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. 2021 Jun 8;16(6):e0252487. doi: 10.1371/journal.pone.0252487

Table 2. Study and population characteristics of included studies for bone mineral density outcome.

Study Country Study design (sample size) Sample size by group Obesity criterion Age (mean ± SD) Sex (% female) BMD assessment tool Site of BMD assessment Quality scorea
Postmenopausal women
Al-Shoumer 2012 Kuwait CS (454) OB: 403 OB: BMI≥25 Range 50–89 100 DXA Total Hip, Femoral Neck, Lumbar Spine 5
NO: 51 NO: BMI<25
Asli 2020 Iran CS (260) OB: 177 OB: BMI≥25 OB: 61.5 ± 9.1 89.6 DXA Total Hip, Femoral Neck, Lumbar Spine, Radius 6
NO: 83 NO: BMI<25 NO: 61.4 ± 8.9
Bilic-Curcic 2017 Croatia CS (114) OB: 83 OB: BMI>27 ≥45 100 DXA Femoral Neck, Lumbar Spine 5
NO: 31 NO: BMI≤27
Chain 2021b Brazil CS (255) OB: 154 OB: Body fat≥40% OB: 53.8 ± 8.2 100 DXA Femoral Neck, Lumbar Spine 4
NO: 101 NO: Body fat<40% NO: 52.1 ± 7.8
Dytfeld 2011 Poland CS (92) OB: 66 OB: WC≥80 69.5 ± 7.3 100 DXA Femoral Neck, Lumbar Spine 5
NO: 26 NO: WC<80
Glogowska-Szelag 2019 Poland CS (80) OB: 40 OB: BMI 30–34.9 NR 100 DXA Lumbar Spine 4
NO: 40 NO: BMI 18–24.9
Holecki 2007 Poland Case-control (62) OB: 43 NR OB: 50.1 ± 4.5 100 DXA Lumbar Spine 6
NO: 19 NO: 53.8 ± 5.2
Ibrahim 2011 Egypt CS (74) OB: 37 OB: BMI>30 OB: 57.4 ± 4.4 100 DXA Femoral Neck, Lumbar Spine 7
NO: 37 NO: BMI<25 NO: 56.6 ± 3.5
Jiajue 2014 China CS (1,410) OB: 810 OB: BMI≥25 OB: 64.0 ± 15.3 100 DXA Femoral Neck, Lumbar Spine 5
NO: 600 NO: BMI<25 NO: 65.6 ± 15.9
Khukhlina 2019 Ukraine CS (60) OB: 30 NR OB: 63.9 ± 1.2 70 DXA Total Hip, Femoral Neck 4
NO: 30 NO: 56.5 ± 3.0
Kim 2016 Korea CS (124) OB: 52 OB: BMI≥25 OB: 60.2 ± 6.7 100 DXA Total Hip, Femoral Neck, Lumbar Spine 8
NO: 72 NO: BMI<25 NO: 59.6 ± 7.4
Korpelainen 2003 Finland CS (1,222) OB: 815 OB: BMI≥28.5 OB: 72.1 ± 1.2 100 DXA Radius 7
NO: 407 NO: BMI<28.5 NO: 72.1 ± 1.7
Machado 2016 Brazil Cohort (433) OB: 266 OB: BMI>27 OB: 72.7 ± 5.7 100 DXA Total Hip, Femoral Neck, Lumbar Spine 7
NO: 167 NO: BMI<27 NO: 74.9 ± 8.1
Mazocco 2017 Brazil CS (392) OB: 299 OB: BMI≥25 59.6 ± 8.2 100 DXA Total Hip, Femoral Neck, Lumbar Spine 6
NO: 93 NO: BMI 18.5–24.9
Mendez 2013 Mexico CS (813) OB: 690 OB: BMI≥25 OB: 59.6 ± 14.0 100 DXA Total Hip, Femoral Neck, Lumbar Spine 7
NO: 123 NO: BMI<25 NO: 59.6 ± 7.5
Messina 2019 Italy CS (60) OB: 30 OB: WC>88 OB: 68 ± 10 100 DXA Lumbar Spine 6
NO: 30 NO: WC≤88 NO: 63 ± 9
