OBJECTIVE:This study investigated the relationship between the pan-immune-inflammation value (PIV) and the perforation diameter in patients with ventricular septal rupture (VSR), as well as the changes in pulmonary artery systolic pressure (ΔPASP) after transcatheter closure. METHODS:The clinical data from 133 VSR patients who underwent transcatheter closure were analyzed. Patients were divided into high and low PIV groups based on a median cutoff value of 6. Boruta was used for exploratory variable screening; prespecified covariate sets were used for adjusted models. A generalized additive model (GAM) was used to explore the potential nonlinear relationships. Where a nonlinear association was suggested by the GAM, a piecewise linear regression model was subsequently fitted to precisely quantify the threshold effects and the differential associations of PIV/100 with ΔPASP and perforation diameter on either side of the identified inflection point. RESULTS:One hundred thirty-three patients with VSR (mean age 67 years, 50.6% female) were enrolled. Linear regression showed no statistically significant association between PIV/100 and ΔPASP. GAM suggested a possible nonlinear pattern between PIV/100 and ΔPASP (and perforation diameter). In piecewise models, an inverse association was observed above the break point, but this pattern was attenuated after multivariable adjustment and in sensitivity analyses. In discrimination analyses, adding PIV/100 to the baseline model yielded a modest numerical increase in AUC, but the incremental gain was not statistically significant. CONCLUSION:PIV may serve as an adjunct inflammatory marker in VSR patients undergoing transcatheter closure; however, the break point findings are exploratory and the incremental predictive value warrants validation in larger, independent cohorts with better adjudication of infection/systemic inflammation.

Background:Ventricular septal rupture (VSR) is a life-threatening complication of acute myocardial infarction (AMI). The C-reactive protein-triglyceride glucose index (CTI) integrates insulin resistance (IR) and inflammation. The present study was designed to investigate the correlation between CTI and 1-year all-cause mortality in VSR patients after AMI. Methods:284 VSR patients were consecutively enrolled at Fuwai Central China Cardiovascular Hospital between January 2018 and April 2025. According to the median CTI value (6.408), the 284 VSR patients were divided into two groups. The relationship between CTI and clinical outcomes was evaluated using multivariate logistic regression analysis, followed by mediation analysis to explore indirect statistical associations. Results:1-year all-cause mortality in VSR patients was 71.8% (204/284). The mortality of the high CTI group was significantly higher than that of the low CTI group (87.3% vs 56.3%, P < 0.001). Multivariate logistic regression analysis revealed that CTI was associated with mortality (OR = 2.89, 95% CI: 1.85-4.51, P < 0.001), with mortality showing an upward trend as CTI levels increased (P < 0.001). Mediation analyses identified indirect statistical associations involving neutrophil count and NT-proBNP, with mediation proportions of 65.8% and 35.3%, respectively (both P < 0.05). Conclusion:CTI is associated with mortality but not independently, with indirect statistical associations involving inflammation and increased cardiac load.

The present study aimed to investigate the association between the alkaline phosphatase-to-platelet ratio index (APPRI) and intensive care unit (ICU) mortality in patients with cardiac arrest (CA), and further explore its potential value for risk stratification in this specific population. A total of 374 CA patients were included in our analysis. They were divided into the survivor group (n = 180) and non-survivor group (n = 194) based on ICU survival status. Baseline characteristics of the two groups were summarized and compared. Univariate and multivariate logistic regression analyses were conducted to explore the association between the alkaline APPRI and ICU mortality. Receiver operating characteristic (ROC) curve analysis was used to determine APPRI’s optimal cutoff value for predicting ICU mortality. The Kaplan-Meier method was applied to estimate survival curves of different groups, with the log-rank test used to compare survival differences. The non-survivor group exhibited higher APPRI values than the survivor group (0.430 [0.296, 0.733] vs.0.358 [0.246, 0.533)], P < 0.001). Univariate logistic regression analysis showed that APPRI (odds ratio (OR) = 1.077, 95

