Exploring the Association Between Hand Grip Strength and Cardiometabolic Health Markers in Hospitalized Adults: A Cross-Sectional Study from Kolkata, India

Exploring the Association Between Hand Grip Strength and Cardiometabolic Health Markers in Hospitalized Adults: A Cross-Sectional Study from Kolkata, India | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Exploring the Association Between Hand Grip Strength and Cardiometabolic Health Markers in Hospitalized Adults: A Cross-Sectional Study from Kolkata, India Bijoya Bhattacharjee, Manisha Maity, Subhrojyoti Bhowmick, Abisa Sinha Adhikary, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6762494/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 19 Apr, 2026 Read the published version in Discover Public Health → Version 1 posted 12 You are reading this latest preprint version Abstract Objectives Sarcopenia and hypertension are significant public health concerns, particularly in aging populations. Their coexistence with visceral adiposity and systemic inflammation further increases cardiovascular risk. This study aimed to explore the association between handgrip strength (HGS)—a non-invasive marker of muscular function—and key cardiometabolic indicators including blood pressure, waist-hip ratio (WHR), visceral adiposity, and inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Methods A cross-sectional, hospital-based study was conducted among 458 adult inpatients (aged 18–80 years) in Kolkata. Participants were selected through purposive sampling. Data collection included measurements of HGS (using a dynamometer), anthropometrics, blood pressure, and biochemical parameters. Malnutrition status was monitored with the Malnutrition Universal Screening Tool (MUST). Statistical analysis was performed using SPSS version 19.0. Results Lower HGS was significantly associated with higher blood pressure, elevated WHR, increased indicators of visceral fat, and elevated levels of CRP and ESR. These findings indicate a link between reduced muscular strength and adverse cardiometabolic profiles. Conclusion Reduced handgrip strength may serve as an early, non-invasive marker for identifying individuals at risk of hypertension and systemic inflammation. Incorporating HGS assessments into routine clinical practice could enhance early detection and support targeted interventions for cardiometabolic health. muscular strength cardiovascular biomarkers inflammatory markers handgrip strength MUST Hand grip Strength Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction The global burden of hypertension is increasing steadily due to high regional prevalence and aging population. The World Health Organization estimates 1.4 billion people worldwide have hypertension. Preventing and treating hypertension is essential for preventing cardiovascular complications. On the other hand, sarcopenia is a medical condition characterized by the progressive loss of skeletal muscle mass and function as a person ages. Sarcopenia is typically associated with aging, but it can also be influenced by factors such as physical inactivity, poor nutrition, and certain medical conditions. Handgrip strength, a simple yet informative measure of muscular function, has gained significant attention in recent years due to its potential as a predictor of overall health and longevity. This comprehensive assessment aims to explore the associations between handgrip strength and these key health indicators, shedding light on their interplay and implications for health and disease. Objectives of the study The primary objective of this study is to comprehensively evaluate the relationship between skeletal muscle strength, as measured by handgrip strength (HGS), and key cardiometabolic risk factors. Specifically, the study aims to investigate the association between hypertension, visceral adiposity, and muscle mass; to assess the prevalence and relevance of inflammatory markers (CRP, ESR) and complete blood count (CBC) in relation to skeletal muscle status; and to explore how these inflammatory markers interact with cardiovascular risk factors and influence muscle strength in the studied adult population. Review of literature: From world perspective and from Indian context there are limited studies depicting association of handgrip strength with blood pressure and other parameters. A literature review on the association of handgrip strength with blood pressure, waist-hip ratio, visceral adiposity index, and C-reactive protein among the adult population reveals a growing body of research that underscores the importance of handgrip strength as a potential predictor and modulator of various health parameters. This review will summarize key findings from a few of the relevant studies available and discuss the implications of these associations. I. Association between Sarcopenia and Inflammation The association between sarcopenia and inflammation is complex and multi-faceted. Several mechanisms link the two components. Chronic Inflammation Chronic inflammation, often referred to as "inflammaging," is a hallmark of aging. It involves an increased production of pro-inflammatory cytokines and a decline in the regulation of the anti-inflammatory response. This chronic inflammatory state can contribute to the development and progression of sarcopenia as shown in Fig. 1 as described by American Heart Association. 1 The image presents a comparative medical illustration of normal muscle tone versus sarcopenia. On the right, a healthy man walking symbolizes active aging. His muscle cross-section reveals well-organized Type 1 and Type 2 fibers, supported by intact motor neurons, balanced protein metabolism, and normal mitochondrial function. On the left, the same muscle appears frail and inactive, depicting sarcopenia. The corresponding muscle cross-section shows muscle atrophy, loss of Type 2 fibers, mitochondrial dysfunction, inflammation, oxidative stress, apoptosis, and motor neuron degeneration. Additional factors such as satellite cell dysfunction, hormonal imbalance, and microvascular changes highlight the progressive nature of sarcopenia. There are various factors involved for inducing chronic inflammatory state, which include as mentioned below: Cytokines 2 - Proinflammatory cytokines like TNF-α, IL-6, and IL-1β promote and sustain systemic inflammation. Insulin Resistance 3 − Impaired insulin signalling increases inflammatory mediator release and promotes chronic inflammation. Oxidative Stress 4 - Excess free radicals damage cells and activate inflammatory pathways. Physical Inactivity 5 - Sedentary behaviour reduces anti-inflammatory cytokine production and increases inflammatory markers. Nutritional Factors 6 - Diets high in sugars, trans fats, and processed foods trigger inflammatory responses. Hormonal Changes 7 - Altered levels of hormones like cortisol and oestrogen can dysregulate immune function and increase inflammation. It's important to note that while inflammation is associated with sarcopenia, causation is not always straightforward, and the relationship may be bidirectional. Sarcopenia itself, especially when associated with physical inactivity and poor nutrition, can contribute to inflammation. II. Sarcopenia and Visceral adiposity Sarcopenia and visceral adiposity are often interconnected in older adults. As people age, they tend to lose muscle mass (sarcopenia) and may simultaneously experience an increase in visceral fat. 7 This combination of muscle loss and increased visceral fat is particularly concerning for health because it can lead to a condition called "sarcopenic obesity" or "muscle-fat infiltration." Sarcopenic obesity is associated with an elevated risk of chronic diseases and adverse health outcomes. 8 The exact mechanisms linking sarcopenia and visceral adiposity are complex and not fully understood, but they likely involve factors such as inflammation, hormonal changes, and decreased physical activity. III. Visceral adiposity and Hypertension Visceral obesity is also linked to increased risk of hypertension, diabetes, atherosclerosis, and CVD and the mechanisms include proinflammatory activity, adipokine production, and worsened insulin sensitivity. Association of visceral adiposity and hypertension are depicted in Table 1 . This table illustrates multiple mechanisms by which visceral fat contributes to hypertension. It highlights metabolic, hormonal, and mechanical factors including inflammation, insulin resistance, dyslipidemia, and hormonal changes like increased aldosterone. Visceral fat also stimulates the sympathetic nervous system, raises stress hormone levels, and affects the renin-angiotensin system, all elevating blood pressure. Mechanical compression of organs, endothelial dysfunction, and sleep apnea—often linked to obesity—further worsen hypertension. Each factor plays a role in disrupting cardiovascular regulation, emphasizing visceral fat as a critical risk element for developing high blood pressure and associated cardiovascular diseases. Table 1 Association between Hypertension and Visceral Adiposity 31 Mechanism Explanation Inflammation Visceral fat is metabolically active and releases inflammatory substances (cytokines), leading to chronic low-grade inflammation and contributing to hypertension. Insulin Resistance Excess visceral fat leads to insulin resistance, which is linked to hypertension and cardiovascular diseases. Dyslipidemia Accumulation of visceral fat alters lipid profiles (increased triglycerides, decreased HDL cholesterol), which is a known risk factor for hypertension and cardiovascular disease. Hormonal Changes Visceral fat increases aldosterone production, affecting salt and water balance in the kidneys and raising blood pressure. Increased Sympathetic Activity Stimulates the sympathetic nervous system, increasing stress hormones (e.g., adrenaline, norepinephrine), which elevate heart rate and blood pressure. Mechanical Compression Excess visceral fat compresses the kidneys and abdominal organs, contributing to increased blood pressure. Endothelial Dysfunction Visceral fat impairs endothelial function in blood vessels, affecting vessel dilation and contributing to high blood pressure. Renin-Angiotensin System Influences the RAAS (renin-angiotensin-aldosterone system), a key regulator of blood pressure; dysregulation contributes to hypertension. Sleep Apnea Obesity/visceral adiposity is linked to sleep apnea, causing breathing disruptions during sleep and elevated blood pressure. IV. Interrelationship Between Inflammation, Sarcopenia and Hypertension The interrelationship between inflammation, sarcopenia, and hypertension is complex and multifaceted. While they are distinct medical conditions, they can influence and exacerbate each other in various ways. As it is already stated above, how inflammation is associated with sarcopenia and this inflammation can trigger hypertension. Here's an overview of how these three conditions is interconnected: IV (a) Inflammation and Hypertension: As shown in schematic representation below in Fig. 2 , Chronic inflammation can contribute to the development of hypertension (high blood pressure). Inflammatory processes can damage blood vessels, impair endothelial function, and promote atherosclerosis (hardening and narrowing of arteries), all of which can increase blood pressure. 