Temporal Trends in Handgrip Strength and Associated Factors among Korean Adults from 2014 to 2019: Analysis of Korea National Health and Nutrition Examination Survey Data

Kim, YK, Lee, HB, and Lee, SH. Trends in mean hand grip strength, cutoff value, and prevalence of low hand grip strength: An analysis of 2014-2019 Korea National Health and Nutrition Examination Survey (KNHANES) data. J Strength Cond Res 39(8): e967-e973, 2025-The European Working Group on Sarcopenia in Older People 2 (EWGSOP2) defines probable sarcopenia as low muscle strength detected by hand grip strength (HGS). According to this guideline, cutoff for low HGS is determined using a T -score of -2.5 based on age group showing the highest HGS (aged 30-39 years). Our hypothesis is that temporal changes in mean HGS of Koreans may lead to changes in the cutoff values for low HGS and the prevalence of probable sarcopenia as defined by the EWGSOP2 guidelines. We analyzed trends of HGS using 6 years of Korea National Health and Nutrition Examination Survey data. We used the EWGSOP2 guidelines to set yearly cutoff values for low HGS and calculated the prevalence of low HGS. The cutoff value for low HGS and the prevalence rate of low HGS in individuals aged 70 years or older were analyzed using linear regression and trend analysis. We observed a significant decreasing trend from 2014 to 2019 in annual cutoff values for low HGS, ranging from 24.5 to 30.9 kg in men and 13.1-17.3 kg in women. Correspondingly, the prevalence of low HGS (probable sarcopenia) varied significantly from 10.4 to 34.2% in men and 9.1-20.8% in women, indicating notable year-to-year fluctuations ( p < 0.001). While pooling multiyear data reduces some variability, it does not fully address fluctuations in prevalence of probable sarcopenia. To enhance the reliability and clinical relevance of low HGS cutoff values, future guidelines should integrate outcome-based criteria with normative data, ensuring adaptability to temporal trends and population-specific characteristics.

Objective: The age-related decline in handgrip strength (HGS) is an important indicator of weakening muscle strength concomitant with aging and sarcopenia. This study was to investigate the association between dietary patterns and HGS.Methods: In this cross-sectional study of 7,624 adults aged 19–64 years who were enrolled in the Korea National Health and Nutrition Examination Survey 2014–2016, we assessed HGS with a digital hand dynamometer while the participants adopted a standing position with their arms lowered. Their diets were examined with a food frequency questionnaire which included 112 food items and were categorized into 26 food groups. To determine the associations between dietary patterns and HGS, we employed a weighted multivariable linear regression model.Results: We identified two dietary patterns: the Prudent and the Western dietary patterns. Individuals in the highest tertile of the Prudent dietary pattern had the highest HGS scores (β = 0.54, p < 0.001). No difference was found among the tertiles of the Western dietary pattern. Sex-specific stratification (2,953 men, 4,671 women) indicated that both sexes showed significant associations with HGS according to the tertiles of their factor loading scores in the Prudent dietary pattern (men, β = 0.49, p = 0.014; women, β = 0.51, p < 0.001).Conclusion: This cross-sectional study of 7,624 adults revealed a significantly positive association between HGS and the Prudent dietary pattern, even after adjusting for potential confounding factors.

ObjectiveWe aimed to investigate the relationship between serum neurofilament light chain (NfL) and grip strength using data from the 2013–2014 US National Health and Nutrition Examination Survey (NHANES).DesignSecondary analysis of...

