{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T12:20:09Z","timestamp":1787746809593,"version":"build-2784847793"},"reference-count":43,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J cachexia sarcopenia muscle"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Body composition is a major determinant of health, yet the role of fat\u2010free mass, a key component of body composition, in mortality remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A PRISMA\u2010guided systematic review and meta\u2010analysis (PROSPERO: 321722) of observational cohort studies in community\u2010dwelling adults was conducted. PubMed was searched from inception to 25 October 2025, and Web of Science and Embase were searched from inception to 31 July 2025. Eligible studies assessed fat\u2010free mass using computed tomography, dual\u2010energy X\u2010ray absorptiometry (DXA), bioelectrical impedance analysis (BIA) or anthropometry. Studies involving hospitalized participants were excluded. Maximally adjusted effect estimates were pooled using random\u2010effects models to calculate summary risk ratios (RRs) and 95% confidence intervals (CIs). Publication bias was assessed using graphical and statistical methods; influence analyses evaluated robustness; E\u2010values quantified potential unmeasured confounding; and meta\u2010regression explored between\u2010study heterogeneity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 7741 screened records, 49 studies met the inclusion criteria (1\u2009149\u2009807 participants; 83\u2009798 deaths). Low versus high fat\u2010free mass was associated with higher all\u2010cause mortality (RR: 1.42, 95% CI: 1.30\u20131.55). Trim\u2010and\u2010fill analysis indicated publication bias (adjusted RR: 1.31, 95% CI: 1.20\u20131.44). Sensitivity analyses confirmed robustness (leave\u2010one\u2010out RR range: 1.39\u20131.43; E\u2010value: 2.19). Associations were consistent across age (\n                      <jats:italic>p<\/jats:italic>\n                      <jats:sub>difference; within\u2010study<\/jats:sub>\n                      \u2009=\u20090.133), geographic region (\n                      <jats:italic>p<\/jats:italic>\n                      <jats:sub>difference<\/jats:sub>\n                      \u2009=\u20090.983) and cause of death (\n                      <jats:italic>p<\/jats:italic>\n                      <jats:sub>difference for cardiovascular diseases; within\u2010study<\/jats:sub>\n                      \u2009=\u20090.240,\n                      <jats:italic>p<\/jats:italic>\n                      <jats:sub>difference for cancer; within\u2010study<\/jats:sub>\n                      \u2009=\u20090.136). Effect sizes varied by sex (men RR: 1.56, 95% CI: 1.32\u20131.85; women RR: 1.25, 95% CI: 1.11\u20131.39;\n                      <jats:italic>p<\/jats:italic>\n                      <jats:sub>difference<\/jats:sub>\n                      \u2009&lt;\u20090.0001) and measurement method: strongest for calf circumference (RR: 2.19, 95% CI: 1.50\u20133.20), moderate for DXA (RR: 1.52, 95% CI: 1.29\u20131.79) and weakest for BIA (RR: 1.23, 95% CI: 1.07\u20131.41).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Low fat\u2010free mass is associated with a 42% higher risk of all\u2010cause mortality in community\u2010dwelling adults. Routinely assessing fat\u2010free mass provides clinical value in identifying high\u2010risk individuals and informing preventive care strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jcsm.70331","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T15:46:33Z","timestamp":1783698393000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Fat\u2010Free Mass and Mortality: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"17","author":[{"given":"Valerie L.","family":"Haas","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Preventive Medicine University of Regensburg  Regensburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0931-8651","authenticated-orcid":false,"given":"Patricia","family":"Fromherz","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Preventive Medicine University of Regensburg  Regensburg Germany"},{"name":"Department of Neurology Medbo District hospital and University hospital of Regensburg  Regensburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Jochem","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Preventive Medicine University of Regensburg  Regensburg Germany"},{"name":"Department of Planetary &amp; 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