18 This figure highlights the complex relationship between sarcopenia and hypertension mediated by inflammation and immune responses. Proinflammatory cytokines contribute to kidney damage, hypertension, and sarcopenia. Macrophages and T lymphocytes play roles in controlling blood pressure and preventing organ damage. Adiposity releases inflammatory substances like cytokines, resistin, leptin, and adiponectin, influencing inflammation and sarcopenia. The innate and adaptive immune systems interact via cytokines, affecting renal function and hypertension. This bidirectional interplay emphasizes how inflammation, immune regulation, and metabolic factors collectively contribute to sarcopenia and hypertension, illustrating a cycle of mutual influence and health impact. IV (b) Sarcopenia and Hypertension: As shown in Fig. 3 , aging leads to chronic inflammation, increasing cytokines (IL-6, IL-8, CRP, TNF, TWEAK) and reducing anti-inflammatory markers (IL-10, IL-15). This causes muscle malfunction, leading to sarcopenia, a condition marked by reduced muscle mass, strength, and physical performance. Hand grip strength is a key indicator of muscle strength and sarcopenia. Declining grip strength reflects loss of muscle function, predicting poor outcomes like hospitalization, disability, and mortality. Thus, hand grip strength serves as a simple, reliable clinical marker to assess sarcopenia risk and its severe consequences in the elderly. Sarcopenia can also impact the regulation of blood sugar levels, which can indirectly affect blood pressure regulation. 22 Sarcopenic obesity has greater risk of hypertension than obese or sarcopenia subjects. Sarcopenia is an age-related muscle disease, associated with higher mortality and morbidity risk. Handgrip dynamometer can be an useful tool to identify sarcopenia and the results can be correlated with body composition analyser in terms of muscle mass present and adiposity. A handgrip dynamometer is a simple device used to measure the maximum force a person can generate while squeezing the handle of the dynamometer with their hand by using cost-effective and easily applicable EWGSOP algorithm. The EWGSOP algorithm refers to the diagnostic algorithm developed by the European Working Group on Sarcopenia in Older People (EWGSOP) for identifying sarcopenia. It is a widely accepted framework to assess sarcopenia based on muscle strength, muscle quantity/quality, and physical performance. This measurement is often referred to as handgrip strength (HGS) and is an important indicator of overall upper body strength. Handgrip dynamometers are commonly used in various settings, including healthcare, to assess an individual's physical fitness and health. Here are some of the key applications of handgrip dynamometers in healthcare that can prove beneficial for the proposed research: Physical Fitness Assessment: Handgrip strength can provide valuable information about muscle strength and endurance, which are important for performing daily activities and maintaining independence 23 . Predicting Health Outcomes: Research has shown that handgrip strength can be a predictor of various health outcomes. For example, lower handgrip strength has been associated with a higher risk of mortality, cardiovascular disease, and disability in older adults. 24 Assessing Nutritional Status: Malnutrition and inadequate dietary intake can lead to a decline in muscle strength, and handgrip dynamometers are used to monitor changes in nutritional status. Screening for Frailty: Frailty is a clinical syndrome characterized by decreased physical reserve and an increased vulnerability to adverse health outcomes. Handgrip strength can help identify individuals at risk of frailty 25 . V. Association of Handgrip Strength with Blood Pressure, Waist – Hip Ratio, Visceral Adiposity Index, CRP Chao Ji et.al, stated in the year 2018 that increased handgrip strength is associated with higher DBP in men and women. In men, especially overweight and obese men, strong handgrip strength may be associated with higher risk of hypertension. 26 On the contrary research by Chang et. al, indicated that individuals with higher handgrip strength often have a lower WHR, suggesting that greater muscle mass may be associated with reduced central adiposity. Lower WHR is generally considered more favorable for metabolic health and reduced risk of cardiovascular diseases. 27 Garcia et al has stated that higher handgrip strength is linked to lower Visceral Adiposity Index (VAI) values. This relationship suggests that muscle strength may help mitigate the adverse effects of visceral fat accumulation, potentially reducing the risk of insulin resistance and metabolic syndrome. 28 C-reactive protein (CRP) is a marker of systemic inflammation and is associated with various chronic diseases. Norman et al (2014), have explored the relationship between handgrip strength and CRP levels and suggested that individuals with higher handgrip strength tend to have lower CRP levels, indicating that muscle strength may have anti-inflammatory effects after conducting study on 620 hospitalized patients (56.4 ± 15.9 years old, 52.3% men) 29 . This is important because chronic inflammation is a key factor in the development of many diseases, including cardiovascular diseases and metabolic disorders. In summary, the literature suggests a significant association between handgrip strength and various health parameters among the adult population. Higher handgrip strength is generally linked to lower blood pressure, a favorable waist-hip ratio, reduced visceral adiposity, and lower C-reactive protein levels. VI. Methodology Study Design & Setting: This cross-sectional, observational study included 458 hospitalized subjects (Male & Female), age 18–80 years who were willing to participate were included in the study after taking informed consent in vernacular language. Sample size was calculated using standard formula with 5% allowable error. Study was conducted at location Peerless Hospital from February 2022 to March 2023. Purposive sampling technique was adopted during sample collection process. Ethical clearance was obtained from the Ethics Committee of Peerless Hospital and B.K. Roy Research Centre, Kolkata, India (PHH&RCLCREC/4020/2023). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institution research committee and the 1964 Helsinki Declaration and its later amendments for comparable ethical standards. Informed written consent was obtained before the study was conducted in vernacular language. Elderly women having a history of thyroid dysfunction, on hormonal replacement therapy, with amenorrhea due to any pathological cause or surgery, on Vitamin D supplementation, with physically or mentally challenged, and with noncooperative in nature were excluded from the study. Data Collection and Anthropometric measurements: Sample size was calculated using 95% confidence interval, 5% margin of error, prevalent hypertensive adult population of West Bengal 42% (Ghosh, R. et al 2019). Estimated sample to be collected was 375 and total data finalized for analysis was 458 after data validation. Information on clinical history such as history of stroke and taking anti-hypertensive medication and habitual status were obtained by trained interviewers. Blood reports were accessed from hospital database, and CRP and ESR were recorded along with Hemoglobin. Systolic and diastolic blood pressures on the right arm were recorded by trained examiners using a blood pressure measuring device (HEM-907; Omron, Kyoto, Japan) after at least 5 min of rest in a sitting position. Hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. Systolic hypertension was defined as systolic blood pressure ≥ 140 mmHg and diastolic hypertension as diastolic blood pressure ≥ 90 mmHg. Height in bare feet was measured using stadiometer. Body weight and body composition analysis was done using an automatic body composition analyzer (Activex). Body mass index (BMI) was calculated as (weight, kg)/(height, m) 2 . Waist Hip ratio, Waist circumference and calf circumference were measured by using measuring tape. Skin fold thickness was measured by skin fold caliper. Camry® (Model EH 101) Hand Dynamometer was used to test the grip of the respondents. The procedure was explained, and the technique was demonstrated to each participant based on the standard procedure recommended by EWGSOP criteria. Participants were positioned in a straight back chair with both feet flat on the floor. For the arm to be tested, the elbow was flexed to 90°, the forearm in neutral position, wrist in 0–15° of extension, and 0–15° of ulnar deviation. The fingers were flexed as needed for maximal contraction. A verbal command of “Squeeze! Harder! Harder! Relax!” was given by the examiner. Three consecutive trials were conducted to measure the average (mean) HGS with 1-minute rest in-between each trial. Values of Hand grip strength was recorded as per the display of the dynamometer and was interpretated as per the manufacturer’s gradation of hand grip strength. Questionnaire used was validated by the medical expert team. MUST (Malnutrition Universal Screening Tool was used to measure the presence of malnutrition.. Statistical analysis - All the statistical analysis was done in SPSS software, version 19.0 (statistical package for the social sciences INC, Chicago, IL, USA) VII. Results Result 1 - The distribution of hand grip strength among hospitalized patients has been represented in the above pie chart. It is observed that 78% of patients had weak hand grip strength, 17% had normal grip strength, 5% had very weak grip strength among N = 458 patients in which number of male and female patients are 222 and 236 respectively. Interpretation : A large majority (83%) of hospitalized individuals demonstrated below-normal grip strength, indicating a high prevalence of sarcopenia or muscle weakness, which may relate to underlying health conditions or aging-related muscle deterioration. Result 2 - Table 2 - Distribution of hand grip strength (HGS) according to their Blood pressure, waist hip ratio, Visceral Adiposity (VA), ESR, CRP values (N=458) Parameters HGS (kg) (N = 458) Statistical Analysis Normal (range) N (%) Weak range N (%) Poor Range) N (%) Total N% Male(N = 222) Female (N = 236) HGS (kg) Median (IQR) Kruskal Wallis-test (p) Spearman Correlation (p) HGS (kg) Median (IQR) Kruskal Wallis-test (p) Spearman Correlation (p) Age 18–45 45–60 60–80 28(25.0) 26(17.23) 23(11.86) 82(72.32) 119(78.81) 156(80.41) 3(2.68) 6(3.97) 13(6.70) 113(100) 151(100) 194(100) 13 (6) 14 (4) 13 (4) 26.836 (0.00) 0.348 (0.00) 16 (2.75) 14 (4) 13 (3.75) 3.216 (0.20) 0.232 (0.07) Blood Pressure Low Normal- Elevated Hypertension stage 1 Hypertension stage 2 Hypertensive crisis 3(17.64) 52(16.35) 4(50.00) 15(20.83) 3(7.32) 0() 12(70.59) 255(79.80) 3(37.5) 53(73.61) 34(82.93) 0() 2(11.76) 11(3.46) 1(12.5) 4(5.56) 4(9.76) 0() 17(100) 318(100) 8(100) 72(100) 41(100) 0(100) 12 (6.75) 13.5 (4) 13 (3.5) 13 (4) 13 (5) 18 (18) Systole 3.464 (0.17) Diastole 3.714 (0.15) Systole 0.088 (0.19) Diastole -0.080 (0.23) 26 (26) 14 (4) 0 (0) 14 (3.3) 13 (8.75) 8 (5) Systole 0.698 (0.70) Diastole 3.173 (0.20) Systole 0.089 (0.49) Diastole -0.230 (0.07) VA 0 1 71(16.82) 6(17.14) 351(83.18) 6 (17.14) 0(0.00) 24(68.57) 422(100) 36(100) 13 (4) 12 (10) 8.321 (0.01) -0.194 (0.00) 14 (4) 12 (12) 0.114 (0.94) -0.005 (0.96) WHR 0 1 2 0(0.00) 18(21.95) 59(15.74) 1(100) 60(73.17) 296(78.93) 0(0.0) 4(4.88) 20(5.33) 1(100) 82(100) 375(100) 13 (5.5) 13 (4) 14 (4) 1.796 (0.40) 0.049 (0.46) 0 (0) 0 (0) 14 (4) 4.054 (0.13) 0.256 (0.04) ESR value (N = 263) 0 1 11(13.92) 24(13.04) 64(81.01) 146 (79.35) 4(5.06) 14(7.61) 79(100) 184(100) 14 (5) 14 (5) 0.068 (0.96) 0.016 (0.85) 14 (4.75) 14 (3.25) 4.982 (.08) 0.184 (0.02) C-RP value (N = 109) 1 2 2(40.0) 15(14.42) 3(60.0) 82 (78.85) 0(0.0) 7(6.73) 5(100) 104(100) 16 (5.5) 14 (4) 4.306 (0.96) 0.205 (0.16) 14.5 (2) 14 (4) 3.039 (0.21) 0.065 (0.62) ** The result is significant p < 0.05 mentioned in bold Table 3 Distribution of hand grip strength (HGS) according to their Blood pressure, waist hip ratio, Visceral Adiposity (VA), ESR, CRP values (N=458) Statistical Test Parameter Interpretation Chi-Square (42.55, p = 0.01) Blood Pressure & HGS Statistically significant; blood pressure is associated with lower HGS Odds Ratio (1.10, CI: 0.64–1.91) Blood Pressure & HGS Indicates slight increased odds of HGS reduction with hypertension (not strongly significant due to wide CI) Kruskal-Wallis Test (p = 0.01) Visceral Adiposity Level & HGS in males Statistically significant negative association Odds Ratio (0.611, CI: 0.02–15.14) WHR in females Positive correlation with HGS (p = 0.04) Interpretation : Hypertension is significantly associated with reduced HGS, indicating cardiovascular health may influence muscle strength. Visceral