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      Grip Strength across the Life Course: Normative Data from Twelve British Studies

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          Abstract

          Introduction

          Epidemiological studies have shown that weaker grip strength in later life is associated with disability, morbidity, and mortality. Grip strength is a key component of the sarcopenia and frailty phenotypes and yet it is unclear how individual measurements should be interpreted. Our objective was to produce cross-sectional centile values for grip strength across the life course. A secondary objective was to examine the impact of different aspects of measurement protocol.

          Methods

          We combined 60,803 observations from 49,964 participants (26,687 female) of 12 general population studies in Great Britain. We produced centile curves for ages 4 to 90 and investigated the prevalence of weak grip, defined as strength at least 2.5 SDs below the gender-specific peak mean. We carried out a series of sensitivity analyses to assess the impact of dynamometer type and measurement position (seated or standing).

          Results

          Our results suggested three overall periods: an increase to peak in early adult life, maintenance through to midlife, and decline from midlife onwards. Males were on average stronger than females from adolescence onwards: males’ peak median grip was 51 kg between ages 29 and 39, compared to 31 kg in females between ages 26 and 42. Weak grip strength, defined as strength at least 2.5 SDs below the gender-specific peak mean, increased sharply with age, reaching a prevalence of 23% in males and 27% in females by age 80. Sensitivity analyses suggested our findings were robust to differences in dynamometer type and measurement position.

          Conclusion

          This is the first study to provide normative data for grip strength across the life course. These centile values have the potential to inform the clinical assessment of grip strength which is recognised as an important part of the identification of people with sarcopenia and frailty.

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          Most cited references 53

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          Frailty in elderly people

          Frailty is the most problematic expression of population ageing. It is a state of vulnerability to poor resolution of homoeostasis after a stressor event and is a consequence of cumulative decline in many physiological systems during a lifetime. This cumulative decline depletes homoeostatic reserves until minor stressor events trigger disproportionate changes in health status. In landmark studies, investigators have developed valid models of frailty and these models have allowed epidemiological investigations that show the association between frailty and adverse health outcomes. We need to develop more efficient methods to detect frailty and measure its severity in routine clinical practice, especially methods that are useful for primary care. Such progress would greatly inform the appropriate selection of elderly people for invasive procedures or drug treatments and would be the basis for a shift in the care of frail elderly people towards more appropriate goal-directed care. Copyright © 2013 Elsevier Ltd. All rights reserved.
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            Cohort Profile: The ‘Children of the 90s’—the index offspring of the Avon Longitudinal Study of Parents and Children

            The Avon Longitudinal Study of Parents and Children (ALSPAC) is a transgenerational prospective observational study investigating influences on health and development across the life course. It considers multiple genetic, epigenetic, biological, psychological, social and other environmental exposures in relation to a similarly diverse range of health, social and developmental outcomes. Recruitment sought to enrol pregnant women in the Bristol area of the UK during 1990–92; this was extended to include additional children eligible using the original enrolment definition up to the age of 18 years. The children from 14 541 pregnancies were recruited in 1990–92, increasing to 15 247 pregnancies by the age of 18 years. This cohort profile describes the index children of these pregnancies. Follow-up includes 59 questionnaires (4 weeks–18 years of age) and 9 clinical assessment visits (7–17 years of age). The resource comprises a wide range of phenotypic and environmental measures in addition to biological samples, genetic (DNA on 11 343 children, genome-wide data on 8365 children, complete genome sequencing on 2000 children) and epigenetic (methylation sampling on 1000 children) information and linkage to health and administrative records. Data access is described in this article and is currently set up as a supported access resource. To date, over 700 peer-reviewed articles have been published using ALSPAC data.
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              Diagnosis of osteoporosis and assessment of fracture risk.

