## 3 Results
### Characteristics of Study Participants in Normal and Incident Metabolic Syndrome According to Gender
\begin{table}
\begin{tabular}{c c c c c c c} \hline \hline \multicolumn{2}{c}{**Standardized**} & \multicolumn{3}{c}{**Women**} & \multicolumn{3}{c}{**Men**} \\ \cline{2-7}
**Delta Change in HGS** & **HR (95\% CD \(p\)\({}^{\star}\)** & **HR (95\% CD) \(p\)\(\$\)** & **HR (95\% CD) \(p\)\({}^{\star}\)** & **HR (95\% CD) \(p\)\(\$\)** \\ \hline \multirow{6}{*}{\(\Delta\) Mean (kg)} & Q1 & 1.105 (0.799–1.529) 0.545 & 1.181 (0.849–1.643) 0.323 & 1.425 (1.035–1.960) 0.030 & 1.349 (0.973–1.870) 0.073 \\  & Q2 & 0.762 (0.536–1.082) 0.128 & 0.749 (0.526–1.068) 0.110 & 1.389 (0.111–1.907) 0.043 & 1.192 (0.864–1.466) 0.285 \\  & Q3 & Reference & Reference & Reference & Reference \\  & Q4 & 0.927 (0.661–1.301) 0.662 & 0.970 (0.689–1.365) 0.861 & 1.333 (0.967–1.837) 0.080 & 1.325 (0.959–1.832) 0.089 \\  & Q5 & 0.864 (0.612–1.221) 0.408 & 0.776 (0.547–1.100) 0.155 & 1.560 (1.136–2.142) 0.006 & 1.500 (1.080–2.085) 0.016 \\ \hline \multirow{6}{*}{\(\Delta\) BMI-relative} & Q1 & 0.938 (0.658–1.337) 0.725 & 1.184 (0.825–1.699) 0.359 & 1.057 (0.769–1.454) 0.732 & 1.102 (0.798–1.523) 0.556 \\  & Q2 & 1.105 (0.784–1.559) 0.567 & 1.117 (0.789–1.581) 0.533 & 1.082 (0.789–1.485) 0.625 & 1.155 (0.840–1.589) 0.376 \\  & Q3 & Reference & Reference & Reference & Reference & Reference \\  & Q4 & 1.417 (1.006–1.997) 0.046 & 1.332 (0.942–1.885) 0.105 & 1.342 (0.986–1.826) 0.061 & 1.335 (0.978–1.821) 0.069 \\  & Q5 & 1.305 (0.913–1.865) 0.144 & 1.258 (0.874–1.811) 0.217 & 1.504 (1.101–2.054) 0.010 & 1.502 (1.091–2.067) 0.013 \\ \hline \multirow{6}{*}{\(\Delta\) Weight-relative} & Q1 & 0.842 (0.992–1.197) 0.337 & 1.028 (0.719–1.472) 0.878 & 1.066 (0.775–1.467) 0.693 & 1.157 (0.838–1.598) 0.376 \\  & Q2 & 1.005 (0.715–1.413) 0.977 & 0.993 (0.705–1.399) 0.966 & 1.057 (0.768–1.454) 0.734 & 1.132 (0.821–1.560) 0.450 \\ \cline{1-1}  & Q3 & Reference & Reference & Reference & Reference \\  & Q4 & 1.228 (0.872–1.730) 0.240 & 1.131 (0.796–1.606) 0.493 & 1.522 (1.119–2.069) 0.007 & 1.486 (1.089–2.029) 0.013 \\ \cline{1-1}  & Q5 & 1.313 (0.923–1.866) 0.130 & 0.869 (0.612–1.234) 0.433 & 1.531 (1.117–2.099) 0.008 & 1.530 (1.107–2.114) 0.010 \\ \hline \multirow{6}{*}{\(\Delta\) WC-relative} & Q1 & 0.719 (0.510–1.015) 0.061 & 0.836 (0.594–1.175) 0.303 & 1.130 (0.824–1.550) 0.448 & 1.044 (0.756–1.443) 0.792 \\ \cline{1-1}  & Q2 & 0.812 (0.579–1.139) 0.227 & Reference & 1.100 (0.801–1.510) 0.557 & 1.028 (0.744–1.421) 0.866 \\ \cline{1-1}  & Q3 & Reference & 1.160 (0.831–1.617) 0.383 & Reference & Reference \\ \cline{1-1}  & Q4 & 1.134 (0.817–1.574) 0.452 & 1.007 (0.710–1.428) 0.968 & 1.378 (0.101–1.881) 0.043 & 1.292 (0.944–1.768) 0. However, the other groups were not associated with iMetS in women. In men, the first, second, and fifth delta changes in mean HGS, and fifth delta changes in BMI- and WC-relative HGS, and fourth and fifth delta changes in weight-relative HGS were associated with iMetS. In the full model, the fifth delta change in HGS and BMI-, and WC-relative HGS, and the fourth and fifth delta changes in weight-HGS were also associated with iMetS (HR = 1.486-1.530, \(p\leq\) 0.025). Based on the comparison of the differences between baseline and the eighth follow-up muscle strength and LPA, HGS and relative HGS were significantly reduced in women (\(p<\) 0.001) and there was no difference in LPA. On the other hand, men showed significant increases in HGS, relative HGS, and LPA (\(p<\) 0.05; Supplementary Table S5). Similarly, we analyzed the effect of vigorous-LPA [34] and these delta changes on incident metabolic syndrome, but the results were not significant (data not shown). Cox Proportional Hazard Ratios for Incident Metabolic Syndrome Components According to Mean Hand Grip Strength, Back Muscle Strength, and Relative Muscle Strength in Gender  
We showed HR per one SD increase, 95% CIs, and \(p\) values for each one SD increase in muscle strength and relative muscle strength in the incidence of each MetS component adjusted for the confounding factors (Table 6 and Table S6).