adiposity negatively impacts HGS in males, emphasizing the metabolic impact on muscle quality. Waist-Hip Ratio (WHR) in females shows a significant positive correlation with HGS, though the odds ratio's wide CI suggests further study is needed. As the data set was skewed, Median & IQR (Interquartile range) were represented as measures of central tendency. Considering blood pressure and HGS, significant statistical associations were observed (Chi-square value: 42.55, p = 0.01), the Odds Ratio (OR) for hypertension and HGS was 1.10 (95% of Confidence Interval (CI)0.64–1.91). But according to Kruskal Wallis test conducted in case of both male and female respondents there is no significant association observed. Considering Spearman's correlation in case of Diastolic pressure there is negative correlation existed with HGS (Both male and female) although it was insignificant (Tables 2 and 3). VA has an insignificant statistical association with HGS (Chi-square:6.98, p = 0.07) and OR was 0.988 (95% of CI 0.39–2.46). In case of male respondents there is significant statistical (Kruskal Wallis test) association between VA and HGS (p = 0.01), also it is significantly negatively correlated with HGS(p = 0.0) (Table 1 ). Again, considering WHR there is 0.21% were only in having normal WHR whereas 17.90% were at moderate risk and 99.78% were at high-risk group and OR was 0.611 (95% of CI 0.02–15.14). In case of female respondents there is significant positive correlation with HGS(p = 0.04). Considering ESR value there is significant statistical association with HGS (Chi square value:108.58, p = 0.0) and OR was 0.92(95% CI 0.43–1.99). Considering CRP value there is no significant association or correlation observed in case of HGS among both male and female (Chi-square value:2.37, p = 0.12). The OR was 0.11(0.01–0.72) more sample size may give one proper indication in this case (Tables 2 & 3). Table 4 HGS and Inflammatory Markers (ESR and CRP) Test Marker Result Chi-square (108.58, p = 0.0) ESR Strong, significant statistical association OR = 0.92 (CI: 0.43–1.99) ESR Suggests mild inverse relation, though not definitive Chi-square (2.37, p = 0.12) CRP No statistically significant association OR = 0.11 (CI: 0.01–0.72) CRP Despite low OR, high p-value weakens the association Interpretation : ESR (Erythrocyte Sedimentation Rate) shows a highly significant association with HGS (p = 0.0), linking systemic inflammation with reduced muscle strength. CRP (C-reactive protein) does not show a significant association, though the odds ratio hints at a potential protective trend that warrants further investigation. There is substantial evidence linking reduced hand grip strength (as a marker of sarcopenia) with hypertension, visceral adiposity, and inflammation (ESR). 83% of hospitalized patients had compromised HGS, underlining its clinical importance. HGS serves as a simple, non-invasive and valuable tool for detecting functional decline and predicting related complications like hospitalization, disability, and mortality. VIII. Significance Conducting a comprehensive assessment of the association of handgrip strength with various health parameters, such as blood pressure, waist-hip ratio, visceral adiposity, C-reactive protein (CRP) levels, and erythrocyte sedimentation rate (ESR) levels, can have several significant implications and benefits: Health Monitoring : By examining the association of HGS with these other health parameters, one can get a more holistic picture of an individual's health. Cardiovascular Health : Understanding how handgrip strength relates to blood pressure can help identify potential risk factors for heart disease and hypertension. Obesity and Body Composition : Exploring the relationship between Waist -hip ratio and visceral adiposity, use of handgrip strength can shed light on the role of muscle strength in maintaining a healthy body composition and potentially reducing the risk of obesity-related health issues. Inflammation and Immune Response : Investigating the association between handgrip strength and the inflammatory markers like CRP and ESR markers can help to understand the potential anti-inflammatory effects of muscular strength and physical fitness. Functional Independence : Handgrip strength is not only an indicator of physical fitness but also a predictor of functional independence in older adults. Understanding its connection with various health parameters can inform strategies for maintaining mobility and quality of life as people age. Intervention Strategies : If the study identifies significant associations between handgrip strength and the mentioned health parameters, it can provide a basis for developing targeted interventions. For example, if low handgrip strength is associated with high blood pressure or increased inflammation, strength training programs could be recommended as a preventive or therapeutic measure. Public Health : Findings from this study could have implications for public health policies and recommendations. It may help in promoting the importance of maintaining muscular strength and overall physical fitness as part of a healthy lifestyle. In conclusion, conducting a comprehensive assessment of the association of handgrip strength with various health parameters has the potential to enhance our understanding of the role of muscular strength in overall health and well-being. This knowledge can inform healthcare practices, interventions, and public health strategies to promote healthier lifestyles and reduce the risk of various health conditions. IX. Possible outcomes The bidirectional association between sarcopenia and cardiovascular disorders, particularly hypertension, can be effectively assessed using the cost-effective and easily applicable EWGSOP algorithm. This approach allows for the evaluation of sarcopenia and its link to hypertension at both the community level and healthcare settings, reducing the need for specialized skills and enabling widespread screening and diagnosis. This approach may redirect the thoughts of policy makers to incorporate assessment of Handgrip strength, Waist Hip Ratio, Body composition analysis along with assessment of biochemical parameters like C- Reactive Protein and Erythrocyte Sedimentation Rate at primary health care setting and all treatment facilities as a screening tool which may predict the prognosis of hypertension and its association with sarcopenia and may help to develop strategies towards preventing debilitating effect of sarcopenia associated with hypertension and other cardiovascular events. In healthcare, handgrip dynamometers are relatively inexpensive, portable, and easy to use, making them a practical tool for assessing and monitoring physical fitness, disease outcome and health and identifying the population at risk. Declarations Ethical approval – Ethical clearance was obtained from the Ethics Committee of Peerless Hospital and B.K. Roy Research Centre, Kolkata, India (PHH&RCLCREC/4020/2023). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institution research committee and the 1964 Helsinki Declaration and its later amendments for comparable ethical standards. Consent to participate - Informed written consent from participants was obtained in vernacular language before the study was conducted. Funding Declaration: No funding received by any authors for the work. Clinical trial number: Not applicable. Consent to Publish declaration: Manuscript Title: Exploring the Association Between Hand Grip Strength and Cardiometabolic Health Markers in Hospitalized Adults: A Cross-Sectional Study from Kolkata, India Journal Name: Discover Public Health As the corresponding author, I confirm on behalf of all co-authors that: We have read and understood the journal’s policies on ethics and consent. We affirm that this manuscript is original, has not been published previously, and is not currently under consideration for publication elsewhere. All authors have significantly contributed to the manuscript and agree to its submission and potential publication in Discover Public Health . We give full consent to the publisher (Springer Nature) to publish the above-mentioned manuscript, including any tables, figures, and supplementary materials, under the journal’s terms and conditions. All data presented in the manuscript were collected in compliance with institutional ethical standards and informed consent was obtained from all participants involved in the study. Corresponding Author: Bijoya Bhattacharjee Institutional Affiliation –Department of Food and Nutrition, Swami Vivekananda University Barrackpore, India; Department of Dietetics and Applied Nutrition, Amity University Kolkata, India Email Address – [email protected] Date – 22.06.2025 On behalf of all authors References Ferrucci L, Fabbri E. Inflammageing: chronic inflammation in ageing, cardiovascular disease, and frailty. Nat Rev Cardiol. 2018;15(9):505–22. 10.1038/s41569-018-0064-2 . PMID: 30065258; PMCID: PMC6146930. Nara H, Watanabe R. Anti-Inflammatory Effect of Muscle-Derived Interleukin-6 and Its Involvement in Lipid Metabolism. Int J Mol Sci. 2021;22(18):9889. 10.3390/ijms22189889 . PMID: 34576053; PMCID: PMC8471880. Dalle S, Rossmeislova L, Koppo K. The Role of Inflammation in Age-Related Sarcopenia. Front Physiol. 2017;8:1045. 10.3389/fphys.2017.01045 . PMID: 29311975; PMCID: PMC5733049. Meng SJ, Yu LJ. Oxidative stress, molecular inflammation and sarcopenia. 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Relevance of Sympathetic Nervous System Activation in Obesity and Metabolic Syndrome. J Diabetes Res. 2015;2015:341583. 10.1155/2015/341583 . Epub 2015 Apr 30. PMID: 26064978; PMCID: PMC4430650. Hall ME, do Carmo JM, da Silva AA, Juncos LA, Wang Z, Hall JE. Obesity, hypertension, and chronic kidney disease. Int J Nephrol Renovasc Dis. 2014;7:75–88. 10.2147/IJNRD.S39739 . Jehan S, Zizi F, Pandi-Perumal SR, Wall S, Auguste E, Myers AK, Jean-Louis G, McFarlane SI. Obstructive Sleep Apnea and Obesity: Implications for Public Health. Sleep Med Disord. 2017;1(4):00019. Epub 2017 Dec 12. PMID: 29517065; PMCID: PMC5836788. Thethi T, Kamiyama M, Kobori H. The link between the renin-angiotensin-aldosterone system and renal injury in obesity and the metabolic syndrome. Curr Hypertens Rep. 2012;14(2):160–9. 10.1007/s11906-012-0245-z . PMID: 22302531; PMCID: PMC3337881. Romero-Corral A, Sert-Kuniyoshi FH, Sierra-Johnson J, Orban M, Gami A, Davison D, Singh P, Pusalavidyasagar S, Huyber C, Votruba S, Lopez-Jimenez F, Jensen MD, Somers VK. Modest visceral fat gain causes endothelial dysfunction in healthy humans. J Am Coll Cardiol. 2010;56(8):662–6. PMID: 20705223; PMCID: PMC3951914. Rafieian-Kopaei M, Setorki M, Doudi M, Baradaran A, Nasri H. Atherosclerosis: process, indicators, risk factors and new hopes. Int J Prev Med. 2014;5(8):927–46. PMID: 25489440; PMCID: PMC4258672. Tanase DM, Gosav EM, Radu S, Ouatu A, Rezus C, Ciocoiu M, Costea CF, Floria M. Arterial Hypertension and Interleukins: Potential Therapeutic Target or Future Diagnostic Marker? Int J Hypertens. 2019;2019:3159283. 10.1155/2019/3159283 . PMID: 31186952; PMCID: PMC6521461. Martinez-Quinones P, McCarthy CG, Watts SW, Klee NS, Komic A, Calmasini FB, Priviero F, Warner A, Chenghao Y, Wenceslau CF. Hypertension Induced Morphological and Physiological Changes in Cells of the Arterial Wall. Am J Hypertens. 2018;31(10):1067–78. 10.1093/ajh/hpy083 . PMID: 29788246; PMCID: PMC6132119. Xing E, Wan C. Prevalence of and factors associated with sarcopenia among elderly individuals with hypertension. J Int Med Res. 2022;50(7):3000605221110490. 10.1177/03000605221110490 . PMID: 35822256; PMCID: PMC9284226. Mesinovic J, Zengin A, De Courten B, Ebeling PR, Scott D. Sarcopenia and type 2 diabetes mellitus: a bidirectional relationship. Diabetes Metab Syndr Obes. 2019;12:1057–72. 10.2147/DMSO.S186600 . PMID: 31372016; PMCID: PMC6630094. Zaccagni L, Toselli S, Bramanti B, Gualdi-Russo E, Mongillo J, Rinaldo N. Handgrip Strength in Young Adults: Association with Anthropometric Variables and Laterality. Int J Environ Res Public Health. 