1.Validation study of hand grip strength measured using Jamar dynamometer and aneroid sphygmomanometer as a diagnostic tool for sarcopenia
Eric Ranniel P. Guevarra ; Julie T. Li-Yu ; Lyndon John Q. Llamado
Philippine Journal of Internal Medicine 2025;63(1):1-6
BACKGROUND
Hand grip strength (HGS) is a tool to measure muscle strength, which is an important component in sarcopenia and frailty. Grip strength (GS) in midlife can predict physical disability in senior years and help evaluate a patient's overall health.
OBJECTIVESThe general purpose of this study is to validate the HGS using an aneroid sphygmomanometer and Jamar dynamometer as a diagnostic tool for sarcpenia. The specific aims of this study are (a) to determine the concurrent criterion validity, (b) to determine the reliability, and (c) to measure the inter-rater agreement of the aneroid sphygmomanometer against the Jamar dynamometer in measuring HGS.
METHODSThis prospective validation study measures HGS using an aneroid sphygmomanometer and Jamar dynamometer obtained from seventy participants 50 years old and above. Statistical methods used in data analysis include Spearman Rho, univariate linear regression analyses, intra-class correlation, inter-rater reliability, intra-rater reliability, Bland-Altman plots, and Lin’s concordance.
RESULTSThere was a significant correlation of HGS with the Jamar dynamometer and aneroid sphygmomanometer regardless of the rater [Spearman Rho (rs=0.762 to 0.778, p=0.001)]. Jamar GS is comparable to GS using a sphygmomanometer with the formula of [Jamar = 0.54 x sphygmomanometer (mmHg) - 45.12].
CONCLUSIONAneroid sphygmomanometer can be used as an option to measure GS and has a valid value to predict the Jamar GS value. Hence, it can be an alternate tool for diagnosing sarcopenia.
Human ; Validation Study ; Grip Strength ; Hand Strength ; Sarcopenia
2.Percentile determination of hand grip strength measured using Jamar Dynamometer and modified Sphygmomanometer among healthy adults
Eric Ranniel P. Guevarra ; Julie T. Li-Yu ; Lyndon John Q. Llamado
Philippine Journal of Internal Medicine 2024;62(2):87-92
		                        		
		                        			Background:
		                        			An accurate, quantifiable assessment of hand grip strength (HGS) can predict overall strength and health
with a good predictor for identifying populations at higher risk for any medical conditions like rheumatoid arthritis,
neuromuscular diseases and stroke that helps clinicians establish realistic treatment goals and provides treatment outcome
data. The purpose of the study is to determine the percentile scores of HGS of healthy adult individuals of various age
groups using Jamar dynamometer and modified sphygmomanometer.
		                        		
		                        			Methods:
		                        			This descriptive study measures HGS using Jamar dynamometer and modified sphygmomanometer obtained
from one hundred twenty healthy participants 20 years old and above. Comparative analyses of the 2 apparatuses were
conducted using One-Way ANOVA. The reference intervals at different percentiles were calculated using the Clinical and
Laboratory Standard Institute (CLSI) guidelines.
		                        		
		                        			Results:
		                        			Grip strength (GS) using Jamar dynamometer (JD) and modified sphygmomanometer (MS) among younger (20-
29 years old) participants, the 50th percentile (Q2) JD score was 28.29 kg with an equivalent MS score of 161.38 mmHg,
were significantly higher compared to those across older age groups especially among the ≥70 years old with a JD Q2
score of 16.74 kg and MS Q2 score of 101.33 mmHg. These findings suggest that HGS decreases with increasing age.
		                        		
		                        			Conclusion
		                        			Scores obtained from this study can serve as preliminary baseline values or guide for interpreting GS
measurements.
		                        		
