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. 2025 Apr;16(2):e13757.
doi: 10.1002/jcsm.13757.

Association Between Handgrip Strength and Cardiovascular Disease Risk in MASLD: A Prospective Study From UK Biobank

Tae Seop Lim  1   2 , Sujin Kwon  3 , Sung A Bae  1   4 , Hye Yeon Chon  1   2 , Seol A Jang  1   3 , Ja Kyung Kim  1   2 , Chul Sik Kim  1   3 , Seok Won Park  1   3 , Kyoung Min Kim  1   3
Affiliations

Association Between Handgrip Strength and Cardiovascular Disease Risk in MASLD: A Prospective Study From UK Biobank

Tae Seop Lim et al. J Cachexia Sarcopenia Muscle. 2025 Apr.

Abstract

Background: This study aimed to investigate the association between handgrip strength (HGS) and cardiovascular disease (CVD) in individuals with metabolic dysfunction-associated steatotic liver disease (MASLD) using data from the UK Biobank cohort.

Methods: A total of 201 563 participants were enrolled in this study. The HGS was measured using a Jamar J00105 hydraulic hand dynamometer. MASLD was defined as the presence of hepatic steatosis accompanied by one or more cardiometabolic criteria. Hepatic steatosis was identified using a fatty liver index ≥ 60. Advanced liver fibrosis was defined by a fibrosis-4 (FIB-4) score > 2.67. To examine the differences in the incidence of CVD, male and female participants were divided into non-MASLD, MASLD with high HGS, MASLD with middle HGS, and MASLD with low-HGS groups.

Results: Of the study participants, 75 498 (37.5%) were diagnosed with MASLD, with a mean age of 56.5 years, and 40.6% were male. The median follow-up duration was 13.1 years. The frequency of incident CVD events increased significantly across groups: 10.9% in non-MASLD, 13.3% in MASLD with high HGS, 14.8% in MASLD with middle HGS, and 18.4% in MASLD with low HGS for males (p < 0.001). In females, the frequency of incident CVD events was 6.1% in non-MASLD, 9.2% in MASLD with high HGS, 10.7% in MASLD with middle HGS, and 13.3% in MASLD with low HGS (p < 0.001). Using the non-MASLD group as a reference, multivariate-adjusted hazard ratios (HRs) (95% confidence intervals [CI]) for CVD varied according to HGS in individuals with MASLD. In males with MASLD, HRs (95% CI) were 1.03 (0.96-1.10) for high HGS, 1.14 (1.07-1.21) for middle HGS, and 1.38 (1.30-1.46) for low HGS; in females with MASLD, they were 1.07 (0.97-1.18) for high HGS, 1.25 (1.14-1.37) for middle HGS, and 1.56 (1.43-1.72) for low HGS. The incidence of CVD events increased as HGS decreased in participants with MASLD, regardless of the presence or absence of advanced liver fibrosis (all p < 0.001).

Conclusions: This large prospective cohort study using the UK Biobank showed that in MASLD, a decrease in HGS was associated with increased CVD risk.

Keywords: cardiovascular disease; fatty liver; handgrip strength; metabolic dysfunction‐associated steatotic liver disease; muscle strength.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Study flow chart. Abbreviations: BMI, body mass index; CVD, cardiovascular disease; GGT, gamma‐glutamyl transferase.
FIGURE 2
FIGURE 2
Incidence of cardiovascular events according to handgrip strength in male (a) and female (b) participants. Abbreviations: CVD, cardiovascular disease; HGS, handgrip strength; MASLD, metabolic dysfunction‐associated steatotic liver disease.
FIGURE 3
FIGURE 3
Cumulative incidence of cardiovascular disease events according to handgrip strength in male (a) and female (b) participants. Abbreviations: CVD, cardiovascular disease; HGS, handgrip strength; MASLD, metabolic dysfunction‐associated steatotic liver disease.
FIGURE 4
FIGURE 4
Incidence of cardiovascular disease events according to HGS in MASLD with or without advanced liver fibrosis in male (a) and female (b) participants. Abbreviations: CVD, cardiovascular disease; HGS, handgrip strength; MASLD, metabolic dysfunction‐associated steatotic liver disease.
See this image and copyright information in PMC

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