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J Sci Med Sport. 2019 Aug;22(8):929-934. doi: 10.1016/j.jsams.2019.04.008. Epub 2019 Apr 23.

Muscle strength field-based tests to identify European adolescents at risk of metabolic syndrome: The HELENA study.

Author information

Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Spain. Electronic address:
School of Kinesiology and Recreation, Illinois State University, United States.
SPORT Research Group (CTS-1024), University of Almería, Spain.
PROmoting FITness and Health through Physical Activity Research Group (PROFITH), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Spain; Department of Biosciences and Nutrition at NOVUM, Karolinska Institutet, Sweden.
Department of Health Sciences, Public University of Navarra, Spain.
GENUD (Growth, Exercise, NUtrition and Development) Research Group, Facultad de Ciencias de la Salud, Instituto Agroalimentario de Aragón (IA2), Universidad de Zaragoza, Instituto de Investigación Sanitaria de Aragón (IIS Aragón) and Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Spain.
Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Belgium.
Department of Nutrition and Dietetics, Harokopio University, Greece.
Univ. Lille, Inserm, CHU Lille, U995 - LIRIC - Lille Inflammation Research International Center, CIC 1403 - Centre d'investigation clinique, France.
Immunonutrition Research Group, Department of Metabolism and Nutrition, Instituto del Frio, Institute of Food Science, Technology and Nutrition, Spanish National Research Council, Spain.
National Institute for Food and Nutrition Research, Italy.
ImFine Research Group, Facultad de Ciencias de la Actividad Física y del Deporte-INEF, Universidad Politécnica de Madrid, Spain; CIBER, CB12/03/30038 Fisiopatología de la Obesidad y la Nutrición, CIBERobn, Instituto de Salud Carlos III (ISCIII), Spain.
Department of Pediatrics, Division of Clinical Nutrition, Medical University of Vienna, Austria.
Department of Medical Physiology, School of Medicine, University of Granada, Spain.



To determine whether handgrip strength (HG) and/or standing long jump (SLJ) are capable of detecting risk of metabolic syndrome (MetS) in European adolescents, and to identify age- and sex-specific cut points for these tests.


Cross-sectional study.


Participants included 969 (aged 12.5-17.5 years old) adolescents from 9 European countries (n = 520 girls). Absolute and relative HG and SLJ tests were used to assess upper and lower muscle strength, respectively. MetS status was determined using the age- and sex-specific cut points proposed by Jolliffe and Janssen´s, Additionally, we computed a continuous cardiometabolic risk index with the average z-score of four cardiometabolic risk factors: Wait circumference, mean arterial pressure, triglycerides/high-density lipoprotein cholesterol, and fasting insulin.


The prevalence of MetS was 3.1% in European adolescents. Relative HG and absolute SLJ were the best tests for detecting the presence of MetS (Area under the receiver operating characteristic (AUC) = 0.799, 95%CI:0.773-0.824; and AUC = 0.695 95%CI:0.665-0.724), respectively) and elevated cardiometabolic risk index (AUC = 0.873, 95%CI:0.838-0.902; and AUC = 0.728 95%CI:0.698-0.756), respectively) and, regardless of cardiorespiratory fitness. We provide age- and sex-specific cut points of upper and lower muscle strength for European adolescents to identify the presence of MetS and elevated cardiometabolic risk index.


The proposed health-related cut points could be used as a starting point to define health-related levels of upper and lower muscle strength in adolescents. Likewise, the diagnostic statistics provided herein can be used to offer feedback to adolescents, parents, and education and health professionals about what it means to meet or fail test standards.


Adolescents; Cardiometabolic risk; Muscle fitness

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