Surrogate Adiposity Markers and Mortality

A Body Shape Index (ABSI) as a risk factor for all-cause mortality among US adults with type 2 diabetes: evidence from the NHANES 1999-2018

Background and objective

A Body Shape Index (ABSI) serves as a potential indicator of fat distribution, offering a more reliable association with all-cause mortality compared to overall adiposity. The present cohort study aims to explore the relationship between ABSI and all-cause mortality in US adults with Type 2 Diabetes (T2D).

Methods

For this cohort study, we extracted information on 5,461 US adults with T2D from the National Health and Nutrition Examination Survey (NHANES) and the NHANES Linked Mortality File. Trends in ABSI from 1999 to 2018 were calculated and analyzed using partial Mann-Kendall tests. To assess the relationship between ABSI and all-cause mortality, as well as the robustness of the association results, we employed weighted restricted cubic splines (RCS), weighted Cox proportional hazards models, sensitivity analyses, and stratified analyses. Additionally, we conducted time-dependent receiver operating characteristic (ROC) curve analysis to evaluate ABSI's predictive capability for all-cause mortality over 3, 5, and 10 years.

Results

Among US adults with Type 2 Diabetes (T2D), the mean ABSI gradually increased from 0.08333 to 0.08444 between 1999 and 2018. Following a median follow-up period of 90 months, 1,355 deaths (24.8% of the participants) occurred due to all causes. A left J-shaped association was observed between ABSI and all-cause mortality, with a 39% increased risk among US adults with T2D who had an ABSI below 0.08105 after full adjustment.

Conclusion

Our research has demonstrated a significant association between an elevated ABSI and the risk of all-cause mortality among US adults with T2D. These findings support the potential use of ABSI as a noninvasive tool to estimate mortality risk among US adults with T2D.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-025-01570-3.

Association between brain resting-state functional activities and obesity: A bidirectional Mendelian randomization study

BACKGROUND

Investigations revealed significant changes in brain activity between people with obesity or overweight and people with normal weight. The causal relationship between body weight and brain functional activity remains unclear and warrants further investigation.

METHODS

We conducted a bidirectional two-sample Mendelian randomization (MR) study. We gathered summary statistics from genome-wide association studies for 191 resting-state functional magnetic resonance imaging phenotypes and obesity traits (body mass index, body fat percentage, waist-to-hip ratio). Inverse variance weighting, the weighted median, MR Egger, and the weighted mode were employed. We conducted pleiotropy and heterogeneity analyses to evaluate robustness and reliability.

RESULTS

Forward analysis revealed that the intensity of spontaneous brain activity in the calcarine, lingual, or cuneus gyri within the visual network (beta = -0.076; 95 % CI: -0.11 to -0.04; p = 6.97 × 10-5) had a causal effect on body weight. The reverse analysis revealed that body weight has a causal effect on the intensity of spontaneous brain activity in the precuneus, angular, and cingulate gyri (beta = 0.209; 95 % CI: 0.11 to 0.31; p = 2.41 × 10-5), and the angular and temporal gyri (beta = 0.215; 95 % CI: 0.11 to 0.32; p = 3.87 × 10-5) within the default mode and central executive network.

CONCLUSIONS

Genetic evidence proves a causal relationship between body weight and brain functional activity.

Association between the Body Roundness Index and spirometric parameters among U.S. Adolescents from NHANES 2007-2012

BACKGROUND

Obesity is an important factor affecting pulmonary function. The Body Roundness Index (BRI) is a new method of assessing body and visceral adiposity, but its association with spirometric parameters in adolescents has not been previously reported.

METHODS

Cross-sectional data were obtained from the 2007 to 2012 National Health and Nutrition Examination Survey (NHANES), with participants having complete data on BRI and spirometric parameters. A generalized linear regression was conducted to explore the independent relationship between BRI and spirometric parameters. Smoothing curve fitting, subgroup analysis, and interaction tests were also performed.

RESULTS

A negative correlation was observed between BRI and pulmonary function. In the fully adjusted model, an increase of one unit in BRI was associated with an increase of 0.08 L in FVC, an increase of 0.04 L in FEV1, an increase of 5.17 L/min in PEF, and a decrease of 0.62% in FEV1/FVC.

CONCLUSION

The results suggest an inverse association between BRI and pulmonary function. However, the clinical significance of this finding warrants further study.

CLINICAL TRIAL NUMBER

Not applicable.

Differential benefits of 12-week morning vs. evening aerobic exercise on sleep and cardiometabolic health: a randomized controlled trial

Modern life and rising stress have contributed to increased sleep disorders and metabolic and cardiovascular diseases. While exercise is known to be an important health intervention, the optimal timing for its effectiveness remains uncertain. This study aims to investigate the effects of a 12-week timed exercise program on sleep, lipid profiles, and vascular function. Fifty-eight sedentary males were divided into three groups: morning exercise (ME) at 6-8 a.m., evening exercise (EE) at 6-8 p.m., and control group (CON) without exercise. The 12-week intervention involved moderate-intensity aerobic exercise (≥ 150 min/week). Sleep was assessed using the Munich ChronoType Questionnaire (MCTQ) and Dim Light Melatonin Onset (DLMO). Metabolic indicators were assessed through body composition and blood biochemical tests. Ultrasound imaging was performed to evaluate hemodynamics at the common carotid artery. Both exercise groups reduced body fat after 12-week exercises, with ME showing significant reductions as early as week 4. Total cholesterol and triglycerides in ME also decreased. Shortened sleep latency was observed in both exercise groups, with DLMO and sleep advanced in ME. Although both exercise groups showed decreased stiffness and increased wall shear stress, EE demonstrated greater enhancements in blood flow rate, center-line velocity, carotid artery dilation and lowering systolic blood pressure. A 12-week aerobic exercise significantly improves physical health in sedentary adults. Morning exercise (6-8 a.m.) is particularly effective for rapid body fat reduction, lowering plasma cholesterol and triglycerides, and advancing sleep-wake cycle. Evening exercise (6-8 p.m.) is more effective for enhancing vascular function.Trial registration: Chinese Clinical Trial Registry, ChiCTR2400094208, 18/12/2024.

Prognostic effect of body roundness index on all-cause mortality among US older adults

The Body Rounds Index (BRI) is an anthropometric indicator specifically developed to evaluate an individual's obesity level, particularly emphasizing central or abdominal obesity. This study aimed to explore the relationship between BRI and all-cause mortality in older U.S. adults. The research sample comprised individuals aged 65 and older from the National Health and Nutrition Examination Survey (NHANES), eligible for mortality analyses between 1999 and 2018. We utilized Cox regression analyses, restricted cubic spline (RCS), threshold effects analysis, Kaplan-Meier curves, and subgroup analyses were conducted to assess how the BRI correlates with all-cause mortality among older adults in the U.S. To further ensure the robustness of our findings, we conducted sensitivity analyses. Among 5371 U.S. older adults (age ≥ 65), with an average age of 72.45 (standard deviation [SD]:5.65) years, 2884 (60%) were women. During the follow-up period, there were 2781 deaths from all causes among the 5371 participants. After adjusting for all covariates, a U-shaped association was identified between BRI and the all cause mortality. Compared to a BRI of less than 4.457, a BRI between 4.457 and 5.538 was associated with a 19% reduction in the likelihood of mortality from any cause (HR = 0.81, 95% CI = 0.69-0.95). A BRI between 5.538 and 6.888 was linked to a 8% reduction in mortality risk (HR = 0.92, 95% CI = 0.79-1.07), while a BRI exceeding 6.888 showed a 1% increase in this risk (HR = 1.01, 95% CI = 0.87-1.17). RCS analysis indicated a U-shaped relationship between BRI and all-cause mortality. The turning point was located at 4.546, with correlations observed both before and after this point. This NHANES-based study highlights the U-shaped relationship between BRI and all-cause mortality among U.S. older adults, suggesting that the BRI has predictive value for mortality outcomes. The findings offer compelling support for utilizing BRI as a non-invasive mortality risk screening tool.

Insulin resistance mediates the association between adiposity markers and incident chronic kidney disease: Findings from the UK Biobank prospective cohort study

BACKGROUND

Limited research exists on fat distribution patterns and chronic kidney disease (CKD)/ end-stage kidney disease (ESKD) risks.

METHODS

This UK Biobank study analyzed 398,307 adults without baseline CKD. Adiposity markers and insulin resistance (IR) indices (TyG index, TG/HDL-C ratio) were assessed. Hazard ratios (HR) and 95% CIs from Cox regression models evaluated adiposity markers and CKD/ESKD risks, with mediation analysis on IR.

RESULTS

Over 13.62 years, 17,583 (3.37 per 1000 person-years) CKD and 1,509 (0.29 per 1000 person-years) ESKD cases occurred. After adjusting for BMI, high waist circumference and waist-to-hip ratio (WHR) were associated with a 23.0 % (HR: 1.23, 95 % CI: 1.19-1.27) and 17.0 % (HR: 1.17, 95 % CI: 1.12-1.22) increased risk of CKD and a 37.0 % (HR: 1.37, 95 % CI: 1.22-1.54) and 39.0 % (HR: 1.39, 95 % CI: 1.29-1.49) increased risk of ESKD, respectively. In the mediation analysis, BMI, waist circumference, and WHR accounted for 12 %, 44.4 %, and 23.8 % of the association between the TyG index and CKD, and 7.4 %, 26.7 %, and 13.9 % of the association between the TG/HDL-C ratio and CKD.

CONCLUSION

Elevated WHR was linked to increased risks of CKD and ESKD. The mediating effect of IR indexes between WHR and CKD was more significant than BMI.

