Ci a ion: Jiménez-Sánchez, A.;
Pe ei a-Cunill, J.L.; Limón-Mi ón, M.L.;
López-Lad ón, A.; Sal ado -Bo ill, F.J.;
Ga cía-Luna, P.P. A C oss-Sec ional
Valida ion S udy o Cam y EH101
e sus JAMAR Plus Handheld
Dynamome e s in Colo ec al Cance
Pa ien s and Thei Co ela ions wi h
Bioelec ical Impedance and
Nu i ional S a us. Nu ien s 2024,16,
1824. h ps://doi.o g/10.3390/
nu16121824
Academic Edi o s: And ea P. Rossi,
Mau izio Ma a and Ming Yang
Recei ed: 4 May 2024
Re ised: 31 May 2024
Accep ed: 3 June 2024
Published: 11 June 2024
Copy igh : © 2024 by he au ho s.
Licensee MDPI, Basel, Swi ze land.
This a icle is an open access a icle
dis ibu ed unde he e ms and
condi ions o he C ea i e Commons
A ibu ion (CC BY) license (h ps://
c ea i ecommons.o g/licenses/by/
4.0/).
nu ien s
A icle
A C oss-Sec ional Valida ion S udy o Cam y EH101 e sus
JAMAR Plus Handheld Dynamome e s in Colo ec al Cance
Pa ien s and Thei Co ela ions wi h Bioelec ical Impedance
and Nu i ional S a us
And és Jiménez-Sánchez 1,*, JoséLuis Pe ei a-Cunill 1,* , Ma ía Luisa Limón-Mi ón2, Amelia López-Lad ón2,
F ancisco Ja ie Sal ado -Bo ill 2and Ped o Pablo Ga cía-Luna 1
1
Unidad de Ges ión Clínica de Endoc inología y Nu ición, Ins i u o de Biomedicina de Se illa, IBiS/Hospi al
Uni e si a io Vi gen del Rocío/CSIC/Uni e sidad de Se illa, A da. Manuel Siu o s/n, 41013 Se ille, Spain;
[email p o ec ed]
2Unidad de Ges ión Clínica de Oncología Médica, Hospi al Uni e si a io Vi gen del Rocío, A da. Manuel
Siu o s/n, 41013 Se ille, Spain; [email p o ec ed] (M.L.L.-M.);
amelia.lopezlad on.sspa@jun adeandalucia.es (A.L.-L.); anciscoj.sal ado .sspa@jun adeandalucia.es (F.J.S.-B.)
*Co espondence: [email p o ec ed] (A.J.-S.); [email p o ec ed] (J.L.P.-C.)
Abs ac : Backg ound: Reduced muscle s eng h (dynapenia) and mass (a ophy) a e p ognos ic
ac o s in oncology. Measu ing maximal handg ip s eng h wi h dynamome e s is easible bu limi ed
by he cos o he e e ence de ice (JAMAR). Me hods: A c oss-sec ional s udy was conduc ed on
colo ec al cance ou pa ien s ea ed wi h chemo he apy o unde ac i e su eillance in ou cen e
om Sep embe 2022 o July 2023. Accu acy, eliabili y, and conco dance we e compa ed o wo
handheld dynamome e s: he JAMAR Plus ( he gold-s anda d de ice) and he Cam y EH101 (a
low-cos index de ice). A simul aneous nu i ional diagnosis wi h GLIM c i e ia and bioelec ical
impedance analysis (BIA) was ca ied ou . Resul s: A o al o 134 pa icipan s we e included. The
median o maximal s eng h o he JAMAR Plus had a non-signi ican di e ence o 1.4 kg om
he Cam y EH101. The accu acy and eliabili y o he de ices we e high. Bland–Al man analysis
showed a 0.8 kg bias and
−
4.1 o 5.6 kg limi s o ag eemen (LoA); a 0.1 kg bias and
−
5.3 o 5.4 kg
LoA in men; a 1.5 kg bias and
−
2.2 o 5.3 kg LoA in women. In o al, 29.85% o he pa icipan s
we e malnou ished. P e alence o dynapenia inc eased om 3.67% wi h he JAMAR Plus o 5.14%
wi h he Cam y EH101. Bo h de ices had a mode a e and signi ican co ela ion wi h BIA-es ima ed
muscle mass. Conclusions: The Cam y EH101 was a cos -e ec i e al e na i e o JAMAR Plus in
ou sample.
Keywo ds: handg ip s eng h; JAMAR; Cam y; Smedley; dynamome e ; colo ec al cance ;
bioelec ical
impedance; muscle mass; GLIM c i e ia; mo pho unc ional assessmen
1. In oduc ion
Nu i ional sc eening, diagnosis, and in e en ion a e o capi al impo ance in on-
cology. One o he co ne s ones o malnu i ion is muscle mass (MM) loss (also known
as muscle a ophy). Subjec - ela ed, umo - ela ed, and ea men - ela ed cha ac e is ics
can cause weigh -independen low MM in oncology [
1
]. A p e ious s udy on colo ec al
cance showed a p e alence o low MM in 39.8% o non-me as a ic and su gically ea ed
pa ien s, wi h a p e alence o up o 46.2% in cases o me as a ic disease [
2
]. MM loss
ac s as an independen p edic o o su i al [
3
,
4
]; physical, cogni i e, and social unc-
ioning [
5
,
6
]; heal h- ela ed quali y o li e [
7
]; pos ope a i e complica ions and hospi al
leng h o s ay [
8
,
9
]; and dose-limi ing oxici y om capeci abine and be acizumab [
10
] in
colo ec al cance .
