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# Handgrip strength reference values and determinants of muscle weakness in French adults: results from the NutriNet-Santé study

Abdouramane Soumaré, Jean-Michel Oppert, Laurent Bourhis, Alice Bellicha, Pilar Galan, Serge Hercberg, Mathilde Touvier, Léopold K Fezeu, Jérémy Vanhelst

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## ► To cite this version:

Abdouramane Soumaré, Jean-Michel Oppert, Laurent Bourhis, Alice Bellicha, Pilar Galan, et al. "Handgrip strength reference values and determinants of muscle weakness in French adults: results from the NutriNet-Santé study." The Journal of Sports Medicine and Physical Fitness, 2025, 10.23736/S0022-4707.25.16833-3. hal-05300208

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Submitted on 6 Oct 2025

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**Title:** Handgrip strength Reference values and determinants of muscle weakness in French adults: Results from the NutriNet-Santé study.

**Running head:** Muscular strength references.

**Authors:** Abdouramane Soumare<fnref n="1" />, Jean-Michel Oppert<fnref n="1" />⁻<fnref n="2" />, Laurent Bourhis<fnref n="1" />, Alice Bellicha<fnref n="1" />, Pilar Galan<fnref n="1" />, Serbe Hercberg<fnref n="1" />, Mathilde Touvier<fnref n="1" />, Léopold K Fezeu<fnref n="1" />#, Jérémy Vanhelst<fnref n="1" />#

**Address correspondence to:**

Jérémy Vanhelst

Equipe de Recherche en Epidémiologie Nutritionnelle (EREN)

UMR U1153 Inserm / U1125 Inrae / Cnam / Université Sorbonne Paris Nord

Centre de Recherche en Epidémiologie et Statistiques - Université Paris Cité (CRESS)

74 rue Marcel Cachin,

F-93017 Bobigny Cedex France

E-mail: jeremy.vanhelst@eren.smbh.univ-paris13.fr

<footnote n="1">¹Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017 Bobigny, France.</footnote>

<footnote n="2">²Department of Nutrition, Human Nutrition Research Center Ile-de-France (CRNH IdF), Pitié-Salpêtrière Hospital (AP-HP), Sorbonne University, Paris, France</footnote>
**Background:** The aim of this study was to determine sex- and age-specific handgrip strength percentiles in French adults and investigate sociodemographic and anthropometric variables associated with lower upper arm strength.

**Methods:** A sample of 18,532 French adults (5,262 men, 13,090 women), aged 18-91, from the NutriNet-Santé cohort (2011-2014) was assessed for handgrip strength. For each hand, the maximum grip strength in kilograms was recorded. Grip strength was analyzed in absolute terms and relative units (relative to body weight and BMI). Percentiles (5th to 95th) were established by age and sex. Sociodemographic, lifestyle, and anthropometric factors associated with low handgrip strength (<20th percentile) were evaluated using logistic regression, considering age, education, income, smoking status, BMI, physical activity, and sitting time.

**Results:** Low BMI was linked to low handgrip strength in both sexes, whereas overweight was protective in men (OR 0.77). In women, lower education correlated with higher odds of low strength (OR 0.78-0.84). Male former or current smokers had higher odds of low grip strength (OR 1.20-1.35), while women showed an inverse association (OR 0.86). Physical activity reduced risk in both sexes, particularly at high activity levels (men OR 0.74; women OR 0.73). Age was a key factor in women, with increased odds in the 45-49 and 55-59 age groups (OR 1.27 and 1.32).

**Conclusions:** The reference values provide reference data for French adults, and these data should be useful in identifying populations at risk of low muscle strength and sarcopenia.

**Keywords:** Muscular strength, dynamometer, norms.
# 1 INTRODUCTION

Robust and consistent evidence demonstrates that physical fitness is a key determinant of adult health and a strong predictor of morbidity and mortality (1,2). Attributes of physical fitness include cardiorespiratory fitness (CRF), musculoskeletal fitness (muscular strength, power, endurance, and flexibility), motor fitness (agility, speed of movement, balance and coordination), and body composition/anthropometry (height, body mass, body mass index (BMI), and waist circumference). Among these, muscle strength constitutes a vital element in maintaining independence in daily activities and promoting healthy ageing in the adult population. As muscle strength is an important indicator of current and future health, it is of great interest to monitor.

Among the various field tests used to assess muscle strength, the most commonly used test is the handgrip test. The handgrip test is a simple, acceptable, inexpensive, feasible and scalable measure of upper muscular strength for clinical and population screening and surveillance, with moderate to high criterion validity and high to very high reliability (3,4). The handgrip test is considered safe for adult populations without or with chronic disease (5).

