Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter October 14, 2020

Association between muscle strength and risk factors for metabolic syndrome in children and adolescents: a systematic review

Tiago R. de Lima ORCID logo, Priscila C. Martins, Giuseppe L. Torre, Alice Mannocci, Kelly S. Silva and Diego A.S. Silva


The aim of this systematic review was to identify and summarize evidence for the association between muscle strength (MS) and metabolic syndrome (MetS), and MS and combinations of risk factors for MetS in children and adolescents. Five databases (Medline/PubMed, EBSCO, Scielo, Scopus, and Web of Knowledge) were searched up to November 2019 with complementary reference list searches. Inclusion criteria were studies that investigated the relationship between MS and MetS or MS and combinations of risk factors for MetS in children and adolescents (≤19 years of age). Risk of bias was assessed using standard procedures. From the total of 15,599 articles initially identified, 13 articles were included, representing 11,641 children and adolescents. Higher MS values were associated with lower risk for MetS or combinations of risk factors for MetS (n=11/13 studies). Of the total of included studies, about 23.1% (03/13) were longitudinal and all included studies were classified as having a moderate risk of bias. This review provides preliminary evidence for a beneficial relationship between MS and MetS among children and adolescents. Additionally, although the body of evidence points to the beneficial relationship between higher MS and lower risk for combination of factors for MetS in children and adolescents, this relationship is inconclusive.

Corresponding author: Tiago Rodrigues de Lima, Research Center in Kinanthropometry and Human Performance, Sports Centre, Federal University of Santa Catarina, University Campus, Trindade, 88010-970, Florianopolis, Santa Catarina, Brazil, Phone: +55 48 9 99342827, E-mail:

  1. Research funding: None declared.

  2. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  3. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Appendix A: Descriptors used in the systematic search

First block

English: “muscle strength”; “resistance training”; “muscular contraction”; “weight training”; “muscular endurance”; “muscle power”; “muscular fitness”; “explosive strength of lower limbs”, “explosive strength of upper limbs”; isometric strength of lower limbs”; “isometric upper limb strength”; “upper limb strength”; “lower limb strength”; “musculoskeletal fitness”; “isometric strength”; “dynamic force”; “isometric contraction”; “isotonic contraction”.

Spanish: “fuerza muscular”; “entrenamiento de resistencia”; “contracción muscular”; “entrenamientocon pesos”; “resistencia muscular”; “potencia muscular”; “aptitud muscular”; “fuerza explosiva de miembros inferiores”, “fuerza explosiva de miembros superiores”; fuerza isométrica de miembros inferiores”; “fuerza isométrica de miembros superiores”; “fuerza de miembros superiores”; “fuerza de miembros inferiores”; “aptitud musculoesquelética”; “fuerza isométrica”; “fuerzadinámica”; “contracción isométrica”; “contracciónisotónica”.

Portuguese: “força muscular”; “treinamento de resistência”; “contração muscular”; “treinamento com pesos”; “resistência muscular”; “potência muscular”; “aptidão muscular”; “força explosiva de membros inferiores”, “força explosiva de membros superiores”; força isométrica de membros inferiores”; “força isométrica de membros superiores”; “força de membros superiores”; “força de membros inferiores”; “aptidão musculoesquelética”; “força isométrica”; “força dinâmica”; “contração isométrica”; “contração isotônica”.

Second block

English: “Child”; “children”; “pediatric”; “adolescent”; “child health”; adolescent health.

Spanish: “Ninõ”; “adolescente”; “saluddelninõ”; “saluddel adolescente”.

Portuguese: “criança”; “adolescente”; “saúde da criança”; “saúde do adolecente”.

Third block

English: “obesity”; “Abdominal obesity”, “body fat”; “Waist circumference”; “blood pressure”; “hypertension”; “Glycemic index”, “glycemic load”, “glycemia”; “cholesterol”; “LDL – cholesterol”; HDL – cholesterol”; “hypercholesterolemia”; “dyslipidemia”; “triglycerides”, “glycemia”, “disorders of glucose metabolism”, “insulin resistance”, metabolic syndrome; “risk factors”; “metabolic diseases”.

Spanish: “obesidad”; “obesidad abdominal”, “grasa corporal”; “circunferencia de la cintura”; “presión arterial”; “hipertensión”; “índice glucémico”, “carga glucémica”, “glucemia”; “colesterol”; “LDL – colesterol”; HDL – colesterol”; “hipercolesterolemia”; “dislipidemia”; “triglicéridos”, “glucemia”, “transtornos del metabolismo de laglucosa”, “resistencia a la Insulina”, Factores de Riesgo; síndrome metabólico; “enfermedades metabólicas”.

