The scientific rationale behind the study rests on two well-established but rarely merged lines of evidence. Malnutrition in older adults is a recognized prognostic factor for total mortality, and in geriatric medicine it is commonly assessed using the Geriatric Nutritional Risk Index, or GNRI. This index integrates serum albumin levels—a marker of protein status and systemic health—with the ratio of actual to ideal body weight derived from height. Separately, muscle weakness has repeatedly been linked to elevated mortality risk, whether measured through handgrip, quadriceps, or respiratory muscle strength. Yet most previous studies that combined nutrition and strength focused on hospitalized patients or people with cancer, and the few community-based analyses either followed participants for only four or five years or relied on body mass index, a contested proxy for nutritional status.

The new study distinguishes itself in a second, more technical way: it measured leg-press strength directly rather than estimating it. Leg-press strength captures the simultaneous explosive extension of the hip, knee, and ankle joints in both lower extremities, recruiting the gluteal muscles, femoral muscles, and calf muscles. Because it engages most of the major leg muscle groups at once, it evaluates a far larger muscle mass than handgrip or isolated quadriceps tests and reflects the functional capacity needed for complex movements such as rising from a chair or climbing stairs. Notably, it is the only conventional strength measure that incorporates the calf muscles, a point of growing relevance since the Asian Working Group for Sarcopenia’s 2025 consensus update designated calf circumference as the key primary tool for sarcopenia case-finding.

Participants were drawn from the Tsurugaya Project, which in 2002 invited 2,730 community-dwelling residents aged 70 or older; 1,198 enrolled and 1,175 consented. After excluding individuals lacking leg-press data, Mini-Mental State Examination data, or albumin values, 1,065 participants entered the final analysis. Each participant sat on a horizontal leg extension device with feet secured on the pedal at a 90-degree knee angle and exerted maximal power as rapidly as possible across five trials, with the highest value recorded in watts. To account for body size, strength was divided by body mass index. Nutritional status was calculated from the GNRI formula: serum albumin in grams per liter multiplied by 1.489, plus the ratio of measured to optimal body weight multiplied by 41.7, with optimal weight determined by sex-specific Lorentz equations.

Rather than importing cutoffs designed for short-term outcomes in hospitalized patients, the researchers derived study-specific thresholds optimized for 16-year all-cause mortality using maximally selected rank statistics. This yielded sex-specific leg-press cutoffs of 272.63 W/kg/m² for men and 129.78 W/kg/m² for women, and a sex-neutral GNRI threshold of 105.11. Critically, the two indices proved nearly independent: the correlation coefficient between leg-press strength and GNRI was just 0.096, and the variance inflation factor of 1.009 ruled out multicollinearity. That statistical independence is precisely what makes their combination informative—each index carries distinct prognostic information that the other cannot supply. Crossing the two binary classifications produced four groups: high-strength/good-GNRI (589 people), high-strength/poor-GNRI (196), low-strength/good-GNRI (157), and low-strength/poor-GNRI (123).

Over 16 years of follow-up, during which mortality data were collected from the Sendai Municipal Authority through July 2018, 415 participants died. Kaplan–Meier survival curves revealed a stark gradient across the four groups. Five-year mortality was 5.60 percent in the high-strength/good-GNRI group but 27.64 percent in the low-strength/poor-GNRI group—nearly five times higher. Intriguingly, the high-strength/poor-GNRI group initially showed better survival than the low-strength/good-GNRI group, hinting that preserved muscle power might partially buffer the dangers of suboptimal nutrition. In fully adjusted Cox proportional hazards models accounting for sex, age, smoking history, Timed Up and Go performance, cognitive scores, and histories of hypertension, diabetes, cardiovascular disease, liver disease, and kidney disease, hazard ratios for all-cause mortality were 1.55 for high-strength/poor-GNRI, 1.69 for low-strength/good-GNRI, and 2.47 for low-strength/poor-GNRI, compared with the reference group. A stepwise increase in risk across categories remained highly significant.

Analyses treating the measures as continuous variables reinforced the pattern: each unit increase in leg-press strength was associated with a small but significant reduction in mortality risk in both men and women, and each unit increase in GNRI was similarly protective. To guard against reverse causality—the possibility that pre-existing illness at baseline had already weakened both strength and nutrition—the researchers excluded the 30 participants who died within the first two years. The stepwise survival gradient persisted, with an adjusted hazard ratio of 2.39 for the low-strength/poor-GNRI group, suggesting the findings were not merely an artifact of pre-existing disease.