2020;17(12):4273. 10.3390/ijerph17124273 . PMID: 32549283; PMCID: PMC7345833. Bohannon RW. Grip Strength: An Indispensable Biomarker For Older Adults. Clin Interv Aging. 2019;14:1681–1691. doi: 10.2147/CIA.S194543. PMID: 31631989; PMCID: PMC6778477. Sousa-Santos AR, Amaral TF. Differences in handgrip strength protocols to identify sarcopenia and frailty - a systematic review. BMC Geriatr. 2017;17:238. https://doi.org/10.1186/s12877-017-0625-y . Ji C, Zheng L, Zhang R, Wu Q, Zhao Y. Handgrip strength is positively related to blood pressure and hypertension risk: results from the National Health and nutrition examination survey. Lipids Health Dis. 2018;17(1):86. 10.1186/s12944-018-0734-4 . PMID: 29665844; PMCID: PMC5904981. Chang CS, Chang YF, Liu PY, Wu SJ, Chiu CJ, Chen CY, Wu CH. Interaction of central obesity and sarcopenia on nutritional status in the community-dwelling older people. Arch Gerontol Geriatr. 2020 Mar-Apr;87:104003. 10.1016/j.archger.2019.104003 . Epub 2019 Dec 17. Erratum in: Arch Gerontol Geriatr. 2020 Sep - Oct;90:104153. PMID: 31874330. Garcia-Hermoso A, Tordecilla-Sanders A, Correa-Bautista JE, Peterson MD, Izquierdo M, Prieto-Benavides D, Sandoval-Cuellar C, González-Ruíz K, Ramírez-Vélez R. Handgrip strength attenuates the adverse effects of overweight on cardiometabolic risk factors among collegiate students but not in individuals with higher fat levels. Sci Rep. 2019;9(1):6986. 10.1038/s41598-019-43471-5 . PMID: 31061449; PMCID: PMC6503140. Norman K, Stobäus N, Kulka K, et al. Effect of inflammation on handgrip strength in the non-critically ill is independent from age, gender and body composition. Eur J Clin Nutr. 2014;68:155–8. https://doi.org/10.1038/ejcn.2013.261 . Ghosh R, Maulik S, De S, Tikader T, Jha SN, Mondal S, Mallik S, Banerjee M. Strengthening opportunistic screening for hypertension: report from a tertiary care institution in a district of West Bengal, India. Int J Community Med Public Health. 2019;6(9):3878–85. https://doi.org/10.18203/2394-6040.ijcmph20193987 . Goswami B, Reang T, Sarkar S, Sengupta S, Bhattacharjee B. Role of body visceral fat in hypertension and dyslipidemia among the diabetic and nondiabetic ethnic population of Tripura: A comparative study. J Family Med Prim Care. 2020;9(6):2885–90. https://doi.org/10.4103/jfmpc.jfmpc_187_20 . Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6762494","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":485194001,"identity":"cf60b499-f064-4ba1-b8e1-b92f74685002","order_by":0,"name":"Bijoya Bhattacharjee","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9ElEQVRIiWNgGAWjYBACA2aGBBCdYAAiPwAxGzvxWpgZG2eAtDAT0gKlwVqaeUBMQlrM2RkePuapYcgzZz9//LHNr23yfMwMjB8+5uDWYtnMkGzMc4yh2LInmbE5t++2YRszA7PkzG14HHaYIU2ah40hccMBkJae24xALWzMvAS1/ANqOf+Ysdmy57Y9cVp424BabgBtYfhxO5GgFpBfDOf2SRQb3HhsOLO34XZyGzDk8PrFnP9M4oM332zyDM4nPvjw489t2/ntzQc/fMSjhYGBJ4GJh0ECwmZsA5MN+NQDAfsBxh9wzh8CikfBKBgFo2BEAgCa+0/FaAu8dwAAAABJRU5ErkJggg==","orcid":"","institution":"Swami Vivekananda University","correspondingAuthor":true,"prefix":"","firstName":"Bijoya","middleName":"","lastName":"Bhattacharjee","suffix":""},{"id":485194002,"identity":"d0b709ea-624e-49cd-ac91-e0073dc06b8e","order_by":1,"name":"Manisha Maity","email":"","orcid":"","institution":"Department of Food and Nutrition, Swami Vivekananda University","correspondingAuthor":false,"prefix":"","firstName":"Manisha","middleName":"","lastName":"Maity","suffix":""},{"id":485194003,"identity":"2fe83479-e8db-4f04-bc97-e2c52bea3191","order_by":2,"name":"Subhrojyoti Bhowmick","email":"","orcid":"","institution":"Peerless Hospital and B.K. Roy Research Centre","correspondingAuthor":false,"prefix":"","firstName":"Subhrojyoti","middleName":"","lastName":"Bhowmick","suffix":""},{"id":485194004,"identity":"6112ed7f-d01c-47de-86c0-c5cb5f7cc406","order_by":3,"name":"Abisa Sinha Adhikary","email":"","orcid":"","institution":"Amity University Kolkata","correspondingAuthor":false,"prefix":"","firstName":"Abisa","middleName":"Sinha","lastName":"Adhikary","suffix":""},{"id":485194005,"identity":"336d23bc-61e9-472b-80c0-853063a1da66","order_by":4,"name":"Debkumar Ghosh","email":"","orcid":"","institution":"Eminent College of Management and Technology","correspondingAuthor":false,"prefix":"","firstName":"Debkumar","middleName":"","lastName":"Ghosh","suffix":""}],"badges":[],"createdAt":"2025-05-27 20:53:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6762494/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6762494/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12982-026-01912-3","type":"published","date":"2026-04-19T15:58:05+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":87039167,"identity":"0ad37b6c-a353-4656-b33b-2f1a6625cbe5","added_by":"auto","created_at":"2025-07-18 13:36:52","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":775640,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eInflammation induced development and progression of sarcopenia described by American Heart Association\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6762494/v1/6e33e2b317a89521be9b65f3.png"},{"id":87036396,"identity":"44e8840e-d527-481c-aa02-a2392b61721a","added_by":"auto","created_at":"2025-07-18 13:20:51","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":164451,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eInterplay Between Inflammation, Immune Response, and Adiposity in the Development of Sarcopenia and Hypertension (\u003c/strong\u003e\u003c/em\u003e\u003csup\u003e\u003cem\u003e\u003cstrong\u003e19,20\u003c/strong\u003e\u003c/em\u003e\u003c/sup\u003e\u003cem\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6762494/v1/7374758d8b1beca34356e580.png"},{"id":87036394,"identity":"2f88d203-6b1a-4fef-bbf1-c810b46fcb45","added_by":"auto","created_at":"2025-07-18 13:20:51","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":42762,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMechanistic Pathway from Aging-Induced Inflammation to Sarcopenia and Its Adverse Health Outcomes: Emphasis on Hand Grip Strength as a Key Indicator \u003c/strong\u003e\u003c/em\u003e\u003csup\u003e\u003cem\u003e\u003cstrong\u003e21\u003c/strong\u003e\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6762494/v1/cefd4e1040c087601224b23b.png"},{"id":87036398,"identity":"dde6575a-e485-4071-88c2-a52953384ac5","added_by":"auto","created_at":"2025-07-18 13:20:51","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":28816,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in the Results section.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6762494/v1/766432c10030f774ca3a4cf0.png"},{"id":107350753,"identity":"1f9212eb-f8de-49e0-9cab-213c2d1ef262","added_by":"auto","created_at":"2026-04-20 16:03:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1822498,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6762494/v1/be54cfb1-405b-45c4-a367-6446e04cdbca.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exploring the Association Between Hand Grip Strength and Cardiometabolic Health Markers in Hospitalized Adults: A Cross-Sectional Study from Kolkata, India","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe global burden of hypertension is increasing steadily due to high regional prevalence and aging population. The World Health Organization estimates 1.4\u0026nbsp;billion people worldwide have hypertension. Preventing and treating hypertension is essential for preventing cardiovascular complications.\u003c/p\u003e\u003cp\u003eOn the other hand, sarcopenia is a medical condition characterized by the progressive loss of skeletal muscle mass and function as a person ages. Sarcopenia is typically associated with aging, but it can also be influenced by factors such as physical inactivity, poor nutrition, and certain medical conditions.\u003c/p\u003e\u003cp\u003eHandgrip strength, a simple yet informative measure of muscular function, has gained significant attention in recent years due to its potential as a predictor of overall health and longevity. This comprehensive assessment aims to explore the associations between handgrip strength and these key health indicators, shedding light on their interplay and implications for health and disease.\u003c/p\u003e\n\u003ch3\u003eObjectives of the study\u003c/h3\u003e\n\u003cp\u003eThe primary objective of this study is to comprehensively evaluate the relationship between skeletal muscle strength, as measured by handgrip strength (HGS), and key cardiometabolic risk factors. Specifically, the study aims to investigate the association between hypertension, visceral adiposity, and muscle mass; to assess the prevalence and relevance of inflammatory markers (CRP, ESR) and complete blood count (CBC) in relation to skeletal muscle status; and to explore how these inflammatory markers interact with cardiovascular risk factors and influence muscle strength in the studied adult population.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eReview of literature:\u003c/h2\u003e\u003cp\u003eFrom world perspective and from Indian context there are limited studies depicting association of handgrip strength with blood pressure and other parameters.\u003c/p\u003e\u003cp\u003eA literature review on the association of handgrip strength with blood pressure, waist-hip ratio, visceral adiposity index, and C-reactive protein among the adult population reveals a growing body of research that underscores the importance of handgrip strength as a potential predictor and modulator of various health parameters. This review will summarize key findings from a few of the relevant studies available and discuss the implications of these associations.\u003c/p\u003e\u003c/div\u003e\n"},{"header":"I. Association between Sarcopenia and Inflammation","content":"\u003cp\u003eThe association between sarcopenia and inflammation is complex and multi-faceted. Several mechanisms link the two components.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eChronic Inflammation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChronic inflammation, often referred to as \"inflammaging,\" is a hallmark of aging. It involves an increased production of pro-inflammatory cytokines and a decline in the regulation of the anti-inflammatory response. This chronic inflammatory state can contribute to the development and progression of sarcopenia as shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e as described by American Heart Association.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e The image presents a comparative medical illustration of normal muscle tone versus sarcopenia. On the right, a healthy man walking symbolizes active aging. His muscle cross-section reveals well-organized Type 1 and Type 2 fibers, supported by intact motor neurons, balanced protein metabolism, and normal mitochondrial function. On the left, the same muscle appears frail and inactive, depicting sarcopenia. The corresponding muscle cross-section shows muscle atrophy, loss of Type 2 fibers, mitochondrial dysfunction, inflammation, oxidative stress, apoptosis, and motor neuron degeneration. Additional factors such as satellite cell dysfunction, hormonal imbalance, and microvascular changes highlight the progressive nature of sarcopenia.\u003c/p\u003e\n\u003cp\u003eThere are various factors involved for inducing chronic inflammatory state, which include as mentioned below:\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003e\n\u003cp\u003eCytokines\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e - Proinflammatory cytokines like TNF-\u0026alpha;, IL-6, and IL-1\u0026beta; promote and sustain systemic inflammation.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eInsulin Resistance\u003csup\u003e3 \u0026minus;\u003c/sup\u003e Impaired insulin signalling increases inflammatory mediator release and promotes chronic inflammation.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eOxidative Stress\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e - Excess free radicals damage cells and activate inflammatory pathways.