Over the years, handgrip strength has been shown to be a strong marker of health in adults (1). Many studies have shown that low handgrip strength in adults is associated with an increased risk of several chronic diseases, including stroke, cardiovascular disease, respiratory disease, cancer, diabetes mellitus, depression and all-cause mortality (6–10). In addition, Manini & Clark (2012) have shown that low handgrip strength is associated with sarcopenia and may be considered a marker of physical function loss, increasing the risk of disability in older adults (11). Low handgrip strength is also recognized as a useful and important indicator of frailty in older individuals (12). Longitudinal data from the multinational Prospective Urban Rural Epidemiology (PURE) study of 139,691 adults aged 35-70 years from 17 countries, followed up for 4 years, showed that for every 5-kg reduction in handgrip strength, the risk of all-cause, cardiovascular and non-cardiovascular mortality increased by 16% and 17%, respectively (8). Similarly, findings from the UK Biobank cohort of half a
1

million participants reported hazard ratios of 1.16 for all-cause mortality and 1.22 for

2

cardiovascular mortality in men, and 1.20 for all-cause mortality and 1.19 for cardiovascular

3

mortality in women, for every 5 kg reduction in grip strength (6). Additional data from the

4

PURE study with a longer follow-up (median 9 years) of 155,722 adults showed that low

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handgrip strength was the third strongest risk factor for all-cause and cardiovascular

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mortality, after low education and tobacco use, in 21 high-, middle- and low-income countries

7

(13). This evidence highlights the importance of adult handgrip strength as a potential proxy

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for health status.

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Reference values for handgrip strength are needed in monitoring fitness in various

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populations. Some reference values have been published for adults in various countries and

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populations and are used for health and fitness screening, profiling, monitoring, and

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surveillance (14–28). Reference values on handgrip strength in French adults are currently

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lacking, and the NutriNet-Santé study provides an opportunity to establish such values.

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Therefore, the main objective of this study was to describe sex- and age-specific reference

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standards for handgrip strength in French adults. The secondary aim was to investigate

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sociodemographic, anthropometric and lifestyle variables associated with a low handgrip

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strength values in this population.

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# MATERIALS and METHODS

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## Study population: the NutriNet-Santé cohort

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This report is based on non-representative data collected from a subsample of the NutriNet-

22

Santé e-cohort. The NutriNet-Santé study is an ongoing web-based cohort that was launched

23

in France in May 2009. The primary aim of this web-based cohort is to assess the

24

relationships between nutrition and health along with the determinants of nutrition-related

25

behaviours. A detailed description has been published elsewhere (29). Volunteers were

26

recruited through a vast multimedia campaign including television, radio, national and

27

regional newspapers, posters, and internet announcements. The campaign directed
individuals to the dedicated study website (http://www.etude-nutrinet-sante.fr), where they could register and provide consent. To maximize outreach, the study was also relayed through a wide network of partner websites (national institutions, local authorities, private firms, and web organizations), and a billboard advertising campaign was maintained and regularly updated via professional channels such as physicians, pharmacists, dentists, municipalities, and business collaborators. Volunteers aged 15 years or older, living in France and having access to the Internet, complete self-administered web-based questionnaires at baseline and at regular time intervals during follow-up via a dedicated website.

The NutriNet-Santé study is conducted in accordance with the Declaration of Helsinki, and all procedures were approved by the Institutional Review Board of the French Institute for Health and Medical Research (IRB INSERM #0000388FWA00005831) and by the National Commission on Informatics and Liberty (CNIL #908,450 and #909,216). All participants provided informed consent and an electronic signature. The study is registered on [ClinicalTrials.gov](http://ClinicalTrials.gov) (NCT03335644).

Between February 2011 and June 2014, a sub-sample of the NutriNet-Santé cohort participated in an IRB-approved ancillary protocol involving clinical and biological assessments (one clinic visit per volunteer). A total of 82 centers were open across metropolitan France. All NutriNet-Santé enrollees who were not pregnant at the time were invited to complete a clinic visit. A total of 19 608 NutriNet-Santé volunteers accepted the invitation and thus constitute the population study on which the present analysis is based. From the total population, 1 255 adults with missing or incomplete data on anthropometric measurements, age or handgrip strength measurements were excluded, resulting in a study sample of 18 352 participants.

## Measurements

### Handgrip strength
1 The Jamar® hydraulic handgrip dynamometer (Sammons Preston Rolyan, Bolingbrook, IL, USA) was used with an adjustable grip to accommodate different hand sizes. There are five different grip positions to accommodate hand size in 5 half-inch increments. The dual scale display shows isometric grip force in pounds and kilograms up to 200 pounds or 90 kilograms, with a peak-hold needle that automatically holds the highest reading until reset.
2
3
4
5
6 The Jamar® hydraulic handgrip dynamometer is recognized as an accurate instrument for measuring handgrip strength, with an excellent intraclass correlation coefficients (ICCs) reported, ranging from 0.85 to 0.98 for intra reliability, and from 0.948 to 0.980 for inter reliability (30–32). Measurements were performed according to the American Society of Hand Therapists guidelines developed in 1981 and updated in 2015 (33). Participants were seated with their shoulders adducted, their elbows flexed at 90°, and their forearms in a neutral position. At this point, the trained investigator supported the base of the dynamometer with one hand and made a reset of the peak-hold needle to zero. The participants were asked to squeeze gradually and continuously for as strongly as possible, between 2 and 3 seconds. The test was performed three times with the right hand, allowing one-minute rest between each measurement, and three times with the left hand using the same procedure. No encouragement was given to the participants during the test. For each hand, the maximum value, expressed in kilograms was recorded. Grip strength was also analysed in two relative units (kilograms of grip strength divided by kilograms of body weight; kilograms of grip strength divided by body mass index).

