Paediatric dominant and non-dominant handgrip reference curves and the association with body composition

Figures & data

Figure 1. Participant flow chart.

Table 1. Descriptive characteristics of the NHANES sample population used to create handgrip reference curves.

Variable	n or %	Mean ± SD
Age, y	4290	13.1 ± 3.9
Gender^1
Male	50.3
Female	49.7
Race/Ethnicity group^1
Non-Hispanic White	54.9
Non-Hispanic Black	13.9
Mexican American	15.2
Other Hispanic	7.0
Other	9.0
Weight, kg	4263	53.2 ± 23.2
WAZ	4263	0.56 ± 1.16
Height, cm	4264	153.2 ± 18.5
HAZ	4264	0.17 ± 1.01
BMI, kg/m^2	4263	21.7 ± 6.1
BMIZ	4263	0.53 ± 1.15
Upper arm length, cm	4202	33.0 ± 4.8
UALZ	4202	0.04 ± 0.98
LBMI, kg/m^2	3244	15.6 ± 3.2
LBMIZ	3244	0.25 ± 1.41
ALSTMI kg/m^2	3239	6.9 ± 1.7
ALSTMIZ	3239	0.17 ± 1.31
FMI, kg/m^2	3219	6.2 ± 3.6
FMIZ	3219	0.42 ± 1.20
Dominant HG, kg	4290	25.9 ± 11.8
Dominant HGZ	4290	0.00 ± 0.98
Non-dominant HG, kg	4290	24.4 ± 11.2
Non-dominant HGZ	4290	0.01 ± 0.98

y, year; kg, kilogram; WAZ, weight Z-score; cm, centimetre; HAZ, height Z-score; BMI/Z, body mass index/Z-score; m², square metre; UALZ, upper arm length Z-score; LBMI/Z, lean body mass index/Z-score; ALSTMI/Z, appendicular lean soft tissue mass index/Z-score; FMI/Z, fat mass index/Z-score; HG/HGZ, handgrip/Z-score.

¹ United States population weighted proportions of gender and self-identified race/ethnicity groups.

Figure 2. Reference curves for dominant and non-dominant handgrip by gender (A) and difference between dominant and non-dominant handgrip with age (B).

Table 2. Reference tables for dominant hand grip (A), non-dominant handgrip (B), and upper arm length (C) in male participants ages 6–19.9 years.

	(A) Dominant handgrip, kg
	Males
Age, y	L	S	5th	10th	25th	50th (M)	75th	90th	95th
6.0 to 6.9	0.19	0.23	7.38	8.06	9.30	10.85	12.61	14.38	15.53
7.0 to 7.9	0.23	0.22	8.52	9.29	10.71	12.47	14.45	16.44	17.72
8.0 to 8.9	0.27	0.22	9.74	10.62	12.23	14.21	16.42	18.62	20.03
9.0 to 9.9	0.30	0.22	11.17	12.18	14.01	16.26	18.74	21.20	22.77
10.0 to 10.9	0.33	0.21	12.90	14.06	16.17	18.73	21.55	24.33	26.10
11.0 to 11.9	0.35	0.21	15.02	16.36	18.79	21.74	24.98	28.15	30.17
12.0 to 12.9	0.37	0.21	17.59	19.15	21.96	25.36	29.08	32.71	35.01
13.0 to 13.9	0.38	0.20	20.54	22.33	25.55	29.43	33.65	37.77	40.37
14.0 to 14.9	0.40	0.20	23.59	25.60	29.20	33.51	38.19	42.73	45.59
15.0 to 15.9	0.42	0.19	26.50	28.68	32.57	37.23	42.24	47.08	50.12
16.0 to 16.9	0.43	0.19	29.09	31.39	35.48	40.34	45.56	50.59	53.73
17.0 to 17.9	0.44	0.18	31.34	33.71	37.90	42.87	48.19	53.29	56.48
18.0 to 18.9	0.44	0.17	33.33	35.74	39.98	44.99	50.35	55.47	58.66
19.0 to 19.9	0.44	0.16	35.20	37.63	41.90	46.94	52.30	57.41	60.59

