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Published on: July 5, 2017
Integrating Leg-Press Strength and Nutritional Status Improves 16-Year Mortality Risk Stratification in General Older
Yilin Du1, Tatsuma Okazaki1, Xiang Li1
1Department of Rehabilitation Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
Background:
Malnutrition and muscle weakness are critical prognostic factors for mortality in older adults. While indices like the Geriatric Nutritional Risk Index (GNRI) are well-established, the long-term prognostic value of integrating nutrition with muscle strength (MS) remains insufficiently established in community-dwelling populations. Currently, very few studies have evaluated the effects on mortality of directly measured leg-press strength, which includes most of the major leg muscles in both lower extremities and involves a substantially larger muscle volume than handgrip or quadriceps muscle strength. This study aimed to clarify whether directly measured leg-press strength predicts mortality and whether integration with GNRI (MS-GNRI) enhances mortality risk stratification.
Methods:
We analysed data from 1065 Japanese community-dwelling individuals aged ≥ 70 years from the Tsurugaya Project, followed for 16 years. Participants were categorized into two groups based on optimal cutoff values for directly measured leg-press strength adjusted for body size (high and low) or by GNRI (poor and good), respectively. Finally, these baseline classifications were integrated to stratify participants into the following four MS-GNRI groups: (1) high-strength/good-GNRI, (2) high-strength/poor-GNRI, (3) low-strength/good-GNRI and (4) low-strength/poor-GNRI. Hazard ratios (HRs) for all-cause mortality were calculated using Cox proportional hazards models.
Results:
During the follow-up, 415 deaths occurred. Low leg-press strength and poor GNRI were independently associated with higher mortality than high strength and good GNRI, respectively; adjusted HRs were 1.81 (95% CI: 1.45-2.25) and 1.59 (1.30-1.95), respectively (both p < 0.01). The MS-GNRI revealed a survival gradient: Using the high-strength/good-GNRI group as the reference, adjusted HRs (95% CI) were 1.55 (1.18-2.03) for the high-strength/poor-GNRI group, 1.69 (1.29-2.23) for the low-strength/good-GNRI group and 2.47 (1.78-3.13) for the low-strength/poor-GNRI group (p for trend < 0.001). Notably, the high-strength/poor-GNRI group and the low-strength/good-GNRI group showed comparable survival probabilities. MS-GNRI significantly improved predictive accuracy and risk reclassification over either indicator alone (Net Reclassification Improvement: 0.62 over strength; 0.41 over GNRI).
Conclusions:
Directly measured leg-press strength is a potent predictor of all-cause mortality. Integrating muscle strength with nutrition via MS-GNRI enhanced mortality risk stratification, suggesting that preserved muscle strength may substantially contribute to longevity alongside nutritional maintenance.
