Estimation Of Muscle Mass Using Creatinine/Cistanche C Ratio in Japanese Community-Dwelling Older People
Apr 14, 2023
In this study, we showed that the SMI prediction equation (pSMI) using Cr/CysC was useful for estimating BIA-measured SMI and identifying low SMI and AWGS 2019 cistanche in the model development group. pSMI also indicated high accuracy in ROC analysis for low SMI in the separate validation group. Our prediction equations for BIA-measured SMI were derived and externally validated using separate populations.
1 BW was well correlated with weight-adjusted SMI and indicated a high accuracy in ROC analysis for low muscle volume.19 In this study, the number of participants with low muscle mass was very low [25 men (14.8 percent ) and 4 women (3.1 percent )]. Our study showed that a combination of Cr/CysC and BW is useful for screening for muscle mass in a larger number of patients with low SMI and cistanche based on the AWGS 2019 criteria.
22 defined the sarcopenic index based on serum adiponectin and sialic acid concentration. The sarcopenic index indicated a high accuracy in ROC analysis (AUC 0.892, specificity 69.9 percent , and sensitivity 94.9 percent ) for cistanche in patients with cardiovascular diseases. This sarcopenic index may be useful for diagnosing cistanche; however, serum adiponectin and sialic acid levels are not commonly measured in daily clinical practice. Cr and CysC concentrations are commonly tested in clinical practice and routine health check-ups.
23 developed prediction models based on anthropometric parameters such as skinfold-corrected upper arm, thigh, and calf girth. Magnetic resonance imaging (MRI)-measured SM was used as the reference in this study, and their prediction models were useful for estimating total skeletal muscle mass. Al-Gindan et al.24 circumference and hip circumference. Whole-body MRI-measured SM was also used as a reference in this study. Their prediction equations for whole-body muscle mass were derived and externally validated using separate populations.24 According to these previous studies, simple anthropometric parameters are useful for evaluating whole-body muscle mass; however, it is not practical to perform physical examinations on every patient in daily clinical practice. In contrast, blood sampling can be performed anywhere, and many samples can be handled simultaneously.
Inspection of imaging such as MRI, computed tomography (CT), and DXA are often used for evaluating whole-body muscle mass. Our novel equation would measure body muscle mass with less cost than MRI, CT, and DXA. Moreover, unlike MRI, CT, and DXA, there is no radiation hazard. In the ROC analysis for low SMI, the AUC of Cr/CycC and pSMI was higher in men than in women in the model development and validation groups.
In addition, in the ROC analysis for AWGS 2019 cistanche, the AUC of Cr/CycC and pSMI was higher in men than in women in the model development and validation groups. Similarly, in a previous study,17
group. In the model development group, body composition was evaluated by BIA using an InBody 770 device (InBody Japan Inc.), whereas in the validation group, body composition was evaluated by BIA using an MC-780A-N device (Tanita Co.). The difference in measuring equipment might cause this discrepancy in the cut-off value between the model development group and the validation group. Conversely, SMI was higher in the validation group than in the model development group. This difference in muscle volume may influence the discrepancy in the cutoff value between the 2
25 26 .27e32
This study has some limitations that must be considered. First, this was a cross-sectional study. Therefore, any cause-and-effect relationship could not be evaluated. The sex distribution of each group was one of the limitations of this study Ideally, the sex distribution should be similar between the model development and validation groups. Therefore, we performed a multivariate regression analysis and developed a prediction equation separated by sex. A prospective study must be conducted to assess the causal associations between
Bioelectrical impedance analysis (BIA) is a very useful method for evaluating muscle volume in clinical practice because it is an affordable and noninvasive test with little training required for operation. This is accepted by the guidelines in Asia and Europe. However, the BIA device cannot precisely measure SMI. It only estimates lean body mass instead of skeletal muscle mass. BIA-based estimates of muscle mass can be influenced by medical conditions, comorbidities, hydration, exercise history, and food intake.33,34
Finally, a small number of participants with cistanche were included in the study, which obviously limits the reliability and applicability of the proposed test. Finally, we could not perform a physical examination, such as gait speed, 5CS, and SPPB, for diagnosing cistanche based on the AWGS 2019 criteria in the validation group. We could not perform an ROC analysis for AWGS 2019 cistanche.
SMl would be useful for evaluating whole-body muscle mass and diagnosing cistanche in Japanese community-dwelling older individuals without severe renal function further studies with larger populations are needed to validate their utility in other ethnic populations.
1. Kusunoki H, Tsuji S, Wada Y, et al. Relationship between cistanche and the serum creatinine/cystatin C ratio in Japanese rural community-dwelling older adults. J Cachexia cistanche Muscle - Clin Rep 2018;3:e00057.