Objective: Clinical studies indicate a link between Gastroesophageal reflux disease (GERD) and lung benign neoplasm (LBN), but genetic evidence is sparse. This study investigates how genetics link GERD and LBN through a two-sample Mendelian randomization (MR) analysis. Methods: Public genetic data were employed to investigate the relationship between GERD as the exposure and LBN as the outcome. To determine causality and verify the robustness and reliability of causal association results, various analytical approaches were applied, including IVW analysis, weighted median, MR-Egger regression, and both simple and weighted models. Sensitivity was evaluated through MR-PRESSO and MR-Egger techniques. The leave-one-out analysis and heterogeneity was performed. Results: IVW analysis showed a genetic link between GERD and LBN (OR= 1.00183, 95% CI = 1.00089 - 1.00278, p = 0.000148). The weighted median estimator supported this finding. Similar estimates were obtained with MR-Egger (OR = 0.99658, p = 0.169), simple mode (OR = 1.00098, p = 0.558), and weighted mode (OR = 1.00120, p = 0.364), though not statistically significant. No significant heterogeneity was detected, and the MR-Egger intercept indicated potential pleiotropy (p = 0.0477). Conclusion: This study presents genetic evidence indicating that GERD may be associated with a slightly increased risk of LBN (effect size small). Keywords: Lung benign neoplasm, Gastroesophageal reflux disease, Mendelian randomization, Causal inference, Genetic epidemiology

Background:The Systemic Immune-Inflammation Index (SII) is a key indicator for assessing inflammatory status. This study aims to determine the association between SII and prognosis following occlusion in patients with post-infarction ventricular septal rupture (PIVSR). Methods:A total of 130 patients admitted to Fuwai Central China Cardiovascular Hospital between 2018 and 2023 were included in this retrospective study. Based on the tertiles of the Systemic Inflammatory Index (SII), the patients were categorized into two groups: 65 patients in the low SII group and 65 in the high SII group. Variable screening was performed using the Least Absolute Shrinkage and Selection Operator (LASSO) analysis. We conducted multivariable logistic regression analyses to rigorously assess the independent association between SII and short-term outcomes in PIVSR patients. After variable selection, a nomogram was constructed using R, and Restricted Cubic Splines (RCS) were employed to flexibly model nonlinear relationships. Subsequently, the predictive abilities of the screened variables and SII for the outcome were independently evaluated using Receiver Operating Characteristic (ROC) curve analysis. Results:A nomogram model incorporating ALT, UREA, NT-proBNP, and SII was developed to predict the short-term prognosis of PIVSR patients following occlusion surgery. ROC curve analysis demonstrated that the area under the curve (AUC) for SII level was 0.702 (95% CI: 0.599-0.804, P < 0.001). Incorporating the Systemic Immune-Inflammation Index (SII) significantly improved prognostic accuracy, with Model 2 demonstrating superior discriminatory power (AUC 0.845 vs 0.828) over Model 1. Conclusion:The Systemic Immune-Inflammation (SII) is a convenient and effective prognostic indicator, and the model incorporating SII can facilitate personalized prognostic assessment for patients with post-infarction ventricular septal rupture (PIVSR).

OBJECTIVES:The purpose of this study was to evaluate the predictive value of the ABIC score in the long-term prognosis of elderly patients with acute exacerbations of chronic heart failure (CHF), and to explore whether its integration with other known prognostic variables could enhance the performance of a predictive model. METHODS:This is a retrospective cohort study of elderly patients with acute exacerbation of CHF who were hospitalized for the first time. The main clinical outcome was all-cause mortality within three years. Cox regression and Lasso regression were used to screen variables. The screened variables, along with the ABIC score, were included in the multivariate Cox regression analysis to construct a predictive nomogram model. RESULTS:A total of 365 patients with acute exacerbation of CHF were included. During the 3-year follow-up period, 87 patients experienced all-cause death, including 53 cardiac deaths. A total of 4 variables [NT-proBNP, serum urea nitrogen (BUN), red cell distribution width-coefficient of variation (RDW-CV) and prealbumin] were screened by univariate Cox regression analysis and Lasso regression analysis. The multivariate COX regression results showed that the risk of death increased by 33% with the increase of ABIC score by 1 point. The results of ROC curve analysis show that the area under the curve (AUC) of the ABIC score is 0.685, while the AUC of the Nomograph including the ABIC score is 0.840. CONCLUSIONS:The ABIC score is associated with long-term adverse outcomes in elderly hospitalized patients with acute exacerbation of CHF. The integration with established prognostic variables (NT-proBNP, BUN, RDW-CV, prealbumin) significantly improves model performance, highlighting the combined value of multiple organ dysfunction and cardiac biomarkers in risk stratification.