Nu ien s 2024,16, 1824. h ps://doi.o g/10.3390/nu16121824 h ps://www.mdpi.com/jou nal/nu ien s
Nu ien s 2024,16, 1824 2 o 18
MM can be measu ed in clinical se ings wi h indi ec body composi ion me hods,
such as compu ed omog aphy (CT), magne ic esonance imaging, and ul asound. MM can
also be es ima ed using doubly indi ec body composi ion me hods, such as bioelec ical
impedance analysis (BIA) and an h opome y.
BIA has widesp ead use in clinical nu i ion [
11
] and ew echnical limi a ions in onco-
logical ou pa ien s [
12
]. The de ice emi s a small cu en ha passes h ough he human
body, measu ing he ollowing aw bioelec ical pa ame e s: esis ance (R), capaci i e
eac ance (X
c
), and phase angle (
θ
). R and X
c
can be adjus ed by heigh and depic ed in
ela ion o he con idence ellipses o a heal hy e e ence popula ion. This me hodology
is called bioimpedance ec o analysis (BIVA) o “RX
c
g aph” [
13
], and i acili a es he
isualiza ion and moni o ing o cellula i y and issue hyd a ion independen ly o weigh .
An RX
c
g aph classi ies subjec s in ou quad an s, op-down and clockwise: lean, cachec ic,
obese, and a hle ic. Rega ding
θ
, i has a mode a e co ela ion wi h CT-measu ed muscle
a ophy and myos ea osis ( a in il a ion in skele al muscle) and has enough speci ici y o
ac as a su oga e o hese condi ions in pa ien s wi h colo ec al cance [
14
]. I is also an
independen isk ac o o mo ali y in di e en cance s [
15
]. Addi ionally,
θ
can be ans-
o med in o a s anda dized phase angle (Z-sco e), which is also an independen p edic o
o mo ali y in oncology [16].
BIA also allows he es ima ion o MM and a mass (FM) wi h eg ession equa ions,
ideally speci ic o he clinical popula ion unde s udy [
17
]. BIA-es ima ed MM has shown a
mode a e co ela ion wi h CT esul s in c oss-sec ional s udies in bo h non-malnou ished
and malnou ished cance pa ien s [
18
,
19
]. In longi udinal s udies, BIA-es ima ed MM has
shown a p edic i e abili y o su i al simila o CT-measu ed MM in colo ec al cance [
20
].
As body composi ion analysis is no always a ailable in clinical scena ios, low s eng h
(dynapenia) can be used as a p oxy o low MM due o i s co ela ion. The e o e, i is
included in ope a i e de ini ions o malnu i ion, such as he GLIM c i e ia [
21
]. In addi ion,
dynapenia is an independen p edic o o lowe quali y o li e [
22
], mo e pos ope a i e
complica ions [23], and wo se su i al [24,25] in colo ec al cance .
In con as o labo a o y me hods, measu emen o maximal handg ip s eng h ia
handheld dynamome y is a easible way o de e mine dynapenia in clinical p ac ice in
ou pa ien s wi h malignancies [
26
] and o he clinical popula ions in ou ine ca e. T adi-
ionally, he gold-s anda d de ice o his ask in clinical nu i ion is he JAMAR hyd aulic
handheld dynamome e wi h analogue eadou . Ne e heless, he e is a new e sion ( he
JAMAR Plus) wi h digi al eadou s ha has subs i u ed he hyd aulic cells wi h elec onic
load senso s. Smedley- ype sp ing handheld dynamome e s wi h digi al eadou s, such as
Baseline, Medline, and Cam y de ices, a e al e na i es o JAMAR ins umen s which also
ha e su i al p edic ion abili y [
27
] and no ma i e alues [
28
]. Thei main p os a e hei
lowe p ice, lowe weigh (356 g o he Cam y de ice e sus 727 g o he JAMAR Plus),
and easie eadabili y (when compa ed o an analogue JAMAR dynamome e ).
Howe e , he e appea o be impo an di e ences in he measu emen capabili ies o
di e en ypes o handheld dynamome e s [
29
] and be ween Smedley- ype and JAMAR-
ype handheld dynamome e s [
30
]. To ou knowledge, i e s udies [
31
–
35
] ha e p e iously
ca ied ou a c oss-sec ional alida ion o he use o he Cam y dynamome e as an index
echnique agains he use o he analogue JAMAR dynamome e as a e e ence echnique in
di e en clinical popula ions. Ou s udy aims o c oss-sec ionally alida e he use o a low-
cos digi al sp ing handheld dynamome e (a Cam y de ice) as an index echnique agains
he use o a digi al elec onic load senso handheld dynamome e ( he JAMAR Plus) as a
e e ence echnique o he measu emen o handg ip s eng h. This s udy elied on a single
ope a o ha measu es ou pa ien s wi h diges i e neoplasms in ou cen e . Seconda ily, we
desc ibe he clinical si ua ion and BIA-de i ed body composi ion o pa ien s, analyzing
he deg ee o co ela ion o bo h handheld dynamome e s wi h MM and a s anda dized
phase angle.
Nu ien s 2024,16, 1824 3 o 18
2. Ma e ials and Me hods
2.1. S udy Design
S udy design: an analy ical obse a ional s udy. Measu emen pe iod: Sep embe 2022
o July 2023.
Subjec s unde s udy: inclusion c i e ia: people
≥
18 yea s old, ei he unde ac i e
chemo he apy ea men (de ined as any ea men session in he las 30 days) o ac i e
su eillance by oncology due o a documen ed diagnosis o colo ec al cance , wi h an
ECOG o 0–3 and who comple ed a speci ic in o med consen p o ocol. Exclusion c i e ia:
medical wa d inpa ien s, ECOG 4–5, su ge y o in e cu en illness leading o hospi al
admission in he p e ious 30 days, pacemake o implan able ca dio e e de ib illa o
(ICD), skin lesions o se e e adhesi e de ma i is con aindica ing he use o elec odes,
consump ion o diu e ics in he las 48 h, se e e cogni i e impai men , o end-o -li e ca e.