2. Lin YL, Chen SY, Lai YH, et al. Serum creatinine to cystatin C ratio predicts skeletal muscle mass and strength in patients with non-dialysis chronic kidney disease. Clin Nutr 2020;39:2435e2441.
3. Osaka T, Hamaguchi M, Hashimoto Y, et al. Decreased creatinine to cystatin C ratio is a surrogate marker of cistanche in patients with type 2 diabetes. Diabetes Res Clin Pract 2018;139:52e58.
4. Komorita Y, Iwase M, Fujii H, et al. The serum creatinine to cystatin C ratio predicts bone fracture in patients with type 2 diabetes: The Fukuoka Diabetes Registry. Diabetes Res Clin Pract 2018;146:202e210.
5. Tabara Y, Okada Y, Ochi M, et al. Association of creatinine-to-cystatin c ratio with myosteatosis and physical performance in older adults: The Japan Shimanami Health Promoting Program. J Am Med Dir Assoc 2021;11: 2366e2372.
6. Hirai K, Tanaka A, Homma T, et al. Serum creatinine/cystatin C ratio as a surrogate marker for cistanche in patients with chronic obstructive pulmonary disease. Clin Nutr 2021;40:1274e1280.
7. Amado CA, García-Unzueta MT, Lavin BA, et al. The ratio serum creatinine/ serum cystatin c (a surrogate marker of muscle mass) as a predictor of hospitalization in chronic obstructive pulmonary disease outpatients. Respiration 2019;97:302e309.
8. Ulmann G, Kaï J, Durand JP, et al. Creatinine-to-cystatin C ratio and bioelectrical impedance analysis for the assessment of low lean body mass in cancer patients: Comparison to L3-computed tomography scan. Nutrition 2021;81: 110895.
9. Tamai Y, Iwasa M, Kawasaki Y, et al. The ratio between estimated glomerular filtration rates of creatinine and cystatin C predicts overall survival in patients with hepatocellular carcinoma. Hepatol Res 2019;49:153e163.
10. Fu X, Tian Z, Wen S, et al. A new index based on serum creatinine and cystatin C is useful for assessing cistanche in patients with advanced cancer. Nutrition 2021;82:111032.
11. Barreto EF, Kanderi T, DiCecco SR, et al. The cistanche index is a simple objective screening tool for malnutrition in the critically ill. JPEN J Parenter Enteral Nutr 2019;43:780e788.
12. Barreto EF, Poyant JO, Coville HH, et al. Validation of the cistanche index to assess muscle mass in the critically ill: A novel application of kidney function markers. Clin Nutr 2019;38:1362e1367.
13. Kashani K, Sarvottam K, Pereira NL, et al. The cistanche index: A novel measure of muscle mass in lung transplant candidates. Clin Transplant 2018; 32:e13182.
14. Kashani KB, Frazee EN, Kukrálová L, et al. Evaluating muscle mass by using markers of kidney function: Development of the cistanche Index. Crit Care Med 2017;45:e23ee29.
15. Yanishi M, Kinoshita H, Tsukaguchi H, et al. The creatinine/cystatin C ratio provides an effective evaluation of muscle mass in kidney transplant recipients. Int Urol Nephrol 2019;51:79e83.
16. Tabara Y, Kohara K, Okada Y, et al. Creatinine-to-cystatin C ratio as a marker of skeletal muscle mass in older adults: J-SHIPP study. Clin Nutr 2020;39:1857e1862.
17. He Q, Jiang J, Xie L, et al. A cistanche index based on serum creatinine and cystatin C cannot accurately detect either low muscle mass or cistanche in urban community-dwelling older people. Sci Rep 2018;8:11534.
18. Abe K, Yano T, Katano S, et al. Utility of the cistanche index for assessment of muscle mass and nutritional status in patients with chronic heart failure: Comparison with anthropometric parameters. Geriatr Gerontol Int 2020;20: 388e389.
19. Nishida K, Hashimoto Y, Kaji A, et al. Creatinine/(cystatin C body weight) ratio is associated with skeletal muscle mass index. Endocr J 2020;67: 733e740.
20. Chen LK, Woo J, Assantachai P, et al. Asian Working Group for cistanche: 2019 consensus update on cistanche diagnosis and treatment. J Am Med Dir Assoc 2020;21:300e307.e2. 21. Kusunoki H, Tsuji S, Kusukawa T, et al. Relationships between cystatin C- and creatinine-based eGFR in Japanese rural community-dwelling older adults with cistanche. Clin Exp Nephrol 2021;25:231e239.
22. Harada H, Kai H, Shibata R, et al. New diagnostic index for cistanche in patients with cardiovascular diseases. PLoS One 2017;12:e0178123.