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Rethinking Low Handgrip Strength: Normative Values, Diagnostic Thresholds, and Sarcopenia Risk in Malaysian Older

Theng Choon Ooi^1,2, Nurul Fatin Malek Rivan¹, Suzana Shahar¹

¹Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Wilayah Persekutuan, Malaysia.

Clinical Interventions in Aging

|June 22, 2026

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This study establishes handgrip strength (HGS) reference values for Malaysian older adults. The Asian Working Group for Sarcopenia criteria identified more low HGS cases than quintile thresholds.

Area of Science:

Gerontology
Public Health
Human Physiology

Background:

Establishing normative reference values for handgrip strength (HGS) is crucial for assessing muscle function in aging populations.
Previous studies have not comprehensively defined HGS norms for Malaysian older adults.

Purpose of the Study:

To determine sex- and age-specific normative reference values for handgrip strength (HGS) in Malaysian older adults.
To compare the prevalence of low HGS using different diagnostic criteria (AWGS 2019 vs. lowest quintile).

Main Methods:

Cross-sectional analysis of 2180 community-dwelling adults aged ≥60 years from the LRGS-TUA cohort.
Application of the lambda-mu-sigma (LMS) method to generate sex-specific percentile curves for HGS.
Comparison of low HGS prevalence using Asian Working Group for Sarcopenia (AWGS) 2019 criteria versus lowest quintile thresholds.

Keywords:

handgrip strength normative reference value older adults sarcopenia

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Main Results:

Peak mean absolute HGS was observed in the 60-64 year age group for both men and women.
Peak normalized HGS varied by sex, with women maintaining stable values longer.
The AWGS 2019 criteria identified a substantially higher prevalence of low HGS (men: 46.2%; women: 48.7%) compared to lowest quintile thresholds (men: 19.6%; women: 20.1%).

Conclusions:

The prevalence of low handgrip strength is higher when using AWGS 2019 criteria compared to lowest quintile thresholds in Malaysian older adults.
Both definitions showed similar associations with sarcopenia-related outcomes, suggesting potential clinical utility.
Further longitudinal validation is needed to confirm the relative clinical utility of these definitions.