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Muscle Weakness Thresholds for Prediction of Diabetes in Adults

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Abstract

Background

Despite the known links between weakness and early mortality, what remains to be fully understood is the extent to which strength preservation is associated with protection from cardiometabolic diseases, such as diabetes.

Purpose

The purposes of this study were to determine the association between muscle strength and diabetes among adults, and to identify age- and sex-specific thresholds of low strength for detection of risk.

Methods

A population-representative sample of 4066 individuals, aged 20–85 years, was included from the combined 2011–2012 National Health and Nutrition Examination Survey (NHANES) data sets. Strength was assessed using a handheld dynamometer, and the single highest reading from either hand was normalized to body mass. A logistic regression model was used to assess the association between normalized grip strength and risk of diabetes, as determined by haemoglobin A1c levels ≥6.5 % (≥48 mmol/mol), while controlling for sociodemographic characteristics, anthropometric measures and television viewing time.

Results

For every 0.05 decrement in normalized strength, there were 1.26 times increased adjusted odds for diabetes in men and women. Women were at lower odds of having diabetes (odds ratio 0.49; 95 % confidence interval 0.29–0.82). Age, waist circumference and lower income were also associated with diabetes. The optimal sex- and age-specific weakness thresholds to detect diabetes were 0.56, 0.50 and 0.45 for men at ages of 20–39, 40–59 and 60–80 years, respectively, and 0.42, 0.38 and 0.33 for women at ages of 20–39, 40–59 and 60–80 years, respectively.

Conclusions and Clinical Relevance

We present thresholds of strength that can be incorporated into a clinical setting for identifying adults who are at risk of developing diabetes and might benefit from lifestyle interventions to reduce risk.

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References

  1. Aguiree F, Brown A, Cho NH, Dahlquist G, Dodd S, Dunning T, Hirst M, Hwang C, Magliano D, Patterson C, et al. IDF Diabetes Atlas: 6th edn. Basel, Switzerland: International Diabetes Federation; 2013.

  2. Gregg EW, Zhuo X, Cheng YJ, Albright AL, Narayan KMV, Thompson TJ. Trends in lifetime risk and years of life lost due to diabetes in the USA, 1985–2011: a modelling study. Lancet Diabetes Endocrinol. 2014;2(11):867–74.

    Article  PubMed  Google Scholar 

  3. Newman AB, Kupelian V, Visser M, Simonsick EM, Goodpaster BH, Kritchevsky SB, Tylavsky FA, Rubin SM, Harris TB. Strength, but not muscle mass, is associated with mortality in the Health, Aging and Body Composition Study cohort. J Gerontol A Biol Sci Med Sci. 2006;61(1):72–7.

    Article  PubMed  Google Scholar 

  4. Al Snih S, Markides KS, Ray L, Ostir GV, and Goodwin JS. Handgrip strength and mortality in older Mexican Americans. J Am Geriatr Soc. 2002;50(7):1250–6.

  5. Ruiz JR, Sui X, Lobelo F, Morrow JR Jr, Jackson AW, Sjostrom M, Blair SN. Association between muscular strength and mortality in men: prospective cohort study. BMJ. 2008;337:a439.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Cooper R, Strand BH, Hardy R, Patel KV, Kuh D. Physical capability in mid-life and survival over 13 years of follow-up: British Birth Cohort Study. BMJ. 2014;348:g2219.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lopez-Jaramillo P, Cohen DD, Gomez-Arbelaez D, Bosch J, Dyal L, Yusuf S, Gerstein HC, ORIGIN Trial Investigators. Association of handgrip strength to cardiovascular mortality in pre-diabetic and diabetic patients: a subanalysis of the ORIGIN trial. Int J Cardiol. 2014;174(2):458–61.

    Article  PubMed  Google Scholar 

  8. Cooper R, Kuh D, Hardy R, Mortality Review G, Falcon Teams HAS, Ahmad R, Sayer AA, Al Snih S, Bath PA, et al. Objectively measured physical capability levels and mortality: systematic review and meta-analysis. BMJ. 2010;341:c4467.

