D 3 -Creatine dilution and the importance of accuracy in the assessment of skeletal muscle mass

William J. Evans, Marc Hellerstein, Eric Orwoll, Steve Cummings, Peggy M. Cawthon

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

Sarcopenia has been described as the age-associated decrease in skeletal muscle mass. However, virtually every study of sarcopenia has measured lean body mass (LBM) or fat free mass (FFM) rather than muscle mass, specifically. In a number of published sarcopenia studies, LBM or FFM is referred to as muscle mass, leading to an incorrect assumption that measuring LBM or FFM is an accurate measure of muscle mass. As a result, the data on the effects of changes in LBM or FFM in older populations on outcomes such as functional capacity, disability, and risk of injurious falls have been inconsistent resulting in the conclusion that muscle mass is only weakly related to these outcomes. We review and describe the assumptions for the most commonly used measurements of body composition. Dual-energy X-ray absorptiometry (DXA) has become an increasingly common tool for the assessment of LBM or FFM and appendicular lean mass as a surrogate, but inaccurate, measurement of muscle mass. Other previously used methods (total body water, bioelectric impedance, and imaging) also have significant limitations. D 3 -Creatine (D 3 -Cr) dilution provides a direct and accurate measurement of creatine pool size and skeletal muscle mass. In a recent study in older men (MrOS cohort), D 3 -Cr muscle mass was associated with functional capacity and risk of injurious falls and disability, while assessments of LBM or appendicular lean mass by DXA were only weakly or not associated with these outcomes. Inaccurate measurements of muscle mass by DXA and other methods have led to inconsistent results and potentially erroneous conclusions about the importance of skeletal muscle mass in health and disease. The assessment of skeletal muscle mass using the D 3 -Cr dilution method in prospective cohort studies may reveal sarcopenia as a powerful risk factor for late life disability and chronic disease.

Original languageEnglish (US)
Pages (from-to)14-21
Number of pages8
JournalJournal of Cachexia, Sarcopenia and Muscle
Volume10
Issue number1
DOIs
StatePublished - Feb 1 2019

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Creatine
Skeletal Muscle
Sarcopenia
Muscles
Fats
Photon Absorptiometry
Body Water
Body Composition
Electric Impedance
Chronic Disease
Cohort Studies
Prospective Studies
Health
Population

Keywords

  • Body composition
  • D -Creatine dilution
  • Duel X-ray absorptiometry
  • Sarcopenia
  • Skeletal muscle

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physiology (medical)

Cite this

D 3 -Creatine dilution and the importance of accuracy in the assessment of skeletal muscle mass . / Evans, William J.; Hellerstein, Marc; Orwoll, Eric; Cummings, Steve; Cawthon, Peggy M.

In: Journal of Cachexia, Sarcopenia and Muscle, Vol. 10, No. 1, 01.02.2019, p. 14-21.

Research output: Contribution to journalReview article

Evans, William J. ; Hellerstein, Marc ; Orwoll, Eric ; Cummings, Steve ; Cawthon, Peggy M. / D 3 -Creatine dilution and the importance of accuracy in the assessment of skeletal muscle mass In: Journal of Cachexia, Sarcopenia and Muscle. 2019 ; Vol. 10, No. 1. pp. 14-21.
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