Male adolescents who have low muscular strength are at increased risk for premature death in young adulthood, according to the findings of a large Swedish study.

Finn Rasmussen, MD, PhD, of the Karolinska Institutet in Stockholm, and colleagues analyzed data from the Swedish military conscription register for 1.14 million Swedish male adolescents aged 16-19 years. Conscription examinations are mandated by law for all young male Swedish citizens.

During a median follow-up of 24 years, 26,145 subjects died. Higher muscular strength in adolescence, as assessed by knee extension and handgrip tests, was associated with a 20%-35% lower risk of premature death from any cause or cardiovascular disease, independent of body mass index or blood pressure, the investigators reported online in the British Medical Journal. The study found no association with mortality from cancer. Stronger adolescents had a 20%-30% lower risk of death from suicide and were 15%-65% less likely to have any psychiatric diagnosis. Adolescents in the lowest tenth of muscular strength showed the greatest risk of death from different causes. All-cause mortality rates, per 100,000 person-years, were 122.3 for the weakest subjects and 86.9 for the strongest. The rates were 9.5 and 5.6, respectively, for death from cardiovascular disease, and 24.6 and 16.9 for death from suicide.

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“Low muscular strength should be considered an emerging risk factor for major causes of death in young adulthood,” the authors concluded.

The finding of an association between low muscular strength and increased suicide risk supports the notion “that physically weaker people might also be mentally more vulnerable,” the authors wrote.