Key notes
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Our findings indicate a lower percentage of fat-free/lean body mass in participants with insulin resistance/glucose tolerance/metabolic syndrome, while higher values were found when expressed in kg.
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The heterogeneity between the studies, should be considered when analyzing the results.
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The evidence on the impact of lean mass on glucose homeostasis in children is limited.
Background
Methods
Data sources and search strategy
Inclusion criteria
Exclusion criteria
Search results
Data extraction
Outcome assessment
Quality assessment
Statistical analysis
Results
Characteristics of the included studies
Participants sample size, country, and age
Maturation stage
FFM/LBM measurement techniques
Reference | Study design | Population n (♀;♂) | Age | Country | Study period | Method to assess maturation stage | Method to assess body composition | Metabolic variables | IR criteria | Body composition outcome by IR | Association: body composition– IR | Secondary outcomes | |
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Non IR mean ± SD | IR mean ± SD | ||||||||||||
Burrows et al. [30] | CS | 667 adolescents (♀ 47.8%; ♂ 52.2%) | 16.8 ± 0.3 | Chile | NA | NA | DXA | Fasting glucose; TG; HDL-C; WC; BP; adiponectin; hs-CRP. | HOMA-IR | (n = 558) | (n = 109) | Adolescents with IR had significantly lower (p < 0.001) mean values of LM (%). | Independently significant association between IR and sarcopenia (OR: 4.9; 95% CI: 3.2–7.5) |
LM (%) 68.7 ± 11.4 | LM (%) 62.0 ± 9.4 | ||||||||||||
Sanches et al. [29] | CT | 66 post-pubertal adolescents with obesity. | 16.8 ± 1.6 | Brazil | Tanner V 100% | Tanner stages | Air-displacement plethysmography (BOD-POD) | LDL-C; HDL-C; VLDL; HOMA-IR; QUICKI; MBP; leptin; adiponectin; Leptin/Adiponectin ratio and resistin. | HOMA-IR; QUICKI | (n = 27) | (n = 39) | No significant difference between groups with IR and non-IR. | |
LBM (%) 52.62 ± 5.77 | LBM (%) 52.42 ± 5.34 | ||||||||||||
Rodríguez-Rodríguez et al. [28] | CS | 443 schoolchildren (♀ 44.4%; ♂ 55.5%) | 10 (9–11) | Spain | NA | NA | Anthropometric measurements (equation of Parizkova for body fat (%)) | Fasting glucose; TG; HDL-C; WC; BP; adiponectin determinations; hs-CRP. | HOMA | (n = 427) (♀ 238; ♂ 189) | (n = 16) (♀ 8; ♂ 8) | Adolescents with IR had significantly lower (p < 0.01) mean values of FFBM (%) and significantly differences with respect to sex (p < 0.05) | |
FFBM (%) ♀ 77.8 (72.1–82.7) ♂ 79.8 (74.2–85.4) Total 78.5 (73.0–83.8) | FFBM (%) ♀69.5 (67.4–74.0) ♂ 72.9 (69.6–81.9) Total 70.6 (68.2–75.8) |
Reference | Study design | Population n (♀; ♂) | Age | Country | Study period | Method to assess maturation stage | Method to assess body composition | Metabolic variables | GT criteria | Body composition outcome by GT. | Association: body composition– GT | Secondary outcomes | |
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NGT Mean ± SD | IGT Mean ± SD | ||||||||||||
Kim, et al. [25] | CS | 205 adolescents (♀ 66%; ♂ 34%) | 14.6 ± 0.2 | USA | NA | Tanner scale IV 30% (n = 61); V 70% (n = 115) | DXA | Glucose; HOMA-IR; insulin; free fatty acids; HbA1c; lipid profile; leptin and adiponectin. | HbA1c and/or a 2-h oral glucose tolerance test (OGTT) | (n = 138) | (n = 38) | FFM was progressively and significantly higher from normal weight to obese and from NGT to IGT (p < 0.0001) | |
Normal weight (n = 49) Tanner IV (55% n = 27); V (45% (n = 22) FFM (kg) 41.3 ± 1.2 | Obese (n = 38) Tanner IV (21% n = 8); V (79% n = 30) FFM (kg) 51.4 ± 1.7 | ||||||||||||