Hypertensive patients are prone to frailty, but the exact link between them remains unclear. This study aims to evaluate the HbA1c glycated index (HGI) as a biomarker for frailty and mortality in hypertensive patients. 1773 hypertensive participants were included in the CHARLS database. HGI was calculated as measured HbA1c minus predicted HbA1c. Associations with frailty and mortality were evaluated via multivariable logistic regression, Cox regression, mediation analysis, and threshold detection. HGI was independently associated with frailty (adjusted OR = 1.28, 95

Introduction:What interventions effectively prevent postoperative stenosis following endoscopic resection (ER) of superficial esophageal cancer? This study aimed to identify effective interventions or combinations through a systematic review and network meta-analysis.Methods:Six databases were systematically searched for eligible studies up to 30 April 2023, on interventions to prevent esophageal stenosis post-ER. Odds ratios (ORs) evaluated stenosis rate (primary outcome) and complications (secondary outcome), while mean differences (MD) evaluated endoscopic balloon dilatation (EBD) sessions post-stenosis.Results:Twenty-three studies involving 1271 patients and 11 different interventions were included. Eight interventions were effective in preventing post-ER stenosis: oral hydrocortisone sodium succinate and aluminum phosphate gel (OHA) (OR: 0.02, 95% credible interval [CrI]: 0.00-0.11), polyglycolic acid (PGA) + ST (OR: 0.02, 95% CrI: 0.00-0.23), oral tranilast (OT) + preemptive endoscopic balloon dilatation (PEBD) (OR: 0.08, 95% CrI: 0.01-0.77), botulinum toxin (BT) (OR: 0.10, 95% CrI: 0.03-0.32), ST (OR: 0.08, 95% CrI: 0.01-0.67), oral steroid (OS) (OR: 0.11, 95% CrI: 0.05-0.28), endoscopic triamcinolone injection (ETI) + OS (OR: 0.17, 95% CrI: 0.07-0.42), and ETI (OR: 0.18, 95% CrI: 0.11-0.30). Five interventions significantly reduced EBD sessions: PGA + ST (MD: -5.78, 95% CrI: -11.04 to -1.21), ETI + OS (MD: -3.27, 95% CrI: -5.37 to -0.72), OS (MD: -6.18, 95% CrI: -9.43 to -3.38), ETI (MD: -3.81, 95% CrI: -5.74 to -1.99), and BT (MD: -2.16, 95% CrI: -4.12 to -0.40). None of the interventions significantly increased complications.Conclusions:This study confirmed the efficacy of OS, ETI, and ETI + OS and verified five other interventions (OHA, PGA + ST, OT + PEBD, BT, and ST) in preventing stenosis. Notably, PGA + ST and BT also reduced the number of EBD sessions.

Environmental heavy metal exposure is a potential yet understudied risk factor for heart failure (HF), a global health burden with rising prevalence. While toxic metals like cadmium (Cd), mercury (Hg), and arsenic (As) are linked to cardiovascular diseases, their roles in HF incidence and prognosis remain unclear. The associations between heavy metals and HF outcomes were analyzed using NHANES 2003–2018 data (n = 11,592). Metals were measured in blood (Cd, Hg, Pb) and urine (As, Hg, others) using inductively coupled plasma mass spectrometry (ICP-MS). Confounding factors were addressed through propensity score matching (PSM). HF incidence was evaluated using logistic regression, while mortality was assessed via Cox regression. Mechanistic pathways were explored through causal mediation analysis. After PSM (n = 987, 337 HF cases), blood Cd showed a positive association with HF incidence (OR:1.35, 95

ObjectiveTo explore the correlation between cholesterol levels and 24-h dynamic blood pressure in postmenopausal women with osteoporosis.MethodsAmbulatory blood pressure monitoring was performed using a portable automated device, and cholesterol levels were measured using a fully automated biochemical analyzer. The relationship between cholesterol and blood pressure was analyzed using Shepherd’s Pi correlation and generalized additive models (GAM) with piecewise linear regression to identify threshold effects.ResultsThe mean age of the participants was 73 years. Shepherd’s Pi correlation analysis revealed a negative correlation between total cholesterol (TC) and intact parathyroid hormone (iPTH), as well as between high-density lipoprotein cholesterol (HDL-C) and β-crosslaps. Using GAM and piecewise linear regression to identify threshold effects, we found that when TC was ≥5.5 mmol/L, it was significantly and positively associated with 24-h mean systolic blood pressure (SBP) (β = 12.62, 95% CI: 5.23–20.00, p < 0.001), as well as with diurnal and nocturnal mean SBP. Similarly, low-density lipoprotein cholesterol (LDL-C) ≥ 3.9 mmol/L showed a positive correlation with multiple blood pressure parameters, including 24-mSBP (β = 18.33, 95% CI: 5.93–30.74, p = 0.004), diastolic blood pressure (DBP), and both diurnal and nocturnal measurements. No significant associations were observed below these threshold values. In contrast, HDL-C < 1 mmol/L was negatively correlated with 24-mSBP (β = −32.13, 95% CI: −57.67 to −6.60, p = 0.014), but not with DBP.ConclusionA threshold effect exists between cholesterol and blood pressure in postmenopausal osteoporosis patients. Elevated TC and LDL-C beyond specific thresholds, as well as low HDL-C, are associated with higher blood pressure levels.