Wi hd awal c i e ion: a he eques o he pa icipan .
Sampling: con enience sampling wi h consecu i e inclusion. Sample size: ollowing
he me hodology p oposed by Lu e al. [
36
] and using he s a is ical package blandPowe
(h ps:// d .io/gi hub/nwisn/blandPowe / /README.md, accessed on 2 June 2024) in
Rs udio so wa e ( e sion 2023.06.1+524), we de e mined a p io i a isk o
ype I e o = 0.05
and a isk o ype II e o = 0.20. Taking he minimum de ec able change in mean handg ip
s eng h o 5.44 kg om Huang e al. [
33
], we inc eased i by 40% and ob ained 7.6 kg, which
we es ablished as he maximal clinically accep able di e ence be ween de ices (del a). On
he o he hand, we ook a mean absolu e di e ence o 0.1 kg and calcula ed a s anda d
de ia ion o he di e ence o 3.1 kg, acco ding o And ade e al. [
35
]. Wi h hese da a, we
ob ained a sample size o n= 132 pai s o measu emen s (and hus pa icipan s).
The s udy was conduc ed in acco dance wi h he Decla a ion o Helsinki and app o ed
by he E hics Commi ee “CEI de los Hospi ales Uni e si a ios Vi gen Maca ena y Vi gen
del Rocío” (p o ocol code: 1006-N-22; da e o app o al: 23 May 2022).
2.2. Da a Collec ion
2.2.1. Clinical Va iables and Cance S aging
The ollowing clinical a iables we e ob ained om digi ized heal h eco ds (“DIRAYA
Clinical S a ion”): age, ECOG pe o mance s a us [
37
], ype o baseline disease, umo
s aging (acco ding o AJCC-TNM, 8 h edi ion) [
38
], ype and da e o ea men . Di e en
sys emic an icance he apies we e applied ollowing s anda d schemes acco ding o
oncology guidelines [39].
2.2.2. Handg ip S eng h P o ocol
Handg ip s eng h was measu ed in kilog ams (kg) using andomly and consecu-
i ely a JAMAR Plus handheld dynamome e (Pe o mance Heal h Sammons P es on,
Wa en ille, IL, USA) and a Cam y EH101 handheld dynamome e (Zhongshan Cam y
Elec onic Co. L d., Zhongshan, China). Bo h de ices we e pu chased new and used
exclusi ely o his s udy. All men we e measu ed using g ip posi ion 2 o he JAMAR
Plus [
40
,
41
] and an equi alen g ip size o he Cam y de ice. Women wi h smalle hands
had hei handg ip size adap ed as p e iously desc ibed [
41
] o bo h handheld dynamome-
e s. Hand wid h (in cm) was measu ed as he dis ance be ween he dis al end o he humb
and he li le inge a maximal abduc ion on a ho izon al su ace using a lexible and
inex ensible ape measu e p oduced by CESCORF (Po o Aleg e, B azil). S eng h was
measu ed exclusi ely in he dominan hand (ei he igh o le upon in e oga ion), ol-
lowing he Sou hamp on p o ocol [
42
]. Fi s , he ini ial de ice was andomly assigned.
Then, a p e- es measu emen was pe o med in all cases wi h each de ice o amilia ize he
pa icipan wi h bo h de ices. Then, h ee measu emen s we e al e na ely (1:1) ob ained
wi h each de ice. Each egis e ed a emp consis ed o a maximal con ac ion o a leas
h ee seconds [
43
], allowing a 60 s es be ween each a emp [
44
]. The pa icipan was no
in o med which o he de ices was conside ed he gold s anda d. Bo h he mean and he
maximum alues o handg ip s eng h we e used o analysis.
Nu ien s 2024,16, 1824 4 o 18
2.2.3. Ope a i e De ini ions o Dynapenia, Malnu i ion, and Sa copenia
To diagnose dynapenia, maximal handg ip s eng h was compa ed o he maximal
handg ip s eng h no ma i e alues de eloped by Dodds e al. [
45
] om popula ion-
based s udies wi h JAMAR and Smedley- ype dynamome e s. These alues a e used in
he Eu opean Wo king G oup on Sa copenia in Olde People (EWGSOP-II) c i e ia [
46
].
Al e na i ely, he NAKO s udy pe cen iles [
47
] o he JAMAR Plus handheld dynamome e
we e used. Dynapenia was de ined bo h wi h a pe cen ile-based app oach (maximal
s eng h below he co esponding 10 h pe cen ile based on age and sex) and a dicho omous
app oach using EWGSOP-II cu o alues (<27 kg in men; <16 kg in women) [46].
Malnu i ion was de ined using he GLIM c i e ia [
48
]. Rega ding he cu o poin o
a ophy, we used he SMI cu o poin s o he Spanish popula ion o Masanés e al. [
49
],
ollowing EWGSOP-II [
46
] and GLIM [
50
] ecommenda ions. We conside ed only unin-
en ional weigh loss when calcula ing GLIM sco es. Sa copenia was de ined using he
EWGSOP-II c i e ia [46].
