Sleep, stress and appetite

OVERVIEW + STUDY DETAILS

Follow the evidence.

Start with the finding and its limits.
Open the study details to look closer.

Controlled study

Short sleep, hormones and hunger: the Spiegel experiment

Sleep restriction experiment • PMID 15583226

In a crossover experiment involving 12 young men, restricted sleep was associated with 18% lower leptin, 28% higher ghrelin and 24% greater subjective hunger than sleep extension.

Evidence design: Randomized crossover clinical trial
Population: Healthy young men; mean age 22 years and mean BMI 23.6 kg/m².
Assessment period: After two days in each experimental condition
Reported units: % relative difference

Keep in view

Only 12 young men, with two two-day conditions; not representative of all populations.
It does not establish future weight gain or a universal hormonal pattern.

See study details — Sleep restriction experiment

Study design and methods

Randomized crossover clinical trial

Randomized crossover trial with two two-day conditions; caloric intake and activity were controlled.

Population

Healthy young men; mean age 22 years and mean BMI 23.6 kg/m².

Study design: Randomized crossover trial with two two-day conditions; caloric intake and activity were controlled.
Reported sample count: 12
Role of the reported sample count: Reported study sample; not necessarily the denominator for each outcome
Included study count: 1
Role of the study count: Single study
Research question: Does partial sleep restriction alter appetite-related hormones and perceived hunger?
Qualified findings: In this small experiment, the restricted-sleep period showed lower leptin, higher ghrelin and greater hunger/appetite than the sleep-extension period. The finding provides short-term experimental evidence without establishing a universal hormonal pattern.
Estimand and analysis rules: Not reported or not verified
Reason the formal estimand is unavailable: A complete formal estimand was not extracted from the verified input.

Extracted outcomes

Reported values, analysis populations and uncertainty, preserved from the curated extraction.
Outcome and group	Reported value	Assessment period	Sample and denominators	Uncertainty
Mean leptin Sleep restriction versus extension Effect estimate	-18 % relative difference reported relative difference Unit: % relative difference	After two days in each experimental condition	Reported N: 12 — unique crossover-study participants; not an outcome-specific denominator 12 — unique participants; scope: crossover study	CI not supplied in the verified scope. Reported p-value: 0.04 (between condition comparison)
Mean ghrelin Sleep restriction versus extension Effect estimate	28 % relative difference reported relative difference Unit: % relative difference	After two days in each experimental condition	Reported N: 12 — unique crossover-study participants; not an outcome-specific denominator 12 — unique participants; scope: crossover study	CI not supplied in the verified scope. Reported p-value: <0.04 (between condition comparison)
Subjective hunger Sleep restriction versus extension Effect estimate	24 % relative difference reported relative difference Unit: % relative difference	After two days in each experimental condition	Reported N: 12 — unique crossover-study participants; not an outcome-specific denominator 12 — unique participants; scope: crossover study	CI not supplied in the verified scope. Reported p-value: <0.01 (between condition comparison)

Mean leptin — Sleep restriction versus extension: extraction context

Outcome role: Not specified in the consulted scope
Scale reference: relative_to_sleep_extension_condition
Extraction location: Original article abstract

The same participants experienced both conditions; do not count them as 24 people.

Mean ghrelin — Sleep restriction versus extension: extraction context

Outcome role: Not specified in the consulted scope
Scale reference: relative_to_sleep_extension_condition
Extraction location: Original article abstract

The same participants experienced both conditions; do not count them as 24 people.

Subjective hunger — Sleep restriction versus extension: extraction context

Outcome role: Not specified in the consulted scope
Scale reference: relative_to_sleep_extension_condition
Extraction location: Original article abstract

The same participants experienced both conditions; do not count them as 24 people.

What the curated evidence supports

In a crossover experiment involving 12 young men, restricted sleep was associated with 18% lower leptin, 28% higher ghrelin and 24% greater subjective hunger than sleep extension.

Limitations

Only 12 young men, with two two-day conditions; not representative of all populations.
It does not establish future weight gain or a universal hormonal pattern.

Verification scope

Verified through 2026-11-04 within the consulted scope.

Bibliographic metadata checked: Yes
Original article abstract consulted: Yes
Full-text consultation: Not consulted
full text verified fields
Official trial registry consulted: No
Statistical analysis plan consulted: No
Verification boundary: Verification is limited to the input's identified abstract/full-text fields. A trial identifier linked by an article does not imply a separate registry review.

Source record

Brief communication: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite (2004)

Source identifiers

PubMed record 15583226
Article DOI: 10.7326/0003-4819-141-11-200412070-00008

Controlled study

Acute stress, cortisol and intake: the Geliebter experiment

Cortisol and intake experiment • PMID 22983369

In Geliebter's experiment involving 20 women with obesity, comparing a cold pressor with warm water on counterbalanced days, no statistically significant relationship was found between the cortisol response and food intake.

Evidence design: Controlled, counterbalanced crossover experiment; order randomization unverified
Population: Twenty women with obesity, assessed while fasting and after an acute laboratory stressor.

Keep in view

Experiment in 20 women; counterbalanced days, with order randomization unverified in the consulted scope.
A statistically nonsignificant association does not establish the absence of any relationship.
Do not extrapolate the acute laboratory stressor to chronic stress or weight loss.

See study details — Cortisol and intake experiment

Study design and methods

Controlled, counterbalanced crossover experiment; order randomization unverified

Controlled crossover experiment on two counterbalanced days: a hand in ice-cold water for two minutes versus warm water. Random assignment of the order was not confirmed; do not label it a randomized trial.

Population

Twenty women with obesity, assessed while fasting and after an acute laboratory stressor.

Study design: Controlled crossover experiment on two counterbalanced days: a hand in ice-cold water for two minutes versus warm water. Random assignment of the order was not confirmed; do not label it a randomized trial.
Reported sample count: 20
Role of the reported sample count: Reported study sample; not necessarily the denominator for each outcome
Included study count: 1
Role of the study count: Single study
Research question: Does the cortisol response to an acute stressor predict appetite or intake at a subsequent meal?
Qualified findings: The ice-cold-water test increased cortisol and perceived stress but did not increase intake at the test meal. Hunger and desire to eat decreased in acute measurements; cortisol concentration did not show a significant relationship with subsequent intake in this experiment.
Estimand and analysis rules: Not reported or not verified
Reason the formal estimand is unavailable: A complete formal estimand was not extracted from the verified input.

What the curated evidence supports

In Geliebter's experiment involving 20 women with obesity, comparing a cold pressor with warm water on counterbalanced days, no statistically significant relationship was found between the cortisol response and food intake.

Limitations

Experiment in 20 women; counterbalanced days, with order randomization unverified in the consulted scope.
A statistically nonsignificant association does not establish the absence of any relationship.
Do not extrapolate the acute laboratory stressor to chronic stress or weight loss.

Verification scope

Verified through 2026-11-04 within the consulted scope.

Bibliographic metadata checked: Yes
Original article abstract consulted: Yes
Full-text consultation: Not consulted
full text verified fields
Official trial registry consulted: No
Statistical analysis plan consulted: No
Verification boundary: Verification is limited to the input's identified abstract/full-text fields. A trial identifier linked by an article does not imply a separate registry review.

Source record

Plasma cortisol levels in response to a cold pressor test did not predict appetite or ad libitum test meal intake in obese women (2012)

Source identifiers

PubMed record 22983369
PubMed Central: PMC3490010
Article DOI: 10.1016/j.appet.2012.08.025

Evidence review

Stress and eating: average associations in the Hill review

Stress and eating review • PMID 33913377

In Hill's review, stress showed small average associations with higher total intake (g=0.114), greater intake of foods the studies classified as less healthy (g=0.116), and lower intake of foods classified as healthy (g=−0.111).