21 According to previous studies, a percentile-based approach was used for the analysis of our
22 secondary objective (34–37). Participants with handgrip strength values below the 20th
23 percentile, based on the age- and sex-specific distributions within our sample, were classified
24 as having muscle weakness, i.e. very low or poor muscle strength (34–37).
25
26

26 Anthropometric measures

27 Body weight was measured to the nearest 0.1 kg using an electronic scale (Tanita Corp.,
28 Tokyo, Japan) with the participant wearing light clothes and without shoes. Height was
1

measured without shoes to the nearest 0.1 cm using a standard medical scale. Body mass

2

index (BMI) was calculated as weight/height² (kg/m²). World Health Organization BMI cut-off

3

points were used: underweight <18.5 kg/m², normal weight between ≥18.5 kg/m² and <25

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kg/m², overweight between ≥25.0 kg/m² and <30 kg/m², and obesity ≥30.0 kg/m² (38).

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## Sociodemographic and lifestyle factors

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NutriNet-Santé participants regularly complete web-based questionnaires. At enrolment and then every year or six months, a set of several questionnaires related to sociodemographic and lifestyle characteristics (educational level, monthly household income, occupation, smoking status, alcohol consumption), physical activity and sitting time (using the International Physical Activity Questionnaire – IPAQ short form) are sent to the participants (39–41). For the present analysis, we used data from the questionnaires last completed by the participants before the clinical evaluation. All the NutriNet-Santé questionnaires are available online (in French) at https://info.etude-nutrinet-sante.fr/siteinfo.

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## Statistical analysis

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The SAS CALMAR macro was employed to correct the study sample through re-weighting of individuals, using auxiliary information derived from a specific set of variables (gender, age and socioeconomic status), designated as calibration variables, obtained from the French population(42,43). All statistical analyses were performed using the Stata module (svy) for complex survey designs. Continuous variables are reported as mean (standard deviation, SD) and categorical variables are reported as percentages. Normality of distributions was assessed using histograms and using the Shapiro-Wilk test. Comparisons of the participant characteristics by gender were made using the Student t test for quantitative variables, and the chi-square test for qualitative variables.

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Handgrip strength values were normally distributed in the overall gender population and after stratification by age groups. Percentiles used included: 5th, 10th, 20th, 30th, 40th, 50th, 60th, 70th,

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80th, 90th, and 95th of the handgrip strength for French adults as a function of age stratified by sex.

2

3

To assess the sex-specific sociodemographic, lifestyle and anthropometric correlates of low handgrip strength (<20th centile), a survey multivariable logistic regression analysis was performed, including the following variables: age group (<30, 30-39, 40-49, 50-59, 60-69, ≥ 70 years), educational level (high school degree, undergraduate, graduate degree), monthly household income per individual (< 1200, 1200 - 1800, 1800 - 2700, > 2700 euros), smoking status (never smoker, former smoker, current smoker), BMI categories (underweight, normal weight, overweight, obesity), physical activity categories estimated by the IPAQ short form (low, moderate, high) and sitting time (hours per week). In this analysis, income data were not adjusted for inflation, as the focus was on making relative comparisons within the cohort.

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All statistics were performed using STATA® (version 14.2; StataCorp LP, College Station, TX). All tests were two-tailed and P<0.05 was considered statistically significant.

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# RESULTS

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## Participants characteristics

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Among the 19 609 individuals who attended the consultation clinics, 1 563 were excluded from the analysis due to missing data on various variables, including weight, height, handgrip strength, and socioeconomic status. Additionally, 2704 participants with a chronic condition (prevalent cancer, type 2 diabetes, myocardial infarction, stroke, heart failure, pulmonary embolism, asthma) were excluded, resulting in a sample size of 15 319 (among which 4132 men). The application of the sample weight yielded a population of 50 406 743 individuals, of whom 47.63% of men. The characteristics of the participants are described in Table 1. The sample includes two-thirds of women. Compared to women, men were older, had higher BMI and had higher proportions of persons with overweight or obesity, with higher education, income, and high physical activity level. Sedentary time did not differ between gender. Men
1

had higher mean handgrip strength (expressed in absolute values) than women, regardless
of the arm tested.

2

3

4

Percentiles of Handgrip strength

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6

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Sex- and age-specific percentile absolute values (P5, P10, P20, P30, P40, P50, P60, P70, P80, P90, and P95) for dominant and non-dominant handgrip strength are reported in Tables 2-3.

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Tables S1-S4 present sex- and age-specific percentile relative values (body weight and BMI) for dominant and non-dominant handgrip strength.

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Associations with sociodemographic, anthropometric and lifestyle variables

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Table 4 presents the adjusted associations of various sociodemographic and anthropometric variables with low handgrip strength (defined as below the 20th centile of handgrip strength) according to sex. The model showed a significant association between BMI and muscle weakness in both sexes (p<0.001). Underweight status was positively associated with low handgrip strength in both sexes (in men: OR 2.14 [1.16-3.96]; in women: OR 1.61 [1.33-1.95]), whereas a negative association was found with overweight status (in men: OR 0.77 [0.66-0.90]; in women: OR 0.93 [0.84-1.03]). There was no significant association with obesity. Educational level was associated with low handgrip strength only in women (For undergraduate degree: OR 0.84 [0.75-0.94]; for graduate degree: OR 0.78 [0.68-0.88]). Positive associations were also observed between smoking status and muscle weakness in men (OR 1.20 [1.03-1.40] and OR 1.35 [1.06-1.73] in former and current smokers, respectively), while inverse associations were found in women (OR 0.86 [0.79-0.94] for former smokers and OR 0.86 [0.75-0.99] for current smokers). Physical activity was negatively associated with muscle weakness in both sexes. In women, the risk decreased with higher physical activity level: OR 0.87 [0.78-0.96] for moderate versus OR 0.73 [0.65-0.82] for high levels. In men, the association was found only for high physical activity level
1

(OR 0.74 [0.61-0.89]). For the age, an association was found only in women and in two age groups: 45-49 years (OR 1.27 [1.05-1.53]) and 55-59 years (OR 1.32 [1.10-1.58]).

