Do muscle mass, muscle density, strength, and physical function similarly influence risk of hospitalization in older adults?
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OBJECTIVES: To examine the association between strength, function, lean mass, muscle density, and risk of hospitalization. DESIGN: Prospective cohort study. SETTING: Two U.S. clinical centers. PARTICIPANTS: Adults aged 70 to 80 (N=3,011) from the Health, Aging and Body Composition Study. MEASUREMENTS: Measurements were of grip strength, knee extension strength, lean mass, walking speed, and chair stand pace. Thigh computed tomography scans assessed muscle area and density (a proxy for muscle fat infiltration). Hospitalizations were confirmed by local review of medical records. Negative binomial regression models estimated incident rate ratios (IRRs) of hospitalization for race‐ and sex‐specific quartiles of each muscle and function parameter separately. Multivariate models adjusted for age, body mass index, health status, and coexisting medical conditions. RESULTS: During an average 4.7 years of follow‐up, 1,678 (55.7%) participants experienced one or more hospitalizations. Participants in the lowest quartile of muscle density were more likely to be subsequently hospitalized (multivariate IRR=1.47, 95% confidence interval (CI)=1.24–1.73) than those in the highest quartile. Similarly, participants with the weakest grip strength were at greater risk of hospitalization (multivariate IRR=1.52, 95% CI=1.30–1.78, Q1 vs. Q4). Comparable results were seen for knee strength, walking pace, and chair stands pace. Lean mass and muscle area were not associated with risk of hospitalization. CONCLUSION: Weak strength, poor function, and low muscle density, but not muscle size or lean mass, were associated with greater risk of hospitalization. Interventions to reduce the disease burden associated with sarcopenia should focus on increasing muscle strength and improving physical function rather than simply increasing lean mass.
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A large observational study using Health ABC data found that low muscle mass was not independently associated with an increased risk of hospitalization, whereas low muscle strength and poor physical performance were associated with increased risks of hospitalization.
“A large observational study using data from Health ABC participants found that low muscle mass was not independently associated with an increased risk of hospitalization (44). However, low muscle strength and poor physical performance were associated with increased risks of hospitalization (44).”
From Health Consequences of Sarcopenic Obesity: A Narrative Review (2020) · cites this paper as [44]
Low muscle density is associated with poor survival and increased risk of hospitalization.
“Low muscle density has also been associated with poor survival and increased risk of hospitalization (Cawthon et al., 2009; Looijaard et al., 2016).”
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., 2009
Loss of muscle performance has a greater negative impact on older adults than loss of muscle mass.
“the preponderance of evidence from years indicates that loss of muscle performance has a greater negative impact on older adults than loss of mass [18, 20–25, 37–39].”
From Targeting Intramyocellular Lipids to Improve Aging Muscle Function (2025) · cites this paper as [37]
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Self-citation
- Authors
- Cawthon, P. M., Fox, K. M., Gandra, S. R., Delmonico, M. J., Chiou, C., Anthony, M. S., Sewall, A., Goodpaster, B., Satterfield, S., Cummings, S. R., Harris, T. B., & for the Health, A. A. B. C. S.
- Affiliations
- National Institutes of Health (US)
- Amgen (United States) (US)
- Corresponding author
- Cawthon, Peggy Mannen
- ORCID
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2009-07-29
- Volume
- 57
- Issue
- 8
- Pages
- 1411-1419
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC3269169
- OpenAlex
- W2103784531
- Cited by
- 414
- References
- 30
- Citations by year
- 2026: 11 · 2025: 16 · 2024: 22 · 2023: 29 · 2022: 25 · 2021: 34 · 2020: 36 · 2019: 33 · 2018: 32 · 2017: 33 · 2016: 31 · 2015: 28 · 2014: 22 · 2013: 19 · 2012: 10
- FWCI
- 9.53
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Journal of Media Literacy Education (submittedVersion, cc-by)
- Funders
- Amgen
- National Institutes of Health (n01ag062101-007, n01ag062103-006, n01ag062106-007)
- National Institute on Aging (N01‐AG‐6–2101, N01 AG062106, N01AG62106, N01-AG-62103, N01 AG062103, N01 AG062101)
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
- Keywords
- hospitalization risk, older adults, muscle strength, muscle density, sarcopenia, lean body mass, physical function, grip strength, quadriceps strength, walking speed, chair stand, muscle fat infiltration, health-related quality of life
- MeSH terms
- Aged, Aged, 80 and over, Body Composition, Female, Medicare, Hospitalization, Humans, Knee Joint, Male, Prospective Studies, Regression Analysis, Risk, Thigh, Tomography, X-Ray Computed, United States, Absorptiometry, Photon, Geriatric Assessment, Poisson Distribution, Walking, Muscle, Skeletal, Hand Strength, Torque, Muscle Strength
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