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003ePhysical Inactivity\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e - Sedentary behaviour reduces anti-inflammatory cytokine production and increases inflammatory markers.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eNutritional Factors\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e - Diets high in sugars, trans fats, and processed foods trigger inflammatory responses.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eHormonal Changes\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e - Altered levels of hormones like cortisol and oestrogen can dysregulate immune function and increase inflammation.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eIt's important to note that while inflammation is associated with sarcopenia, causation is not always straightforward, and the relationship may be bidirectional. Sarcopenia itself, especially when associated with physical inactivity and poor nutrition, can contribute to inflammation.\u003c/p\u003e"},{"header":"II. Sarcopenia and Visceral adiposity","content":"\u003cp\u003eSarcopenia and visceral adiposity are often interconnected in older adults. As people age, they tend to lose muscle mass (sarcopenia) and may simultaneously experience an increase in visceral fat.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eThis combination of muscle loss and increased visceral fat is particularly concerning for health because it can lead to a condition called \"sarcopenic obesity\" or \"muscle-fat infiltration.\" Sarcopenic obesity is associated with an elevated risk of chronic diseases and adverse health outcomes.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eThe exact mechanisms linking sarcopenia and visceral adiposity are complex and not fully understood, but they likely involve factors such as inflammation, hormonal changes, and decreased physical activity.\u003c/p\u003e"},{"header":"III.\tVisceral adiposity and Hypertension","content":"\u003cp\u003eVisceral obesity is also linked to increased risk of hypertension, diabetes, atherosclerosis, and CVD and the mechanisms include proinflammatory activity, adipokine production, and worsened insulin sensitivity. Association of visceral adiposity and hypertension are depicted in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. This table illustrates multiple mechanisms by which visceral fat contributes to hypertension. It highlights metabolic, hormonal, and mechanical factors including inflammation, insulin resistance, dyslipidemia, and hormonal changes like increased aldosterone. Visceral fat also stimulates the sympathetic nervous system, raises stress hormone levels, and affects the renin-angiotensin system, all elevating blood pressure. Mechanical compression of organs, endothelial dysfunction, and sleep apnea\u0026mdash;often linked to obesity\u0026mdash;further worsen hypertension. Each factor plays a role in disrupting cardiovascular regulation, emphasizing visceral fat as a critical risk element for developing high blood pressure and associated cardiovascular diseases.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eAssociation between Hypertension and Visceral Adiposity\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMechanism\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eExplanation\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInflammation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVisceral fat is metabolically active and releases inflammatory substances (cytokines), leading to chronic low-grade inflammation and contributing to hypertension.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInsulin Resistance\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eExcess visceral fat leads to insulin resistance, which is linked to hypertension and cardiovascular diseases.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDyslipidemia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAccumulation of visceral fat alters lipid profiles (increased triglycerides, decreased HDL cholesterol), which is a known risk factor for hypertension and cardiovascular disease.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHormonal Changes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVisceral fat increases aldosterone production, affecting salt and water balance in the kidneys and raising blood pressure.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIncreased Sympathetic Activity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eStimulates the sympathetic nervous system, increasing stress hormones (e.g., adrenaline, norepinephrine), which elevate heart rate and blood pressure.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMechanical Compression\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eExcess visceral fat compresses the kidneys and abdominal organs, contributing to increased blood pressure.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEndothelial Dysfunction\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVisceral fat impairs endothelial function in blood vessels, affecting vessel dilation and contributing to high blood pressure.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRenin-Angiotensin System\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInfluences the RAAS (renin-angiotensin-aldosterone system), a key regulator of blood pressure; dysregulation contributes to hypertension.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSleep Apnea\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eObesity/visceral adiposity is linked to sleep apnea, causing breathing disruptions during sleep and elevated blood pressure.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e"},{"header":"IV. Interrelationship Between Inflammation, Sarcopenia and Hypertension","content":"\u003cp\u003eThe interrelationship between inflammation, sarcopenia, and hypertension is complex and multifaceted. While they are distinct medical conditions, they can influence and exacerbate each other in various ways. As it is already stated above, how inflammation is associated with sarcopenia and this inflammation can trigger hypertension. Here's an overview of how these three conditions is interconnected:\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003eIV (a) Inflammation and Hypertension:\u003c/h2\u003e\n\u003cp\u003eAs shown in schematic representation below in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, Chronic inflammation can contribute to the development of hypertension (high blood pressure). Inflammatory processes can damage blood vessels, impair endothelial function, and promote atherosclerosis (hardening and narrowing of arteries), all of which can increase blood pressure.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e This figure highlights the complex relationship between sarcopenia and hypertension mediated by inflammation and immune responses. Proinflammatory cytokines contribute to kidney damage, hypertension, and sarcopenia. Macrophages and T lymphocytes play roles in controlling blood pressure and preventing organ damage. Adiposity releases inflammatory substances like cytokines, resistin, leptin, and adiponectin, influencing inflammation and sarcopenia. The innate and adaptive immune systems interact via cytokines, affecting renal function and hypertension. This bidirectional interplay emphasizes how inflammation, immune regulation, and metabolic factors collectively contribute to sarcopenia and hypertension, illustrating a cycle of mutual influence and health impact.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eIV (b) Sarcopenia and Hypertension:\u003c/h3\u003e\n\u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e, aging leads to chronic inflammation, increasing cytokines (IL-6, IL-8, CRP, TNF, TWEAK) and reducing anti-inflammatory markers (IL-10, IL-15). This causes muscle malfunction, leading to sarcopenia, a condition marked by reduced muscle mass, strength, and physical performance. Hand grip strength is a key indicator of muscle strength and sarcopenia. Declining grip strength reflects loss of muscle function, predicting poor outcomes like hospitalization, disability, and mortality. Thus, hand grip strength serves as a simple, reliable clinical marker to assess sarcopenia risk and its severe consequences in the elderly.\u003c/p\u003e\n\u003cp\u003eSarcopenia can also impact the regulation of blood sugar levels, which can indirectly affect blood pressure regulation.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eSarcopenic obesity has greater risk of hypertension than obese or sarcopenia subjects. Sarcopenia is an age-related muscle disease, associated with higher mortality and morbidity risk.\u003c/p\u003e\n\u003cp\u003eHandgrip dynamometer can be an useful tool to identify sarcopenia and the results can be correlated with body composition analyser in terms of muscle mass present and adiposity.\u003c/p\u003e\n\u003cp\u003eA handgrip dynamometer is a simple device used to measure the maximum force a person can generate while squeezing the handle of the dynamometer with their hand by using cost-effective and easily applicable EWGSOP algorithm. The EWGSOP algorithm refers to the diagnostic algorithm developed by the European Working Group on Sarcopenia in Older People (EWGSOP) for identifying sarcopenia. It is a widely accepted framework to assess sarcopenia based on muscle strength, muscle quantity/quality, and physical performance. This measurement is often referred to as handgrip strength (HGS) and is an important indicator of overall upper body strength. Handgrip dynamometers are commonly used in various settings, including healthcare, to assess an individual's physical fitness and health.\u003c/p\u003e\n\u003cp\u003eHere are some of the key applications of handgrip dynamometers in healthcare that can prove beneficial for the proposed research:\u003c/p\u003e\n\u003ch3\u003ePhysical Fitness Assessment:\u003c/h3\u003e\n\u003cp\u003eHandgrip strength can provide valuable information about muscle strength and endurance, which are important for performing daily activities and maintaining independence\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003ch2\u003ePredicting Health Outcomes:\u003c/h2\u003e\n\u003cp\u003eResearch has shown that handgrip strength can be a predictor of various health outcomes. For example, lower handgrip strength has been associated with a higher risk of mortality, cardiovascular disease, and disability in older adults.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n\u003ch2\u003eAssessing Nutritional Status:\u003c/h2\u003e\n\u003cp\u003eMalnutrition and inadequate dietary intake can lead to a decline in muscle strength, and handgrip dynamometers are used to monitor changes in nutritional status.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n\u003ch2\u003eScreening for Frailty:\u003c/h2\u003e\n\u003cp\u003eFrailty is a clinical syndrome characterized by decreased physical reserve and an increased vulnerability to adverse health outcomes. Handgrip strength can help identify individuals at risk of frailty\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"V. Association of Handgrip Strength with Blood Pressure, Waist – Hip Ratio, Visceral Adiposity Index, CRP","content":"\u003cp\u003eChao Ji et.al, stated in the year 2018 that increased handgrip strength is associated with higher DBP in men and women. In men, especially overweight and obese men, strong handgrip strength may be associated with higher risk of hypertension.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e On the contrary research by Chang et. al, indicated that individuals with higher handgrip strength often have a lower WHR, suggesting that greater muscle mass may be associated with reduced central adiposity. Lower WHR is generally considered more favorable for metabolic health and reduced risk of cardiovascular diseases.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e Garcia et al has stated that higher handgrip strength is linked to lower Visceral Adiposity Index (VAI) values. This relationship suggests that muscle strength may help mitigate the adverse effects of visceral fat accumulation, potentially reducing the risk of insulin resistance and metabolic syndrome.