title: Muscle Weakness Thresholds for Prediction of Diabetes in Adults.
abstract: BACKGROUND
  Despite the known links between weakness and early mortality, what remains to be fully understood is the extent to which strength preservation is associated with protection from cardiometabolic diseases, such as diabetes.
  
  
  OBJECTIVE
  The purposes of this study were to determine the association between muscle strength and diabetes among adults, and to identify age- and sex-specific thresholds of low strength for detection of risk.
  
  
  METHODS
  A population-representative sample of 4066 individuals, aged 20-85 years, was included from the combined 2011-2012 National Health and Nutrition Examination Survey (NHANES) data sets. Strength was assessed using a handheld dynamometer, and the single highest reading from either hand was normalized to body mass. A logistic regression model was used to assess the association between normalized grip strength and risk of diabetes, as determined by haemoglobin A1c levels ≥6.5 % (≥48 mmol/mol), while controlling for sociodemographic characteristics, anthropometric measures and television viewing time.
  
  
  RESULTS
  For every 0.05 decrement in normalized strength, there were 1.26 times increased adjusted odds for diabetes in men and women. Women were at lower odds of having diabetes (odds ratio 0.49; 95 % confidence interval 0.29-0.82). Age, waist circumference and lower income were also associated with diabetes. The optimal sex- and age-specific weakness thresholds to detect diabetes were 0.56, 0.50 and 0.45 for men at ages of 20-39, 40-59 and 60-80 years, respectively, and 0.42, 0.38 and 0.33 for women at ages of 20-39, 40-59 and 60-80 years, respectively.
  
  
  CONCLUSIONS
  We present thresholds of strength that can be incorporated into a clinical setting for identifying adults who are at risk of developing diabetes and might benefit from lifestyle interventions to reduce risk.
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan Hospital and Health Systems, 325 E. Eisenhower Parkway, Suite 300, Ann Arbor, MI, 48108, USA. mdpeterz@med.umich.edu.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Peterson
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Peng
authors.initials: P
authors.lastname: Zhang
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Palak
authors.initials: P
authors.lastname: Choksi
authors.affiliation: Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA.
authors.forename: Kyriakos S
authors.initials: KS
authors.lastname: Markides
authors.affiliation: Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA.|Division of Geriatrics, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA.
authors.forename: Soham
authors.initials: S
authors.lastname: Al Snih
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000886:Anthropometry; D003920:Diabetes Mellitus / Q000175:diagnosis*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D018737:Hand Strength; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness; D012307:Risk Factors; D057185:Sedentary Behavior; D012737:Sex Factors; D055105:Waist Circumference
chemical_list: D006442:Glycated Hemoglobin