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. 2012 Nov 20:345:e7279.
doi: 10.1136/bmj.e7279.

Muscular strength in male adolescents and premature death: cohort study of one million participants

Francisco B Ortega  1 , Karri Silventoinen, Per Tynelius, Finn Rasmussen
Affiliations

Muscular strength in male adolescents and premature death: cohort study of one million participants

Francisco B Ortega et al. BMJ. .

Abstract

Objectives: To explore the extent to which muscular strength in adolescence is associated with all cause and cause specific premature mortality (<55 years).

Design: Prospective cohort study.

Setting: Sweden.

Participants: 1,142,599 Swedish male adolescents aged 16-19 years were followed over a period of 24 years.

Main outcome measures: Baseline examinations included knee extension, handgrip, and elbow flexion strength tests, as well as measures of diastolic and systolic blood pressure and body mass index. Cox regression was used to estimate hazard ratios for mortality according to muscular strength categories (tenths).

Results: During a median follow-up period of 24 years, 26,145 participants died. Suicide was a more frequent cause of death in young adulthood (22.3%) than was cardiovascular diseases (7.8%) or cancer (14.9%). High muscular strength in adolescence, as assessed by knee extension and handgrip tests, was associated with a 20-35% lower risk of premature mortality due to any cause or cardiovascular disease, independently of body mass index or blood pressure; no association was observed with mortality due to cancer. Stronger adolescents had a 20-30% lower risk of death from suicide and were 15-65% less likely to have any psychiatric diagnosis (such as schizophrenia and mood disorders). Adolescents in the lowest tenth of muscular strength showed by far the highest risk of mortality for different causes. All cause mortality rates (per 100,000 person years) ranged between 122.3 and 86.9 for the weakest and strongest adolescents; corresponding figures were 9.5 and 5.6 for mortality due to cardiovascular diseases and 24.6 and 16.9 for mortality due to suicide.

Conclusions: Low muscular strength in adolescents is an emerging risk factor for major causes of death in young adulthood, such as suicide and cardiovascular diseases. The effect size observed for all cause mortality was equivalent to that for well established risk factors such as elevated body mass index or blood pressure.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: the study was supported by a grant to FR from the Swedish Research Council, and FBO was supported by grants from the Spanish Ministry of Science and Innovation; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Hazard ratios (95% CI) for relation of muscular strength, body mass index, and blood pressure with all cause premature death. Models were adjusted for birth cohort, conscription age, and conscription office (n=1 142 599)
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Fig 2 Hazard ratios (95% CI) for relation of muscular strength, body mass index, and blood pressure with premature death from cardiovascular disease. Models were adjusted for birth cohort, conscription age, and conscription office (n=1 118 154)
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Fig 3 Hazard ratios (95% CI) for relation of muscular strength, body mass index, and blood pressure with premature death from suicide. Models were adjusted for birth cohort, conscription age, and conscription office (n=1 121 480)
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Fig 4 Hazard ratios (95% CI) for relation of muscular strength, body mass index, and blood pressure with premature death from cancer. Models were adjusted for birth cohort, conscription age, and conscription office (n=1 119 790)
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Fig 5 Hazard ratios (95% CI) for relation of muscular strength, body mass index, and blood pressure, mutually adjusted, with all cause premature death and death from cardiovascular disease and suicide. Models were additionally adjusted for birth cohort, conscription age, and conscription office
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Fig 6 Hazard ratios (95% CI) for relation of muscular strength with all cause premature death, stratified by body mass index (BMI) categories. Models were adjusted for birth cohort, conscription age, and conscription office
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