Olmos 2018 Spain Cohort (2,597) OB: 2094 OB: BMI≥25 OB: 65.4 ± 13.4 70.3 DXA Total Hip, Femoral Neck, Lumbar Spine 6
NO: 503 NO: BMI<25 NO: 61.0 ± 10.2
Papakitsou 2004 Greece CS (130) OB: 104 OB: BMI≥25 55.5 (range: 54.2–56.7) 100 DXA Femoral Neck, Lumbar Spine 7
NO: 26 NO: BMI<25
Povoroznyuk 2017 Ukraine CS (566) OB: 230 OB: BMI≥30 OB: 64.5 ± 8.2 100 DXA Femoral Neck, Lumbar Spine, Radius 6
NO: 336 NO: BMI<30 NO: 64.2 ± 8.1
Ribot 1987 France CS (176) OB: 77 NR OB: 53.2 ± 6.0 100 DXA Lumbar Spine 1
NO: 99 NO: 53.1 ± 5.7
Scott 2020b Australia Cohort (1,692) OB: 1424 OB: BMI≥30 OB: 70.0 ± 0.1 100 DXA Total Hip 7
NO:268 NO: BMI<30 NO: 70.0 ± 0.1
Shaarawy 2003 Egypt CS (90) OB: 37 OB: BMI>30 58.8 ± 0.5 100 DXA Lumbar Spine 4
NO: 53 NO: BMI 20–25
Shiraki 1991 Japan CS (65) OB: 22 OB: BMI≥25 OB: 72.8 ± 8.0 100 DXA Radius 5
NO: 43 NO: BMI 20–24.9 NO: 75.3 ± 5.9
Shayganfar 2020 Iran CS (1361) OB: 1134 OB: BMI≥25 56.4 ± 10.4 77.6 DXA Femoral Neck, Lumbar Spine 5
NO: 337 NO: BMI<25
Silva 2007 Brazil Retrospective CS (588) OB: 299 OB: BMI≥25 OB: 54.5 ± 3.7 100 DXA Femoral Neck, Lumbar Spine 4
NO: 289 NO: BMI<25 NO: 53.9 ± 4
Sornay-Rendu 2013 France Case-control (189) OB: 63 OB: BMI≥30 OB: 68.6 ± 7 100 DXA, HR-pQCT Total Hip, Lumbar Spine, Radius, Tibia 8
NO: 126 NO: BMI 18.5–24.9 NO: 68.2 ± 7.4
Tajik 2013 Malaysia CS (297) OB: 218 OB: BMI≥25 OB: 56.2 ± 6.5 100 DXA Femoral Neck, Lumbar Spine 7
NO: 79 NO: BMI<25 NO: 56.1 ± 4.1
Tanaka 2013 Japan Cohort (1,479) OB: 348 OB: BMI≥25 OB: 63.2 ± 10.1 100 DXA Femoral Neck, Lumbar Spine 5
NO: 1131 NO: BMI 18.5–24.9 NO: 62.5 ± 11.2
Tarquini 1997 Italy CS (95) OB: 60 OB: BMI≥25 OB: 59.5 ± 6.3 100 DXA Radius 5
NO: 35 NO: BMI<25 NO: 58.3 ± 8.8
Tay 2018 USA Cohort (30) OB: 10 OB: BMI≥30 OB: 65.3 ± 9.3 70 DXA Total Hip, Femoral Neck, Lumbar Spine, Radius 7
NO: 20 NO: BMI<30 NO: 61.7 ± 13.4
Wu 2016 China CS (212) OB: 88 OB: BMI>25 OB: 64.4 ± 5.3 100 DXA Femoral Neck, Lumbar Spine 4
NO: 124 NO: BMI<25 NO: 63.5 ± 4.7
Zhou 2010 China CS (1,479) OB: 750 OB: BMI≥25 OB: 57.5 ± 7.4 100 DXA Total Hip, Femoral Neck, Lumbar Spine 5
NO: 729 NO: BMI<25 NO: 56.8 ± 5.8
Premenopausal women
Baheiraei 2005 Australia CS (88) OB: 65 OB: BMI≥25 48.5 ± 8.3 100 DXA Femoral Neck, Lumbar Spine 5
NO: 23 NO: BMI<25
Bachmann 2014 and Schorr 2019 USA CS (122) OB: 53 OB: BMI≥25 OB: 26.5 ± 5.6 100 DXA Total Hip, Femoral Neck, Lumbar Spine, Radius 7
NO: 69 NO: BMI 18.5–24.9 NO: 26.7 ± 6.2
