{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T23:42:56Z","timestamp":1768088576391,"version":"3.49.0"},"reference-count":50,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2022,10,21]],"date-time":"2022-10-21T00:00:00Z","timestamp":1666310400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001349","name":"the SINGAPORE NATIONAL MEDICAL RESEARCH COUNCIL GRANT","doi-asserted-by":"publisher","award":["NMRC\/CSA-SI\/0010\/2017"],"award-info":[{"award-number":["NMRC\/CSA-SI\/0010\/2017"]}],"id":[{"id":"10.13039\/501100001349","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>We hypothesized that a combined index of upper and lower body muscle strength would be more strongly associated with diabetes than either measure alone. Women recruited into the Integrated Women\u2019s Health Program had their handgrip strength (HGS) measured using a dynamometer and underwent a timed 5-repetition chair stand (RCS) test. HGS &lt; 18 kg and RCS performance \u2265 12 s assessed upper and lower body strength, respectively, both individually and combined in a muscle strength index (MSI). Diabetes was defined as physician-diagnosed, use of anti-diabetic medication, or fasting blood glucose \u2265 7.0 mmol\/L. Binary logistic regression examined the associations between muscle strength and diabetes. Of 1170 midlife women, 12.1% had diabetes. A low HGS was independently associated with diabetes (aOR: 1.59, 95% CI: 1.03, 2.44). Prolonged RCS was also associated with diabetes (aOR: 1.59, 95% CI: 1.09, 2.30), but this was not independent of visceral adiposity and muscle mass. A poor MSI had higher odds of diabetes (aOR: 2.37, 95% CI: 1.40, 4.03), independent of age, ethnicity, education level, menopausal status, smoking, alcohol consumption, physical activity, height, visceral adiposity, and muscle mass. The combination of both upper and lower body muscle strength into a composite MSI was more strongly associated with diabetes than either weak HGS or prolonged RCS alone in midlife women.<\/jats:p>","DOI":"10.3390\/ijerph192013654","type":"journal-article","created":{"date-parts":[[2022,10,24]],"date-time":"2022-10-24T02:31:03Z","timestamp":1666578663000},"page":"13654","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["The Associations between Upper and Lower Body Muscle Strength and Diabetes among Midlife Women"],"prefix":"10.3390","volume":"19","author":[{"given":"Beverly W. X.","family":"Wong","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Singapore 119228, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Win Pa Pa","family":"Thu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Singapore 119228, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yiong Huak","family":"Chan","sequence":"additional","affiliation":[{"name":"Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael S.","family":"Kramer","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Singapore 119228, Singapore"},{"name":"Department of Epidemiology and Biostatistics and of Pediatrics, Faculty of Medicine, McGill University, Montreal, QC H3G 2M1, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2667-7146","authenticated-orcid":false,"given":"Susan","family":"Logan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Singapore 119228, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0752-4408","authenticated-orcid":false,"given":"Jane A.","family":"Cauley","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eu-Leong","family":"Yong","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Singapore 119228, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,21]]},"reference":[{"key":"ref_1","unstructured":"NCD Risk Factor Collaboration (2016). Worldwide trends in diabetes since 1980: A pooled analysis of 751 population-based studies with 4.4 million participants. Lancet, 387, 1513\u20131530."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.1001\/jama.2009.726","article-title":"Diabetes in Asia: Epidemiology, risk factors, and pathophysiology","volume":"301","author":"Chan","year":"2009","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1111\/1753-0407.12384","article-title":"Projection of prediabetes and diabetes population size in Singapore using a dynamic Markov model","volume":"9","author":"Wong","year":"2017","journal-title":"J. Diabetes"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Bellou, V., Belbasis, L., Tzoulaki, I., and Evangelou, E. (2018). Risk factors for type 2 diabetes mellitus: An exposure-wide umbrella review of meta-analyses. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0194127"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1097\/00005082-200201000-00003","article-title":"Risk factors for type 2 diabetes mellitus","volume":"16","author":"Fletcher","year":"2002","journal-title":"J. Cardiovasc. Nurs."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"681232","DOI":"10.3389\/fmed.2021.681232","article-title":"Prevalence of Sarcopenia and Its Association With Diabetes: A Meta-Analysis of Community-Dwelling Asian Population","volume":"8","author":"Chung","year":"2021","journal-title":"Front. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1007\/s41999-019-00216-x","article-title":"Association between sarcopenia and diabetes: A systematic review and meta-analysis of observational studies","volume":"10","author":"Veronese","year":"2019","journal-title":"Eur. Geriatr. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1093\/ageing\/afy169","article-title":"Sarcopenia: Revised European consensus on definition and diagnosis","volume":"48","author":"Bahat","year":"2019","journal-title":"Age Ageing"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1111\/joim.13344","article-title":"Muscle-strengthening activities and risk of cardiovascular disease, type 2 diabetes, cancer and mortality: A review of prospective cohort studies","volume":"290","author":"Giovannucci","year":"2021","journal-title":"J. Intern. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1007\/s00125-019-4867-4","article-title":"Cardiorespiratory fitness, muscular strength and risk of type 2 diabetes: A systematic review and meta-analysis","volume":"62","author":"Tarp","year":"2019","journal-title":"Diabetologia"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1093\/ageing\/29.3.235","article-title":"Relationships between physical performance measures, age, height and body weight in healthy adults","volume":"29","author":"Samson","year":"2000","journal-title":"Age Ageing"},{"key":"ref_12","first-page":"186","article-title":"Changes in muscle mass and strength after menopause","volume":"9","author":"Maltais","year":"2009","journal-title":"J. Musculoskelet. Neuronal Interact."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e3365","DOI":"10.1002\/dmrr.3365","article-title":"Handgrip strength-A risk indicator for type 2 diabetes: Systematic review and meta-analysis of observational cohort studies","volume":"37","author":"Kunutsor","year":"2021","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/S0140-6736(14)62000-6","article-title":"Prognostic value of grip strength: Findings from the Prospective Urban Rural Epidemiology (PURE) study","volume":"386","author":"Leong","year":"2015","journal-title":"Lancet"},{"key":"ref_15","first-page":"k1651","article-title":"Associations of grip strength with cardiovascular, respiratory, and cancer outcomes and all cause mortality: Prospective cohort study of half a million UK Biobank participants","volume":"361","author":"Welsh","year":"2018","journal-title":"BMJ"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1111\/ggi.12077","article-title":"Poor correlation between handgrip strength and isokinetic performance of knee flexor and extensor muscles in community-dwelling elderly women","volume":"14","author":"Felicio","year":"2014","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1016\/j.jamda.2018.04.019","article-title":"Handgrip strength cannot be assumed a proxy for overall muscle strength","volume":"19","author":"Yeung","year":"2018","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1002\/jcsm.12268","article-title":"Pitfalls in the measurement of muscle mass: A need for a reference standard","volume":"9","author":"Buckinx","year":"2018","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1159\/000091824","article-title":"Is hand-held dynamometry useful for the measurement of quadriceps strength in older people? A comparison with the gold standard Bodex dynamometry","volume":"52","author":"Martin","year":"2006","journal-title":"Gerontology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1093\/gerona\/59.11.1207","article-title":"Repeated chair stands as a measure of lower limb strength in sexagenarian women","volume":"59","author":"McCarthy","year":"2004","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2465","DOI":"10.1016\/j.apmr.2013.06.007","article-title":"Postural control and functional strength in patients with type 2 diabetes mellitus with and without peripheral neuropathy","volume":"94","author":"Vaz","year":"2013","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1177\/0898264310366738","article-title":"Physical function and health status in aging Puerto Rican adults: The Boston Puerto Rican Health Study","volume":"22","author":"Price","year":"2010","journal-title":"J. Aging Health"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.1093\/gerona\/61.11.1194","article-title":"Correlates of decline in lower extremity performance in older women: A 10-year follow-up study","volume":"61","author":"Forrest","year":"2006","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1093\/ije\/dyx278","article-title":"Cohort Profile: The Integrated Women\u2019s Health Programme (IWHP): A study of key health issues of midlife Singaporean women","volume":"47","author":"Thu","year":"2018","journal-title":"Int. J. Epidemiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1093\/ageing\/afr051","article-title":"A review of the measurement of grip strength in clinical and epidemiological studies: Towards a standardised approach","volume":"40","author":"Roberts","year":"2011","journal-title":"Age Ageing"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/S0894-1130(00)80052-6","article-title":"Validity of the Dexter Evaluation System\u2019s Jamar dynamometer attachment for assessment of hand grip strength in a normal population","volume":"13","author":"Bellace","year":"2000","journal-title":"J. Hand Ther."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.jamda.2019.12.012","article-title":"Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment","volume":"21","author":"Chen","year":"2020","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"M644","DOI":"10.1093\/gerona\/56.10.M644","article-title":"Measuring higher level physical function in well-functioning older adults: Expanding familiar approaches in the Health ABC study","volume":"56","author":"Simonsick","year":"2001","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3205","DOI":"10.1519\/JSC.0b013e318234e59f","article-title":"Test-retest reliability of the five-repetition sit-to-stand test: A systematic review of the literature involving adults","volume":"25","author":"Bohannon","year":"2011","journal-title":"J. Strength Cond. