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Handgrip strength cut-off points for early detection of cardiometabolic risk in Chilean children

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Abstract

The aim of this study was to determine whether handgrip strength is associated with cardiometabolic risk in children. The secondary aim was to establish sex-specific handgrip strength cut-off points for early detection of cardiometabolic risk. A total sample of 452 Chilean children (267 girls and 185 boys) aged 7–9 years old was analyzed. Muscle fitness was measured by an adjustable dynamometer and normalized by body mass (i.e., handgrip strength/body mass). Sex-specific cardiometabolic risk scores were computed as the sum of the waist-to-height ratio (Equation 1) or waist circumference (Equation 2) and insulin, triglycerides, high-density lipoproteins, and glycemia levels. Receiver operating curve (ROC) analyses were performed to identify those with cardiometabolic risk scores > 1 standard deviation above the mean. ROC analyses showed a significant discriminating accuracy of normalized handgrip strength in identifying cardiometabolic risk in boys (≤ 0.33) and girls (≤ 0.40) using both equations. The highest sensitivity was offered by Equation 2 for boys [46%; 95% CI (32–59%)] and for girls [71%; 95% CI (60–80)]. The greatest specificity was also offered by Equation 2 for boys [82%; 95% CI (74–88)] and girls [63%; 95% CI (55–70)]. Since the values obtained by ROC analyses are low (especially in boys), caution is warranted regarding the strength of the existing evidence base.

Conclusion: These specific cut-off points according to sex for possible cardiometabolic risk could be used by Chilean health professionals and school staff as an initial assessment in the field setting.

What is known

• There is strong evidence for the importance of muscular fitness during childhood and adolescence for cardiometabolic risk.

• There has been no research to establish minimum handgrip strength capacity levels to predict cardiometabolic risk among Chilean children.

What is new

• Cut-off points for handgrip strength relative to body mass to identify cardiometabolic risk in Chilean children are 0.33 in boys and 0.40 in girls.

• The early use of these cut-off points and its appropriate identification could have benefits of preventive and diagnostic therapeutic intervention and as a starting point to define adequate levels of handgrip strength.

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Data availability

The data presented in this study are available on request from the corresponding author. The data are not publicly available because they belong to minors.

Code availability

N/A.

Abbreviations

AUC:

Area under curve

BMI:

Body mass index

HDL:

High-density lipoprotein cholesterol

HOMA-IR:

Homeostatic Model Assessment for Insulin Resistance

LDL:

Low-density lipoprotein cholesterol

RIA:

Radioimmunoassay

ROC:

Operating characteristic curve

WC:

Waist circumference

WHtR:

Waist-to-height ratio

References

  1. Eckel RH, Grundy SM, Zimmet PZ (2005) The metabolic syndrome. Lancet 365:1415–1428. https://doi.org/10.1016/S0140-6736(05)66378-7

    Article  PubMed  CAS  Google Scholar 

  2. Sovio U, Skow A, Falconer C, Park MH, Viner RM, Kinra S (2013) Improving prediction algorithms for cardiometabolic risk in children and adolescents. J Obes 2013:1–6. https://doi.org/10.1155/2013/684782

    Article  Google Scholar 

  3. Peterson MD, Zhang P, Saltarelli WA, Visich PS, Gordon PM (2016) Low muscle Strength thresholds for the detection of cardiometabolic risk in adolescents. Am J Prev Med 50:593–599. https://doi.org/10.1016/j.amepre.2015.09.019

    Article  PubMed  Google Scholar 

  4. Leong DP, Teo KK, Rangarajan S, Lopez-Jaramillo P, Avezum A Jr, Orlandini A, Seron P, Ahmed SH, Rosengren A, Kelishadi R, Rahman O, Swaminathan S, Iqbal R, Gupta R, Lear SA, Oguz A, Yusoff K, Zatonska K, Chifamba J, Igumbor E, Mohan V, Anjana RM, Gu H, Li W, Yusuf S (2015) Prognostic value of grip strength: findings from the Prospective urban rural epidemiology (PURE) study. Lancet 386(9990):266–273. https://doi.org/10.1016/s0140-6736(14)62000-6

    Article  PubMed  Google Scholar 

  5. García-Hermoso A, Cavero-Redondo I, Ramírez-Vélez R, Ruiz JR, Ortega FB, Lee D-C, Martínez-Vizcaíno V (2018) Muscular strength as a predictor of all-cause mortality in an apparently healthy population: a systematic review and meta-analysis of data from approximately 2 million men and women. Arch Phys Med Rehabil 99:2100–2113.e5. https://doi.org/10.1016/j.apmr.2018.01.008

    Article  PubMed  Google Scholar 

  6. García-Hermoso A, Ramírez-Campillo R, Izquierdo M (2019) Is muscular fitness associated with future health benefits in children and adolescents? A Systematic Review and Meta-Analysis of Longitudinal Studies. Sports Med 49:1079–1094. https://doi.org/10.1007/s40279-019-01098-6

