Weight-adjusted waist index reflects fat and muscle mass in the opposite direction in older adults

Association between weight-adjusted waist index and mortality: The mediative role of depressive symptoms

BACKGROUND

Recent studies have shown that weight-adjusted waist index (WWI) plays an important role in influencing mortality. Depression is a predictor of accelerated mortality. The aim of this study was to investigate the relationship between WWI and all-cause and cardiovascular disease (CVD)-specific mortality and to analyze the mediating role of depression in this relationship.

METHODS

Adults from the National Health and Nutrition Examination Survey (NHANES) 2005-2020 were included in this study. The WWI was computed as follows: WWI = waist circumference/square root of body weight. Depression symptoms were evaluated with the Patient Health Questionnaire 9 (PHQ-9). Multivariable logistic regression analyses estimated the association between WWI, depression and mortality. Mediation analyses tested the mediating effects of depression.

RESULTS

A total 45,130 participants were included and mean age was 49.24 ± 16.90 years. There was a significant correlation between the WWI, depression and mortality (P < 0.05). With increasing WWI quartiles, the risk of all-cause mortality increased (Q2: 6 %, Q3: 24 %, Q4: 52 %) and CVD-specific mortality increased (Q2: 26 %, Q3: 74 %, Q4: 105 %). With a 1.3 % and 1.4 % mediation rate, mediation analysis revealed that depression mediated the relationship between WWI and all-cause mortality and CVD-specific mortality.

CONCLUSIONS

The WWI showed a positive correlation with the risk of both all-cause mortality and CVD-specific mortality in American adults. Depressive symptoms played a minor mediating role in the relationship between the WWI and these mortalities. Nonetheless, extensive prospective studies are required to explore the interactions among these factors more comprehensively.

Gender differences in the association between weight-adjusted waist index and migraine: A cross-sectional study

OBJECTIVE

This study examines how weight-adjusted waist index (WWI) correlates with the occurrence of migraine in U.S. adults.

BACKGROUND

Being overweight significantly increases the likelihood of experiencing migraines; nonetheless, conventional metrics like waist circumference (WC) and body mass index (BMI) might not completely capture the level of migraine risk tied to obesity. WWI integrates the strengths of WC while minimizing its correlation with BMI, which might make it a more accurate indicator of central obesity-related migraine susceptibility.

METHODS

This study performed a cross-sectional analysis using data from 9,688 participants obtained from the National Health and Nutrition Examination Survey (NHANES), covering the years 1999-2004. Migraine occurrence was evaluated through questionnaires, and participants' WWI was computed. Weighted multivariable logistic regression models were used to examine the association between WWI and migraines. Restricted cubic splines (RCS) were applied to evaluate the dose-response relationship between WWI and migraines. Furthermore, interaction tests and subgroup analyses were executed. The receiver operating characteristic (ROC) curve, paired with DeLong et al.'s test, was employed to compare the predictive power of WWI, BMI, and WC for migraines.

RESULTS

The overall prevalence of migraines was found to be 21.50% (weighted population: 31,888,075 out of 148,278,824). In Model 3, the link between WWI and migraines in women showed no statistical significance (OR = 0.94, 95% CI: 0.82-1.07). In this model, each unit increase in WWI among men was linked to a 22% higher risk of migraines (OR = 1.22, 95% CI: 1.05-1.42). When stratified by quintiles, individuals in the third quintile (Q3) displayed a 69% higher likelihood of experiencing migraines compared to those in the first quintile (Q1) (OR = 1.69, 95% CI: 1.19-2.40), with a significant inflection point observed at 10.95 cm/√kg. Significant interactions were noted among various age groups (p for interaction = 0.018). WWI demonstrated a stronger predictive capability for migraine compared to BMI and WC.

CONCLUSION

A U-shaped positive correlation of WWI with migraines was observerd among adult males in the U.S., while no significant correlation was found in females. Within the context of BMI and WC, WWI exhibited a superior predictive capacity for migraines.

Anthropometric Measures and Mortality Risk in Individuals With Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A Population-Based Cohort Study

BACKGROUND/AIMS

As the primary anthropometric measure in metabolic dysfunction-associated steatotic liver disease (MASLD), waist circumference (WC) may more accurately reflect the visceral fat distribution than body mass index (BMI). This study aimed to compare the prognostic value of BMI, WC and WC-related indices including waist-hip ratio (WHR), body shape index (BSI) and weight-adjusted-waist index (WWI) in individuals with MASLD.

METHODS

The study population was derived from four large-scale cohorts: the National Health and Nutrition Examination Survey (NHANES 2017-2020 and NHANES III), the Kailuan Cohort and the UK Biobank Cohort. We evaluated the mortality risk across these measures using multivariate Cox proportional hazards regression and restrictive cubic spline.

