Cutpoints for low appendicular lean mass that identify older adults with clinically significant weakness
Open accessAbstract
BACKGROUND: Low lean mass is potentially clinically important in older persons, but criteria have not been empirically validated. As part of the FNIH (Foundation for the National Institutes of Health) Sarcopenia Project, this analysis sought to identify cutpoints in lean mass by dual-energy x-ray absorptiometry that discriminate the presence or absence of weakness (defined in a previous report in the series as grip strength <26kg in men and <16kg in women). METHODS: In pooled cross-sectional data stratified by sex (7,582 men and 3,688 women), classification and regression tree (CART) analysis was used to derive cutpoints for appendicular lean body mass (ALM) that best discriminated the presence or absence of weakness. Mixed-effects logistic regression was used to quantify the strength of the association between lean mass category and weakness. RESULTS: In primary analyses, CART models identified cutpoints for low lean mass (ALM <19.75kg in men and <15.02kg in women). Sensitivity analyses using ALM divided by body mass index (BMI: ALMBMI) identified a secondary definition (ALMBMI <0.789 in men and ALMBMI <0.512 in women). As expected, after accounting for study and age, low lean mass (compared with higher lean mass) was associated with weakness by both the primary (men, odds ratio [OR]: 6.9 [95% CI: 5.4, 8.9]; women, OR: 3.6 [95% CI: 2.9, 4.3]) and secondary definitions (men, OR: 4.3 [95% CI: 3.4, 5.5]; women, OR: 2.2 [95% CI: 1.8, 2.8]). CONCLUSIONS: ALM cutpoints derived from a large, diverse sample of older adults identified lean mass thresholds below which older adults had a higher likelihood of weakness.
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Recommended cutpoint for appendicular lean body mass (measured with DXA) is 19.75 kg for men and 15.02 kg for women.
“Efforts to create cutpoints for muscle mass and muscle strength from population studies (community-dwelling older adults) recommended cutpoint for grip strength of 26 kg for men vs. 16 kg for women, and for appendicular lean body mass (measured with DXA) of 19.75 kg for men vs. 15.02 kg for women (Alley et al., 2014; Cawthon et al., 2014).”
From Myosteatosis in the Context of Skeletal Muscle Function Deficit: An Interdisciplinary Workshop at the National Institute on Aging (2020) · cites this paper as Cawthon et al., 2014
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- Authors
- Cawthon, P. M., Peters, K. W., Shardell, M. D., McLean, R. R., Dam, T.-T. L., Kenny, A. M., Fragala, M. S., Harris, T. B., Kiel, D. P., Guralnik, J. M., Ferrucci, L., Kritchevsky, S. B., Vassileva, M. T., Studenski, S. A., & Alley, D. E.
- Affiliations
- California Pacific Medical Center (US)
- University of Maryland, College Park (US)
- Beth Israel Deaconess Medical Center (US)
- Columbia University (US)
- University of Central Florida (US)
- National Institutes of Health (US)
- Wake Forest University (US)
- Foundation for the National Institutes of Health (US)
- University of Pittsburgh (US)
- Corresponding author
- Cawthon, P. M.
- ORCID
- Venue
- The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-04-14
- Volume
- 69
- Issue
- 5
- Pages
- 567-575
- ISSN
- 1079-5006 (ISSN-L)
- 1758-535X
- PMC
- PMC3991141
- OpenAlex
- W2099091257
- Cited by
- 388
- References
- 31
- Citations by year
- 2026: 13 · 2025: 30 · 2024: 33 · 2023: 39 · 2022: 28 · 2021: 36 · 2020: 32 · 2019: 32 · 2018: 40 · 2017: 39 · 2016: 29 · 2015: 28 · 2014: 8 · 2012: 1
- FWCI
- 23.05
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- The Journals of Gerontology Series A (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- Journal of International Crisis and Risk Communication Research (submittedVersion)
- Funders
- Foundation for the National Institutes of Health (P30 AG024827)
- Amgen
- Eli Lilly and Company
- National Institutes of Health (1u13ag041583-01, AG024827)
- National Institute on Aging (1U13AG041583, AG 024827, P30AG024827)
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Keywords
- appendicular lean mass, sarcopenia, muscle weakness, older adults, cut-off values, grip strength, dual-energy X-ray absorptiometry, body mass index, sex differences
- MeSH terms
- Age Factors, Aged, Cross-Sectional Studies, Female, Humans, Male, Sex Factors, Thinness, United States, Absorptiometry, Photon, Body Mass Index, Hand Strength, Muscle Weakness, Sarcopenia
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