Associations of lower values of peak oxygen uptake and handgrip strength with a smaller liver volume
Keywords:
Peak oxygen uptake, handgrip strength, liver volume
Abstract
Background and aims: The associations between physical fitness markers and liver volume in the general population are unclear. We investigated the associations of peak oxygen uptake (VO2peak)and handgrip strength with liver volume in a general population sample.
Methods and results: Data were taken from 1,531 German adults (51.3% women), aged 20 to 88 years, from two cohorts of the population-based Study of Health in Pomerania (SHIP-START-2 and SHIP-TREND-0). We analysed cross-sectional associations of VO2peak and handgrip strength with liver volume derived from magnetic resonance imaging (MRI) by using multivariable linear regression models. These models were adjusted for age, sex, body fat mass, pre-existing type 2 diabetes, daily alcohol consumption, smoking status, and use of hypoglycaemic or antihypertensive medications. We observed significant associations of lower VO2peak and handgrip strength with a smaller liver volume in the whole population, as well as in both men and women. In the whole population, a 1 L/min lower VO2peak was associated with a 0.15 cm3 (95% confidence interval [CI]: 0.11 to 0.19; P < 0.0001) smaller liver volume for both sexes together. Similarly, a 1 kg lower handgrip strength was associated with a 7.05 cm3 (95% CI: 4.87 to 9.23; P < 0.001) smaller liver volume in the whole population.
Conclusion: Our results derived from a large community-based sample showed that lower values of VO2peak and handgrip strength were associated with a smaller liver volume. These results might explain the possible negative effects of sedentary lifestyle on liver volume – the sedentary liver.
Downloads
Download data is not yet available.
References
1. Davidson T, Vainshelboim B, Kokkinos P, Myers J, Ross R. Cardiorespiratory fitness versus physical activity as predictors of all-cause mortality in men. Am Heart J 2018;196:156–62. https://doi.org/10.1016/j.ahj.2017.08.022
2. Kondamudi N, Mehta A, Thangada ND, Pandey A. Physical activity and cardiorespiratory fitness: vital signs for cardiovascular risk assessment. Curr Cardiol Rep 2021;23:172. https://doi.org/10.1007/s11886-021-01596-y
3. Ross R, Blair SN, Arena R, Church TS, Després J-P, Franklin BA, et al. Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign: a scientific statement from the American Heart Association. Circulation 2016;134:e653–99. https://doi.org/10.1161/CIR.0000000000000461
4. de Lima TR, Martins PC, Moreno YMF, Chaput J-P, Tremblay MS, Sui X, et al. Muscular fitness and cardiometabolic variables in children and adolescents: a systematic review. Sports Med. 2022;52:1555–75. https://doi.org/10.1007/s40279-021-01631-6
5. Kaminsky LA, Arena R, Ellingsen Ø, Harber MP, Myers J, Ozemek C, et al. Cardiorespiratory fitness and cardiovascular disease – the past, present, and future. Progr Cardiovasc Dis 2019;62:86–93. https://doi.org/10.1016/j.pcad.2019.01.002
6. Tarp J, Stole AP, Blond K, Grontved A. Cardiorespiratory fitness, muscular strength and risk of type 2 diabetes: a systematic review and meta-analysis. Diabetologia 2019;62:1129–42. https://doi.org/10.1007/s00125-019-4867-4
7. Peterson MD, Rhea MR, Sen A, Gordon PM. Resistance exercise for muscular strength in older adults: a meta-analysis. Age Res Rev 2010;9:226–37. https://doi.org/10.1016/j.arr.2010.03.004
8. McGrath RP, Kraemer WJ, Snih SA, Peterson MD. Handgrip strength and health in aging adults. Sports Med 2018;48:1993–2000. https://doi.org/10.1007/s40279-018-0952-y
9. Manini TM, Clark BC. Dynapenia and aging: an update. J Gerontol A Biol Sci Med Sci 2012;67:28–40. https://doi.org/10.1093/gerona/glr010
10. Laukkanen JA, Kurl S, Salonen R, Rauramaa R, Salonen JT. The predictive value of cardiorespiratory fitness for cardiovascular events in men with various risk profiles: a prospective population-based cohort study. Eur Heart J 2004;25:1428–37. https://doi.org/10.1016/j.ehj.2004.06.013
