Delving Into the Nuances: Absolute Versus Relative Handgrip Strength for Probable Sarcopenia in Prediabetes

Background: Sarcopenia reflects a clinically relevant reduction in muscle strength and performance, contributing to adverse metabolic outcomes, including prediabetes. While absolute handgrip strength (HGS) is used in diagnostic criteria, relative HGS (RHGS) may better reflect functional muscle impairment, particularly in populations with variable adiposity. This study aimed to assess the prevalence of probable sarcopenia using absolute HGS and to evaluate the diagnostic performance of RHGS in identifying low HGS-defined probable sarcopenia among prediabetic adults. Methods: A cross-sectional study was conducted among 149 prediabetic adults aged 30-60 years at a tertiary care center. Absolute HGS was measured using a digital dynamometer following standardized protocols. Probable sarcopenia was identified using established Asian Working Group for Sarcopenia (AWGS) 2019 cutoff values. RHGS was calculated as HGS/body mass index (BMI). Receiver operating characteristic (ROC) analysis was performed to assess the discriminatory ability of RHGS in identifying low HGS-defined probable sarcopenia. Sociodemographic and biochemical parameters were also collected and analyzed using SPSS v23 (IBM Corp., Armonk, NY, USA). Results: Probable sarcopenia was identified in 8% of the study population. RHGS was significantly lower in individuals with low HGS (p < 0.001). ROC analysis demonstrated that RHGS had excellent discriminatory ability with a corrected area under the curve (AUC) of 0.867. An optimal cutoff of 0.835 yielded a sensitivity of 66.7% and specificity of 96.4%. Lower RHGS was also associated with adverse metabolic parameters. Conclusions: RHGS demonstrated excellent discriminatory ability and may serve as a practical screening and confirmatory tool for identifying low muscle strength in prediabetic populations. RHGS, by accounting for body composition, may serve as an appropriate marker, especially in populations with heterogeneous BMI profiles. Integrating RHGS into routine prediabetes assessment can support early identification and prevention of sarcopenia.