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DISCUSSION

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Muscle strength is a robust marker of increased risk of morbidity and mortality (1,6,44).

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Sex and age-specific reference values are needed to assess and interpret measures of muscle strength indicators at individual and population level. Data from the PURE study showed that handgrip strength values differ between geographical regions pointing to the importance of defining country-specific reference values (28). Based on a large population data set, we describe sex- and age- specific reference values for handgrip strength in French adults.

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Given the lack of normative values for handgrip strength in French adults, the results of our study, which provide sex- and age-specific reference standards for the use of the handgrip test, are relevant. These reference values are of public health interest and necessary for screening, monitoring and making a national surveillance. The use of appropriate normative quintiles to classify handgrip strength for our national normative reference values can be used as follows: (i) below the 20th centile as 'very low/poor'; (ii) 20-40th centiles as 'low/poor'; (iii) 40-60th centiles as 'moderate'; (iv) 60-80th centiles as 'high/good'; (v) and adults above the 80th centile as 'very high/good'. We encourage French healthcare professionals to incorporate handgrip strength assessments, which are simple to implement in medical consultations, alongside our normative data to identify individuals with low muscular strength and, consequently, poor health status.

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Our data reveal that men exhibit higher handgrip performance than women, consistent with findings from previous studies (19,36,45). Furthermore, both sexes reach peak strength between the ages of 40 and 45. After this age range, handgrip strength begins to decline as age increases, which aligns with findings from previous studies (19,20,24,28,45). Two

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potential explanations for the difference in sex and age can be proposed. First, hormonal
factors play a significant role, as higher testosterone levels in men contribute to increased
muscle mass (46,47). Additionally, the decline in testosterone with age may explain the
observed variations in muscle mass and strength among older adults (46). This evidence is
highlighted by studies using compound ultrasound imaging and magnetic resonance
imaging, which demonstrate that young adults and men have greater fat-free mass
compared to older adults and women, respectively (48,49). Our findings showed that the
older group (age ≥ 70 years) had approximately 20% less handgrip strength than the
younger age group for both sexes. Secondly, disparities in physical activity levels may further
impact muscle strength. Previous research has shown that engaging in high levels of daily
physical activity or adhering to physical activity guidelines correlate with enhanced physical
fitness levels including muscle strength (50-52). Data from several large cohorts have shown
that physical activity levels are lower in women than in men (53-55). A worldwide pooled
analysis of 358 population-based surveys involving 1.9 million participants provided
additional evidence showing that the prevalence of insufficient physical activity is higher in
women than in men (56). More recently, in a large sample of French adults, Verdot et al.
(2022) demonstrated a substantial and significant difference between men and women in
meeting physical activity guidelines, with 70.6% and 52.7%, respectively (57). Hence, the
lower level of physical activity among women, along with a lower percentage of French
women meeting physical activity guidelines, may explain the discrepancy in muscular fitness
between men and women in our study.

22

We identified some sociodemographic, anthropometric and lifestyle factors as associated
with a low handgrip strength. As previously shown, we found that BMI categories was a
factor independently associated with the occurrence of low handgrip strength in both sexes
(35). Among adults, having a low BMI was a risk factor for low handgrip strength. This can be
explained by the fact that underweight adults typically have less muscle mass, which directly
contributes to reduced muscle strength. Smoking status was another factor associated with
low handgrip strength. Participants who said they were former smoker had lower handgrip strength compared to their non-smoking peers. This finding is consistent with previous studies showing the detrimental effects of smoking on muscular strength (35,58). Researchers have attributed this effect to the constituents of circulating cigarette smoke, which appear to play an important role by causing loss of muscle mass, reducing oxygen delivery and impairing mitochondrial function (59). Conversely, our study surprisingly shows that smoking has a protective effect in women. While we do not have a definitive explanation for this finding, one possible hypothesis is that less healthy former female smokers were less likely to participate in the clinical evaluation, resulting in a relatively healthier subgroup remaining in the sample. Adults with low levels of daily physical activity levels are also more likely to have low handgrip strength. The association of physical activity with health benefits is widely recognized, and it has previously been described that high levels of physical activity are associated with better handgrip strength outcomes compared to inactive counterparts (50–52).

Our findings have several important public health implications. Promotion and prevention strategies should focus on middle adulthood in order to maintain the high levels of muscle strength observed in young adulthood. Several targets for improving physical fitness can be identified, and interventions should focus on both men and women to increase time spent in physical activity and reduce sedentary behavior. First, participation in sports club may be a modifiable factor for potentially beneficial changes in physical fitness and lifestyle habits (60–62). Second, active commuting to work may be an opportunity and a viable way for adults to improve physical fitness. A systematic review showed that active commuting to work (such as walking or cycling) was associated with higher muscle strength in adults (63). The work environment may also be an important determinant of physical fitness in adults.