Evidence design: Systematic review and meta-analysis
Population: Healthy adults; explicitly defined stress measures and varied eating behaviors.
Assessment period: Varying protocols and time points across the review
Reported units: Hedges’ g

Keep in view

Small average effects and between-study heterogeneity; not everyone's response.
119,820 is the review-wide total; each effect's denominator was not verified.
Food categories come from the studies; they do not morally characterize people who eat them.
It does not establish cortisol as a causal mediator.

See study details — Stress and eating review

Review design and extraction scope

Systematic review and meta-analysis

Systematic review and meta-analysis of 54 studies on stress and non-disordered eating.

Population

Healthy adults; explicitly defined stress measures and varied eating behaviors.

Study design: Systematic review and meta-analysis of 54 studies on stress and non-disordered eating.
Reported sample count: 119820
Role of the reported sample count: Review-wide total; not an outcome-specific denominator
Included study count: 54
Role of the study count: Review-wide total; not an outcome-specific denominator
Research question: What is the magnitude of the relationship between stress and total intake or food choices?
Qualified findings: Stress was associated with a small average increase in intake and in consumption of foods classified as less healthy, and with lower consumption of those classified as healthy. Significant heterogeneity was not explained by the moderators examined.
Estimand and analysis rules: Not reported or not verified
Reason the formal estimand is unavailable: A complete formal estimand was not extracted from the verified input.

How to read this review

Included studies may differ in population, design and outcomes. Review-wide counts describe coverage and cannot be used as the sample size of every estimate.

Included studies: 54 — Review-wide total; not an outcome-specific denominator.

Extracted review results and scope

Study counts describe review scope. Review-wide participant totals are not outcome-specific denominators.

Reported values, analysis populations and uncertainty, preserved from the curated extraction.
Outcome and group	Reported value	Assessment period	Sample and denominators	Uncertainty
Association with total intake Stress–eating association Effect estimate	0.114 Hedges’ g standardized association Unit: Hedges’ g	Varying protocols and time points across the review	Reported N: 119820 — review-wide participants; not an outcome-specific denominator 119820 — review total participants; scope: all review studies 54 — review total studies; scope: all review studies Not reported or not verified — outcome specific participants; scope: total intake association Not reported or not verified — outcome specific studies; scope: total intake association	Each effect's CI and denominator were not verified in the abstract.
Association with foods classified as less healthy in the studies Stress–eating association Effect estimate	0.116 Hedges’ g standardized association Unit: Hedges’ g	Varying protocols and time points across the review	Reported N: 119820 — review-wide participants; not an outcome-specific denominator 119820 — review total participants; scope: all review studies 54 — review total studies; scope: all review studies Not reported or not verified — outcome specific participants; scope: study defined less healthy food intake Not reported or not verified — outcome specific studies; scope: study defined less healthy food intake	Each effect's CI and denominator were not verified in the abstract.
Association with foods classified as healthy in the studies Stress–eating association Effect estimate	-0.111 Hedges’ g standardized association Unit: Hedges’ g	Varying protocols and time points across the review	Reported N: 119820 — review-wide participants; not an outcome-specific denominator 119820 — review total participants; scope: all review studies 54 — review total studies; scope: all review studies Not reported or not verified — outcome specific participants; scope: study defined healthier food intake Not reported or not verified — outcome specific studies; scope: study defined healthier food intake	Each effect's CI and denominator were not verified in the abstract.

Association with total intake — Stress–eating association: extraction context

Outcome role: Not specified in the consulted scope
Scale reference: standardized_effect
Extraction location: Original systematic-review abstract

Synthesis of varied designs; do not interpret it as one causal trial.

Association with foods classified as less healthy in the studies — Stress–eating association: extraction context

Outcome role: Not specified in the consulted scope
Scale reference: standardized_effect
Extraction location: Original systematic-review abstract

Synthesis of varied designs; do not interpret it as one causal trial.

Association with foods classified as healthy in the studies — Stress–eating association: extraction context

Outcome role: Not specified in the consulted scope
Scale reference: standardized_effect
Extraction location: Original systematic-review abstract

Synthesis of varied designs; do not interpret it as one causal trial.

What the curated evidence supports

In Hill's review, stress showed small average associations with higher total intake (g=0.114), greater intake of foods the studies classified as less healthy (g=0.116), and lower intake of foods classified as healthy (g=−0.111).

Limitations

Small average effects and between-study heterogeneity; not everyone's response.
119,820 is the review-wide total; each effect's denominator was not verified.
Food categories come from the studies; they do not morally characterize people who eat them.
It does not establish cortisol as a causal mediator.

Verification scope

Verified through 2026-11-04 within the consulted scope.

Bibliographic metadata checked: Yes
Original article abstract consulted: Yes
Full-text consultation: Not consulted
full text verified fields
Official trial registry consulted: No
Statistical analysis plan consulted: No
Verification boundary: Verification is limited to the input's identified abstract/full-text fields. A trial identifier linked by an article does not imply a separate registry review.

Source record

Stress and eating behaviours in healthy adults: a systematic review and meta-analysis (2022)

Source identifiers

PubMed record 33913377
Article DOI: 10.1080/17437199.2021.1923406

Evidence review

Sleep duration, food intake and hormones: a trial review

Sleep restriction review • PMID 34620371

The review of 50 trials found indications of greater intake, hunger and appetite with sleep restriction, but not a consistent pattern of changes in leptin, ghrelin and cortisol.

Evidence design: Systematic review of randomized clinical trials
Population: Adults, children and adolescents; varied populations and experimental conditions.
Assessment period: Study count, with no single intervention duration
Reported units: trials

Keep in view

Protocols and age groups varied; no single verified magnitude applies to all outcomes.
50 counts trials, not participants or the denominator for each outcome.
Reviews may share trials; do not sum their samples as independent evidence.

See study details — Sleep restriction review

Review design and extraction scope

Systematic review of randomized clinical trials

Systematic review of randomized trials; search through July 2020.

Population

Adults, children and adolescents; varied populations and experimental conditions.

Study design: Systematic review of randomized trials; search through July 2020.
Reported sample count: Not reported or not verified
Role of the reported sample count: Review-wide total; not an outcome-specific denominator
Included study count: 50
Role of the study count: Review-wide total; not an outcome-specific denominator
Research question: How does sleep duration affect intake, desire to eat, body measurements and hormones?
Qualified findings: The review suggests greater intake, hunger and appetite with sleep restriction. The synthesis did not identify a consistent influence on leptin, ghrelin and cortisol. This supports cautious wording about hormonal mechanisms.
Estimand and analysis rules: Not reported or not verified
Reason the formal estimand is unavailable: A complete formal estimand was not extracted from the verified input.

How to read this review

Included studies may differ in population, design and outcomes. Review-wide counts describe coverage and cannot be used as the sample size of every estimate.

Included studies: 50 — Review-wide total; not an outcome-specific denominator.

Extracted review results and scope

Study counts describe review scope. Review-wide participant totals are not outcome-specific denominators.

Reported values, analysis populations and uncertainty, preserved from the curated extraction.
Outcome and group	Reported value	Assessment period	Sample and denominators	Uncertainty
Trials included in the review Review scope Review scope count; not a clinical effect	50 trials Included study count Unit: trials	Study count, with no single intervention duration	Participant N: not applicable to a study count Not reported or not verified — review total participants not verified; scope: review	Review-scope count, not an estimated effect; a CI is not applicable.

Trials included in the review — Review scope: extraction context

Outcome role: Not specified in the consulted scope
Extraction location: Original systematic-review abstract

43 adult trials and seven child/adolescent trials; do not use 50 as a participant denominator.

What the curated evidence supports

The review of 50 trials found indications of greater intake, hunger and appetite with sleep restriction, but not a consistent pattern of changes in leptin, ghrelin and cortisol.

