Article Text

Body composition and risk of heart failure: protocol for a systematic review and meta-analysis
  1. Ayodipupo S. Oguntade1,
  2. Danyao Jin1,
  3. Nazrul Islam1,
  4. Reem Malouf2,
  5. Hannah Taylor1,
  6. Rishi Caleyachetty1,
  7. Sarah Lewington1,3,4 and
  8. Ben Lacey1
  1. 1Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK
  2. 2National Perinatal Epidemiological Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
  3. 3MRC Population Health Research Unit, NDPH, University of Oxford, Oxford, UK
  4. 4UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
  1. Correspondence to Dr Ayodipupo S. Oguntade; ayodipupo.oguntade{at}


Introduction Although there is strong evidence of an association between general adiposity and incidence of heart failure, previous systematic reviews and meta-analyses have not reliably assessed the association of heart failure risk with other aspects of body composition (such as body fat distribution or lean mass), or between body composition and risk of heart failure subtypes. We aim to conduct a systematic review and meta-analysis of prospective studies to address these uncertainties, and inform efforts to prevent and treat heart failure.

Methods and analysis The Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols statement was used as a template for this protocol. A systematic search of Medline, Embase and Global Health from database inception to present will be conducted to identify prospective studies reporting on the associations between major measures of body composition (body mass index, waist circumference, waist–hip ratio, total body fat, visceral adiposity tissue and lean mass) and risk of heart failure. Article screening and selection will be performed by two reviewers independently, and disagreements will be adjudicated by consensus or by a third reviewer. Data from eligible articles will be extracted, and article quality will be assessed using the Newcastle-Ottawa Scale. Relative risks (and 95% CIs) will be pooled in a fixed effect meta-analysis, if there is no prohibitive heterogeneity of studies as assessed using the Cochrane Q statistic and I2 statistic. Subgroup analyses will be by age, sex, ethnicity and heart failure subtypes. Publication bias in the meta-analysis will be assessed using Egger’s test and funnel plots.

Ethics and dissemination This work is secondary analyses on published data and ethical approval is not required. We plan to publish results in an open-access peer-reviewed journal, present it at international and national conferences, and share the findings on social media.

PROSPERO registration number CRD42020224584.

  • heart failure
  • epidemiology
  • systematic reviews as topic
  • obesity
  • meta-analysis

Data availability statement

Data sharing is not applicable as no datasets generated and/or analysed for this study.

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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Data availability statement

Data sharing is not applicable as no datasets generated and/or analysed for this study.

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  • Contributors ASO, DJ, BL, RC and SL conceptualised the study. ASO, NI, SL, BL, RC and HT designed the statistical analysis plan. BL, RC, SL, NI, RM and HT provided training in systematic review, data synthesis and supervised the protocol. ASO wrote the initial draft. All authors contributed to the final draft and approved the final manuscript.

  • Funding This work was funded by a doctoral scholarship to ASO from the Nuffield Department of Population Health (NDPH), University of Oxford (Oxford, UK). BL acknowledges support from the UK Biobank, the National Institute for Health Research Biomedical Research Centre (Oxford, UK), and the BHF Centre of Research Excellence (Oxford, UK).

  • Competing interests SL reports grants from the Medical Research Council (MRC) and research funding from the US Centres for Disease Control and Prevention Foundation (with support from Amgen) during the conduct of the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.