Does handgrip strength improve cardiometabolic risk stratification beyond detailed body composition? NHANES 2011-2014 with temporal validation

Background: Handgrip strength is associated with cardiometabolic abnormalities, but whether it adds information once detailed adiposity and muscle mass are known is unclear. Methods: We studied adults aged 40-59 years from NHANES 2011-2012 (development, n=508) and 2013-2014 (temporal validation, n=616). The outcome was at least two of four non-adiposity abnormalities (elevated blood pressure, fasting glucose or triglycerides, or low HDL cholesterol); waist circumference was not part of the outcome. A prespecified feature ladder added DXA body fat percentage and visceral adipose tissue to age,

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