The strengths of the study are the large sample size of adults with gender-specific information across France, the use of standardized procedures, and the robust established
methodology for assessing muscle strength. These strengths improve the applicability and implementation of our findings and the statistical robustness of the results. Another strength is the establishment of percentiles for sex and age, which recognizes the well-documented influence of age and sex on levels of physical fitness. Secondly, the use of the Jamar hydraulic handgrip dynamometer is recognized as an accurate and objective instrument for measuring muscular strength with an excellent intra- and inter-reliability, and widely used in international studies. Lastly, we decided to use values below the 20th centile according to age and sex for each age group, a methodology previously used (35,36). Indeed, if a single threshold for handgrip strength had been used for men and women, the prevalence of lower muscular strength would have been higher in older adults compared with younger adults.

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## 12 CONCLUSIONS

The NutriNet-Santé study provided an opportunity to establish sex- and age-specific handgrip strength percentile reference values for French adults. Our normative values have been reported as 5th to 95th percentiles to enable adults to assess their own level of physical fitness. These reference standards are particularly valuable for health professionals in assessing at-risk individuals and are useful for health surveillance regarding adults with low handgrip strength. In addition, we identified at-risk groups for lower handgrip performance, including underweight individuals, women with lower educational levels, men who smoke, and older individuals aged 45 and above. This should lead to the development of interventions and programmes designed to increase muscle strength in target groups with the aim to improve health and quality of life of adult populations.
## ACKNOWLEDGEMENTS

The authors warmly thank all the volunteers of the NutriNet-Santé cohort for their continuous participation in the study and for participating in the NutriNet-Santé biobank project. The authors also thank Cédric Agaesse (manager), Alexandre De-Sa and Rebecca Lutchia (dietitians); Selim Aloui (manager), Thi Hong Van Duong, Régis Gatibelza, Jagatjit Mohinder and Aladi Timera (computer scientists); Julien Allegre, Nathalie Arnault, Laurent Bourhis, and Nicolas Dechamp (data-managers and statisticians); Paola Yvroud (health event validator); and Maria Gomes (participants' support) for their technical contribution to the NutriNet-Santé study, for their dedication and engagement to collect and manage the data used for this study, and for ensuring continuing communication with the cohort participants. This work only reflects the authors' views, and the funders are not responsible for any use that might be made of the information it contains. Researchers were independent from funders. The research question developed in this Article corresponds to a strong concern of the participants involved in the NutriNet-Santé cohort, and of the public in general. The results of the present study will be disseminated to the NutriNet-Santé participants through the cohort website and public seminars.

## Competing interest

All authors declare no competing interest.

## Data availability

The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request. Researchers from public institutions are invited to submit a collaboration request, including their institution and a brief description of the project, to collaboration@etude-nutrinet-sante.fr. All requests will be subject to review by the steering committee of the NutriNet-Santé study. A financial contribution may be requested. Should the collaboration be accepted, a data access agreement will be required,
and authorization from the relevant administrative authorities may also be necessary. In
accordance with existing regulations, no personal data will be accessible.

Funding

The NutriNet-Santé cohort study was supported by the following public institutions: Ministère de la Santé, Santé Publique France, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement (INRAE), Conservatoire National des Arts et Métiers (CNAM) and Université Sorbonne Paris Nord. Study investigators are independent from the funders. Funders had no role in the study design, the collection, analysis, and interpretation of data, the writing of the manuscript, or the decision to submit the article for publication.

Authors’ contributions:

Designed research, contributed to the conception and interpretation of the analyses: LB,
JMO, AB, PG, SH, MT, LF and JV.

Statistical analysis: AS and LF

Drafted the manuscript. AS, LF and JV.