11. Leong DP, Teo KK, Rangarajan S, Lopez-Jaramillo P, Avezum A, Orlandini A, et al. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet 2015;386:266–73. https://doi.org/10.1016/S0140-6736(14)62000-6
12. Gal DL, Santos AC, Barros H. Leisure-time versus full-day energy expenditure: a cross-sectional study of sedentarism in a Portuguese urban population. BMC Public Health 2005;5:16. https://doi.org/10.1186/1471-2458-5-16
13. Dunn MA, Kappus MR, Bloomer PM, Duarte-Rojo A, Josbeno DA, Jakicic JM. Wearables, physical activity, and exercise testing in liver disease. Semin Liver Dis 2021;41:128–35. https://doi.org/10.1055/s-0040-1716564
14. Baker CJ, Martinez-Huenchullan SF, D’Souza M, Xu Y, Li M, Bi Y, et al. Effect of exercise on hepatic steatosis: are benefits seen without dietary intervention? A systematic review and meta-analysis. J Diabetes 2021;13:63–77. https://doi.org/10.1111/1753-0407.13086
15. López-Gil JF, Ramírez-Vélez R, Alarcón-Jiménez J, Izquierdo M, García-Hermoso A. Low handgrip strength is associated with higher liver enzyme concentrations in US adolescents. Pediatr Res 2021;91:984–90. https://doi.org/10.1038/s41390-021-01530-6
16. Markus MRP, Ittermann T, Drzyzga CJ, Bahls M, Schipf S, Siewert-Markus U, et al. Lower cardiorespiratory fitness is associated with a smaller and stiffer heart: the Sedentary’s heart. JACC Cardiovasc Imaging 2021;14:310–3. https://doi.org/10.1016/j.jcmg.2020.07.032
17. Markus MRP, Ittermann T, Drzyzga CJ, Bahls M, Schipf S, Siewert-Markus U, et al. Cardiac MRI shows an association of lower cardiorespiratory fitness with decreased myocardial mass and higher cardiac stiffness in the general population – the Sedentary’s Heart. Progr Cardiovasc Dis 2021;68:25–35. https://doi.org/10.1016/j.pcad.2021.09.003
18. Markus MRP, Ittermann T, Kim S, Schipf S, Siewert-Markus U, Santana CC, et al. Lower muscular strength is associated with smaller left and right chambers and lower cardiac mass in the general population – the Sedentary’s Heart. Progr Cardiovasc Dis 2021;68:36–51. https://doi.org/10.1016/j.pcad.2021.09.004
19. Drzyzga CJ, Bahls M, Ittermann T, Völzke H, Bülow R, Hammer F, et al. Lower cardiorespiratory fitness is associated with right ventricular geometry and function – the Sedentary’s Heart: SHIP. J Am Heart Assoc 2021;10:e021116. https://doi.org/10.1161/JAHA.120.021116
20. Zinterl I, Ittermann T. Low cardiopulmonary fitness is associated with higher liver fat content and higher gamma-glutamyltransferase concentrations in the general population – “The Sedentary’s Liver”. Liver Int 2022;42:585–94. https://doi.org/10.1111/liv.15162
21. Lee S-B, Kwon Y-J, Jung D-H, Kim J-K. Association of muscle strength with non-alcoholic fatty liver disease in Korean adults. Int J Environ Res Public Health 2022;19:1675. https://doi.org/10.3390/ijerph19031675
22. Naeem M, Markus MRP, Mousa M, Schipf S, Dörr M, Steveling A, et al. Associations of liver volume and other markers of hepatic steatosis with all-cause mortality in the general population. Liver Int 2022;42:575–84. https://doi.org/10.1111/liv.15133
23. Volzke H, Alte D, Schmidt CO, Radke D, Lorbeer R, Friedrich N, et al. Cohort profile: the study of health in Pomerania. Int J Epidemiol 2011;40:294–307. https://doi.org/10.1093/ije/dyp394
24. Gläser S, Koch B, Ittermann T, Christoph S, Marcus D, Felix SB, et al. Influence of age, sex, body size, smoking, and beta blockade on key gas exchange exercise parameters in an adult population. Eur J Cardiovasc Prev Rehabil 2010;17:469–76. https://doi.org/10.1097/HJR.0b013e328336a124
25. Köhler A, King R, Bahls M, Groß S, Steveling A, Gärtner S, et al. Cardiopulmonary fitness is strongly associated with body cell mass and fat-free mass: the Study of Health in Pomerania (SHIP). Scand J Med Sci Sports 2018;28:1628–35. https://doi.org/10.1111/sms.13057