RESULTS

The Pearson correlation coefficient of WC with hepatic steatosis and fibrosis was better than that of BMI. WC [Quartile 4 vs. Quartile 1: HR (hazard ratio) = 1.48 (95% confidence interval (CI) 1.13-1.93)] and WC-related indices [Quartile 4 vs. Quartile 1: WHR HR = 3.21 (95% CI 2.36-4.37); BSI HR = 3.22 (95% CI 2.48-4.17); WWI HR = 4.72 (95% CI 3.36-6.62)], but not BMI [obesity vs. lean: HR = 0.90 (95% CI 0.72-1.12)], indicated a significant mortality risk gradient among individuals with MASLD. The finding was consistent across sex and racial/ethnic subgroups, with external validation supporting the WC-related indices. MASLD and fibrosis prevalence showed a dose-dependent pattern across WC-related index quartiles. Notably, low BMI and high WC-related indices portended the highest mortality risk.

CONCLUSIONS

WC and WC-related indices are better parameters in prognosticating MASLD than BMI. The BMI-related 'obesity paradox' may be a misnomer resulting from the use of an incorrect metric. WC should be measured more routinely among individuals with MASLD.

Evaluating Anthropometric Indices for Malnutrition Assessment in Older Adults: Scoping Review

Purpose of Review

The demographic transition in both global and national populations indicates a growing trend in the older population. This burgeoning older population brings about constraints marked by the effective presence of malnutrition alongside functional and physiological changes. Conducting screenings and assessments to prevent malnutrition and enable early intervention is crucial. In epidemiological and clinical studies, these screenings and assessments are often conducted through anthropometric measurements and a range of indices derived from them, encompassing both traditional ones like BMI (Body Mass Index) and newer ones like BRI (Body Roundness Index), BAI (Body Adiposity Index), ABSI (A Body Shape Index), CI (Conicity Index), WWI (Waist adjusted Weight Index), AVI (Abdominal Volume Index), Demiquet, and Mindeks. There is a lack of scrutiny regarding studies comparing these indices based on the type of malnutrition in the older population, hence this review aims to address the gap in the literature.

Recent Findings

Analysis of existing research reveals that BRI and waist-to-height ratio serve as predictors of obesity-related body fat quantity/distribution and metabolic risks, while WWI stands out in sarcopenic obesity, and Demiquet and Mindeks are prominent indices for screening inadequate nutrition.

Summary

Choosing anthropometric indices that do not include height in the older populations can have certain advantages. However, the selection of these indices should depend on the specific variable being assessed or screened such as obesity, malnutrition, or sarcopenic obesity.

Association between the weight-adjusted waist index and age-related macular degeneration: Results from NHANES 2005-2008

The present study aimed to explore the association between weight-adjusted waist index (WWI) levels, a newly proposed indicator for assessing obesity, and the risk of age-related macular degeneration (AMD). A cross-sectional analysis of 20,497 participants was conducted using the National Health and Nutrition Examination Survey (NHANES) 2005-2008 dataset. Trend tests, multivariable logistic regression, and smoothing curve fitting were performed to examine the association between WWI and the risk of AMD. In addition, subgroup analysis and interaction tests were used to test this association in different groups. A total of 5476 participants were included in the study, of whom 420 (7.7%) had AMD. The risk of age-related macular degeneration increased with increasing WWI in all models. In the fully adjusted model, a 55% increase in the prevalence of AMD was observed in the highest tertile (tertile 3: >11.52) of WWI (OR 1.55, 95% CI 1.09, 2.21) compared to the lowest tertile (tertile 1: <10.85). The interaction tests revealed that age, chronic kidney disease, and cardiovascular disease had significant interactions with WWI on AMD risk (P for interaction < .05). This study revealed that higher WWI levels were associated with increased risk of AMD, suggesting that managing obesity according to WWI may reduce AMD risk. However, additional research is warranted to corroborate our results.

Association between body roundness index and obstructive sleep apnea: a cross-sectional study from the NHANES (2005-2008 to 2015-2020)

BACKGROUND

Obstructive sleep apnea (OSA) is linked to obesity, and the body roundness index (BRI) is an innovative measure of obesity that more accurately reflects visceral and total body fat. The relationship between BRI and the likelihood of OSA is unclear, so we aimed to investigate the association between BRI and the prevalence of OSA.

