Handgrip Strength Thresholds to Detect Cardiometabolic Risk in Youth: Cross-Sectional Study and Meta-Analysis

Muscular fitness, particularly handgrip strength, is increasingly recognized as a robust marker of cardiometabolic risk (CMR) in children and adolescents. However, evidence-based diagnostic thresholds for identifying at-risk individuals remain scarce, particularly in children. This study aimed to (1) establish sex-specific diagnostic thresholds for handgrip strength normalized to body weight to identify elevated CMR in children aged 8-11 years, and (2) synthesize existing evidence through a systematic review and meta-analysis across pediatric age groups, integrating the new data with existing evidence.

We analyzed cross-sectional data from 1124 Spanish children (49.7% girls) aged 8-11 years participating in the MOVI-2 study. Normalized handgrip strength was associated with a CMR index composed of waist circumference, triglyceride-to-HDL ratio, mean arterial pressure and fasting insulin. Diagnostic accuracy was assessed using receiver operating characteristic curves and optimized with the Youden Index. Results from the MOVI-2 study and other diagnostic accuracy studies were combined in a meta-analysis for identifying the optimal threshold for normalized handgrip strength to identify elevated CMR in youth.

In the MOVI-2 study, thresholds were 0.38 for boys and 0.34 for girls, with area under the curve (AUC) of 0.77 (95% CI: 0.73-0.81) and 0.75 (95% CI: 0.70-0.79), respectively. The systematic review and meta-analysis followed PRISMA-DTA guidelines and included nine additional studies (n = 10 588). Meta-analytic thresholds for normalized handgrip strength were 0.30 for girls and 0.39 for boys in childhood (6-12 years), and 0.36 for girls and 0.42 for boys in adolescence (13-18 years), with the highest diagnostic accuracy observed in adolescent girls (AUC = 0.80, 95% CI: 0.77-0.83; Youden Index = 0.60). Children showed greater heterogeneity, particularly in specificity.

Despite certain limitations, our findings provide clinically relevant, sex- and age-specific thresholds for normalized handgrip strength to identify elevated CMR in youth. These thresholds may serve as a valuable starting point for CMR screening in both boys and girls.