The Prevalence of Urinary Incontinence Among Community Dwelling Men: Results From the National Health and Nutrition Examination Survey

The onset and progression of sarcopenia are highly variable among individuals owing to genetic and environmental factors. However, there are a limited number of studies measuring the heritability of muscle strength in large numbers of parent-adult offspring pairs. We aimed to investigate the familial correlation and heritability of hand grip strength (HGS) among Korean adults. This family-based cohort study on data from the Korea National Health and Nutrition Examination Survey (2014 to 2019) included 5,004 Koreans aged ≥19 years from 1,527 families. HGS was measured using a digital grip strength dynamometer. Familial correlations of HGS were calculated in different pairs of relatives. Variance component methods were used to estimate heritability. The heritability estimate of HGS among Korean adults was 0.154 (standard error, 0.066). Correlation coefficient estimates for HGS between parent-offspring, sibling, and spouse pairs were significant at 0.07, 0.10, and 0.23 (P<0.001, P=0.041, and P<0.001, respectively). The total variance in the HGS phenotype was explained by additive genetic (15.4%), shared environmental (11.0%), and unique environmental (73.6%) influences. The odds of weak HGS significantly increased in the offspring of parents with weak HGS (odds ratio [OR], 1.69-3.10; P=0.027-0.038), especially in daughters (OR, 2.04-4.64; P=0.029-0.034). HGS exhibits a familial correlation and significant heritable tendency in Korean adults. Therefore, Asian adults, especially women, who have parents with weak HGS, need to pay special attention to their muscle health with the help of healthy environmental stimuli.

Background: The prevalence of diabetes has been rising sharply since 1980, reaching 422 million cases worldwide in 2014. Physical activity and handgrip strength may be associated with good glycaemic control among patients with diabetes Objective: We tested the association between handgrip strength and glycemic control in type 2 diabetes patients, from National Health and Nutritional Examination Survey NHANES 2011-2014 and the contribution of the study covariates to this association. Hypothesis: Muscle strength is positively associated with glycemic control in type two diabetes. Methodology: This cross-sectional study examined the association between handgrip strength and glycaemic control among patients with diabetes. Data on 1058 participants aged 40 and older were collected from the NHANES. Muscle strength was assessed using a handgrip dynamometer, and blood samples were obtained to observe the glycaemic control values. Height, body weight, physical activity, insulin use, smoking status, alcohol use, participant demographics, and income-to-poverty ratio were all considered in the study. Results: logistic regression analysis was used to assess the association between handgrip strength and poor glycaemic control among participants with diabetes. Three models were used, each model adjusted to include different variables. OR values revealed no association between handgrip strength and glycaemic control. However, model 2, which was adjusted for sedentary activity, income-topoverty ratio, education, and smoking, shows a trend towards an association. Patients in quartile 4 of handgrip had 0.59 odds of poor glycaemic control, OR = 0.59 (95% CI: 0.34–1.02). However, in model 3 this effect was diluted when further adjusted for insulin use, OR = 0.81 (95% CI: 0.47– 1.38). Further analysis was performed to examine the mean decline in handgrip strength among non-insulin and insulin users. Non-insulin users, both men and women, have higher handgrip strength as compared to insulin users. Conclusion: There was no association found between handgrip and glycaemic control among patients with diabetes.

BackgroundAnemia, which is a major public health problem worldwide, represents a decline in the oxygenation function, and can therefore be related to low strength. However, hemoglobin cannot repair muscles directly, but is beneficial only in a supportive role. Previous studies on the relationship between handgrip strength and anemia have been controversial. Thus, we aimed to analyze the association between handgrip strength and anemia in Korean adults.MethodsThis cross-sectional study used the 2013–2017 data from the 6th and 7th Korean National Health and Nutrition Examination Survey (KNHANES) that included 16,638 Korean adults, aged ≥19 years, who met the inclusion or exclusion criteria. Differences in sociodemographic factors (sex, age, education, income, and employment), lifestyle factors (alcohol consumption, smoking, and physical activity), and illness and health factors [body mass index (BMI), vitamin intake, iron intake, comorbid illnesses, and handgrip strength] by existence of anemia, were analyzed using the Chi square test. Binary logistic regression analysis was used to measure the association between handgrip strength and anemia, while adjusting for other possible confounders. Subgroup analysis, stratified by sex and age, was performed.ResultsAmong Korean adults aged ≥19 years, 745,296 (7.7%) had anemia. A higher odds ratio, adjusted for other covariates/factors (OR) of anemia occurred in the weak handgrip strength group than in the strong handgrip strength group (OR = 1.92, 95% CI: 1.58–2.33). The subgroup analysis showed a higher OR adjusted for other covariates/factors of anemia in the weak handgrip strength group than in the strong handgrip strength group, regardless of sex or age. However, the association was greater for males (OR = 2.13, 95% CI: 1.35–3.34) and for those aged ≥65 years (OR = 1.92, 95% CI: 1.42–2.58).ConclusionThis study showed a strong association between handgrip strength and anemia that was particularly strong for males and those aged ≥65 years.