DeSimone 1990 USA CS (216) OB: 51 OB: >30% ideal body weight OB: 67.0 ± 14.3 100 DXA Femoral Neck, Lumbar Spine, Radius 2
NO: 67.5 ± 16.3 NO: 165 NO: ≤30% ideal body weight
El Hage 2014 Lebanon CS (3,989) OB: 2708 OB: BMI≥25 OB: 62.3 ± 11.8 100 DXA Radius 3
NO: 1281 NO: BMI<25 NO: 56.8 ± 12.6
Gafane 2015 South Africa Epidemiological (434) OB: 261 OB: BMI≥25 OB: 61.6 ± 8.6 100 DXA Radius 8
NO: 173 NO: BMI<25 NO: 59.5 ± 7.1
Indhavivadhana 2015 Thailand CS (427) OB: 208 OB: WC≥80 52.6 ± 5.4 100 DXA Femoral Neck, Lumbar Spine 5
NO: 219 NO: WC<80
Jang 2016 Korea CS (1,296) OB: 263 OB: BMI≥23 32.8 ± 3.9 100 DXA Total Hip, Lumbar Spine 5
NO: 1033 NO: BMI<23
Kumar 2016 India CS (234) OB: 95 OB: BMI≥23 NR 100 DXA Femoral Neck, Lumbar Spine 5
NO: 139 NO: BMI<23
Liel 1988 USA CS (182) OB: 42 OB: >30% ideal body weight OB: 37.0 ± 10.2 100 DXA Femoral Neck, Lumbar Spine, Radius 2
NO: 140 NO: 34.5 ± 11.8 NO: ≤30% ideal body weight
Lim 2019 Korea CS (143) OB: 54 OB: BMI≥25 OB: 21.4 ± 1.0 100 DXA Femoral Neck, Lumbar Spine 8
NO: 89 NO: BMI<25 NO: 21.0 ± 1.2
Liu 2014 USA CS (471) OB: 281 OB: BMI≥25 OB: 48.6 ± 17.8 100 DXA Total Hip, Femoral Neck, Lumbar Spine, Radius 6
NO: 190 NO: BMI<25 NO: 35.8 ± 11.8
Maimoun 2020 France CS (152) OB: 38 OB: BMI≥30 OB: 21.3 ± 2.9 100 DXA Total Hip, Lumbar Spine, Radius 7
NO: 38 NO: BMI<30 NO: 21.0 ± 3.2
Maimoun 2020 France CS (318) OB: 139 OB: BMI≥30 OB: 47.0 ± 15.2 100 DXA Total Hip, Lumbar Spine, Radius 7
NO: 40 NO: BMI<30 NO: 45.6 ± 16.9
Pereira 2007 Brazil CS (27) OB: 16 OB: BMI≥30 OB: 37.8 ± 1.7 100 DXA Femoral Neck, Lumbar Spine, Radius 6
NO: 11 NO: BMI<30 NO: 37.2 ± 3.1
Pollock 2011 USA CS (48) OB: 15 OB: Body fat≥32% OB: 19.0 ± 1.1 100 pQCT Radius, Tibia 6
NO: 33 NO: Body fat<32% NO: 19.3 ± 1.3
Pollock 2007 USA CS (115) OB: 22 OB: Body fat≥32% OB: 18.4 ± 0.5 100 pQCT Radius, Tibia 8
NO: 93 NO: Body fat<32% NO: 18.2 ± 0.4
Segall-Gutierrez 2013 USA CS (15) OB: 10 OB: BMI≥30 20–35 100 DXA Lumbar Spine 6
NO: 5 NO: BMI 18.5–24.9
Sukumar 2011 USA Case-control (111) OB: 52 OB: BMI>35 OB: 52.7 ± 11.7 100 DXA Total Hip, Femoral Neck, Lumbar Spine 8
NO: 59 NO: BMI<27 NO: 50.6 ± 8.5
Takata 1999 Japan CS (51) OB: 20 OB: BMI>25 OB: 52.8 ± 13.4 100 DXA Total Hip, Lumbar Spine 3
NO: 31 NO: BMI 21–25 NO: 54.7 ± 15.4
Wampler 2005 USA CS (1,568) OB: 970 OB: BMI≥25 Range 50–79 100 DXA Total Hip, Femoral Neck, Lumbar Spine 5
NO: 598 NO: BMI<25
Wang 2020b China CS (1,272) OB: 502 OB: BMI≥25 OB: 50.4 ± 12.1 100 DXA Radius 6
NO: 770 NO: BMI<25 NO: 44.8 ± 14.3
