{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T16:00:02Z","timestamp":1792512002579,"version":"4.5.0"},"reference-count":67,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T00:00:00Z","timestamp":1756166400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>This study aims to develop and validate age- and sex-specific normative reference standards for muscular strength (MS) using the LMS (Lambda\u2013Mu\u2013Sigma) method and to establish Health Benefit Zones (HBZs) for Pakistani adolescents aged 12\u201316\u202fyears.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cross-sectional study was conducted with 2,970 adolescents (49.7% boys, 50.3% girls) selected through stratified random sampling from 60 public high schools across three divisions of South Punjab. Anthropometric indicators and muscular strength were measured following standardized protocols. Using the LMS, age- and sex-specific normative reference values and smoothed percentile curves (3rd, 10th, 35th, 50th, 65th, and 90th) were developed. Five Health Benefit Zones (Very Poor, Poor, Medium, Good, and Excellent) were derived from these percentile ranges to classify strength levels. The robustness of the generated standards was examined through internal cross-validation using a back-generation procedure to confirm high predictive accuracy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Boys demonstrated significantly higher muscular strength than girls across all ages (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001), with strength increasing progressively with age in both sexes. At age 16, median MS reached 35.47\u202fkg for boys and 20.18\u202fkg for girls. LMS-derived percentile reference values and percentile curves illustrated consistent age- and sex-related growth trends. Approximately 40% of participants fell within the \u201cpoor\u201d or \u201cvery poor\u201d HBZs. MAPE values remained below \u00b10.05, indicating excellent model fit. Compared to international benchmarks, adolescents from South Punjab exhibited lower MS values across corresponding age groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study provides the first LMS-based, age- and sex-specific normative reference standards and HBZs for muscular strength among Pakistani adolescents. These standards offer a population-relevant tool for fitness assessment, enable early identification of youth at risk of low muscular strength, and support targeted interventions to enhance strength development and overall physical health in school-aged populations.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1616298","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T09:54:55Z","timestamp":1756202095000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Development and cross-validation of LMS-based normative reference standards and health benefits zones for muscular strength among adolescents by age and sex"],"prefix":"10.3389","volume":"13","author":[{"given":"Yang","family":"Yang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed Ghufran","family":"Hadier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liu","family":"Long","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed Muhammad Zeeshan Haider","family":"Hamdani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed Danish","family":"Hamdani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,26]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2629","DOI":"10.1007\/s40279-021-01524-8","article-title":"Health-related criterion-referenced cut-points for musculoskeletal fitness among youth: a systematic review","volume":"51","author":"Fraser","year":"2021","journal-title":"Sports Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1186\/s13052-021-01113-5","article-title":"Normative data for handgrip strength in Iranian healthy children and adolescents aged 7-18\u202fyears: comparison with international norms","volume":"47","author":"Rostamzadeh","year":"2021","journal-title":"Ital J Pediatr"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"8026","DOI":"10.3390\/ijerph17218026","article-title":"Test\u2013retest reliability of handgrip strength measurement in children and preadolescents","volume":"17","author":"G\u0105sior","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1186\/s41043-024-00500-y","article-title":"Hand grip strength as a proposed new vital sign of health: a narrative review of evidences","volume":"43","author":"Vaishya","year":"2024","journal-title":"J Health Popul Nutr"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"590","DOI":"10.1016\/j.jped.2022.02.004","article-title":"Normative values for handgrip strength in Colombian children and adolescents from 6 to 17 years of age: estimation using quantile regression","volume":"98","author":"Mart\u00ednez-Torres","year":"2022","journal-title":"J Pediatr"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"145","DOI":"10.29052\/IJEHSR.v8.i3.2020.145-152","article-title":"Association of Grip Strength with obesity cortisol; possible indicators of biological ageing","volume":"8","author":"Mirza","year":"2020","journal-title":"J Int J Endorsing Health Sci Res"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"2050312120910358","DOI":"10.1177\/2050312120910358","article-title":"What are the association patterns between handgrip strength and adverse health conditions? 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