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The aim of our study was to investigate the association of grip strength and the trajectories of preclinical obesity progression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were collected from 93 275 participants in the UK Biobank. Preclinical obesity was diagnosed based on an excess of anthropometric parameters, defined as elevated body mass index combined with at least 1 abnormal measure among waist circumference, waist-to-hip ratio, waist-to-height ratio, or percentage body fat, in the absence of obesity-induced dysfunctions. Three models captured different trajectories from baseline to dysfunctions and death, with or without intermediate progression. A multistate model was used to investigate the association between grip strength and the preclinical obesity progression and multiple-cause mortality risk. Sensitivity analyses were performed using free muscle volume, total lean mass, and muscle-to-weight ratio as exposures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 8163 death events over a mean follow-up of 13.4 years, each SD increase in grip strength was associated with a significantly reduced risk of preclinical obesity progression at each stage, with the strongest inverse association observed in baseline to first dysfunction [fully adjusted hazard ratio (HR): 0.86, 95% confidence interval (CI): 0.85-0.88]. Compared to the lowest tertile, the highest grip strength significantly showed protective effects across all trajectory models, with double dysfunctions to all-cause death yielding the most pronounced associations (fully adjusted HR: 0.77, 95% CI: 0.70-0.84). Further subgroup and sensitivity analysis showed consistent results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Increased grip strength was significantly associated with a decreased risk of obesity-induced dysfunctions progression and multiple-cause mortality. These findings underscore the importance of improving muscle mass and strength in preclinical obesity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/clinem\/dgaf521","type":"journal-article","created":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T11:44:37Z","timestamp":1758023077000},"page":"e746-e757","source":"Crossref","is-referenced-by-count":5,"title":["Handgrip Strength and Trajectories of Preclinical Obesity Progression: A Multistate Model Analysis Using the UK Biobank"],"prefix":"10.1210","volume":"111","author":[{"given":"Manrong","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease , Shanghai 200233 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