Normalized Hand Grip and Back Muscle Strength as Risk Factors for Incident Type 2 Diabetes Mellitus: 16 Years of Follow-Up in a Population-Based Cohort Study
Received 30 October 2020
Accepted for publication 7 January 2021
Published 17 February 2021 Volume 2021:14 Pages 741—750
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Prof. Dr. Juei-Tang Cheng
Yoo-Jeong Jeon,1 Seung Ku Lee,2,3 Chol Shin2– 5
1Department of Sports & Health Science, Hanbat National University, Daejeon, Korea; 2Institute of Human Genomic Study, College of Medicine, Korea University Ansan Hospital, Ansan-si, Gyeonggi-do, Republic of Korea; 3College of Medicine, Korea University, Seoul, Republic of Korea; 4Department of Pulmonary, Sleep and Critical Care Medicine, College of Medicine, Korea University Ansan Hospital, Ansan-si, Gyeonggi-do, Republic of Korea; 5Transdisciplinary Major in Learning Health Systems, Department of Healthcare, Sciences, Graduate School, Korea University, Seoul, Republic of Korea
Correspondence: Chol Shin
Department of Pulmonary, Sleep and Critical Care Medicine, College of Medicine, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Gyeonggi-do, Ansan-si, 15355, Republic of Korea
Purpose: Muscle strength is associated with type 2 diabetes mellitus (T2DM). However, it is controversial whether muscle strength and normalized muscle strength is a risk factor for T2DM. Moreover, the relationship of back muscle strength (BMS) and incident T2DM has not been reported. In this study, we investigated the relationship between HGS, BMS, normalized HGS and BMS, and incident T2DM.
Methods: A total of 2699 non-diabetes subjects aged 40– 69 years (1313 women and 1386 men) in the Korean Genome and Epidemiology Study (KoGES) Ansan cohort were followed for 16 years. At the baseline and biennial follow‐up visits, fasting glucose, postprandial 2-h glucose, clinical examinations, HGS, and BMS were measured by trained interviewers and examiners. HGS and BMS were measured at baseline. The relationships between incident T2DM, HGS, BMS, and normalized HGS and BMS were estimated using Cox proportional hazard regression models after adjusting for the confounding factors.
Results: HGS and BMS were not associated with incident T2DM in multivariate analysis. However, the hazard ratio (HR) per one standard deviation (SD) increase in the body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR)-normalized HGS, and BMS was associated with a lower risk for incident T2DM in both women and men after adjusting for the confounding factors (HR = 0.842– 0.880-fold for women, p ≤ 0.015; HR = 0.887– 0.903-fold for men, p ≤ 0.024). In the sub-analysis of menopause status, the HR per one SD increase in BMI, weight2/3, WC, and WHR-normalized HGS was associated with a lower risk for incident T2DM in both pre- and post-menopausal women after adjusting for the confounding factors (HR = 0.860– 0.820-fold for premenopausal, P ≤ 0.006; HR = 0.900– 0.867-fold for postmenopausal, p ≤ 0.024). Additionally, we confirmed that the quartile group with higher muscle strength was associated with a lower risk for incident T2DM.
Conclusion: The present study suggested that normalized HGS and BMS were associated with a lower risk for the future development of T2DM. Moreover, weak muscle strength in premenopausal women may be the cause of T2DM. Further research is needed to determine whether efforts to improve muscle strength, such as exercise can reduce the risk of T2DM.
Keywords: incident type 2 diabetes mellitus, hand grip strength, back strength
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