Clinical utility of handgrip strength for identifying cardiometabolic risk in children and adolescents: a scoping review

Background Cardiometabolic risk in children and adolescents is an increasing global concern, driven by rising rates of obesity, physical inactivity, and unhealthy lifestyle behaviors. Early alterations such as insulin resistance, dyslipidemia, elevated blood pressure, and low-grade inflammation may develop during childhood and persist into adulthood, contributing to premature cardiovascular disease. Identifying simple, accessible, and reliable markers for early risk detection is therefore a priority in pediatric clinical practice and prevention strategies, particularly in diverse healthcare settings. Aim of review To synthesize the available evidence on the clinical utility of handgrip strength (HGS) in relation to cardiometabolic risk in children and adolescents. Key scientific concepts of review Available evidence indicates that lower HGS is observed in relation to less favorable cardiometabolic profiles across different pediatric populations, including higher adiposity, elevated blood pressure, unfavorable lipid profiles, insulin resistance, and inflammatory markers. Relative HGS, adjusted for body size, is frequently reported as a more informative measure than absolute strength, although different normalization strategies have been used. Considerable heterogeneity is evident in measurement protocols, dynamometry procedures, normalization methods, and population characteristics, which limits comparability across studies and the interpretation of findings. The relationship between HGS and cardiometabolic variables appears to be influenced by body composition, particularly the balance between lean and fat mass, and may vary according to population characteristics. Most of the available evidence is based on observational designs, predominantly cross-sectional, which limits causal inference. Although HGS represents a simple, low-cost, and non-invasive measure, the absence of standardized protocols, normative values, and validated cut-off points currently limits its use in routine clinical practice. Overall, HGS may represent a potential complementary measure for early identification and risk stratification, although further standardization and longitudinal studies are needed to clarify its clinical utility.