		                        		
		                        		
		                        			Hand Strength
		                        			;
		                        		
		                        			 Sphygmomanometers 
		                        			
		                        		
		                        	
3.Investigation and influencing factors on pelvic floor muscle strength of 929 adult females in gynecological outpatient department.
Hong Mei ZHU ; Lei GAO ; Bing XIE ; Wei JIAO ; Xiu Li SUN
Chinese Journal of Obstetrics and Gynecology 2023;58(5):351-358
		                        		
		                        			
		                        			Objective: To investigate the present situation of pelvic floor muscle strength, and to analyze the factors affecting pelvic floor muscle strength. Methods: The data of patients who were admitted into the general outpatient department of gynecology, Peking University People's Hospital from October 2021 to April 2022 were collected, and the patients who met the exclusion criteria were included in this cross sectional study. The patient's age, height, weight, education level, defecation way and defecation time, birth history, maximum newborn birth weight, occupational physical activity, sedentary time, menopause, family history and disease history were recorded by questionnaire. Morphological indexes such as waist circumference, abdomen circumference and hip circumference were measured with tape measure. Handgrip strength level was measured with grip strength instrument. After performing routine gynecological examinations, the pelvic floor muscle strength was evaluated by palpation with modified Oxford grading scale (MOS). MOS grade>3 was taken as normal group and ≤3 as decreased group. Binary logistic regression was used to investigate the related factors of deceased pelvic floor muscle strength. Results: A total of 929 patients were included in the study, and the average MOS grade was 2.8±1.2. By univariate analysis, birth history, menopausal time, defecation time, handgrip strength level, waist circumference and abdominal circumference were related to the decrease of pelvic floor muscle strength (all P<0.05). By binary logistic regression analysis, the level of handgrip strength (OR=0.913, 95%CI: 0.883-0.945; P<0.001) was correlated with normal pelvic floor muscle strength; waist circumference (OR=1.025, 95%CI: 1.005-1.046; P=0.016), birth history (OR=2.224, 95%CI: 1.570-3.149; P<0.001), sedentary time> 8 hours (OR=2.073, 95%CI: 1.198-3.587; P=0.009) were associated with the decrease of pelvic floor muscle strength. Conclusions: The level of handgrip strength is related to the normal pelvic floor muscle strength of females, while the waist circumference, birth history and sedentary time>8 hours are related to the decrease of pelvic floor muscle strength of females. In order to prevent the decrease of pelvic floor muscle strength, it is necessary to carry out relevant health education, enhance exercise, improve the overall strength level, reduce daily sedentary time, maintain symmetry, and carry out comprehensive overall intervention to improve pelvic floor muscle function.
		                        		
		                        		
		                        		
		                        			Adult
		                        			;
		                        		
		                        			Female
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Cross-Sectional Studies
		                        			;
		                        		
		                        			Gynecology
		                        			;
		                        		
		                        			Hand Strength
		                        			;
		                        		
		                        			Muscle Contraction/physiology*
		                        			;
		                        		
		                        			Muscle Strength/physiology*
		                        			;
		                        		
		                        			Outpatients
		                        			;
		                        		
		                        			Pelvic Floor/physiology*
		                        			
		                        		
		                        	
4.Frailty prevalence and its associations in a subacute geriatric ward in Singapore.
Christine Yuanxin CHEN ; Thulasi CHANDRAN ; Vivian Cantiller BARRERA ; Rachelle Tumbokon TAN-PANTANAO ; Tanya Joy Zapata QUICHO ; Zin Tun THANT ; Kiat Sern GOH
Singapore medical journal 2023;64(3):196-202
		                        		
		                        			INTRODUCTION:
		                        			Our aim was to study the prevalence of frailty and its associated factors in a subacute geriatric ward.
		                        		
		                        			METHODS:
		                        			This was a cross-sectional study of 167 participants between June 2018 and June 2019. Baseline demographics and participants' Mini Nutritional Assessment, Geriatric Depression Scale, Mini Mental State Examination, Charlson's Comorbidity Index and LACE index scores were obtained. Functional measurements such as modified Barthel's Index scores and hand grip strength (HGS) were taken. Frailty was assessed using the Clinical Frailty Scale (CFS) and the FRAIL scale. Data on history of healthcare utilisation, medications, length of stay, selected blood investigations and presence of geriatric syndromes were also collected.
		                        		
		                        			RESULTS:
		                        			The prevalence of pre-frailty (CFS 4) and frailty (CFS ≥ 5) was 16.2% and 63.4%, respectively. There were significant associations between CFS and age (pre-frail vs. non-frail: odds ratio [OR] 1.14, 95% confidence interval [CI] 1.04-1.25, P = 0.006; frail vs. non-frail: OR 1.08, 95% CI 1.01-1.15, P = 0.021), HGS at discharge (frail vs. non-frail: OR 0.90, 95% CI 0.82-0.99, P = 0.025), serum albumin (frail vs. non-frail: OR 0.90, 95% CI 0.82-0.99, P = 0.035) and the presence of urinary incontinence (frail vs. non-frail: OR 3.03, 95% CI 1.19-7.77, P = 0.021).
		                        		
