{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T10:33:51Z","timestamp":1793010831463,"version":"4.5.0"},"reference-count":26,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100002241","name":"Japan Science and Technology Agency","doi-asserted-by":"publisher","award":["JPMJSC2308"],"award-info":[{"award-number":["JPMJSC2308"]}],"id":[{"id":"10.13039\/501100002241","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011692","name":"General Insurance Association of Japan","doi-asserted-by":"publisher","award":["25\u201029"],"award-info":[{"award-number":["25\u201029"]}],"id":[{"id":"10.13039\/501100011692","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J cachexia sarcopenia muscle"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Malnutrition and muscle weakness are critical prognostic factors for mortality in older adults. While indices like the Geriatric Nutritional Risk Index (GNRI) are well\u2010established, the long\u2010term prognostic value of integrating nutrition with muscle strength (MS) remains insufficiently established in community\u2010dwelling populations. Currently, very few studies have evaluated the effects on mortality of directly measured leg\u2010press strength, which includes most of the major leg muscles in both lower extremities and involves a substantially larger muscle volume than handgrip or quadriceps muscle strength. This study aimed to clarify whether directly measured leg\u2010press strength predicts mortality and whether integration with GNRI (MS\u2010GNRI) enhances mortality risk stratification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed data from 1065 Japanese community\u2010dwelling individuals aged \u2265\u200970\u2009years from the Tsurugaya Project, followed for 16\u2009years. Participants were categorized into two groups based on optimal cutoff values for directly measured leg\u2010press strength adjusted for body size (high and low) or by GNRI (poor and good), respectively. Finally, these baseline classifications were integrated to stratify participants into the following four MS\u2010GNRI groups: (1) high\u2010strength\/good\u2010GNRI, (2) high\u2010strength\/poor\u2010GNRI, (3) low\u2010strength\/good\u2010GNRI and (4) low\u2010strength\/poor\u2010GNRI. Hazard ratios (HRs) for all\u2010cause mortality were calculated using Cox proportional hazards models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During the follow\u2010up, 415 deaths occurred. Low leg\u2010press strength and poor GNRI were independently associated with higher mortality than high strength and good GNRI, respectively; adjusted HRs were 1.81 (95% CI: 1.45\u20132.25) and 1.59 (1.30\u20131.95), respectively (both\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). The MS\u2010GNRI revealed a survival gradient: Using the high\u2010strength\/good\u2010GNRI group as the reference, adjusted HRs (95% CI) were 1.55 (1.18\u20132.03) for the high\u2010strength\/poor\u2010GNRI group, 1.69 (1.29\u20132.23) for the low\u2010strength\/good\u2010GNRI group and 2.47 (1.78\u20133.13) for the low\u2010strength\/poor\u2010GNRI group (\n                      <jats:italic>p<\/jats:italic>\n                      for trend &lt;\u20090.001). Notably, the high\u2010strength\/poor\u2010GNRI group and the low\u2010strength\/good\u2010GNRI group showed comparable survival probabilities. MS\u2010GNRI significantly improved predictive accuracy and risk reclassification over either indicator alone (Net Reclassification Improvement: 0.62 over strength; 0.41 over GNRI).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Directly measured leg\u2010press strength is a potent predictor of all\u2010cause mortality. Integrating muscle strength with nutrition via MS\u2010GNRI enhanced mortality risk stratification, suggesting that preserved muscle strength may substantially contribute to longevity alongside nutritional maintenance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jcsm.70375","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T14:24:18Z","timestamp":1789568658000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Integrating Leg\u2010Press Strength and Nutritional Status Improves 16\u2010Year Mortality Risk Stratification in General Older Adults"],"prefix":"10.1002","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-3427-2702","authenticated-orcid":false,"given":"Yilin","family":"Du","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine Tohoku University Graduate School of Medicine  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7110-3168","authenticated-orcid":false,"given":"Tatsuma","family":"Okazaki","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine Tohoku University Graduate School of Medicine  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine Tohoku University Graduate School of Medicine  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keisuke","family":"Obata","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine Tohoku University Graduate School of Medicine  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8880-8554","authenticated-orcid":false,"given":"Naoki","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine Tohoku University Graduate School of Medicine  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Miura","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine Tohoku University Graduate School of Medicine  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1278-0717","authenticated-orcid":false,"given":"Midori","family":"Miyagi","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine Tohoku University Graduate School of Medicine  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryoichi","family":"Nagatomi","sequence":"additional","affiliation":[{"name":"Designing Future Health Initiative, Promotion Office of Strategic Innovation Tohoku University  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mana","family":"Kogure","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Epidemiology Tohoku Medical Megabank Organization  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1467-161X","authenticated-orcid":false,"given":"Naoki","family":"Nakaya","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Epidemiology Tohoku Medical Megabank Organization  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsushi","family":"Hozawa","sequence":"additional","affiliation":[{"name":"Division of Epidemiology, Graduate School of Medicine Tohoku University  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3574-649X","authenticated-orcid":false,"given":"Satoru","family":"Ebihara","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine Tohoku University Graduate School of Medicine  Sendai 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