The effect of different measurement modalities in the association of lean mass with mortality: A systematic review and meta-analysis

Gloria Hoi-Yee Li, Grace Koon-Yee Lee, Philip Chun-Ming Au, Marcus Chan, Hang-Long Li, Bernard Man-Yung Cheung, Ian Chi-Kei Wong, Victor Ho-Fun Lee, James Mok, Benjamin Hon-Kei Yip, Kenneth King-Yip Cheng, Chih-Hsing Wu, Ching-Lung Cheung

Research output: Journal article publicationJournal articleAcademic researchpeer-review


Lean mass is commonly measured by 3 modalities, dual energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), and computerized tomography (CT). CT is considered the most accurate, while lean mass measured by DXA and BIA often consists of non-muscle compartment, and hence considered less accurate when compared with CT. It remains unclear if the association of lean mass with mortality would differ using different measurement modalities. A systematic review and meta-analysis of lean mass and mortality was conducted. The analysis was stratified by different measurement modalities and health conditions. Pooled hazard ratios were estimated using a random effects model. This meta-analysis included 188 studies with 98 468 participants. Reduced lean mass measured by BIA, DXA, and CT, was associated with increased risk of mortality with a hazard ratio (HR) of 1.35 (95% CI, 1.21–1.49), 1.18 (95% CI, 1.06–1.30), and 1.44 (95% CI, 1.32–1.57), respectively. Similarly, low lean mass defined by BIA-, DXA-, and CT-measurement was associated with increased risk of mortality, with an HR of 1.81 (95% CI, 1.56–2.10), 1.44 (95% CI, 1.29–1.60), and 1.78 (95% CI, 1.64–1.93). Reduced and low lean mass were robustly associated with increased mortality in studies using different measurement modalities.
Original languageEnglish
Pages (from-to)S13-S18
JournalOsteoporosis and Sarcopenia
Issue numberSuppl 1
Early online date12 Mar 2021
Publication statusPublished - Mar 2021


  • Lean mass
  • BIA
  • DXA
  • Mortality
  • Original

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