Limitations

Protocols and age groups varied; no single verified magnitude applies to all outcomes.
50 counts trials, not participants or the denominator for each outcome.
Reviews may share trials; do not sum their samples as independent evidence.

Verification scope

Verified through 2026-11-04 within the consulted scope.

Bibliographic metadata checked: Yes
Original article abstract consulted: Yes
Full-text consultation: Not consulted
full text verified fields
Official trial registry consulted: No
Statistical analysis plan consulted: No
Verification boundary: Verification is limited to the input's identified abstract/full-text fields. A trial identifier linked by an article does not imply a separate registry review.

Source record

Effect of sleep duration on dietary intake, desire to eat, measures of food intake and metabolic hormones: A systematic review of clinical trials (2021)

Source identifiers

PubMed record 34620371
Article DOI: 10.1016/j.clnesp.2021.07.029

Controlled study

Sleep extension and energy intake: the Tasali trial

Sleep extension trial • NCT02253368

In Tasali's trial involving 80 adults with overweight and short sleep, two weeks of sleep extension produced a −270 kcal/day difference in the change in estimated energy intake relative to control (95% CI −393 to −147).

In the same trial, the difference in sleep duration was 1.2 hours per night in favor of the intervention (95% CI 1.0–1.4).

Weight results during 68 or 72 treatment weeks and a two-week sleep intervention answer different questions from a withdrawal comparison after initial treatment. SURMOUNT-4 provides that specific comparison for 52 weeks after randomization.

Evidence design: Randomized parallel clinical trial
Population: Adults aged 21–40 years, with BMI 25.0–29.9 kg/m² and habitual sleep shorter than 6.5 h/night.
Assessment period: Two intervention weeks following two baseline weeks
Reported units: kcal/day; hours/night

Keep in view

80 adults aged 21–40 with overweight and habitual sleep shorter than 6.5 hours; single center.
Two intervention weeks do not establish sustained weight-loss maintenance.
Intake was estimated from energy balance, not measured by directly counting food.

See study details — Sleep extension trial

Study design and methods

Randomized parallel clinical trial

Single-center randomized trial; two baseline weeks and two intervention weeks in the usual environment; intention-to-treat analysis.

Population

Adults aged 21–40 years, with BMI 25.0–29.9 kg/m² and habitual sleep shorter than 6.5 h/night.

Study design: Single-center randomized trial; two baseline weeks and two intervention weeks in the usual environment; intention-to-treat analysis.
Reported sample count: 80
Role of the reported sample count: Reported study sample; not necessarily the denominator for each outcome
Included study count: 1
Role of the study count: Single study
Research question: Does extending sleep reduce objectively estimated energy intake in adults with overweight and short sleep?
Qualified findings: Counseling to extend sleep increased sleep duration and reduced estimated intake compared with control. Total expenditure did not differ significantly. This is a two-week finding; it does not demonstrate weight-loss maintenance.
Estimand and analysis rules: Not reported or not verified
Reason the formal estimand is unavailable: A complete formal estimand was not extracted from the verified input.

Extracted outcomes

Reported values, analysis populations and uncertainty, preserved from the curated extraction.
Outcome and group	Reported value	Assessment period	Sample and denominators	Uncertainty
Sleep duration Sleep extension minus control Effect estimate	1.2 hours/night reported between-group change difference Unit: hours/night	Two intervention weeks following two baseline weeks	Reported N: 80 — total randomized trial sample; not a group denominator 80 — randomized total; scope: trial	95% confidence interval: 1 to 1.4 Reported p-value: <0.001 (Between-group comparison)
Estimated energy intake Sleep extension minus control Effect estimate	-270 kcal/day reported between-group change difference Unit: kcal/day	Two intervention weeks following two baseline weeks	Reported N: 80 — total randomized trial sample; not a group denominator 80 — randomized total; scope: trial	95% confidence interval: -393 to -147 Reported p-value: <0.001 (Between-group comparison)

Sleep duration — Sleep extension minus control: extraction context

Outcome role

Not specified in the consulted scope

Scale reference

intervention_vs_control_change

Estimand and analysis rules

Name: Not reported or not verified
Analysis population: Intention-to-treat, as described in the verified input
formal estimand not extracted: Yes

Extraction location

Original article abstract; intervention duration checked in PMC full text

N=80 is the trial total; arm sizes and effect-specific N were not extracted.

Estimated energy intake — Sleep extension minus control: extraction context

Outcome role

Not specified in the consulted scope

Scale reference

intervention_vs_control_change

Estimand and analysis rules

Name: Not reported or not verified
Analysis population: Intention-to-treat, as described in the verified input
formal estimand not extracted: Yes

Extraction location

Original article abstract; intervention duration checked in PMC full text

N=80 is the trial total; arm sizes and effect-specific N were not extracted.

What the curated evidence supports

In Tasali's trial involving 80 adults with overweight and short sleep, two weeks of sleep extension produced a −270 kcal/day difference in the change in estimated energy intake relative to control (95% CI −393 to −147).
In the same trial, the difference in sleep duration was 1.2 hours per night in favor of the intervention (95% CI 1.0–1.4).
Weight results during 68 or 72 treatment weeks and a two-week sleep intervention answer different questions from a withdrawal comparison after initial treatment. SURMOUNT-4 provides that specific comparison for 52 weeks after randomization.

Limitations

80 adults aged 21–40 with overweight and habitual sleep shorter than 6.5 hours; single center.
Two intervention weeks do not establish sustained weight-loss maintenance.
Intake was estimated from energy balance, not measured by directly counting food.

Verification scope

Verified through 2026-11-04 within the consulted scope.

Bibliographic metadata checked: Yes
Original article abstract consulted: Yes
Full-text consultation: selected_fields_only
full text verified fields: intervention_duration
pmcid_linkage
Official trial registry consulted: No
Statistical analysis plan consulted: No
Verification boundary: Verification is limited to the input's identified abstract/full-text fields. A trial identifier linked by an article does not imply a separate registry review.

Source record

Effect of Sleep Extension on Objectively Assessed Energy Intake Among Adults With Overweight in Real-life Settings: A Randomized Clinical Trial (2022)

Source identifiers

PubMed record 35129580
PubMed Central: PMC8822469
Article DOI: 10.1001/jamainternmed.2021.8098

Evidence review

Sleep and emotional eating: a review of associations

Sleep and emotional eating review • PMID 37242168

The Zeron-Rugerio review brings together studies of sleep and emotional eating and supports discussion of their association; the selected evidence does not establish that either causes the other.

Evidence design: Systematic review of observational and interventional studies
Population: Populations from studies on sleep, eating behavior and obesity; this does not represent a single clinical population.

Keep in view

Association does not establish causal direction or an individual's response.
No pooled magnitude, CI or effect-specific denominator was verified for this card.

See study details — Sleep and emotional eating review

Review design and extraction scope

Systematic review of observational and interventional studies

Systematic review of cross-sectional, longitudinal and intervention studies; searches in Medline and Scopus, from January 2011 to December 2022.

Population

Populations from studies on sleep, eating behavior and obesity; this does not represent a single clinical population.

Study design: Systematic review of cross-sectional, longitudinal and intervention studies; searches in Medline and Scopus, from January 2011 to December 2022.
Reported sample count: Not reported or not verified
Role of the reported sample count: Review-wide total; not an outcome-specific denominator
Included study count: Not reported or not verified
Role of the study count: Review-wide total; not an outcome-specific denominator
Research question: Can emotional eating and disinhibition help explain the association between inadequate sleep and obesity?
Qualified findings: The review identifies associations of inadequate sleep with emotional eating and disinhibition, particularly among women. The authors propose these behaviors as possible links in the sleep–obesity relationship; the synthesis does not establish universal causal mediation or the efficacy of a specific intervention.
Estimand and analysis rules: Not reported or not verified
Reason the formal estimand is unavailable: A complete formal estimand was not extracted from the verified input.

