Higher muscle mass and stronger handgrip appear to pull in opposite directions when it comes to the walls of the carotid arteries, according to a cross-sectional study of community-dwelling adults aged 60 and older in Chuncheon, Korea. The research, published in BMC Geriatrics, found that greater fat-free mass index (FFMI) was associated with thicker carotid intima-media, while stronger grip was associated with a thinner one — a dissociation that may help explain why muscle quantity and muscle quality do not carry the same cardiovascular signal.
The analysis drew on the 2007 assessment of the Hallym Aging Study. Of 702 participants who attended that assessment, 611 were aged 60 or older, and 352 community-dwelling Korean adults with complete measurements of carotid intima-media thickness (cIMT), FFMI, the atherogenic index of plasma (AIP), and brachial-ankle pulse wave velocity (ba-PWV) were included. The median age was 72.0 years, and 49.1% were men. FFMI was calculated from fat-free mass measured by bioelectrical impedance analysis, divided by height squared. Handgrip strength was assessed with a digital dynamometer, and dynapenia was defined using the sex-specific cutoffs of the Asian Working Group for Sarcopenia 2019.
The primary exposures were standardized FFMI and handgrip strength, and their independent associations with mean cIMT were tested in multivariable linear regression with both muscle measures entered simultaneously — a design choice that allowed the study to separate the effect of muscle mass from that of muscle strength. An extended model additionally adjusted for AIP and ba-PWV.
The results were strikingly divergent. In the primary multivariable model, each 1-standard-deviation increase in FFMI was associated with a 0.035-mm higher mean cIMT (95% CI, 0.014 to 0.056), whereas each 1-standard-deviation increase in handgrip strength was associated with a 0.034-mm lower mean cIMT (95% CI, −0.064 to −0.004). In other words, after mutual adjustment, more muscle mass tracked with thicker — not thinner — carotid walls, while stronger grip tracked with thinner walls. The confidence interval for handgrip strength sits close to the null, so the protective association, though statistically significant, is modest and should be interpreted with caution.
The study also examined the relationship in the reverse direction as a secondary analysis, using multivariable logistic regression with dynapenia as the dependent variable. Higher mean cIMT was associated with greater odds of dynapenia: each 0.1-mm increase in mean cIMT corresponded to an odds ratio of 1.23 (95% CI, 1.06 to 1.43). This suggests that subclinical atherosclerosis and diminished muscle strength travel together in this older population, although the cross-sectional design cannot establish which comes first.
That design limitation matters. Because cIMT, FFMI, handgrip strength, and the covariates were all measured at the same time, the associations cannot be read as causal. The extended model’s adjustment for AIP and ba-PWV was intended to probe whether these vascular and metabolic markers explain the associations, but the cross-sectional snapshot cannot resolve directionality.
The authors’ stated conclusion is measured: among community-dwelling adults aged 60 years and older, higher FFMI and greater handgrip strength were associated with higher and lower mean cIMT, respectively, after multivariable adjustment.
Subject of Research: Cross-sectional associations of fat-free mass index and handgrip strength with carotid intima-media thickness in older Korean adults
Article Title: Associations of fat-free mass index and handgrip strength with carotid intima-media thickness among community-dwelling adults aged 60 years and older in Chuncheon, Korea: a cross-sectional study
Article References: Kim, H.-J., & Kim, C. (2026). Associations of fat-free mass index and handgrip strength with carotid intima-media thickness among community-dwelling adults aged 60 years and older in Chuncheon, Korea: a cross-sectional study. BMC Geriatrics. https://doi.org/10.1186/s12877-026-08548-7
Image Credits: AI Generated
DOI: 10.1186/s12877-026-08548-7
Keywords: carotid intima-media thickness, fat-free mass index, handgrip strength, dynapenia, sarcopenia, atherosclerosis, older adults, cross-sectional study, Korea, arterial stiffness, Hallym Aging Study, BMC Geriatrics
News Source: Ophelia Keating. (October 29, 2026). Muscle mass and strength linked to carotid artery thickness in older Korean adults. Scienmag.