Portuguese: “obesidade”; “obesidade abdominal”, “gordura corporal”; “circunferência da cintura”; “pressão artérial”; “hipertensão”; “índice glicêmico”, “carga glicêmica”, “GL”; “colesterol”; “LDL – colesterol”; HDL – colesterol”; “hipercolesterolemia”; “dislipidemia”; “triglicerídeos”, “GL”, “transtornos do metabolismo da glicose”, resistência à insulina”, “síndrome metabólica”; fatores de risco; doenças metabólicas.

Appendix B: Adapted version of the effective public health practice project quality assurance tool (EPHPP)

Appendix B. Version adapted from Effective Public Health Practice Project quality assessment tool (EPHPP).

  1. Selection bias

    1. Do the individuals selected to participate in the study representatively reflect the population of interest?

    2. What percentage of respondents agreed to participate in the survey?

  2. Study design

    1. Was the randomization method described?

    2. Was the method appropriate?

  3. Confounders

    1. Were there important differences between groups before intervention?

    2. If so, indicate the percentage of reliability factors that were controlled (stratification, sampling, analysis)?

  4. Blinding

    1. Do the outcome assessors have previous knowledge about the individuals being tested?

    2. Were the study participants aware of the research question?

  5. Data; collections; methods

    1. Were the data collection tools valid?

    2. Were the collection tools reliable?

  6. Losses and exclusions

    1. Were losses and individuals excluded from analyses described in numbers or justification?

    2. Did the study indicate the percentage of participants who completed the study?

* The evaluation items and the results for each question were calculated according to Thomas et al. (2004). The final score for all domains varied between: Strong (1)/Moderate (0)/Weak (−1).


Thomas B, Ciliska D, Dobbins M, Micucci S. A process for systematically reviewing the literature: providing the research evidence for public health nursing interventions. Worldviews Evidence-Based Nurs 2004;1:176–84.


1. Eckel, RH, Grundy, SM, Zimmet, PZ. The metabolic syndrome. Lancet 2005;365:1415–28. in Google Scholar

2. Artero, EG, Lee, D-C, Lavie, CJ, España-Romero, V, Sui, X, Church, TS, et al. Effects of muscular strength on cardiovascular risk factors and prognosis. J Cardiopulm Rehabil Prev 2012;32:351. in Google Scholar

3. Castro-Piñero, J, Artero, EG, España-Romero, V, Ortega, FB, Sjöström, M, Suni, J, et al. Criterion-related validity of field-based fitness tests in youth: a systematic review. Br J Sports Med 2010;44:934–43. in Google Scholar PubMed

4. Smith, JJ, Eather, N, Morgan, PJ, Plotnikoff, RC, Faigenbaum, AD, Lubans, DR. The health benefits of muscular fitness for children and adolescents: a systematic review and meta-analysis. Sports Med 2014;44:1209–23. in Google Scholar PubMed

5. Huang, TT-K, Ball, GD, Franks, PW. Metabolic syndrome in youth: current issues and challenges. Appl Physiol Nutr Metabol 2007;32:13–22. in Google Scholar PubMed

6. Ford, ES, Li, C. Defining the metabolic syndrome in children and adolescents: will the real definition please stand up?. J Pediatr 2008;152:160–4. e13. in Google Scholar PubMed

7. Kang, Y, Park, S, Kim, S, Koh, H. Handgrip strength among Korean adolescents with metabolic syndrome in 2014-2015. J Clin Densitom 2018;18:1094–6950.10.1016/j.jocd.2018.09.002Search in Google Scholar PubMed

8. Perez-Bey, A, Segura-Jimenez, V, Fernandez-Santos, JD, Esteban-Cornejo, I, Gomez-Martinez, S, Veiga, OL, et al. The role of adiposity in the association between muscular fitness and cardiovascular disease. J Pediatr 2018;199:178–+. in Google Scholar PubMed

9. Castro-Pinero, J, Laurson, KR, Artero, EG, Ortega, FB, Labayen, I, Ruperez, AI, et al. Muscle strength field-based tests to identify European adolescents at risk of metabolic syndrome: the HELENA study. J Sci Med Sport 2019;22:929–34. in Google Scholar PubMed

