Peggy M Cawthon1,2, Eric S Orwoll3, Katherine E Peters1, Kristine E Ensrud4,5,6, Jane A Cauley7, Deborah M Kado8, Marcia L Stefanick9, James M Shikany10, Elsa S Strotmeyer7, Nancy W Glynn7, Paolo Caserotti11, Mahalakshmi Shankaran12, Marc Hellerstein12,13, Steven R Cummings1,2, William J Evans12,14. 1. Research Institute, California Pacific Medical Center, San Francisco. 2. Department of Epidemiology and Biostatistics, University of California, San Francisco. 3. Department of Medicine, Oregon Health and Science University, Portland. 4. Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minnesota. 5. Division of Epidemiology and Community Health, University of Minnesota, Minneapolis. 6. Department of Medicine, University of Minnesota, Minneapolis. 7. Department of Epidemiology, University of Pittsburgh, Pennsylvania. 8. Departments of Family Medicine & Public Health and Internal Medicine, University of California, San Diego. 9. Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, California. 10. Division of Preventive Medicine, University of Alabama at Birmingham. 11. Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense. 12. Department of Nutritional Sciences and Toxicology, University of California, Berkeley. 13. Department of Medicine, University of California, San Francisco. 14. Department of Medicine, Duke University, Durham, North Carolina.
Abstract
BACKGROUND: Direct assessment of skeletal muscle mass in older adults is clinically challenging. Relationships between lean mass and late-life outcomes have been inconsistent. The D3-creatine dilution method provides a direct assessment of muscle mass. METHODS: Muscle mass was assessed by D3-creatine (D3Cr) dilution in 1,382 men (mean age, 84.2 years). Participants completed the Short Physical Performance Battery (SPPB); usual walking speed (6 m); and dual x-ray absorptiometry (DXA) lean mass. Men self-reported mobility limitations (difficulty walking 2-3 blocks or climbing 10 steps); recurrent falls (2+); and serious injurious falls in the subsequent year. Across quartiles of D3Cr muscle mass/body mass, multivariate linear models calculated means for SPPB and gait speed; multivariate logistic models calculated odds ratios for incident mobility limitations or falls. RESULTS: Compared to men in the highest quartile, those in the lowest quartile of D3Cr muscle mass/body mass had slower gait speed (Q1: 1.04 vs Q4: 1.17 m/s); lower SPPB (Q1: 8.4 vs Q4: 10.4 points); greater likelihood of incident serious injurious falls (odds ratio [OR] Q1 vs Q4: 2.49, 95% confidence interval [CI]: 1.37, 4.54); prevalent mobility limitation (OR Q1 vs Q4,: 6.1, 95% CI: 3.7, 10.3) and incident mobility limitation (OR Q1 vs Q4: 2.15 95% CI: 1.42, 3.26); p for trend < .001 for all. Results for incident recurrent falls were in the similar direction (p = .156). DXA lean mass had weaker associations with the outcomes. CONCLUSIONS: Unlike DXA lean mass, low D3Cr muscle mass/body mass is strongly related to physical performance, mobility, and incident injurious falls in older men.
BACKGROUND: Direct assessment of skeletal muscle mass in older adults is clinically challenging. Relationships between lean mass and late-life outcomes have been inconsistent. The D3-creatine dilution method provides a direct assessment of muscle mass. METHODS: Muscle mass was assessed by D3-creatine (D3Cr) dilution in 1,382 men (mean age, 84.2 years). Participants completed the Short Physical Performance Battery (SPPB); usual walking speed (6 m); and dual x-ray absorptiometry (DXA) lean mass. Men self-reported mobility limitations (difficulty walking 2-3 blocks or climbing 10 steps); recurrent falls (2+); and serious injurious falls in the subsequent year. Across quartiles of D3Cr muscle mass/body mass, multivariate linear models calculated means for SPPB and gait speed; multivariate logistic models calculated odds ratios for incident mobility limitations or falls. RESULTS: Compared to men in the highest quartile, those in the lowest quartile of D3Cr muscle mass/body mass had slower gait speed (Q1: 1.04 vs Q4: 1.17 m/s); lower SPPB (Q1: 8.4 vs Q4: 10.4 points); greater likelihood of incident serious injurious falls (odds ratio [OR] Q1 vs Q4: 2.49, 95% confidence interval [CI]: 1.37, 4.54); prevalent mobility limitation (OR Q1 vs Q4,: 6.1, 95% CI: 3.7, 10.3) and incident mobility limitation (OR Q1 vs Q4: 2.15 95% CI: 1.42, 3.26); p for trend < .001 for all. Results for incident recurrent falls were in the similar direction (p = .156). DXA lean mass had weaker associations with the outcomes. CONCLUSIONS: Unlike DXA lean mass, low D3Cr muscle mass/body mass is strongly related to physical performance, mobility, and incident injurious falls in older men.
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