ABC | Volume 115, Nº2, August 2020

Original Article Jesus et al. Meta-analysis: body adiposity and apolipoproteins Arq Bras Cardiol. 2020; 115(2):163-171 All studies had adopted a prospective design (Q1), partially presented the inclusion and exclusion criteria (Q2), used valid and reliable measures (Q3), had a high level of detail in the description of the exposure (Q7), used appropriate indicators and valid and reliable means of measure (Q14). Two articles used the strategy of recruiting participants between groups (Q5) and, in six other articles, this item was not applied because there was no separation by groups. Only one article21 did not state the exclusion criteria (Q2). Methodological Quality Assessment Among the eight studies included in the systematic review, all showed good methodological quality, reaching eight 21-23 and seven stars. 24-28 The main limitation observed in studies with a score of seven was the lack of description of control factors in terms of comparability of cohorts. The results are shown in Table 2. Results of the Meta-analysis This meta-analysis included data from 7,974 individuals, whose outcomes are shown in Figures 2 to 5. When assessing the influence of excess body adiposity on serum ApoB values, an average increase of 4.94 mg/dL was observed (95%CI: 4.22 to 5.67 mg/dL) at the levels of this biochemical marker in individuals with excess body adiposity. An average reduction of -8.13 mg/dL (95%CI: -9.09 to -7.17 mg/dL) was identified in the serum levels of ApoA1 in children and adolescents with excess body adiposity (Figures 2 and 3). Considering the age of the individuals followed up in the original studies, we could carry out a subgroup analysis. According to the results, described in Figure 4, the mean increase in serum ApoB values in individuals with excess body adiposity was greater in the population aged ten years or older (adolescents), when compared to those younger than ten years (WMD 10.60 mg/dL [95%CI: 7.47 to 13.73] and 4.62 mg/dL [95%CI: 3.88 to 5.37], respectively). Also for ApoA1, excess body adiposity was associated with a greater mean reduction in the serum values of this marker in adolescents aged ten years or older (WMD -10.43 mg/ dL [95%CI: -14.35 to -6.51]), compared to children under ten years old (WMD -7.99 mg/dL [95%CI: -8.98 to -6.99]) (Figure 5) . Table 1 – Main characteristics of studies included in the systematic review *Body Mass Index (BMI); † Dual-energy X-ray absorptiometry (DXA) Author and year Country Mean age Sample by exposure group General sample Follow-up (months) Adiposity measure With excess adiposity Without excess adiposity Falaschetti et al. 2001 England 9.9 years 1,602 5,987 7,589 120 * BMI Larsson et al. 2010 Sweden 10 years 29 115 144 120 BMI Benson et al. 2012 USA 12 years 87 75 162 12 BMI Wilke et al. 2016 Canada 11.7 years 218 412 630 48 BMI and †DXA Yamazaki 2008 Japan 12 years 19 60 79 144 Adiposity rebound Bogaert et al. 2003 Australia 8.6 years - - 59 12 BMI Howe et al. 2010 England 9.9 years - - 7.033 120 DXA Mehta et al. 2002 Australia 15.7 years - - 139 120 BMI Source: author. Table 2 – Evaluation of methodological quality of the studies included in the systematic review according to the Newcastle Ottawa Scale Study Selection Comparability of cohorts based on design or analysis Outcome of each study Total stars Benson et al. (2012) 4 stars SP 3 stars 7 Bogaert et al. (2003) 4 stars 1 star 3 stars 8 Falaschetti et al. (2001) 4 stars SP 3 stars 7 Howe et al. (2010) 4 stars 1 star 3 stars 8 Larsson et al (2010) 4 stars SP 3 stars 7 Mehta et al (2002) 4 stars 1 star 3 stars 7 Wilke et al. (2016) 4 stars SP 3 stars 7 Yamazaki (2008) 4 stars SP 3 stars 7 166