All authors critically revised the manuscript, and approved the final version of the manuscript
to be submitted.
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<table><caption>Table 1. Characteristics of study participant by gender</caption><thead><tr><th></th><th>Men</th><th>Women</th><th>P*</th></tr></thead><tbody><tr><td>Sex, %</td><td>47.6</td><td>52.4</td><td></td></tr><tr><td>Age (years)</td><td>47.9 ± 12.0</td><td>49.8 ± 19.5</td><td>0.03</td></tr><tr><td>Height (cm)</td><td>176 ± 5.61</td><td>162 ± 7.49</td><td>&lt;0.0001</td></tr><tr><td>Weight (kg)</td><td>76.6 ± 10.0</td><td>62.8 ± 14.5</td><td>&lt;0.0001</td></tr><tr><td>BMI (kg/m²)</td><td>24.8 ± 3.1</td><td>23.8 ± 5.3</td><td>&lt;0.0001</td></tr><tr><td>Waist circumference (cm)</td><td>88.0 ± 8.7</td><td>79.4 ± 13.4</td><td>&lt;0.0001</td></tr><tr><td>BMI categories</td><td></td><td></td><td>&lt;0.0001</td></tr><tr><td>Underweight</td><td>1.66</td><td>4.71</td><td></td></tr><tr><td>Normal weight</td><td>59.32</td><td>65.32</td><td></td></tr><tr><td>Overweight</td><td>30.18</td><td>21.18</td><td></td></tr><tr><td>Obesity</td><td>8.83</td><td>8.49</td><td></td></tr><tr><td>Educational level</td><td></td><td></td><td>0.002</td></tr><tr><td>High school degree</td><td>27.72</td><td>21.42</td><td></td></tr><tr><td>Undergraduate degree</td><td>41.76</td><td>48.36</td><td></td></tr><tr><td>Graduate degree</td><td>30.52</td><td>30.23</td><td></td></tr><tr><td>Monthly income, € per household</td><td></td><td></td><td>0.09</td></tr><tr><td>&lt; 1200</td><td>20.82</td><td>17.69</td><td></td></tr><tr><td>1200-1800</td><td>25.32</td><td>26.39</td><td></td></tr><tr><td>1800-2700</td><td>24.82</td><td>21.99</td><td></td></tr><tr><td>&gt; 2700</td><td>22.36</td><td>25.60</td><td></td></tr><tr><td>Missing</td><td>6.68</td><td>8.34</td><td></td></tr><tr><td>Smoking status</td><td></td><td></td><td>&lt;0.0001</td></tr><tr><td>Never smoker</td><td>42.7</td><td>46.8</td><td></td></tr><tr><td>Former smoker</td><td>43.4</td><td>41.9</td><td></td></tr><tr><td>Current Smoker</td><td>13.9</td><td>11.3</td><td></td></tr><tr><td>Physical activity level (IPAQ)</td><td></td><td></td><td>&lt;0.0001</td></tr><tr><td>Low</td><td>19.5</td><td>21.7</td><td></td></tr><tr><td>Moderate</td><td>36.5</td><td>45.1</td><td></td></tr><tr><td>High</td><td>44.0</td><td>33.2</td><td></td></tr><tr><td>Sitting time (h/week)</td><td>40.0 ± 16.0</td><td>41.2 ± 24.7</td><td>0.17</td></tr><tr><td>Handgrip strength, %</td><td></td><td></td><td>0.15</td></tr><tr><td>Right-handed</td><td>87.4</td><td>89.07</td><td></td></tr><tr><td>Left-handed</td><td>10.65</td><td>8.54</td><td></td></tr><tr><td>Ambidextrous</td><td>1.94</td><td>2.39</td><td></td></tr><tr><td>Handgrip strength (kg)</td><td></td><td></td><td>&lt;0.0001</td></tr><tr><td>Dominant arm</td><td>46.4 ± 6.5</td><td>28.0 ± 6.8</td><td></td></tr><tr><td>Non dominant arm</td><td>44.2 ± 6.6</td><td>26.4 ± 6.6</td><td>&lt;0.0001</td></tr><tr><td>Ambidextrous</td><td>48.5 ± 7.6</td><td>28.9 ± 6.5</td><td>&lt;0.0001</td></tr></tbody></table>

Values are mean ± standard deviation or number (%)

<footnote>* For comparison between men and women, a t-test for continuous variables and chi-squared test for categorical variables were used.</footnote>
<table><caption>**Table 2.** Estimation of centiles for handgrip strength (absolute values, kg) of the dominant arm for French adult men and women.</caption><thead><tr><th rowspan="2"></th><th rowspan="2">n (weighted)</th><th rowspan="2">Mean ± SD</th><th colspan="11">Percentiles</th></tr><tr><th>5</th><th>10</th><th>20</th><th>30</th><th>40</th><th>50</th><th>60</th><th>70</th><th>80</th><th>90</th><th>95</th></tr></thead><tbody><tr><td colspan="13"><strong>Men</strong></td></tr><tr><td>&lt; 30 years</td><td>4 415 874</td><td>46.4 ± 4.00</td><td>30</td><td>34</td><td>40</td><td>42</td><td>45</td><td>47</td><td>48</td><td>50</td><td>54</td><td>58</td><td>60</td></tr><tr><td>30-39 years</td><td>3 656 317</td><td>49.7 ± 5.67</td><td>35</td><td>39</td><td>42</td><td>45</td><td>48</td><td>50</td><td>53</td><td>54</td><td>57</td><td>60</td><td>64</td></tr><tr><td>40-49 years</td><td>4 445 040</td><td>48.6 ± 5.37</td><td>33</td><td>38</td><td>43</td><td>45</td><td>47</td><td>48</td><td>50</td><td>52</td><td>55</td><td>60</td><td>61</td></tr><tr><td>50-59 years</td><td>6 340 088</td><td>47.1 ± 5.02</td><td>34</td><td>38</td><td>40</td><td>42</td><td>44</td><td>46</td><td>49</td><td>52</td><td>55</td><td>57</td><td>59</td></tr><tr><td>60-69 years</td><td>1 903 335</td><td>46.2 ± 1.75</td><td>33</td><td>37</td><td>40</td><td>42</td><td>45</td><td>46</td><td>48</td><td>50</td><td>53</td><td>57</td><td>58</td></tr><tr><td>≥ 70 years</td><td>3 248 667</td><td>38.7 ± 4.30</td><td>28</td><td>31</td><td>34</td><td>36</td><td>37</td><td>38</td><td>40</td><td>42</td><td>44</td><td>48</td><td>50</td></tr><tr><td colspan="13"><strong>Women</strong></td></tr><tr><td>&lt; 30 years</td><td>4 337 652</td><td>29.4 ± 5.09</td><td>21</td><td>23</td><td>25</td><td>27</td><td>28</td><td>29</td><td>30</td><td>32</td><td>34</td><td>37</td><td>39</td></tr><tr><td>30-39 years</td><td>3 609 529</td><td>30.8 ± 6.74</td><td>22</td><td>24</td><td>26</td><td>28</td><td>29</td><td>31</td><td>32</td><td>33</td><td>35</td><td>38</td><td>40</td></tr><tr><td>40-49 years</td><td>4 811 443</td><td>30.1 ± 6.30</td><td>22</td><td>24</td><td>26</td><td>27</td><td>29</td><td>30</td><td>31</td><td>33</td><td>34</td><td>37</td><td>39</td></tr><tr><td>50-59 years</td><td>7 095 069</td><td>28.0 ± 5.84</td><td>20</td><td>22</td><td>24</td><td>25</td><td>27</td><td>28</td><td>29</td><td>30</td><td>32</td><td>34</td><td>37</td></tr><tr><td>60-69 years</td><td>1 705 596</td><td>26.7 ± 1.65</td><td>18</td><td>20</td><td>23</td><td>24</td><td>26</td><td>27</td><td>28</td><td>29</td><td>31</td><td>33</td><td>35</td></tr><tr><td>≥ 70 years</td><td>4 838 134</td><td>22.7 ± 2.43</td><td>17</td><td>18</td><td>19</td><td>20</td><td>21</td><td>22</td><td>24</td><td>25</td><td>27</td><td>28</td><td>30</td></tr></tbody></table>