Obese (n = 89) Tanner IV (29% n = 26); V (71% n = 63) FFM (kg) 49.2 ± 1.0 | |||||||||||||
Goran et al. [99] | CS | 150 children and adolescents (♀ 43.3% ♂ 56.7%) | 11.0 ± 1.7 | USA | NA | Tanner stages I (36% n = 54) II (33.3% n = %50) III (8.6% n = 13) IV (12% n = 18) V (9.3% n = 14) | DXA | Fasting glucose; 2-h oral glucose tolerance test; fasting insulin | 2-h oral glucose tolerance test (OGTT) | (n = 87) | (n = 35) | No significant difference between groups with NGT and IGT | |
LBM (kg) 35.9 ± 10.3 | LBM (kg) 36.3 ± 10.0 | ||||||||||||
Weiss et al. [31] | CS | 28 children and adolescents with obesity (♀ 57.1; ♂ 42.8) | 13.5 ± 2.1 | USA | NA | Tanner stages. PrepubertaTanner (28.6% n = 8); pubertal (71.4% n = 20). | DXA | Fasting glucose; 2 h glucose; fasting insulin; fasting C-peptide; leptin; adiponectin; HbA1c; plasma fatty acids; glycerol; glycerol turnover, and lipid oxidation rates. | Euglycaemic hyperinsulinaemic clamp and the hyperglycaemic clamp. | (n = 14) (♀ 6; ♂ 8) | (n = 14) (♀ 6; ♂ 8) | No significant difference between groups with IGT and NGT | |
LBM (kg) 55.9 ± 9.4 | LBM (kg) 53.2 ± 15.2 |
Reference | Study design | Population n (♀; ♂) | Age | Country | Study period | Method to assess maturation stage | Method to assess body composition | Metabolic variables | MetS criteria | Body composition outcome by MetS | Association: body composition– MetS | Secondary outcomes | |
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No MetS mean ± SD | MetS mean ± SD | ||||||||||||
Khammassi et [42]. | CT | 92 adolescents with obesity | 12-25 | France | NA | Tanner stages 3-4 | DXA | Glucose, insulin, TG, TC, HDL-c, LDL-c, HOMA-IR, WC and BP. | Based by Chen et al. | (n = 44) FFM (kg) 48.52 ± 7.24 | (n = 40) FFM (kg) 55.49 ± 7.34 | FFM was significantly higher in the MetS group p < 0.001. | |
Behrooz et al. [100] | CS | 90 children and adolescents (♀ 51.1% ♂;48.9%) | 10-18 | Iran | 2019 | Tanner stages. | BIA | fasting glucose, insulin, lipid profile, spexin, high-sensitivity C-reactive protein (hs-CRP) and HOMA-IR | Based by Cook et al. | (n = 76) | (n = 14) | No significant difference between groups with MetS and non-MetS. | |
Muscle mass(kg) 40.45 ± 15.06 | Muscle mass(kg) 52.90 ± 13.52 | ||||||||||||
Gonzalez-Gil et al. [24] | CS | 46 normal weight, 40 obese, and 40 MetS children (♀ 51.6%; ♂ 48.4%) | 6-12 | Mexico | NA | NA | BIA and anthropometric measurements | BP, irisin, leptin, adiponectin, adipsin, resistin, TG, fasting glucose, HDL-c) levels, and WC. | Based by Cook et al. | (n = 86) | (n = 40) | Muscle mass, FFM was significantly higher in the obese and MetS groups compared to control group (normal weight) | Lean-fat ration (muscle mass (kg)/fat mass (kg)) was significantly lower in the obese 0.433 (0.380–0.627) and the MetS group 0.447 (0.345–.610) compared with the normal weight group 1.68 (1.25–2.01) Negative correlations between plasma irisin concentration and FFM (rs = − 0.257) were found. The noteworthy, lean-fat ratio was found to have a positive correlation with irisin (0.489; p < 0.001). Leptin was found to be positively correlated with, FFM (rs = 0.329) and negative correlation with lean-fat ratio (rs = − 0.376). |
Normal weight (n = 46) FFM (kg) 23.05 (20.3–26.8) Muscle mass (kg) 6.43 (5.4–7.9) | Obese (n = 40) FFM (kg) 29.06 (24.4–32.8) Muscle mass (kg) 7.58 (6.5–9.0) | ||||||||||||
Obese (n = 40) FFM (kg) 27.22 (23.9–31.4) Muscle mass (kg) 6.56 (5.8–7.5) | |||||||||||||
Masquio et al. [27] | CT | 108 postpuberty obese adolescents | 15-19 | Brazil | 2004 | Tanner scale. Postpuberty Tanner ≥V 100% | Air- Displacement plethysmography BOD-POD | Glucose, insulin, TG, TC, HDL-c, LDL-c, leptin, adiponectin, PAI-1, CRP, ICAM-1, VCAM-1, (L/A ratio), (A/L ratio), HOMA-IR, QUICKI, WC, BP. | International Diabetes Federation criteria | (n = 76) | (n = 32) | MetS group presented significantly higher FFM (kg) p < 0.05. | |