Wiacek 2010 Poland CS (4,359) OB: 2984 OB: BMI≥25 Range 40–79 100 DXA Femoral Neck 3
NO: 1375 NO: BMI<25
Zantut-Wittmann Brazil Cohort (52) OB: 22 OB: BMI≥25 Range 20–39 100 DXA Total Hip, Femoral Neck, Lumbar Spine 6
NO: 30 NO: BMI<25
Men
Ayoub 2017 Lebanon CS (67) OB: 44 OB: BMI≥25 OB: 22.4 ± 3.6 0 DXA Total Hip, Femoral Neck, Lumbar Spine 7
NO: 23 NO: BMI 18.5–24.9 NO: 22.2 ± 2.8
Chain 2021b Brazil CS (249) OB: 136 OB: Body fat≥30% OB: 51.7 ± 7.9 0 DXA Femoral Neck, Lumbar Spine 4
NO: 113 NO: Body fat<30% NO: 54.2 ± 7.9
Choi 2015 Korea CS (1,089) OB: 368 OB: BMI≥25 58.8 ± 7.5 0 DXA Total Hip, Femoral Neck 7
NO: 721 NO: BMI<25
Jiang 2015 China CS (358) OB: 219 OB: BMI≥24 72.8 ± 9.5 0 DXA Total Hip, Femoral Neck, Lumbar Spine 5
NO: 139 NO: BMI<24
Kanazawa 2008 Japan CS (163) OB: 73 OB: BMI≥24 OB: 56.8 ± 21.0 0 DXA Femoral Neck, Lumbar Spine, Radius 7
NO: 90 NO: BMI<24 NO: 58.6 ± 15.3
Kang 2014 China CS (502) OB: 365 OB: BMI≥24 OB: 61.3 ± 23.6 0 DXA Total Hip, Femoral Neck, Lumbar Spine 7
NO: 137 NO: BMI<24 NO: 64.7 ± 17.1
Nielson 2011 and Shen 2015 USA CS (3,067) OB: 2238 OB: BMI≥30 OB: 72.8 ± 7.8 0 DXA Total Hip 8
NO: 829 NO: BMI<30 NO: 74.5 ± 6.3
Salamat 2013 Iran CS (230) OB: 135 OB: BMI≥25 OB: 61.7 ± 8.1 0 DXA Total Hip, Femoral Neck, Lumbar Spine 6
NO: 95 NO: BMI<25 NO: 63.9 ± 7.9
Scott 2017 Australia Epidemiological (1,486) OB: 631 OB: body fat≥30% OB: 78.0 ± 6.5 0 DXA Total Hip 6
NO: 855 NO: Body fat<30% NO: 78.3 ± 7.8
Scott 2020b Australia Cohort (1,719) OB: 1503 OB: BMI≥30 OB: 70.0 ± 0.1 0 DXA Total Hip 7
NO:216 NO: BMI<30 NO: 70.0 ± 0.1
Tencerova 2019 Denmark CS (54) OB: 35 OB: BMI≥25 OB: 34.8 ± 2.6 0 DXA Total Hip, Femoral Neck, Lumbar Spine 7
NO: 19 NO: BMI<25 NO: 31.0 ± 3.0
Wang 2020b China CS (850) OB:472 OB: BMI≥25 OB: 45.5 ± 14.1 0 DXA Radius 5
NO: 378 NO: BMI<25 NO: 45.8 ± 16.2
Mixed population
Amarendra Reddy 2009 India CS (303) OB: 151 OB: BMI>25 OB: 28.0 ± 7.7 50.8 DXA Total Hip, Femoral Neck, Lumbar Spine, Radius 6
NO: 152 NO: BMI≤25 NO: 27.7 ± 8.8
Andersen 2014 Denmark CS (72) OB: 36 OB: BMI>30 OB: 41± 8 66.7 DXA, HR-pQCT Lumbar Spine, Radius, Tibia 7
NO: 36 NO: BMI 19.5–24.8 NO: 40.1 ± 7.8
Buta 2012 Romania CS (67) OB: 43 OB: BMI≥25 OB: 48.7 ± 16.8 100 DXA Lumbar Spine 6
NO: 24 NO: BMI<25 NO: 47.8 ± 9.4
De Araujo 2017 Brazil Case-control (78) OB: 54 NR OB: 53.0 ± 13.6 57.7 DXA Total Hip, Femoral Neck, Lumbar Spine 3
NO: 24 NO: 55.0 ± 7.0
Dubois 2003 Netherlands CS (28) OB: 14 OB: BMI≥25 OB: 60 ± 14.9 50 DXA Total Hip, Femoral Neck, Lumbar Spine 6
