Associations of grip strength with cardiovascular, respiratory, and cancer outcomes and all cause mortality: prospective cohort study of half a million UK Biobank participantsBMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k1651 (Published 08 May 2018) Cite this as: BMJ 2018;361:k1651
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We read the article “Associations of grip strength with cardiovascular, respiratory, and cancer outcomes and all cause mortality: prospective cohort study of half a million UK Biobank participants” authored by Carlos A Celis-Morales et al  with great interest. The authors have convincingly proved that grip strength is strongly and inversely associated with all-cause mortality and incidence of and mortality from cardiovascular disease, respiratory disease, chronic obstructive pulmonary disease, all cancer, and sub types of cancer .
We agree with the above findings, we opine that above noted chronic diseases have considerable burden, but the authors have not evaluated the efficacy of hand grip strength on pre transplant/post-transplant population group that have severe malnutrition and thus are immunologically weakened. Hand grip strength will preempt programs to establish pre- habilitation strategies. There is already published evidence that these approaches to identify at risk patients and institution of pre-habilitation will contribute to functional independence and improved quality of life after transplant. 
In addition, hand grip is a simple tool to measure frailty and severity of disease. This tool will help confirm the suitability of wait listed patients for transplant surgery. This may again aid to institute targeted programs that will help decrease frailty and improve quality of life patient in preparation of organ transplantation .
1. Associations of grip strength with cardiovascular, respiratory, and cancer outcomes and all-cause mortality: prospective cohort study of half a million UK Biobank participants. Celis-Morales CA, Welsh P et al. BMJ. 2018 May 8;361:k1651
2. Multivisceral Transplantation Rehabilitation Program-Case Report. Loschi TM, Cinacchi MPRG et al. Transplant Proc. 2018 Apr;50(3):824-826
3. Quality of life in liver transplant candidates: frailty is a better indicator than severity of liver disease. Derck JE, Thelen AE et al. Transplantation. 2015 Feb;99(2):340-4
Competing interests: No competing interests