## 3 Results
### Characteristics of Study Participants in Normal and Incident Metabolic Syndrome According to Gender
\begin{table}
\begin{tabular}{c c c c c} \hline \hline  & \multicolumn{2}{c}{**HGS**} & \multicolumn{2}{c}{**BMS**} \\ \cline{2-5}  & **Univariate** & **Multivariate** & **Univariate** & **Multivariate** \\  & **HR (95\% CD \(p\) * & HR (95\% CD \(p\) * & HR (95\% CD) \(p\) * \\ \hline  & & & **Women** & \\ \hline Mean (kg) & 1.176 (1.066-1.296) 0.001 & 1.042 (0.938-1.157) 0.445 & 1.045 (0.951-1.149) 0.355 & 0.932 (0.845-1.028) 0.161 \\ BMI-relative & 1.680 (1.514-1.864) \(<\) 0.001 & 1.494 (1.337-1.671) \(<\) 0.001 & 1.352 (1.224-1.494) \(<\) 0.001 & 1.192 (1.072-1.324) 0.001 \\ Weight-relative & 1.618 (1.461-1.792) \(<\) 0.001 & 1.454 (1.306-1.620) \(<\) 0.001 & 1.297 (1.175-1.432) \(<\) 0.001 & 1.158 (1.044-1.283) 0.005 \\ WC-relative & 1.662 (1.501-1.841) \(<\) 0.001 & 1.447 (1.293-1.620) \(<\) 0.001 & 1.314 (1.190-1.451) \(<\) 0.001 & 1.135 (1.022-1.261) 0.019 \\ \hline  & & & & \\ \hline Mean HGS (kg) & 1.076 (0.984-1.176) 0.107 & 1.078 (0.982-1.182) 0.114 & 0.982 (0.903-1.069) 0.679 & 0.987 (0.905-1.076) 0.766 \\ BMI-relative & 1.454 (1.324-1.596) \(<\) 0.001 & 1.470 (1.335-1.618) \(<\) 0.001 & 1.203 (1.106-1.309) \(<\) 0.001 & 1.212 (1.113-1.320) \(<\) 0.001 \\ Weight-relative & 1.465 (1.338-1.604) \(<\) 0.001 & 1.472 (1.342-1.614) \(<\) 0.001 & 1.207 (1.110-1.313) \(<\) 0.001 & 1.212 (1.114-1.317) \(<\) 0.001 \\ WC-relative & 1.422 (1.298-1.559) \(<\) 0.001 & 1.431 (1.302-1.574) \(<\) 0.001 & 1.187 (1.091-1.292) \(<\) 0.001 & 1.190 (1.092-1.297) \(<\) 0.001 \\ \hline  & & & & \\ \hline \hline \end{tabular}
\begin{tabular}{c c c c c} \hline \hline \multicolumn{5}{c}{Abbreviation: HGS, handgrid strength; BMC, back muscle strength; HR, hazard ratio; GL, confidence interval; BMI, body mass index; WC, waist circumference. * Adjusted for baseline muscle strength plus age; family history of DM (yes, no); family history of hypertension (yes, no); job (homemaker, white collar, or blue collar); income (KRW < 1,000,000, KRW 1,000,000\(\circ\) or <2,000,000, KRW 2,000,000\(\circ\) or <4,000,000, or KRW 4,000,000\(\circ\)); education (<12 years and \(\geq\)12 years); married status (yes, no); smoker (never smoker, ex-smoker, or current smoker); alcohol consumption (g/day); and leisure physical activity (METs). Women added menopause (yes, no).  
\end{table} 
Table 2: Adjusted hazard ratio (HR) of incident metabolic syndrome associated with inverse one standard deviation increase in mean hand grip strength, back muscle strength, and relative muscle strength according to gender. associated with iMetS in both women and men. For sensitivity analyses, we calculated the HR for inverse one standard deviation increase in mean HGS, BMS, and relative muscle strength, stratified by follow-up time (second, sixth, and ninth follow-up) and gender subgroups (Table S3). We were able to confirm that a similar trend was maintained during the follow-up period. Cox Proportional Hazard Ratios for Incident Metabolic Syndrome According to Quartile Groups of Mean Hand Grip Strength, Back Muscle Strength, and Relative Muscle Strength by Gender  
Participants were divided into quartile groups based on gender-specific HGS and BMC, and relative HGS and BMC (Table 3 and Table S4). In univariate analysis, HGS and BMS was not associated with iMetS in both women and men. However, BMI-, weight-, and WC-relative HGS and BMS were shown to have higher HR rates for iMetS in women and men (HR = 1.718-3.858, \(p\leq 0.001\) in women and HR = 1.377-2.515, \(p\leq 0.015\) for men), excluding the third quartile of the BMS of men. After adjusting for confounders, HGS and BMS was also not associated with iMetS in both women and men. However, the first, second, and third quartile of BMI-, weight-, and WC-relative HGS and BMS was shown to have higher HR values for iMetS in women and men (HR = 1.459-2.821, \(p\leq 0.001\) for women and HR = 1.368-2.821, \(p\leq 0.024\) for men), excluding the third quartile of the BMS of men. Additionally, the \(p\) value for linear trend was shown to be significant (\(p<0.001\)).