Chen Xiaoli, Li Aihua, Du Leilei, Peng Jia, Ma Qilin
Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China.
BMC Public Health. 2025 Aug 14;25(1):2757. doi: 10.1186/s12889-025-24113-0.
To examine the relationships of abdominal obesity indices [visceral adiposity index (VAI), lipid accumulation product (LAP), and waist circumference (WC)] with all-cause and cardiovascular disease (CVD) mortality in varying glucose metabolism statuses populations.
This study utilized NHANES data (1999-2018), including 17,718 participants, and linked mortality documents from the National Death Index through December 31, 2019. Participants were categorized by glucose metabolism status into diabetes mellitus (DM), prediabetes (Pre-DM), or normal glucose regulation (NGR), and separately categorized as quartiles based on abdominal obesity indices. Cox proportional hazards regression models assessed the associations between glucose metabolism status, abdominal obesity indices, and all-cause and CVD mortality. The joint effect of glucose metabolism status and abdominal obesity was also analyzed. Restricted cubic splines (RCS) were applied to investigate potential non-linear relationships. The predictive performance of the models was evaluated using C-statistics to assess improvements with the inclusion of LAP or WC across different glucose metabolism statuses.
Across a median follow-up period of 9.4 years, 2,685 deaths (846 from CVD) were documented. Compared to NGR, Pre-DM and DM were associated with increased all-cause mortality [adjusted HR = 1.249 (1.132, 1.377) and 1.628 (1.429, 1.853)] and CVD mortality [HR = 1.321 (1.105, 1.579) and 1.665 (1.322, 2.097)]. As well as WC, were significant predictors of all-cause [HR = 1.527 (1.255, 1.859)] and CVD mortality [HR = 1.576 (1.104, 2.249)], while LAP was only associated with all-cause mortality [HR = 1.199 (1.029, 1.395)]. Combined analysis revealed that individuals with Pre-DM or DM in the highest quartiles of WC had 1.567-fold and 2.493-fold elevated risks of all-cause mortality, in contrast with individuals having NGR in the lowest quartiles. The inclusion of WC into the baseline models enhanced the C-statistics for assessing all-cause mortality in Pre-DM groups (p < 0.001).
WC and LAP are important predictors of mortality, especially in those with impaired glucose metabolism. Integrating WC into predictive models enhances risk assessment for all-cause mortality in Pre-DM groups. These findings emphasize the importance of comprehensive risk assessments that incorporate both abdominal obesity and glucose metabolic health.
探讨腹部肥胖指数[内脏脂肪素指数（VAI）、脂质蓄积产物（LAP）和腰围（WC）]与不同糖代谢状态人群的全因死亡率和心血管疾病（CVD）死亡率之间的关系。
本研究利用了美国国家健康与营养检查调查（NHANES）1999 - 2018年的数据，包括17718名参与者，并通过2019年12月31日与国家死亡指数的死亡记录相链接。参与者根据糖代谢状态分为糖尿病（DM）、糖尿病前期（Pre - DM）或血糖正常调节（NGR），并根据腹部肥胖指数分别分为四分位数。Cox比例风险回归模型评估了糖代谢状态、腹部肥胖指数与全因死亡率和CVD死亡率之间的关联。还分析了糖代谢状态和腹部肥胖的联合效应。应用受限立方样条（RCS）来研究潜在的非线性关系。使用C统计量评估模型的预测性能，以评估在不同糖代谢状态下纳入LAP或WC后的改善情况。
在中位随访期9.4年期间，记录了2685例死亡（846例死于CVD）。与NGR相比，Pre - DM和DM与全因死亡率升高相关[调整后风险比（HR）= 1.249（1.132，1.377）和1.628（1.429，1.853）]以及CVD死亡率[HR = 1.321（1.105，1.579）和1.665（1.322，2.097）]。与WC一样，是全因死亡率[HR = 1.527（1.255，1.859）]和CVD死亡率[HR = 1.576（1.104，2.249）]的显著预测因素，而LAP仅与全因死亡率相关[HR = 1.199（1.029，1.395）]。综合分析显示，WC最高四分位数的Pre - DM或DM个体的全因死亡风险分别比WC最低四分位数的NGR个体高1.567倍和2.493倍。将WC纳入基线模型可提高Pre - DM组评估全因死亡率的C统计量（p < 0.001）。
WC和LAP是死亡率的重要预测因素，尤其是在糖代谢受损人群中。将WC纳入预测模型可增强Pre - DM组全因死亡率的风险评估。这些发现强调了综合风险评估的重要性，该评估应同时考虑腹部肥胖和糖代谢健康。
