{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T08:39:59Z","timestamp":1768552799433,"version":"3.49.0"},"posted":{"date-parts":[[2021,7,31]]},"group-title":"Geriatric Medicine","reference-count":58,"publisher":"openRxiv","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2021,7,31]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Weakness is a natural age-related condition meaning the loss of muscle strength that impairs older adults\u2019 mobility and quality of life. Because the relationship between muscle strength and body-size variables is non-linear, weakness is misclassified in older adults with extreme body size (e.g., light, short, heavy, or tall). This misclassification can be overcome using the allometric approach.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To propose cut-off points for older adults\u2019 weakness for upper and lower limbs muscle strength normalized by body size with the ratio standard and allometric scaling.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>\n                    Ninety-four community-dwelling older adults (69.1% women) were assessed for 49 body-size variables (anthropometry, body composition and body indexes), handgrip strength (HGS), one maximum repetition measurement for knee extensors (1RM\n                    <jats:sub>knee extensors<\/jats:sub>\n                    ), isokinetic knee extension peak torque at 60\u00b0\/s (\n                    <jats:sub>knee extension<\/jats:sub>\n                    PT\n                    <jats:sup>60\u00b0\/s<\/jats:sup>\n                    ), and six-minute walk test (6MWT). Ratio standard (muscle strength\/body size) and allometric scaling (muscle strength\/body size\n                    <jats:sup>b<\/jats:sup>\n                    ; when\n                    <jats:sup>b<\/jats:sup>\n                    is the allometric exponent) were applied for body-size variables that significantly were correlated with HGS, 1RM\n                    <jats:sub>knee extensors<\/jats:sub>\n                    and\n                    <jats:sub>knee extension<\/jats:sub>\n                    PT\n                    <jats:sup>60\u00b0\/s<\/jats:sup>\n                    . Cut-off points were computed based on ROC curve and Youden index. When there was mobility limitation (6MWT&lt;400m) cut-off were computed according to sex.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>\n                    Absolute HGS, 1RM\n                    <jats:sub>knee extensors<\/jats:sub>\n                    and\n                    <jats:sub>knee extension<\/jats:sub>\n                    PT\n                    <jats:sup>60\u00b0\/s<\/jats:sup>\n                    cut-off points were not adequate because they were associated with body size (r&gt;0.30). But it was corrected with muscle strength normalization according to body size-variables: HGS (n=1); 1RM\n                    <jats:sub>knee extensors<\/jats:sub>\n                    (n=24) and\n                    <jats:sub>knee extension<\/jats:sub>\n                    PT\n                    <jats:sup>60\u00b0\/s<\/jats:sup>\n                    (n=24). The best cut-off points, with the highest area under the curve (AUC), were found after normalization for men: HGS\/forearm circumference (1.33 kg\/cm, AUC=0.74), 1RM\n                    <jats:sub>knee extensors<\/jats:sub>\n                    \/triceps skinfold (4.22 kg\/mm, AUC=0.81), and\n                    <jats:sub>knee extension<\/jats:sub>\n                    PT\n                    <jats:sup>60\u00b0\/s<\/jats:sup>\n                    \/body mass*height\n                    <jats:sup>0.43<\/jats:sup>\n                    (13.0 Nm\/kg*m\n                    <jats:sup>0.43<\/jats:sup>\n                    , AUC=0.94); and for women: HGS\/forearm circumference (1.04 kg\/cm, AUC=0.70), 1RM\n                    <jats:sub>knee extensors<\/jats:sub>\n                    \/body mass (0.54 kg\/kg, AUC=0.76); and\n                    <jats:sub>knee extension<\/jats:sub>\n                    PT\n                    <jats:sup>60\u00b0\/s<\/jats:sup>\n                    \/body mass\n                    <jats:sup>0.72<\/jats:sup>\n                    (3.14 Nm\/kg\n                    <jats:sup>0.72<\/jats:sup>\n                    ; AUC=0.82).\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Normalization removes the effect of extreme body size on muscle strength and improves the accuracy to identify weakness at population level, reducing the risk of false-positive cases.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Highlights<\/jats:title>\n                  <jats:list list-type=\"bullet\">\n                    <jats:list-item>\n                      <jats:p>This study proposed a new approach to identify muscle weakness in older adults based on upper and lower limbs muscle strength normalized by body size (ratio standard and allometry).<\/jats:p>\n                    <\/jats:list-item>\n                    <jats:list-item>\n                      <jats:p>The identification of functional limitation is more precise when procedures of muscle strength normalization is applied.<\/jats:p>\n                    <\/jats:list-item>\n                  <\/jats:list>\n                <\/jats:sec>","DOI":"10.1101\/2021.07.28.21261230","type":"posted-content","created":{"date-parts":[[2021,7,31]],"date-time":"2021-07-31T09:50:25Z","timestamp":1627725025000},"source":"Crossref","is-referenced-by-count":1,"title":["Identification of muscle weakness in older adults from normalized lower and upper limbs strength"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7490-9466","authenticated-orcid":false,"given":"Pedro Pugliesi","family":"Abdalla","sequence":"first","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7988-968X","authenticated-orcid":false,"given":"Lucimere","family":"Bohn","sequence":"additional","affiliation":[]},{"given":"Leonardo 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