Abstract
Objectives
It is unknown whether muscle mass measured by the D3-creatine dilution method is a superior predictor of incident mobility disability
than traditional components of sarcopenia definitions (including grip strength, walking
speed, appendicular lean mass). The objective of this study was to determine the relative
importance of strength; physical performance; and lean, fat, and muscle mass in predicting
incident mobility disability in older men.
Design
Longitudinal cohort study of participants in the Osteoporotic Fractures in Men (MrOS)
study.
Setting and Participants
Muscle mass was assessed by D3-creatine dilution in 1098 men (aged 83.7 ± 3.7 years). Participants also completed
anthropomorphic measures, 6-m walking speed (m/s), grip strength (kg), chair stands
(seconds), and dual x-ray absorptiometry appendicular lean mass (ALM), and total body
fat percentage. Men self-reported incident mobility disability defined by the development
of an inability to complete at least one of walking 2-3 blocks, climbing 10 steps,
or carrying 10 lb over 2.2 ± 0.3 years.
Methods
Classification and regression tree analysis was conducted to determine relative variable
importance and algorithm cutpoints for predicting incident mobility disability. Given
the proximity of walking speed with the primary outcome (mobility disability), analyses
were conducted with and without walking speed.
Results
Walking speed followed by D3Cr muscle mass/weight were the most important variables (variable importance: 53%
and 12%, respectively) in the prediction of self-reported incident mobility disability.
D3Cr muscle mass was the most important variable in predicting incident mobility disability
when walking speed was excluded, followed by chair stands (variable importance: 35%
and 33%, respectively). Body fat percentage, ALM, and grip strength were not selected
as nodes in either analysis and had low or negligible variable importance.
Conclusions and Implications
This study has provided valuable insights into the importance of different variables
in predicting incident mobility disability in older men. Muscle mass by D3Cr may be a key tool for predicting the risk of negative outcomes in older adults
in the future, particularly in post-acute and long-term care settings.
Keywords
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Article info
Publication history
Published online: May 04, 2020
Footnotes
The Osteoporotic Fractures in Men (MrOS) Study is supported by National Institutes of Health funding. The following institutes provide support: the National Institute on Aging (NIA), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Center for Advancing Translational Sciences (NCATS), and NIH Roadmap for Medical Research under the following grant numbers: U01AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160, and UL1 TR000128. Funding for the D3Cr muscle mass measure was provided by NIAMS (grant number R01 AR065268). GlaxoSmithKline provided in-kind support by providing the D3-creatine dose and analysis of urine samples.
J.Z. was supported to undertake this research by the Australian and New Zealand Society for Geriatric Medicine Travelling Scholarship, the Australian Institute for Musculoskeletal Science, and was also supported by an Australian Government Research Training Program Scholarship.
S.B.-O. is supported by a National Health and Medical Research Council (NHMRC, of Australia) Career Development Fellowship (GNT1107510, 2016-2019) and a Medicine, Dentistry and Health Sciences (MDHS) Faculty Research Fellowship, University of Melbourne (2020).
D.S. is supported by a National Health and Medical Research Council (NHMRC) Australia RD Wright Biomedical Career Development Fellowship (GNT1123014) and a NHMRC Australia Investigator Grant (GNT1174886).
Conflicts of interest: T.B. reports salary support from grants from the National Institutes of Health and Merck & Co.
P.C. receives institutional research funding from Abbott and Nestle for work outside of this paper. P.C. is a consultant for BioAge Labs also for work outside of this paper.
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