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e C-reactive protein (CRP) is a marker of systemic inflammation and is associated with various chronic diseases. Norman et al (2014), have explored the relationship between handgrip strength and CRP levels and suggested that individuals with higher handgrip strength tend to have lower CRP levels, indicating that muscle strength may have anti-inflammatory effects after conducting study on 620 hospitalized patients (56.4\u0026thinsp;\u0026plusmn;\u0026thinsp;15.9 years old, 52.3% men)\u003csup\u003e29\u003c/sup\u003e. This is important because chronic inflammation is a key factor in the development of many diseases, including cardiovascular diseases and metabolic disorders.\u003c/p\u003e\n\u003cp\u003eIn summary, the literature suggests a significant association between handgrip strength and various health parameters among the adult population. Higher handgrip strength is generally linked to lower blood pressure, a favorable waist-hip ratio, reduced visceral adiposity, and lower C-reactive protein levels.\u003c/p\u003e"},{"header":"VI. Methodology","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n\u003ch2\u003eStudy Design \u0026amp; Setting:\u003c/h2\u003e\n\u003cdiv id=\"Sec16\" class=\"Section3\"\u003e\n\u003cp\u003eThis cross-sectional, observational study included 458 hospitalized subjects (Male \u0026amp; Female), age 18\u0026ndash;80 years who were willing to participate were included in the study after taking informed consent in vernacular language. Sample size was calculated using standard formula with 5% allowable error. Study was conducted at location Peerless Hospital from February 2022 to March 2023. Purposive sampling technique was adopted during sample collection process.\u003c/p\u003e\n\u003cp\u003eEthical clearance was obtained from the Ethics Committee of Peerless Hospital and B.K. Roy Research Centre, Kolkata, India (PHH\u0026amp;RCLCREC/4020/2023). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institution research committee and the 1964 Helsinki Declaration and its later amendments for comparable ethical standards. Informed written consent was obtained before the study was conducted in vernacular language. Elderly women having a history of thyroid dysfunction, on hormonal replacement therapy, with amenorrhea due to any pathological cause or surgery, on Vitamin D supplementation, with physically or mentally challenged, and with noncooperative in nature were excluded from the study.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n\u003ch2\u003eData Collection and Anthropometric measurements:\u003c/h2\u003e\n\u003cp\u003eSample size was calculated using 95% confidence interval, 5% margin of error, prevalent hypertensive adult population of West Bengal 42% (Ghosh, R. et al 2019). Estimated sample to be collected was 375 and total data finalized for analysis was 458 after data validation.\u003c/p\u003e\n\u003cp\u003eInformation on clinical history such as history of stroke and taking anti-hypertensive medication and habitual status were obtained by trained interviewers. Blood reports were accessed from hospital database, and CRP and ESR were recorded along with Hemoglobin.\u003c/p\u003e\n\u003cp\u003eSystolic and diastolic blood pressures on the right arm were recorded by trained examiners using a blood pressure measuring device (HEM-907; Omron, Kyoto, Japan) after at least 5 min of rest in a sitting position. Hypertension was defined as systolic blood pressure\u0026thinsp;\u0026ge;\u0026thinsp;140 mmHg and/or diastolic blood pressure\u0026thinsp;\u0026ge;\u0026thinsp;90 mmHg. Systolic hypertension was defined as systolic blood pressure\u0026thinsp;\u0026ge;\u0026thinsp;140 mmHg and diastolic hypertension as diastolic blood pressure\u0026thinsp;\u0026ge;\u0026thinsp;90 mmHg.\u003c/p\u003e\n\u003cp\u003eHeight in bare feet was measured using stadiometer. Body weight and body composition analysis was done using an automatic body composition analyzer (Activex). Body mass index (BMI) was calculated as (weight, kg)/(height, m)\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Waist Hip ratio, Waist circumference and calf circumference were measured by using measuring tape. Skin fold thickness was measured by skin fold caliper.\u003c/p\u003e\n\u003cp\u003eCamry\u0026reg; (Model EH 101) Hand Dynamometer was used to test the grip of the respondents. The procedure was explained, and the technique was demonstrated to each participant based on the standard procedure recommended by EWGSOP criteria. Participants were positioned in a straight back chair with both feet flat on the floor. For the arm to be tested, the elbow was flexed to 90\u0026deg;, the forearm in neutral position, wrist in 0\u0026ndash;15\u0026deg; of extension, and 0\u0026ndash;15\u0026deg; of ulnar deviation. The fingers were flexed as needed for maximal contraction. A verbal command of \u0026ldquo;Squeeze! Harder! Harder! Relax!\u0026rdquo; was given by the examiner. Three consecutive trials were conducted to measure the average (mean) HGS with 1-minute rest in-between each trial. Values of Hand grip strength was recorded as per the display of the dynamometer and was interpretated as per the manufacturer\u0026rsquo;s gradation of hand grip strength. Questionnaire used was validated by the medical expert team. MUST (Malnutrition Universal Screening Tool was used to measure the presence of malnutrition..\u003c/p\u003e\n\u003cp\u003eStatistical analysis - All the statistical analysis was done in SPSS software, version 19.0 (statistical package for the social sciences INC, Chicago, IL, USA)\u003c/p\u003e\n\u003c/div\u003e"},{"header":"VII. Results","content":"\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n\u003ch2\u003eResult 1 -\u003c/h2\u003e\n\u003cp\u003eThe distribution of hand grip strength among hospitalized patients has been represented in the above pie chart. It is observed that 78% of patients had weak hand grip strength, 17% had normal grip strength, 5% had very weak grip strength among N\u0026thinsp;=\u0026thinsp;458 patients in which number of male and female patients are 222 and 236 respectively.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\n\u003ch2\u003e\u003cstrong\u003eInterpretation\u003c/strong\u003e:\u003c/h2\u003e\n\u003cp\u003eA large majority (83%) of hospitalized individuals demonstrated below-normal grip strength, indicating a high prevalence of sarcopenia or muscle weakness, which may relate to underlying health conditions or aging-related muscle deterioration.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\n\u003ch2\u003eResult 2 -\u003c/h2\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\n\u003cp\u003e\u003cstrong\u003eTable 2 - Distribution of hand grip strength (HGS) according to their Blood pressure, waist hip ratio, Visceral Adiposity (VA), ESR, CRP values (N=458)\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Taba\" border=\"1\"\u003e\u003ccolgroup\u003e\u003c/colgroup\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eParameters\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eHGS (kg) (N\u0026thinsp;=\u0026thinsp;458)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"6\" align=\"left\"\u003e\n\u003cp\u003eStatistical Analysis\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eNormal\u003c/p\u003e\n\u003cp\u003e(range)\u003c/p\u003e\n\u003cp\u003eN\u003c/p\u003e\n\u003cp\u003e(%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eWeak\u003c/p\u003e\n\u003cp\u003erange\u003c/p\u003e\n\u003cp\u003eN (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003ePoor\u003c/p\u003e\n\u003cp\u003eRange)\u003c/p\u003e\n\u003cp\u003eN (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003cp\u003eN%\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eMale(N\u0026thinsp;=\u0026thinsp;222)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eFemale (N\u0026thinsp;=\u0026thinsp;236)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eHGS (kg)\u003c/p\u003e\n\u003cp\u003eMedian (IQR)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eKruskal Wallis-test\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(p)\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSpearman Correlation\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(p)\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eHGS (kg)\u003c/p\u003e\n\u003cp\u003eMedian (IQR)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eKruskal Wallis-test\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(p)\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSpearman Correlation\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(p)\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e18\u0026ndash;45\u003c/p\u003e\n\u003cp\u003e45\u0026ndash;60\u003c/p\u003e\n\u003cp\u003e60\u0026ndash;80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e28(25.0)\u003c/p\u003e\n\u003cp\u003e26(17.23)\u003c/p\u003e\n\u003cp\u003e23(11.86)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e82(72.32)\u003c/p\u003e\n\u003cp\u003e119(78.81)\u003c/p\u003e\n\u003cp\u003e156(80.41)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3(2.68)\u003c/p\u003e\n\u003cp\u003e6(3.97)\u003c/p\u003e\n\u003cp\u003e13(6.70)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e113(100)\u003c/p\u003e\n\u003cp\u003e151(100)\u003c/p\u003e\n\u003cp\u003e194(100)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e13 (6)\u003c/p\u003e\n\u003cp\u003e14 (4)\u003c/p\u003e\n\u003cp\u003e13 (4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e26.836\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(0.00)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e0.348\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(0.00)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e16 (2.75)\u003c/p\u003e\n\u003cp\u003e14 (4)\u003c/p\u003e\n\u003cp\u003e13 (3.75)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3.216\u003c/p\u003e\n\u003cp\u003e(0.20)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0.232\u003c/p\u003e\n\u003cp\u003e(0.07)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBlood Pressure\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLow\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNormal-\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eElevated\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHypertension stage 1\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHypertension stage 2\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHypertensive crisis\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3(17.64)\u003c/p\u003e\n\u003cp\u003e52(16.35)\u003c/p\u003e\n\u003cp\u003e4(50.00)\u003c/p\u003e\n\u003cp\u003e15(20.83)\u003c/p\u003e\n\u003cp\u003e3(7.32)\u003c/p\u003e\n\u003cp\u003e0()\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e12(70.59)\u003c/p\u003e\n\u003cp\u003e255(79.80)\u003c/p\u003e\n\u003cp\u003e3(37.5)\u003c/p\u003e\n\u003cp\u003e53(73.61)\u003c/p\u003e\n\u003cp\u003e34(82.93)\u003c/p\u003e\n\u003cp\u003e0()\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2(11.76)\u003c/p\u003e\n\u003cp\u003e11(3.46)\u003c/p\u003e\n\u003cp\u003e1(12.5)\u003c/p\u003e\n\u003cp\u003e4(5.56)\u003c/p\u003e\n\u003cp\u003e4(9.76)\u003c/p\u003e\n\u003cp\u003e0()\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e17(100)\u003c/p\u003e\n\u003cp\u003e318(100)\u003c/p\u003e\n\u003cp\u003e8(100)\u003c/p\u003e\n\u003cp\u003e72(100)\u003c/p\u003e\n\u003cp\u003e41(100)\u003c/p\u003e\n\u003cp\u003e0(100)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e12 (6.75)\u003c/p\u003e\n\u003cp\u003e13.5 (4)\u003c/p\u003e\n\u003cp\u003e13 (3.5)\u003c/p\u003e\n\u003cp\u003e13 (4)\u003c/p\u003e\n\u003cp\u003e13 (5)\u003c/p\u003e\n\u003cp\u003e18 (18)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSystole\u003c/p\u003e\n\u003cp\u003e3.464\u003c/p\u003e\n\u003cp\u003e(0.17)\u003c/p\u003e\n\u003cp\u003eDiastole\u003c/p\u003e\n\u003cp\u003e3.714\u003c/p\u003e\n\u003cp\u003e(0.15)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSystole\u003c/p\u003e\n\u003cp\u003e0.088\u003c/p\u003e\n\u003cp\u003e(0.19)\u003c/p\u003e\n\u003cp\u003eDiastole\u003c/p\u003e\n\u003cp\u003e-0.080\u003c/p\u003e\n\u003cp\u003e(0.23)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e26 (26)\u003c/p\u003e\n\u003cp\u003e14 (4)\u003c/p\u003e\n\u003cp\u003e0 (0)\u003c/p\u003e\n\u003cp\u003e14 (3.3)\u003c/p\u003e\n\u003cp\u003e13 (8.75)\u003c/p\u003e\n\u003cp\u003e8 (5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSystole\u003c/p\u003e\n\u003cp\u003e0.698\u003c/p\u003e\n\u003cp\u003e(0.70)\u003c/p\u003e\n\u003cp\u003eDiastole\u003c/p\u003e\n\u003cp\u003e3.173\u003c/p\u003e\n\u003cp\u003e(0.20)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSystole\u003c/p\u003e\n\u003cp\u003e0.089\u003c/p\u003e\n\u003cp\u003e(0.49)\u003c/p\u003e\n\u003cp\u003eDiastole\u003c/p\u003e\n\u003cp\u003e-0.230\u003c/p\u003e\n\u003cp\u003e(0.07)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eVA\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e71(16.82)\u003c/p\u003e\n\u003cp\u003e6(17.14)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e351(83.18)\u003c/p\u003e\n\u003cp\u003e6 (17.14)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0(0.00)\u003c/p\u003e\n\u003cp\u003e24(68.57)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e422(100)\u003c/p\u003e\n\u003cp\u003e36(100)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e13 (4)\u003c/p\u003e\n\u003cp\u003e12 (10)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e8.321\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(0.01)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-0.194\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(0.00)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e14 (4)\u003c/p\u003e\n\u003cp\u003e12 (12)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0.114\u003c/p\u003e\n\u003cp\u003e(0.94)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e-0.005\u003c/p\u003e\n\u003cp\u003e(0.96)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eWHR\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0(0.00)\u003c/p\u003e\n\u003cp\u003e18(21.95)\u003c/p\u003e\n\u003cp\u003e59(15.74)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1(100)\u003c/p\u003e\n\u003cp\u003e60(73.17)\u003c/p\u003e\n\u003cp\u003e296(78.93)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0(0.0)\u003c/p\u003e\n\u003cp\u003e4(4.88)\u003c/p\u003e\n\u003cp\u003e20(5.33)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1(100)\u003c/p\u003e\n\u003cp\u003e82(100)\u003c/p\u003e\n\u003cp\u003e375(100)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e13 (5.5)\u003c/p\u003e\n\u003cp\u003e13 (4)\u003c/p\u003e\n\u003cp\u003e14 (4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1.796\u003c/p\u003e\n\u003cp\u003e(0.40)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0.049\u003c/p\u003e\n\u003cp\u003e(0.46)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0 (0)\u003c/p\u003e\n\u003cp\u003e0 (0)\u003c/p\u003e\n\u003cp\u003e14 (4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4.054\u003c/p\u003e\n\u003cp\u003e(0.13)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e0.256\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(0.04)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eESR value (N\u0026thinsp;=\u0026thinsp;263)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e11(13.92)\u003c/p\u003e\n\u003cp\u003e24(13.04)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e64(81.01)\u003c/p\u003e\n\u003cp\u003e146 (79.35)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4(5.06)\u003c/p\u003e\n\u003cp\u003e14(7.61)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e79(100)\u003c/p\u003e\n\u003cp\u003e184(100)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e14 (5)\u003c/p\u003e\n\u003cp\u003e14 (5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0.068\u003c/p\u003e\n\u003cp\u003e(0.96)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0.016\u003c/p\u003e\n\u003cp\u003e(0.85)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e14 (4.75)\u003c/p\u003e\n\u003cp\u003e14 (3.25)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4.982\u003c/p\u003e\n\u003cp\u003e(.08)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e0.184\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(0.02)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eC-RP value\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(N\u0026thinsp;=\u0026thinsp;109)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2(40.0)\u003c/p\u003e\n\u003cp\u003e15(14.42)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3(60.0)\u003c/p\u003e\n\u003cp\u003e82 (78.85)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0(0.0)\u003c/p\u003e\n\u003cp\u003e7(6.73)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e5(100)\u003c/p\u003e\n\u003cp\u003e104(100)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e16 (5.5)\u003c/p\u003e\n\u003cp\u003e14 (4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4.306\u003c/p\u003e\n\u003cp\u003e(0.96)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0.205\u003c/p\u003e\n\u003cp\u003e(0.16)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e14.5 (2)\u003c/p\u003e\n\u003cp\u003e14 (4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3.039\u003c/p\u003e\n\u003cp\u003e(0.21)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0.065\u003c/p\u003e\n\u003cp\u003e(0.62)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"11\"\u003e** The result is significant \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 mentioned in bold\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable\u0026nbsp;3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDistribution of hand grip strength (HGS) according to their Blood pressure, waist hip ratio, Visceral Adiposity (VA), ESR, CRP values (N=458)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\u003ccolgroup\u003e\u003c/colgroup\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eStatistical Test\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eParameter\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eInterpretation\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eChi-Square (42.55, p\u0026thinsp;=\u0026thinsp;0.01)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBlood Pressure \u0026amp; HGS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eStatistically significant; blood pressure is associated with lower HGS\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eOdds Ratio (1.10, CI: 0.64\u0026ndash;1.91)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBlood Pressure \u0026amp; HGS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIndicates slight increased odds of HGS reduction with hypertension (not strongly significant due to wide CI)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eKruskal-Wallis Test (p\u0026thinsp;=\u0026thinsp;0.01)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVisceral Adiposity Level \u0026amp; HGS in males\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eStatistically significant negative association\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eOdds Ratio (0.611, CI: 0.02\u0026ndash;15.14)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWHR in females\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePositive correlation with HGS (p\u0026thinsp;=\u0026thinsp;0.04)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\n\u003ch2\u003e\u003cstrong\u003eInterpretation\u003c/strong\u003e:\u003c/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eHypertension is significantly associated with reduced HGS, indicating cardiovascular health may influence muscle strength.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eVisceral adiposity negatively impacts HGS in males, emphasizing the metabolic impact on muscle quality.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eWaist-Hip Ratio (WHR) in females shows a significant positive correlation with HGS, though the odds ratio's wide CI suggests further study is needed.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eAs the data set was skewed, Median \u0026amp; IQR (Interquartile range) were represented as measures of central tendency. Considering blood pressure and HGS, significant statistical associations were observed (Chi-square value: 42.55, p\u0026thinsp;=\u0026thinsp;0.01), the Odds Ratio (OR) for hypertension and HGS was 1.10 (95% of Confidence Interval (CI)0.64\u0026ndash;1.91). But according to Kruskal Wallis test conducted in case of both male and female respondents there is no significant association observed. Considering Spearman's correlation in case of Diastolic pressure there is negative correlation existed with HGS (Both male and female) although it was insignificant (Tables\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e and 3). VA has an insignificant statistical association with HGS (Chi-square:6.98, p\u0026thinsp;=\u0026thinsp;0.07) and OR was 0.988 (95% of CI 0.39\u0026ndash;2.46). In case of male respondents there is significant statistical (Kruskal Wallis test) association between VA and HGS (p\u0026thinsp;=\u0026thinsp;0.01), also it is significantly negatively correlated with HGS(p\u0026thinsp;=\u0026thinsp;0.0) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Again, considering WHR there is 0.21% were only in having normal WHR whereas 17.90% were at moderate risk and 99.78% were at high-risk group and OR was 0.611 (95% of CI 0.02\u0026ndash;15.14). In case of female respondents there is significant positive correlation with HGS(p\u0026thinsp;=\u0026thinsp;0.04). Considering ESR value there is significant statistical association with HGS (Chi square value:108.58, p\u0026thinsp;=\u0026thinsp;0.0) and OR was 0.92(95% CI 0.43\u0026ndash;1.99). Considering CRP value there is no significant association or correlation observed in case of HGS among both male and female (Chi-square value:2.37, p\u0026thinsp;=\u0026thinsp;0.12). The OR was 0.11(0.01\u0026ndash;0.72) more sample size may give one proper indication in this case (Tables\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e \u0026amp; 3).\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eHGS and Inflammatory Markers (ESR and CRP)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\u003ccolgroup\u003e\u003c/colgroup\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTest\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMarker\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eResult\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eChi-square (108.58, p\u0026thinsp;=\u0026thinsp;0.0)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eESR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eStrong, significant statistical association\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eOR\u0026thinsp;=\u0026thinsp;0.92 (CI: 0.43\u0026ndash;1.99)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eESR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSuggests mild inverse relation, though not definitive\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eChi-square (2.37, p\u0026thinsp;=\u0026thinsp;0.12)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCRP\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo statistically significant association\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eOR\u0026thinsp;=\u0026thinsp;0.11 (CI: 0.01\u0026ndash;0.72)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCRP\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDespite low OR, high p-value weakens the association\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\n\u003ch2\u003e\u003cstrong\u003eInterpretation\u003c/strong\u003e:\u003c/h2\u003e\n\u003cp\u003eESR (Erythrocyte Sedimentation Rate) shows a highly significant association with HGS (p\u0026thinsp;=\u0026thinsp;0.0), linking systemic inflammation with reduced muscle strength. CRP (C-reactive protein) does not show a significant association, though the odds ratio hints at a potential protective trend that warrants further investigation. There is substantial evidence linking reduced hand grip strength (as a marker of sarcopenia) with hypertension, visceral adiposity, and inflammation (ESR). 