METHODS

We used data from the National Health and Nutrition Examination Survey (NHANES; 2005-2008 to 2015-2020) to conduct a cross-sectional study involving 24,476 individuals aged 18 years or older. OSA was assessed using three standardized NHANES questionnaire items measuring monthly daytime sleepiness, weekly apnea events, and habitual snoring frequency. A formula that uses the height and waist measures from the body measurements is used to calculate the BRI. Covariates, including sex, age, race/ethnicity, education level, marital status, poverty-income ratio (PIR), alcohol consumption, smoking status, high blood pressure (HBP), diabetes, and sleep duration were controlled using multivariate logistic regression models. Subgroup analyses, interaction tests, and smoothed curve fitting were also performed.

RESULTS

After controlling for confounders, BRI showed a positive correlation with OSA. Among the 24,476 participants aged 18 and older, 11,856 were diagnosed with OSA. The full model revealed a significant positive association between BRI and OSA incidence (OR = 1.11, 95% CI: 1.08-1.14, p < 0.0001). Participants in the highest percentile of BRI had an 87% greater likelihood of developing OSA compared to those in the lowest percentile (OR = 1.87, 95% CI: 1.62-2.16, p < 0.0001).

CONCLUSION

BRI levels have shown a favorable correlation with the rising rates of OSA in the United States. The BRI serves as a straightforward anthropometric predictor of OSA.

Weight-adjusted waist index as a new predictor of osteoporosis in postmenopausal patients with T2DM

This study aimed to investigate the predictive value of the weight-adjusted waist index (WWI) for osteoporosis in postmenopausal patients with type 2 diabetes mellitus (T2DM). This cross-sectional study included 229 postmenopausal patients with T2DM (mean age 64.53 ± 7.4 years). Collect anthropometric data. Bone mineral density (BMD) of the lumbar spine and femoral necks was measured using dual-energy X-ray absorptiometry. Calculate WWI and Osteoporosis Self-Assessment Tool for Asians (OSTA). Use SPSS 25.0 to analyze data employing binary logistic regression and the receiver operating characteristic (ROC) curve. WWI in osteoporosis group was significantly higher than that in non-osteoporosis group (11.54 ± 0.82 vs. 11.07 ± 0.73, P = 0.000), while the OSTA was significantly lower in osteoporosis group compared to non-osteoporosis group (- 1.40 (- 2.8, 0.40) vs. 0.10 (- 1.45,1.80), P = 0.000). Binary logistic regression analysis indicated that the risk of osteoporosis in WWI ≥ 11.55 group was 3.158 times higher than that in WWI < 11.55 group (95% CI 1.714-5.820, P = 0.000). The risk in OSTA ≤ - 1 group was 3.935 times higher than that in OSTA > - 1 group (95% CI 2.168-7.141, P = 0.000). The area under the ROC curve for OSTA and WWI in predicting the risk of osteoporosis in postmenopausal patients with T2DM aged over 70 was 0.761 and 0.808, respectively, with sensitivities of 0.429 and 0.714. In postmenopausal patients with T2DM, WWI is closely associated with osteoporosis and negatively correlates with BMD. Among postmenopausal T2DM patients aged over 70, WWI may be superior to OSTA in predicting osteoporosis.

Association of weight-adjusted waist index with all-cause and cardiovascular mortality in individuals with osteoarthritis

BACKGROUND

The Weight-Adjusted waist index (WWI) is a novel obesity assessment parameter that has been shown to be associated with mortality in various chronic disease populations and is also linked to the onset of osteoarthritis (OA). The aim of this study is to investigate whether WWI is associated with all-cause and cardiovascular mortality in OA population.

METHODS

The study analyzed a cohort of 3,554 OA patients drawn from the National Health and Nutrition Examination Survey (NHANES) conducted between 2005 and 2018. Kaplan-Meier survival curves, Cox proportional hazards regression models, and subgroup analyses were utilized to assess the association between WWI and mortality outcomes. The dose-response relationship was examined using a restricted cubic spline (RCS) model.

RESULTS

Among the 3,554 OA individuals, 611 participants were determined as deceased (13%), and 26% of the deaths were due to cardiovascular causes. The fully adjusted Cox proportional hazards model revealed that elevated WWI values were significantly associated with a higher risk of all-cause mortality (HR = 1.28, 95% CI 1.07‒1.52). The association between WWI and cardiovascular mortality in OA patients was only observed in the minimally adjusted model (HR = 1.43, 95% CI 1.12‒1.81). A similar conclusion was observed when the participants were grouped according to WWI tertiles. Kaplan-Meier survival curves demonstrated elevated mortality rates among individuals with higher WWI. The dose-response analysis indicated a linear positive relationship between WWI and mortality rates. The above associations remained consistent across all subgroups.

