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Meta-Analysis
. 2022 Aug 25:13:984828.
doi: 10.3389/fendo.2022.984828. eCollection 2022.

Close association between lifestyle and circulating FGF21 levels: A systematic review and meta-analysis

Zonghao Qian  1   2 , Yucong Zhang  1   2 , Ni Yang  1   2 , Hao Nie  1   2 , Zhen Yang  1   2 , Pengcheng Luo  1   2 , Xiuxian Wei  1   2 , Yuqi Guan  1   2 , Yi Huang  1   2 , Jinhua Yan  1   2 , Lei Ruan  1   2 , Cuntai Zhang  1   2 , Le Zhang  1   2
Affiliations
Meta-Analysis

Close association between lifestyle and circulating FGF21 levels: A systematic review and meta-analysis

Zonghao Qian et al. Front Endocrinol (Lausanne). .

Abstract

Background: The impact of lifestyle factors on circulating fibroblast growth factor 21 (cFGF21) remains unclear. We conducted this systematic review and meta-analysis to evaluate the association between lifestyle factors and cFGF21 levels.

Methods: We included studies that evaluated the effects of different lifestyles on cFGF21 concentration in adults, which included smoking, exercise, diets, alcohol consumption and weight loss. Random effects models or fixed effects models were used for meta-analysis to calculate the standardized mean difference (SMD) and 95% confidence interval according to the heterogeneity among studies. Study quality was assessed using the Newcastle-Ottawa Scale for cohort studies, the Joanna Briggs Institution Checklist for cross-sectional studies, and the PEDro scale for experimental studies.

Results: A total of 50 studies with 1438 individuals were included. Overall, smoking, a hypercaloric carbohydrate-rich diet, a hypercaloric fat-rich diet, amino acid or protein restriction, excessive fructose intake and alcohol consumption significantly upregulated cFGF21 levels (p<0.05), whereas fish oil intake and calorie restriction with sufficient protein intake significantly decreased cFGF21 (p<0.05). Compared to the preexercise cFGF21 level, the cFGF21 level significantly increased within 3 hours postexercise (p<0.0001), while it significantly decreased in the blood sampled >6 h postexercise (p=0.01). Moreover, higher exercise intensity resulted in higher upregulation of cFGF21 at 1-hour post exercise (p=0.0006).

Conclusion: FGF21 could serve as a potential biomarker for the assessment of different lifestyle interventions. When it is used for this purpose, a standard study protocol needs to be established, especially taking into consideration the intervention types and the sampling time post-intervention.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021254758, identifier CRD42021254758.

Keywords: biomarker; circulating FGF21; diet; exercise; lifestyle.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Preferred reporting items for systemic reviews and meta-analysis flow diagram of literature screening. cFGF21, circulating fibroblast growth factor 21.
Figure 2
Figure 2
Forest plot of cFGF21 concentration in individuals with or without smoking. Fixed effect models were used as the pooling method. The mean value refers to the mean cFGF21 concentration in each group. cFGF21, circulating fibroblast growth factor 21.
Figure 3
Figure 3
Forest plot of cFGF21 concentration in individuals before and after different diet interventions. Random effect models were used as the pooling method. The mean value refers to the mean cFGF21 concentration in each group. cFGF21, circulating fibroblast growth factor 21.
Figure 4
Figure 4
Forest plot of cFGF21 concentration in individuals before and after alcohol consumption. Fixed effect models were used as the pooling method. The mean value refers to the mean cFGF21 concentration in each group. cFGF21, circulating fibroblast growth factor 21.
Figure 5
Figure 5
Forest plot of cFGF21 concentration in individuals before and after calorie restriction-induced weight loss. Random effect models were used as the pooling method. The mean value refers to the mean cFGF21 concentration in each group. cFGF21, circulating fibroblast growth factor 21.
Figure 6
Figure 6
Forest plot of acute exercise effects on cFGF21 concentration sampled within 3 hours postexercise. Random effect models were used as the pooling method. The mean value refers to the mean cFGF21 concentration in each group. cFGF21, circulating fibroblast growth factor 21.
Figure 7
Figure 7
Forest plot of cFGF21 concentration in individuals with different exercise intensities. Fixed effect models were used as the pooling method. The mean value refers to the mean cFGF21 concentration in each group. cFGF21, circulating fibroblast growth factor 21.
Figure 8
Figure 8
Forest plot of exercise effects on cFGF21 concentration sampled more than 6 hours postexercise. Random effect models were used as the pooling method. The mean value refers to the mean cFGF21 concentration in each group. cFGF21, circulating fibroblast growth factor 21.
Figure 9
Figure 9
The exercise-induced cFGF21 level changes over time and with different exercise intensities. The figure includes two curves depicting changes in relative cFGF21 levels in subjects undergoing relatively higher- and lower-intensity exercises during the pre-exercise (Pre) and post-exercise (Post) periods. cFGF21, circulating fibroblast growth factor 21.
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