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Global Associations of Calf Circumference with Total Mortality: A Systematic Review and Meta-Analysis
38 Pages Posted: 5 Jan 2021
More...Abstract
OBJECTIVE: To perform a systematic review and meta-analysis and quantify the associations of total mortality with calf circumference (CC) in adults aged 18 years or older.
DATA SOURCES: A systematic searching was conducted in PubMed, EMBASE, Cochrane Library, and Web of Science up to May 9, 2020.
STUDY SELECTION: Longitudinal observational studies reporting the relationships of total mortality with CC or corresponding Kaplan-Meier survival curves were included in this systematic review.DATA
SYNTHESIS: The pooled hazard ratio (HR) and 95% confidence interval (CI) of total mortality with both CC per 1 cm increase and CC in categorical pattern were assessed using standard meta-analysis approaches. Overall survival curves for high vs. low CC category were also pooled in Kaplan-Meier curves.
RESULTS: The final analyses consisted of sixteen cohort studies, involving in 29,554 participants, across which large heterogeneity was observed (I2 =87.3%, P<0.01). In categorical analyses, those with high CC had a lower risk of total mortality (HR, 0.49, 95% CI, 0.39-0.60; P <0.01), compared to those with low CC, and this significance was attenuated in adults aged <65 years old. In continuous analyses, however, marginal significance was observed for total death risk with CC per 1 cm increase (HR, 0.98, 95% CI, 0.96-1.00; P =0.08) after trim-and-fill method due to publication bias. The summary survival curves showed the mean survival time was 86.54 months (95% CI, 76.10-85.99) and 142.46 months (95% CI, 138.65-142.75) at low CC group and high CC group, respectively.
CONCLUSIONS: Despite large heterogeneity and publication bias, those with high CC had still longer life expectance, especially for elder adults, but more studies were needed to assess this association among those aged <65 years old.
Funding: This study was funded by the China government grants from ChineseAcademy of Medical Sciences Innovation Fund for Medical Sciences (CIFMS, 2016 I2M-2-004) and Construction of Basic Information Technology Support System and Platform for National Prevention and Treatment of Cardiovascular Diseases.
Conflicts of Interest: None.
Keywords: Calf circumference (CC); Mortality; Systematic review; Meta-analysis
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