Defining obesity in the context of cancer: thinking beyond body mass index

Obesity is a condition of excess body fat. Although it has been identified as a risk factor for multiple cancers in part because of its 'metainflammatory' state, it has also been paradoxically associated with improved response to immune checkpoint inhibition. To study obesity, one must first understand how best to define it. In this opinion article, we briefly discuss factors that are impacting net effects of obesity and highlight complementary measures that should be considered beyond body mass index (BMI) when attempting to assess the potential effects of obesity in cancer.

Transcriptomic analysis of adipose tissue reveals adipogenesis is modulated by the degree of weight loss in patients with obesity

BACKGROUND AND AIMS

Obesity is a complex condition with a diverse presentation and highly variable response to treatment. It is increasingly evident that obesity requires a plethora of interventions informed by biomarkers to optimise the chance of success. Adipose tissue is a metabolically active endocrine tissue and its metabolic response to intervention has the potential to provide key information to design targeted treatments to tackle obesity. To this aim, this study sought to identify, through transcriptomics analysis, common elements between adipose tissue of those undergoing bariatric surgery to those who were successful in losing weight through a lifestyle intervention.

METHODS AND RESULTS

Transcriptomic data from Gene Expression Omnibus were extracted from three bariatric surgery interventions and three lifestyle interventions. Paired linear mixed modelling using the limma package in R was used to determine differentially expressed genes before and after the interventions. Unpaired linear mixed modelling was used to determine differentially expressed genes between high and low responders to the intervention. Differentially modulated pathways were analysed with PathVisio and downloaded for graphic representation from the WikiPathways database.

CONCLUSION

We demonstrated that successful lifestyle interventions and bariatric surgery share the modulation of the Adipogenesis pathway (WP236). Leptin expression was positively correlated with weight loss, only up to a 10 % weight loss, suggesting a possible involvement of its dysregulation in explaining individual propensity to weight regain and potentially indicating who requires a targeted intervention. We also identify an interesting relationship between RBL2 expression and weight loss that requires further investigation.

The Relationship between Visceral Fat Accumulation and Risk of Cardiometabolic Multimorbidity: The Roles of Accelerated Biological Aging

OBJECTIVES

To investigate the association between visceral fat accumulation and the risk of cardiometabolic multimorbidity (CMM) and the potential roles of accelerated biological aging in this relationship.

METHODS

Using data from the UK Biobank, a nationwide cohort study was conducted using the available baseline body roundness index (BRI) measurement. Biological aging was assessed using the Klemera-Doubal method for biological age and the phenotypic age algorithms. The association between the BRI and CMM was estimated using the Cox proportional hazards regression model, while the roles of biological aging were examined through interaction and mediation analyses.

RESULTS

During a median follow-up of 14.52 years, 6156 cases of CMM were identified. A significant association was observed between the BRI and CMM. The hazard ratio (HR) for CMM was 3.72 (95% confidence interval [CI]: 3.35-4.13) for individuals in the highest quartile compared with those in the lowest quartile of the BRI. More importantly, the BRI (AUC, 0.701; 95% CI, 0.694-0.707) demonstrated superior predictive performance relative to body mass index (AUC, 0.657; 95% CI, 0.650-0.664). Furthermore, the BRI exhibited additive interactions with accelerated biological aging on the risk of CMM, and accelerated biological aging partially mediated the association between the BRI and CMM.

CONCLUSIONS

These findings provide evidence for the application of the BRI as a novel and readily accessible screening tool associated with CMM, suggesting that the effective management of visceral fat and biological aging deceleration may hold promise for reducing CMM risk.

Associations between serum lipids and glaucoma: a cohort study of 400 229 UK Biobank participants

PURPOSE

To examine the associations of commonly-used serum lipid measures (high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC) and triglycerides (TG)) with glaucoma.

METHODS

This prospective cohort study included 400 229 participants from the UK Biobank. Cox regression and restricted cubic spline models and polygenic risk scores were employed to investigate the associations between serum lipids and glaucoma.

RESULTS

Over a mean follow-up of 14.44 years, 6868 (1.72%) participants developed glaucoma. Multivariate Cox regression revealed that higher levels of HDL-C were associated with an increased risk of glaucoma (HR for 1-SD increase in HDL-C 1.05, 95% CI 1.02 to 1.08, p=0.001), while elevated levels of LDL-C (HR 0.96, 95% CI 0.94 to 0.99, p=0.005), TC (HR 0.97, 95% CI 0.94 to 1.00, p=0.037) and TG (HR 0.96, 95% CI 0.94 to 0.99, p=0.008) were all associated with reduced risk. The analysis examining the associations between polygenic risk score of serum lipids and glaucoma showed per 1-SD increment of HDL-C genetic risk was associated with a 5% greater hazard of glaucoma (HR 1.05, 95% CI 1.00 to 1.11, p=0.031). However, the polygenic risk score of LDL-C, TC, and TG did not show a significant association with glaucoma.

CONCLUSIONS

Elevated HDL-C is associated with an increased risk of glaucoma, while elevated LDL-C, TC, and TG levels are associated with a lower risk of glaucoma. This study enhances our understanding of the association between lipid profile and glaucoma and warrants further investigation of lipid-focused treatments in glaucoma management.

The relationship between body roundness index (BRI) and suicidal ideation: evidence from NHANES 2013-2018

IMPORTANCE

Emerging research suggests a complex interplay between physical health metrics and mental health outcomes, including suicidal ideation. The body roundness index (BRI), a novel measure of body size, may offer insights into this relationship. This study seeks to investigate the intricate connection between BRI and suicidal ideation in a sample that reflects the entire U.S. population-working to validate the potential of BRI as a predictor of suicidal ideation.

METHODS

Data from the NHANES spanning 2013 to 2018 was used in this cross-sectional study to analyze a sample of 14,058 participants. BRI was calculated based on height and waist circumference measurements. Suicidal ideation was assessed using the Mental Health-Depression Screener Questionnaire ninth question. To investigate potential non-linear relationships between BRI and suicidal ideation, we employed generalized additive models and smooth curve fitting, and used ROC curves to compare the predictive ability of BMI and BRI for suicidal ideation. Subgroup analyses and interaction tests were utilized to study the moderating effects of categorical covariates.

RESULTS

Multiple logistic regression analysis revealed a significant positive correlation between increased BRI and heightened suicidal ideation, with a nonlinear pattern persisting even after adjustment for covariates. This nonlinear relationship was reinforced by a sharp increase in the prevalence of suicidal ideation when the BRI exceeded 6.7. Based on ROC curve analysis, BRI demonstrates a slightly stronger predictive ability for suicide ideation compared to BMI. Subgroup analyses confirmed the relative robustness of this association across populations, including age, education and PRI, etc. However, the interaction between the two was influenced by gender, coronary artery disease and angina pectoris.

CONCLUSION

In conclusion, our cross-sectional study reveals a significant positive correlation between increased BRI and heightened suicidal ideation, with a sharp increase in prevalence when BRI exceeds 6.7. It is recommended that appropriate BRI be maintained to minimize suicidal ideation.

Association between body roundness index and incidence of type 2 diabetes in a population-based cohort study

There is limited national data on the association between body roundness index (BRI) and type 2 diabetes (T2D). A total of 10,785 participants from the China Health and Retirement Longitudinal Study (CHARLS) with repeated BRI measurements from 2011 to 2020 were included. We used Cox proportional hazards model and restricted cubic splines (RCS) to examine the association between BRI and T2D. During a mean follow-up of 7.72 years, 1,653 incident T2D cases were documented. Multivariable Cox proportional hazards regression model demonstrated a significant correlation between the BRI and the risk of T2D. Specifically, every 1-SD increase in BRI corresponded to a 27% heightened risk of T2D (HR: 1.27, 95% CI 1.20-1.35). The analysis also uncovered a non-linear pattern in this relationship, pinpointed by an inflection point at a BRI value of 3.96. Before the inflection point, the HR was 0.85 (95% CI 0.74-0.96), while after the inflection point, the HR increased to 1.29 (95% CI 1.18-1.41). In the middle-aged and elderly Chinese population, elevated BRI was significantly and positively associated with T2D risk. BRI could be a valuable addition to current clinical and public health strategies aimed at reducing the burden of T2D.

Obesity, Visceral Adipose Tissue, and Essential Hypertension: Evidence From a Mendelian Randomization Study and Mediation Analysis

This study aims to investigate the causal relationship between obesity and essential hypertension, and evaluate the mediation effect of visceral adipose tissue (VAT) by Mendelian randomization (MR) analysis. We included body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), WC adjusted for BMI (WCadjbmi), and WHR adjusted for BMI (WHRadjbmi) as obesity-related anthropometric traits. In the bidirectional MR analyses, we found that higher BMI (OR, 1.638; p = 3.97 × 10-19), WC (OR, 1.702; p = 1.45 × 10-12), and WHR (OR, 1.863; p = 1.84 × 10-8) were significantly associated with increased risk of essential hypertension, while no evidence of reverse causality was observed. Then, in the two-step MR analyses, all five anthropometric traits had a positive and significant association with VAT mass, especially WC (OR, 2.315; p = 1.00 × 10-210). Meanwhile, higher predicted VAT mass was significantly associated with increased risk of essential hypertension (OR, 1.713; p = 1.18 × 10-38). Furthermore, the mediation analyses revealed that VAT had a significant mediation effect on the causal relationship between obesity-related anthropometric traits and essential hypertension, and mediated proportions in BMI, WC, and WHR were 77.8%, 80.1%, and 41.4%, respectively. Finally, the sensitivity analyses using two other datasets showed a similar result. In conclusion, our results showed that BMI, WC, and WHR have a positive and significant association with increased risk of essential hypertension. Moreover, VAT has a significant mediation effect on the causal relationship between obesity-related anthropometric traits and essential hypertension. Our study provided important statistical evidence suggesting that VAT may play a crucial meditation role in the occurrence and development of obesity-related hypertension.