OBJECTIVESThis study investigated physical activity (PA) participation based on demographic, physical, and psychological variables in Korean adults.METHODSParticipants were divided into four groups (combined, aerobic only, resistance only, and neither) based on meeting the PA guidelines using moderate and vigorous PA time and resistance exercise frequency from the Korea National Health and Nutrition Examination Survey 2017. The association between meeting the PA guidelines and demographic, medical, fitness, lifestyle, and psychological variables were analyzed using complex samples crosstabs and a general linear model.RESULTSOf the 5,820 Korean adults, 66.0% did not meet any of the guidelines. Among demographic factors, sex, age, marital status, income, education level, occupation, and employment status were associated with meeting the PA guidelines. Chronic disease prevalence, weight, waist circumference, body mass index, diastolic blood pressure, glucose, high-density lipoprotein and triglyceride levels, hand-grip strength, resting heart rate, and family history of chronic disease in the medical and fitness variables; frequency of drinking and eating breakfast, total calorie, water, protein, and fat intake in the lifestyle variables; and perceived stress, depression, suicidal thoughts, and quality of life in the psychological variables were associated with meeting PA guidelines.CONCLUSIONSMost Korean adults participate in insufficient PA. Moreover, individuals who are socially underprivileged, have low-income or poor physical and mental health conditions participated in relatively less PA. Our findings suggest that government and individual efforts are required to increase PA and resolve health inequality in Korean adults.

To the Editor

Background: The purpose of this study was to explore the association between the high perceived stress of adults and the types and amounts of their physical activities. Methods: The subjects consisted of 5,624 adults aged 20 and older from the 2017 Korean National Health and Nutrition Examination Survey data. The three types of physical activity (aerobic activity, muscular exercise and walking) were investigated and the amounts of physical activity were calculated with time used in each activity were calculated. To examine the association between the high perceived stress and physical activity, complex samples multiple logistic regression analyses were performed with controlling participants’ demographic and socio-economic, health status and health behavior characteristics. Results: There were 1,539 people (27.36%) in the high stress perceived group, and the subjects in the high stress perceived group seemed to perform less time to walking (weighted mean: 217.23 minutes/ week) than the low or not stress perceived group (weighted mean: 241.09 minutes/week). The proportion of subjects doing muscular exercise 3 or more days in a week seemed to higher in the lower stress perceived group than the high stress perceived group. The multiple logistic regression analyses results showed significant correlations between walking or doing muscular exercise and high-perceived stress (p&amp;lt;0.01). Additionally, the proportion of activity at work seemed to be a significant factor in the perceived stress level. Conclusions: There appears to be a correlation between physical activity especially muscular activity and perceived stress, such that further studies will lead to improvements in stress management strategies.