10. de Lima Rodrigues, T, Custódio, PM, Henrique, PG, Augusto, DSS. Muscular fitness and cardiovascular risk factors in children and adolescents: a systematic review. J Strength Condit Res 2018.10.1519/JSC.0000000000002840Search in Google Scholar PubMed

11. Liberati, A, Altman, DG, Tetzlaff, J, Mulrow, C, Gøtzsche, PC, Ioannidis, JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 2009;6: e1000100. in Google Scholar PubMed PubMed Central

12. Weiss, R, Bremer, AA, Lustig, RH. What is metabolic syndrome, and why are children getting it?. Ann N Y Acad Sci 2013;1281:123–40. in Google Scholar PubMed PubMed Central

13. Thomas, B, Ciliska, D, Dobbins, M, Micucci, S. Quality assessment tool for quantitative studies dictionary: the Effective Public Health Practice Project (EPHPP). McMaster University; 2008.Search in Google Scholar

14. Thomas, B, Ciliska, D, Dobbins, M, Micucci, S. A process for systematically reviewing the literature: providing the research evidence for public health nursing interventions. Worldviews Evidence-Based Nurs 2004;1:176–84. in Google Scholar

15. Steene-Johannessen, J, Andersen, SA, Kolle, E, Andersen, LB. Low muscle fitness is associated with metabolic risk in youth. Med Sci Sports Exerc 2009;41:1361–7. in Google Scholar

16. Mota, J, Vale, S, Martins, C, Gaya, A, Moreira, C, Santos, R, et al. Influence of muscle fitness test performance on metabolic risk factors among adolescent girls. Diabetol Metab Syndrome 2010;2:1–7. in Google Scholar PubMed PubMed Central

17. Artero, EG, Ruiz, JR, Ortega, FB, Espana-Romero, V, Vicente-Rodriguez, G, Molnar, D, et al. Muscular and cardiorespiratory fitness are independently associated with metabolic risk in adolescents: the HELENA study. Pediatr Diabetes 2011;12:704–12. in Google Scholar PubMed

18. Grontved, A, Ried-Larsen, M, Moller, NC, Kristensen, PL, Froberg, K, Brage, S, et al. Muscle strength in youth and cardiovascular risk in young adulthood (the European Youth Heart Study). Br J Sports Med 2015;49:90–4. in Google Scholar PubMed

19. Zaqout, M, Michels, N, Bammann, K, Ahrens, W, Sprengeler, O, Molnar, D, et al. Influence of physical fitness on cardio-metabolic risk factors in European children. The IDEFICS study. Int J Obes 2016;40:1119–25. in Google Scholar PubMed

20. Lee, H-S, Jeong, W-W, Choi, Y-J, Seo, Y-G, Noh, H-M, Song, H-J, et al. Association between physical fitness and cardiometabolic risk of children and adolescents in Korea. Korean J Fam Med 2018.10.4082/kjfm.17.0085Search in Google Scholar PubMed PubMed Central

21. Cohen, DD, Gomez-Arbelaez, D, Camacho, PA, Pinzon, S, Hormiga, C, Trejos-Suarez, J, et al. Low muscle strength is associated with metabolic risk factors in Colombian children: the ACFIES study. PloS One 2014;9: e93150. in Google Scholar PubMed PubMed Central

22. Ramirez-Velez, R, Pena-Ibagon, JC, Martinez-Torres, J, Tordecilla-Sanders, A, Correa-Bautista, JE, Lobelo, F, et al. Handgrip strength cutoff for cardiometabolic risk index among Colombian children and adolescents: the FUPRECOL Study. Sci Rep 2017;7:42622. in Google Scholar

23. Fraser, BJ, Huynh, QL, Schmidt, MD, Dwyer, T, Venn, AJ, Magnussen, CG. Childhood muscular fitness phenotypes and adult metabolic syndrome. Med Sci Sports Exerc 2016;48:1715–22. in Google Scholar

24. Peterson, MD, Saltarelli, WA, Visich, PS, Gordon, PM. Strenǵth capacity and cardiometabolic risk clustering in adolescents. Pediatrics 2014;133:e896–903. in Google Scholar

25. Zimmet, P, Alberti, G, Kaufman, F, Tajima, N, Silink, M, Arslanian, S, et al. The metabolic syndrome in children and adolescents. Lancet 2007;369:2059–61. in Google Scholar