Waist-to-Height Ratio, Waist Circumference, and Body Mass Index in Relation to Full Cardiometabolic Risk in an Adult Population from Medellin, Colombia

Background/Objectives: Few studies have compared the associations of different adiposity markers with cardiometabolic risk factors in individuals without diabetes or cardiovascular disease (CVD), particularly in South America. Moreover, the associations with more severe cardiometabolic risk, defined by the simultaneous presence of altered glycemia, blood pressure, and dyslipidemia, remain unknown. We examined whether the waist-to-height ratio (W-HtR), waist circumference (WC), and BMI were independently associated with cardiometabolic risk in a chronic disease prevention program in Medellín, Colombia. Methods: A cross-sectional study was conducted in 29,236 adults (age: 19-121 years) without diabetes or CVD. Exposures included increased W-HtR (>0.5), increased WC (≥80 cm for women, ≥90 cm for men), and overweight/obesity. The outcomes were dyslipidemia, elevated glycemia, high blood pressure, and full cardiometabolic risk (FCMR), defined as the presence of all three factors. Logistic regressions adjusted for sociodemographic and lifestyle covariates and additional adiposity markers were used. Cubic spline analyses examined the shape of associations. Results: Most individuals were over 40 years old (97.6%), only 40 were ≥100 years, and 16.5% (n = 4821) had FCMR. Increased W-HtR tripled the odds of FCMR compared with normal W-HtR (OR: 3.04, 95%CI: 2.45-3.77, p < 0.001). Increased WC doubled the odds of FCMR (p < 0.001). W-HtR remained the strongest predictor after adjusting for WC (OR: 1.99, 95%CI: 1.59-2.50) and BMI (OR: 2.48, 95%CI: 1.99-3.08). Cubic spline analyses showed a linear association between W-HtR and FCMR, whereas the BMI-FCMR association plateaued at approximately 30 kg/m2. Conclusions: In this cross-sectional study of a large middle-to-older-aged cohort, W-HtR was the strongest adiposity marker correlated with cardiometabolic risk.

SDCCAG3 inhibits adipocyte hypertrophy and improves obesity-related metabolic disorders via SDCCAG3/SMURF1/PPARγ axis

Obesity is a prevalent global disease associated with various metabolic disorders. The expansion of white adipose tissue plays a pivotal role in regulating obesity-related metabolic dysfunctions. This study identified serum-defined colon cancer antigen 3 (SDCCAG3) as a novel key modulator of adipocyte metabolism. In adipose-specific SDCCAG3 knockout mice fed a high-fat diet, pathological expansion of adipose tissue, impaired glucose tolerance, insulin resistance, increased inflammatory markers, and augmented hepatic lipid accumulation were observed. Conversely, obesity models by specific overexpression of SDCCAG3 in adipose tissue confirmed that SDCCAG3 alleviated pathological expansion of adipose tissue, improved obesity-related metabolic disorders, with no observed changes in adipose tissue development under normal dietary conditions. Mechanistically, SDCCAG3 enhanced the stability of peroxisome proliferator-activated receptor gamma (PPARγ) by preventing its degradation via the ubiquitin-proteasome system through the SMAD specific E3 ubiquitin protein ligase 1 (SMURF1). Additionally, SDCCAG3 was subjected to negative transcriptional regulation by PPARγ, forming a SDCCAG3-PPARγ-SDCCAG3 loop that enhanced adipocyte lipid metabolism. Collectively, these findings demonstrated that SDCCAG3 functioned as a beneficial positive regulator of adipose tissue expansion and metabolic homeostasis, indicating its potential as a therapeutic target for metabolic diseases associated with nutrient excess.

Global Effect of Cardiovascular Risk Factors on Lifetime Estimates

BACKGROUND

Five risk factors account for approximately 50% of the global burden of cardiovascular disease. How the presence or absence of classic risk factors affects lifetime estimates of cardiovascular disease and death from any cause remains unclear.

METHODS

We harmonized individual-level data from 2,078,948 participants across 133 cohorts, 39 countries, and 6 continents. Lifetime risk of cardiovascular disease and death from any cause was estimated up to 90 years of age according to the presence or absence of arterial hypertension, hyperlipidemia, underweight and overweight or obesity, diabetes, and smoking at 50 years of age. Differences in life span (in terms of additional life-years free of cardiovascular disease or death from any cause) according to the presence or absence of these risk factors were also estimated. Risk-factor trajectories were analyzed to predict lifetime differences according to risk-factor variation.

RESULTS

The lifetime risk of cardiovascular disease was 24% (95% confidence interval [CI], 21 to 30) among women and 38% (95% CI, 30 to 45) among men for whom all five risk factors were present. In the comparison between participants with none of the risk factors and those with all the risk factors, the estimated number of additional life-years free of cardiovascular disease was 13.3 (95% CI, 11.2 to 15.7) for women and 10.6 (95% CI, 9.2 to 12.9) for men; the estimated number of additional life-years free of death was 14.5 (95% CI, 9.1 to 15.3) for women and 11.8 (95% CI, 10.1 to 13.6) for men. As compared with no changes in the presence of all risk factors, modification of hypertension at an age of 55 to less than 60 years was associated with the most additional life-years free of cardiovascular disease, and modification of smoking at an age of 55 to less than 60 years was associated with the most additional life-years free of death.

CONCLUSIONS

The absence of five classic risk factors at 50 years of age was associated with more than a decade greater life expectancy than the presence of all five risk factors, in both sexes. Persons who modified hypertension and smoking in midlife had the most additional life-years free of cardiovascular disease and death from any cause, respectively. (Funded by the German Center for Cardiovascular Research [DZHK]; ClinicalTrials.gov number, NCT05466825.).

A protection motivation theory-guided telehealth coaching program for middle-aged adults with cardiometabolic risk: A feasibility trial

BACKGROUND

Health coaching to address the escalated cardiometabolic risk in middle-aged adults in primary health care is underexplored. This study aimed to examine the feasibility and acceptability of a protection motivation theory-guided telehealth coaching program among middle-aged adults with cardiometabolic risks.

METHODS

This was a pretest-posttest study. The three-month intervention included four nurse-facilitated telehealth sessions tailored to individual cardiometabolic risks.

RESULTS

Thirty participants were recruited through social media and a community center. The eligibility and enrollment rates were 16.1% and 78.9%, respectively. Attrition at six months after enrollment was 33.3%, and intervention attendance was 82.5%. Most of the participants (76.7%) were satisfied with the program. Significant improvements were noted in the INTERHEART score for cardiometabolic risks, self-efficacy, anxiety, stress, and central obesity but not in health-promoting behaviors, depression, sleep quality, physical activity level, and physiological outcomes at six-month post-enrolment.

CONCLUSION

A theory-based telehealth coaching was feasible and well-accepted among middle-aged adults, with potential in reducing cardiometabolic risks among middle-aged adults in primary care. This study revealed significant improvement in cardiometabolic risk, self-efficacy, anxiety, stress, and central obesity but changes for health-promoting behaviors, depression, sleep quality, physical activity level, and physiological outcomes were not noted. Progression to a definitive trial was supported with implication for future trials, including lowering the threshold of cardiometabolic risk to improve subject recruitment, change of assessment sessions to promote adherence to fasting instruction, and use of digital recording to facilitate health coaching process.

TRIAL REGISTRATION

This trial was retrospectively registered on 05/07/2022 at ClinicalTrials.gov (identifier: NCT05444140).

The J-shaped relationship between body roundness index and adult asthma: insights from NHANES 2001-2018

Background

Many studies have used Body Mass Index (BMI) to define obesity and examine its potential link to adult asthma. However, BMI overlooks body fat distribution, which may significantly impact health. Unlike BMI, the Body Roundness Index (BRI) can more accurately reflect body fat distribution. Therefore, this study examined BRI's relationship with asthma prevalence in U.S. adults.

Methods

This study was based on data from the National Health and Nutrition Examination Survey (NHANES) between 2001 and 2018 and covered 40,052 adult participants. Participants were categorized into four quartile groups based on their BRI levels: Quartile 1 (1.05, 3.80); Quartile 2 (3.80, 5.06); Quartile 3 (5.06, 6.61); Quartile 4 (6.61, 23.48). The association between BRI and asthma prevalence was assessed via weighted multivariate logistic regression, smoothed curve fitting, threshold effects, subgroup, and sensitivity analysis. BRI's predictive power was compared to BMI and waist circumference using z-scores.

Results

Of the study population, 5,605 participants had asthma (13.99% prevalence). After adjusting for possible confounders, the results showed that higher BRI was linked to greater asthma prevalence (OR = 1.41, 95% CI:1.27, 1.56, p < 0.0001). A J-shaped relationship between BRI and asthma prevalence (p-nonlinearity = 0) was found, with asthma prevalence rising significantly when BRI surpassed 4.34. BRI outperformed BMI and waist circumference in predicting asthma (BRI: OR = 1.180; BMI: OR = 1.169; W.C.: OR = 1.166). Subgroup and sensitivity analyses confirmed our results' robustness.

Conclusion

Adult asthma prevalence increases with increasing BRI levels, showing a J-shaped relationship. Keeping BRI under 4.34 is vital for lowering asthma prevalence, especially for overweight or obese individuals. In addition, BRI outperformed BMI and waist circumference in predicting asthma occurrence.