BackgroundThere are conflicting researches on the relationship between muscular strength and depression, the most common mental illness. There is no study of relationship between muscular strength and depression using national data from young adults to seniors. For example, there has not been a study done explaining mediating pathways among the influences of handgrip strength on depression. Here, we conducted survey for the association between relative handgrip strength and depression and explain mediated pathways for quality of life.MethodsA cross-sectional study was administered to 4298 Korean adult subjects, aged 19–80 years, based on the 6th Korean National Health and Nutrition Examination Survey (KNHANES VI) of 2014. Handgrip strength reported as the average with each hand. The relative handgrip strength is defined as the handgrip strength divided by the body mass index (BMI). We performed analysis for all subjects and age groups (young adult, middle-aged, and elderly). We analyzed the association using multivariate linear regression and logistic regression. We also conducted mediation analysis for quality of life, which was measured by the EuroQol Five-Dimension Questionnaire (EQ5D).ResultsAfter adjusting for covariates, handgrip strength was inversely associated with the PHQ-9 score (P < 0.05). The odds ratios (OR) of depression symptoms were statistically significant for participants in the first and second quartile of handgrip strength compared to those with the highest quartile in entire sample, young adult, middle-aged, and elderly. There was about a 50% mediation effect of EQ5D in the relationship between handgrip strength and depression.ConclusionsUsing a large national sample, our results found that lower handgrip strength is associated with an increased risk of depression in Korean adult (young adult, middle-aged, and elderly). Our results suggest that increasing muscular strength may prevent depression in Korean adults.

BackgroundAdequate physical activity (PA) is essential for preventing sarcopenia in older adults. However, there are insufficient epidemiological data on the intensity of PA needed to prevent age-related sarcopenia. The purpose of this study was to investigate the association of PA intensity with skeletal muscle mass and muscle strength.MethodsThis was a population-based study with a cross-sectional design that was conducted using data from the 2008 − 2011 and 2014 − 2018 Korea National Health and Nutrition Examination Surveys, which included a total of 11,162 participants aged ≥ 60 years. PA was assessed using the results of a questionnaire and organized by intensity, frequency, and duration. The study population was divided into the following groups based on PA intensity: no exercise, walking only, moderate PA, and vigorous PA. To assess sarcopenia, skeletal muscle index (SMI) and hand grip strength (HGS) were measured as indicators of muscle mass and strength, respectively. Logistic regression analysis was used to explore the relationship between PA intensity and sarcopenia.ResultsSMI and HGS were significantly higher in men and women engaged in moderate to vigorous PA than in those who did not exercise. The odds ratios (ORs) for sarcopenia defined based on SMI and HGS were lowest in men engaged in vigorous PA (0.444, 95% confidence interval [CI]: 0.242 − 0.818 and 0.450, 95% CI: 0.228 − 0.890, respectively). In women, the OR for sarcopenia defined based on HGS was the lowest in the group engaged in vigorous PA (0.441, 95% CI: 0.199 − 0.975), while there was no risk reduction for sarcopenia defined based on SMI.ConclusionsModerate to vigorous PA was highly correlated with SMI and HGS in men and women. Intensive PA was positively correlated with sarcopenia prevention, which can be monitored using HGS.

Non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is an indicator of imbalance in lipid metabolism and has been associated with a variety of metabolic diseases. Hand Grip Strength (HGS) is an important indicator for assessing muscle function and overall health. The aim of this study was to investigate the relationship between NHHR and HGS, with the aim of revealing how lipid metabolism affects muscle strength and may provide an early indication of metabolic health and muscle dysfunction. We collected demographic and clinical data from 6,573 adults aged 20–60 years from the National Health and Nutrition Examination Survey (NHANES) database from 2011 to 2014.NHHR is defined as the ratio of total cholesterol minus high-density lipoprotein levels (HDL-C) divided by HDL-C. HGS is expressed as relative grip strength and is defined as the sum of the maximum readings for each hand/body mass index ratio. Among the data analysis techniques used in this study were multifactor linear regression, smoothed curve fitting, subgroups, and interactions. There was a negative correlation between NHHR and HGS in the 6573 participants included. After adjusting for all covariates, each unit increase in log2-NHHR was associated with a 0.28 [−0.28 (−0.31, −0.26)] decrease in HGS, and this negative correlation remained stable across subgroups (p < 0.01 for the test of trend). The analyses also identified a nonlinear association between NHHR and HGS with an inflection point of 1.74. Interaction tests showed that the negative correlation between NHHR and HGS differed significantly across age, gender, and stratification by diabetes status. Our study suggests that there may be a negative correlation between HGS and NHHR in adults aged 20–60 years in the U.S. Considering that a decline in HGS is an important manifestation of sarcopenia, it may be relevant to the prevention and control of sarcopenia through close detection and management of NHHR.

