title: Association between low muscle mass, functional limitations and hospitalisation in heart failure: NHANES 1999-2004.
abstract: OBJECTIVE
  Muscle mass decreases with age, and heart failure (HF) patients may experience greater reductions due to pathophysiological processes associated with this disease. Reduced muscle mass may predispose HF patients to functional limitations and increased morbidity and mortality. This study estimated the associations between HF, low muscle mass (LMM), functional limitations and hospitalisation, as well as the combined effect of HF and LMM on these outcomes in a nationally representative sample.
  
  
  METHODS
  A cross-sectional survey.
  
  
  METHODS
  the National Health and Nutrition Examination Survey 1999-2004.
  
  
  METHODS
  A total of 402 HF (weighted 3,994,205) and 7,061 non-HF participants (weighted 91,058,850), ≥45 years with dual-energy X-ray absorptiometry measurements.
  
  
  METHODS
  the 20th percentile of the sex-specific distribution of lean appendicular mass residuals from linear regression with height and fat mass as predictors, served as the LMM cut-point. Logistic regression provided adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association of HF and LMM with functional limitations and hospitalisation.
  
  
  RESULTS
  There were statistically significant adjusted associations between HF and limitations in household chores, walking one-fourth of a mile and hospitalisation (OR (95% CI): 2.5 (1.7 -3.8), 1.9 (1.2 -3.0) and 1.6 (1.1 -2.4), respectively). LMM was significantly associated with limitations in household chores and walking one-fourth of a mile (OR (95% CI): 1.5 (1.2, 1.9) and 1.4 (1.2, 1.7), respectively). Interaction between HF and LMM was noted for the associations with functional limitations.
  
  
  CONCLUSIONS
  This hypothesis-generating study found a synergistic interaction between HF and LMM; the presence of LMM increased the negative effects of HF. HF patients may experience increased disease burden due to LMM.
authors.affiliation: World Wide Epidemiology, GlaxoSmithKline, Collegeville, PA 19426, USA.
authors.forename: Julia R
authors.initials: JR
authors.lastname: DiBello
authors.affiliation: Clinical Development and Discovery Medicine, GlaxoSmithKline, Research Triangle Park, NC, USA.
authors.forename: Ram
authors.initials: R
authors.lastname: Miller
authors.affiliation: Value Evidence and Outcomes, GlaxoSmithKline, Collegeville, PA, USA.
authors.forename: Rezaul
authors.initials: R
authors.lastname: Khandker
authors.affiliation: World Wide Epidemiology, GlaxoSmithKline, Collegeville, PA 19426, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Bourgeois
authors.affiliation: World Wide Epidemiology, GlaxoSmithKline, London, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Galwey
authors.affiliation: Clinical Development and Discovery Medicine, GlaxoSmithKline, Research Triangle Park, NC, USA.
authors.forename: Richard V
authors.initials: RV
authors.lastname: Clark
mesh_terms: D015502:Absorptiometry, Photon; D000203:Activities of Daily Living; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology*; D009749:Nutrition Surveys; D063868:Patient Outcome Assessment; D015995:Prevalence
keywords: NHANES; functional impairment; heart failure; low muscle mass; older people; prevalence; skeletal muscle