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The association between low calf circumference and mortality: a systematic review and meta-analysis

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A Letter to the Editor to this article was published on 19 April 2022

Key summary points

AbstractSection Aim

The aim of this systematic review was to quantify the association between low calf circumference and mortality.

AbstractSection Findings

Low calf circumference (CC) was associated with a higher risk of mortality than normal calf circumference, with a pooled HR of 2.42 (95% CI 1.97–2.97, I2 = 74.3.0%). In addition, this association between low calf circumference and morality was still statistically significant in the subgroup analysis across different settings, including hospitals, nursing homes and communities.

AbstractSection Message

Calf circumference, which is simple and convenient to measure, could be used to stratify the high-risk groups, as low calf circumference was significantly associated with mortality among patients.

Abstract

Purpose

Low calf circumference is an important indicator of malnutrition and has been widely studied, especially among older adults. However, data on the association between low calf circumference and mortality have been inconsistent. This systematic review was aimed to quantify this association.

Methods

The internet databases (PubMed, Embase, ScienceDirect and Cochrane Library databases) were systematically searched from inception to November 01, 2021 for studies investigating the association between low calf circumference and mortality. A random effects model was adopted to pool the relevant data.

Results

Low calf circumference was associated with a higher risk of mortality than normal calf circumference, with a pooled HR of 2.42 (95% CI 1.97–2.97, I2 = 74.3%). In addition, this association between low calf circumference and morality was still statistically significant in the subgroup analysis across different settings, including hospitals (pooled HR = 2.63, 95% CI 1.93–3.58), nursing homes (pooled HR = 2.49, 95% CI 1.76–3.54), and communities (pooled HR = 2.22, 95% CI 1.60–3.07). Other subgroup analyses based on different cutoffs of calf circumference showed that, compared to individual with normal calf circumference, participants with low calf circumference had an increased risk of mortality (pooled HR = 2.66, 95% CI 2.06–3.43) when using the Asian Working Group for Sarcopenia (AWGS) criterion (≤ 34 cm for males and ≤ 33 cm for females). Similar results were found when the Mini Nutritional Assessment (MNA) criterion (≤ 31 cm) was used, with a pooled HR of 2.11 (95% CI 1.59–2.81).

Conclusion

Calf circumference, which is simple and convenient to measure, could be used to stratify the high-risk group, as low calf circumference was significantly associated with mortality among patients. Interventions, including exercise and nutrition programs, could be conducted promptly once low calf circumference is detected.

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Availability of data and materials

The data sets generated and/or analyzed during the current study are available in the PubMed database.

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Acknowledgements

The authors thank the staff of Peking Union Medical College and People's Hospital of Baoan, Shenzhen, for their guidance and support.

Funding

This work was not supported by any funding.

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Authors and Affiliations

  1. Department of Emergency, The Affiliated Baoan Hospital of Southern Medical University, People’s Hospital of Baoan Shenzhen, Shenzhen, China

    Jian Wei, Chun-Lan Chen, Wu-yuan Tao, Yuan-Jiang Ying & Wen-Wu Zhang

  2. Department of Nursing, Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital (Dongdan Campus), Bei**g, 100730, China

    **g Jiao, **n-Juan Wu & **ao-Ming Zhang

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Contributions

XJW, XMZ and WWZ were responsible for the concept and design. JW and XMZ helped design the study and wrote the initial manuscript. JJ and CLC collected data. Screening and selecting the articles were conducted by WYT and YJY. XMZ and JW extracted all of the raw data and finished the assessment of the quality of bias. All authors read and approved the manuscript.

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Correspondence to Wen-Wu Zhang, **n-Juan Wu or **ao-Ming Zhang.

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Wei, J., Jiao, J., Chen, CL. et al. The association between low calf circumference and mortality: a systematic review and meta-analysis. Eur Geriatr Med 13, 597–609 (2022). https://doi.org/10.1007/s41999-021-00603-3

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