CONCLUSION

Elevated WWI levels were associated with a higher risk of all-cause mortality in OA individuals independently.

CLINICAL TRIAL NUMBER

Not applicable.

Weight-adjusted-waist index is associated with urinary albumin-creatinine ratio in normal body mass index adults: a cross-sectional study from NHANES 2001-2018

Obesity promotes chronic kidney disease and albuminuria. Whether weight-adjusted-waist index (WWI) is correlated with albuminuria reflected by urinary albumin-to-creatinine ratio (UACR) in normal body mass index (BMI) population and the effect of hypertension and hyperglycemia on the association remain unclear. This cross-sectional study included adults with complete WWI and UACR data in the National Health and Nutrition Examination Survey (NHANES) database from 2001 to 2018. WWI was defined as waist circumference (WC) divided by the square root of weight. Linear regression, restricted cubic splines (RCS) curve and logistic regression were performed to evaluate the relationship between WWI and albuminuria risk. The relationship in different blood pressure and glucose subgroups were further investigated. 10,105 participants were finally included. The prevalence of albuminuria was 5.05%. WWI in albuminuria group was higher. RCS curve analysis showed the relationship between WWI and albuminuria risk increased linearly in patients with hypertension or hyperglycemia, while a U-shaped curve relationship in normoglycemic or non-hypertensive individuals. Logistic regression results indicated increased WWI was an independent risk factor for albuminuria reflected by UACR in normal BMI population even after adjusting for confounding factors, especially in males. When patients only had hypertension with normal blood glucose, WWI was still independently associated with albuminuria. Elevated WWI increased albuminuria risk in normal BMI adults, especially in males and patients with hypertension or hyperglycemia, even in hypertension patients without hyperglycemia. Assessment of WWI to identify early renal dysfunction should be emphasized.

Association of weight-adjusted waist index (WWI) with overactive bladder (OAB): a cross-sectional study from NHANES 2005-2018

The overactive bladder (OAB) is associated with obesity and inflammation. The weight-adjusted waist index (WWI) has emerged as a novel and more accurate measure of obesity compared to traditional indices, while the Dietary Inflammatory Index (DII) quantifies the inflammatory potential of one's diet. However, the relationship between WWI, DII, and OAB remains unclear. This study aims to elucidate the association between WWI and OAB and to determine whether this relationship is mediated by dietary inflammation. Data from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018, comprising 10,176 participants, were analyzed in this study. The association between WWI and OAB was examined using multivariate logistic regression models, smooth curve fitting, and subgroup analysis. Furthermore, the predictive capabilities of various anthropometric indices-including WWI, body roundness index (BRI), body mass index (BMI), waist circumference, body fat percentage (BF%), and weight-on OAB incidence were assessed using Receiver Operating Characteristic (ROC) curve analysis. Finally, a mediation analysis was conducted to explore whether the DII mediates the relationship between WWI and OAB. There was a significant positive association between WWI and OAB. After adjusting for covariates, for each unit increase in WWI, there was a 40% increase in the prevalence of OAB (OR 1.40, 95% CI 1.25-1.58, P < 0.001). This positive correlation persisted when WWI was categorized into quartiles. The dose-response curve showed a significant linear positive correlation between WWI and OAB. The correlation between WWI and OAB persisted in subgroup analysis. The ROC curve analysis revealed that WWI had a superior predictive capability compared to traditional obesity indices, with an area under the curve (AUC) of 0.661 (95% CI 0.648-0.674, all P < 0.001). The results of the mediation analysis showed that 5.02% of the association between WWI and OAB was mediated by DII (P = 0.016). Our findings suggest that individuals with higher WWI may have an increased risk of OAB. Additionally, an anti-inflammatory diet may be beneficial in preventing OAB. Given the cross-sectional nature of this study, we cannot establish a causal relationship. Future longitudinal studies are needed to validate this association and investigate the potential biological mechanisms underlying this relationship.

Association between weight-adjusted waist index and carotid atherosclerotic plaque in patients with type 2 diabetes in the Chinese population

PURPOSE

The purpose of this study is to investigate the relationship between the weight-adjusted waist index (WWI) and the incidence of carotid atherosclerotic plaque in patients with type 2 diabetes (T2DM) in the Chinese population.

METHODS

A retrospective cross sectional analysis was conducted on data from 801 adult patients from May 2018 to January 2024. Spearman's correlation analysis was used to determine the correlation between WWI and carotid atherosclerotic plaque and analyzed the factors influencing carotid atherosclerotic plaque through binary logistic regression. Additionally, the area under the receiver operating characteristic (ROC) curve (AUC) was calculated to analyze the optimal cut-off point for WWI to predict carotid atherosclerotic plaque.

