Design and Comparison of Criterion-referenced Standards for Grip Strength in U.S. Children and Adolescents

We designed grip strength standards for youth by back-extrapolating cutpoints based on weakness at age 65. Existing standards, based on insufficient bone mineral content (BMC), were also compared in a nationally representative sample. Altogether, 6837 participants (n = 2199 <= 18.9 years of age) from the National Health and Nutrition Examination Survey had dominant hand, grip strength assessed. Lambda Mu Sigma regression was used to create percentiles of strength and identify thresholds linked with clinically relevant weakness (CRW) in older adults. Approximately 93% and 75% of young people met standards based on CRW and BMC, respectively. Non-Hispanic white and black youth were more likely to meet grip strength cutpoints. Underweight children were less likely (odds ratios = 0.20 to 0.26), while overweight/obese youth were more likely (1.38 to 2.71), to meet strength standards compared to normal weight. The standards can be used with, or in place of, normative standards when evaluating grip strength.