Attenuation of skeletal muscle and strength in the elderly: The Health ABCStudy

Although loss of muscle mass is considered a cause of diminished muscle str ength with aging, little is known regarding whether composition of aging mu scle affects strength. The skeletal muscle attenuation coefficient, as dete rmined by computed tomography, is a noninvasive measure of muscle density, and lower values reflect increased muscle lipid content. This investigation examined the hypothesis that lower values for muscle attenuation are assoc iated with lower voluntary isokinetic knee extensor strength at 60 degrees /s in 2,627 men and women aged 70-79 yr participating in baseline studies o f the Health ABC Study, a longitudinal study of health, aging, and body com position. Strength was higher in men than in women (132.3 +/- 34.5 vs. 81.4 +/- 22.0 N.m, P < 0.01). Men had greater muscle attenuation values (37.3 < plus/minus> 6.5 vs. 34.7 +/- 7.0 Hounsfield units) and muscle cross-section al area (CSA) at the midthigh than women (132.7 +/- 22.4 vs. 93.3 +/- 17.5 cm(2), P < 0.01 for both). The strength per muscle CSA (specific force) was also higher in men (1.00 <plus/minus> 0.21 vs. 0.88 +/- 0.21 N.m.cm(-2)). The attenuation coefficient was significantly lower for hamstrings than for quadriceps (28.7 +/- 8.7 vs. 41.1 +/- 6.9 Hounsfield units, P < 0.01). Mid thigh muscle attenuation values were lowest (P < 0.01) in the eldest men an d women and were negatively associated with total body fat (r = -0.53, P < 0.01). Higher muscle attenuation values were also associated with greater s pecific force production (r = 0.26, P < 0.01). Multivariate regression anal ysis revealed that the attenuation coefficient of muscle was independently associated with muscle strength after adjustment for muscle CSA and midthig h adipose tissue in men and women. These results demonstrate that the atten uation values of muscle on computed tomography in older persons can account for differences in muscle strength not attributed to muscle quantity.