83% of hospitalized patients had compromised HGS, underlining its clinical importance. HGS serves as a simple, non-invasive and valuable tool for detecting functional decline and predicting related complications like hospitalization, disability, and mortality.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u0026nbsp;\u003c/div\u003e"},{"header":"VIII. Significance","content":"\u003cp\u003eConducting a comprehensive assessment of the association of handgrip strength with various health parameters, such as blood pressure, waist-hip ratio, visceral adiposity, C-reactive protein (CRP) levels, and erythrocyte sedimentation rate (ESR) levels, can have several significant implications and benefits:\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eHealth Monitoring\u003c/b\u003e: By examining the association of HGS with these other health parameters, one can get a more holistic picture of an individual's health.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eCardiovascular Health\u003c/b\u003e: Understanding how handgrip strength relates to blood pressure can help identify potential risk factors for heart disease and hypertension.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eObesity and Body Composition\u003c/b\u003e: Exploring the relationship between Waist -hip ratio and visceral adiposity, use of handgrip strength can shed light on the role of muscle strength in maintaining a healthy body composition and potentially reducing the risk of obesity-related health issues.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eInflammation and Immune Response\u003c/b\u003e: Investigating the association between handgrip strength and the inflammatory markers like CRP and ESR markers can help to understand the potential anti-inflammatory effects of muscular strength and physical fitness.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eFunctional Independence\u003c/b\u003e: Handgrip strength is not only an indicator of physical fitness but also a predictor of functional independence in older adults. Understanding its connection with various health parameters can inform strategies for maintaining mobility and quality of life as people age.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eIntervention Strategies\u003c/b\u003e: If the study identifies significant associations between handgrip strength and the mentioned health parameters, it can provide a basis for developing targeted interventions. For example, if low handgrip strength is associated with high blood pressure or increased inflammation, strength training programs could be recommended as a preventive or therapeutic measure.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003ePublic Health\u003c/b\u003e: Findings from this study could have implications for public health policies and recommendations. It may help in promoting the importance of maintaining muscular strength and overall physical fitness as part of a healthy lifestyle.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eIn conclusion, conducting a comprehensive assessment of the association of handgrip strength with various health parameters has the potential to enhance our understanding of the role of muscular strength in overall health and well-being. This knowledge can inform healthcare practices, interventions, and public health strategies to promote healthier lifestyles and reduce the risk of various health conditions.\u003c/p\u003e"},{"header":"IX. Possible outcomes","content":"\u003cp\u003eThe bidirectional association between sarcopenia and cardiovascular disorders, particularly hypertension, can be effectively assessed using the cost-effective and easily applicable EWGSOP algorithm.\u003c/p\u003e\u003cp\u003eThis approach allows for the evaluation of sarcopenia and its link to hypertension at both the community level and healthcare settings, reducing the need for specialized skills and enabling widespread screening and diagnosis.\u003c/p\u003e\u003cp\u003eThis approach may redirect the thoughts of policy makers to incorporate assessment of Handgrip strength, Waist Hip Ratio, Body composition analysis along with assessment of biochemical parameters like C- Reactive Protein and Erythrocyte Sedimentation Rate at primary health care setting and all treatment facilities as a screening tool which may predict the prognosis of hypertension and its association with sarcopenia and may help to develop strategies towards preventing debilitating effect of sarcopenia associated with hypertension and other cardiovascular events.\u003c/p\u003e\u003cp\u003eIn healthcare, handgrip dynamometers are relatively inexpensive, portable, and easy to use, making them a practical tool for assessing and monitoring physical fitness, disease outcome and health and identifying the population at risk.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval –\u003c/strong\u003e Ethical clearance was obtained from the Ethics Committee of Peerless Hospital and B.K. Roy Research Centre, Kolkata, India (PHH\u0026amp;RCLCREC/4020/2023).\u0026nbsp;All procedures performed in studies involving human participants were in accordance with the ethical standards of the institution research committee and the 1964 Helsinki Declaration and its later amendments for comparable ethical standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate -\u003c/strong\u003e Informed written consent from participants was obtained in vernacular language before the study was conducted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Declaration:\u0026nbsp;\u003c/strong\u003eNo funding received\u0026nbsp;by any authors for the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish declaration:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eManuscript Title:\u0026nbsp;\u003c/strong\u003e\u003cem\u003eExploring the Association Between Hand Grip Strength and Cardiometabolic Health Markers in Hospitalized Adults: A Cross-Sectional Study from Kolkata, India\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eJournal Name: \u003cem\u003eDiscover Public Health\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs the corresponding author, I confirm on behalf of all co-authors that:\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eWe have read and understood the journal’s policies on ethics and consent.\u003c/li\u003e\n \u003cli\u003eWe affirm that this manuscript is original, has not been published previously, and is not currently under consideration for publication elsewhere.\u003c/li\u003e\n \u003cli\u003eAll authors have significantly contributed to the manuscript and agree to its submission and potential publication in \u003cem\u003eDiscover Public Health\u003c/em\u003e.\u003c/li\u003e\n \u003cli\u003eWe give full consent to the publisher (Springer Nature) to publish the above-mentioned manuscript, including any tables, figures, and supplementary materials, under the journal’s terms and conditions.\u003c/li\u003e\n \u003cli\u003eAll data presented in the manuscript were collected in compliance with institutional ethical standards and informed consent was obtained from all participants involved in the study.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding Author: Bijoya Bhattacharjee\u003cbr\u003e\u003c/strong\u003eInstitutional Affiliation –Department of Food and Nutrition, Swami Vivekananda University Barrackpore, India; Department of Dietetics and Applied Nutrition, Amity University Kolkata, India\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;Email Address – [email protected]\u003cbr\u003e\u0026nbsp;Date – 22.06.2025\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOn behalf of all authors\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFerrucci L, Fabbri E. 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J Family Med Prim Care. 2020;9(6):2885\u0026ndash;90. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4103/jfmpc.jfmpc_187_20\u003c/span\u003e\u003cspan address=\"10.4103/jfmpc.jfmpc_187_20\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"muscular strength, cardiovascular biomarkers, inflammatory markers, handgrip strength, MUST, Hand grip Strength","lastPublishedDoi":"10.21203/rs.3.rs-6762494/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6762494/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e\u003cbr\u003e\nSarcopenia and hypertension are significant public health concerns, particularly in aging populations. Their coexistence with visceral adiposity and systemic inflammation further increases cardiovascular risk. This study aimed to explore the association between handgrip strength (HGS)—a non-invasive marker of muscular function—and key cardiometabolic indicators including blood pressure, waist-hip ratio (WHR), visceral adiposity, and inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003cbr\u003e\nA cross-sectional, hospital-based study was conducted among 458 adult inpatients (aged 18–80 years) in Kolkata. Participants were selected through purposive sampling. Data collection included measurements of HGS (using a dynamometer), anthropometrics, blood pressure, and biochemical parameters. Malnutrition status was monitored with the Malnutrition Universal Screening Tool (MUST). Statistical analysis was performed using SPSS version 19.0.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003cbr\u003e\nLower HGS was significantly associated with higher blood pressure, elevated WHR, increased indicators of visceral fat, and elevated levels of CRP and ESR. These findings indicate a link between reduced muscular strength and adverse cardiometabolic profiles.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003cbr\u003e\nReduced handgrip strength may serve as an early, non-invasive marker for identifying individuals at risk of hypertension and systemic inflammation. Incorporating HGS assessments into routine clinical practice could enhance early detection and support targeted interventions for cardiometabolic health.\u003c/p\u003e","manuscriptTitle":"Exploring the Association Between Hand Grip Strength and Cardiometabolic Health Markers in Hospitalized Adults: A Cross-Sectional Study from Kolkata, India","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-18 13:20:47","doi":"10.21203/rs.3.rs-6762494/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-01T08:02:55+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-01T09:51:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"80377189386662307875596302414665794327","date":"2025-09-25T06:16:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"82667374212835548744161683194996439869","date":"2025-09-22T03:48:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-08T07:04:21+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-17T18:47:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"95283963032825940112203538321568465237","date":"2025-07-17T05:03:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"101607905930210911747099084312528197119","date":"2025-07-14T12:02:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-14T11:33:17+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-24T16:44:01+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-22T03:35:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2025-06-22T03:32:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"91a76495-a6d8-430d-8109-281d61a53fea","owner":[],"postedDate":"July 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-20T16:01:16+00:00","versionOfRecord":{"articleIdentity":"rs-6762494","link":"https://doi.org/10.1186/s12982-026-01912-3","journal":{"identity":"discover-public-health","isVorOnly":false,"title":"Discover Public Health"},"publishedOn":"2026-04-19 15:58:05","publishedOnDateReadable":"April 19th, 2026"},"versionCreatedAt":"2025-07-18 13:20:47","video":"","vorDoi":"10.1186/s12982-026-01912-3","vorDoiUrl":"https://doi.org/10.1186/s12982-026-01912-3","workflowStages":[]},"version":"v1","identity":"rs-6762494","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6762494","identity":"rs-6762494","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}