小腿围与全因死亡率：基于趋势估计方法的系统评价和荟萃分析。

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

机构信息

Lu Yin, Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing 102300, China. E-mail:

出版信息

J Nutr Health Aging. 2022;26(9):826-838. doi: 10.1007/s12603-022-1838-0.

DOI:10.1007/s12603-022-1838-0

PMID:36156674

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.

摘要

目的

通过合并基于经验二分法 CC、连续 CC 和剂量反应 CC 的各种分析，对成人（18 岁及以上）的总死亡率与小腿围（CC）进行系统评价和荟萃分析，并定量评估两者之间的相关性。

方法

我们在 PubMed、EMBASE、Cochrane 图书馆和 Web of Science 中检索了截至 2022 年 4 月 12 日发表的相关研究。本系统评价包括报告总死亡率与 CC 关系的纵向观察性研究。我们计算了每一项研究中 CC 每增加 1cm 时总死亡率的合并相对风险（RR）和 95%置信区间（CI），并采用标准荟萃分析方法对这些数值进行合并。对荟萃分析采用了 Newcastle-Ottawa 量表（NOS）、推荐评估、制定与评估分级方法（GRADE）和效果修饰分析可信度评估工具（ICEMAN）进行评估。

结果

我们的分析共纳入了 37 项队列研究，涉及 62736 名参与者，观察到中等程度的异质性（I2=75.7%，P<0.001），但未发现发表偏倚。研究质量评分范围为 6 至 9 分（平均 7.7 分），仅有 3 项研究得分为 6 分（质量中等）。我们观察到总死亡风险与 CC 每增加 1cm 呈负相关（RR，0.95；95%CI，0.94-0.96；P<0.001；GRADE 质量=高）。仅在养老院居民（CC 每增加 1cm，死亡率风险降低 6.9%）、社区居民（5.4%）和住院患者（4.8%）中观察到略有差异（meta 回归 P 值=0.617）。根据 ICEMAN 工具，发现了可信亚组差异较小。