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Estimation of skeletal muscle mass in 4-year-old children using the D3-creatine dilution method
Aysha Sidiqi1,2, Farzana Fariha3, Shaila S Shanta3
1Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada.
Insights
The creatine-(methyl-D3) dilution method is feasible for measuring skeletal muscle mass in young children in community settings. However, further optimization is needed due to high variability in results.
Area of Science:
- Pediatric Nutrition and Body Composition Analysis
- Stable Isotope Dilution Techniques in Human Physiology
Background:
- Limited data exists on applying the creatine-(methyl-D3) (D3Cr) dilution method for skeletal muscle mass (SMM) assessment in young children.
- This study evaluated the feasibility and performance of the D3Cr method in a field setting with 4-year-old children in Bangladesh.
Purpose of the Study:
- To assess the feasibility of deploying the D3Cr dilution method for SMM measurement in young children in a community setting.
- To evaluate the performance and precision of the D3Cr method for SMM estimation in this population.
Main Methods:
- Administered an oral dose of D3Cr (10 mg) to 100 children and collected single fasting urine samples.
- Analyzed urinary creatine, creatinine, D3Cr, and D3-creatinine enrichment using liquid chromatography-tandem mass spectrometry.
- Compared SMM estimates with appendicular lean mass (ALM) from dual-energy x-ray absorptiometry and grip strength measurements.
Main Results:
- SMM was successfully measured in 91% of participants with no adverse events.
- Mean SMM was significantly greater than ALM (4.5 vs. 3.2 kg).
- Precision of SMM measurements was low (intraclass correlation = 0.20), and grip strength was not associated with SMM.
Conclusions:
- The D3Cr dilution method is feasible for community-based SMM estimation in young children.
- High within-child variability in SMM estimates necessitates further refinement of the D3Cr method before widespread research implementation.
Background:
Given limited experience in applying the creatine-(methyl-D3) (D3Cr) dilution method to measure skeletal muscle mass (SMM) in young children, the feasibility of deployment in a fielding setting and performance of the method was assessed in a cohort of 4-year-old children in Dhaka, Bangladesh.
Methods:
Following D3Cr oral dose (10 mg) administration, single fasting urine samples were collected at 2-4 days (n = 100). Twenty-four-hour post-dose collections and serial spot urine samples on days 2, 3 and 4 were obtained in a subset of participants (n = 10). Urinary creatine, creatinine, D3Cr and D3-creatinine enrichment were analyzed by liquid chromatography-tandem mass spectrometry. Appendicular lean mass (ALM) was measured by dual-energy x-ray absorptiometry and grip strength was measured by a hand-held dynamometer.
Results:
SMM was measured successfully in 91% of participants, and there were no adverse events. Mean ± SD SMM was greater than ALM (4.5 ± 0.4 and 3.2 ± 0.6 kg, respectively). Precision of SMM was low (intraclass correlation = 0.20; 95% CI: 0.02, 0.75; n = 10). Grip strength was not associated with SMM in multivariable analysis (0.004 kg per 100 g of SMM; 95% CI: -0.031, 0.038; n = 91).
Conclusions:
The D3Cr dilution method was feasible in a community setting. However, high within-child variability in SMM estimates suggests the need for further optimization of this approach.
Impact:
The D3-creatine (D3Cr) stable isotope dilution method was considered a feasible method for the estimation of skeletal muscle mass (SMM) in young children in a community setting and was well accepted among participants. SMM was weakly associated with both dual-energy x-ray absorptiometry-derived values of appendicular lean mass and grip strength. High within-child variability in estimated values of SMM suggests that further optimization of the D3Cr stable isotope dilution method is required prior to implementation in community research settings.