2.2.4. Bioelec ical Impedance Analysis P o ocol
Bioelec ical impedance was measu ed wi h a phase-sensi i e ouchsc een impedance
de ice (Nu ilab™, Ake n, Flo ence, I aly), wo king wi h an al e na ing sinusoidal elec ic
cu en o 230
µ
A a an ope a ing equency o 50 kHz (
±
1%). The de ice was calib a ed
e e y mo ning using he s anda d con ol ci cui supplied by he manu ac u e wi h a
known impedance esis ance (R) = 380
Ω
and eac ance (X
c
) = 45
Ω
. Impedance da a we e
shown di ec ly on an LCD ouchsc een de ice and s o ed in in e nal memo y. Accu acy:
Rz:
±
0.1
Ω
; X
c
:
±
0.1
Ω
; CV% < 1%. The pu e bioelec ic pa ame e s ob ained we e Z
(impedance, in
Ω
), R ( esis ance, in
Ω
), X
c
( eac ance, in
Ω
), and phase angle (
θ= an−1
(X
c
/R), in
◦
). The measu emen echnique acco ded wi h he ESPEN p o ocol [
51
]. A e
ensu ing as ing om solids o a leas eigh hou s, as ing om liquids o a leas
wo hou s, emp ying o he bladde wi hin 15 min p io o he es , and emo al o me allic
(jewel y) and elec omagne ic de ices (sma phones and o he wea ables), he pa icipan s
we e placed in a supine posi ion and s a ic elec ici y was emo ed. The pa icipan s’ a ms
we e sepa a ed a 30
◦
and hei legs a 45
◦
. The elec ode placemen a ea was cleaned
wi h 70
◦
alcohol. Once d y, wo se s o adhesi e Ag/AgCl low-impedance elec odes
(Bi a odes™ Ake n S l; Flo ence, I aly) designed o accu a e and sensi i e bioimpedance
measu emen s we e placed p oximally o he phalangeal–me aca pal join on he do sal
su ace o he igh hand and dis ally o he ans e se a ch on he supe io su ace o he
igh oo . Senso elec odes we e placed a he midpoin be ween he dis al p ominence
o he adius and ulna o he igh w is and be ween he medial and la e al malleoli
o he igh ankle. The clamps o he measu ing cable we e hen a ached, a oiding he
occu ence o loops. A e an app oxima e ime o i e minu es in supine posi ion, he
pa icipan s unde wen h ee consecu i e measu emen s, and each R, X
c
, and
θ
alue was
egis e ed. Janssen e al.’s equa ion [
52
] was used o es ima e skele al muscle mass (SMM).
The Skele al Muscle Index (SMI) was calcula ed as SMI = SMM/H
2
, whe e H = heigh (m).
θ
alues we e ans o med in o Z-sco es acco ding o he e e ence alues p o ided by
Bosy-Wes phal e al. [53]
. BIVA was pe o med acco ding o Piccoli e al. [
13
], as p e iously
desc ibed. S anda dized phase angle alues below
−
1.65 SD we e de ined as pa hological,
as p e ious s udies ha e shown hei p edic i e alue in oncological popula ions [54].
2.2.5. Basic An h opome y P o ocol
Heigh and weigh measu emen s we e pe o med acco ding o ESPEN ecommenda-
ions [
51
]. Heigh was measu ed wi h an SECA wall-moun ed measu ing od (seca GmbH
& Co. KG, Hambu g, Ge many) ins alled a 200 mm. Weigh was measu ed using a new
and calib a ed po able weigh measu emen de ice, he CAS PB-150 (CAS Co po a ion,
Seoul, Republic o Ko ea), wi h a capaci y o up o 150 kg and wo anges o measu ing
sensi i i y (20 g di e ences up o 60 kg; 50 g di e ences be ween 60 and 150 kg).
Nu ien s 2024,16, 1824 5 o 18
2.2.6. Da a Quali y
Da a quali y: all ield measu emen s we e ca ied ou by a single esea che wi h expe-
ience in body composi ion analysis (A.J.S.). Following QUADAS-2 ecommenda ions [
55
],
body composi ion analysis and de e mina ion o handg ip s eng h we e pe o med wi hin
15 min o each o he and by a single examine , wi h he pa icipan blinded o which hand-
held dynamome e was he gold s anda d. Cance s agings, ea men s, and pe o mance
sco es we e egis e ed in he da abase as eco ded by oncologis s (M.L.L.-M. and A.L.-L.)
in heal h eco ds.
2.3. Da a Analysis
S a is ical analysis: RS udio so wa e ( e sion 2023.06.1+524) and he packages
idy e se
,
psych,cowplo ,i ,ggpub , and Rcmd we e used. Desc ip i e s a is ics o he a iables
o in e es we e de e mined. The p esence o absence o no mali y was analyzed wi h
he Shapi o–Wilk es . Va iables wi h a no mal dis ibu ion we e desc ibed as means
and s anda d de ia ions (SDs). Non-no mally dis ibu ed a iables we e desc ibed as
medians and in e qua ile anges (IQRs). Nex , we compa ed measu es o cen al endency
(a compa ison o means wi h a - es in case o a no mal dis ibu ion acco ding o he
Shapi o–Wilk es and homoscedas ici y, and a compa ison o medians wi h he Wilcoxon
signed- ank es o he wise) o maximal and a e age handg ip s eng h wi h bo h handheld
dynamome e s (JAMAR Plus and Cam y). P opo ions we e es ed wi h X
2
es s, using
Ya es’s con inui y co ec ion i n
i
< 5. The p esence o andom o sys ema ic bias and
he magni ude o ag eemen was de e mined by a Bland–Al man analysis. Limi s o
ag eemen (LoA) we e de ined wi h 95% con idence as
d±
1.96
SD
, whe e d= he mean
o he di e ence be ween he me hods and SD = he s anda d de ia ion o he di e ence
be ween he me hods [
56
]. The ela i e eliabili y o each ins umen was assessed wi h
he in aclass co ela ion coe icien (ICC), conside ing alues o 0.75–0.90 as a “good”
co ela ion
and 0.91–1.00
as an “excellen ” co ela ion [
57
]. As his s udy had a single
clinical examine and we wan ed o ex apola e ou esul s o ou ine clinical p ac ice,
we chose a wo-way andomized model o ICC (2,1), acco ding o Sh ou and Fleiss [
58
],
wi h he ollowing o mula:
MS −MSe
MS +(K−1)MSe+K
n(MSc−MSe)
, whe e MS = he mean squa e o
ows, MSe = he mean squa e o e o , MSc = he mean squa e o columns, k= he numbe
o measu emen s wi h he ins umen , and n= he numbe o subjec s. We assessed he
absolu e eliabili y o each ins umen by he s anda d e o o measu emen (SEM) and i s
minimum de ec able change (MDC), as p e iously desc ibed [
33
]. Simple co ela ion was
calcula ed ia he Pea son co ela ion coe icien . S a is ical signi icance was de e mined in
all es s as a p- alue < 0.05.