How to read this review

Included studies may differ in population, design and outcomes. Review-wide counts describe coverage and cannot be used as the sample size of every estimate.

What the curated evidence supports

The Zeron-Rugerio review brings together studies of sleep and emotional eating and supports discussion of their association; the selected evidence does not establish that either causes the other.

Limitations

Association does not establish causal direction or an individual's response.
No pooled magnitude, CI or effect-specific denominator was verified for this card.

Verification scope

Verified through 2026-11-04 within the consulted scope.

Bibliographic metadata checked: Yes
Original article abstract consulted: Yes
Full-text consultation: Not consulted
full text verified fields
Official trial registry consulted: No
Statistical analysis plan consulted: No
Verification boundary: Verification is limited to the input's identified abstract/full-text fields. A trial identifier linked by an article does not imply a separate registry review.

Source record

Are Emotional Eating and Other Eating Behaviors the Missing Link in the Relationship between Inadequate Sleep and Obesity? A Systematic Review (2023)

Source identifiers

PubMed record 37242168
PubMed Central: PMC10223856
Article DOI: 10.3390/nu15102286

THE RESEARCH LANDSCAPE

Explore the research landscape

See the scale of the consolidated catalog, the prioritized registry cohort, and the smaller set of evidence cards published in this release.

46,042

Consolidated research records

112,151

Mapped files

Scientific catalog areas

Explore all 16 scientific areas

Clinical obesity and overweight14,981

GLP-1, GIP and incretin medicines2,081

Insulin resistance and glycemic health6,298

Calorie deficit and energy balance580

Thermogenesis and energy expenditure461

Fat oxidation and ketosis74

Intermittent fasting and chrononutrition621

Nutrition, eating and satiety5,932

Muscle preservation and body composition3,735

Gut microbiome and metabolomics607

Physical activity and exercise3,696

Sleep, stress and eating behavior1,358

Weight maintenance and regain164

Bariatric and metabolic surgery2,383

Digital technologies and remote interventions585

Cardiovascular, liver and inflammatory outcomes2,486

Catalog identities consolidate DOI, NCT, PMID, PMCID and normalized titles; the count is not a certified count of independent peer-reviewed publications.

Prioritized clinical registry records

570 records

Weight as a primary outcome: 342
BMI as a primary outcome: 112
Adiposity or waist as a primary outcome: 49
Weight-related outcomes only as secondary outcomes: 29
No direct weight-related outcome identified: 38

Each record has one principal outcome class. This classification does not mean that a trial has only one outcome or that its findings have passed full scientific appraisal.

PUBLISHED CURATED EVIDENCE

13evidence cards

Directed selection of sources and claims verified within the fields and sections actually consulted.

60 result records23 reviewed claims

Search covers these 13 published evidence cards.

Catalog size and metadata completeness do not grade scientific certainty. The 570-record panorama describes a prioritized registry cohort, not 570 publicly reviewed evidence cards.

THE INAUGURAL BRIEFING

Video in preparation

Muscle, Strength & Weight Loss: What Does DXA Measure?

Planned inaugural nuViteo YouTube briefing on DXA lean mass, skeletal muscle, and strength, grounded in the SURMOUNT-1 substudy and EWGSOP2 evidence.

Read the briefing outline

OVERVIEW + STUDY DETAILS

Sources supporting the briefing.

Start with the finding and its limits.
Open the study details to look closer.

Conceptual consensus

EWGSOP2: sarcopenia definition and assessment

EWGSOP2 • PMID 30312372

In this analysis, DXA lean mass is fat-free mass minus bone mineral content. It includes tissues other than muscle and, alone, does not describe strength or diagnose sarcopenia.

Under EWGSOP2, low strength indicates probable sarcopenia; low muscle quantity or quality confirms the diagnosis, and low physical performance together with the other criteria identifies severe sarcopenia.

Evidence design: Diagnostic consensus concept

Keep in view

Diagnostic consensus; it does not estimate a treatment effect or individual risk.
A decrease in total DXA lean mass alone does not diagnose sarcopenia.

See study details — EWGSOP2

Definitions and assessment framework

Diagnostic consensus concept

Expert consensus updating the European definition and diagnostic approach to sarcopenia; not an intervention trial.

Diagnostic concepts

Diagnostic state
Probable sarcopenia
Definition
Low muscle strength identifies probable sarcopenia.
Diagnostic state
Confirmed sarcopenia
Definition
Low muscle quantity or quality confirms the diagnosis in the presence of low strength.
Diagnostic state
Severe sarcopenia
Definition
Low strength, low muscle quantity/quality and low physical performance together identify severe sarcopenia.

Assessment sequence

Find cases
Assess muscle strength
Confirm muscle quantity or quality
Determine severity with physical performance

What the curated evidence supports

In this analysis, DXA lean mass is fat-free mass minus bone mineral content. It includes tissues other than muscle and, alone, does not describe strength or diagnose sarcopenia.
Under EWGSOP2, low strength indicates probable sarcopenia; low muscle quantity or quality confirms the diagnosis, and low physical performance together with the other criteria identifies severe sarcopenia.

Limitations

Diagnostic consensus; it does not estimate a treatment effect or individual risk.
A decrease in total DXA lean mass alone does not diagnose sarcopenia.

Verification scope

Verified through 2026-11-04 within the consulted scope.

Bibliographic metadata checked: Yes
Original article abstract consulted: Yes
Full-text consultation: Consulted
Official trial registry consulted: No
Statistical analysis plan consulted: No
Verification boundary: Verification is limited to the specific fields and sources consulted; it is not a full systematic appraisal or GRADE rating.

Source record

Sarcopenia: revised European consensus on definition and diagnosis (2019). Age and ageing.

Source identifiers

Article DOI: 10.1093/ageing/afy169
PubMed record 30312372
PubMed Central: PMC6322506

Controlled study

SURMOUNT-1 DXA: weight, fat and lean soft tissue at 72 weeks

SURMOUNT-1 DXA • NCT04184622

The DXA substudy analyzed 160 participants: 124 receiving pooled tirzepatide doses and 36 receiving placebo. At 72 weeks, changes in weight, fat and lean mass were −21.3%, −33.9% and −10.9% with tirzepatide, versus −5.3%, −8.2% and −2.6% with placebo.

In this analysis, DXA lean mass is fat-free mass minus bone mineral content. It includes tissues other than muscle and, alone, does not describe strength or diagnose sarcopenia.

The article describes roughly three quarters of combined fat and lean mass losses as fat. This sample-level composition does not justify saying that one quarter of lost weight was skeletal muscle.

Evidence design: Randomized trial substudy
Population: Subset of SURMOUNT-1 adults with obesity or overweight and a weight-related complication, without type 2 diabetes; 73.1% female; mean age 46.2 years, weight 102.5 kg and BMI 38.0 kg/m2.
Assessment period: Baseline to week 72
Reported units: percentage points; % change; % of combined fat and lean mass loss; kg

Keep in view

160 of 255 substudy enrollees were analyzed; 5, 10 and 15 mg doses were pooled.
DXA lean mass does not directly measure skeletal muscle or strength.
There was no multiplicity adjustment; missing data from three participants used last observation carried forward.

See study details — SURMOUNT-1 DXA

Study design and methods

Randomized trial substudy

Prespecified DXA body-composition substudy nested within randomized SURMOUNT-1; pooled tirzepatide doses; additional post hoc subgroup analyses.

Population

Subset of SURMOUNT-1 adults with obesity or overweight and a weight-related complication, without type 2 diabetes; 73.1% female; mean age 46.2 years, weight 102.5 kg and BMI 38.0 kg/m2.