SD indicates standard deviation.
<table><caption>**Table 3.** Estimation of centiles for handgrip strength (absolute values, kg) of non-dominant arm for French adult men and women.</caption><thead><tr><th rowspan="2"></th><th rowspan="2">n (weighted)</th><th rowspan="2">Mean ± SD</th><th colspan="11">Percentiles</th></tr><tr><th>5</th><th>10</th><th>20</th><th>30</th><th>40</th><th>50</th><th>60</th><th>70</th><th>80</th><th>90</th><th>95</th></tr></thead><tbody><tr><td colspan="13"><em>Men</em></td></tr><tr><td>&lt; 30 years</td><td>4 415 874</td><td>43.7 ± 4.07</td><td>29</td><td>33</td><td>36</td><td>39</td><td>42</td><td>43</td><td>46</td><td>49</td><td>52</td><td>54</td><td>58</td></tr><tr><td>30-39 years</td><td>3 656 317</td><td>47.3 ± 5.44</td><td>33</td><td>36</td><td>40</td><td>44</td><td>45</td><td>48</td><td>51</td><td>52</td><td>54</td><td>58</td><td>58</td></tr><tr><td>40-49 years</td><td>4 445 040</td><td>46.5 ± 5.56</td><td>32</td><td>36</td><td>40</td><td>42</td><td>44</td><td>47</td><td>49</td><td>50</td><td>54</td><td>57</td><td>59</td></tr><tr><td>50-59 years</td><td>6 340 088</td><td>45.0 ± 5.13</td><td>33</td><td>35</td><td>38</td><td>41</td><td>43</td><td>45</td><td>47</td><td>48</td><td>51</td><td>55</td><td>59</td></tr><tr><td>60-69 years</td><td>1 903 335</td><td>44.2 ± 1.19</td><td>32</td><td>35</td><td>38</td><td>41</td><td>42</td><td>44</td><td>47</td><td>48</td><td>50</td><td>54</td><td>54</td></tr><tr><td>≥ 70 years</td><td>3 248 667</td><td>36.5 ± 4.55</td><td>26</td><td>29</td><td>31</td><td>32</td><td>34</td><td>36</td><td>38</td><td>40</td><td>42</td><td>46</td><td>48</td></tr><tr><td colspan="13"><em>Women</em></td></tr><tr><td>&lt; 30 years</td><td>4 337 652</td><td>27.5 ± 4.83</td><td>20</td><td>21</td><td>23</td><td>25</td><td>26</td><td>27</td><td>28</td><td>30</td><td>32</td><td>34</td><td>36</td></tr><tr><td>30-39 years</td><td>3 609 529</td><td>29.0 ± 6.51</td><td>20</td><td>22</td><td>25</td><td>26</td><td>28</td><td>29</td><td>30</td><td>32</td><td>33</td><td>36</td><td>38</td></tr><tr><td>40-49 years</td><td>4 811 443</td><td>28.5 ± 6.14</td><td>21</td><td>22</td><td>24</td><td>26</td><td>27</td><td>28</td><td>30</td><td>31</td><td>32</td><td>35</td><td>38</td></tr><tr><td>50-59 years</td><td>7 095 069</td><td>26.6 ± 5.84</td><td>19</td><td>20</td><td>22</td><td>24</td><td>25</td><td>27</td><td>28</td><td>29</td><td>30</td><td>33</td><td>35</td></tr><tr><td>60-69 years</td><td>1 705 596</td><td>25.2 ± 1.45</td><td>18</td><td>20</td><td>21</td><td>23</td><td>24</td><td>25</td><td>26</td><td>27</td><td>29</td><td>31</td><td>33</td></tr><tr><td>≥ 70 years</td><td>4 838 134</td><td>21.4 ± 2.63</td><td>16</td><td>16</td><td>17</td><td>19</td><td>20</td><td>21</td><td>22</td><td>23</td><td>25</td><td>28</td><td>30</td></tr></tbody></table>

