Functional and Metabolic Correlates of Age- and Sex-Normalized Handgrip Strength in Children with Metabolic Dysfunction-Associated Steatotic Liver Disease

Background: To characterize associations of age- and sex-normalized handgrip strength with physical activity, functional status, fatigue, metabolic parameters, and liver disease characteristics in children with metabolic dysfunction-associated steatotic liver disease (MASLD). Methods: This cross-sectional analysis included a prospectively recruited pediatric MASLD cohort. Maximum handgrip strength was measured using a Takei GRIP-A dynamometer following a protocol aligned with the Canadian Health Measures Survey and normalized using Canadian age- and sex-specific reference values. Low grip strength was defined as <25th percentile. Physical activity, functional status, and fatigue were assessed using the Physical Activity Vital Sign, Lansky Play-Performance Scale, and child- and parent-proxy PedsQL Multidimensional Fatigue Scale, respectively. Results: Fifty children were included (median age, 14.0 years; 70% male; median BMI z-score, 3.1). Low handgrip strength was present in 17/50 participants (34%). Normalized grip strength correlated inversely with controlled attenuation parameter (CAP; rho = −0.34, p = 0.024) and positively with HDL cholesterol (rho = 0.49, p < 0.001), weekly exercise (rho = 0.42, p = 0.003), and Lansky score (rho = 0.35, p = 0.012). Children with low grip strength had lower weekly exercise, Lansky scores, and HDL cholesterol. Median CAP was 318 dB/m in children with low grip strength and 296 dB/m in those without low grip strength (p = 0.085). Conclusions: Lower age- and sex-normalized handgrip strength was associated with lower physical activity, poorer functional status, lower HDL cholesterol, and higher CAP in children with MASLD. These findings support further study of handgrip strength as a simple functional measure in pediatric MASLD.