    Article  PubMed  PubMed Central  Google Scholar 

  9. McLean RR, Shardell MD, Alley DE, Cawthon PM, Fragala MS, Harris TB, Kenny AM, Peters KW, Ferrucci L, Guralnik JM, et al. Criteria for clinically relevant weakness and low lean mass and their longitudinal association with incident mobility impairment and mortality: the Foundation for the National Institutes of Health (FNIH) Sarcopenia Project. J Gerontol A Biol Sci Med Sci. 2014;69(5):576–83.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Spruit MA, Sillen MJH, Groenen MTJ, Wouters EFM, Franssen FME. New normative values for handgrip strength: results from the UK Biobank. J Am Med Dir Assoc. 2013;14(10):775.e5–11.

  11. Alley DE, Shardell MD, Peters KW, McLean RR, Dam T-TL, Kenny AM, Fragala MS, Harris TB, Kiel DP, Guralnik JM, et al. Grip strength cutpoints for the identification of clinically relevant weakness. J Gerontol A Biol Sci Med Sci. 2014;69(5):559–66.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Senechal M, McGavock JM, Church TS, Lee DC, Earnest CP, Sui X, Blair SN. Cut points of muscle strength associated with metabolic syndrome in men. Med Sci Sports Exerc. 2014;46(8):1475–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Moore AZ, Caturegli G, Metter EJ, Makrogiannis S, Resnick SM, Harris TB, Ferrucci L. Difference in muscle quality over the adult life span and biological correlates in the Baltimore Longitudinal Study of Aging. J Am Geriatr Soc. 2014;62(2):230–6.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kalyani RR, Metter EJ, Egan J, Golden SH, Ferrucci L. Hyperglycemia predicts persistently lower muscle strength with aging. Diabetes Care. 2015;38(1):82–90.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Peterson MD, Saltarelli WA, Visich PS, Gordon PM. Strength capacity and cardiometabolic risk clustering in adolescents. Pediatrics. 2014;133(4):e896–903.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Cohen DD, Gomez-Arbelaez D, Camacho PA, Pinzon S, Hormiga C, Trejos-Suarez J, Duperly J, Lopez-Jaramillo P. Low muscle strength is associated with metabolic risk factors in Colombian children: the ACFIES study. PloS One. 2014;9(4):e93150.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Artero EG, Ruiz JR, Ortega FB, Espana-Romero V, Vicente-Rodriguez G, Molnar D, Gottrand F, Gonzalez-Gross M, Breidenassel C, Moreno LA, et al. Muscular and cardiorespiratory fitness are independently associated with metabolic risk in adolescents: the HELENA study. Pediatr Diabetes. 2011;12(8):704–12.

    Article  PubMed  Google Scholar 

  18. Sairenchi T, Iso H, Irie F, Fukasawa N, Ota H, Muto T. Underweight as a predictor of diabetes in older adults: a large cohort study. Diabetes Care. 2008;31(3):583–4.

    Article  PubMed  Google Scholar 

  19. International Expert Committee. International Expert Committee report on the role of the A1c assay in the diagnosis of diabetes. Diabetes care. 2009;32(7):1327–34.

    Article  Google Scholar 

  20. Tam CS, Xie W, Johnson WD, Cefalu WT, Redman LM, Ravussin E. Defining insulin resistance from hyperinsulinemic–euglycemic clamps. Diabetes care. 2012;35(7):1605–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. National Health and Nutrition Examination Survey. Muscle strength procedures manual. http://www.cdc.gov/nchs/data/nhanes/nhanes_11_12/Muscle_Strength_Proc_Manual.pdf. Accessed 4 May 2015.

  22. World Health Organization. Global physical activity questionnaire (GPAQ) analysis guide. http://www.who.int/chp/steps/resources/GPAQ_Analysis_Guide.pdf. Accessed 27 April 2015.

  23. Bull FC, Maslin TS, Armstrong T. Global physical activity questionnaire (GPAQ): nine country reliability and validity study. J Phys Act Health. 2009;6(6):790–804.

    PubMed  Google Scholar 

  24. Lumley T. Complex surveys; a guide to analysis using R. Hoboken: Wiley; 2010.

    Google Scholar 

  25. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes care. 2010;33(Suppl 1):S62–9.

    Article  PubMed Central  Google Scholar 

  26. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes care. 2014;37(Suppl 1):S81–90.