3. Resul s
3.1. Gene al Cha ac e is ics o he Sample
A o al o n= 134 pa icipan s we e measu ed, and hei clinical and demog aphic
cha ac e is ics a e shown in Table 1. All subjec s we e included o s a is ical analysis.
Table 1. Clinical and demog aphic cha ac e is ics o he s udy sample.
Pa ame e Resul s
Sample size (ni)n= 134
Age (yea s) Me = 65.7 yea s
IQR = 13.4 yea s
Olde han 65 (ni)n= 71 (52.98%)
Female (ni)n= 64 (47.76%)
Type o neoplasm (ni)
Righ colon, n= 32
Rec um, n= 36
Sigma, n= 27

Nu ien s 2024,16, 1824 6 o 18
Table 1. Con .
Pa ame e Resul s
Type o neoplasm (ni)
Le colon, n= 15
T ans e se colon, n= 11
Rec osigmoid, n= 10
K ukenbe g’s umo (colon as he p ima y si e), n= 1
S age (TNM) a diagnosis
IIA (n= 24); IIB (n= 3); IIC (n= 4)
IIIA (n= 12); IIIB (n= 43); IIIC (n= 13)
IVA (n= 14); IVB (n= 15); IVC (n= 6)
P e ious su ge y Yes, n= 123
No, n= 11
Ac i e chemo he apy (ni)No, n= 102
Yes, n= 32
ECOG (ni)
0, n= 86
1, n= 42
2, n= 5
3, n= 1
Clinical cha ac e is ics o he sample. Nume ical alues a e exp essed as absolu e equencies (n), pe cen ages (%),
medians (Me), and in e qua ile anges (IQRs).
3.2. Handg ip S eng h De e mined wi h Handheld Dynamome e s
The en i e sample was analyzed in he c oss-sec ional alida ion o he dynamome e s.
No pa icipan s had unde gone p e ious su ge y o had in e cu en diseases ha may
ha e a ec ed hei hand biomechanics.
3.2.1. Co ela ion and P ecision
The co ela ion be ween he maximal handg ip s eng hs de e mined by he JAMAR
Plus and Cam y de ices was e y high ( = 0.969; p< 2.2
×
10
−16
). The co ela ion be ween
he a e age handg ip s eng hs de e mined by he JAMAR Plus and Cam y de ices was
also e y high ( = 0.974; p< 2.2
×
10
−16
). A g aphical ep esen a ion o his co ela ion
analysis is shown in Figu e 1.
Nu ien s 2024, 16, x FOR PEER REVIEW 7 o 19
Figu e 1. Simple linea eg ession o maximal handg ip s eng h (A) and a e age handg ip s eng h
(B) be ween JAMAR Plus and Cam y handheld dynamome e s. The pe ec bisec o o in e de ice
eg ession is shown as a solid ed line, and he linea eg ession model be ween he de ices is shown
as a solid blue line.
The main a iables ela ed o he handheld dynamome e s a e summa ized in Table
2. The e was a p e alence o igh -handed pa icipan s, and he men had bigge dominan
hands han he women. n = 63 women and all he men pe o med handg ip s eng h meas-
u emen s wi h he JAMAR Plus g ip in posi ion 2 and a Cam y equi alen . Bo h maximal
and a e age s eng h wi h bo h handg ip dynamome e s we e highe in men han in
women. Women—bu no men—had a g ea e diffe ence in maximal s eng h be ween
handg ip dynamome e s.
Table 2. S eng h measu emen s, p ecision, and eliabili y o he de ices in he s udy sample.
