Relationship Between Inflammatory Biomarkers and Skeletal Muscle Fatty Infiltration: A Systematic Review and Meta-Analysis
Leila Jamshidi, Chanelle Montpetit, Hadi Zahedi, Jessika Seecharran, Peter John Darlington, Veronique Pepin, Maryse FortinBackground
Intramuscular fat (IMF) accumulation, a feature of myosteatosis, reflects impaired skeletal muscle quality. Chronic systemic inflammation may contribute to IMF accumulation, but this association has not been comprehensively synthesized.
Objectives
To systematically evaluate and quantitatively synthesize associations between systemic inflammatory biomarkers and skeletal muscle IMF in adults.
Design
Systematic review and meta-analysis conducted according to PRISMA guidelines.
Data Sources and Methods
PubMed, Scopus, and Web of Science were searched from inception to November 24, 2025. Eligible adult studies assessed systemic inflammatory biomarkers and IMF using validated methods; studies without validated IMF assessment or extractable association data were excluded. Risk of bias was assessed using design-specific Joanna Briggs Institute critical appraisal tools. Two reviewers independently extracted data. Extractable correlations were pooled using random-effects meta-analysis after Fisher’s Z transformation.
Results
Twenty-one studies involving 5,929 participants were included. Pooled associations with IMF were weak for CRP (r ≈ 0.15; [95% CI: 0.04 to 0.25]; [95% PI: −0.18 to 0.45]) and IL-6 (r ≈ 0.20; [95% CI: 0.03 to 0.35]; [95% PI: −0.39 to 0.67]), whereas TNF-α showed a negligible pooled association (r = −0.05; [95% CI: −0.35 to 0.26]; [95% PI: −0.90 to 0.88]). All prediction intervals included the null, indicating uncertainty in associations expected in future comparable studies. Associations appeared more consistent in populations with sustained inflammatory or immune-metabolic burden. Interpretation was limited by substantial heterogeneity, variable IMF assessment methods, inconsistent covariate adjustment, and predominantly observational designs.
Conclusion
Systemic inflammatory biomarkers show weak associations with skeletal muscle IMF. Inflammation may contribute to myosteatosis within a multifactorial process, but the small effect sizes suggest limited stand-alone clinical utility.