ObjectivesThe association between vitamin D and blood pressure in elderly patients with hypertension complicated by osteoporosis remains unclear. The objective of this study is to explore whether vitamin D deficiency contributes to elevated blood pressure in elderly individuals with both hypertension and osteoporosis.MethodsThis study represents a single-center retrospective observational investigation carried out at the Zhongshan Hospital Affiliated to Xiamen University. Ambulatory blood pressure, bone density, vitamin D levels, and additional laboratory parameters were collected upon admission. The association between vitamin D and ambulatory blood pressure outcomes was assessed using Spearman correlation tests and partial correlation analyses. The relationship between vitamin D and changes in blood pressure was analyzed through Generalized Additive Models, and threshold analysis was conducted to explore potential thresholds.Results139 patients with newly diagnosed osteoporosis were consecutively included (mean age 73 years, 84.9% female). There is a negative correlation between 25-(OH) D3 and 24 h mean systolic blood pressure (mSBP), diurnal mSBP, nocturnal mSBP, maximum SBP, respectively. The results of the generalized additive model analysis show that there is a nonlinear relationship between 25-(OH) D3 and 24 h mSBP, diurnal mSBP, nocturnal mSBP, respectively. After determining the critical point of 25-(OH) D3 as 42 nmol/L, a segmented linear regression model was used to calculate the effect size and 95% confidence interval on both sides of the critical point. When 25-(OH) D3 is ≤42 nmol/L, it significantly negatively correlates with 24 h, diurnal, and nocturnal mean SBP. Conversely, when 25-(OH) D3 exceeds 42 nmol/L, there is no statistically significant association with 24 h, diurnal, or nocturnal mSBP.ConclusionThere was a significant negative correlation between vitamin D levels and blood pressure levels in elderly patients with hypertension and osteoporosis.

Objectives The relationship between the MELD-XI score, a modified version of the MELD score, and the long-term prognosis of hospitalized patients with chronic heart failure is unclear. The aim of this study was to determine the long-term prognostic relationship of MELD-XI score in patients with chronic heart failure. Methods This is a retrospective cohort study of patients with chronic heart failure who were initially hospitalized in the Second Affiliated Hospital of Chongqing Medical University from February 2017 to December 2017. The primary clinical outcome was all-cause mortality within 3 years. Cox regression and lasso regression were used to screen variables and build a prognostic model. Combined with the MELD-XI score, the final model was adjusted, and the predictive ability of the model was evaluated. Survival curves were estimated using the Kaplan–Meier method and compared by the log rank test. Results A total of 400 patients with chronic heart failure were included (median age 76 years, 51.5% female). During the 3-year follow-up period, there were 97 all-cause deaths, including 63 cardiac deaths. Six characteristic variables (NT-proBNP, BUN, RDW CV, Na+ and prealbumin) were selected by univariate Cox regression and lasso regression. Survival analysis results showed that elevated MELD-XI score at baseline predicted the risk of all-cause mortality at 3 years in patients (HR 3.19, 95% CI 2.11–4.82, P < 0.001; HRadjusted 1.79, 95% CI 1.09–2.92, P = 0.020). Subgroup analysis showed that MELD-XI score still had prognostic value in the subgroup without chronic kidney disease (HR 3.30 95%CI 2.01–5.42 P < 0.001; HRadjusted 1.88 95%CI 1.06–3.35 P = 0.032, P for interaction = 0.038). Conclusions This study proved that the MELD-XI score at admission was related to the poor prognosis of hospitalized patients with chronic heart failure within 3 years.