Sauver J, Fielding RA, Atkinson E, White TA, McGree M, Weston S, LeBrasseur NK. The Influence of Body Mass Index on Biomarkers of Cellular Senescence in Older Adults

Obesity accelerates the onset and progression of age-related conditions. In preclinical models, obesity drives cellular senescence, a cell fate that compromises tissue health and function, in part through a robust and diverse secretome. In humans, components of the secretome have been used as senescence biomarkers that are predictive of age-related disease, disability, and mortality. Here, using biospecimens and clinical data from two large and independent cohorts of older adults, we tested the hypothesis that the circulating concentrations of senescence biomarkers are influenced by body mass index. After adjusting for age, sex, and race, we observed significant increases in activin A, Fas, MDC, PAI1, PARC, TNFR1, and VEGFA, and a significant decrease in RAGE, from normal weight, to overweight, to obesity body mass index categories by linear regression in both cohorts (all p < .05). These results highlight the influence of body mass index on circulating concentrations of senescence biomarkers.

Non-alcoholic fatty liver disease is associated with structural covariance network reconfiguration in cognitively unimpaired adults with type 2 diabetes

Type 2 diabetes (T2D) is often accompanied by non-alcoholic fatty liver disease (NAFLD), both of which are related to brain damage and cognitive impairment. However, cortical structural alteration and its relationship with metabolism and cognition in T2D with NAFLD (T2NAFLD) and without NAFLD (T2noNAFLD) remain unclear. The brain MRI scans, clinical measures and neuropsychological test were evaluated in 50 normal controls (NC), 73 T2noNAFLD, and 58 T2NAFLD. The cortical thickness and graph theory properties of structural covariance network was calculated. Statistical analyses included one-way analysis of covariance with post hoc, partial correlation and mediation analysis. The nonparametric permutation test was performed to evaluate differences in topological properties of structural covariance network. We found T2NAFLD group had worse glucose and lipid profiles, more obesity and more severe insulin resistance, and poorer working memory compared to T2noNAFLD and NC. T2D patients demonstrated increase in cortical thickness compared to NC, but no difference between the two T2D groups. The structural covariance network integration decreased in T2D patients, with T2NAFLD exhibiting more obvious network reconfiguration at node level. Cortical thickness mediated the relationship between post-prandial glucose, waist-hip ratio, and working memory. The findings suggest that cortical thickening may be a compensatory response to reduced network integration, with NAFLD exacerbating regional structural network changes in T2D. This research advances our understanding of how these metabolic comorbidities contribute to cognitive decline, potentially guiding future therapeutic strategies for T2D patients with and without NAFLD.

Association of surrogate adiposity markers with prevalence, all-cause mortality and long-term survival of heart failure: a retrospective study from NHANES database

Introduction

Obesity, especially abdominal obesity, is more common in patients with heart failure (HF), but body mass index (BMI) cannot accurately describe fat distribution. Several surrogate adiposity markers are available to reflect fat distribution and quantity. The objective of this study was to explore which adiposity marker is most highly correlated with HF prevalence, all-cause mortality and patients' long-term survival.

Methods

The National Health and Nutrition Examination Survey (NHANES) database provided all the data for this study. Logistic regression analyses were adopted to compare the association of each surrogate adiposity marker with the prevalence of HF. Cox proportional hazards models and restricted cubic spline (RCS) analysis were employed to assess the association between surrogate adiposity markers and all-cause mortality in HF patients. The ability of surrogate adiposity markers to predict long-term survival in HF patients was assessed using time-dependent receiver operating characteristic (ROC) curves.

Results

46,257 participants (1,366 HF patients) were encompassed in this retrospective study. An area under the receiver operating characteristic curve (AUC) for the prevalence of HF assessed by weight-adjusted-waist index (WWI) was 0.70 (95% CI: 0.69-0.72). During a median follow-up of 70 months, 700 of 1366 HF patients' death were recorded. The hazard ratio (HR) for HF patients' all-cause mortality was 1.33 (95% CI: 1.06-1.66) in the a body shape index (ABSI) quartile 4 group and 1.43 (95% CI: 1.13-1.82) in the WWI quartile 4 group, compared with the lowest quartile group. The AUC for predicting 5-year survival of HF patients using the ABSI was 0.647 (95% CI: 0.61-0.68).

Conclusions

WWI is strongly correlated with the prevalence of HF. In HF patients, those with higher WWI and ABSI tend to higher all-cause mortality. ABSI can predict patients' long-term survival. We recommend the use of WWI and ABSI for assessing obesity in HF patients.

Effect of once-weekly subcutaneous semaglutide on abdominal visceral fat area in Japanese adults with overweight and obesity: A post hoc analysis of the STEP 6 trial

OBJECTIVE

A post hoc analysis of a subset of participants with visceral fat area (VFA) measurements in the STEP 6 trial was conducted to examine both the correlation between VFA and clinical parameters and the effect of semaglutide on VFA in key subgroups.

METHODS

Participants were Japanese adults aged ≥ 20 years with obesity disease, randomized to once-weekly subcutaneous semaglutide 2.4 mg, semaglutide 1.7 mg, or placebo, plus lifestyle recommendations, for 68 weeks. Correlation between baseline VFA (and change in VFA from baseline to week 68) and clinical parameters (body weight, body mass index [BMI], waist circumference, hepatic parameters, glycated hemoglobin, blood pressure, lipids, high-sensitivity C-reactive protein, and plasminogen activator inhibitor-1 [PAI-1]) was evaluated. Percentage change in VFA between semaglutide and placebo was compared across subgroups.

RESULTS

Among 180 participants (semaglutide 2.4 mg, n = 89; semaglutide 1.7 mg, n = 46; placebo, n = 45), mean VFA was 170.0 cm2 across subgroups. A positive correlation (Pearson's correlation coefficient [r] ≥0.3) was observed between baseline VFA and body weight (r = 0.415), BMI (r = 0.374), and both JASSO and WHO criterion waist circumference (r = 0.458 and r = 0.555). Correlation between changes in VFA and body weight, waist circumference, high-density and very low-density lipoprotein cholesterol, triglycerides, PAI-1, aspartate aminotransferase, and alanine transaminase were observed in ≥ 1 treatment arm. Semaglutide 2.4 mg and 1.7 mg reduced VFA compared with placebo in all subgroups.

CONCLUSIONS

VFA partially correlated with clinical parameters in Japanese adults with obesity disease. Subcutaneous semaglutide was an efficacious treatment option for the reduction of VFA, regardless of clinical characteristics.

TRIAL REGISTRY NAME

CT.gov TRIAL REGISTRATION IDENTIFICATION NUMBER: NCT03811574.

Sex-specific Associations of Aldosterone and Renin With Body Composition: A Population-based Cohort Study

CONTEXT

Renin-angiotensin-aldosterone system (RAAS) activation is closely linked to obesity; however, the sex-specific associations between RAAS activity and body composition among individuals without obesity are not well understood.

OBJECTIVE

To investigate the associations of aldosterone and renin with body composition according to sex in the general population.

DESIGN

Population-based cohort study.

SETTING

Québec (Canada).

PARTICIPANTS

Adults aged 40 to 69 years enrolled in CARTaGENE between 2009 and 2010 (N = 3687).

EXPOSURES

Plasma aldosterone and renin concentrations.

MAIN OUTCOME MEASURES

Body composition assessed via anthropometrics (waist circumference and waist-to-hip ratio), bioelectrical impedance (lean body mass, fat mass, and muscle mass), and cardiac magnetic resonance imaging (epicardial and pericardial adipose tissue volumes).

RESULTS

The mean (SD) age and body mass index were 55 (8) years and 27.3 (4.8) kg/m2, respectively. Among males, higher aldosterone and renin were associated with increased waist circumference, increased waist-to-hip ratio, increased fat mass, decreased lean body mass, and decreased muscle mass (P < .05). Aldosterone (P = .02), but not renin (P = .43), was associated with increased ectopic cardiac adiposity in males. In contrast, higher renin (P < .05), but not aldosterone (P ≥ .05), was associated with increased waist circumference, increased waist-to-hip ratio, and increased cardiac adiposity in females. Among females, higher renin and aldosterone were associated with increased fat mass (P < .05) but were not associated with lean body mass or muscle mass (P ≥ .05). All aforementioned associations were independent of body weight.

CONCLUSION

Independent of body weight, increased RAAS activity is associated with unfavorable differences in body composition; however, the strength and pattern of association varies by sex.

Temporal trends, associated risk factors and longitudinal cardiovascular outcomes of body roundness among middle-aged and older Chinese adults: from the China Health and Retirement Longitudinal Study 2011-2018

Background

Obesity is a major global health issue, driving high morbidity and mortality rates. The body roundness index (BRI), which includes waist circumference, offers a more accurate measure of visceral and total body fat. However, despite evidence of BRI's effectiveness in predicting obesity-related diseases, national-level data, especially from non-Western populations like China, remain limited.

Methods

This study utilized data from the China Health and Retirement Longitudinal Study (CHARLS), a large, nationally representative cohort of Chinese adults, to examine the temporal trends of BRI, identify associated risk factors, and investigate the longitudinal associations between BRI and cardiovascular disease (CVD) outcomes. BRI was calculated using height and waist circumference measurements. Temporal trends and risk factors were analyzed cross-sectionally, while longitudinal associations were examined using Cox proportional hazards models adjusted for confounders. Mediation analyses were conducted to assess the role of intermediate factors such as hypertension and diabetes in the relationship between BRI and CVD.