(B) Non-dominant handgrip, kg

	Males
Age, y	L	S	5th	10th	25th	50th (M)	75th	90th	95th
6.0 to 6.9	0.24	0.23	7.05	7.71	8.94	10.46	12.17	13.88	14.99
7.0 to 7.9	0.25	0.23	8.10	8.86	10.25	11.97	13.90	15.84	17.09
8.0 to 8.9	0.27	0.22	9.24	10.09	11.66	13.59	15.75	17.91	19.29
9.0 to 9.9	0.29	0.22	10.57	11.55	13.32	15.51	17.93	20.34	21.88
10.0 to 10.9	0.32	0.22	12.20	13.31	15.34	17.83	20.57	23.28	25.01
11.0 to 11.9	0.35	0.21	14.18	15.48	17.82	20.67	23.80	26.88	28.84
12.0 to 12.9	0.37	0.21	16.55	18.05	20.76	24.04	27.63	31.14	33.37
13.0 to 13.9	0.40	0.21	19.23	20.96	24.06	27.80	31.88	35.85	38.35
14.0 to 14.9	0.43	0.20	22.00	23.95	27.42	31.60	36.11	40.48	43.23
15.0 to 15.9	0.45	0.20	24.63	26.76	30.55	35.06	39.92	44.60	47.52
16.0 to 16.9	0.49	0.19	26.96	29.23	33.24	38.00	43.09	47.95	50.99
17.0 to 17.9	0.53	0.19	28.97	31.35	35.53	40.45	45.66	50.62	53.69
18.0 to 18.9	0.59	0.18	30.74	33.21	37.53	42.57	47.86	52.85	55.93
19.0 to 19.9	0.65	0.17	32.41	34.97	39.41	44.55	49.90	54.91	57.98

(C) Upper arm length, cm

Age, y	L	S	5th	10th	25th	50th (M)	75th	90th	95th
6.0 to 6.9	0.23	0.07	22.32	22.87	23.82	24.90	26.02	27.06	27.70
7.0 tp 7.9	0.27	0.07	23.60	24.19	25.20	26.36	27.56	28.67	29.35
8.0 to 8.9	0.29	0.07	24.88	25.51	26.59	27.82	29.10	30.28	31.00
9.0 to 9.9	0.25	0.07	26.20	26.86	28.00	29.31	30.66	31.92	32.69
10.0 to 10.9	0.15	0.07	27.56	28.26	29.46	30.83	32.26	33.60	34.43
11.0 to 11.9	0.00	0.07	28.96	29.68	30.92	32.36	33.86	35.28	36.16
12.0 to 12.9	−0.15	0.07	30.31	31.05	32.33	33.81	35.38	36.87	37.79
13.0 to 13.9	−0.28	0.07	31.55	32.30	33.60	35.13	36.74	38.28	39.24
14.0 to 14.9	−0.38	0.07	32.61	33.37	34.68	36.23	37.87	39.44	40.42
15.0 to 15.9	−0.40	0.06	33.45	34.21	35.53	37.08	38.73	40.31	41.30
16.0 to 16.9	−0.35	0.06	34.06	34.82	36.15	37.70	39.35	40.92	41.89
17.0 to 17.9	−0.23	0.06	34.48	35.25	36.58	38.13	39.76	41.31	42.27
18.0 to 18.9	−0.06	0.06	34.78	35.56	36.89	38.44	40.05	41.57	42.50
19.0 to 19.9	0.13	0.06	35.03	35.81	37.16	38.70	40.29	41.78	42.69

Table 3. Reference tables for dominant hand grip (A), non-dominant handgrip (B), and upper arm length (C) in female participants ages 6-19.9 years.

(A) Dominant handgrip, kg

	Females
Age, y	L	S	5th	10th	25th	50th (M)	75th	90th	95th
6.0 to 6.9	−0.28	0.22	7.05	7.58	8.58	9.89	11.46	13.18	14.36
7.0 to 7.9	−0.16	0.21	8.33	8.97	10.18	11.74	13.58	15.54	16.87
8.0 to 8.9	−0.06	0.21	9.72	10.49	11.92	13.75	15.88	18.11	19.60
9.0 to 9.9	0.02	0.21	11.24	12.15	13.83	15.95	18.40	20.92	22.58
10.0 to 10.9	0.08	0.21	12.88	13.93	15.86	18.29	21.05	23.87	25.71
11.0 to 11.9	0.13	0.21	14.56	15.75	17.92	20.63	23.69	26.78	28.79
12.0 to 12.9	0.16	0.20	16.20	17.51	19.88	22.83	26.13	29.45	31.59
13.0 to 13.9	0.18	0.20	17.72	19.11	21.64	24.75	28.23	31.70	33.93
14.0 to 14.9	0.21	0.19	19.03	20.49	23.12	26.35	29.92	33.46	35.73
15.0 to 15.9	0.25	0.19	20.10	21.61	24.31	27.60	31.22	34.77	37.04
16.0 to 16.9	0.31	0.18	20.93	22.48	25.25	28.58	32.20	35.73	37.95
17.0 to 17.9	0.38	0.18	21.60	23.18	26.00	29.36	32.97	36.45	38.63
18.0 to 18.9	0.46	0.17	22.17	23.80	26.66	30.03	33.62	37.04	39.18
19.0 to 19.9	0.54	0.17	22.73	24.39	27.28	30.67	34.23	37.60	39.68

