Calf circumference as a predictor of dementia and mild cognitive impairment: A meta-analysis

Calf circumference (CC) is a simple and reliable measure of muscle mass, but
literature on the relationship between CC and dementia is scarce. This meta-analysis
aimed to assess CC as a predictor of dementia and mild cognitive impairment. We
searched PubMed/MEDLINE, Cochrane Library, and the first 100 articles in Google
Scholar, with no date limitation (up to May 2026). The keywords calf circumference,
dementia, cognitive dysfunction, cognitive decline, cognitive impairment, and
Alzheimer's disease were used. The search included references of the selected studies.
The name of the authors, author's name, and country, year of publication, calf
circumference among cases and controls, and the association of dementia and calf
circumference were collected. Three hundred-nine studies were found, 103 remained
after duplication removal, 28 full texts were checked and eight studies (8241
participants) were eligible for meta-analysis. The study found a negative association
of calf circumference with dementia, Mean difference, -2.28. 95% CI, -4.23 to -.052,
and P-value for overall effect, 0.01 However, substantial heterogeneity was evident, I2
for heterogeneity, 99%, P-value<0.00001. The chi-square was 659.52. The negative
association of calf circumference and dementia remained robot after removing the
study with the highest heterogeneity, MD, -1.23. 95% CI, -1.48 to -.97, and P-value
for overall effect <0.001, and Z score=9.48. No significant heterogeneity was found
I2= 22%, P-value, 0.28. The chi-square was 3.83. Calf circumference is negatively
associated with cognitive decline; further studies focusing on calf circumference/waist
circumference ratio are needed.