26. Kuhn JP, Hernando D, Munoz del Rio A, Evert M, Kannengiesser S, Volzke H, et al. Effect of multipeak spectral modeling of fat for liver iron and fat quantification: correlation of biopsy with MR imaging results. Radiology 2012;265:133–42. https://doi.org/10.1148/radiol.12112520
27. Kromrey ML, Ittermann T, vWahsen C, Plodeck V, Seppelt D, Hoffmann RT, et al. Reference values of liver volume in Caucasian population and factors influencing liver size. Eur J Radiol 2018;106:32–37. https://doi.org/10.1016/j.ejrad.2018.07.005
28. Warburton DE, Haykowsky MJ, Quinney HA, Blackmore D, Teo KK, Taylor DA, et al. Blood volume expansion and cardiorespiratory function: effects of training modality. Med Sci Sports Exerc 2004;36:991–1000. https://doi.org/10.1249/01.MSS.0000128163.88298.CB
29. Convertino VA. Blood volume response to physical activity and inactivity. Am J Med Sci 2007;334:72–9. https://doi.org/10.1097/MAJ.0b013e318063c6e4
30. Sawka MN, Young AJ, Pandolf KB, Dennis RC, Valeri CR. Erythrocyte, plasma, and blood volume of healthy young men. Med Sci Sports Exerc 1992;24:447–53. https://doi.org/10.1249/00005768-199204000-00009
31. Wang Z, Deurenberg P, Wang W, Pietrobelli A, Baumgartner RN, Heymsfield SB. Hydration of fat-free body mass: review and critique of a classic body-composition constant. Am J Clin Nutr 1999;69:833–41. https://doi.org/10.1093/ajcn/69.5.833
32. Markus MR, Stritzke J, Siewert U, Lieb W, Luchner A, Döring A, et al. Variation in body composition determines long-term blood pressure changes in pre-hypertension: the MONICA/KORA (Monitoring Trends and Determinants on Cardiovascular Diseases/Cooperative Research in the Region of Augsburg) cohort study. J Am Coll Cardiol 2010;56:65–76. https://doi.org/10.1016/j.jacc.2010.01.056
33. Kyle UG, Genton L, Gremion G, Slosman DO, Pichard C. Aging, physical activity and height-normalized body composition parameters. Clin Nutr 2004;23:79–88. https://doi.org/10.1016/S0261-5614(03)00092-X
34. Ekstedt M, Nasr P, Kechagias S. Natural history of NAFLD/NASH. Curr Hepatol Rep 2017;16:391–7. https://doi.org/10.1007/s11901-017-0378-2
35. Kim G, Kim JH. Impact of skeletal muscle mass on metabolic health. Endocrinol Metab (Seoul) 2020;35:1–6. https://doi.org/10.3803/EnM.2020.35.1.1
36. van der Windt DJ, Sud V, Zhang H, Tsung A, Huang H. The effects of physical exercise on fatty liver disease. Gene Expr 2018;18:89–101. https://doi.org/10.3727/105221617X15124844266408
37. Seppelt D, Ittermann T, Kromrey ML, Kolb C, vWahsen C, Heiss P, et al. Simple diameter measurement as predictor of liver volume and liver parenchymal disease. Sci Rep 2022;12:1257. https://doi.org/10.1038/s41598-022-04825-8
2. Kondamudi N, Mehta A, Thangada ND, Pandey A. Physical activity and cardiorespiratory fitness: vital signs for cardiovascular risk assessment. Curr Cardiol Rep 2021;23:172. https://doi.org/10.1007/s11886-021-01596-y
3. Ross R, Blair SN, Arena R, Church TS, Després J-P, Franklin BA, et al. Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign: a scientific statement from the American Heart Association. Circulation 2016;134:e653–99. https://doi.org/10.1161/CIR.0000000000000461
4. de Lima TR, Martins PC, Moreno YMF, Chaput J-P, Tremblay MS, Sui X, et al. Muscular fitness and cardiometabolic variables in children and adolescents: a systematic review. Sports Med. 2022;52:1555–75. https://doi.org/10.1007/s40279-021-01631-6
5. Kaminsky LA, Arena R, Ellingsen Ø, Harber MP, Myers J, Ozemek C, et al. Cardiorespiratory fitness and cardiovascular disease – the past, present, and future. Progr Cardiovasc Dis 2019;62:86–93. https://doi.org/10.1016/j.pcad.2019.01.002
6. Tarp J, Stole AP, Blond K, Grontved A. Cardiorespiratory fitness, muscular strength and risk of type 2 diabetes: a systematic review and meta-analysis. Diabetologia 2019;62:1129–42. https://doi.org/10.1007/s00125-019-4867-4
