Abstract
ABSTRACT
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
p
for trend
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.