title: Adequate muscular strength may help to reduce mortality risk in those with an elevated gamma gap.
abstract: BACKGROUND
  An elevated (≥3.1g/dl) gamma gap (Total Protein (g/dl)-Albumin (g/dl)) is associated with increased heart failure risk and an increased mortality risk. Adequate muscular strength is associated with reduced mortality risk, but the potential protective effects of muscular strength on mortality among those with an elevated gamma gap has yet to be investigated, which was this study's purpose.
  
  
  METHODS
  Data from the 1999-2002 NHANES were utilized, with follow-up through 2011. Lower extremity strength was objectively-measured via a knee extensor test. Gamma gap was measured from a blood sample. 2776 participants (50-85yrs) constituted the analytic sample.
  
  
  RESULTS
  After adjustments, and among those with an elevated gamma gap, a 50N increase in lower extremity strength was associated with a 27% reduced risk of all-cause mortality (HRadjusted=0.73; 95% CI: 0.65-0.82; P<0.001).
  
  
  CONCLUSIONS
  Having adequate lower extremity strength in middle-age and older adult years may be of critical importance in reducing mortality risk, particularly among those with an elevated gamma gap.
authors.affiliation: Jackson Heart Study Vanguard Center of Oxford, Physical Activity Epidemiology Laboratory, Department of Health, Exercise Science and Recreation Management, The University of Mississippi, University, MS 38677, United States. Electronic address: pdloprin@olemiss.edu.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Loprinzi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000418:Albumins / Q000378:metabolism*; D001798:Blood Proteins / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D053580:Muscle Strength / Q000502:physiology*; D009749:Nutrition Surveys / Q000639:trends; D012307:Risk Factors
chemical_list: D000418:Albumins; D001798:Blood Proteins
keywords: Albumin; Clinical; Deaths; Epidemiology; Exercise; Gamma gap; Inflammation; Mortality; NHANES; Protein; Strength; Survival