		                        			CONCLUSION
		                        			Frailty is highly prevalent in the subacute geriatric setting and has many associated factors. In this study, independent factors associated with frailty were age, HGS at discharge, serum albumin and urinary incontinence. This has implications for future resource allocation for frail older inpatients and may help direct further research to study the effectiveness of frailty-targeted interventions.
		                        		
		                        		
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Aged
		                        			;
		                        		
		                        			Frailty/epidemiology*
		                        			;
		                        		
		                        			Frail Elderly
		                        			;
		                        		
		                        			Hand Strength
		                        			;
		                        		
		                        			Prevalence
		                        			;
		                        		
		                        			Singapore/epidemiology*
		                        			;
		                        		
		                        			Cross-Sectional Studies
		                        			;
		                        		
		                        			Fatigue Syndrome, Chronic
		                        			;
		                        		
		                        			Geriatric Assessment
		                        			;
		                        		
		                        			Urinary Incontinence
		                        			;
		                        		
		                        			Serum Albumin
		                        			
		                        		
		                        	
5.Low Grip Strength and Increased Mortality Hazard among Middle-Aged and Older Chinese Adults with Chronic Diseases.
Kai Hong XIE ; Xiao HAN ; Wei Jun ZHENG ; Su Fang ZHUANG
Biomedical and Environmental Sciences 2023;36(3):213-221
		                        		
		                        			OBJECTIVE:
		                        			This study aims to evaluate the association between lower grip strength and mortality hazard.
		                        		
		                        			METHODS:
		                        			We selected 10,280 adults aged 45 to 96 years old from the China Health and Retirement Longitudinal Study and used multivariate Cox proportional hazard models to assess the association of grip strength with mortality hazard. In addition, we explored the possibility of a nonlinear relationship using a 4-knot restricted spline regression.
		                        		
		                        			RESULTS:
		                        			We found that elevated grip strength was associated with lower mortality up to a certain threshold. The baseline quartile values of grip strength were 30, 37, and 44 kg for males and 25, 30, and 35 kg for females. After adjusting for confounders, with category 1 as the reference group, the adjusted HRs were 0.58 (0.42-0.79) in males and 0.70 (0.48-0.99) in females (category 4). We also found a linear association between grip strength values and all-cause death risk (males, P = 0.274; females, P = 0.883) using restricted spline regression. For males with a grip strength < 37 kg and females with a grip strength < 30 kg, grip strength and death were negatively associated.
		                        		
		                        			CONCLUSION
		                        			Grip strength below a sex-specific threshold is inversely associated with mortality hazard among middle-aged and older Chinese adults with chronic diseases.
		                        		
		                        		
		                        		
		                        			Aged
		                        			;
		                        		
		                        			Aged, 80 and over
		                        			;
		                        		
		                        			Female
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Male
		                        			;
		                        		
		                        			Middle Aged
		                        			;
		                        		
		                        			Chronic Disease
		                        			;
		                        		
		                        			East Asian People
		                        			;
		                        		
		                        			Hand Strength
		                        			;
		                        		
		                        			Longitudinal Studies
		                        			
		                        		
		                        	
6.The correlation of sleep duration and insomnia with low muscle mass, strength and quality in Chinese adults.
Qiao Rui WEN ; Man WU ; Lang PAN ; Jun LYU ; Yu GUO ; Pei PEI ; Huai Dong DU ; Jun Shi CHEN ; Can Qing YU ; Zheng Ming CHEN ; Li Ming LI
Chinese Journal of Epidemiology 2022;43(2):175-182
		                        		