Results

A total of 12,902 participants were included for risk factor analysis, 10,525 for longitudinal analysis, and 7,310 for cumulative analysis. BRI continued to rise slowly across survey cycles but was higher in women, older adults, and urban residents. Multivariable analysis identified age, alcohol consumption, elevated blood pressure, and diabetes as positive predictors of BRI, while male sex, rural residence, and smoking were negatively associated. Higher baseline BRI was significantly associated with increased CVD risk (HR: 1.44, 95% CI: 1.22-1.69), stroke (HR: 1.49, 95% CI: 1.12-1.98), and heart disease (HR: 1.47, 95% CI: 1.22-1.77). Cumulative BRI similarly predicted increased risks of CVD, stroke, and heart disease. Mediation analysis showed that hypertension accounted for 20.69% of the association between BRI and CVD risk.

Conclusions

BRI is a robust predictor of CVD risk. Targeting hypertension and other metabolic conditions could mitigate the elevated CVD risk associated with high BRI in Chinese adults. These findings underscore the importance of incorporating BRI into public health strategies to better manage obesity-related health risks in China.

The L-shaped association between body roundness index and all-cause mortality in osteoporotic patients: a cohort study based on NHANES data

Purpose

This study aims to investigate the relationship between the body roundness index (BRI) and overall mortality rates in individuals with osteoporosis (OP), utilizing information sourced from the NHANES database, in order to assess BRI's capability as an indicator for predicting mortality risk.

Methods

Data from NHANES (2005 to 2010, 2013-2014, and 2017-2018) were analyzed, including 1,596 osteoporotic individuals aged 50 and above. BRI was calculated based on waist circumference (WC) and height, categorizing participants into high (>4.07) and low (≤4.07) BRI groups. To analyze the relationship between BRI and mortality while accounting for important covariates, we employed weighted Cox proportional hazards models, conducted Kaplan-Meier survival analyses, and utilized restricted cubic splines (RCS).

Results

Higher BRI was significantly associated with better long-term survival, showing an "L"-shaped nonlinear inverse relationship with mortality, with a threshold at BRI = 5. In subgroup analyses, this association remained relatively stable.

Conclusion

The "L"-shaped association between BRI and mortality indicates that BRI may serve as a useful indicator for evaluating mortality risk in patients with OP, thereby informing clinical interventions and public health approaches.

The fibrosis-4 index and its association with carotid atherosclerosis in type 2 diabetes: a cross-sectional study in China

BACKGROUND

The medical community has long been concerned about the cardiovascular disease risk in patients with type 2 diabetes. While liver fibrosis scores were originally designed for application in individuals with liver steatosis, an increasing number of studies have shown that they are also associated with cardiovascular disease risk. However, the association between Fibrosis-4 (Fib-4) in liver fibrosis scores and carotid atherosclerosis (CA) in patients with type 2 diabetes remains unclear.

OBJECTIVE

The aim of this study is to investigate the association between the Fib-4 index and CA in patients with Type 2 diabetes. Additionally, it seeks to determine whether this relationship is influenced by factors including gender, age, body mass index (BMI), hypertension, and other variables.

METHODS

Screening based on inclusion and exclusion criteria identified 2658 hospitalized patients with type 2 diabetes. Subsequently, patients were divided into three groups according to Fib-4 values (Fib-4 < 1.3, 1.3 ≤ Fib-4 < 2.67, Fib-4 ≥ 2.67). Logistic regression analysis was then applied to evaluate the association between Fib-4 and the presence of CA in type 2 diabetes. Further stratified analyses were conducted considering gender, age (using 60 years as the threshold), hypertension status, smoking, alcohol consumption, and BMI groups (using 24 kg/m2 as the threshold), aiming to investigate potential effect heterogeneity within predefined subgroups. ROC curve analysis was used to evaluate the predictive power of the Fib-4 value for CA, increased CIMT, and carotid plaques.

RESULTS

The study encompassed 2658 patients diagnosed with type 2 diabetes, comprising 1441 males and 1217 females, with an average age of 56.71 ± 10.22 years. Among them, 1736 individuals (65.3%) exhibited CA, 1243 (46.8%) had increased carotid intima-media thickness (CIMT), and 1273 (47.9%) manifested carotid plaques. Following adjustments for various factors, the prevalence of CA exhibited a progressive increase in the Fib-4 < 1.3, 1.3 ≤ Fib-4 < 2.67, and Fib-4 ≥ 2.67 groups, with statistically significant differences (P < 0.05). Moreover, the prevalence of increased CIMT and carotid plaques in the Fib-4 ≥ 2.67 group remained significantly higher than that in the Fib-4 < 1.3 group after considering various factors (P < 0.05). In the 1.3 ≤ Fib-4 < 2.67 group, subsequent to adjustments for gender, smoking, and drinking, the prevalence of increased CIMT and carotid plaques surpassed that in the Fib-4 < 1.3 group (P < 0.05). Despite further adjustments for multiple factors, the prevalence of increased CIMT and carotid plaques persisted higher than that in the Fib-4 < 1.3 group, yet the difference lacked statistical significance (P > 0.05). The results of the ROC curve analysis indicated that the AUC for Fib-4 predicting CA was 0.602 (P < 0.001, 95% CI: 0.579-0.625), while the AUC values for increased CIMT and carotid plaques were 0.561 (P < 0.001, 95% CI: 0.540-0.583) and 0.580 (P < 0.001, 95% CI: 0.558-0.601), respectively.

CONCLUSION

Elevated Fib-4 levels (Fib-4 ≥ 1.3) are positively associated with CA in patients with type 2 diabetes, including increased CIMT and the presence of carotid plaques. As such, Fib-4 may serve as a potential biomarker for the detection of CA in patients with type 2 diabetes. However, its clinical utility needs further validation, particularly in larger sample sizes and multicenter studies.

[Different Types of Obesity Play a Modifying Role in the Association Between Physical Activity and Metabolic Dysfunction-Associated Fatty Liver Disease]

Objective

To explore the association between physical activity levels and metabolic dysfunction-associated fatty liver disease (MAFLD) and the modifying effects of different types of obesity.

Methods

A cross-sectional study was conducted on 19925 participants recruited from the Chengdu sub-cohort of the Southwest China Natural Population Cohort. The participants were recruited between 2018 and 2019. The association between physical activity and MAFLD prevalence was examined using the inverse probability weighting (IPW) method based on the generalized propensity score (GPS). The odds ratios (OR) and the 95% confidence interval (CI) for moderate and vigorous physical activity were calculated using the mild physical activity group as a reference. A restricted cubic spline function was used to model the exposure-response relationship between physical activity and MAFLD risk. The potential modifying effects of obesity types on the association between physical activity and MAFLD were evaluated in male and female populations.

Results

The prevalence of MAFLD was 17.30%. Compared to those engaging in mild physical activity, individuals participating in vigorous and moderate physical activities had a lower risk of MAFLD, with OR (95% CI) being 0.76 (0.67, 0.86) and 0.85 (0.76, 0.94), respectively. The exposure-response relationship showed a nonlinear association between physical activity and MAFLD risks (P nonlinearity = 0.005). The protective effect of physical activity against MAFLD was observed when physical activity reached approximately 20 METs-h/d. However, when physical activity exceeded 70 METs-h/d, no significant effect on MAFLD risk was observed. Among the female population, obesity type significantly modified the association between physical activity and MAFLD (P < 0.05). In females with central obesity, the protective effect of physical activity on MAFLD showed a threshold effect, with the lowest disease risk observed at approximately 25 METs-h/d. However, physical activity exceeding 37.5 METs-h/d showed no statistically significant association with MAFLD risk. In contrast, for females with peripheral obesity, high levels of physical activity had limited effects on reducing MAFLD risks.

Conclusion

Moderate physical activity can significantly reduce the risk of MAFLD, and the obesity types can modify this association. It is recommended that individuals engage in approximately 20-70 METs-h/d of physical activity. For females with central obesity, physical activity should not exceed 37.5 METs-h/d, while for females with peripheral obesity, it should not exceed 30 METs-h/d.

Sexual identity differences in ideal cardiovascular health among cisgender adults in the All of Us Research Program

BACKGROUND

Cardiovascular health (CVH) disparities have been documented among sexual minority adults, yet prior research has focused on individual CVH metrics. We sought to examine sexual identity differences in CVH using the American Heart Association's composite measure of ideal CVH, which provides a more comprehensive assessment of future CVD risk.

METHODS

Data from the All of Us Research Program were analyzed. Sexual identity was categorized as heterosexual, gay/lesbian, bisexual, or other. Individual CVH health metrics and cumulative ideal CVH (range 0-100) were assessed. We ran sex-stratified multiple linear regression models to estimate differences across individual CVH metrics and cumulative ideal CVH between sexual minority and heterosexual adults. We also explored differences in CVH across racial/ethnic and age groups.

RESULTS

The sample included 11 047 cisgender adults with a mean age of 61.1 years (± 13.85); 80% were non-Hispanic White. Lesbian women, gay men, and bisexual women reported greater nicotine exposure than their heterosexual counterparts. Compared to heterosexual men, gay men (B [95% CI] = -8.95 [-14.50, -3.39]) had worse physical activity scores. Gay men also had better body mass index scores than heterosexual men (B [95% CI] = 3.21 [0.09, 6.33]). Bisexual women and men had lower cumulative ideal CVH scores than heterosexual adults. Exploratory analyses revealed several differences in individual CVH metrics and cumulative ideal CVH across racial/ethnic and age groups.

CONCLUSIONS

Clinical interventions to improve the CVH of bisexual adults are needed. Findings can inform the design of interventions that are tailored for specific subgroups of sexual minority adults.

Obesity modifies the association between abnormal glucose metabolism and atrial fibrillation in older adults: a community-based longitudinal and prospective cohort study

OBJECTIVE

To investigate the modifying role of obesity in the association between abnormal glucose metabolism and atrial fibrillation (AF) risk in older individuals.