               J Kanis (2002)
              The diagnosis of osteoporosis centres on the assessment of bone mineral density (BMD). Osteoporosis is defined as a BMD 2.5 SD or more below the average value for premenopausal women (T score < -2.5 SD). Severe osteoporosis denotes osteoporosis in the presence of one or more fragility fractures. The same absolute value for BMD used in women can be used in men. The recommended site for diagnosis is the proximal femur with dual energy X-ray absorptiometry (DXA). Other sites and validated techniques, however, can be used for fracture prediction. Although hip fracture prediction with BMD alone is at least as good as blood pressure readings to predict stroke, the predictive value of BMD can be enhanced by use of other factors, such as biochemical indices of bone resorption and clinical risk factors. Clinical risk factors that contribute to fracture risk independently of BMD include age, previous fragility fracture, premature menopause, a family history of hip fracture, and the use of oral corticosteroids. In the absence of validated population screening strategies, a case finding strategy is recommended based on the finding of risk factors. Treatment should be considered in individuals subsequently shown to have a high fracture risk. Because of the many techniques available for fracture risk assessment, the 10-year probability of fracture is the desirable measurement to determine intervention thresholds. Many treatments can be provided cost-effectively to men and women if hip fracture probability over 10 years ranges from 2% to 10% dependent on age.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2014
                4 December 2014
                : 9
                : 12
                Affiliations
                [1 ]MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
                [2 ]MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom
                [3 ]Institute for Social and Economic Research, University of Essex, Colchester, United Kingdom
                [4 ]Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom
                [5 ]Social & Public Health Sciences Unit, Medical Research Council, Glasgow, United Kingdom
                [6 ]Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
                [7 ]MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
                [8 ]Department of Epidemiology and Public Health, University College London, London, United Kingdom
                University of Valencia, Spain
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: RD HES RC DK CC AAS. Analyzed the data: RD. Wrote the paper: RD. Provided data: HES RC MB IJD EMD GD CRG HMI CJ TBK DAL SMR JMS AS KT DK CC AAS. Commented on drafts of the paper and approved the final version: HES RC MB IJD EMD GD CRG HMI CJ TBK DAL SMR JMS AS KT DK CC AAS.

                Article
                PONE-D-14-38921
                10.1371/journal.pone.0113637
                4256164
                25474696
                068cb6f8-23f5-40bd-bc17-e1dc19d95ca8

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Pages: 15
                Funding
                RD is supported by a Wellcome Trust Fellowship (Grant number WT099055AIA). RC and DK are supported by the UK Medical Research Council (programme code MC_UU_12019/4). CJ is supported by the AXA Research Fund. MB is funded by the University of Essex and ESRC. DAL and KT work in a unit that receives support from the UK Medical Research Council (MC_UU_12013/5 and MC_UU_12013/9, respectively). Core support for the ALSPAC study is provided by the UK Medical Research Council and Wellcome Trust (092731). Acknowledgements: We are extremely grateful to all of the families who took part in this study, the midwives for recruiting them, and the whole ALSPAC team, which includes interviewers, computer and laboratory technicians, clerical workers, research scientists, volunteers, managers, receptionists and nurses. The English Longitudinal Study of Ageing was developed by a team of researchers based at University College London, the Institute for Fiscal Studies and the National Centre for Social Research. The funding is provided by the National Institute on Aging (grants 2RO1AG7644-01A1 and 2RO1AG017644) and a consortium of UK government departments coordinated by the Office for National Statistics. The Hertfordshire Ageing Study and the Hertfordshire Cohort Study were funded by the UK Medical Research Council, the Wellcome Trust, Arthritis Research United Kingdom and the University of Southampton. The Lothian Birth Cohort 1921 was funded by the Biotechnology and Biological Sciences Research Council, by a Royal Society-Wolfson Research Merit Award, and by the Scottish Government's Chief Scientist Office. The Lothian Birth Cohort 1936 was funded by Age UK (Disconnected Mind project). The work was done within the Centre for Cognitive Ageing and Cognitive Epidemiology (Mr/K026992/1); funding from the Medical Research Council and the Biotechnology and Biological Sciences Research Council is appreciated. For collating and collecting data, we thank the LBC1921 and LBC1936 research teams and the research nurses and staff at the Wellcome Trust Clinical Research Facility at the Western General Hospital, Edinburgh. The MRC National Survey of Health and Development is funded by the UK Medical Research Council. The Newcastle 85+ Study was funded by grants from the UK Medical Research Council (G0500997), the Dunhill Medical Trust (R124/0509), and the Newcastle Healthcare Charity. The research was also supported by the National Institute for Health Research Newcastle Biomedical Research Centre, based at Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University. The waves of the Southampton Women's Survey included in this analysis were funded by the Medical Research Council, the University of Southampton, Dunhill Medical Trust, Arthritis Research UK and the UK Food Standards Agency. UKHLS is funded by the Economic and Social Research Council (ESRC). The study is carried out by the Institute for Social and Economic Research and data are made available through the UK Data Service. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Anatomy
                Musculoskeletal System
                Muscles
                Muscle Fibers
                Skeletal Muscle Fibers
                Biomechanics
                Hand Strength
                Medicine and Health Sciences
                Epidemiology
                Epidemiology of Aging
                Lifecourse Epidemiology
                Custom metadata
                The authors confirm that, for approved reasons, some access restrictions apply to the data underlying the findings. All data used for this study are owned by third parties. Data access arrangements for the various datasets are described in the Supporting Information files.

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