(B) Non-dominant handgrip, kg

	Females
Age, y	L	S	5th	10th	25th	50th (M)	75th	90th	95th
6.0 to 6.9	−0.43	0.22	6.86	7.35	8.30	9.58	11.15	12.91	14.15
7.0 to 7.9	−0.27	0.22	8.01	8.62	9.77	11.28	13.10	15.08	16.44
8.0 to 8.9	−0.12	0.22	9.23	9.96	11.33	13.10	15.19	17.40	18.88
9.0 to 9.9	0.00	0.22	10.56	11.43	13.04	15.09	17.46	19.92	21.55
10.0 to 10.9	0.10	0.22	11.98	12.99	14.85	17.19	19.86	22.58	24.36
11.0 to 11.9	0.17	0.21	13.43	14.58	16.68	19.30	22.25	25.22	27.14
12.0 to 12.9	0.22	0.21	14.85	16.12	18.43	21.28	24.47	27.65	29.70
13.0 to 13.9	0.25	0.21	16.17	17.52	19.99	23.02	26.37	29.70	31.83
14.0 to 14.9	0.28	0.20	17.31	18.73	21.31	24.45	27.91	31.32	33.49
15.0 to 15.9	0.32	0.19	18.24	19.72	22.37	25.58	29.10	32.53	34.71
16.0 to 16.9	0.37	0.19	18.97	20.49	23.21	26.47	30.01	33.44	35.60
17.0 to 17.9	0.44	0.19	19.54	21.11	23.88	27.19	30.73	34.15	36.28
18.0 to 18.9	0.50	0.18	20.01	21.62	24.45	27.79	31.34	34.73	36.83
19.0 to 19.9	0.57	0.18	20.44	22.09	24.98	28.35	31.90	35.26	37.34

(C) Upper arm length, cm

Age, y	L	S	5th	10th	25th	50th (M)	75th	90th	95th
6.0 to 6.9	−0.82	0.07	22.11	22.63	23.55	24.64	25.84	27.01	27.75
7.0 to 7.9	−0.82	0.07	23.53	24.08	25.06	26.22	27.49	28.73	29.52
8.0 to 8.9	−0.79	0.07	24.95	25.54	26.57	27.80	29.14	30.45	31.28
9.0 to 9.9	−0.72	0.07	26.35	26.96	28.05	29.35	30.75	32.12	32.99
10.0 to 10.9	−0.59	0.07	27.65	28.30	29.45	30.80	32.26	33.67	34.56
11.0 to 11.9	−0.42	0.07	28.82	29.50	30.70	32.10	33.60	35.03	35.93
12.0 to 12.9	−0.23	0.07	29.81	30.52	31.75	33.19	34.70	36.14	37.04
13.0 to 13.9	−0.04	0.07	30.58	31.31	32.56	34.02	35.55	36.98	37.87
14.0 to 14.9	0.14	0.06	31.12	31.86	33.14	34.61	36.14	37.57	38.44
15.0 to 15.9	0.31	0.06	31.47	32.22	33.52	35.00	36.52	37.94	38.80
16.0 to 16.9	0.46	0.06	31.68	32.45	33.76	35.24	36.76	38.16	39.01
17.0 to 17.9	0.61	0.06	31.82	32.60	33.92	35.41	36.92	38.31	39.15
18.0 to 18.9	0.76	0.06	31.92	32.71	34.05	35.54	37.05	38.43	39.26
19.0 to 19.9	0.91	0.06	32.02	32.82	34.17	35.67	37.17	38.54	39.35

Table 4. Correlations between unadjusted and adjusted handgrip Z-scores, anthropometric, and body composition measures using data from 3209 NHANES participants with complete DXA data.