7. Peterson MD, Rhea MR, Sen A, Gordon PM. Resistance exercise for muscular strength in older adults: a meta-analysis. Age Res Rev 2010;9:226–37. https://doi.org/10.1016/j.arr.2010.03.004
8. McGrath RP, Kraemer WJ, Snih SA, Peterson MD. Handgrip strength and health in aging adults. Sports Med 2018;48:1993–2000. https://doi.org/10.1007/s40279-018-0952-y
9. Manini TM, Clark BC. Dynapenia and aging: an update. J Gerontol A Biol Sci Med Sci 2012;67:28–40. https://doi.org/10.1093/gerona/glr010
10. Laukkanen JA, Kurl S, Salonen R, Rauramaa R, Salonen JT. The predictive value of cardiorespiratory fitness for cardiovascular events in men with various risk profiles: a prospective population-based cohort study. Eur Heart J 2004;25:1428–37. https://doi.org/10.1016/j.ehj.2004.06.013
11. Leong DP, Teo KK, Rangarajan S, Lopez-Jaramillo P, Avezum A, Orlandini A, et al. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet 2015;386:266–73. https://doi.org/10.1016/S0140-6736(14)62000-6
12. Gal DL, Santos AC, Barros H. Leisure-time versus full-day energy expenditure: a cross-sectional study of sedentarism in a Portuguese urban population. BMC Public Health 2005;5:16. https://doi.org/10.1186/1471-2458-5-16
13. Dunn MA, Kappus MR, Bloomer PM, Duarte-Rojo A, Josbeno DA, Jakicic JM. Wearables, physical activity, and exercise testing in liver disease. Semin Liver Dis 2021;41:128–35. https://doi.org/10.1055/s-0040-1716564
14. Baker CJ, Martinez-Huenchullan SF, D’Souza M, Xu Y, Li M, Bi Y, et al. Effect of exercise on hepatic steatosis: are benefits seen without dietary intervention? A systematic review and meta-analysis. J Diabetes 2021;13:63–77. https://doi.org/10.1111/1753-0407.13086
15. López-Gil JF, Ramírez-Vélez R, Alarcón-Jiménez J, Izquierdo M, García-Hermoso A. Low handgrip strength is associated with higher liver enzyme concentrations in US adolescents. Pediatr Res 2021;91:984–90. https://doi.org/10.1038/s41390-021-01530-6
16. Markus MRP, Ittermann T, Drzyzga CJ, Bahls M, Schipf S, Siewert-Markus U, et al. Lower cardiorespiratory fitness is associated with a smaller and stiffer heart: the Sedentary’s heart. JACC Cardiovasc Imaging 2021;14:310–3. https://doi.org/10.1016/j.jcmg.2020.07.032
17. Markus MRP, Ittermann T, Drzyzga CJ, Bahls M, Schipf S, Siewert-Markus U, et al. Cardiac MRI shows an association of lower cardiorespiratory fitness with decreased myocardial mass and higher cardiac stiffness in the general population – the Sedentary’s Heart. Progr Cardiovasc Dis 2021;68:25–35. https://doi.org/10.1016/j.pcad.2021.09.003
18. Markus MRP, Ittermann T, Kim S, Schipf S, Siewert-Markus U, Santana CC, et al. Lower muscular strength is associated with smaller left and right chambers and lower cardiac mass in the general population – the Sedentary’s Heart. Progr Cardiovasc Dis 2021;68:36–51. https://doi.org/10.1016/j.pcad.2021.09.004
19. Drzyzga CJ, Bahls M, Ittermann T, Völzke H, Bülow R, Hammer F, et al. Lower cardiorespiratory fitness is associated with right ventricular geometry and function – the Sedentary’s Heart: SHIP. J Am Heart Assoc 2021;10:e021116. https://doi.org/10.1161/JAHA.120.021116
20. Zinterl I, Ittermann T. Low cardiopulmonary fitness is associated with higher liver fat content and higher gamma-glutamyltransferase concentrations in the general population – “The Sedentary’s Liver”. Liver Int 2022;42:585–94. https://doi.org/10.1111/liv.15162
21. Lee S-B, Kwon Y-J, Jung D-H, Kim J-K. Association of muscle strength with non-alcoholic fatty liver disease in Korean adults. Int J Environ Res Public Health 2022;19:1675. https://doi.org/10.3390/ijerph19031675
22. Naeem M, Markus MRP, Mousa M, Schipf S, Dörr M, Steveling A, et al. Associations of liver volume and other markers of hepatic steatosis with all-cause mortality in the general population. Liver Int 2022;42:575–84. https://doi.org/10.1111/liv.15133
23. Volzke H, Alte D, Schmidt CO, Radke D, Lorbeer R, Friedrich N, et al. Cohort profile: the study of health in Pomerania. Int J Epidemiol 2011;40:294–307. https://doi.org/10.1093/ije/dyp394