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1007\/BF03325265","article-title":"The five-times-sit-to-stand test: Validity, reliability and detectable change in older females","volume":"24","author":"Goldberg","year":"2012","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1097\/GME.0000000000001355","article-title":"Objective measures of physical performance associated with depression and\/or anxiety in midlife Singaporean women","volume":"26","author":"Ganasarajah","year":"2019","journal-title":"Menopause"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"S81","DOI":"10.2337\/dc14-S081","article-title":"Diagnosis and classification of diabetes mellitus","volume":"37","year":"2014","journal-title":"Diabetes Care"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1123\/jpah.6.6.790","article-title":"Global physical activity questionnaire (GPAQ): Nine country reliability and validity study","volume":"6","author":"Bull","year":"2009","journal-title":"J. Phys. Act. Health"},{"key":"ref_34","first-page":"370","article-title":"How to define obesity? Evidence-based multiple action points for public awareness, screening, and treatment: An extension of Asian-Pacific recommendations","volume":"17","author":"Pan","year":"2008","journal-title":"Asia Pac. J. Clin. Nutr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1080\/09720502.2010.10700699","article-title":"Collinearity diagnostics of binary logistic regression model","volume":"13","author":"Midi","year":"2010","journal-title":"J. Interdiscip. Math."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Nick, T.G., and Campbell, K.M. (2007). Logistic regression. Top. Biostat., 273\u2013301.","DOI":"10.1007\/978-1-59745-530-5_14"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1097\/GME.0000000000000714","article-title":"Reproductive history and risk of type 2 diabetes mellitus in postmenopausal women: Findings from the Women\u2019s Health Initiative","volume":"24","author":"LeBlanc","year":"2017","journal-title":"Menopause"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2123","DOI":"10.2337\/dc09-0227","article-title":"Alcohol as a risk factor for type 2 diabetes: A systematic review and meta-analysis","volume":"32","author":"Baliunas","year":"2009","journal-title":"Diabetes Care"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1585","DOI":"10.2337\/dc06-0057","article-title":"Ethnicity, obesity, and risk of type 2 diabetes in women: A 20-year follow-up study","volume":"29","author":"Shai","year":"2006","journal-title":"Diabetes Care"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.maturitas.2020.04.003","article-title":"Risk factors for insulin resistance in midlife Singaporean women","volume":"137","author":"Thu","year":"2020","journal-title":"Maturitas"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1016\/j.amepre.2020.01.016","article-title":"Grip Strength Cut Points for Diabetes Risk Among Apparently Healthy U.S. Adults","volume":"58","author":"Brown","year":"2020","journal-title":"Am. J. Prev. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1111\/j.1532-5415.1991.tb01616.x","article-title":"The timed \u201cUp & Go\u201d: A test of basic functional mobility for frail elderly persons","volume":"39","author":"Podsiadlo","year":"1991","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Zhang, W., Shen, S., Wang, W., Zhou, C., Xu, L., Qiu, J., Wang, J., Meng, X., Liang, Y., and Niu, K. (2014). Poor lower extremity function was associated with pre-diabetes and diabetes in older chinese people. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0115883"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"18376","DOI":"10.18632\/aging.203285","article-title":"Association of a composite score of relative grip strength and timed up and go test with incident type 2 diabetes mellitus: Guangzhou Biobank Cohort Study","volume":"13","author":"Liang","year":"2021","journal-title":"Aging"},{"key":"ref_45","first-page":"267","article-title":"Reliability of 1-repetition maximum estimation for upper and lower body muscular strength measurement in untrained middle aged type 2 diabetic patients","volume":"3","author":"Rangra","year":"2012","journal-title":"Asian J. Sport. Med."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Gr\u00f8ntved, A., Pan, A., Mekary, R.A., Stampfer, M., Willett, W.C., Manson, J.E., and Hu, F.B. (2014). Muscle-strengthening and conditioning activities and risk of type 2 diabetes: A prospective study in two cohorts of US women. PLoS Med., 11.","DOI":"10.1371\/journal.pmed.1001587"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"294","DOI":"10.2337\/diabetes.53.2.294","article-title":"Strength training increases insulin-mediated glucose uptake, GLUT4 content, and insulin signaling in skeletal muscle in patients with type 2 diabetes","volume":"53","author":"Holten","year":"2004","journal-title":"Diabetes"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1507","DOI":"10.2337\/dc06-2537","article-title":"Accelerated loss of skeletal muscle strength in older adults with type 2 diabetes: The health, aging, and body composition study","volume":"30","author":"Park","year":"2007","journal-title":"Diabetes Care"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1002\/dmrr.2658","article-title":"Neuromuscular dysfunction in type 2 diabetes: Underlying mechanisms and effect of resistance training","volume":"32","author":"Orlando","year":"2016","journal-title":"Diabetes\/Metab. Res. Rev."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1080\/02701367.1999.10608028","article-title":"A 30-s chair-stand test as a measure of lower body strength in community-residing older adults","volume":"70","author":"Jones","year":"1999","journal-title":"Res. Q. Exerc. Sport"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/20\/13654\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:58:43Z","timestamp":1760144323000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/20\/13654"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,21]]},"references-count":50,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["ijerph192013654"],"URL":"https:\/\/doi.org\/10.3390\/ijerph192013654","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,21]]}}}