Assessment period

Value: 72
Unit: weeks

Parent trial randomized participants

2539

Substudy enrollees

255

Substudy analyzed participants

160

Analyzed participants by arm

Tirzepatide, pooled doses: 124
Placebo: 36

Analysis denominator basis

Participants in the substudy who were randomized, received >=1 dose and had nonmissing baseline and postbaseline DXA measurements. Of 255 enrolled, 160 completed baseline and week-72 or early-discontinuation scans and were included.

Dose pooling

5, 10 and 15 mg tirzepatide pooled; these results cannot be relabeled as a 15-mg-only effect.

Measurement definition

Measurement method: Whole-body dual-energy X-ray absorptiometry (DXA)
Measurement timing: Baseline before first dose and end of treatment at week 72 (within 14 days) or early discontinuation.
DXA lean mass definition: DXA lean mass = fat-free mass minus total bone mineral content. It is lean soft tissue, not a direct skeletal-muscle measurement.
Fat-free mass definition: Includes nonfat tissues such as muscle, bone, organs, ligaments, tendons and water; fat-free mass itself was not the reported endpoint.
Skeletal muscle measured directly: No
Direct strength or physical-performance outcome in this card: No

Statistical analysis

Analysis population label in the figure: Modified intention-to-treat population (efficacy analysis set)
Statistical model: ANCOVA for body weight, fat and lean measures: baseline response covariate and treatment factor; waist used MMRM.
Missing-data handling: Three missing week-72 observations imputed by last observation carried forward.
Multiplicity adjustment: No
Formal estimand specification: Efficacy analysis set; a separate, fully specified five-attribute estimand was not verified in the substudy full text.
Parent-trial estimand must not be inherited without qualification: Yes

Extracted outcomes

Reported values, analysis populations and uncertainty, preserved from the curated extraction.
Outcome and group	Reported value	Assessment period	Sample and denominators	Uncertainty
Percent change in body weight Tirzepatide pooled 5/10/15 mg Effect estimate	-21.3 % change least-squares mean Unit: % change	Baseline to week 72 Study weeks 0–72	Reported N: 124 — substudy analysis population 2539 — parent trial randomized total; scope: parent trial 255 — substudy enrolled; scope: DXA substudy 160 — substudy analyzed; scope: DXA substudy 124 — substudy analysis arm; scope: Tirzepatide, pooled doses	Arm confidence interval not verified; no reconstruction was performed.
Percent change in body weight Placebo Effect estimate	-5.3 % change least-squares mean Unit: % change	Baseline to week 72 Study weeks 0–72	Reported N: 36 — substudy analysis population 2539 — parent trial randomized total; scope: parent trial 255 — substudy enrolled; scope: DXA substudy 160 — substudy analyzed; scope: DXA substudy 36 — substudy analysis arm; scope: Placebo	Arm confidence interval not verified; no reconstruction was performed.
Percent change in body weight Pooled tirzepatide minus placebo Effect estimate	-16 percentage points adjusted mean difference Unit: percentage points	Baseline to week 72 Study weeks 0–72	Reported N: 160 — combined substudy analysis population 2539 — parent trial randomized total; scope: parent trial 255 — substudy enrolled; scope: DXA substudy 160 — substudy analyzed; scope: DXA substudy	95% confidence interval: -19.4 to -12.6 Reported p-value: <0.001 (between group comparison no multiplicity adjustment)
Percent change in fat mass Tirzepatide pooled 5/10/15 mg Effect estimate	-33.9 % change least-squares mean Unit: % change	Baseline to week 72 Study weeks 0–72	Reported N: 124 — substudy analysis population 2539 — parent trial randomized total; scope: parent trial 255 — substudy enrolled; scope: DXA substudy 160 — substudy analyzed; scope: DXA substudy 124 — substudy analysis arm; scope: Tirzepatide, pooled doses	Arm confidence interval not verified; no reconstruction was performed.
Percent change in fat mass Placebo Effect estimate	-8.2 % change least-squares mean Unit: % change	Baseline to week 72 Study weeks 0–72	Reported N: 36 — substudy analysis population 2539 — parent trial randomized total; scope: parent trial 255 — substudy enrolled; scope: DXA substudy 160 — substudy analyzed; scope: DXA substudy 36 — substudy analysis arm; scope: Placebo	Arm confidence interval not verified; no reconstruction was performed.
Percent change in fat mass Pooled tirzepatide minus placebo Effect estimate	-25.7 percentage points adjusted mean difference Unit: percentage points	Baseline to week 72 Study weeks 0–72	Reported N: 160 — combined substudy analysis population 2539 — parent trial randomized total; scope: parent trial 255 — substudy enrolled; scope: DXA substudy 160 — substudy analyzed; scope: DXA substudy	95% confidence interval: -31.4 to -20 Reported p-value: <0.001 (between group comparison no multiplicity adjustment)
Percent change in DXA lean soft tissue mass Tirzepatide pooled 5/10/15 mg Effect estimate	-10.9 % change least-squares mean Unit: % change	Baseline to week 72 Study weeks 0–72	Reported N: 124 — substudy analysis population 2539 — parent trial randomized total; scope: parent trial 255 — substudy enrolled; scope: DXA substudy 160 — substudy analyzed; scope: DXA substudy 124 — substudy analysis arm; scope: Tirzepatide, pooled doses	Arm confidence interval not verified; no reconstruction was performed.
Percent change in DXA lean soft tissue mass Placebo Effect estimate	-2.6 % change least-squares mean Unit: % change	Baseline to week 72 Study weeks 0–72	Reported N: 36 — substudy analysis population 2539 — parent trial randomized total; scope: parent trial 255 — substudy enrolled; scope: DXA substudy 160 — substudy analyzed; scope: DXA substudy 36 — substudy analysis arm; scope: Placebo	Arm confidence interval not verified; no reconstruction was performed.
Percent change in DXA lean soft tissue mass Pooled tirzepatide minus placebo Effect estimate	-8.3 percentage points adjusted mean difference Unit: percentage points	Baseline to week 72 Study weeks 0–72	Reported N: 160 — combined substudy analysis population 2539 — parent trial randomized total; scope: parent trial 255 — substudy enrolled; scope: DXA substudy 160 — substudy analyzed; scope: DXA substudy	95% confidence interval: -10.6 to -6.1 Reported p-value: <0.001 (between group comparison no multiplicity adjustment)
Absolute change in fat mass Tirzepatide pooled 5/10/15 mg Effect estimate	-15.9 kg least-squares mean Unit: kg	Baseline to week 72 Study weeks 0–72	Reported N: 124 — substudy analysis population 2539 — parent trial randomized total; scope: parent trial 255 — substudy enrolled; scope: DXA substudy 160 — substudy analyzed; scope: DXA substudy 124 — substudy analysis arm; scope: Tirzepatide, pooled doses	Arm confidence interval not verified; no reconstruction was performed.
Absolute change in fat mass Placebo Effect estimate	-3.6 kg least-squares mean Unit: kg	Baseline to week 72 Study weeks 0–72	Reported N: 36 — substudy analysis population 2539 — parent trial randomized total; scope: parent trial 255 — substudy enrolled; scope: DXA substudy 160 — substudy analyzed; scope: DXA substudy 36 — substudy analysis arm; scope: Placebo	Arm confidence interval not verified; no reconstruction was performed.
Absolute change in fat mass Pooled tirzepatide minus placebo Effect estimate	-12.3 kg adjusted mean difference Unit: kg	Baseline to week 72 Study weeks 0–72	Reported N: 160 — combined substudy analysis population 2539 — parent trial randomized total; scope: parent trial 255 — substudy enrolled; scope: DXA substudy 160 — substudy analyzed; scope: DXA substudy	95% confidence interval: -15.1 to -9.6 Reported p-value: <0.001 (between group comparison no multiplicity adjustment)
Absolute change in DXA lean soft tissue mass Tirzepatide pooled 5/10/15 mg Effect estimate	-5.6 kg least-squares mean Unit: kg	Baseline to week 72 Study weeks 0–72	Reported N: 124 — substudy analysis population 2539 — parent trial randomized total; scope: parent trial 255 — substudy enrolled; scope: DXA substudy 160 — substudy analyzed; scope: DXA substudy 124 — substudy analysis arm; scope: Tirzepatide, pooled doses	Arm confidence interval not verified; no reconstruction was performed.
Absolute change in DXA lean soft tissue mass Placebo Effect estimate	-1.2 kg least-squares mean Unit: kg	Baseline to week 72 Study weeks 0–72	Reported N: 36 — substudy analysis population 2539 — parent trial randomized total; scope: parent trial 255 — substudy enrolled; scope: DXA substudy 160 — substudy analyzed; scope: DXA substudy 36 — substudy analysis arm; scope: Placebo	Arm confidence interval not verified; no reconstruction was performed.
Absolute change in DXA lean soft tissue mass Pooled tirzepatide minus placebo Effect estimate	-4.4 kg adjusted mean difference Unit: kg	Baseline to week 72 Study weeks 0–72	Reported N: 160 — combined substudy analysis population 2539 — parent trial randomized total; scope: parent trial 255 — substudy enrolled; scope: DXA substudy 160 — substudy analyzed; scope: DXA substudy	95% confidence interval: -5.6 to -3.2 Reported p-value: <0.001 (between group comparison no multiplicity adjustment)
Fat fraction of combined fat and lean mass losses Pooled tirzepatide Descriptive result; not an effect estimate	74 % of combined fat and lean mass loss reported proportion Unit: % of combined fat and lean mass loss	Baseline to week 72 Study weeks 0–72	Reported N: 124 — substudy analysis population 2539 — parent trial randomized total; scope: parent trial 255 — substudy enrolled; scope: DXA substudy 160 — substudy analyzed; scope: DXA substudy	Confidence interval for the fraction not verified.
Lean soft tissue fraction of combined fat and lean mass losses Pooled tirzepatide Descriptive result; not an effect estimate	26 % of combined fat and lean mass loss reported proportion Unit: % of combined fat and lean mass loss	Baseline to week 72 Study weeks 0–72	Reported N: 124 — substudy analysis population 2539 — parent trial randomized total; scope: parent trial 255 — substudy enrolled; scope: DXA substudy 160 — substudy analyzed; scope: DXA substudy	Confidence interval for the fraction not verified.
Fat fraction of combined fat and lean mass losses Placebo Descriptive result; not an effect estimate	75 % of combined fat and lean mass loss reported proportion Unit: % of combined fat and lean mass loss	Baseline to week 72 Study weeks 0–72	Reported N: 36 — substudy analysis population 2539 — parent trial randomized total; scope: parent trial 255 — substudy enrolled; scope: DXA substudy 160 — substudy analyzed; scope: DXA substudy	Confidence interval for the fraction not verified.
Lean soft tissue fraction of combined fat and lean mass losses Placebo Descriptive result; not an effect estimate	25 % of combined fat and lean mass loss reported proportion Unit: % of combined fat and lean mass loss	Baseline to week 72 Study weeks 0–72	Reported N: 36 — substudy analysis population 2539 — parent trial randomized total; scope: parent trial 255 — substudy enrolled; scope: DXA substudy 160 — substudy analyzed; scope: DXA substudy	Confidence interval for the fraction not verified.