    Article  Google Scholar 

  27. van Dijk JW, Manders RJF, Tummers K, Bonomi AG, Stehouwer CDA, Hartgens F, van Loon LJC. Both resistance- and endurance-type exercise reduce the prevalence of hyperglycaemia in individuals with impaired glucose tolerance and in insulin-treated and non-insulin-treated type 2 diabetic patients. Diabetologia. 2012;55(5):1273–82.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Dunstan DW, Daly RM, Owen N, Jolley D, De Courten M, Shaw J, Zimmet P. High-intensity resistance training improves glycemic control in older patients with type 2 diabetes. Diabetes Care. 2002;25(10):1729–36.

    Article  PubMed  Google Scholar 

  29. Black LE, Swan PD, Alvar BA. Effects of intensity and volume on insulin sensitivity during acute bouts of resistance training. J Strength Cond Res. 2010;24(4):1109–16.

    Article  PubMed  Google Scholar 

  30. Yardley JE, Kenny GP, Perkins BA, Riddell MC, Balaa N, Malcolm J, Boulay P, Khandwala F, Sigal RJ. Resistance versus aerobic exercise: acute effects on glycemia in type 1 diabetes. Diabetes Care. 2013;36(3):537–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Hansen E, Landstad BJ, Gundersen KT, Torjesen PA, Svebak S. Insulin sensitivity after maximal and endurance resistance training. J Strength Cond Res. 2012;26(2):327–34.

    Article  PubMed  Google Scholar 

  32. Lee S, Bacha F, Hannon T, Kuk JL, Boesch C, Arslanian S. Effects of aerobic versus resistance exercise without caloric restriction on abdominal fat, intrahepatic lipid, and insulin sensitivity in obese adolescent boys: a randomized, controlled trial. Diabetes. 2012;61(11):2787–95.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Grontved A, Pan A, Mekary RA, Stampfer M, Willet WC, Manson JE, Hu FB. Muscle-strengthening and conditioning activities and risk of type 2 diabetes: a prospective study in two cohorts of US women. Plos Med. 2014;11(1):e1001587.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Naci H, Ioannidis JPA. Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study. BMJ. 2013;347:f5577.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Peterson MD, Liu D, Gordish-Dressman H, Hubal MJ, Pistilli E, Angelopoulos TJ, Clarkson PM, Moyna NM, Pescatello LS, Seip RL, et al. Adiposity attenuates muscle quality and the adaptive response to resistance exercise in non-obese, healthy adults. Int J Obes (Lond). 2011;35:1095–103.

    Article  CAS  PubMed Central  Google Scholar 

  36. Delmonico MJ, Harris TB, Visser M, Park SW, Conroy MB, Velasquez-Mieyer P, Boudreau R, Manini TM, Nevitt M, Newman AB, et al. Longitudinal study of muscle strength, quality, and adipose tissue infiltration. Am J Clin Nutr. 2009;90(6):1579–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Hilton TN, Tuttle LJ, Bohnert KL, Mueller MJ, Sinacore DR. Excessive adipose tissue infiltration in skeletal muscle in individuals with obesity, diabetes mellitus, and peripheral neuropathy: association with performance and function. Phys Ther. 2008;88(11):1336–44.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Zhang P, Peterson M, Su GL, Wang SC. Visceral adiposity is negatively associated with bone density and muscle attenuation. Am J Clin Nutr. 2015;101(2):337–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Author contributions

Mark Peterson and Soham Al Snih acquired the research data. Mark Peterson and Peng Zhang performed all of the analyses. Mark Peterson wrote the manuscript. Palak Choksi, Soham Al Snih and Kyriakos Markides reviewed/edited the manuscript and contributed to the interpretation of the results. All authors reviewed the final submitted manuscript.

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Correspondence to Mark D. Peterson.

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Funding source

Mark Peterson is funded by the National Institutes of Health (Grant No. 1KO1 HD074706).

Role of the Sponsor

The funders had no role in the design and conduct of the study; the collection, analysis and interpretation of the data; or the preparation, review and approval of the manuscript.

Disclosures

The authors (Mark Peterson, Peng Zhang, Palak Choksi, Kyriakos Markides and Soham Al Snih) have no conflicts of interest that are directly relevant to the content of this article.

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Peterson, M.D., Zhang, P., Choksi, P. et al. Muscle Weakness Thresholds for Prediction of Diabetes in Adults. Sports Med 46, 619–628 (2016). https://doi.org/10.1007/s40279-015-0463-z

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