Background/Objectives: Research on oral dysfunctions as contributing factors to obstructive sleep apnea (OSA) is needed to prevent and treat OSA. This study aimed to explore the association of OSA with oral dysfunction and examine its impact on nutrient intake, physical activity, and handgrip strength. Methods: This cross-sectional study analyzed data from the Eighth cycle Korea National Health and Nutrition Examination Survey (KNHANES, 2019–2021). The OSA group included diagnosed individuals and those over 40 years with symptoms such as snoring, fatigue, or witnessed breathing pauses during sleep. The non-OSA group included individuals not meeting these criteria. Using 1:1 propensity score matching to control for confounders (sex, age, lifestyle factors), 7636 participants were included. Oral dysfunction was assessed based on chewing problems, complaints of chewing discomfort, and speech difficulties. Nutrient intake, physical activity, and handgrip strength were analyzed using the Rao–Scott χ2 test, complex sample t-test, and complex sample logistic regression. Results: The OSA group demonstrated significantly more oral dysfunction elements than the non-OSA group (p < 0.001). Higher energy intake was observed in the OSA group, with no significant differences in macronutrient intake. Physical activity levels were similar between groups; however, OSA participants without oral problems had higher handgrip strength (p < 0.05). Regression analysis showed increased OSA risk correlated with greater oral dysfunction and lower protein intake. Conclusions: This study revealed a strong association between oral dysfunction and OSA risk. Focusing on the assessment and early intervention of oral dysfunctions that influence OSA risk factors may aid in the early detection and prevention of OSA.

BackgroundSarcopenia contributes to an increased risk of falls and fractures, and reduced mobility, and mortality. Supplementation with dietary protein and amino acids has been suggested as a potential strategy to slow or prevent the associated loss of muscle mass and strength. However, most previous studies have focused on dietary protein or limited populations, such as older adults. Therefore, this study aimed to investigate the relationship between dietary protein and amino acid intake and handgrip strength (HG) in Korean adults.MethodsThis study used data from the 2014–2019 Korea National Health and Nutrition Examination Survey. A total of 18,565 adults who participated in a 1-day 24-hour recall method were included. Protein intake was calculated as a percentage of total energy intake from food sources (animal and plant). Amino acid intake (g/day), including essential amino acids (EAAs), branched-chain amino acids (BCAAs), and non essential amino acids (NEAAs), was assessed using a database expanded based on amino acid composition databases constructed by national institutions. Low HG was diagnosed based on the 2019 guidelines of the Asian Working Group on Sarcopenia.ResultsIn the fully adjusted model, total and plant protein intakes were positively associated with HG levels (kg) (β = 0.04 and 0.07 per 1% increase, respectively; p < 0.05 for both). Participants aged ≥ 65 years in the highest NEAA intake group had a 42% lower risk of low HG compared to those in the lowest intake group (odds ratio 0.58; 95% confidence interval 0.35–0.97; p for trend = 0.1026). A lower risk of HG was observed in older participants whose plant protein intake ranged from 8 to 10% of energy, compared to those consuming less than 7%. However, no association was found when intake exceeded 10% of energy.ConclusionsThese findings suggest that a high intake of NEAAs and a moderately high intake of plant protein may be associated with a lower risk of low HG among Korean older adults. Further prospective studies are needed to explore the effects of protein and amino acid intake on muscle mass and strength.