METHODS

From April 2007 to November 2011, 11,663 participants aged ≥60 years were enrolled in the Shandong area. Glucose metabolic status was determined using fasting plasma glucose and hemoglobin A1c levels, and obesity was determined using body mass index (BMI), waist-to-hip ratio (WHR), and visceral fat area (VFA). Obesity-associated metabolic activities were assessed using the adiponectin-to-leptin ratio (ALR), galectin-3, and triglyceride-glucose index (TyG). New-onset AF was diagnosed by ICD-10.

RESULTS

During an average of 11.1 years of follow-up, 1343 participants developed AF. AF risks were higher in those with prediabetes, uncontrolled diabetes, and well-controlled diabetes than with normoglycemia. The hazard ratios were decreased by 14.79%, 40.29%, and 25.23% in those with prediabetes; 31.44%, 53.56%, and 41.90% in those with uncontrolled diabetes; and 21.16%, 42.38%, and 27.59% in those with well-controlled diabetes after adjusting for BMI, WHR, and VFA, respectively. The population-attributable risk percentages of general obesity, central obesity, and high VFA for new-onset AF were 10.43%, 34.78%, and 31.30%, respectively. ALR, galectin-3, and TyG significantly mediated the association of BMI, WHR, and VFA with AF risk (all Padj. < 0.001).

CONCLUSION

Obesity mediates the association between abnormal glucose metabolism and AF risk in older individuals. WHR is a more effective modifier than BMI and VFA for moderating the association. ALR, TyG, and galectin-3 mediate the moderating effect of obesity on the association between abnormal glucose metabolism and AF risk.

Association between adipose deposition and mortality among adults without major cardiovascular risk factors

AIM

To examine the association between adiposity and mortality in U.S. adults without major cardiovascular risk factors.

METHODS

We analyzed 7,948 adults (4,123 women, 3,825 men) aged > 20 years from the National Health and Nutrition Examination Survey (2003-2004, 2011-2016). Participants with cardiovascular disease, estimated glomerular filtration rate < 60 ml/min/1.73m², diabetes, hypertension, or pregnancy were excluded. Adiposity measures, assessed by dual-energy x-ray absorptiometry or anthropometrics, included android and gynoid fat mass index (FMI), android-to-gynoid ratio, subcutaneous, abdominal, and visceral FMI, BMI, and waist circumference. We employed multivariable-adjusted Cox regression and restricted cubic spline models to assess sex-specific associations between adiposity measures and all-cause mortality.

RESULTS

Over a median follow-up of 7.8 years, there were 83 deaths among women and 119 among men. In women, BMI, waist circumference, and gynoid FMI showed non-linear associations with all-cause mortality, while in men, BMI, waist circumference, and android-to-gynoid ratio demonstrated similar non-linear associations. In final adjusted models, a 1-SD increase in visceral, subcutaneous, and abdominal FMI among women was associated with 61 % (HR 1.61, 95 % CI 1.17-2.21), 87 % (HR 1.87, 95 % CI 1.13-3.08), and 89 % (HR 1.89, 95 % CI 1.19-2.99) higher mortality risk, respectively. Women in the lowest tertile of gynoid FMI had an 82 % (HR 1.82, 95 % CI 1.01-3.29) higher mortality risk compared to those in the middle tertile. In final adjusted models, a 1-SD increase in gynoid, android, visceral, subcutaneous, and abdominal FMI among men was associated with 30 % (HR 1.30, 95 % CI 1.02-1.65), 41 % (HR 1.41, 95 % CI 1.09-1.83), 54 % (HR 1.54, 95 % CI 1.04-2.28), 69 % (HR 1.69, 95 % CI 1.25-2.29), and 76 % (HR 1.76, 95 % CI 1.25-2.48) higher mortality risk, respectively. Additionally, men in the middle tertile of android-to-gynoid ratio had a 2.68-fold higher mortality risk compared to the lowest tertile, while men in the highest BMI tertile had an 83 % higher mortality risk compared to the lowest tertile. Sex modified the association between gynoid FMI and mortality (P-interaction = 0.008).

CONCLUSION

Imaging-based adiposity measures have distinct prognostic value for mortality beyond traditional anthropometrics in adults without cardiovascular risk factors.

The various associations between whole /regional fat mass and trajectory of cardiometabolic diseases: a nonlinear multistate model

OBJECTIVE

This study aimed to investigate the association of whole body/regional fat mass (FM) with cardiometabolic disease (CMD) trajectory.

METHODS

We conducted a prospective analysis using the UK Biobank. The FM index (FMI), a surrogate for whole body FM, and regional FM (i.e., arm, leg, and trunk) were examined as exposures. A nonlinear multistate framework was used to evaluate the association  between whole/regional FM and CMD trajectory.

RESULTS

Among the 423,966 participants (mean age 56.1 [SD 8.10] years, 43.9% men) with a median follow-up of 13.5 years, varied associations were identified between whole/regional FM and transitions in the CMD trajectory. Upper body FM (i.e., arm and trunk) exhibited significant positive J-shaped associations in the transitions from first CMD (FCMD) or cardiometabolic multimorbidity to death; however, FMI and leg FM demonstrated L-shaped associations. Leg FM played a beneficial role in the transition from FCMD to death, with a hazard ratio of 0.950 (95% CI: 0.931-0.968) per 1 kg.

CONCLUSIONS

Body fat composition and distribution revealed various associations with CMD trajectory, highlighting their clinical importance. Upper body FM among those participants with FCMD or cardiometabolic multimorbidity demonstrated positive J-shaped associations toward death, providing no evidence of the "obesity paradox."

Fat Distribution as a Determinant of Vitamin D Status: A Cross-Sectional Study of Adults in the United States

BACKGROUND

This study aimed to elucidate correlations between obesity-related indicators and vitamin D (VD) status in a nationally representative sample of U.S. adults.

METHODS

We analysed data from 9168 adults aged 20-59 years obtained from the 2011-2018 National Health and Nutrition Examination Survey. Serum 25 hydroxyvitamin D [25(OH)D] levels were measured and categorised into quartiles. Anthropometric measurements, including weight, waist circumference, and fat mass in various body regions quantified through dual-energy X-ray absorptiometry, were collected. Multiple imputation was employed to replace missing data. The importance of obesity-related indicators and serum 25(OH)D concentration was explored using multiple linear regression adjusted for demographics, lifestyle factors, dietary intake, and clinical biomarkers, and stepwise regression.

RESULTS

Weight, waist circumference, and fat mass across all body regions were inversely associated with serum 25(OH)D levels (all p < 0.001). Notable differences were observed between men and women. Stepwise regression revealed a strong inverse correlation between visceral adipose tissue and serum 25(OH)D concentration in men [β 95% CI: -13.04 (-18.10, -7.99), p < 0.001], whereas in women, only weight was significantly correlated with serum 25(OH)D concentration [β 95% CI: -0.20 (-0.28, -0.12), p < 0.001]. Demographic attributes, seasonal sunlight exposure, dietary VD, calcium, phosphorus, and magnesium intake, and biomarkers including alkaline phosphatase and creatinine also emerged as significant predictors.

CONCLUSIONS

Besides conventional obesity measures, abdominal fat metrics exhibit robust associations with VD deficiency, especially in men. Public health initiatives and clinical management strategies for hypovitaminosis D in obese populations should consider nuanced aspects of adiposity distribution alongside other demographic, lifestyle, and dietary factors influencing VD.

The quest for optimal ketamine dosing formula in treatment-resistant major depressive disorder

BACKGROUND

Emerging evidence indicates that intravenous ketamine is effective in managing treatment-resistant unipolar and bipolar depression. Clinical studies highlight its favorable efficacy, safety, and tolerability profile within a dosage range of 0.5-1.0 mg/kg based on actual body weight. However, data on alternative dosage calculation methods, particularly in relation to body mass index (BMI) and therapeutic outcomes, remain limited.

METHODS

This retrospective analysis of an open-label study aims to evaluate dose calculation strategies and their impact on treatment response among inpatients with treatment-resistant major depressive disorder (MDD) (n = 28). The study employed the Boer and Devine formulas to determine lean body mass (LBM) and ideal body weight (IBW), and the Mosteller formula to estimate body surface area (BSA). The calculated doses were then compared with the actual doses administered or converted to a dosage per square meter for both responders and non-responders.

RESULTS

Regardless of treatment response, defined as a reduction of 50% in the Montgomery-Åsberg Depression Rating Scale, the use of alternative ketamine dosing formulas resulted in underdosing compared to the standardized dose of 0.5 mg/kg. Only two participants received higher doses (102.7% and 113.0%) when the Devine formula was applied.

CONCLUSIONS

This study suggests that ketamine dosing formulas, alternative to the standardized 0.5 mg/kg based on body weight, may lead to underdosing and potentially impact outcome interpretation. To enhance dosing accuracy, future studies should consider incorporating body impedance analysis and waist-to-hip ratio measurements, as this study did not account for body composition.

Exposure to sugar rationing in the first 1000 days of life protected against chronic disease

We examined the impact of exposure to sugar restrictions within 1000 days after conception on type 2 diabetes and hypertension, leveraging quasi-experimental variation from the end of the United Kingdom's sugar rationing in September 1953. Rationing restricted sugar intake to levels within current dietary guidelines, and consumption nearly doubled immediately after rationing ended. Using an event study design with UK Biobank data comparing adults conceived just before or after rationing ended, we found that early-life rationing reduced type 2 diabetes and hypertension risk by about 35 and 20% and delayed disease onset by 4 and 2 years, respectively. Protection was evident with in utero exposure and increased with postnatal sugar restriction, especially after 6 months, when eating of solid foods likely began. In utero sugar rationing alone accounted for about one-third of the risk reduction.

