Whole-Body Composition and Muscle Strength

Whole body composition was determined using DEXA. Total body fat mass (g) and total and regional lean mass (g) were measured using a Lunar DPX-MD + densitometer (GE Medical Systems, Madison, WI). Appendicular skeletal muscle mass (ASM, kg) was defined as the sum of the lean soft tissue mass of the arms and legs [16 (link)], and BMI-corrected ASM (ASM/BMI) was also calculated [17 (link)]. Handgrip strength was measured using a digital strength dynamometer (TKK 5401, Takei, Japan) to evaluate muscle strength. During the assessment, participants were asked to stand upright with their feet hip-width apart and arms extended straight down to the side unless they were physically limited. The dynamometer was held by the testing hand in a neutral (not flexed or extended) and comfortable position. Two trials for each hand were performed with a one-minute rest after each trial, and the values from both hands were averaged for analysis.