Asian Reference Values for Handgrip Strength, Gait Speed, Five‐Times‐Sit‐to‐Stand Test, Muscle Mass and Calf Circumference

BACKGROUND: Handgrip strength, gait speed, Five-Times-Sit-to-Stand Test (FTSST) performance, skeletal muscle mass and calf circumference are important health outcomes, particularly useful for diagnosing sarcopenia. The aim of this study was to establish reference (normative) values for handgrip strength, gait speed, FTSST performance, skeletal muscle mass and calf circumference by pooling individual participant data from national cohorts in Asia. METHODS: We conducted a pooled analysis of individual participant data from 20 national cohorts representing 12 Asian countries (China, India, Indonesia, Israel, Japan, Lebanon, Malaysia, Mongolia, Philippines, Republic of Korea, Singapore and Sri Lanka). We included cohorts with data on at least one relevant outcome collected among community-dwelling individuals aged 20 years and older (up to 100+ years). Data were harmonized and stratified by sex and 5-year age groups with the 5th, 10th, 20th, 30th, 40th, 50th, 60th, 70th, 80th, 90th and 95th percentile calculated for each outcome. Pan-Asian, regional (East, South, Southeast and West Asia) and country-specific reference values were calculated. RESULTS: The number of participants in the analysis was as follows: 277921 (54.6% females) for handgrip strength; 13 474 (50.4% females) for 2.5-m gait speed; 139 121 (54.9% females) for 4-m gait speed; 55 235 (52.2% females) for FTSST performance; 49 309 (56.6% females) for skeletal muscle mass via bioelectrical impedance analysis or dual-energy x-ray absorptiometry; and 19 465 (55.8% females) for calf circumference. The established reference values were generally more favourable among younger age groups, compared with older age groups, and they also varied across Asian regions. The largest regional analysis was performed for handgrip strength, and indicated higher values in East and West Asia, compared with South and Southeast Asia. There were also differences in the established reference values between sexes, typically indicating greater handgrip strength, higher gait speed, better performance on the FTSST, more skeletal muscle mass and larger calf circumference among males, compared with females. CONCLUSIONS: This study provides the most comprehensive set of reference values for handgrip strength, gait speed, FTSST performance, skeletal muscle mass and calf circumference in the Asian population. The findings demonstrate clear gradients by age and sex, as well as regional variation. The reference values for Asian populations provided in this study offer a valuable resource for clinical, public health and research applications.