Lower appendicular lean mass identifies a skeletal muscle phenotype of heart failure in U.S. adults
L Alrubaye, S A Alkoutami, S A Alkoutami, H A Alkarawi, H A Alkarawi, J Peltz, J Peltz, A Abdelwahed, A Abdelwahed, S Sarfraz, S Sarfraz, H Alrubaye, H Alrubaye, S R Yalamanchili, S R Yalamanchili, R Peesapati, L A AbdullahAbstract
Background
Heart failure (HF) is characterized by impaired functional capacity and skeletal muscle abnormalities, yet population-based data using objective measures of muscle mass are limited. Dual-energy X-ray absorptiometry (DXA) enables precise assessment of appendicular lean mass (ALM), a key marker of sarcopenia and frailty. We examined the association between DXA-derived lean mass and prevalent HF in a nationally representative cohort.
Methods
We analyzed adults aged ≥20 years from the 2005–2006 National Health and Nutrition Examination Survey with available whole-body DXA data. Appendicular lean mass was calculated as the sum of arm and leg lean mass and indexed to height squared (ALM/height²). Participants were categorized into sex-combined quartiles of ALM/height², with the highest quartile as reference. Heart failure was defined by self-reported physician diagnosis. Survey-weighted logistic regression assessed the association between lean mass and prevalent HF, adjusting for age, sex, race/ethnicity, and body mass index. Sensitivity analyses included binary DXA-defined sarcopenia and continuous lean mass measures.
Results
Among participants with valid DXA measurements, lower appendicular lean mass was associated with higher odds of prevalent HF. Compared with the highest ALM/height² quartile, individuals in the lowest quartile had more than two-fold higher odds of HF (adjusted OR 2.38, 95% CI 0.64–8.88), with a graded increase in odds across decreasing quartiles. DXA-defined sarcopenia was associated with higher odds of prevalent heart failure (adjusted OR 1.81, 95% CI 0.93–3.51).. Associations were directionally consistent when lean mass was analyzed as a continuous standardized variable.
Conclusions
Lower DXA-derived appendicular lean mass is associated with a higher prevalence of heart failure in U.S. adults. These findings support a skeletal muscle–related heart failure phenotype and highlight the importance of objective body composition assessment in population-based HF research.For image description, please refer to the figure legend and surrounding text.