BackgroundIdentifying patients with low muscle mass is crucial for the diagnosis of sarcopenia. Although the Creatinine/Cystatin C (Cr/CysC) is recommended as a simplified indicator to identify patients with low muscle mass, its ability to assess muscle mass and predict a poor prognosis has not been validated. We aimed to determine the diagnosis value of Cr/CysC for low muscle mass and examine the association of Cr/CysC with mortality.MethodsIn this cohort study we analyzed data from the National Health and Nutrition Examination Survey from 1999 to 2002. Follow-up was conducted up to December, 2015. Appendicular skeletal mass was calculated based on dual-energy X-ray absorptiometry (DXA) scans. Low muscle mass was defined referring to five international diagnostic criteria. The diagnostic value of Cr/CysC as a replacement indicator of muscle mass was measured using area under the curve, positive percent agreement, negative percent agreement and kappa. Cox proportional hazards regression models were developed to examine the association between Cr/CysC and risk of mortality.ResultsThis cohort study of 3,741 adults comprised 1,823 females (48.73%), with a weighted mean (SE) age of 44.46 (0.43) years. The positive percent agreement of Cr/CysC for the diagnosis of low muscle mass was poor (40.23–58.74%), except for Foundation of the National Institute of Health (FNIH) criteria (80.90–58.97%). But the negative percent agreement of Cr/CysC for the diagnosis of low muscle mass was high (males: 62.15–88.17%; females: 55.26–82.30%). Moreover, the risk of death was reduced by 2% per 0.01 unit increase in Cr/CysC (aHR, 0.98; 95% CI, 0.98–0.99, P < 0.001).ConclusionsCr/CysC performed well not only in identifying non-sarcopenia cases, especially when based on FNIH diagnostic criteria, but also in revealing a positive association with higher risk of mortality. The optimal cut-off values for Cr/CysC were <1.0 in males and <0.8 in females. Expanding the use of Cr/CysC would allow for early and targeted treatment of sarcopenia.

ObjectiveThe American Heart Association (AHA) proposed the concept of ideal cardiovascular health (CVH) to reduce the risk of cardiovascular mortality. We attempted to broaden the impact of CVH and further contribute to AHA 2030 goals by identifying the relationship between CVH and non-cardiovascular diseases such as sarcopenia.DesignCross-sectional surveySettingNational Health and Nutrition Examination Survey conducted in the USA from 2011 to 2018.ParticipantsThis study included participants with reliable first 24-hour dietary recall and ≥20 years of age and excluded those who could not diagnose sarcopenia or insufficient data to calculate the CVH scores.Primary and secondary outcome measuresThe prevalence of sarcopenia as measured by dual-energy X-ray absorptiometry.ResultsThis cohort study involving 9326 adults≥20 years comprised 4733 females (50.0%). The number of intermediate or ideal and poor CVH participants was 5654 and 3672 with mean CVH score of 9.70±0.03 and 5.66±0.04, respectively. After adjusting for related confounding factors, intermediate or ideal CVH was associated with an odds reduction of sarcopenia than poor CVH (adjusted OR (aOR): 0.36, 95% CI 0.26 to 0.50, p<0.001) and the odds of sarcopenia was significantly lower for each incremental increase of 1 in CVH metrics (aOR: 0.75, 95% CI 0.71 to 0.79, p<0.001). Moreover, if the number of ideal CVH metrics was>5, the odds of sarcopenia decreased by up to 84% (aOR: 0.16, 95% CI 0.08 to 0.30).ConclusionsOur findings suggest a relationship between the CVH and the prevalence of sarcopenia in adults. The results of our study can contribute to achieving the 2030 public health goal of achieving CVH for all, which may be supported by efforts to reduce the prevalence of sarcopenia.

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