NO: 14 NO: BMI<25 NO: 61 ± 14.4
Evans 2015 UK CS (223) OB: 146 OB: BMI≥30 OB: 49.8 ± 9.9 50.7 DXA, HR-pQCT Lumbar Spine, Radius, Tibia 8
NO: 77 NO: BMI 18.5–24.9 NO: 49.8 ± 9.8
Gandham 2020 Australia Cohort (1,099) OB: 303 OB: BMI≥30 OB: 62.5 ± 7.2 51.2 DXA Total Hip, Lumbar Spine 6
NO: 796 NO: BMI<30 NO: 62.2 ± 7.6
Kao 1994 China CS (343) OB: 158 OB: BMI>25 NR 72.3 DXA Lumbar Spine 5
NO: 185 NO: BMI<25
Kin 1991 Japan CS (812) OB: 163 OB: BMI≥25 20+ 77.5 DXA Lumbar Spine 6
NO: 649 NO: BMI<25
Kirchengast 2002 Austria CS (119) OB: 64 OB: BMI≥25 71.7 ± 7.7 56.3 DXA Femoral Neck 6
NO: 55 NO: BMI<25
Lim 2013 Korea Cohort (25) OB: 16 OB: BMI>25 OB: 23.3 ± 0.2 52 DXA Total Hip, Femoral Neck, Lumbar Spine 8
NO: 9 NO: BMI≤25 NO: 24.6 ± 0.3
Lloyd 2016 USA CS (2,570) OB: 1718 OB: BMI≥25 OB: 73.4 ± 4.0 50.8 DXA Total Hip, Femoral Neck 7
NO: 852 NO: BMI<25 NO: 73.9 ± 2.9
Rudman 2019 UK CS (342) OB: 243 OB: BMI≥25 62.5 ± 0.5 55.6 DXA Femoral Neck, Lumbar Spine 4
NO: 99 NO: BMI 18.5–24.9
Scott 2016 Australia Cohort (2,134) OB: 781 NR OB: 63.6 ± 10.2 50.8 DXA Total Hip, Lumbar Spine 5
NO: 1353 NO: 63.3 ± 11.0
Scott 2018 Australia CS (168) OB: 79 OB: BMI≥30 67.8 ± 12.0 53.8 pQCT Tibia 6
NO: 89 NO: BMI<30
Studies not included in the meta-analysis
Bener 2005 Qatar CS (649) OB: 303 OB: BMI≥30 NR 100 DXA Femoral Neck, Lumbar Spine 8
NO: 346 NO: BMI<30
Dickey 2006 Ireland CS (328) OB: 143 OB: BMI≥25 OB: 46 60.1 DXA Femoral Neck, Lumbar Spine 3
NO: 185 NO: BMI 20–24.9 NO: 48
Gojkovic 2020 Serbia CS (1974) OB: 1395 OB: BMI≥25 Range 54–76 94.5 DXA Femoral Neck, Lumbar Spine 5
NO: 579 NO: BMI<25
Gomez-Cabello 2013 Spain CS (223) NR OB: BMI≥25 Rage 65–89 71.3 DXA Femoral Neck, Lumbar Spine 8
NO: BMI<25
Jawhar 2020 Malaysia Cohort (635) NR OB: BMI≥25 60.0 ± 11.5 100 DXA Total Hip, Femoral Neck 4
NO: BMI<25
Vandevyver 1997 Belgium CS (748) OB: 190 OB: BMI≥30 70.8 NR DXA Femoral Neck 3
NO: 558 NO: BMI<30
Yoon 2019 Korea CS (2552) OB: 1510 OB: BMI≥23 ≥50 0 DXA Femoral Neck 5
NO: 1042 NO: BMI<23

CS: cross-sectional; OB: obese; NO: non-obese; BMI: Body Mass Index; WC: Waist circumference.

BMI is expressed in kg/m2.

WC is expressed in cm.

aQuality score was obtained from the Joanna Briggs Institute tool (JBI): <4: high risk of bias; 4–6 moderate risk of bias; ≥7 low risk of bias.

bThese studies fall into two subgroup categories (postmenopausal women, premenopausal women, men) as results were stratified by sex.