Dose-Response Association Between Handgrip Strength and All-Cause Mortality Across Different Levels of Systemic...

Longitudinal associations between C-reactive protein (CRP) and handgrip strength from cohort studies remain inconsistent. We investigated the dose-response association between handgrip strength and all-cause mortality across different levels of systemic inflammation.

We analysed data from 20 941 participants (mean age 68 years ±9.4 SD; 43.1% men) from the Survey of Health, Ageing and Retirement in Europe (SHARE) Waves 6 to 9. CRP levels were categorized as > 3, > 10 and > 25 mg/L. Time-varying Cox proportional hazards regression with restricted cubic splines modeled associations between handgrip strength and all-cause mortality, adjusting for age, sex, BMI, smoking, education, marital status, geographic region and medications.

During 4.8-5.3 years follow-up, mortalities were 14.7% (CRP > 3 mg/L), 22.5% (CRP > 10 mg/L) and 30.2% (CRP > 25 mg/L). A curvilinear dose-response association existed between handgrip strength and mortality across all CRP levels with a significant interaction found between CRP and handgrip strength (p = 0.0131). Using median handgrip strength as reference (30 kg for CRP > 3 mg/L; 28 kg for CRP > 10 and > 25 mg/L), participants at the 10th percentile showed hazard ratios of 1.84 (95% CI 1.59-2.14), 1.69 (95% CI 1.33-2.15) and 1.92 (95% CI 1.17-3.17), respectively. Participants at the 90th percentile demonstrated protective effects: HR 0.57 (95% CI 0.43-0.74), 0.50 (95% CI 0.30-0.82) and 0.38 (95% CI 0.17-0.87).

Handgrip strength demonstrates a strong inverse dose-response association with mortality across varying inflammation levels. Protective effects persist even with elevated inflammatory markers, supporting handgrip strength as an accessible biomarker for mortality risk stratification in older adults regardless of inflammatory status.