The association between haemoglobin concentrations and muscle mass determined from urinary creatinine excretion rate: a population‐based cohort study

• DOI: 10.1111/bjh.16912
• Publication Date: 2020-06-24T14:15:24Z
• Authors: Hanneke J. C. M. ...; Suzanne P. Stam; Melanie M. van de...; Stephan J. L. Bakker; Michele F. Eisenga
• Keywords: Adult; Male; LIFELINES; 24-h urinary creatinine excretion rate; Hemoglobins; 03 medical and health sciences; 0302 clinical medicine; Humans; Prospective Studies; ANEMIA; Renal Insufficiency, Chronic; Muscle, Skeletal; Aged; OLDER; DISABILITY; MEN; Anemia; Middle Aged; haemoglobin; PREVALENCE; muscle mass; Creatinine; Female; HEALTH; PHYSICAL PERFORMANCE

Anaemia is highly prevalent in the general population, particularly elderly.1-3 Diminished haemoglobin concentrations, a marker of anaemia, are known to strongly impact health-related quality life, most prominently impairing physical functioning.4, 5 This negative on perceived functioning pronounced among older individuals, (i.e. ≥60 years)5. Indeed, previous studies have revealed that low concentrations associated with less performance and muscle strength patient population.6, 7 Although association has unequivocally been demonstrated, data about direct relationship between mass, subsequently diminished performance, unknown. Hence, current study, we aimed assess as reflected by 24-h urinary creatinine excretion rate (CER), population. For this purpose, used prospective population-based Lifelines cohort study. multidisciplinary study examining health behaviours 167 729 persons living north Netherlands.8 analyses, adult participants full clinical biochemical available (n = 141 252), excluded urine volume than 500 ml 561; 0·4%) and/or more thanone missing void 1211; 0·9%), resulting total exclusion 1718 participants, leaving 139 534 eligible for analyses. CER was determined multiplying concentration volume. Both be influenced age gender. To account potential influence, were gender-stratified split into individuals <60 years. Similarly, age- gender-adjusted levels. Subsequently, performed multivariable logistic regression investigate quartiles risk being lowest quartile CER, upper reference. Adjustments age, gender, estimated glomerular filtration (eGFR; calculated Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation, body surface area (BSA; using Dubois' formula), smoking, daily alcohol consumption number medications per group (<60 years). Information smoking collected from self-administered questionnaires.9, 10 We repeated analyses males females separately. As sensitivity analysis, adjusted high-sensitivity C-reactive protein (hs-CRP; n 53 858 participants; years 6709 participants). A P value ≤0·05 considered significant all included mean (± SD) 44·5 ± 12·8 81 341 (58·3%) females. Mean BSA 2·1 0·2 m2 1·8 females, eGFR 96·7 15·1 ml/min/1·73 m2. Twenty-one cent smoked currently, 11% consumed basis, median 1 (interquartile range 0–2). Baseline demographics characteristics according shown Table I. Across noted increase CER. The present both years) gender groups (Table I). In subsequent identified (≥60 years), contrast years, within had an increased having gender-specific [odds ratio (OR), 1·20, 95% CI 1·09–1·33; < 0·001; Fig 1], independent confounders. same pattern when subdividing but not (OR, 1·23; 1·06–1·44; 0·008 males, OR, 1·17, 1·03–1·33; 0·016 1). Sensitivity analysis subset did materially alter overall OR 1·18 (95% 1·00–1·40; 0·05) concentrations. show lower mass emphasises importance adequate respect mass. Our results keeping Cesari et al., showing cross-sectional fashion 909 decreased density assessed peripheral calf quantitative computer tomography.6 mechanism, hypothesise link could explained poor oxygenation, or atrophy due disuse caused fatigue.6, 7, 11 Another mechanism underlying inflammation. remained adjustment hs-CRP, became slightly attenuated, might smaller sample size analysis. factor played role basal metabolism, possibly related hormonal factors, such androgens, which contribute reduced mass.12, 13 Strengths our it shows first unprecedented large cohort, utilises established method determining mass.14 limitation residual confounding cannot despite multiple conclusion, Future will need whether maintaining at higher prevents decrease individuals. Biobank initiative made possible subsidy Dutch Ministry Health, Welfare Sport, Economic Affairs, University Medical Center Groningen (UMCG Netherlands), Northern Provinces Netherlands. authors wish acknowledge services Cohort Study, contributing research centers delivering Lifelines, participants. declare no conflicts interest. HJCMW, SJLB MFE contributed design. HJCMW statistical SPS, MMvdK, interpretation wrote draft edited paper. provided mentorship. All read approved final manuscript.