24. Gläser S, Koch B, Ittermann T, Christoph S, Marcus D, Felix SB, et al. Influence of age, sex, body size, smoking, and beta blockade on key gas exchange exercise parameters in an adult population. Eur J Cardiovasc Prev Rehabil 2010;17:469–76. https://doi.org/10.1097/HJR.0b013e328336a124
25. Köhler A, King R, Bahls M, Groß S, Steveling A, Gärtner S, et al. Cardiopulmonary fitness is strongly associated with body cell mass and fat-free mass: the Study of Health in Pomerania (SHIP). Scand J Med Sci Sports 2018;28:1628–35. https://doi.org/10.1111/sms.13057
26. Kuhn JP, Hernando D, Munoz del Rio A, Evert M, Kannengiesser S, Volzke H, et al. Effect of multipeak spectral modeling of fat for liver iron and fat quantification: correlation of biopsy with MR imaging results. Radiology 2012;265:133–42. https://doi.org/10.1148/radiol.12112520
27. Kromrey ML, Ittermann T, vWahsen C, Plodeck V, Seppelt D, Hoffmann RT, et al. Reference values of liver volume in Caucasian population and factors influencing liver size. Eur J Radiol 2018;106:32–37. https://doi.org/10.1016/j.ejrad.2018.07.005
28. Warburton DE, Haykowsky MJ, Quinney HA, Blackmore D, Teo KK, Taylor DA, et al. Blood volume expansion and cardiorespiratory function: effects of training modality. Med Sci Sports Exerc 2004;36:991–1000. https://doi.org/10.1249/01.MSS.0000128163.88298.CB
29. Convertino VA. Blood volume response to physical activity and inactivity. Am J Med Sci 2007;334:72–9. https://doi.org/10.1097/MAJ.0b013e318063c6e4
30. Sawka MN, Young AJ, Pandolf KB, Dennis RC, Valeri CR. Erythrocyte, plasma, and blood volume of healthy young men. Med Sci Sports Exerc 1992;24:447–53. https://doi.org/10.1249/00005768-199204000-00009
31. Wang Z, Deurenberg P, Wang W, Pietrobelli A, Baumgartner RN, Heymsfield SB. Hydration of fat-free body mass: review and critique of a classic body-composition constant. Am J Clin Nutr 1999;69:833–41. https://doi.org/10.1093/ajcn/69.5.833
32. Markus MR, Stritzke J, Siewert U, Lieb W, Luchner A, Döring A, et al. Variation in body composition determines long-term blood pressure changes in pre-hypertension: the MONICA/KORA (Monitoring Trends and Determinants on Cardiovascular Diseases/Cooperative Research in the Region of Augsburg) cohort study. J Am Coll Cardiol 2010;56:65–76. https://doi.org/10.1016/j.jacc.2010.01.056
33. Kyle UG, Genton L, Gremion G, Slosman DO, Pichard C. Aging, physical activity and height-normalized body composition parameters. Clin Nutr 2004;23:79–88. https://doi.org/10.1016/S0261-5614(03)00092-X
34. Ekstedt M, Nasr P, Kechagias S. Natural history of NAFLD/NASH. Curr Hepatol Rep 2017;16:391–7. https://doi.org/10.1007/s11901-017-0378-2
35. Kim G, Kim JH. Impact of skeletal muscle mass on metabolic health. Endocrinol Metab (Seoul) 2020;35:1–6. https://doi.org/10.3803/EnM.2020.35.1.1
36. van der Windt DJ, Sud V, Zhang H, Tsung A, Huang H. The effects of physical exercise on fatty liver disease. Gene Expr 2018;18:89–101. https://doi.org/10.3727/105221617X15124844266408
37. Seppelt D, Ittermann T, Kromrey ML, Kolb C, vWahsen C, Heiss P, et al. Simple diameter measurement as predictor of liver volume and liver parenchymal disease. Sci Rep 2022;12:1257. https://doi.org/10.1038/s41598-022-04825-8
Published
2025-05-16
How to Cite
Naeem , M., Markus , M. R. P., Bahls , M., Mousa , M., Dörr , M., Kühn , J.-P., Bülow , R., Felix , S. B., Targher , G., Stubbe , B., Ewert , R., Völzke , H., & Ittermann , T. (2025). Associations of lower values of peak oxygen uptake and handgrip strength with a smaller liver volume. Upsala Journal of Medical Sciences, 130, e11924. https://doi.org/10.48101/ujms.v130.11924
Section
Original Articles
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright of their work, with first publication rights granted to Upsala Medical Society. Read the full Copyright- and Licensing Statement.