Pa ame e To al Sample Men Women p-Value
Measu ing side (ni) Righ , n = 125
Le , n = 9
Righ , n = 65
Le , n = 5
Righ , n = 60
Le , n = 4 <2.2 × 10−16
Hand size (cm) Me = 20.0
IQR = 2.0
Me = 21.0
IQR = 2.0
Me = 19.0
IQR = 2.0 7.827 × 10−11
Fi s dynamome e (ni) JAMAR, n = 63
Cam y, n = 71
JAMAR, n = 38
Cam y, n = 32
JAMAR, n = 25
Cam y, n = 39 0.299
Maximal s eng h JAMAR (kg) Me = 33.4
IQR = 12.6
Me = 40.0
IQR = 12.0
Me = 28.4
IQR = 7.8 4.387 × 10−13
A e age s eng h JAMAR (kg) Me = 32.3
IQR = 12.1
Me = 32.0
IQR = 14.1
Me = 32.5
IQR = 10.2 1.205 × 10−12
ICC JAMAR 0.968 0.961 0.931 NC
SD diffe ences JAMAR (kg) 2.3 2.3 2.3 NC
SEM JAMAR (kg) 0.4 0.4 0.6 NC
MDC JAMAR (kg) 1.1 1.2 1.6 NC
Maximal s eng h Cam y (kg) Me = 32.0
IQR = 13.1
Me = 39.0
IQR = 11.8
Me = 27.4
IQR = 7.6 9.127 × 10−15
A e age s eng h Cam y (kg) Me = 31.0
IQR = 12.6
Me = 37.3
IQR = 11.0
Me = 26.2
IQR = 6.98 8.215 × 10−15
ICC Cam y 0.971 0.958 0.938 NC
SD diffe ences Cam y (kg) 2.4 2.4 2.4 NC
SEM Cam y (kg) 0.4 0.5 0.6 NC
Figu e 1. Simple linea eg ession o maximal handg ip s eng h (A) and a e age handg ip s eng h
(B) be ween JAMAR Plus and Cam y handheld dynamome e s. The pe ec bisec o o in e de ice
eg ession is shown as a solid ed line, and he linea eg ession model be ween he de ices is shown
as a solid blue line.
Nu ien s 2024,16, 1824 7 o 18
The main a iables ela ed o he handheld dynamome e s a e summa ized in Table 2.
The e was a p e alence o igh -handed pa icipan s, and he men had bigge dominan
hands han he women. n= 63 women and all he men pe o med handg ip s eng h
measu emen s wi h he JAMAR Plus g ip in posi ion 2 and a Cam y equi alen . Bo h
maximal and a e age s eng h wi h bo h handg ip dynamome e s we e highe in men han
in women. Women—bu no men—had a g ea e di e ence in maximal s eng h be ween
handg ip dynamome e s.
Table 2. S eng h measu emen s, p ecision, and eliabili y o he de ices in he s udy sample.
Pa ame e To al Sample Men Women p-Value
Measu ing side (ni)Righ , n= 125
Le , n= 9
Righ , n= 65
Le , n= 5
Righ , n= 60
Le , n= 4 <2.2 ×10−16
Hand size (cm) Me = 20.0
IQR = 2.0
Me = 21.0
IQR = 2.0
Me = 19.0
IQR = 2.0 7.827 ×10−11
Fi s dynamome e (ni)JAMAR, n= 63
Cam y, n= 71
JAMAR, n= 38
Cam y, n= 32
JAMAR, n= 25
Cam y, n= 39 0.299
Maximal s eng h JAMAR (kg) Me = 33.4
IQR = 12.6
Me = 40.0
IQR = 12.0
Me = 28.4
IQR = 7.8 4.387 ×10−13
A e age s eng h JAMAR (kg) Me = 32.3
IQR = 12.1
Me = 32.0
IQR = 14.1
Me = 32.5
IQR = 10.2 1.205 ×10−12
ICC JAMAR 0.968 0.961 0.931 NC
SD di e ences JAMAR (kg) 2.3 2.3 2.3 NC
SEM JAMAR (kg) 0.4 0.4 0.6 NC
MDC JAMAR (kg) 1.1 1.2 1.6 NC
Maximal s eng h Cam y (kg) Me = 32.0
IQR = 13.1
Me = 39.0
IQR = 11.8
Me = 27.4
IQR = 7.6 9.127 ×10−15
A e age s eng h Cam y (kg) Me = 31.0
IQR = 12.6
Me = 37.3
IQR = 11.0
Me = 26.2
IQR = 6.98 8.215 ×10−15
ICC Cam y 0.971 0.958 0.938 NC
SD di e ences Cam y (kg) 2.4 2.4 2.4 NC
SEM Cam y (kg) 0.4 0.5 0.6 NC
MDC Cam y (kg) 1.1 1.3 1.6 NC
Di e ence in maximal s eng h be ween de ices (kg)
Me = 0.6
IQR = 2.9
Me = −0.1
IQR = 3.1
Me = 1.2
IQR = 2.5 0.377 ×10−3
Nume ical alues a e exp essed as absolu e equencies (n), pe cen ages (%), medians (Me), in e qua ile anges
(IQRs), s anda d de ia ions (SDs), s anda d e o s o measu emen s (SEMs), minimum de ec able changes (MDCs),
in aclass co ela ion coe icien s (ICCs), and no compu ed (NC). p- alues we e only compu ed o he o al
sample in case o p opo ions (measu ing side, i s dynamome e ), and he es we e compu ed g ouping by sex.
3.2.2. Compa ison o Maximal Handg ip S eng h be ween De ices
Maximal s eng h o bo h he JAMAR Plus and Cam y handheld dynamome e s
ollowed a non-no mal dis ibu ion. The median maximal s eng h o he JAMAR Plus
dynamome e was 33.4 kg and he median maximal s eng h o he Cam y dynamome e
was 32.0 kg, wi h a non-signi ican di e ence o +1.4 kg in a o o he JAMAR Plus. A
g aphical ep esen a ion is shown in Figu e 2A. To imp o e compa abili y wi h p e ious
s udies, maximal s eng h o he JAMAR Plus a e aged 34.5 kg (SD = 9.4 kg) and maximal
s eng h o he Cam y de ice a e aged 33.7 kg (SD = 10.1 kg). When g ouped by sex, he
median maximal s eng h was 40.0 kg o males and 28.4 kg o emales wi h he JAMAR
Plus, while he median maximal s eng h was 39.0 kg o males and 27.4 kg o emales wi h
he Cam y de ice. The e we e non-signi ican di e ences in men (+1.0 kg in a o o he
Nu ien s 2024,16, 1824 8 o 18
JAMAR Plus) and women (+1.0 kg in a o o he JAMAR Plus). A g aphical ep esen a ion
is shown in Figu e 2B.