	HAZ	BMIZ	UALZ	LBMIZ	ALSTMIZ	FMIZ
Non-dominant HGZ	0.42 p < .001	0.36 p < .001	0.46 p < .001	0.51 p < .001	0.54 p < .001	0.17 p < .001
Non-dominant HGZ, adjusted for HAZ	−0.02 p  =  .46	0.30 p < .001	0.11 p < .001	0.43 p < .001	0.46 p < .001	0.12 p < .001
Non-dominant HGZ, adjusted for UALZ	0.11 p < .001	0.16 p < .001	−0.02 p = .33	0.31 p < .001	0.34 p < .001	−0.01 p = .62
Dominant HGZ	0.43 p < .001	0.37 p < .001	0.47 p < .001	0.51 p < .001	0.54 p < .001	0.17 p < .001
Dominant HGZ, adjusted for HAZ	−0.01 p = .64	0.31 p < .001	0.12 p < .001	0.44 p < .001	0.46 p < .001	0.12 p < .001
Dominant HGZ, adjusted for UALZ	0.13 p < .001	0.17 p < .001	−0.02 p = .46	0.30 p < .001	0.34 p < .001	−0.02 p = .47

HAZ, height Z-score; BMIZ, body mass index Z-score; UALZ, upper arm length Z-score; LBMIZ, lean body mass index Z-score; ALSTMIZ, appendicular lean soft tissue mass index Z-score; FMIZ, fat mass index Z-score. HGZ, handgrip Z-score.

Table 5. Equations to predict D-HGZ and ND-HGZ based on body size as described in Equation 3 in text.