Abstract Aims Chronic heart failure (CHF) is often a common comorbidity in critically ill patients admitted to the intensive care unit (ICU) and carries an extremely poor prognosis. The study aimed to investigate the relationship between the blood urea nitrogen to serum albumin ratio (BAR) and the prognosis of patients with CHF admitted to the ICU. Methods and results This retrospective cohort study included 1545 critically ill patients with CHF as a diagnosed comorbidity admitted to the ICU deposited in the MIMIC‐III database, of whom 90 day all‐cause mortality was 27.6% (n = 427) and in‐hospital mortality was 17.3% (n = 267). The results of multiple logistic regression analysis indicated that BAR is an independent risk factor for in‐hospital mortality in critically ill patients with CHF [compared with BAR ≤ 0.83; 0.83 < BAR ≤ 1.24: odds ratio (OR) 2.647, 95% confidence interval (CI) 1.797–3.900, P < 0.001; BAR ≥ 1.24: OR 3.628, 95% CI 2.604–5.057, P < 0.001]. Multiple COX regression analysis found a relationship between BAR and all‐cause mortality at 90 day follow‐up (0.83 < BAR ≤ 1.24: OR 1.948, 95% CI 1.259–3.014, P < 0.003; BAR ≥ 1.24: OR 1.807, 95% CI 1.154–2.830, P < 0.01; BAR ≤ 0.83 as a reference). Kaplan–Meier curves also showed similar results as well (P < 0.001). The areas under the receiver operating characteristic curves for predicting in‐hospital mortality and 90 day all‐cause mortality were 0.622 and 0.647, respectively. Conclusions BAR is an independent risk factor for in‐hospital mortality and 90 day mortality in critically ill patients with CHF admitted to the ICU.

Background and Aims: Studies have shown that dipeptidyl peptidase-4 (DDP-4) inhibitors have anti-atherosclerotic effects. However, in the PROLOGUE study, sitagliptin failed to slow the progression of carotid intima-media thickness (CIMT) relative to conventional therapy. We conducted a post hoc analysis of the PROLOGUE study and compared the effects of sitagliptin and conventional therapy on changes in CIMT in subgroups with or without hyperuricemia. Methods: The PROLOGUE study was a randomized controlled trial of 442 patients with type 2 diabetes mellitus (T2DM). Patients were randomized to receive sitagliptin added therapy or conventional therapy. Based on the serum uric acid levels of all study populations in the PROLOGUE study, we divided them into hyperuricemia subgroup ( n = 104) and non-hyperuricemia subgroup ( n = 331). The primary outcome was changed in carotid intima-media thickness (CIMT) parameters compared with baseline during the 24 months treatment period. Results: In the hyperuricemia subgroup, compared with the conventional therapy group, the changes in the mean internal carotid artery (ICA)-IMT and max ICA-IMT at 24 months were significantly lower in the sitagliptin group [−0.233 mm, 95% confidence interval (CI) (−0.419 to 0.046), p = 0.015 and −0.325 mm, 95% CI (−0.583 to −0.068), p = 0.014], although there was no significant difference in the common carotid artery CIMT. Conclusion: The results of our analysis indicated that sitagliptin attenuated the progression of CIMT than conventional therapy in T2DM and hyperuricemia patients.

Backgroundː Previous studies have shown that both serum creatinine and D-dimer levels were associated with atherosclerotic coronary artery disease (CAD). We aimed to determine whether DCR is associated with coronary Gensini score in patients with ST-elevation myocardial infarction (STEMI). Methodsː 337 STEMI patients with complete D-dimer and creatinine and other necessary information were included in the analysis. According to the values of the DCR, patients were divided into the lower DCR group (DCR ≤ 1.42, n = 173) and the higher DCR group (DFR > 1.42, n = 174), and the differences between the two groups were compared. Multivariate linear and multivariate logistic regression analyses were performed to determine independent predictors of Gensini score. Resultsː High DCR group had higher Gensini score compared with low DCR group (P < 0.05). DCR was positively correlated with Gensini score (r=0.493, P < 0.001). Multiple linear regression analysis showed that Previous MI (r=11.312, P=0.035) and DCR (r=5.129, P<0.001) were independent risk factors associated with Gensini score. Multivariate logistic regression analysis showed that, compared to the group 1, DCR is independent risk factor for Group 2, Group 3, Group 4 (P <0.001). DCR is positively correlated with coronary Gensini score in STEMI patients and can be used as an independent predictor of higher Gensini score. Conclusionsː As a new and useful clinical marker, DCR is positively correlated with coronary Gensini score in STEMI patients and can be used as an independent predictor of higher Gensini score.