Percent change in body weight — Tirzepatide pooled 5/10/15 mg: extraction context

Outcome role

Exploratory, post hoc

Scale reference

Baseline value of the same tissue or weight

Estimand and analysis rules

Name

Not reported or not verified

Analysis set

Modified intention-to-treat population (efficacy analysis set)

Definition verification status

Full formal estimand not verified; do not inherit the parent-trial treatment-regimen estimand.

Statistical analysis

Analysis population label in the figure: Modified intention-to-treat population (efficacy analysis set)
Statistical model: ANCOVA for body weight, fat and lean measures: baseline response covariate and treatment factor; waist used MMRM.
Missing-data handling: Three missing week-72 observations imputed by last observation carried forward.
Multiplicity adjustment: No
Formal estimand specification: Efficacy analysis set; a separate, fully specified five-attribute estimand was not verified in the substudy full text.
Parent-trial estimand must not be inherited without qualification: Yes

Extraction location

Full text section 3.2; Figure 1 or supplementary Figure S2

Percent change in body weight — Placebo: extraction context

Outcome role

Exploratory, post hoc

Scale reference

Baseline value of the same tissue or weight

Estimand and analysis rules

Name

Not reported or not verified

Analysis set

Modified intention-to-treat population (efficacy analysis set)

Definition verification status

Full formal estimand not verified; do not inherit the parent-trial treatment-regimen estimand.

Statistical analysis

Analysis population label in the figure: Modified intention-to-treat population (efficacy analysis set)
Statistical model: ANCOVA for body weight, fat and lean measures: baseline response covariate and treatment factor; waist used MMRM.
Missing-data handling: Three missing week-72 observations imputed by last observation carried forward.
Multiplicity adjustment: No
Formal estimand specification: Efficacy analysis set; a separate, fully specified five-attribute estimand was not verified in the substudy full text.
Parent-trial estimand must not be inherited without qualification: Yes

Extraction location

Full text section 3.2; Figure 1 or supplementary Figure S2

Percent change in body weight — Pooled tirzepatide minus placebo: extraction context

Outcome role

Exploratory, post hoc

Scale reference

Difference in percent change

Estimand and analysis rules

Name

Not reported or not verified

Analysis set

Modified intention-to-treat population (efficacy analysis set)

Definition verification status

Full formal estimand not verified; do not inherit the parent-trial treatment-regimen estimand.

Statistical analysis

Analysis population label in the figure: Modified intention-to-treat population (efficacy analysis set)
Statistical model: ANCOVA for body weight, fat and lean measures: baseline response covariate and treatment factor; waist used MMRM.
Missing-data handling: Three missing week-72 observations imputed by last observation carried forward.
Multiplicity adjustment: No
Formal estimand specification: Efficacy analysis set; a separate, fully specified five-attribute estimand was not verified in the substudy full text.
Parent-trial estimand must not be inherited without qualification: Yes

Extraction location

Full text section 3.2

No multiplicity adjustment.

Percent change in fat mass — Tirzepatide pooled 5/10/15 mg: extraction context

Outcome role

primary_substudy_objective

Scale reference

Baseline value of the same tissue or weight

Estimand and analysis rules

Name

Not reported or not verified

Analysis set

Modified intention-to-treat population (efficacy analysis set)

Definition verification status

Full formal estimand not verified; do not inherit the parent-trial treatment-regimen estimand.

Statistical analysis

Analysis population label in the figure: Modified intention-to-treat population (efficacy analysis set)
Statistical model: ANCOVA for body weight, fat and lean measures: baseline response covariate and treatment factor; waist used MMRM.
Missing-data handling: Three missing week-72 observations imputed by last observation carried forward.
Multiplicity adjustment: No
Formal estimand specification: Efficacy analysis set; a separate, fully specified five-attribute estimand was not verified in the substudy full text.
Parent-trial estimand must not be inherited without qualification: Yes

Extraction location

Full text section 3.2; Figure 1 or supplementary Figure S2

Percent change in fat mass — Placebo: extraction context

Outcome role

primary_substudy_objective

Scale reference

Baseline value of the same tissue or weight

Estimand and analysis rules

Name

Not reported or not verified

Analysis set

Modified intention-to-treat population (efficacy analysis set)

Definition verification status

Full formal estimand not verified; do not inherit the parent-trial treatment-regimen estimand.