26. Lorenzo, C, Williams, K, Hunt, KJ, Haffner, SM. The national cholesterol education program–adult treatment panel III, international Diabetes federation, and world health organization definitions of the metabolic syndrome as predictors of incident cardiovascular disease and diabetes. Diabetes Care 2007;30:8–13. in Google Scholar PubMed

27. Jolliffe, CJ, Janssen, I. Development of age-specific adolescent metabolic syndrome criteria that are linked to the Adult Treatment Panel III and International Diabetes Federation criteria. J Am Coll Cardiol 2007;49:891–8. in Google Scholar PubMed

28. de Ferranti, SD, Gauvreau, K, Ludwig, DS, Neufeld, EJ, Newburger, JW, Rifai, N. Prevalence of the metabolic syndrome in American adolescents: findings from the third national health and nutrition examination survey. Circulation 2004;110:2494–7. in Google Scholar PubMed

29. Ahrens, W, Moreno, L, Mårild, S, Molnár, D, Siani, A, De Henauw, S, et al. Metabolic syndrome in young children: definitions and results of the IDEFICS study. Int J Obes 2014;38:S4–14. in Google Scholar PubMed

30. National Cholesterol Education Program. Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). Circulation 2002:3143–421.10.1161/circ.106.25.3143Search in Google Scholar

31. Grundy, SM, Cleeman, JI, Daniels, SR, Donato, KA, Eckel, RH, Franklin, BA, et al. Diagnosis and management of the metabolic syndrome: an American Heart association/national Heart, Lung, and blood Institute scientific statement. Circulation 2005;112:2735–52. in Google Scholar PubMed

32. Benson, AC, Torode, ME, Fiatarone Singh, MA. Muscular strength and cardiorespiratory fitness is associated with higher insulin sensitivity in children and adolescents. Int J Pediatr Obes 2006;1:222–31. in Google Scholar PubMed

33. Sothern, M, Loftin, M, Suskind, R, Udall, J, Blecker, U. The health benefits of physical activity in children and adolescents: implications for chronic disease prevention. Eur J Pediatr 1999;158:271–4. in Google Scholar PubMed

34. Malina, RM, Bouchard, C, Bar-Or, O. Growth, maturation, and physical activity, 2nd ed. Human kinetics; 2004.10.5040/9781492596837Search in Google Scholar

35. Clarkson, HM. Musculoskeletal assessment: joint range of motion and manual muscle strength, 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2000.Search in Google Scholar

36. Brunet, M, Chaput, J, Tremblay, A. The association between low physical fitness and high body mass index or waist circumference is increasing with age in children: the ‘Quebec en Forme’Project. Int J Obes 2007;31:637–43. in Google Scholar PubMed

37. García-Artero, E, Ortega, FB, Ruiz, JR, Mesa, JL, Delgado, M, González-Gross, M, et al. Lipid and metabolic profiles in adolescents are affected more by physical fitness than physical activity (AVENA study). Rev Esp Cardiol 2007;60:581–8. in Google Scholar PubMed

38. Artero, EG, España‐Romero, V, Ortega, F, Jiménez‐Pavón, D, Ruiz, J, Vicente‐Rodríguez, G, et al. Health‐related fitness in adolescents: underweight, and not only overweight, as an influencing factor. The AVENA study. Scand J Med Sci Sports 2010;20:418–27.10.1111/j.1600-0838.2009.00959.xSearch in Google Scholar PubMed

39. Jiménez-Pavón, D, Ortega, F, Valtuena, J, Castro-Piñero, J, Gómez-Martínez, S, Zaccaria, M, et al. Muscular strength and markers of insulin resistance in European adolescents: the HELENA Study. Eur J Appl 2012;112:2455–65. in Google Scholar PubMed

40. Gurka, MJ, Ice, CL, Sun, SS, DeBoer, MD. A confirmatory factor analysis of the metabolic syndrome in adolescents: an examination of sex and racial/ethnic differences. Cardiovasc Diabetol 2012;11:128. in Google Scholar PubMed PubMed Central

41. Friend, A, Craig, L, Turner, S. The prevalence of metabolic syndrome in children: a systematic review of the literature. Metab Syndr Relat Disord 2013;11:71–80. in Google Scholar PubMed

Supplementary material

The online version of this article offers supplementary material (

Received: 2020-03-24
Accepted: 2020-08-31
Published Online: 2020-10-14
Published in Print: 2021-01-27

© 2020 Walter de Gruyter GmbH, Berlin/Boston

Scroll Up Arrow