Creatinine to cystatin C ratio, a biomarker of sarcopenia measures and falls risk in community-dwelling older women

Document Type

Journal Article

Publication Title

The journals of gerontology. Series A, Biological sciences and medical sciences





First Page


Last Page


PubMed ID



Oxford Academic


School of Medical and Health Sciences / Institute for Nutrition Research




National Health and Medical Research Council - grants: 254627, 303169, 572604 / NHMRC of Australia Emerging Leader (Level 2) Fellowship (ID: GNT1174886) / NHMRC of Australia Senior Research Fellowship (ID: 1116973) / National Heart Foundation of Australia Future Leader Fellowship (ID: 102817) / Healthway, Western Australian Health Promotion Foundation / Royal Perth Hospital Career Advancement Fellowship (ID: CAF 130/2020)

Grant Number

NHMRC Numbers : 254627, 303169, 572604, GNT1174886, 1116973

Grant Link

http://purl.org/au-research/grants/nhmrc/1116973 http://purl.org/au-research/grants/nhmrc/25462 http://purl.org/au-research/grants/nhmrc/303169 http://purl.org/au-research/grants/nhmrc/572604


Sim, M., Dalla Via, J., Scott, D., Lim, W. H., Hodgson, J. M., Zhu, K., ... & Lewis, J. R. (2022). Creatinine to cystatin C ratio, a biomarker of sarcopenia measures and falls risk in community-dwelling older women. The Journals of Gerontology: Series A, 77(7), 1389-1397. https://doi.org/10.1093/gerona/glab369


BACKGROUND: The ratio of creatinine to cystatin C (Cr:Cyc) has been proposed as a biomarker of sarcopenia, as greater Cr:Cyc is typically associated with greater muscle mass. We examined the relationship between Cr:Cyc with individual sarcopenia measures, 5-year self-reported falls, and 12-year fall-related hospitalizations in a prospective cohort study of 1 118 community-dwelling older women (mean age 75.2 ± 2.7 years). METHODS: Serum Cr:Cyc, hand grip strength, and timed-up-and-go performance were assessed at baseline (1998), while dual-energy x-ray absorptiometry-derived appendicular lean mass (ALM)/height2 (m) was obtained in a subset of women at baseline and 1 year (n = 334). Incident 5-year self-reported falls and 12-year falls-related hospitalizations were considered. RESULTS: In a multivariable-adjusted model, women with the lowest Cr:Cyc (Quartile [Q] 1) had 5% (1.0 kg) weaker grip strength, as well as 3.7% (0.22 kg/m2) and 5.5% (0.031) lower ALM adjusted for height2 or body mass index, respectively, compared to women in Q4 (all p < .05). 329 women reported an incident fall over 5 years, and 326 fall-related hospitalizations were recorded over 12 years. Women in Q1 of Cr:Cyc had a greater relative hazard for a fall over 5 years (hazard ratio [HR] 1.50; 95% confidence interval [CI] 1.11-2.01) and fall-related hospitalization over 12 years (HR 1.53; 95% CI 1.13-2.07) compared to Q4 in the multivariable-adjusted model. CONCLUSION: These findings support further investigation into the use of Cr:Cyc as a muscle biomarker to help clinicians identify individuals at risk of falls for early inclusion into evidence-based primary prevention programs targeting improvements to diet and exercise.



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