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Calf Circumference and All-Cause Mortality: A Systematic Review and Meta-Analysis Based on Trend Estimation Approaches

  • Original Research
  • Published:
The journal of nutrition, health & aging

Abstract

Objectives

To perform a systematic review and meta-analysis and quantify the associations of total mortality with calf circumference (CC) in adults 18 years and older via combining various analyses based on empirical dichotomic CC, continuous CC, and dose-response CC.

Methods

We conducted a systematic search of relevant studies in PubMed, EMBASE, Cochrane Library, and Web of Science published through April 12, 2022. This systematic review includes longitudinal observational studies reporting the relationships of total mortality with CC. We calculated the pooled relative risk (RR) and 95% confidence interval (CI) of total mortality with CC per 1 cm for each study and combined the values using standard meta-analysis approaches. Newcastle-Ottawa scale (NOS), Grading of Recommendations, Assessment, Development and Evaluations approach (GRADE), and the Instrument for assessing the Credibility of Effect Modification Analyses (ICEMAN) were assessed for meta-analyses.

Results

Our analysis included a total of 37 cohort studies involving 62,736 participants, across which moderate heterogeneity was observed (I2=75.7%, P<0.001), but no publication bias was found. Study quality scores ranged from 6 to 9 (mean 7.7), with only three studies awarded a score of 6 (fair quality). We observed an inverse trend between total death risk and CC per 1 cm increase (RR, 0.95, 95% CI, 0.94–0.96; P<0.001; GRADE quality=high). Only a very slight difference was found among residents of nursing homes (6.9% mortality risk reduction per one cm CC increase), community-dwellers (5.4%), and those living in hospitals (4.8%), respectively (P for meta-regression=0.617). Low credible subgroup difference was found based on the ICEMAN tool.

Conclusions

Calf circumference is a valid anthropometric measure for mortality risk prediction in a community, nursing home, or hospital.

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  1. These authors contributed equally to this work.

Authors and Affiliations

  1. Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Fuwai Hospital, Beijing, China, 102300

    X. Li, X. Lang, L. Ding, S. Li & Lu Yin

  2. University of Minnesota, Minneapolis, MN, USA

    S. Peng

  3. Department of Health Management, The Third Xiangya Hospital, Central South University, Changsha, China

    Y. Li

  4. Department of Emergency, Zhongshan Hospital of Xiamen University, Xiamen, China

    Xiaomei Liu

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Li, X., Lang, X., Peng, S. et al. Calf Circumference and All-Cause Mortality: A Systematic Review and Meta-Analysis Based on Trend Estimation Approaches. J Nutr Health Aging 26, 826–838 (2022). https://doi.org/10.1007/s12603-022-1838-0

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