Obesity and risk for liver disease: a two-sample Mendelian randomisation study

The associations between obesity and liver diseases are complex and diverse. To explore the causal relationships between obesity and liver diseases, we applied two-sample Mendelian randomisation (MR) and multivariable MR analysis. The data of exposures (BMI and WHRadjBMI) and outcomes (liver diseases and liver function biomarker) were obtained from the open genome-wide association study database. A two-sample MR study revealed that the genetically predicted BMI and WHRadjBMI were associated with non-alcoholic fatty liver disease, liver fibrosis and autoimmune hepatitis. Obesity was not associated with primary biliary cholangitis, liver failure, liver cell carcinoma, viral hepatitis and secondary malignant neoplasm of liver. A higher WHRadjBMI was associated with higher levels of biomarkers of lipid accumulation and metabolic disorders. These findings indicated independent causal roles of obesity in non-alcoholic fatty liver disease, liver fibrosis and impaired liver metabolic function rather than in viral or autoimmune liver disease.

Obesity-related Asthma: A Pathobiology-based Overview of Existing and Emerging Treatment Approaches

Although obesity-related asthma is associated with worse asthma outcomes, optimal treatment approaches for this complex phenotype are still largely unavailable. This state-of-the-art review article synthesizes evidence for existing and emerging treatment approaches for obesity-related asthma and highlights pathways that offer potential targets for novel therapeutics. Existing treatments targeting insulin resistance and obesity, including metformin and GLP-1 (glucagon-like-peptide 1) receptor agonists, have been associated with improved asthma outcomes, although GLP-1R agonist data in asthma are limited to individuals with comorbid obesity. Monoclonal antibodies approved for treatment of moderate to severe asthma generally appear to be effective in individuals with obesity, although this is based on retrospective or secondary analysis of clinical trials; moreover, although most of these asthma biologics are approved for use in the pediatric population, the impact of obesity on their efficacy has not been well studied in youth. Potential therapeutic targets being investigated include IL-6, arginine metabolites, nitro-fatty acids, and mitochondrial antioxidants, with clinical trials for each currently underway. Potential therapeutic targets include adipose tissue eosinophils and the GLP-1-arginine-advanced glycation end products axis, although data in humans are still needed. Finally, transcriptomic and epigenetic studies of "obese asthma" demonstrate enrichment of IFN-related signaling pathways, Rho-GTPase pathways, and integrins, suggesting that these too could represent future treatment targets. We advocate for further study of these potential therapeutic mechanisms and continued investigation of the distinct inflammatory pathways characteristic of obesity-related asthma, to facilitate effective treatment development for this unique asthma phenotype.

Association between sleep duration and three obesity indicators among middle-aged and elderly adults: findings from the NHANES 2005-2014

Objective

Obesity has emerged as a worldwide problem. In recent years, it has been verified that there is an association between sleep duration and obesity indicators. This provides a new approach to control obesity. In this study, the relationship between duration of sleep and body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) among Americans ≥45 years old was investigated.

Methods

Data was collected from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2014. The link between sleep duration and obesity indicators was analysed using multiple regression models and weighted smoothed curve fitting. Subgroup analysis was conducted to assess the consistency of the connection between sleep duration and obesity indicators across various groups.

Results

This study involved 7,118 males and 7,265 females, with an average age of 62.09. After total adjustment, sleep duration was negatively correlated with BMI (β = -0.19, 95%CI: -0.26, -0.12), WC (β = -0.36, 95%CI: -0.53, -0.19) and WHtR (β = -0.27, 95%CI: -0.38, -0.17). Subgroup analyses revealed more significant negative associations between sleep duration and BMI, WC, and WHtR among non-Hispanic White participants, and those without diabetes and hypertension.

Conclusion

Sleep duration was significantly negatively associated with BMI, WC, and WHtR, suggesting that longer sleep duration may contribute to lower obesity indicators in middle-aged and elderly Americans. Subgroup analysis showed that their negative correlation differed between races, diabetes, or hypertension status. However, additional prospective studies are required to validate these findings and investigate potential causal relationships.

Association between cardiometabolic index (CMI) and periodontitis in US adults: analysis of NHANES data (2009-2014)

BACKGROUND

The cardiometabolic index (CMI) is a new predictor of obesity-related diseases, but its link to periodontitis is under-researched. This study aims to examine the potential association between the CMI and periodontitis.

METHODS

We conducted a cross-sectional study using the National Health and Nutrition Examination Survey (NHANES) database (2009-2014) to examine the potential association between CMI and periodontitis. The study utilized a weighted multivariate logistic model to assess the association between TG, HDL-C, TG/HDL-C, obesity indices (BMI, WC, WHtR, CMI), and periodontitis, employing the area under the receiver operating characteristic curves (ROC) to estimate areas under the curve (AUC). Furthermore, generalized smooth curve fitting was conducted to examine the relationship between CMI and periodontitis. Finally, the study incorporated subgroup analysis and interaction tests to examine consistency across different populations.

RESULTS

TG/HDL-C, WHtR, and CMI were positively associated with periodontitis in the fully adjusted classification model. It was observed that for each unit increase in CMI, there was a corresponding 17.8% increase in the prevalence of periodontitis [1.178 (1.049, 1.322) 0.00562] and 18.7% increase in the prevalence of moderate/severe [1.187 (1.057, 1.334) 0.00376] in the fully adjusted model. When CMI was used as a categorical variable, the adjusted OR for periodontitis prevalence increased significantly with increasing CMI after adjusting for all potential covariates (T3 vs. T1: OR, 1.28 [1.06, 1.55], p < 0.05). The ROC analysis indicated that a larger area under the curve was found in the CMI [0.554 (0.538-0.570)] than in the WC [0.544 (0.528-0.560)] and WHtR [0.544 (0.528-0.561)]. Nonetheless, the discrepancy observed did not reach statistical significance (all p > 0.05). Further generalized smooth curve fitting and threshold effect models indicated a positive linear correlation between CMI and periodontitis. Moreover, there is no interactive association between TG/HDL-C, WHtR, CMI, and periodontitis.

CONCLUSIONS

This cross-sectional study revealed a positive relationship between CMI and periodontitis. Further prospective studies are warranted to validate our findings.

Case Study: The Weighty Issue of Treatment Options for Obese Dialysis Patients

Obesity is a complex chronic disease and common comorbidity in kidney failure and is the leading causes of death and disability in this population. Guidelines do not specifically address the preferred weight management option(s) for obesity while on dialysis. Large body size is a limiting factor for consideration of a kidney transplantation. We report on a successful bariatric surgery with a young adult after 5.5 years on dialysis with hope for a future transplant. Success was demonstrated with progressive weight loss without adverse changes in renal clinical markers accompanied by improvements in exercise tolerance and health status thereby improving her suitability for a kidney transplant. Further studies and guidelines are needed to address weight loss options for those with obesity on dialysis and want to lose weight.

Multi-modal characterisation of early-stage, subclinical cardiac deterioration in patients with type 2 diabetes

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a major risk factor for heart failure with preserved ejection fraction and cardiac arrhythmias. Precursors of these complications, such as diabetic cardiomyopathy, remain incompletely understood and underdiagnosed. Detection of early signs of cardiac deterioration in T2DM patients is critical for prevention. Our goal is to quantify T2DM-driven abnormalities in ECG and cardiac imaging biomarkers leading to cardiovascular disease.

METHODS

We quantified ECG and cardiac magnetic resonance imaging biomarkers in two matched cohorts of 1781 UK Biobank participants, with and without T2DM, and no diagnosed cardiovascular disease at the time of assessment. We performed a pair-matched cross-sectional study to compare cardiac biomarkers in both cohorts, and examined the association between T2DM and these biomarkers. We built multivariate multiple linear regression models sequentially adjusted for socio-demographic, lifestyle, and clinical covariates.

RESULTS

Participants with T2DM had a higher resting heart rate (66 vs. 61 beats per minute, p < 0.001), longer QTc interval (424 vs. 420ms, p < 0.001), reduced T wave amplitude (0.33 vs. 0.37mV, p < 0.001), lower stroke volume (72 vs. 78ml, p < 0.001) and thicker left ventricular wall (6.1 vs. 5.9mm, p < 0.001) despite a decreased Sokolow-Lyon index (19.1 vs. 20.2mm, p < 0.001). T2DM was independently associated with higher heart rate (beta = 3.11, 95% CI = [2.11,4.10], p < 0.001), lower stroke volume (beta = -4.11, 95% CI = [-6.03, -2.19], p < 0.001) and higher left ventricular wall thickness (beta = 0.133, 95% CI = [0.081,0.186], p < 0.001). Trends were consistent in subgroups of different sex, age and body mass index. Fewer significant differences were observed in participants of non-white ethnic background. QRS duration and Sokolow-Lyon index showed a positive association with the development of cardiovascular disease in cohorts with and without T2DM, respectively. A higher left ventricular mass and wall thickness were associated with cardiovascular outcomes in both groups.

CONCLUSION

T2DM prior to cardiovascular disease was linked with a higher heart rate, QTc prolongation, T wave amplitude reduction, as well as lower stroke volume and increased left ventricular wall thickness. Increased QRS duration and left ventricular wall thickness and mass were most strongly associated with future cardiovascular disease. Although subclinical, these changes may indicate the presence of autonomic dysfunction and diabetic cardiomyopathy.

Associations of childhood and adulthood body size, and child-to-adult body size change with adult telomere length

AIM

To comprehensively examine the associations of childhood and adulthood body size, and child-to-adult body size change with adult leucocyte telomere length (LTL).

