To examine the independent and combined associations of obesity and muscle strength with mortality in adult men and women.
Follow-up study with 33 years of mortality follow-up.
A total of 3594 men and women aged 50–91 years at baseline with 3043 deaths during the follow-up.
Body mass index (BMI) and handgrip strength were measured at baseline.
Based on Cox models adjusted for age, sex, education, smoking, alcohol use, physical activity and chronic conditions, baseline obesity (BMI⩾30 kg m−2) was associated with mortality among participants aged 50–69 years (hazard ratio (HR) 1.14, 95% confidence interval (CI), 1.01–1.28). Among participants aged 70 years and older, overweight and obesity were protective (HR 0.77, 95% CI, 0.66–0.89 and HR 0.76, 95% CI, 0.62–0.92). High handgrip strength was inversely associated with mortality among participants aged 50–69 (HR 0.89, 95% CI, 0.80–1.00) and 70 years and older (HR 0.78, 95% CI, 0.66–0.93). Compared to normal-weight participants with high handgrip strength, the highest mortality risk was observed among obese participants with low handgrip strength (HR 1.23, 95% CI, 1.04–1.46) in the 50–69 age group and among normal-weight participants with low handgrip strength (HR 1.30, 95% CI, 1.09–1.54) among participants aged 70+ years. In addition, in the old age group, overweight and obese participants with high handgrip strength had significantly lower mortality than normal-weight participants with high handgrip strength (HR 0.79, 95% CI, 0.67–0.92 and HR 0.77, 95% CI, 0.63–0.94).
Both obesity and low handgrip strength, independent of each other, predict the risk of death in adult men and women with additive pattern. The predictive value of obesity varies by age, whereas low muscle strength predicts mortality in all age groups aged>50 years and across all BMI categories. When promoting health among older adults, more attention should be paid to physical fitness in addition to body weight and adiposity.
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WHO. Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation: Geneva, Switzerland, 2000.
Flegal KM, Kit BK, Orpana H, Graubard BI . Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA 2013; 309: 71–82.
Prospective Studies Collaboration Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J et al. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet 2009; 373: 1083–1096.
Mehta NK, Chang VW . Secular declines in the association between obesity and mortality in the United States. Popul Dev Rev 2011; 37: 435–451.
Stenholm S, Sainio P, Rantanen T, Alanen E, Koskinen S . Effect of co-morbidity on the association of high body mass index with walking limitation among men and women aged 55 years and older. Aging Clin Exp Res 2007; 19: 277–283.
Koster A, Harris TB, Moore SC, Schatzkin A, Hollenbeck AR, van Eijk JTM et al. Joint associations of adiposity and physical activity with mortality: The National Institutes of Health-AARP Diet and Health Study. Am J Epidemiol 2009; 169: 1344–1351.
Wei M, Kampert JB, Barlow CE, Nichaman MZ, Gibbons LW, Paffenbarger RS Jr. et al. Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men. J Am Med Assoc 1999; 282: 1547–1553.
Hu G, Tuomilehto J, Silventoinen K, Barengo NC, Peltonen M, Jousilahti P . The effects of physical activity and body mass index on cardiovascular, cancer and all-cause mortality among 47 212 middle-aged Finnish men and women. Int J Obes (Lond) 2005; 29: 894–902.
Sui X, LaMonte MJ, Laditka JN, Hardin JW, Chase N, Hooker SP et al. Cardiorespiratory fitness and adiposity as mortality predictors in older adults. J Am Med Assoc 2007; 298: 2507–2516.
Rantanen T, Volpato S, Ferrucci L, Heikkinen E, Fried LP, Guralnik JM . Handgrip strength and cause-specific and total mortality in older disabled women: exploring the mechanism. J Am Geriatr Soc 2003; 51: 636–641.
Ruiz JR, Sui X, Lobelo F, Morrow JR Jr., Jackson AW, Sjostrom M et al. Association between muscular strength and mortality in men: prospective cohort study. BMJ 2008; 337: a439.
Metter EJ, Talbot LA, Schrager M, Conwit R . Skeletal muscle strength as a predictor of all-cause mortality in healthy men. J Gerontol A Biol Sci Med Sci 2002; 57: B359–B365.
US Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. 2008.
Rantanen T, Harris T, Leveille SG, Visser M, Foley D, Masaki K et al. Muscle strength and body mass index as long-term predictors of mortality in initially healthy men. J Gerontol A Biol Sci Med Sci 2000; 55A: M168–M173.
Ruiz JR, Sui X, Lobelo F, Lee DC, Morrow JR Jr, Jackson AW et al. Muscular strength and adiposity as predictors of adulthood cancer mortality in men. Cancer Epidemiol Biomarkers Prev 2009; 18: 1468–1476.
Aromaa A, Heliövaara M, Impivaara O, Knekt P, Maatela J, Joukamaa M et al Health, Functional Limitations and Need for Care in Finland. Basic Results from the Mini-Finland Health Survey. Publications of the Social Insurance Institution AL:32 (In Finnish with an English summary: 525–554): Helsinki and Turku, 1989. p 793.
Lehtonen R, Kuusela V . Statistical Efficiency of the Mini-Finland Health Survey's Sampling Desing (In Finnish, with English summary). Publications of the Social Insurance Institution ML: Helsinki and Turku, 65 1986.
Heliövaara M, Mäkelä M, Knekt P, Impivaara O, Aromaa A . Determinants of sciatica and low-back pain. Spine 1991; 16: 608–614.
National Institutes of Health, National Heart L, and Blood Institute. The Practical Guide: Identification. Evaluation, and Treatment of Overweight and Obesity in Adults NIH Publication No. 00-4084, 2000.
Lauretani F, Russo C, Bandinelli S, Bartali B, Cavazzini C, Di Iorio A et al. Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia. J Appl Physiol 2003; 95: 1851–1860.
Rantanen T, Era P, Kauppinen M, Heikkinen E . Maximal isometric muscle strength and socioeconomic status, health, and physical activity in 75-year-old persons. J Aging Phys Act 1994; 2: 206–220.
Mälkiä E . Muscular Performance as a Determinant of Physical Ability in Finnish Adult Population. Publications of the Social Insurance Institution AL:23 (In Finnish with an English summary: 119–122): Turku, 1983. p 148.
Sanchez-Craig M, Wilkinson DA, Davila R . Empirically based guidelines for moderate drinking: 1-year results from three studies with problem drinkers. Am J Public Health 1995; 85: 823–828.
Mäkelä M, Heliövaara M, Sievers K, Impivaara O, Knekt P, Aromaa A . Prevalence, determinants, and consequences of chronic neck pain in Finland. Am J Epidemiol 1991; 134: 1356–1367.
Ajani UA, Lotufo PA, Gaziano JM, Lee IM, Spelsberg A, Buring JE et al. Body mass index and mortality among US male physicians. Ann Epidemiol 2004; 14: 731–739.
Corrada MM, Kawas CH, Mozaffar F, Paganini-Hill A . Association of body mass index and weight change with all-cause mortality in the elderly. Am J Epidemiol 2006; 163: 938–949.
Janssen I, Mark AE . Elevated body mass index and mortality risk in the elderly. Obes Rev 2007; 8: 41–59.
Kuk JL, Ardern CI . Influence of age on the association between various measures of obesity and all-cause mortality. J Am Geriatr Soc 2009; 57: 2077–2084.
Stevens J, Cai J, Pamuk ER, Williamson DF, Thun MJ, Wood JL . The effect of age on the association between body-mass index and mortality. N Engl J Med 1998; 338: 1–7.
Janssen I, Katzmarzyk PT, Ross R . Body mass index is inversely related to mortality in older people after adjustment for waist circumference. J Am Geriatr Soc 2005; 53: 2112–2118.
Oreopoulos A, Kalantar-Zadeh K, Sharma AM, Fonarow GC . The obesity paradox in the elderly: potential mechanisms and clinical implications. Clin Geriatr Med 2009; 25: 643–659 viii.
Ferreira I, Stehouwer CD . Obesity paradox or inappropriate study designs? Time for life-course epidemiology. J Hypertens 2012; 30: 2271–2275.
Masters RK, Powers DA, Link BG . Obesity and US Mortality Risk Over the Adult Life Course. Am J Epidemiol 2013; 177: 431–442.
