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

Li, Xiang; Lang, Xiabing; Peng, Songguo; Ding, Lei; Li, S.; Li, Yini; Yin, Lu; Liu, Xiaomei

doi:10.1007/s12603-022-1838-0

Cited by 3 publications

(2 citation statements)

References 137 publications

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“…(3) a cohort study of 601 hospitalized patients observed that low calf circumference (<34 cm for men and <33 cm for women) was an independent predictor of in-hospital death and death at 6 months after discharge 22 ; (4) a cohort study involving 12,138 patients with cancer established that calf circumference values <32.8 cm for men and <30 cm for women were associated with higher mortality risk. 29 The review also excluded studies analyzing continuous calf circumference. 26 In this study, we found no association between calf circumference (with or without BMI adjustment) and ICU or in-hospital outcomes in critically ill patients, encompassing mortality and extended LOS.…”

Section: Resultsmentioning

confidence: 99%

“…Among the studies, 10 studies utilized the cutoff points for low calf circumference as applied in our sample, and only one considered BMI as a confounder in the analysis. However, their search strategy omitted four relevant studies: (1) a retrospective cross‐sectional study with 548 elderly hospitalized patients found an association between calf circumference <31 cm and higher mortality 27 ; (2) a cohort study with 120 hospitalized patients with hematologic malignancy showed no association between calf circumference <31 cm and higher mortality 28 ; (3) a cohort study of 601 hospitalized patients observed that low calf circumference (<34 cm for men and <33 cm for women) was an independent predictor of in‐hospital death and death at 6 months after discharge 22 ; (4) a cohort study involving 12,138 patients with cancer established that calf circumference values <32.8 cm for men and <30 cm for women were associated with higher mortality risk 29 . The review also excluded studies analyzing continuous calf circumference 26 …”

Section: Discussionmentioning

confidence: 99%

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Absence of association between low calf circumference, adjusted or not for adiposity, and ICU mortality in critically ill adults: A secondary analysis of a cohort study

Bernardes,

Stello,

Milanez

et al. 2024

J Parenter Enteral Nutr

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Background and AimDespite its correlation with skeletal muscle mass and its predictive value for adverse outcomes in clinical settings, calf circumference is a metric underexplored in intensive care. We aimed to determine whether adjusting low calf circumference for adiposity provides superior prognostic value for intensive care unit (ICU) mortality and other clinical outcomes in critically ill patients than its unadjusted measurement.MethodsIn a secondary analysis of a cohort study across five ICUs, we assessed critically ill patients within 24 hours of ICU admission. We adjusted calf circumference for body mass index (BMI) (25–29.9, 30–39.9, and ≥ 40 kg/m2) by subtracting it in 3, 7, or 12 cm, respectively. Values ≤ 34 cm for males and ≤ 33 cm for females identified low calf circumference.ResultsWe analyzed 325 patients. In the primary risk‐adjusted analysis, the ICU death risk was similar between the low and preserved calf circumference (BMI‐adjusted) groups (HR 0.90, 95% CI 0.47–1.73). Low calf circumference (unadjusted) increased the odds of ICU readmission 2.91 times (95% CI, 1.40–6.05). Every 1 cm increase in calf circumference as a continuous variable reduced ICU readmission odds by 12%. Calf circumference showed no significant association with other clinical outcomes.ConclusionsCalf circumference BMI‐adjusted did not exhibit independent associations with ICU and in‐hospital death, nor did ICU and in‐hospital LOS compared to its unadjusted measurement. However, low calf circumference (unadjusted and BMI‐adjusted) was independently associated with ICU readmission, mainly when analyzed as a continuous variable.This article is protected by copyright. All rights reserved.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Absence of association between low calf circumference, adjusted or not for adiposity, and ICU mortality in critically ill adults: A secondary analysis of a cohort study

Bernardes,

Stello,

Milanez

et al. 2024

J Parenter Enteral Nutr

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Is Calf Circumference Associated With Clinical and Nutritional Outcome in Older Patients?

MAZZINI,

AQUINO,

CAMARGO

et al. 2023

ABCD, arq. bras. cir. dig.

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BACKGROUND: Previous studies have shown a relationship between calf circumference (CC) and outcomes in hospitalized patients. AIMS: To investigate the relationship between CC and clinical and nutritional outcomes in older in-patients (OiP) in a surgery ward. METHODS: This was a cross-sectional study with 417 OiP in a surgery ward. Clinical variables, anthropometry, and nutritional screening instruments such as subjective global assessment (SGA), mini nutritional assessment (MNA), and nutritional risk screening (NRS) were used in the investigation. The tests Pearson’s chi-square, Mann-Whitney, Kruskal-Wallis, and Spearman’s coefficient, and multiple linear regression analyses were used to review the factors associated with CC. RESULTS: Lower CC values were found in the age group 80 years and over (p<0.0001), presence of complications (p=0.0269), NRS (p<0.0001), SGA (p<0.0001), and MNA (p<0.0001). Gender (p=0.0011; partial R2=0.01151), age (p=0.0002; partial R2=0.06032), body mass index (p≤0.0001; partial R2=0.40820), and arm circumference (p≤0.0001; partial R2=0.11890) are variables that together were associated with CC. There was also a relationship between SGA (p=0.0166; partial R2=0.00605) and absence of complications during hospitalization (p=0.0047; R2=0.01154) with CC. CONCLUSIONS: Gender, age, body mass index, and arm circumference were jointly associated with CC, in addition to SGA and absence of complications. The CC is a relevant indicator for OiP in the clinical practice.

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The association of central and extremity circumference with all-cause mortality and cardiovascular mortality: a cohort study

Liu,

Jin,

Feng

et al. 2023

Front. Cardiovasc. Med.

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BackgroundCentral obesity increases the risk of several diseases, including diabetes, cardiovascular disease (CVD), and cancer. However, the association between extremity obesity and mortality has not been extensively evaluated. The objective of this study was to investigate the quantitative effects of waist circumference (WC), arm circumference (AC), calf circumference (CC), and thigh circumference (TC) on all-cause mortality and CVD mortality.MethodsThe study used data from the National Health and Nutrition Examination Survey (NHANES) sample survey from 1999 to 2006. A total of 19,735 participants were included in the study. We divided the participants into four groups (Q1–Q4) and used Q1 as a reference to compare the risk of all-cause mortality and CVD mortality in Q2–Q4. COX proportional hazard regression model was used to analyze the relationship between WC, AC, CC and TC on all-cause and CVD mortality. In addition, we conducted a stratified analysis of gender.ResultsAfter a mean follow-up of 11.8 years, we observed a total of 3,446 deaths, of which 591 were due to cardiovascular disease. The results showed that for both men and women, compared to the first group, the risk of all-cause mortality was significantly higher in the other three groups of WC and significantly lower in the other three groups of AC, CC, and TC. Similar results were observed after adjusting for confounding factors such as demographics.ConclusionsOur results show that all-cause and CVD mortality are positively associated with measures of central obesity and negatively associated with measures of extremity obesity, and that AC, CC, and TC can be used as potential tools to measure prognosis in the general population.

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

Cited by 3 publications

References 137 publications

Absence of association between low calf circumference, adjusted or not for adiposity, and ICU mortality in critically ill adults: A secondary analysis of a cohort study

Absence of association between low calf circumference, adjusted or not for adiposity, and ICU mortality in critically ill adults: A secondary analysis of a cohort study

Is Calf Circumference Associated With Clinical and Nutritional Outcome in Older Patients?

The association of central and extremity circumference with all-cause mortality and cardiovascular mortality: a cohort study

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