		                        			
		                        			Objective: To explore the relationship of sleep duration and insomnia with muscle mass, strength, and quality in Chinese adults. Methods: Based on the second resurvey of China Kadoorie Biobank (CKB) in 2013-2014, logistic regression models were used to analyze the correlation of sleep duration, insomnia, and its duration with low muscle mass, handgrip strength, and muscle quality. Results: The average sleep duration of the study population was (7.4±1.5) hours. Morbidities of short sleep duration (<6 hours), long sleep duration (≥9 hours), and insomnia were 9.3%,17.4%,and 29.9%,respectively. Compared with those who slept for 7- hours, those who slept for ≥9 hours were more likely to have low muscle mass, low handgrip strength,and low arm muscle quality (AMQ), and the OR (95%CI) of low appendicular skeletal muscle mass index (ASMI), low total skeletal muscle mass index (TSMI), low grip strength and low AMQ were 1.32 (1.18-1.48),1.26 (1.13-1.41), 1.33 (1.18-1.49) and 1.16 (1.03-1.30), respectively. Compared with participants without insomnia, insomnia patients were more likely to have low muscle mass,and the longer the duration of insomnia,the higher the risk (P for trend <0.001). Participants who reported <6 hours sleep duration and insomnia had a higher proportion of low ASMI and low TSMI,compared with those who slept for 7- hours and without insomnia, the OR (95%CI) were 1.26 (1.08-1.47) and 1.25 (1.07-1.46), respectively. Conclusions: Participants who reported ≥9 hours sleep duration were more likely to have low muscle mass,low handgrip strength,and low AMQ. Participants with insomnia had lower muscle mass, and the longer the duration of insomnia, the higher the proportion of low ASMI and low TSMI.
		                        		
		                        		
		                        		
		                        			Adult
		                        			;
		                        		
		                        			China/epidemiology*
		                        			;
		                        		
		                        			Hand Strength
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Muscles
		                        			;
		                        		
		                        			Sleep/physiology*
		                        			;
		                        		
		                        			Sleep Initiation and Maintenance Disorders/epidemiology*
		                        			
		                        		
		                        	
7.A prospective cohort study on the association between grip strength and cognitive function in adults aged 50 years and above.
Ye RUAN ; Yan Fei GUO ; Shuang Yuan SUN ; Zhe Zhou HUANG ; Yu Jun DONG ; Yan SHI ; Fan WU
Chinese Journal of Epidemiology 2022;43(10):1611-1618
		                        		
		                        			
		                        			Objective: To evaluate the association between grip strength (GS) and cognitive function in a population-based longitudinal cohort of Chinese adults aged ≥50 years. Methods: The study population of 3 600 adults was from the baseline survey and two rounds of follow up of World Health Organization (WHO) study of global ageing and adult health (SAGE) in five districts of Shanghai (Hongkou, Huangpu, Minhang, Qingpu and Pudong) after excluding individuals with self-report stroke and depression. The effects of baseline GS on cognitive function and its changes were evaluated. Factor analysis was applied to generate an overall cognition score based on verbal recall trials, verbal fluency test, forward digit span test and backward digit span test. Linear mixed effects model was used to examine the predictive capability of baseline GS for changes in cognitive function. Results: A total of 3 600 participants aged (61.2±8.1) years at baseline survey were included in this study, including 1 668 (46.3%) men and 1 932 (53.7%) women. The average of baseline GS and total cognitive function score were (28.19±12.18) kg and (58.93±14.56) respectively. Cognitive function score declined significantly during the follow-up, however, the changes were different among different age groups, education level groups and household income groups. After adjusted for age, education level, marital status, household income, co-morbidity of chronic conditions, drinking status, smoking status, physical activity level, vegetable/fruit intakes and BMI, no relationships between the baseline GS and cognitive score at baseline survey and at 1st follow-up were observed, however, compared with lower GS quartile group, there was a significant relationship between higher baseline GS level and better cognitive function at 2nd follow-up. The participants with highest GS quartile had better cognitive performance over time (male: β=1.938,95%CI:0.644-3.231,P=0.003, female: β=2.192,95%CI:0.975-3.409,P<0.001 and those aged 50-64 years: β=1.652,95%CI:0.646-2.659,P=0.001) than those with the lowest quartile. Conclusions: Higher baseline GS was significantly related to better cognitive function with slow decline. Thus, it is an indicator of cognitive function in middle-aged and elderly Chinese.
		                        		
