## 3 Results
### Characteristics of Study Participants in Normal and Incident Metabolic Syndrome According to Gender
Cox Proportional Hazard Ratios for Incident Metabolic Syndrome According to Delta Change of Mean Hand Grip Strength and Relative Hand Grip Strength in Gender  
We obtained the delta change in HGS in baseline and at the which we used to confirm risk of iMetS (Tables 4 and 5). \begin{table}
\begin{tabular}{c c c c c c} \hline \hline \multirow{2}{*}{**Muscle Strength**} & \multirow{2}{*}{**Group**} & \multicolumn{2}{c}{**HGS**} & \multicolumn{2}{c}{**BMS**} \\ \cline{3-6}  & & \multicolumn{2}{c}{**Women**} & \multicolumn{2}{c}{**Men**} & \multicolumn{2}{c}{**Women**} & \multicolumn{2}{c}{**Men**} \\  & & **HR (95\% CD) \(p\)*** & **HR (95\% CD) \(p\)*** & **HR (95\% CD) \(p\)*** & **HR (95\% CD) \(p\)*** \\ \hline \multirow{4}{*}{Mean (kg)} & Q4 & Reference & Reference & Reference & Reference \\  & Q3 & 0.880 (0.669–1.159) 0.363 & 1.032 (0.805–1.323) 0.801 & 1.135 (0.877–1.469) 0.336 & 0.897 (0.706–1.139) 0.372 \\  & Q2 & 0.896 (0.685–1.173) 0.426 & 1.117 (0.875–1.426) 0.375 & 0.907 (0.688–1.197) 0.491 & 1.141 (0.903–1.441) 0.268 \\  & Q1 & 0.897 (0.674–1.194) 0.456 & 1.173 (0.914–1.505) 0.211 & 0.895 (0.676–1.185) 0.439 & 0.968 (0.757–1.238) 0.794 \\ \hline \multicolumn{6}{l}{\(p\) value for linear trend} & 0.506 & 0.166 & 0.224 & 0.72 \\ \hline \multirow{4}{*}{BMI-relative} & Q4 & Reference & Reference & Reference & Reference \\  & Q3 & 1.801 (1.293–2.511) 0.001 & 1.369 (1.042–1.799) 0.024 & 1.787 (1.334–2.393) \textless{} 0.001 & 1.188 (0.921–1.531) 0.185 \\  & Q2 & 2.209 (1.597–3.057) \textless{} 0.001 & 1.553 (1.188–2.030) 0.001 & 1.631 (1.213–2.193) 0.001 & 1.551 (1.215–1.980) \textless{} 0.001 \\  & Q1 & 2.821 (2.028–3.923) \textless{} 0.001 & 2.401 (1.854–3.110) \textless{} 0.001 & 1.579 (1.163–2.143) 0.003 & 1.596 (1.247–2.041) \textless{} 0.001 \\ \hline \multicolumn{6}{l}{\(p\) value for linear trend} & \textless{}0.001 & \textless{}0.001 & 0.009 & \textless{}0.001 \\ \hline \multirow{4}{*}{Weight-relative} & Q4 & Reference & Reference & Reference & Reference \\  & Q3 & 1.868 (1.350–2.585) \textless{} 0.001 & 1.486 (1.129–1.955) 0.005 & 1.649 (1.236–2.200) 0.001 & 1.193 (0.925–1.538) 0.174 \\  & Q2 & 2.166 (1.572–2.986) \textless{} 0.001 & 1.858 (1.420–2.431) \textless{} 0.001 & 1.601 (1.197–2.141) 0.002 & 1.484 (1.165–1.890) 0.001 \\  & Q1 & 2.700 (1.962–3.717) \textless{} 0.001 & 2.514 (1.940–3.258) \textless{} 0.001 & 1.531 (1.134–2.067) 0.005 & 1.642 (1.291–2.089) \textless{} 0.001 \\ \hline \multicolumn{6}{l}{\(p\) value for linear trend} & \textless{}0.001 & \textless{}0.001 & 0.01 & -0.001 \\ \hline \multirow{4}{*}{WC-relative} & Q4 & Reference & Reference & Reference & Reference \\  & Q3 & 1.694 (1.229–2.335) 0.001 & 1.517 (1.156–1.991) 0.003 & 1.670 (1.258–2.217) \textless{} 0.001 & 1.006 (0.780–1.299) 0.962 \\  & Q2 & 2.109 (1.536–2.896) \textless{} 0.001 & 1.743 (1.333–2.279) \textless{} 0.001 & 1.459 (1.092–1.950) 0.011 & 1.368 (1.076–1.739) 0.011 \\  & Q1 & 2.242 (1.613–3.115) \textless{} 0.001 & 2.315 (1.783–3.006) \textless{} 0.001 & 1.485 (1.100–2.004) 0.010 & 1.460 (1.144–1.862) 0.002 \\ \hline \multicolumn{6}{l}{\(p\) value for linear trend} & \textless{}0.001 & \textless{}0.001 & 0.03 & \textless{}0.001 \\ \hline \hline \end{tabular}
\end{table} 
Table 3: Adjusted hazard ratio (HR) of incident metabolic syndrome associated with quartile group of mean hand grip strength, back muscle strength, and relative muscle strength according to gender. The MetS risk of increase in normalized delta change in muscle strength and relative muscle strength was shown in Table 4. After the adjustment of baseline muscle strength, the HRs per invers one SD increase in delta change in BMI-, weight-, and WC-relative HGS and BMS were associated with a high risk of iMetS in women and men (HR = 1.131-1.216, \(p\leq 0.005\)). However, the delta changes in HGS in both women and men were not associated with iMetS. In the full model, the HR per one SD increase in delta change in BMI-, weight-, and WC-relative HGS were associated with a high risk of iMetS in only men (HR = 1.148-1.174, \(p\leq 0.010\)).