Nu ien s 2024, 16, x FOR PEER REVIEW 8 o 19
MDC Cam y (kg) 1.1 1.3 1.6 NC
Diffe ence in maximal s eng h be ween de ices (kg) Me = 0.6
IQR = 2.9
Me = −0.1
IQR = 3.1
Me = 1.2
IQR = 2.5 0.377 × 10−3
Nume ical alues a e exp essed as absolu e equencies (n), pe cen ages (%), medians (Me), in e -
qua ile anges (IQRs), s anda d de ia ions (SDs), s anda d e o s o measu emen s (SEMs), mini-
mum de ec able changes (MDCs), in aclass co ela ion coefficien s (ICCs), and no compu ed (NC).
p- alues we e only compu ed o he o al sample in case o p opo ions (measu ing side, i s dy-
namome e ), and he es we e compu ed g ouping by sex.
3.2.2. Compa ison o Maximal Handg ip S eng h be ween De ices
Maximal s eng h o bo h he JAMAR Plus and Cam y handheld dynamome e s ol-
lowed a non-no mal dis ibu ion. The median maximal s eng h o he JAMAR Plus dy-
namome e was 33.4 kg and he median maximal s eng h o he Cam y dynamome e
was 32.0 kg, wi h a non-signi ican diffe ence o +1.4 kg in a o o he JAMAR Plus. A
g aphical ep esen a ion is shown in Figu e 2A. To imp o e compa abili y wi h p e ious
s udies, maximal s eng h o he JAMAR Plus a e aged 34.5 kg (SD = 9.4 kg) and maximal
s eng h o he Cam y de ice a e aged 33.7 kg (SD = 10.1 kg). When g ouped by sex, he
median maximal s eng h was 40.0 kg o males and 28.4 kg o emales wi h he JAMAR
Plus, while he median maximal s eng h was 39.0 kg o males and 27.4 kg o emales
wi h he Cam y de ice. The e we e non-signi ican diffe ences in men (+1.0 kg in a o o
he JAMAR Plus) and women (+1.0 kg in a o o he JAMAR Plus). A g aphical ep esen-
a ion is shown in Figu e 2B.
Figu e 2. Box-and-whiske plo s wi h o e lapping geome ies o poin s o ep esen he dis ibu ion
o maximal s eng h in he sample: o e all sample in (A); da a g ouped by sex in (B). Type o
handheld dynamome e on he X-axis; maximal s eng h (in kg) on he Y-axis. The p- alue o he
median diffe ence o maximal s eng h acco ding o he ype o dynamome e used (JAMAR Plus
o Cam y) is shown in squa e b acke s. The dashed g ey lines join he esul s o he same pa ici-
pan s acco ding o hei iden i ica ion numbe s.
0.42
0
10
20
30
40
50
60
JAMAR Plus Cam y
Dynamome e
Maximal s eng h (kg)
A0.94
0.14
Men Women
JAMAR Plus Cam y
0
10
20
30
40
50
60
0
10
20
30
40
50
60
Dynamome e
Maximal s eng h (kg)
B
Figu e 2. Box-and-whiske plo s wi h o e lapping geome ies o poin s o ep esen he dis ibu ion
o maximal s eng h in he sample: o e all sample in (A); da a g ouped by sex in (B). Type o handheld
dynamome e on he X-axis; maximal s eng h (in kg) on he Y-axis. The p- alue o he median
di e ence o maximal s eng h acco ding o he ype o dynamome e used (JAMAR Plus o Cam y)
is shown in squa e b acke s. The dashed g ey lines join he esul s o he same pa icipan s acco ding
o hei iden i ica ion numbe s.
3.2.3. Compa ison o A e age Handg ip S eng h be ween De ices
The a e age s eng h o bo h he JAMAR Plus and Cam y de ices ollowed a non-
no mal dis ibu ion. The median a e age s eng h o he JAMAR Plus was 32.3 kg,
and he median a e age s eng h o he Cam y de ice was 31.0 kg. The e was a non-
signi ican di e ence o +1.3 kg in a o o he JAMAR Plus. A g aphical ep esen a ion
is shown in Figu e 3A. When di ided by sex, he median o he a e age s eng h was
38.2 kg in males and 27.4 kg in emales o he JAMAR Plus, while he median o a e age
s eng h
was 37.3 kg
in males and 26.2 kg in emales o he Cam y de ice. The e we e non-
signi ican di e ences in men (+0.9 kg in a o o he JAMAR Plus) and women (
+1.2 kg
in
a o o he JAMAR Plus). A g aphical ep esen a ion is shown in Figu e 3B.
3.2.4. Dis ibu ion o Di e ences be ween De ices
Di e ences in maximal s eng h be ween he handheld dynamome e s ollowed a
no mal dis ibu ion and a e g aphically ep esen ed in Figu e 4A. When g ouped by sex,
di e ences in maximal s eng h we e also no mally dis ibu ed in bo h men and women
and a e g aphically ep esen ed in Figu e 4B.
Nu ien s 2024,16, 1824 9 o 18
Nu ien s 2024, 16, x FOR PEER REVIEW 9 o 19
3.2.3. Compa ison o A e age Handg ip S eng h be ween De ices
The a e age s eng h o bo h he JAMAR Plus and Cam y de ices ollowed a non-
no mal dis ibu ion. The median a e age s eng h o he JAMAR Plus was 32.3 kg, and
he median a e age s eng h o he Cam y de ice was 31.0 kg. The e was a non-signi i-
can diffe ence o +1.3 kg in a o o he JAMAR Plus. A g aphical ep esen a ion is shown
in Figu e 3A. When di ided by sex, he median o he a e age s eng h was 38.2 kg in
males and 27.4 kg in emales o he JAMAR Plus, while he median o a e age s eng h
was 37.3 kg in males and 26.2 kg in emales o he Cam y de ice. The e we e non-signi -
ican diffe ences in men (+0.9 kg in a o o he JAMAR Plus) and women (+1.2 kg in a o
o he JAMAR Plus). A g aphical ep esen a ion is shown in Figu e 3B.
