Novel risk factors for type 2 diabetes and other adverse cardiometabolic outcomes – handgrip strength and other markers of physical fitness

Supervisor: Dr Setor Kunutsor - skk30@leicester.ac.uk

Project Description:

Cardiovascular disease is the leading cause of mortality associated with type 2 diabetes (T2D). Older age, obesity and lifestyle factors such as physical inactivity, smoking, excessive alcohol consumption and unhealthy diet are major risk factors for T2D. Although these established risk factors explain a large proportion of T2D risk, identification of individuals at high risk still remains a difficult undertaking, as a substantial amount of residual risk remains to be ascertained. There is still an urgent need to identify novel and simple markers that could be used to identify people at high risk of developing T2D.

Physical fitness is one of the strongest predictors of future health status and has components such as cardiorespiratory fitness, muscular strength, muscular power, balance, coordination, and flexibility. These markers including handgrip strength (a proxy measure of muscular strength) are emerging as strong risk indicators for adverse health outcomes. Though associations between individual markers of physical fitness and risk of T2D and other cardiometabolic outcomes have been demonstrated, available studies of such markers have been too small or insufficiently detailed to reliably characterise the nature of any associations and their relevance for predicting disease risk. Furthermore, the long-term relevance of these markers to disease risk is uncertain, given that employing baseline measurements of these markers could underestimate the true strength of any aetiological associations. 
Using the UK Biobank and other data sources, the specific objectives of the proposed project include:

1. Quantification of independent and combined associations of baseline levels of markers of physical fitness such as handgrip strength with the risk of type 2 diabetes and other adverse cardiometabolic conditions

2. Assessing the long-term relevance of these markers to risk of these outcomes using repeat measures of these markers

3. Assessment of whether measurement of such markers may help better identify people at increased risk of these conditions than traditional risk factors and can be integrated into clinical care using methods such as Harrell’s C-index, likelihood ratio test, R2, Akaike, Bayesian information criterion, net-reclassification improvement, integrated-discrimination-improvement, and decision curve analysis

Measures of physical fitness such as handgrip strength can be simple and inexpensive to assess and may not require skilled expertise and resources. If demonstrated to be useful in identifying people at increased of T2D and other cardiometabolic outcomes, they could easily be incorporated into routine screening programmes and clinical practice.

References:

Kunutsor SK, Voutilainen A, Laukkanen JA. Handgrip strength improves prediction of type 2 diabetes: a prospective cohort study. Ann Med. 2020 Dec;52(8):471-478
Kunutsor SK, Isiozor NM, Khan H, Laukkanen JA. Handgrip strength-A risk indicator for type 2 diabetes: Systematic review and meta-analysis of observational cohort studies. Diabetes Metab Res Rev. 2021 Feb;37(2):e3365