Application of the D3-creatine muscle mass assessment tool to a geriatric weight loss trial: A pilot study

IF 8.9 1区医学 Journal of Cachexia, Sarcopenia and Muscle Pub Date : 2023-09-05 DOI:10.1002/jcsm.13322

Kristen M. Beavers, Allison E. Avery, Mahalakshmi Shankaran, William J. Evans, S. Delanie Lynch, Caitlyn Dwyer, Marjorie Howard, Daniel P. Beavers, Ashley A. Weaver, Leon Lenchik, Peggy M. Cawthon

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Abstract

Background

Traditionally, weight loss (WL) trials utilize dual energy X-ray absorptiometry (DXA) to measure lean mass. This method assumes lean mass, as the sum of all non-bone and non-fat tissue, is a reasonable proxy for muscle mass. In contrast, the D₃-creatine (D₃Cr) dilution method directly measures whole body skeletal muscle mass, although this method has yet to be applied in the context of a geriatric WL trial. The purpose of this project was to (1) describe estimates of change and variability in D₃Cr muscle mass in older adults participating in an intentional WL intervention and (2) relate its change to other measures of body composition as well as muscle function and strength.

Methods

The INVEST in Bone Health trial (NCT04076618), used as a scaffold for this ancillary pilot project, is a three-armed, 12-month randomized, controlled trial designed to determine the effects of resistance training or weighted vest use during intentional WL on a battery of musculoskeletal health outcomes among 150 older adults living with obesity. A convenience sample of 24 participants (n = 8/arm) are included in this analysis. At baseline and 6 months, participants were weighed, ingested a 30 mg D₃Cr tracer dose, provided a fasted urine sample 3–6 days post-dosage, underwent DXA (total body fat and lean masses, appendicular lean mass) and computed tomography (mid-thigh and trunk muscle/intermuscular fat areas) scans, and performed 400-m walk, stair climb, knee extensor strength, and grip strength tests.

Results

Participants were older (68.0 ± 4.4 years), mostly White (75.0%), predominantly female (66.7%), and living with obesity (body mass index: 33.8 ± 2.7 kg/m²). Six month total body WL was −10.3 (95% confidence interval, CI: −12.7, −7.9) kg. All DXA and computed tomography-derived body composition measures were significantly decreased from baseline, yet D₃Cr muscle mass did not change [+0.5 (95% CI: −2.0, 3.0) kg]. Of muscle function and strength measures, only grip strength significantly changed [+2.5 (95% CI: 1.0, 4.0) kg] from baseline.

Conclusions

Among 24 older adults, significant WL with or without weighted vest use or resistance training over a 6-month period was associated with significant declines in all bioimaging metrics, while D₃Cr muscle mass and muscle function and strength were preserved. Treatment assignment for the trial remains blinded; therefore, full interpretation of these findings is limited. Future work in this area will assess change in D₃Cr muscle mass by parent trial treatment group assignment in all study participants.

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D3肌酸肌质量评估工具在老年减肥试验中的应用：一项初步研究

背景传统上，减肥（WL）试验使用双能X射线吸收仪（DXA）来测量瘦质量。该方法假设瘦质量是所有非骨和非脂肪组织的总和，是肌肉质量的合理代表。相比之下，D3肌酸（D3Cr）稀释法直接测量全身骨骼肌质量，尽管这种方法尚未应用于老年WL试验。该项目的目的是（1）描述参与有意WL干预的老年人D3Cr肌肉质量的变化和可变性的估计，以及（2）将其变化与身体成分以及肌肉功能和力量的其他测量联系起来。方法骨健康投资试验（NCT04076618）作为该辅助试点项目的支架，是一项为期12个月的三组随机对照试验，旨在确定150名肥胖老年人在故意WL期间进行阻力训练或使用加重背心对肌肉骨骼健康结果的影响。本次分析包括24名参与者（n=8/arm）的方便样本。在基线和6个月时，对参与者进行称重，摄入30 mg D3Cr示踪剂剂量，在给药后3-6天提供禁食尿样，接受DXA（全身脂肪和瘦块、阑尾瘦块）和计算机断层扫描（大腿中部和躯干肌肉/肌间脂肪区），并进行400米步行、爬楼梯、膝盖伸肌力量，以及握力测试。结果参与者年龄较大（68.0±4.4岁），大多数是白人（75.0%），主要是女性（66.7%），患有肥胖症（体重指数：33.8±2.7 kg/m2）。6个月的全身WL为−10.3（95%置信区间，CI:−12.7，−7.9）kg，而D3Cr肌肉质量没有变化[+0.5（95%CI:-2.0，3.0）kg]。在肌肉功能和力量测量中，只有握力与基线相比有显著变化[+2.5（95%CI:1.0，4.0）kg]。结论在24名老年人中，在6个月的时间里，使用或不使用加重背心或阻力训练的显著WL与所有生物成像指标的显著下降有关，同时D3Cr肌肉质量、肌肉功能和力量得以保留。试验的治疗分配仍然是盲目的；因此，对这些发现的全面解释是有限的。该领域的未来工作将通过父母试验治疗组的分配来评估所有研究参与者的D3Cr肌肉质量的变化。

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来源期刊

Journal of Cachexia, Sarcopenia and Muscle Medicine-Orthopedics and Sports Medicine

自引率

12.40%

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期刊介绍： The Journal of Cachexia, Sarcopenia, and Muscle is a prestigious, peer-reviewed international publication committed to disseminating research and clinical insights pertaining to cachexia, sarcopenia, body composition, and the physiological and pathophysiological alterations occurring throughout the lifespan and in various illnesses across the spectrum of life sciences. This journal serves as a valuable resource for physicians, biochemists, biologists, dieticians, pharmacologists, and students alike.