    Article  PubMed  Google Scholar 

  7. Smith JJ, Eather N, Morgan PJ, Plotnikoff RC, Faigenbaum AD, Lubans DR (2014) The health benefits of muscular fitness for children and adolescents: a systematic review and meta-analysis. Sports Med 44:1209–1223. https://doi.org/10.1007/s40279-014-0196-4

    Article  PubMed  Google Scholar 

  8. Cesa CC, Sbruzzi G, Ribeiro RA, Barbiero SM, de Oliveira PR, Eibel B, Machado NB, Marques R das V, Tortato G, dos Santos TJ, Leiria C, Schaan BD, Pellanda LC (2014) Physical activity and cardiovascular risk factors in children: meta-analysis of randomized clinical trials. Prev Med 69:54–62. https://doi.org/10.1016/j.ypmed.2014.08.014

    Article  PubMed  Google Scholar 

  9. Martinez-Vizcaino V, Martinez MS, Aguilar FS, Martinez SS, Gutierrez RF, Lopez MS, Martinez PM, Rodriguez-Artalejo F (2010) Validity of a single-factor model underlying the metabolic syndrome in children: a confirmatory factor analysis. Diabetes Care 33:1370–1372. https://doi.org/10.2337/dc09-2049

    Article  PubMed  PubMed Central  Google Scholar 

  10. Fraser BJ, Huynh QL, Schmidt MD, Dwyer T, Venn AJ, Magnussen CG (2016) Childhood muscular fitness phenotypes and adult metabolic syndrome. Med Sci Sports Exerc 48:1715–1722. https://doi.org/10.1249/MSS.0000000000000955

    Article  PubMed  CAS  Google Scholar 

  11. Ramírez-Vélez R, Peña-Ibagon JC, Martínez-Torres J, Tordecilla-Sanders A, Correa-Bautista JE, Lobelo F, García-Hermoso A (2017) Handgrip strength cutoff for cardiometabolic risk index among Colombian children and adolescents: The FUPRECOL Study. Sci Rep 7:42622. https://doi.org/10.1038/srep42622

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  12. Castro-Piñero J, Perez-Bey A, Cuenca-Garcia M, Cabanas-Sanchez V, Gómez-Martínez S, Veiga OL, Marcos A, Ruiz JR, Marcos A, Gomez-Martinez S, Nova E, Diaz L-E, Zapatera B, Veses AM, Hernandez A, Gheorghe A, Castro-Piñero J, Mora-Vicente J, Gonzalez Montesinos JL, Conde-Caveda J, Ruiz JR, Ortega FB, Moledo CP, Baeza AC, Chillon P, del Rosario FJ, Galo AG, Guerra GB, Alfonso AD, Parrilla F, Gomez R, Gavala J, Veiga OL, Villagra HA, Del Campo J, Cordente C, Diaz M, Tejero CM, Acha A, Moya JM, Sanz A, Martinez-Gomez D, Cabanas-Sanchez V, Rodriguez Romo G, Izquierdo R, Garcia-Cervantes L, Esteban-Cornejo I, Bandres F, Lucia A, Santiago C, Gomez-Gallego F (2019) Muscle Fitness cut points for early assessment of cardiovascular risk in children and adolescents. J Pediatr 206:134–141.e3. https://doi.org/10.1016/j.jpeds.2018.10.026

    Article  PubMed  Google Scholar 

  13. Castro-Piñero J, Laurson KR, Artero EG, Ortega FB, Labayen I, Ruperez AI, Zaqout M, Manios Y, Vanhelst J, Marcos A, Polito A, Gonzalez-Gross M, Widhalm K, Moreno LA, Gutierrez A, Ruiz JR (2019) Muscle strength field-based tests to identify European adolescents at risk of metabolic syndrome: The HELENA study. J Sci Med Sport 22:929–934. https://doi.org/10.1016/j.jsams.2019.04.008

    Article  PubMed  Google Scholar 

  14. Garcia-Hermoso A, Cofre-Bolados C, Andrade-Schnettler R, Ceballos-Ceballos R, Fernández-Vergara O, Vegas-Heredia ED, Ramírez-Vélez R, Izquierdo M (2021) Normative reference values for handgrip strength in chilean children at 8–12 years old using the empirical distribution and the Lambda, Mu, and Sigma statistical methods. J Strength Cond Res 35:260–266. https://doi.org/10.1519/JSC.0000000000002631

  15. González L, Corvalán C, Pereira A, Kain J, Garmendia ML, Uauy R (2014) Early adiposity rebound is associated with metabolic risk in 7-year-old children. Int J Obes 38:1299–1304. https://doi.org/10.1038/ijo.2014.97

    Article  CAS  Google Scholar 

  16. Capon T (2016) Standardised anatomical alignment of the head in a clinical photography studio. A comparison between the Frankfort Horizontal and the natural head position. J Vis Commun Med 39:105–111. https://doi.org/10.1080/17453054.2016.1246059

    Article  PubMed  Google Scholar 

  17. Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J (2007) Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 85:660–667. https://doi.org/10.2471/BLT.07.043497

