Hospital Management, Innovative Medical Research Department, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Xin Guo
- Department of General Surgery of the First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Xiaonan Ma
- Department of General Surgery of the Peking Union Medical College Hospital, Beijing, 100032, China
| | - Xiuxiu Yang
- Department of General Surgery of the Sixth Medical Center, Chinese People's Liberation Army General Hospital, Beijing, 100048, China
| | - Jing Zhou
- Department of General Surgery of the First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China.
- Department of General Surgery & Institute of General Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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Araújo MM, Lima RM, de Carvalho KMB, Botelho PB. What Is the Best Method for Diagnosing Osteosarcopenic Adiposity in Women After Long-Term Bariatric Surgery? A Comparison and Validation of Different Criteria. Nutrients 2024; 16:3965. [PMID: 39599750 PMCID: PMC11597721 DOI: 10.3390/nu16223965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Revised: 10/05/2024] [Accepted: 10/14/2024] [Indexed: 11/29/2024] Open
Abstract
BACKGROUND/OBJECTIVES To evaluate the agreement and discriminant validation of different osteosarcopenic adiposity (OSAd) diagnostic criteria in women post-Roux-en-Y gastric bypass (RYGB) surgery. METHODS Surgery. This is a cross-sectional study with women ≥2 years post-RYGB. OSAd was diagnosed using three criteria: Kelly for OSAd; ESPEN/EASO and SDOC for SO, associated with WHO osteopenia, respectively. Agreement was assessed with Cohen's Kappa, and the predictive discriminatory capability was evaluated by sensitivity, specificity, and accuracy, using impairment of physical function and the increased risk of fracture as reference standards.; Results: A total of 178 women were evaluated, with a mean age of 45.2 ± 9.6 years old and postoperative time of 6.6 ± 3.6 years. The prevalence of OSAd was 2.2% [Kelly]; 2.8% [ESPEN/EASO + WHO]; 6.2% [SDOC + WHO]. Moderate agreement was found between Kelly and ESPEN/EASO (k = 0.658, p < 0.001), but agreement with SDOC was null (k = 0.104, p = 0.114). All criteria demonstrated high specificity (94.0-98.2%) and low sensitivity (0.0-16.7%), with Kelly showing the highest accuracy (92.7%); Conclusions: Among the evaluated criteria, Kelly presented the highest accuracy and 2.2% of OSAd prevalence. Despite consistently high specificity, all criteria exhibited low sensitivity. These findings highlight the need for more sensitive diagnostic approaches for OSAd in postoperative RYGB populations.
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Affiliation(s)
- Maísa Miranda Araújo
- Graduate Program in Human Nutrition, University of Brasilia, Brasília 70910-900, Brazil; (R.M.L.); (K.M.B.d.C.); (P.B.B.)
| | - Ricardo Moreno Lima
- Graduate Program in Human Nutrition, University of Brasilia, Brasília 70910-900, Brazil; (R.M.L.); (K.M.B.d.C.); (P.B.B.)
- Graduate Program in Physical Education, University of Brasilia, Brasília 70910-9000, Brazil
| | | | - Patrícia Borges Botelho
- Graduate Program in Human Nutrition, University of Brasilia, Brasília 70910-900, Brazil; (R.M.L.); (K.M.B.d.C.); (P.B.B.)
- Faculty of Applied Sciences, State University of Campinas, Campinas 13484-350, Brazil
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Machado DRL, Abdalla PP, Bohn L, Stratton G, Mota J. Foreign allometric exponents adequately normalize isokinetic knee extension strength to identify muscle weakness and mobility limitation in Portuguese older adults: a cross-sectional study. BMC Geriatr 2022; 22:757. [PMID: 36114479 PMCID: PMC9479406 DOI: 10.1186/s12877-022-03413-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/05/2022] [Indexed: 11/21/2022] Open
Abstract
Background Identifying muscle weakness is challenging, because the reduction of strength with aging does not depend only on sarcopenia, but also on sensorimotor deficits. Nevertheless, this identification is improved by adjusting muscle strength allometrically, by removing the influence of body size. However, the effectiveness of foreign models to normalize these (dys)functionalities is not yet tested. This study aimed to compare and apply foreign allometric exponents for normalizing isokinetic knee extension strength in Portuguese older adults to identify muscle weakness/mobility limitation. Additionally, to attest any populational difference, data of these people and Brazilian older adults were compared Methods This is a cross-sectional study encompassing 226 Portuguese (n = 132) and Brazilian (n = 94) older adults. Mobility limitation (six-minute walk test, at lowest quartile), lower limb strength (knee extension isokinetic strength at 60º/s), and body dimensions measures were taken. Foreign allometric exponents (b) were used to normalize Portuguese strength (strength/body-size variablesb). Non-normalized and normalized strength were compared (ROC) to generate the most accurate cut-point for identifying muscle weakness/mobility limitation. Results Older Portuguese men and women had better mobility than their Brazilian counterparts. Older Portuguese women had superior muscle strength to Brazilian women. Normalization from 11 foreign models removed the influence of body size on muscle strength, with a negligible correlation (r ≤ 0.30). In contrast to the non-normalized strength, the normalized strength cut-off points were sufficiently accurate (AUC ≥ 0.70) to avoid identifying false-negative cases of weakness/mobility limitation. Conclusions Portuguese older women were stronger and had superior functional capacity compared to Brazilian ones. Normalized foreign models improved the accuracy in identifying muscle weakness/mobility limitation in Portuguese older adults. The isokinetic knee extension muscle strength normalized, even using foreign allometric exponents, should be better than no adjustment.
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