The most consequential results concern predictive performance. The concordance index, which quantifies how well a model discriminates between those who die and those who survive, was 0.54 for muscle strength alone and 0.59 for GNRI alone—but rose to 0.63 for the combined MS-GNRI index, a statistically significant improvement. Net reclassification improvement, which measures how many individuals are correctly shifted into appropriate risk categories, reached 0.62 over muscle strength alone and 0.41 over GNRI alone, implying gains in predictive accuracy of 62 percent and 41 percent respectively. Time-dependent area-under-the-curve analyses told the same story at both 8 years (0.70 for the combined index versus 0.65 and 0.61 for the individual measures) and 12 years (0.67 versus 0.64 and 0.59).

The authors place these findings in the context of Japan’s leading causes of death—malignancy, cardiovascular disease, and pneumonia. Prior cohort work suggests diminished leg-press strength raises cancer mortality risk, while studies of quadriceps weakness in the very old point to possible links with pneumonia death; malnutrition, by contrast, worsens mortality across all major causes. The study has limitations the authors acknowledge candidly: without head-to-head comparison, it cannot establish whether leg-press strength outperforms handgrip or quadriceps measures, the cohort was exclusively Japanese so generalizability to other ethnic groups remains untested, and the study-specific cutoffs require validation in independent cohorts. Still, the message is clear and clinically actionable. Adequate nutrition is essential for longevity, but preserved muscle strength appears to be a critical, partially independent determinant of survival. Whether deliberately training leg-press power can actually reduce mortality risk remains the field’s next great question—and one that could reshape how clinicians screen the world’s aging populations.

Subject of Research: Combining leg-press muscle strength and nutritional status to predict long-term all-cause mortality in community-dwelling older adults

Article Title: Integrating Leg‐Press Strength and Nutritional Status Improves 16‐Year Mortality Risk Stratification in General Older Adults

Article References: Du, Y., Okazaki, T., Li, X., Obata, K., Suzuki, N., Miura, T., Miyagi, M., Nagatomi, R., Kogure, M., Nakaya, N., Hozawa, A., & Ebihara, S. (2026). Integrating Leg‐Press Strength and Nutritional Status Improves 16‐Year Mortality Risk Stratification in General Older Adults. Journal of Cachexia, Sarcopenia and Muscle, 17(5), Article e70375. https://doi.org/10.1002/jcsm.70375

Image Credits: AI Generated

DOI: 10.1002/jcsm.70375

Keywords: leg-press strength, Geriatric Nutritional Risk Index, all-cause mortality, older adults, sarcopenia, malnutrition, Tsurugaya Project, risk stratification, muscle strength, aging, cohort study, serum albumin

The new LE8 score, introduced by the American Heart Association, refines previous cardiovascular health assessment algorithms by encompassing eight critical health behaviors and factors. This study set out to quantify the association between cardiovascular health levels as measured by the LE8 score and mortality risks, providing a nuanced understanding of survival outcomes in both cancer-affected populations and those cancer-free. Researchers meticulously applied Cox proportional hazards regression models and utilized restricted cubic spline analyses to dissect these relationships with statistical precision.

Among the 29,352 adults studied, only a minority—14.8%—achieved a high LE8 cardiovascular health score, whereas 20.3% registered low scores indicative of suboptimal cardiovascular wellness. This distribution highlights a widespread public health challenge and underscores the importance of cardiovascular health maintenance. The stratification of LE8 scores into low, moderate, and high categories enabled a clear demonstration of how cardiovascular health correlates with mortality risk gradients.

For adults without cancer, the calculated hazard ratios (HRs) delineated a protective effect associated with improved LE8 scores. Specifically, individuals with moderate LE8 scores exhibited a 29% reduction in all-cause mortality risk compared to those with low scores, while those with high scores experienced an astounding 54% reduction. These findings underscore the LE8 score’s robustness as a prognostic tool and its potential utility in primary prevention strategies targeting cardiovascular events and overall survival enhancement.

When focusing on cardiovascular disease (CVD) mortality, the protective association strengthened further. Moderate LE8 scores correlated with a 42% risk reduction, and high scores nearly tripled the survival advantage with a 70% reduction in CVD mortality. This emphasizes the comprehensive cardiovascular protective effect embedded within the composite LE8 metric and validates its construction encompassing multiple modifiable health-related behaviors and biological parameters.

