Department of Cardiology, Zhuhai hospital affiliated with Jinan University (Zhuhai People's Hospital), Zhuhai, China.
Department of cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China.
BMC Cardiovasc Disord. 2023 Oct 21;23(1):514. doi: 10.1186/s12872-023-03543-x.
Cardiometabolic multimorbidity (CMM) and obesity represent two major health problems. The relationship between adiposity indices and CMM, however, remains understudied. This study aimed to investigate the associations of body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), a body shape index (ABSI), body roundness index (BRI), and conicity index (CI) with CMM among Chinese adults.
Data of 101,973 participants were collected from a population-based screening project in Southern China. CMM was defined as having two or more of the following diseases: coronary heart disease, stroke, hypertension, and diabetes. The relationship between the six adiposity indices and CMM was investigated by multivariate logistic regression and restricted cubic splines. Receiver operator characteristic curve, C-statistic and net reclassification index were used to estimate the discriminative and incremental values of adiposity indices on CMM.
Logistic regression models showed the six adiposity indices were all significantly associated with the odds of CMM with non-linear relationships. For per SD increment, WC (Odds ratio [OR]: 1.66; 95% confidence interval (CI): 1.62-1.70) and WHtR (OR, 1.61; 95% CI, 1.58-1.65) were more significantly associated with a higher prevalence of CMM than BMI (OR, 1.55; 95% CI, 1.52-1.58) (all P < 0.05). In addition, WC, WHtR, and BRI displayed significantly better performance in detecting CMM compared with BMI (all P < 0.05). Their respective area under the curve (AUC) values were 0.675 (95% CI: 0.670-0.680), 0.679 (95% CI: 0.675-0.684), and 0.679 (95% CI: 0.675-0.684), while BMI yielded an AUC of 0.637 (95% CI: 0.632-0.643). These findings hold true across all subgroups based on sex and age. When Adding WC, WHtR, or BRI to a base model, they all provided larger incremental values for the discrimination of CMM compared with BMI (all P < 0.05).
Adiposity indices were closely associated with the odds of CMM, with WC and WHtR demonstrating stronger associations than BMI. WC, WHtR, and BRI were superior to BMI in discriminative ability for CMM. Avoidance of obesity (especially abdominal obesity) may be the preferred primary prevention strategy for CMM while controlling for other major CMM risk factors.
心脏代谢性合并症（CMM）和肥胖是两个主要的健康问题。然而，体脂指数与 CMM 之间的关系仍研究不足。本研究旨在探讨中国成年人的体重指数（BMI）、腰围（WC）、腰高比（WHtR）、身体形状指数（ABSI）、身体圆润指数（BRI）和锥形指数（CI）与 CMM 之间的关系。
本研究的数据来自中国南方一项基于人群的筛查项目，共纳入了 101973 名参与者。CMM 定义为患有两种或两种以上以下疾病：冠心病、中风、高血压和糖尿病。采用多变量逻辑回归和限制立方样条分析探讨了六种体脂指数与 CMM 之间的关系。使用接收者操作特征曲线、C 统计量和净重新分类指数来评估体脂指数对 CMM 的预测和增量价值。
Logistic 回归模型显示，这六个体脂指数与 CMM 的发生几率均呈显著相关，且呈非线性关系。对于每增加一个标准差，WC（比值比 [OR]：1.66；95%置信区间 [CI]：1.62-1.70）和 WHtR（OR：1.61；95% CI：1.58-1.65）与 CMM 的患病率显著相关，高于 BMI（OR：1.55；95% CI：1.52-1.58）（均 P<0.05）。此外，WC、WHtR 和 BRI 在检测 CMM 方面的表现均显著优于 BMI（均 P<0.05）。它们的曲线下面积（AUC）值分别为 0.675（95% CI：0.670-0.680）、0.679（95% CI：0.675-0.684）和 0.679（95% CI：0.675-0.684），而 BMI 的 AUC 值为 0.637（95% CI：0.632-0.643）。这些发现适用于所有基于性别和年龄的亚组。当将 WC、WHtR 或 BRI 添加到基本模型中时，与 BMI 相比，它们都为 CMM 的判别提供了更大的增量值（均 P<0.05）。
体脂指数与 CMM 的发生几率密切相关，其中 WC 和 WHtR 与 BMI 相比具有更强的相关性。WC、WHtR 和 BRI 在 CMM 的判别能力方面优于 BMI。在控制其他主要 CMM 风险因素的同时，避免肥胖（尤其是腹部肥胖）可能是 CMM 的首选一级预防策略。