Introduction. In recent years, gamma-glutamyl transpeptidase to platelet ratio (GPR) has been proposed as a new inflammatory marker. We aimed to evaluate the association between GPR and outcomes after cardiac arrest (CA). Methods. A total of 354 consecutive patients with CA were included in this retrospective study. Patients were divided into three groups according to tertiles of GPR (low, n = 119 ; middle, n = 117 ; and high, n = 118 ). To determine the relationship between GPR and prognosis, a logistic regression analysis was performed. The ability of GPR to predict the outcomes was evaluated by receiver operating characteristic (ROC) curve analysis. Two prediction models were established, and the likelihood ratio test (LRT) and the Akaike Information Criterion (AIC) were utilized for model comparison. Results. Among the 354 patients (age 62 [52, 74], 254/354 male) who were finally included in the analysis, those in the high GPR group had poor outcomes. Multivariate logistic regression analysis revealed that GPR was independently associated with the three outcomes, for ICU mortality ( odds ratios OR = 1.738 , 95% confidence interval (CI): 1.221-2.474, P = 0.002 ), hospital mortality ( OR = 1.676 1.164 − 2.413 , P = 0.005 ), and unfavorable neurologic outcomes ( OR = 1.623 1.121 − 2.351 , P = 0.010 ). The area under the ROC curve was 0.611 (95% Cl: 0.558-0.662) for ICU mortality, 0.600 (95% CI: 0.547-0.651) for hospital mortality, and 0.602 (95% CI: 0.549-0.653) for unfavorable neurologic outcomes. Further, the LRT analysis showed that compared with the model without GPR, the GPR-combined model had a higher likelihood ratio χ 2 score and smaller AIC. Conclusion. GPR, as an inflammatory indicator, was independently associated with outcomes after CA. GPR is helpful in estimating the clinical outcomes of patients with CA.

Aim: To investigate whether fibrinogen/albumin ratio (FAR) has an association with the coronary collateral circulation (CCC) in patients with stable coronary artery disease. Materials & methods: A total of 391 patients with stable coronary artery disease who underwent coronary angiography were included. The patients were divided into two groups according to the Rentrop score. Results: The poorly developed CCC group had a significantly higher FAR level compared with the well-developed CCC group (p < 0.001). In the multivariate analysis, the FAR (odds ratio: 1.700; 95% CI: 1.420-2.036; p < 0.001) was an independent predictor of poorly developed CCC. Conclusion: FAR can be used as one of the independent predictors of CCC formation.

This systematic review and meta-analysis aim to explore the effects of HMB on body composition in older adults. Available evidence suggests that HMB supplementation in older adults can promote increased muscle mass but may not be effective in reducing fat mass. The results of subgroup analysis indicated that exercise might limit the effect of HMB supplementation in older people, but this did not indicate that exercise did not help the muscle mass and function of older people. This study not only illustrates that HMB supplementation is an effective way to improve sarcopenia in older people but also highlights the urgent need to develop rational exercise programs to meet the needs of older people. Beta-hydroxy beta-methylbutyrate (HMB), a metabolite of leucine, is currently widely used in athletes to increase muscle mass and strength and has also been used as a nutritional supplement in recent years to maintain muscle mass in muscular atrophic diseases of older people. However, the effects of HMB supplementation on muscle mass, muscle strength, and physical function in older people remain controversial. The purpose of this review was to explore the effects of HMB on body composition in older adults. The PubMed, EMBASE and Cochrane Central Register of Controlled Trials databases were searched to obtain the randomized controlled trials needed as a basis for systematic review and meta-analysis. A total of 9 studies (448 participants) were eventually found eligible. The pooled results showed that HMB supplementation significantly increased fat-free mass in older people compared with the control group (effect size: 0.37; 95% Cl 0.16, 0.58; Z value = 3.47, P = 0.001; Fixed-effect model). But it had no effect on fat mass (effect size: − 0.04 95% CI − 0.26, 0.18; Z value = 0.36, P = 0.716, fixed-effect model). Subgroup analysis of HMB supplementation alone showed a significant improvement in fat-free mass in older people (effect size: 0.59; 95% CI 0.32, 0.87; Z = 4.24, P < 0.001; fixed-effect model), whereas HMB supplementation combined with exercise intervention showed no additional fat-free mass change (effect size: 0.06; 95% CI − 0.26, 0.38; Z = 0.38, P = 0.705; Fixed-effect model). HMB supplementation is beneficial for improving body composition in older people. However, the effect of HMB supplementation combined with exercise therapy to improve muscle mass is not obvious. Exercise programs need to be designed according to the different physical health of older people.