SD indicates standard deviation.
<table><caption>**Table 4.** Multivariate analysis of independent factors associated with muscle weakness* in French adult men (n=5262) and women (n =13090)</caption><thead><tr><th rowspan="2">Variables</th><th colspan="2">Men</th><th colspan="2">Women</th></tr><tr><th>Odds-ratio (95% CI)</th><th>P</th><th>Odds-ratio (95% CI)</th><th>P</th></tr></thead><tbody><tr><td><strong>BMI categories</strong></td><td></td><td>0.0003</td><td></td><td>&lt;0.0001</td></tr><tr><td>Underweight</td><td>2.14 (1.16 - 3.96)</td><td>0.015</td><td>1.61 (1.33 - 1.95)</td><td>&lt;0.0001</td></tr><tr><td>normal</td><td>1</td><td>1</td><td>1</td><td></td></tr><tr><td>overweight</td><td>0.77 (0.66 - 0.90)</td><td>0.001</td><td>0.93 (0.84 - 1.03)</td><td>0.175</td></tr><tr><td>obese</td><td>0.85 (0.67 - 1.07)</td><td>0.167</td><td>0.98 (0.86 - 1.13)</td><td>0.817</td></tr><tr><td><strong>Monthly income, € per household</strong></td><td></td><td>0.1636</td><td></td><td>0.0646</td></tr><tr><td>&lt; 1200</td><td>1.22 (0.92 - 1.60)</td><td>0.163</td><td>1.18 (1.01 - 1.37)</td><td>0.031</td></tr><tr><td>1200-1800</td><td>1</td><td>1</td><td>1</td><td></td></tr><tr><td>1800-2700</td><td>0.92 (0.76 - 1.13)</td><td>0.448</td><td>1.13 (1.00 - 1.27)</td><td>0.042</td></tr><tr><td>&gt; 2700</td><td>0.89 (0.73 - 1.09)</td><td>0.258</td><td>1.01 (0.90 - 1.14)</td><td>0.820</td></tr><tr><td><strong>Educational level</strong></td><td></td><td>0.4634</td><td></td><td>0.0006</td></tr><tr><td>High school degree</td><td>1</td><td>1</td><td>1</td><td></td></tr><tr><td>Undergraduate degree</td><td>1.05 (0.87 - 1.26)</td><td>0.594</td><td>0.84 (0.75 - 0.94)</td><td>0.003</td></tr><tr><td>Graduate degree</td><td>1.13 (0.93 - 1.37)</td><td>0.228</td><td>0.78 (0.68 - 0.88)</td><td>0.0001</td></tr><tr><td><strong>Smoking status</strong></td><td></td><td>0.0147</td><td></td><td>0.0016</td></tr><tr><td>Never -smoker</td><td>1</td><td>1</td><td>1</td><td></td></tr><tr><td>Former smoker</td><td>1.20 (1.03 - 1.40)</td><td>0.019</td><td>0.86 (0.79 - 0.94)</td><td>0.001</td></tr><tr><td>Current smoker</td><td>1.35 (1.06 - 1.73)</td><td>0.015</td><td>0.86 (0.75 - 0.99)</td><td>0.046</td></tr><tr><td><strong>Physical activity</strong></td><td></td><td>0.0014</td><td></td><td>&lt;0.0001</td></tr><tr><td>Low</td><td>1</td><td>1</td><td>1</td><td></td></tr><tr><td>medium</td><td>0.92 (0.76 - 1.11)</td><td>0.386</td><td>0.87 (0.78 - 0.96)</td><td>0.008</td></tr><tr><td>High</td><td>0.74 (0.61 - 0.89)</td><td>0.001</td><td>0.73 (0.65 - 0.82)</td><td>0.0001</td></tr><tr><td><strong>Age (years)</strong></td><td></td><td>0.9961</td><td></td><td>&lt;0.0001</td></tr><tr><td>&lt;30</td><td>1</td><td>1</td><td>1</td><td></td></tr><tr><td>30-34</td><td>0.90 (0.59 - 1.39)</td><td>0.646</td><td>1.13 (0.92 - 1.40)</td><td>0.244</td></tr><tr><td>35-39</td><td>0.87 (0.57 - 1.33)</td><td>0.522</td><td>0.91 (0.73 - 1.14)</td><td>0.421</td></tr><tr><td>40-44</td><td>1.03 (0.69 - 1.54)</td><td>0.877</td><td>0.95 (0.77 - 1.17)</td><td>0.606</td></tr><tr><td>45-49</td><td>0.97 (0.66 - 1.43)</td><td>0.879</td><td>1.27 (1.05 - 1.53)</td><td>0.014</td></tr><tr><td>50-54</td><td>1.05 (0.72 - 1.53)</td><td>0.794</td><td>0.92 (0.76 - 1.11)</td><td>0.406</td></tr><tr><td>55-59</td><td>1.00 (0.70 - 1.45)</td><td>0.986</td><td>1.32 (1.10 - 1.58)</td><td>0.003</td></tr><tr><td>60-64</td><td>1.02 (0.73 - 1.46)</td><td>0.903</td><td>1.14 (0.95 - 1.36)</td><td>0.168</td></tr><tr><td>65-69</td><td>1.04 (0.73 - 1.46)</td><td>0.845</td><td>1.28 (1.05 - 1.56)</td><td>0.014</td></tr><tr><td>≥ 70</td><td>0.98 (0.69 - 1.41)</td><td>0.919</td><td>1.14 (0.90 - 1.43)</td><td>0.287</td></tr></tbody></table>

<footnote>* Muscle weakness was defined as handgrip strength below the 20th percentile, calculated separately for each sex and age group, based on the distribution within our sample</footnote>