Zamboni M, Mazzali G, Zoico E, Harris TB, Meigs JB, Di Francesco V et al. Health consequences of obesity in the elderly: a review of four unresolved questions. Int J Obes (Lond) 2005; 29: 1011–1029.
Hardy R, Kuh D . Commentary: BMI and mortality in the elderly—a life course perspective. Int J Epidemiol 2006; 35: 179–180.
Preston SH, Mehta NK, Stokes A . Modeling Obesity Histories in Cohort Analyses of Health and Mortality. Epidemiology 2013; 24: 158–166.
Newman AB, Kupelian V, Visser M, Simonsick EM, Goodpaster BH, Kritchevsky SB et al. 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; 61A: M72–M77.
Cesari M, Pahor M, Lauretani F, Zamboni V, Bandinelli S, Bernabei R et al. Skeletal muscle and mortality results from the InCHIANTI Study. J Gerontol A Biol Sci Med Sci 2009; 64: 377–384.
Barzilay JI, Cotsonis GA, Walston J, Schwartz AV, Satterfield S, Miljkovic I et al. Insulin resistance is associated with decreased quadriceps muscle strength in nondiabetic adults aged >or=70 years. Diabetes Care 2009; 32: 736–738.
Stenholm S, Maggio M, Lauretani F, Bandinelli S, Ceda G, Di Iorio A et al. Anabolic and catabolic biomarkers as predictors of muscle strength decline: the InCHIANTI Study. Rejuvenation Res 2010; 13: 3–11.
Valenti G, Denti L, Maggio M, Ceda G, Volpato S, Bandinelli S et al. Effect of DHEAS on skeletal muscle over the life span: the InCHIANTI study. J Gerontol A Biol Sci Med Sci 2004; 59: 466–472.
Cappola AR, Bandeen-Roche K, Wand GS, Volpato S, Fried LP . Association of IGF-I levels with muscle strength and mobility in older women. J Clin Endocrinol Metab 2001; 86: 4139–4146.
Sabia S, Dugravot A, Kivimäki M, Brunner E, Shipley MJ, Singh-Manoux A . Effect of intensity and type of physical activity on mortality: results from the Whitehall II cohort study. Am J Public Health 2012; 102: 698–704.
Rantanen T, Guralnik JM, Foley D, Masaki K, Leveille S, Curb JD et al. Midlife hand grip strength as a predictor of old age disability. J Am Med Assoc 1999; 281: 558–560.
Sallinen J, Stenholm S, Rantanen T, Heliovaara M, Sainio P, Koskinen S . Hand-grip strength cut points to screen older persons at risk for mobility limitation. J Am Geriatr Soc 2010; 58: 1721–1726.
Liu CJ, Latham NK . Progressive resistance strength training for improving physical function in older adults. Cochrane Database Syst Rev 2009; (3): CD002759.
Stenholm S, Rantanen T, Alanen E, Reunanen A, Sainio P, Koskinen S . Obesity history as a predictor of walking limitation at old age. Obesity 2007; 15: 929–938.
Mendes de Leon CF, Hansberry MR, Bienias JL, Morris MC, Evans DA . Relative weight and mobility: a longitudinal study in a biracial population of older adults. Ann Epidemiol 2006; 16: 770–776.
Miller SL, Wolfe RR . The danger of weight loss in the elderly. J Nutr Health Aging 2008; 12: 487–491.
Freedman DM, Sigurdson AJ, Rajaraman P, Doody MM, Linet MS, Ron E . The mortality risk of smoking and obesity combined. Am J Prev Med 2006; 31: 355–362.
The authors wish to thank Dr Tommi Härkänen for statistical support. This work was supported by grants from the Academy of Finland (264944 and 273850) and National Institute of Aging (RO1 #AG040212–01).
The authors declare no conflict of interest.
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Stenholm, S., Mehta, N., Elo, I. et al. Obesity and muscle strength as long-term determinants of all-cause mortality—a 33-year follow-up of the Mini-Finland Health Examination Survey. Int J Obes 38, 1126–1132 (2014). https://doi.org/10.1038/ijo.2013.214
- body mass index
- muscle strength