Habitual creatine intake is associated with greater lean body mass and handgrip strength in the U.S. general population

Abstract

Background

Creatine is a nitrogen-containing conditionally essential nutrient obtained primarily from animal-based foods and has been widely studied for its ergogenic benefits when used in combination with resistance training. However, its independent association with musculoskeletal health markers in the general population remains underexplored.

Objective

To examine the relationship between habitual dietary creatine intake and indicators of muscle mass and strength in a large, nationally representative sample of the U.S. population.

Methods

We analyzed data from 108,403 participants across the NHANES 1999–2023 cycles. Dietary creatine intake was estimated using 24-h dietary recalls. Total lean body mass (excluding bone mineral content) was available for 43,042 individuals, and combined grip strength data were available for 13,612 individuals. Multivariable linear regression models were used to examine associations between creatine intake and musculoskeletal health outcomes, adjusting for dietary, demographic, hormonal, and physical activity-related confounders.

Results

Higher dietary creatine intake was significantly associated with greater total lean body mass and handgrip strength (P < 0.01). Participants in the highest quartile of habitual creatine intake exhibited the most favorable musculoskeletal profiles. Each additional gram of dietary creatine intake was associated with a 2.66 kg increase in lean body mass and a 5.24 kg increase in handgrip strength. Moderate correlations were also observed between creatine intake and other body composition parameters, including bone mineral content and total body fat percentage.

Conclusions

Our study suggests that higher dietary creatine intake is associated with favorable musculoskeletal outcomes, even after adjustment for physical activity, within a cross-sectional framework. These findings point to dietary creatine as a factor of interest in relation to musculoskeletal health, meriting further study. Further longitudinal and mechanistic research is needed to establish causality and better understand the underlying biological pathways.