Figu e 3. Box-and-whiske plo s wi h o e lapping geome ies o poin s o ep esen he a e age
s eng h dis ibu ion in he sample: o e all sample in (A); da a ace ed by sex in (B). Type o
handheld dynamome e on he X-axis; maximal s eng h (in kg) on he Y-axis. The p- alue o he
median diffe ence o maximal s eng h acco ding o he ype o dynamome e used is shown in
squa e b acke s. The dashed g ey lines join he esul s o he same pa icipan s acco ding o hei
iden i ica ion numbe s.
3.2.4. Dis ibu ion o Diffe ences be ween De ices
Diffe ences in maximal s eng h be ween he handheld dynamome e s ollowed a
no mal dis ibu ion and a e g aphically ep esen ed in Figu e 4A. When g ouped by sex,
diffe ences in maximal s eng h we e also no mally dis ibu ed in bo h men and women
and a e g aphically ep esen ed in Figu e 4B.
0.4
0
10
20
30
40
50
60
JAMAR Plus Cam y
Dynamome e
Mean s eng h (kg)
A
0.83
0.15
Men Women
JAMAR Plus Cam y
0
10
20
30
40
50
60
0
10
20
30
40
50
60
Dynamome e
Mean s eng h (kg)
B
Figu e 3. Box-and-whiske plo s wi h o e lapping geome ies o poin s o ep esen he a e age
s eng h dis ibu ion in he sample: o e all sample in (A); da a ace ed by sex in (B). Type o
handheld dynamome e on he X-axis; maximal s eng h (in kg) on he Y-axis. The p- alue o he
median di e ence o maximal s eng h acco ding o he ype o dynamome e used is shown in
squa e b acke s. The dashed g ey lines join he esul s o he same pa icipan s acco ding o hei
iden i ica ion numbe s.
Nu ien s 2024, 16, x FOR PEER REVIEW 10 o 19
Figu e 4. His og ams o he mean s eng h diffe ences be ween dynamome e s: o e all sample in
(A); da a g ouped by sex in (B). Absolu e diffe ences exp essed in kg on he X-axis; absolu e e-
quencies p esen ed on he Y-axis.
3.2.5. Bland–Al man Analysis
Bland–Al man analysis o he whole sample showed a 0.8 kg sys ema ic bias in a o
o he JAMAR Plus dynamome e , wi h limi s o ag eemen o −4.1 o 5.6 kg. Only n = 6
measu emen s (4.47%) we e ou side he limi s o ag eemen . A g aphical ep esen a ion
is p esen ed in Figu e 5A. Bland–Al man analysis o he men showed a 0.1 kg sys ema ic
bias in a o o he JAMAR Plus dynamome e , wi h limi s o ag eemen o −5.3 o 5.4 kg.
Only n = 3 measu emen s (4.28%) we e ou side he limi s o ag eemen . A g aphical ep-
esen a ion is p esen ed in Figu e 5B. Bland–Al man analysis o he women showed a 1.5
kg sys ema ic bias in a o o he JAMAR Plus dynamome e , wi h limi s o ag eemen o
−2.2 o 5.3 kg. Only n = 2 measu emen s (3.12%) we e ou side he limi s o ag eemen . A
g aphical ep esen a ion is p esen ed in Figu e 5C.
1
5
10
15
20
25
30
−7 −6 −5 −4 −3 −2 −1 0 1 2 3 4 5 6 7 8
Absolu e di e ence be ween dynamome e s in maximal s eng h (kg)
Absolu e equency
(
n
i
)
A
Men Women
−7−6−5−4−3−2−1012345678
1
5
10
15
1
5
10
15
Absolu e di e ence be ween dynamome e s in maximal s eng h (kg)
Absolu e equency
(
n
i
)
B
Figu e 4. His og ams o he mean s eng h di e ences be ween dynamome e s: o e all sample in (A);
da a g ouped by sex in (B). Absolu e di e ences exp essed in kg on he X-axis; absolu e equencies
p esen ed on he Y-axis.
3.2.5. Bland–Al man Analysis
Bland–Al man analysis o he whole sample showed a 0.8 kg sys ema ic bias in a o
o he JAMAR Plus dynamome e , wi h limi s o ag eemen o
−
4.1 o 5.6 kg. Only n= 6
measu emen s (4.47%) we e ou side he limi s o ag eemen . A g aphical ep esen a ion
Nu ien s 2024,16, 1824 16 o 18
In o med Consen S a emen : In o med consen was ob ained om all subjec s in ol ed in he s udy.
Da a A ailabili y S a emen : The da a p esen ed in his s udy a e a ailable on eques om he
co esponding au ho due o Eu opean legisla ion on da a p o ec ion.
Acknowledgmen s: The BIA de ice (Nu ilab) used in his s udy was p o ided by he “Beca FSEEN
p oyec o de in es igación de composición co po al median e impedanciome ía” g an . This s udy
was also suppo ed by he “Beca SANCYD-F esenius 2021 de in es igación al p oyec o sob e nue as
écnicas en composición co po al en la alo ación nu icional” g an .
Con lic s o In e es : The au ho s decla e no con lic s o in e es .
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