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Table 3 Studies investigating the association between FFM/LBM and MetS in children and adolescents

From: Fat-free/lean body mass in children with insulin resistance or metabolic syndrome: a systematic review and meta-analysis

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
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
  1. CS Cross-sectional studies, LS Longitudinal study, NA Not available, MetS Metabolic syndrome, No MetS No metabolic syndrome, TG Triglycerides, HDL-C High density lipoprotein cholesterol, TC Total cholesterol, WC Waist circumference, BP Blood pressure, SGOT Serum glutamic oxaloacetic transaminase, SGPT Serum glutamic pyruvic transaminase, TSH Thyroid-stimulating hormone, ISI Insulin sensitivity index, OGTT Oral glucose tolerance test, DI Disposition index, HOMA-IR Homeostasis model assessment insulin resistance index, QUICKI Quantitative insulin sensitivity check index, DXA Dual energy X-ray absorptiometry, BIA Bioelectrical impedance analysis, LBMI Lean body mass index, FFMI Fat free mass index, FFM Fat-free mass