Intriguingly, when the population was stratified to reflect adults with cancer diagnosis histories, the LE8 score continued to demonstrate a protective trend against all-cause mortality, albeit with slightly attenuated effect sizes. Here, moderate cardiovascular health scores were associated with a 27% reduced risk of death, a significant finding affirming that optimal cardiovascular health remains critically relevant even among individuals grappling with oncologic disease. However, high LE8 scores in cancer patients did not exhibit statistically significant mortality risk reductions as clearly, indicating complex interplay between cancer pathology and cardiovascular health factors.

A noteworthy aspect of this study was the consistent protective effects observed across all eight components of the LE8 score in relation to cardiovascular mortality. This finding confirms the integrated nature of cardiovascular health determinants and advocates for multipronged interventions rather than singular focus on isolated risk factors. Each LE8 element—from diet and physical activity to blood pressure, cholesterol, glucose levels, body mass index, smoking status, and sleep health—played a vital role in enhancing cardiovascular prognosis.

The methodological approach using Cox regression modeling allowed adjustment for critical confounders, strengthening the causal inferences drawn from the associations observed. The use of restricted cubic splines further permitted the exploration of potential nonlinear relationships between LE8 score levels and mortality risks, enhancing understanding beyond binary risk categorizations and revealing dose-response dynamics.

Crucially, this study bridges a knowledge gap concerning the interplay between cardiovascular health and cancer survivorship, an increasingly pertinent arena given the rising numbers of aging cancer survivors prone to cardiovascular complications. The data advocate for integrating cardiovascular health optimization as an essential aspect of comprehensive cancer care and survivorship programs to improve longevity outcomes.

Moreover, the public health implications are profound. Given the prevalence of suboptimal cardiovascular health in the general population and the mounting burden of cancer diagnoses, strategies to improve LE8 scores at the population level could translate into reduced overall mortality and better quality of life. Health policy initiatives could prioritize cardiovascular health screening using the LE8 algorithm, lifestyle modification programs, and targeted therapeutics integration across diverse clinical settings.

This pioneering research dovetails with ongoing efforts to enhance predictive algorithms incorporating lifestyle, biological, and clinical factors to generate personalized mortality risk profiles. It reinforces the importance of holistic health metrics that capture multiple dimensions of well-being beyond traditional singular biomarker assessments, advancing precision medicine paradigms.

In conclusion, the 2025 study led by Peng et al. provides robust epidemiological evidence that the Life’s Essential 8 cardiovascular health score is a powerful tool for predicting both cardiovascular and all-cause mortality risks in adults, regardless of cancer status. These findings serve as a clarion call for clinicians, researchers, and public health authorities to embrace the LE8 paradigm to foster healthier populations and mitigate deaths linked to cardiovascular disease and potentially cancer-associated mortality.

Continued longitudinal research and intervention trials are warranted to explore causality more definitively and assess how modifications in LE8 components may translate into mortality improvements over time, particularly in vulnerable groups such as cancer survivors. As the medical community progresses toward integrated chronic disease prevention and management, the Life’s Essential 8 stands out as a beacon guiding evidence-based cardiovascular health promotion.

Subject of Research:
Cardiovascular health assessment using the American Heart Association’s Life’s Essential 8 (LE8) and its association with all-cause and cardiovascular mortality in adults with and without cancer.

Article Title:
Association of the American Heart Association’s new “Life’s Essential 8″ cardiovascular health with all-cause and cardiovascular mortality in adults with and without cancer: a retrospective cohort study.

Article References:
Peng, S., Chen, Q., Liu, Q., et al. Association of the American Heart Association’s new “Life’s Essential 8” cardiovascular health with all-cause and cardiovascular mortality in adults with and without cancer: a retrospective cohort study. BMC Cancer 25, 1706 (2025). https://doi.org/10.1186/s12885-025-14464-7

Image Credits:
Scienmag.com

DOI:
10.1186/s12885-025-14464-7 (Published 04 November 2025)

Keywords:
Cardiovascular health, Life’s Essential 8, all-cause mortality, cardiovascular mortality, cancer survivorship, NHANES, retrospective cohort study, AHA health metrics