FFM (%) 54.87 ± 7.02 | FFM (%) 54.60 ± 6.31 | ||||||||||||
FFM (kg) 54.62 ± 9.48 | FFM (kg) 59.97 ± 8.28 | ||||||||||||
Weber et al. [26] | CS | 3004 (♀ 44%; ♂ 56%) | 16.1 ± 2.5 | USA | 1999-2006 | NA | DXA | Fasting glucose; insulin; TG; HDL-C; WC; BP. | International Diabetes Federation criteria | (n = 2835) | (n = 169 ♀ 5.1%; ♂ 6.8%) | Participants with MetS had significantly greater LBMI compared with participants No MetS (p < 0.0001). | LBMI-Z was significantly associated with a greater odds of low HDL-C(1.5; 95% CI 1.2–1.9), elevated BP (1.8; 95% CI: 1.1–2.9), high WC (3.7; 95% CI: 2.4 –5.9), and elevated fasting insulin (1.8; 95% CI 1.4 –2.5), independent of FMI-Z. |
LBMI-Z −0.07 ± 0.96 | LBMI-Z 1.09 ± 0.92 | ||||||||||||
Ayvaz et al. [119] | CS | 32 normal weight and 32 children with obesity (♀ 35.9%; ♂ 64.0%) | 13.6 ± 2.1 | Turkey | 2007 | NA | BIA | Fasting glucose; TG; HDL-C; WC; BP; creatinine; uric acid; total protein; albumin; SGOT; SGPT; serum lipids; C-reactive protein; fibrinogen; fasting insulin level; TSH and HOMA-IR. | Ianuzzi | (n = 17 obese children) | (n = 15 obese children) | Obese children with MetS had significantly lower (p < 0.05) mean values of FFM index. No significant difference of FFM and FFM% between the groups with MetS and No MetS. | |
FFM (kg) 42.65 ± 9.38 | FFM (kg) 49.24 ± 13.17 | ||||||||||||
FFM (%) 0.69 ± 0.05 | FFM (%) 0.67 ± 0.07 | ||||||||||||
FFMI (kg/m2)
19.63 ± 2.18 | FFMI (kg/m2)
18.14 ± 1.82 | ||||||||||||
Brufani et al. [33] | CS | 439 children and adolescents with obesity (♀ 51.5%; ♂ 48.5%) | 5.2–17.9 | Italy | 2003-2010 | Tanner stages. PrepubertaTanner stage I (45.8% n = 201); pubertal Tanner stage II-V (54.2% n = 238). | DXA | Glucose; insulin; C peptide; HDL-C; TC; TG; ISI; OGTT; DI; BP. | Based on the National Cholesterol Education Program | (n = 177) | (n = 24) | No significant difference of LBMI between the groups with MetS and No MetS. | LBMI to be positively associated with MetS (p = 0.004) |
Prepubertal LBMI (kg/m2) 15.2 ± 1.5 | Prepubertal LBMI (kg/m2) 15.7 ± 1.5 | ||||||||||||
(n = 187) | (n = 51) | ||||||||||||
Pubertal LBMI (kg/m2) 17.6 ± 2.4 | Pubertal LBMI (kg/m2) 18.2 ± 2.7 | ||||||||||||
Hsu et al. [34] | CS | 105 (♀ 75%; ♂ 25%) | 13 ± 3 | USA | 2009 | Tanner stages I (18.1% n = 19) II (19.0% n = 20) III (3.8% n = 4) IV (17.1% n = 18) V (41.9% n = 44) | Air- Displacement plethysmography BOD-POD | Fasting glucose; HDL-C; TG; BP and WC. | Based on Cruz et al. and Cook et al. | (n = 88) Tanner I (21.6% n = 19); II (19.3% n = 17); III (2.3% n = 2); IV (13.6% n = 12); V (43.2% n = 38) | (n = 17) Tanner I (0% n = 0); II (17.6% n = 3); III (11.8% n = 2); IV (35.3% n = 8); V (35.3% n = 8) | Participants with MetS had greater total lean tissue mass (p = 0.02) and lower percent lean tissue mass (p = 0.002) | |
Total lean tissue mass (kg) 45.96 ± 16.25 | Total lean tissue mass (kg) 56.03 ± 14.02 | ||||||||||||
Lean tissue mass (%) 67.79 ± 10.97 | Lean tissue mass (%) 58.79 ± 8.71 | ||||||||||||
Brufani et al. [32] | LS | 55 prepubertal children with obesity (♀ 36,3%; ♂ 63.6%) | 9.6 ± 1.3 | Italy | 2004-2006 | Marshall and Tanner I (100% n = 55) | DXA | Fasting glucose; insulin; TG; HDL-C; BP; HOMA-IR; QUICKI; ISI | Weiss et al. | (n = 37) Tanner I (100% n = 37) | (n = 8) Tanner I (100% n = 8) | No significant difference between groups with MetS and No MetS. | |
FFM (%) 56.3 ± 3.1 | FFM (%) 55.8 ± 4.3 | ||||||||||||
FFM (kg) 31.4 ± 6.5 | FFM (kg) 30.8 ± 5.0 |