Statistical analysis

Analysis population label in the figure: Modified intention-to-treat population (efficacy analysis set)
Statistical model: ANCOVA for body weight, fat and lean measures: baseline response covariate and treatment factor; waist used MMRM.
Missing-data handling: Three missing week-72 observations imputed by last observation carried forward.
Multiplicity adjustment: No
Formal estimand specification: Efficacy analysis set; a separate, fully specified five-attribute estimand was not verified in the substudy full text.
Parent-trial estimand must not be inherited without qualification: Yes

Extraction location

Full text section 3.2; Figure 1 or supplementary Figure S2

Percent change in fat mass — Pooled tirzepatide minus placebo: extraction context

Outcome role

primary_substudy_objective

Scale reference

Difference in percent change

Estimand and analysis rules

Name

Not reported or not verified

Analysis set

Modified intention-to-treat population (efficacy analysis set)

Definition verification status

Full formal estimand not verified; do not inherit the parent-trial treatment-regimen estimand.

Statistical analysis

Analysis population label in the figure: Modified intention-to-treat population (efficacy analysis set)
Statistical model: ANCOVA for body weight, fat and lean measures: baseline response covariate and treatment factor; waist used MMRM.
Missing-data handling: Three missing week-72 observations imputed by last observation carried forward.
Multiplicity adjustment: No
Formal estimand specification: Efficacy analysis set; a separate, fully specified five-attribute estimand was not verified in the substudy full text.
Parent-trial estimand must not be inherited without qualification: Yes

Extraction location

Full text section 3.2

No multiplicity adjustment.

Percent change in DXA lean soft tissue mass — Tirzepatide pooled 5/10/15 mg: extraction context

Outcome role

secondary

Scale reference

Baseline value of the same tissue or weight

Estimand and analysis rules

Name

Not reported or not verified

Analysis set

Modified intention-to-treat population (efficacy analysis set)

Definition verification status

Full formal estimand not verified; do not inherit the parent-trial treatment-regimen estimand.

Statistical analysis

Analysis population label in the figure: Modified intention-to-treat population (efficacy analysis set)
Statistical model: ANCOVA for body weight, fat and lean measures: baseline response covariate and treatment factor; waist used MMRM.
Missing-data handling: Three missing week-72 observations imputed by last observation carried forward.
Multiplicity adjustment: No
Formal estimand specification: Efficacy analysis set; a separate, fully specified five-attribute estimand was not verified in the substudy full text.
Parent-trial estimand must not be inherited without qualification: Yes

Extraction location

Full text section 3.2; Figure 1 or supplementary Figure S2

Lean mass means lean soft tissue excluding bone mineral content; it is not skeletal muscle mass.

Percent change in DXA lean soft tissue mass — Placebo: extraction context

Outcome role

secondary

Scale reference

Baseline value of the same tissue or weight

Estimand and analysis rules

Name

Not reported or not verified

Analysis set

Modified intention-to-treat population (efficacy analysis set)

Definition verification status

Full formal estimand not verified; do not inherit the parent-trial treatment-regimen estimand.

Statistical analysis

Analysis population label in the figure: Modified intention-to-treat population (efficacy analysis set)
Statistical model: ANCOVA for body weight, fat and lean measures: baseline response covariate and treatment factor; waist used MMRM.
Missing-data handling: Three missing week-72 observations imputed by last observation carried forward.
Multiplicity adjustment: No
Formal estimand specification: Efficacy analysis set; a separate, fully specified five-attribute estimand was not verified in the substudy full text.
Parent-trial estimand must not be inherited without qualification: Yes

Extraction location

Full text section 3.2; Figure 1 or supplementary Figure S2

Lean mass means lean soft tissue excluding bone mineral content; it is not skeletal muscle mass.

Percent change in DXA lean soft tissue mass — Pooled tirzepatide minus placebo: extraction context

Outcome role

secondary

Scale reference

Difference in percent change

Estimand and analysis rules

Name

Not reported or not verified

Analysis set

Modified intention-to-treat population (efficacy analysis set)

Definition verification status

Full formal estimand not verified; do not inherit the parent-trial treatment-regimen estimand.

Statistical analysis

Analysis population label in the figure: Modified intention-to-treat population (efficacy analysis set)
Statistical model: ANCOVA for body weight, fat and lean measures: baseline response covariate and treatment factor; waist used MMRM.
Missing-data handling: Three missing week-72 observations imputed by last observation carried forward.
Multiplicity adjustment: No
Formal estimand specification: Efficacy analysis set; a separate, fully specified five-attribute estimand was not verified in the substudy full text.
Parent-trial estimand must not be inherited without qualification: Yes

Extraction location

Full text section 3.2

No multiplicity adjustment.

Absolute change in fat mass — Tirzepatide pooled 5/10/15 mg: extraction context

Outcome role

secondary

Scale reference

absolute_change

Estimand and analysis rules

Name

Not reported or not verified

Analysis set

Modified intention-to-treat population (efficacy analysis set)

Definition verification status

Full formal estimand not verified; do not inherit the parent-trial treatment-regimen estimand.

Statistical analysis

Analysis population label in the figure: Modified intention-to-treat population (efficacy analysis set)
Statistical model: ANCOVA for body weight, fat and lean measures: baseline response covariate and treatment factor; waist used MMRM.
Missing-data handling: Three missing week-72 observations imputed by last observation carried forward.
Multiplicity adjustment: No
Formal estimand specification: Efficacy analysis set; a separate, fully specified five-attribute estimand was not verified in the substudy full text.
Parent-trial estimand must not be inherited without qualification: Yes

Extraction location

Full text section 3.2; Figure 1 or supplementary Figure S2

Absolute change in fat mass — Placebo: extraction context

Outcome role

secondary

Scale reference

absolute_change

Estimand and analysis rules

Name

Not reported or not verified

Analysis set

Modified intention-to-treat population (efficacy analysis set)

Definition verification status

Full formal estimand not verified; do not inherit the parent-trial treatment-regimen estimand.

Statistical analysis

Analysis population label in the figure: Modified intention-to-treat population (efficacy analysis set)
Statistical model: ANCOVA for body weight, fat and lean measures: baseline response covariate and treatment factor; waist used MMRM.
Missing-data handling: Three missing week-72 observations imputed by last observation carried forward.
Multiplicity adjustment: No
Formal estimand specification: Efficacy analysis set; a separate, fully specified five-attribute estimand was not verified in the substudy full text.
Parent-trial estimand must not be inherited without qualification: Yes

Extraction location

Full text section 3.2; Figure 1 or supplementary Figure S2

Absolute change in fat mass — Pooled tirzepatide minus placebo: extraction context

Outcome role

secondary

Scale reference

absolute_difference

Estimand and analysis rules

Name

Not reported or not verified

Analysis set

Modified intention-to-treat population (efficacy analysis set)

Definition verification status

Full formal estimand not verified; do not inherit the parent-trial treatment-regimen estimand.

Statistical analysis

Analysis population label in the figure: Modified intention-to-treat population (efficacy analysis set)
Statistical model: ANCOVA for body weight, fat and lean measures: baseline response covariate and treatment factor; waist used MMRM.
Missing-data handling: Three missing week-72 observations imputed by last observation carried forward.
Multiplicity adjustment: No
Formal estimand specification: Efficacy analysis set; a separate, fully specified five-attribute estimand was not verified in the substudy full text.
Parent-trial estimand must not be inherited without qualification: Yes

Extraction location

Full text section 3.2

No multiplicity adjustment.