		                        		
		                        		
		                        			Adult
		                        			;
		                        		
		                        			Aged
		                        			;
		                        		
		                        			Middle Aged
		                        			;
		                        		
		                        			Female
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Male
		                        			;
		                        		
		                        			Prospective Studies
		                        			;
		                        		
		                        			China/epidemiology*
		                        			;
		                        		
		                        			Hand Strength
		                        			;
		                        		
		                        			Cognition
		                        			;
		                        		
		                        			Educational Status
		                        			
		                        		
		                        	
8.Association of handgrip strength with semen characteristics: a study with repeated measurements among healthy Chinese men.
Bin SUN ; Heng-Gui CHEN ; Peng DUAN ; Zhou-Zheng TU ; Ying-Jun CHEN ; Tian-Qing MENG ; Cheng-Liang XIONG ; Yi-Xin WANG ; An PAN
Asian Journal of Andrology 2022;24(6):594-600
		                        		
		                        			
		                        			Accumulating epidemiological evidence shows that handgrip strength provides predictive potential in physical, mental, and reproductive health status. However, the associations between handgrip strength and semen characteristics have not been explored. We recruited 1382 eligible men at the Hubei Province Human Sperm Bank (Wuhan, China) who had their handgrip strength measured at recruitment and provided 6458 repeated semen specimens within a 6-month period. Semen characteristics, including semen volume, sperm motility parameters (immotility, nonprogressive motility, and progressive motility), and sperm concentration, were assessed. Mixed-effect models and restricted cubic spline functions were applied to investigate the relationship of handgrip strength with repeated measurements of semen characteristics. After adjusting for confounding factors, the mixed-effect models revealed that handgrip strength was positively associated with semen volume, sperm concentration, progressive motility, total motility, and total count (all P for trend < 0.05). Compared to men in the lowest quartile, those in the highest quartile of handgrip strength had higher semen volume, sperm concentration, progressive motility, total motility, and total count, with measurements of 14.2% (95% confidence interval [CI]: 5.9%-23.2%), 19.5% (95% CI: 7.3%‒33.1%), 9.5% (95% CI: 3.4%‒15.9%), 8.8% (95% CI: 3.2%‒14.6%), and 36.4% (95% CI: 18.9%‒56.5%), respectively. These positive dose-response relationships were further confirmed in restricted cubic splines, where handgrip strength was modeled as a continuous variable. Handgrip strength, as an indicator of muscular function and strength, was positively associated with semen characteristics in a dose-dependent manner.
		                        		
		                        		
		                        		
		                        			Male
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Semen
		                        			;
		                        		
		                        			Sperm Motility
		                        			;
		                        		
		                        			Hand Strength
		                        			;
		                        		
		                        			Sperm Count
		                        			;
		                        		
		                        			Semen Analysis
		                        			;
		                        		
		                        			Spermatozoa
		                        			;
		                        		
		                        			China/epidemiology*
		                        			
		                        		
		                        	
9.Association between height-related polymorphism rs17081935 and reduced handgrip strength in relation to status of atherosclerosis: a cross-sectional study.
Yuji SHIMIZU ; Shin-Ya KAWASHIRI ; Kazuhiko ARIMA ; Yuko NOGUCHI ; Hirotomo YAMANASHI ; Kenichi NOBUSUE ; Fumiaki NONAKA ; Seiko NAKAMICHI ; Yasuhiro NAGATA ; Takahiro MAEDA
Environmental Health and Preventive Medicine 2021;26(1):83-83
		                        		
		                        			BACKGROUND:
		                        			Aging is a process that increases oxidative stress. Increased oxidative stress leads to the development of atherosclerosis and mitochondrial dysfunction. Mitochondria contribute to energy production that might have a beneficial influence on maintaining muscle strength. Therefore, the height-related single nucleotide polymorphism (SNP) rs17081935, which is also reported to be associated with mitochondrial metabolism, might be associated with reduced muscle strength and this association might be affected by atherosclerosis status. To clarify those associations, a cross-sectional study of 1374 elderly Japanese individuals aged 60-89 years was conducted.
		                        		
		                        			METHODS:
		                        			Logistic regression was used to clarify the association between rs17081935 and reduced handgrip strength. Since atherosclerosis might affect handgrip strength, participants were stratified by atherosclerosis status. Reduced handgrip strength was defined as being in the lowest quintile of handgrip strength (< 25.6 kg for men and < 16.1 kg for women).
		                        		