    Article  PubMed  PubMed Central  Google Scholar 

  18. Gómez-Campos R, Andruske C, Hespanhol J, Torres J, Arruda M, Luarte-Rocha C, Cossio-Bolaños M (2015) Waist circumferences of Chilean students: comparison of the CDC-2012 standard and proposed percentile curves. IJERPH 12:7712–7724. https://doi.org/10.3390/ijerph120707712

    Article  PubMed  PubMed Central  Google Scholar 

  19. Ruiz JR, Castro-Pinero J, Espana-Romero V, Artero EG, Ortega FB, Cuenca MM, Jimenez-Pavon D, Chillon P, Girela-Rejon MJ, Mora J, Gutierrez A, Suni J, Sjostrom M, Castillo MJ (2011) Field-based fitness assessment in young people: the ALPHA health-related fitness test battery for children and adolescents. Br J Sports Med 45:518–524. https://doi.org/10.1136/bjsm.2010.075341

    Article  PubMed  Google Scholar 

  20. Radziuk J (2014) Homeostastic Model Assessment and Insulin Sensitivity/Resistance. Diabetes 63:1850–1854. https://doi.org/10.2337/db14-0116

    Article  PubMed  CAS  Google Scholar 

  21. Anderssen SA, Cooper AR, Riddoch C, Sardinha LB, Harro M, Brage S, Andersen LB (2007) Low cardiorespiratory fitness is a strong predictor for clustering of cardiovascular disease risk factors in children independent of country, age and sex. Eur J Cardiovasc Prev Rehabil 14:526–531. https://doi.org/10.1097/HJR.0b013e328011efc1

    Article  PubMed  Google Scholar 

  22. Steene-Johannessen J, Anderssen SA, Kolle E, Andersen LB (2009) Low muscle fitness is associated with metabolic risk in youth: medicine & science in sports & exercise 41:1361–1367 . https://doi.org/10.1249/MSS.0b013e31819aaae5

  23. Holten MK, Zacho M, Gaster M, Juel C, Wojtaszewski JFP, Dela F (2004) Strength training increases insulin-mediated glucose uptake, GLUT4 content, and insulin signaling in skeletal muscle in patients with type 2 diabetes. Diabetes 53:294–305. https://doi.org/10.2337/diabetes.53.2.294

    Article  PubMed  CAS  Google Scholar 

  24. Álvarez C, Ramírez-Campillo R, Ramírez-Vélez R, Martínez C, Castro-Sepúlveda M, Alonso-Martínez A, Izquierdo M (2018) Metabolic effects of resistance or high-intensity interval training among glycemic control-nonresponsive children with insulin resistance. Int J Obes 42:79–87. https://doi.org/10.1038/ijo.2017.177

    Article  CAS  Google Scholar 

Download references

Acknowledgments

AGH is a Miguel Servet Fellow (Instituto de Salud Carlos III-FSE–CP18/0150). RR-V is funded in part by a Postdoctoral Fellowship Resolution ID 420/2019 of the Universidad Pública de Navarra.

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Authors and Affiliations

  1. Departamento de Actividad Física y Deporte, Facultad de Ciencias del Deporte, Universidad de Murcia (UM), 30720, San Javier, Region of Murcia, Spain

    José Francisco López-Gil

  2. Institute of Nutrition and Food Technology (INTA), University of Chile, 7830490, Santiago, Chile

    Gerardo Weisstaub

  3. Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, 31008, Pamplona, Navarra, Spain

    Robinson Ramírez-Vélez & Antonio García-Hermoso

  4. Universidad de Santiago de Chile (USACH), Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, 71783-5, Santiago, Chile

    Antonio García-Hermoso

Authors
  1. José Francisco López-Gil
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  2. Gerardo Weisstaub
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  3. Robinson Ramírez-Vélez
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  4. Antonio García-Hermoso
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Contributions

Conceptualization, A.G.-H. and R.R.-V.; methodology, A.G.-H. and R.R.-V.; software, R.R.-V.; validation J.L.-G., G.W., A.G.-H. and R.R.-V.; formal analysis, A.G.-H. and R.R.-V.; investigation, G.W.; resources, A.G.-H. and R.R.-V.; data curation, A.G.-H. and R.R.-V.; writing—original draft preparation, J.L.-G. and A.G.-H.; writing—review and editing, J.L.-G., A.G.-H. and R.R.-V.; visualization, G.W.; supervision, G.W.; project administration, G.W.; funding acquisition, G.W.

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Correspondence to Antonio García-Hermoso.

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The authors declare no conflict of interest.

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Communicated by Gregorio Paolo Milani

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López-Gil, J.F., Weisstaub, G., Ramírez-Vélez, R. et al. Handgrip strength cut-off points for early detection of cardiometabolic risk in Chilean children. Eur J Pediatr 180, 3483–3489 (2021). https://doi.org/10.1007/s00431-021-04142-8

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  • DOI: https://doi.org/10.1007/s00431-021-04142-8

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