METHODS

We included 453 602 participants from the UK Biobank. Childhood body size at the age of 10 years was collected through a questionnaire. Adulthood body size was assessed using body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), fat mass index (FMI), and fat-free mass index (FFMI).

RESULTS

Individuals with plumper body size in childhood exhibited shorter LTL in adulthood (-0.0086 [-0.0017, -0.0004]). Adulthood BMI (-0.0286 [-0.0315, -0.0258]), WC (-0.0271 [-0.0303, -0.0238]), WHR (-0.0269 [-0.0308, -0.0230]) and FMI (-0.0396 [-0.0438, -0.0351]) were negatively associated with LTL, whereas FFMI (0.0095 [0.0039, 0.0152]) was positively associated with LTL. Compared to individuals consistently having an average/normal weight in both childhood and adulthood, those who maintained or developed overweight/obesity from childhood to adulthood had a shorter adult LTL, regardless of childhood body size. Notably, the LTL shortening effect was not observed in individuals with plumper body size in childhood but normal weight in adulthood.

CONCLUSIONS

Childhood and adulthood obesity are both associated with LTL shortening in adulthood. Transitioning to or maintaining overweight/obese status from childhood to adulthood is associated with shorter adult LTL, whereas this effect can be reversed if plumper children become normal weight.

The Mediating Roles of Lung Function Traits and Inflammatory Factors on the Associations between Measures of Obesity and Risk of Lower Respiratory Tract Infections: A Mendelian Randomization Study

BACKGROUND

Identifying mediators between obesity-related traits and lower respiratory tract infections (LRTIs) would inform preventive and therapeutic strategies to reduce the burden of LRITs. We aimed to recognize whether lung function and inflammatory factors mediate their associations.

METHODS

We conducted a two-step, two-sample Mendelian randomization (MR) analysis. Two-sample MR was performed on (1) obesity-related traits (i.e., body mass index [BMI], waist circumference [WC], and waist-to-hip ratio [WHR]) and LRTIs (i.e., acute bronchitis, acute bronchiolitis, bronchiectasis, influenza, and pneumonia), (2) obesity-related traits and potential mediators, and (3) potential mediators and LRTIs. Next, two-step MR was applied to infer whether the mediation effects exist.

RESULTS

We found that C-reactive protein (CRP), interleukin-6 (IL-6), and forced expiratory volume in the first second (FEV1) mediated 32.59% (95% CI: 17.90%, 47.27%), 7.96% (95% CI: 1.79%, 14.14%), and 4.04% (95% CI: 0.34%, 7.74%) of the effect of BMI on pneumonia, and they mediated 26.90% (95% CI: 13.98%, 39.83%), 10.23% (95% CI: 2.72%, 17.73%), and 4.67% (95% CI: 0.25%, 9.09%) of the effect of WC on pneumonia, respectively. Additionally, CRP, forced vital capacity (FVC), and FEV1 mediated 18.66% (95% CI: 8.70%, 28.62%), 8.72% (95% CI: 1.86%, 15.58%), and 8.41% (95% CI: 2.77%, 14.06%) of the effect of BMI on acute bronchitis, and they mediated 19.96% (95% CI: 7.44%, 32.48%), 12.19% (95% CI: 2.00%, 22.39%), and 12.61% (95% CI: 2.94%, 22.29%) of the effect of WC on acute bronchitis, respectively.

CONCLUSIONS

Health interventions linked to reducing inflammation and maintaining normal lung function could help mitigate the risk of obesity-related LRTIs.

Physical Activity Decreases Inflammation and Delays the Development of Obesity-Associated Pancreatic Ductal Adenocarcinoma

Obesity is a risk factor for pancreatic ductal adenocarcinoma (PDAC), a deadly disease with limited preventive strategies. Lifestyle interventions to decrease obesity represent a potential approach to prevent obesity-associated PDAC. In this study, we examined whether decreasing obesity through physical activity (PA) and/or dietary changes could decrease inflammation in humans and prevent obesity-associated PDAC in mice. Comparison of circulating inflammatory-associated cytokines in subjects (overweight and obese) before and after a PA intervention revealed PA lowered systemic inflammatory cytokines. Mice with pancreatic-specific inducible KrasG12D expression were exposed to PA and/or dietary interventions during and after obesity-associated cancer initiation. In mice with concurrent diet-induced obesity and KrasG12D expression, the PA intervention led to lower weight gain, suppressed systemic inflammation, delayed tumor progression, and decreased proinflammatory signals in the adipose tissue. However, these benefits were not as evident when obesity preceded pancreatic KrasG12D expression. Combining PA with diet-induced weight loss (DI-WL) delayed obesity-associated PDAC progression in the genetically engineered mouse model, but neither PA alone nor combined with DI-WL or chemotherapy prevented PDAC tumor growth in orthotopic PDAC models regardless of obesity status. PA led to the upregulation of Il15ra in adipose tissue. Adipose-specific overexpression of Il15 slowed PDAC growth but only in nonobese mice. Overall, our study suggests that PA alone or combined with DI-WL can reduce inflammation and delay obesity-associated PDAC development or progression. Lifestyle interventions that prevent or manage obesity or therapies that target weight loss-related molecular pathways could prevent progression of PDAC. Significance: Physical activity reduces inflammation and induces changes to adipose-related signaling to suppress pancreatic cancer, supporting the potential of obesity management strategies to reduce the risk of developing pancreatic cancer. See related commentary by Sogunro and Muzumdar, p. 2935.

Time-restricted eating with or without a low-carbohydrate diet improved myocardial status and thyroid function in individuals with metabolic syndrome: secondary analysis of a randomized clinical trial

BACKGROUND

Obesity and metabolic syndrome (MetS) have become urgent worldwide health problems, predisposing patients to unfavorable myocardial status and thyroid dysfunction. Low-carbohydrate diet (LCD) and time-restricted eating (TRE) have been confirmed to be effective methods for weight management and improving MetS, but their effects on the myocardium and thyroid are unclear.

METHODS

We conducted a secondary analysis in a randomized clinical diet-induced weight-loss trial. Participants (N = 169) diagnosed with MetS were randomized to the LCD group, the 8 h TRE group, or the combination of the LCD and TRE group for 3 months. Myocardial enzymes and thyroid function were tested before and after the intervention. Pearson's or Spearman's correlation was assessed between functions of the myocardium and thyroid and cardiometabolic parameters at baseline.

RESULTS

A total of 162 participants who began the trial were included in the intention-to-treat (ITT) analysis, and 57 participants who adhered to their assigned protocol were involved in the per-protocol (PP) analysis. Relative to baseline, lactate dehydrogenase, creatine kinase MB, hydroxybutyrate dehydrogenase, and free triiodothyronine (FT3) declined, and free thyroxine (FT4) increased after all 3 interventions (both analyses). Creatine kinase (CK) decreased only in the TRE (- 18 [44] U/L, P < 0.001) and combination (- 22 [64] U/L, P = 0.003) groups (PP analysis). Thyrotropin (- 0.24 [0.83] μIU/mL, P = 0.011) and T3 (- 0.10 ± 0.04 ng/mL, P = 0.011) decreased in the combination group (ITT analysis). T4 (0.82 ± 0.39 μg/dL, P = 0.046), thyroglobulin antibodies (TgAb, 2 [1] %, P = 0.021), and thyroid microsomal antibodies (TMAb, 2 [2] %, P < 0.001) increased, while the T3/T4 ratio (- 0.01 ± 0.01, P = 0.020) decreased only in the TRE group (PP analysis). However, no significant difference between groups was observed in either analysis. At baseline, CK was positively correlated with the visceral fat area. FT3 was positively associated with triglycerides and total cholesterol. FT4 was negatively related to insulin and C-peptide levels. TgAb and TMAb were negatively correlated with the waist-to-hip ratio.

CONCLUSIONS

TRE with or without LCD confers remarkable metabolic benefits on myocardial status and thyroid function in subjects with MetS.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04475822.

The Relationship Between Central Obesity and Osteoarthritis in US Adults: The Mediating Role of Biological Aging Acceleration

OBJECTIVE

This study aims to investigate the association between central obesity and the risk of osteoarthritis, and the mediating role of biological age and biological aging advance in this relationship.

METHODS

The study is based on data from the National Health and Nutrition Examination Survey (NHANES) for the years 2005-2018. Thirteen commonly used clinical traits were used to calculate the Klemera-Doubal method age (KDM-Age) and phenotypic age (Pheno-Age) as two measures of biological aging. Additionally, KDM-Age advance and Pheno-Age advance were calculated as two measures of biological aging advance. Weighted multivariable logistic regression was used to analyze the association between central obesity and the risk of osteoarthritis (OA). Mediation analysis was then applied to elucidate the role of biological aging and biological aging advance in this relationship.

RESULTS

A total of 31,162 subjects aged ≥20 years were included in this study, of which 3,964 subjects reported having OA (14%). Compared to the Non-OA group, the OA group showed significantly higher proportions of central obesity, KDM-Age, KDM-Age advance, PhenoAge, and PhenoAge advance. Compared to the Non-central obesity group, the central obesity group had higher KDM-Age, KDM-Age advance, PhenoAge, PhenoAge advance, and a higher risk of OA (p < 0.05). Additionally, higher KDM-Age, KDM-Age advance, PhenoAge, and PhenoAge advance were positively correlated with the risk of OA (p < 0.05). Mediation analysis revealed that part of the association between central obesity and the risk of OA was mediated by KDM-Age, KDM-Age advance, PhenoAge, and PhenoAge advance (p < 0.05).

CONCLUSION

Central obesity increases the risk of OA, with part of this association being mediated by biological aging and biological aging advance.