Dominant hand grip, kg
	HAZ adjustment equations		UALZ adjustment equations
Age, y	Males (R^2 = 0.28, n = 2142)	Females (R^2 = 0.24, n = 2122)	Males (R^2 = 0.25, n = 2113)	Females (R^2 = 0.26, n = 2089)
6.0 to 6.9	−0.223 + (HAZ * 0.356)	−0.087 + (HAZ * 0.476)	−0.077 + (UALZ * 0.344)	0.035 + (UALZ * 0.395)
7.0 to 7.9	−0.109 + (HAZ * 0.391)	−0.199 + (HAZ * 0.460)	−0.005 + (UALZ * 0.454)	−0.152 + (UALZ * 0.445)
8.0 to 8.9	−0.125 + (HAZ * 0.457)	−0.286 + (HAZ * 0.423)	0.014 + (UALZ * 0.458)	−0.143 + (UALZ * 0.392)
9.0 to 9.9	−0.120 + (HAZ * 0.405)	−0.421 + (HAZ * 0.534)	−0.011 + (UALZ * 0.399)	−0.178 + (UALZ * 0.479)
10.0 to 10.9	−0.248 + (HAZ * 0.619)	−0.413 + (HAZ * 0.635)	0.078 + (UALZ * 0.553)	−0.107 + (UALZ * 0.532)
11.0 to 11.9	−0.430 + (HAZ * 0.604)	−0.341 + (HAZ * 0.602)	−0.093 + (UALZ * 0.635)	−0.115 + (UALZ * 0.618)
12.0 to 12.9	−0.588 + (HAZ * 0.627)	0.039 + (HAZ * 0.585)	−0.239 + (UALZ * 0.556)	0.054 + (UALZ * 0.685)
13.0 to 13.9	−0.321 + (HAZ * 0.745)	0.035 + (HAZ * 0.435)	−0.091 + (UALZ * 0.610)	−0.051 + (UALZ * 0.434)
14.0 to 14.9	−0.055 + (HAZ * 0.537)	0.283 + (HAZ * 0.295)	0.052 + (UALZ * 0.464)	0.191 + (UALZ * 0.357)
15.0 to 15.9	0.193 + (HAZ * 0.441)	0.238 + (HAZ * 0.334)	0.219 + (UALZ * 0.473)	0.147 + (UALZ * 0.303)
16.0 to 16.9	0.285 + (HAZ * 0.330)	−0.044 + (HAZ * 0.261)	0.221 + (UALZ * 0.279)	−0.055 + (UALZ * 0.325)
17.0 to 17.9	0.065 + (HAZ * 0.298)	0.184 + (HAZ * 0.459)	0.023 + (UALZ * 0.293)	0.074 + (UALZ * 0.620)
18.0 to 18.9	0.016 + (HAZ * 0.340)	0.016 + (HAZ * 0.464)	−0.021 + (UALZ * 0.494)	−0.048 + (UALZ * 0.473)
19.0 to 19.9	−0.123 + (HAZ * 0.562)	0.113 + (HAZ * 0.401)	−0.054 + (HAZ * 0.694)	0.033 + (HAZ * 0.367)
Non-dominant hand grip, kg
	HAZ adjustment equations		UALZ adjustment equations
Age, y	Males (R^2 = 0.26, n = 2142)	Females (R^2 = 0.23, n = 2122)	Males (R^2 = 0.23, n = 2113)	Females (R^2 = 0.26, n = 2089)
6.0 to 6.9	−0.202 + (HAZ * 0.394)	−0.147 + (HAZ * 0.540)	−0.039 + (UALZ * 0.390)	−0.005 + (UALZ * 0.463)
7.0 tp 7.9	−0.135 + (HAZ * 0.367)	−0.216 + (HAZ * 0.464)	−0.037 + (UALZ * 0.424)	−0.157 + (UALZ * 0.441)
8.0 to 8.9	−0.124 + (HAZ * 0.489)	−0.305 + (HAZ * 0.372)	0.026 + (UALZ * 0.461)	−0.175 + (UALZ * 0.390)
9.0 to 9.9	−0.115 + (HAZ * 0.382)	−0.466 + (HAZ * 0.582)	−0.018 + (UALZ * 0.348)	−0.203 + (UALZ * 0.533)
10.0 to 10.9	−0.291 + (HAZ * 0.582)	−0.360 + (HAZ * 0.592)	0.021 + (UALZ * 0.541)	−0.070 + (UALZ * 0.478)
11.0 to 11.9	−0.310 + (HAZ * 0.523)	−0.307 + (HAZ * 0.559)	−0.027 + (UALZ * 0.557)	−0.097 + (UALZ * 0.565)
12.0 to 12.9	−0.616 + (HAZ * 0.634)	0.094 + (HAZ * 0.547)	−0.264 + (UALZ * 0.561)	0.106 + (UALZ * 0.646)
13.0 to 13.9	−0.356 + (HAZ * 0.724)	0.041 + (HAZ * 0.395)	−0.141 + (UALZ * 0.618)	−0.042 + (UALZ * 0.435)
14.0 to 14.9	−0.023 + (HAZ * 0.466)	0.248 + (HAZ * 0.331)	0.072 + (UALZ * 0.414)	0.133 + (UALZ * 0.507)
15.0 to 15.9	0.211 + (HAZ * 0.400)	0.174 + (HAZ * 0.294)	0.228 + (UALZ * 0.458)	0.084 + (UALZ * 0.277)
16.0 to 16.9	0.333 + (HAZ * 0.494)	−0.046 + (HAZ * 0.280)	0.221 + (UALZ * 0.358)	−0.056 + (UALZ * 0.384)
17.0 to 17.9	−0.023 + (HAZ * 0.295)	0.189 + (HAZ * 0.500)	−0.066 + (UALZ * 0.260)	0.074 + (UALZ * 0.579)
18.0 to 18.9	0.075 + (HAZ * 0.268)	0.083 + (HAZ * 0.448)	0.044 + (UALZ * 0.467)	0.021 + (UALZ * 0.463)
19.0 to 19.9	−0.118 + (HAZ * 0.520)	0.019 + (HAZ * 0.452)	−0.064 + (UALZ * 0.583)	−0.065 + (UALZ * 0.375)

HAZ, Height for Age Z-score; UALZ, Upper Arm Length Z-score.

Figure 3. Dominant and non-dominant handgrip Z-scores by race/ethnicity group.

Data availability statement

The data that support the findings of this study are openly available from the Centres for Disease Control and Prevention (CDC), National Centre for Health Statistics (NCHS). National Health and Nutrition Examination Survey Data. Hyattsville, MD: U.S. Department of Health and Human Services, Centres for Disease Control and Prevention, 2011–2014, https://wwwn.cdc.gov/nchs/nhanes/continuousnhanes/overview.aspx?BeginYear=2011 and https://wwwn.cdc.gov/nchs/nhanes/continuousnhanes/overview.aspx?BeginYear=2013.