		                        			RESULTS:
		                        			No significant associations were found between a minor allele of rs17081935 and reduced handgrip strength among elderly participants without atherosclerosis. A significant inverse association was observed among elderly participants with atherosclerosis. After adjusting for known cardiovascular risk factors and height, the adjusted odd ratio (OR) and 95% confidence interval (CI) for reduced handgrip strength and a minor allele of rs17081935 were 1.13 (0.86, 1.43) for elderly participants without atherosclerosis and 0.55 (0.36, 0.86) for those with atherosclerosis, respectively.
		                        		
		                        			CONCLUSION
		                        			A minor allele of the height-related SNP rs17081935 was significantly inversely associated with reduced handgrip strength among older individuals with atherosclerosis, but not among those without atherosclerosis.
		                        		
		                        		
		                        		
		                        			Aged
		                        			;
		                        		
		                        			Aged, 80 and over
		                        			;
		                        		
		                        			Atherosclerosis/epidemiology*
		                        			;
		                        		
		                        			Body Height
		                        			;
		                        		
		                        			Cross-Sectional Studies
		                        			;
		                        		
		                        			Female
		                        			;
		                        		
		                        			Hand Strength
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Japan/epidemiology*
		                        			;
		                        		
		                        			Male
		                        			;
		                        		
		                        			Middle Aged
		                        			;
		                        		
		                        			Polymorphism, Single Nucleotide
		                        			;
		                        		
		                        			Prevalence
		                        			
		                        		
		                        	
10.Lower albumin levels are associated with frailty measures, trace elements, and an inflammation marker in a cross-sectional study in Tanushimaru.
Maki YAMAMOTO ; Hisashi ADACHI ; Mika ENOMOTO ; Ako FUKAMI ; Sachiko NAKAMURA ; Yume NOHARA ; Akiko SAKAUE ; Nagisa MORIKAWA ; Hitoshi HAMAMURA ; Kenta TOYOMASU ; Yoshihiro FUKUMOTO
Environmental Health and Preventive Medicine 2021;26(1):25-25
		                        		
		                        			BACKGROUND:
		                        			There is little data on the association between the lower nutrition represented by serum albumin levels and related factors in a general population. The present study aimed to determine whether the albumin level positioned as some kind of biomarker with frailty measures, trace elements, and an inflammation marker.
		                        		
		                        			METHODS:
		                        			In 2018, we performed an epidemiological survey in 1368 subjects who resided in Tanushimaru, Japan, in which we examined the blood chemistry including albumin, trace elements, hormone levels, and carotid ultrasonography. Albumin levels were categorized into 4 groups (G1 [3.2-3.9 mg/dL], G2 [4.0-4.3 mg/dL], G3 [4.4-4.6 mg/dL], and G4 [4.7-5.3 mg/dL]). The participants underwent measurements of handgrip strength and were tested by asking to walk 5 m. Their cognitive functions were evaluated by the mini-mental state examination (MMSE).
		                        		
		                        			RESULTS:
		                        			Multiple stepwise regression analysis demonstrated that albumin levels were significantly and independently associated with age (inversely), systolic blood pressures, estimated glomerular filtration rate (eGFR), MMSE score, frailty measures (handgrip strength), an inflammation marker (high-sensitivity C-reactive protein), hormones (growth hormone (inversely) and insulin-like growth factor-1), and trace elements (calcium, magnesium, iron, and zinc), with a linear trend.
		                        		
		                        			CONCLUSIONS
		                        			Lower albumin levels, even in the normal range, were found to be related factors of frailty measures, trace elements, and an inflammation marker in a general population.
		                        		
		                        		
		                        		
		                        			Aged
		                        			;
		                        		
		                        			Albumins/metabolism*
		                        			;
		                        		
		                        			Biomarkers/blood*
		                        			;
		                        		
		                        			Cross-Sectional Studies
		                        			;
		                        		
		                        			Female
		                        			;
		                        		
		                        			Frailty/physiopathology*
		                        			;
		                        		
		                        			Hand Strength/physiology*
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Inflammation/blood*
		                        			;
		                        		
		                        			Japan
		                        			;
		                        		
		                        			Male
		                        			;
		                        		
		                        			Trace Elements/blood*
		                        			
		                        		
		                        	
            

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