Absolute change in DXA lean soft tissue mass — Tirzepatide pooled 5/10/15 mg: extraction context

Outcome role

secondary

Scale reference

absolute_change

Estimand and analysis rules

Name

Not reported or not verified

Analysis set

Modified intention-to-treat population (efficacy analysis set)

Definition verification status

Full formal estimand not verified; do not inherit the parent-trial treatment-regimen estimand.

Statistical analysis

Analysis population label in the figure: Modified intention-to-treat population (efficacy analysis set)
Statistical model: ANCOVA for body weight, fat and lean measures: baseline response covariate and treatment factor; waist used MMRM.
Missing-data handling: Three missing week-72 observations imputed by last observation carried forward.
Multiplicity adjustment: No
Formal estimand specification: Efficacy analysis set; a separate, fully specified five-attribute estimand was not verified in the substudy full text.
Parent-trial estimand must not be inherited without qualification: Yes

Extraction location

Full text section 3.2; Figure 1 or supplementary Figure S2

Lean mass means lean soft tissue excluding bone mineral content; it is not skeletal muscle mass.

Absolute change in DXA lean soft tissue mass — Placebo: extraction context

Outcome role

secondary

Scale reference

absolute_change

Estimand and analysis rules

Name

Not reported or not verified

Analysis set

Modified intention-to-treat population (efficacy analysis set)

Definition verification status

Full formal estimand not verified; do not inherit the parent-trial treatment-regimen estimand.

Statistical analysis

Analysis population label in the figure: Modified intention-to-treat population (efficacy analysis set)
Statistical model: ANCOVA for body weight, fat and lean measures: baseline response covariate and treatment factor; waist used MMRM.
Missing-data handling: Three missing week-72 observations imputed by last observation carried forward.
Multiplicity adjustment: No
Formal estimand specification: Efficacy analysis set; a separate, fully specified five-attribute estimand was not verified in the substudy full text.
Parent-trial estimand must not be inherited without qualification: Yes

Extraction location

Full text section 3.2; Figure 1 or supplementary Figure S2

Lean mass means lean soft tissue excluding bone mineral content; it is not skeletal muscle mass.

Absolute change in DXA lean soft tissue mass — Pooled tirzepatide minus placebo: extraction context

Outcome role

secondary

Scale reference

absolute_difference

Estimand and analysis rules

Name

Not reported or not verified

Analysis set

Modified intention-to-treat population (efficacy analysis set)

Definition verification status

Full formal estimand not verified; do not inherit the parent-trial treatment-regimen estimand.

Statistical analysis

Analysis population label in the figure: Modified intention-to-treat population (efficacy analysis set)
Statistical model: ANCOVA for body weight, fat and lean measures: baseline response covariate and treatment factor; waist used MMRM.
Missing-data handling: Three missing week-72 observations imputed by last observation carried forward.
Multiplicity adjustment: No
Formal estimand specification: Efficacy analysis set; a separate, fully specified five-attribute estimand was not verified in the substudy full text.
Parent-trial estimand must not be inherited without qualification: Yes

Extraction location

Full text section 3.2

No multiplicity adjustment.

Fat fraction of combined fat and lean mass losses — Pooled tirzepatide: extraction context

Outcome role: Exploratory, post hoc
Scale reference: fat_loss_plus_lean_mass_loss
Extraction location: Full text Table 1 formula and section 3.2

Fraction of combined fat and lean mass losses; not a skeletal-muscle fraction or an individual prediction.

Lean soft tissue fraction of combined fat and lean mass losses — Pooled tirzepatide: extraction context

Outcome role: Exploratory, post hoc
Scale reference: fat_loss_plus_lean_mass_loss
Extraction location: Full text Table 1 formula and section 3.2

Fraction of combined fat and lean mass losses; not a skeletal-muscle fraction or an individual prediction.

Fat fraction of combined fat and lean mass losses — Placebo: extraction context

Outcome role: Exploratory, post hoc
Scale reference: fat_loss_plus_lean_mass_loss
Extraction location: Full text Table 1 formula and section 3.2

Fraction of combined fat and lean mass losses; not a skeletal-muscle fraction or an individual prediction.

Lean soft tissue fraction of combined fat and lean mass losses — Placebo: extraction context

Outcome role: Exploratory, post hoc
Scale reference: fat_loss_plus_lean_mass_loss
Extraction location: Full text Table 1 formula and section 3.2

Fraction of combined fat and lean mass losses; not a skeletal-muscle fraction or an individual prediction.

What the curated evidence supports

The DXA substudy analyzed 160 participants: 124 receiving pooled tirzepatide doses and 36 receiving placebo. At 72 weeks, changes in weight, fat and lean mass were −21.3%, −33.9% and −10.9% with tirzepatide, versus −5.3%, −8.2% and −2.6% with placebo.
In this analysis, DXA lean mass is fat-free mass minus bone mineral content. It includes tissues other than muscle and, alone, does not describe strength or diagnose sarcopenia.
The article describes roughly three quarters of combined fat and lean mass losses as fat. This sample-level composition does not justify saying that one quarter of lost weight was skeletal muscle.

Limitations

160 of 255 substudy enrollees were analyzed; 5, 10 and 15 mg doses were pooled.
DXA lean mass does not directly measure skeletal muscle or strength.
There was no multiplicity adjustment; missing data from three participants used last observation carried forward.

Verification scope

Verified through 2026-11-04 within the consulted scope.

Bibliographic metadata checked: Yes
Original article abstract consulted: Yes
Full-text consultation: Consulted
Official trial registry consulted: Yes
Statistical analysis plan consulted: No
Verification boundary: Verification is limited to the specific fields and sources consulted; it is not a full systematic appraisal or GRADE rating.

Source record

Body composition changes during weight reduction with tirzepatide in the SURMOUNT-1 study of adults with obesity or overweight (2025). Diabetes, obesity & metabolism.

Source identifiers

Article DOI: 10.1111/dom.16275
PubMed record 39996356
PubMed Central: PMC11965027
Trial registration: NCT04184622
Structured registry: NCT04184622

Sleep, stress and appetite

Follow the evidence.

Keep in view

Study design and methods

Population

Extracted outcomes

Mean leptin — Sleep restriction versus extension: extraction context

Mean ghrelin — Sleep restriction versus extension: extraction context

Subjective hunger — Sleep restriction versus extension: extraction context

What the curated evidence supports

Limitations

Verification scope

Source record

Source identifiers

Keep in view

Study design and methods

Population

What the curated evidence supports

Limitations

Verification scope

Source record

Source identifiers

Keep in view

Review design and extraction scope

Population

How to read this review

Extracted review results and scope

Association with total intake — Stress–eating association: extraction context

Association with foods classified as less healthy in the studies — Stress–eating association: extraction context

Association with foods classified as healthy in the studies — Stress–eating association: extraction context

What the curated evidence supports

Limitations

Verification scope

Source record

Source identifiers

Keep in view

Review design and extraction scope

Population

How to read this review

Extracted review results and scope

Trials included in the review — Review scope: extraction context

What the curated evidence supports

Limitations

Verification scope

Source record

Source identifiers

Keep in view

Study design and methods

Population

Extracted outcomes

Sleep duration — Sleep extension minus control: extraction context

Estimated energy intake — Sleep extension minus control: extraction context

What the curated evidence supports

Limitations

Verification scope

Source record

Source identifiers

Keep in view

Review design and extraction scope

Population

How to read this review

What the curated evidence supports

Limitations

Verification scope

Source record

Source identifiers

Explore it for yourself.

Questions for Your Visit

Explore the research landscape

Prioritized clinical registry records

Muscle, Strength & Weight Loss: What Does DXA Measure?

Sources supporting the briefing.

Keep in view

Definitions and assessment framework

What the curated evidence supports

Limitations

Verification scope

Source record

Source identifiers

Keep in view