RESULTS

Compared with the non-carotid atherosclerotic plaque group, the incidence of hypertension, systolic blood pressure, in the carotid atherosclerotic plaque group were higher than in the non-carotid plaque group(P < 0.05). Correlation analysis showed that WWI was positively correlated with carotid atherosclerotic plaque (r = 0.263)(P < 0.05). Binary logistic regression analysis showed that WWI was an independent risk factor for carotid atherosclerotic plaque in patients with T2DM. The ROC curve analysis for the WWI yielded an AUC of 0.65 (95% CI = 0.611-0.69, P < 0.05) for predicting the presence of carotid atherosclerotic plaque.

CONCLUSION

WWI was independently associated with the occurrence of carotid atherosclerotic plaque in patients with T2DM. Given its simplicity and widespread use, WWI emerges as a novel and practical predictor for assessing the risk of developing carotid atherosclerotic plaque in Chinese patients with T2DM.

Weight-adjusted waist index and its relationship with systemic inflammatory Index and metabolic indices in overweight and obese individuals: A cross-sectional study

BackgroundObesity- characterized by excessive adiposity- is associated with various comorbidities, including metabolic, cardiovascular, and liver diseases. Chronic low-grade inflammation is a key factor in complications associated with obesity. This study aimed to investigate the associations between systemic inflammatory indices (SIIs) and weight-adjusted waist index (WWI), alongside metabolic and liver function biomarkers in overweight and obese individuals.MethodThis cross-sectional study included 350 overweight or obese participants (body mass index (BMI) ≥ 25 kg/m2) from both genders. Weight, height, waist, hip, and neck circumferences were measured and BMI, WWI, and the ratios of waist to height (WHtR) and hip (WHR) were estimated. Fasting blood samples were taken to assess SII as well as metabolic parameters.ResultsIn this study, males had significantly higher weight and WC compared to females, whereas the mean level of WWI (p < 0001) and WHtR (p = 0.01) in women were greater than in men. A significant correlation was observed between WWI and SII (r = 0.113, p = 0.039), and other associations were observed between HbA1c levels (r = -0.117, p = 0.033) and monocyte-to-lymphocyte ratio (MLR), and fasting blood sugar (FBS) and neutrophil-to-lymphocyte ratio NLR (r = 0.110, p = 0.041). SII quartiles showed significant differences in aspartate aminotransferase AST levels (p < 0.001), and significant variations in WHtR and MLR were also observed (r = -0.112, p = 0.043).ConclusionOur results reveal strong and significant correlations between systemic inflammatory markers, including SII, MLR, and PLR, and important obesity measures, as well as metabolic and liver function parameters in individuals with obesity.

Association between Body Roundness Index and Depression Among Middle-aged and Older Adults in Chinese Communities: An Empirical Analysis Based on CHARLS Data

BACKGROUND

The relationship between depression and obesity has been confirmed by multiple studies. Compared to conventional measurement indicators such as body mass index or waist circumference, the body roundness index (BRI) demonstrates higher accuracy in assessing body fat content, especially visceral adiposity. Nevertheless, despite the advantages of BRI in measuring fat, the specific link between BRI and depression remains unclear. This study aims to clarify the potential correlation using data from the China Health and Retirement Longitudinal Study (CHARLS).

METHODS

This study used CHARLS data from 2015 and 2020. We screened and included 7,258 middle-aged and older adults without depressive symptoms at baseline. We explored the connection between BRI and depression risk through logistic regression analyses, restricted cubic spline analyses, subgroup analyses, and interaction tests.

RESULTS

After adjusting for covariates, a positive correlation was observed between BRI and depression risk. Specifically, a one-unit increase in BRI led to a 14% increase in depression risk (OR =  1.14, 95% CI: 1.09-1.20, P <  0.001).

CONCLUSION

BRI is linked to a higher risk of depression in middle-aged and older adults in China and can be used as a simple indicator to predict depression.

Association between novel adiposity parameters and hyperuricemia: a cross-sectional study

Objectives

Body mass index (BMI) is a commonly used parameters to measure obesity, but it cannot well reflect the distribution of body fat, which has limitations in clinical practice. Novel adiposity parameters have emerged as substitution to BMI to assess obesity. This study aimed to comprehensively investigate the association between hyperuricemia and novel adiposity parameters.

Methods

We included data from the National Health and Nutrition Examination Survey from 1999-2006. Weighted logistic regression was employed to evaluate the relations between hyperuricemia and novel adiposity parameters, including body roundness index (BRI), weight-adjusted waist index (WWI), a body shape index (ABSI), and conicity index (CoI). To assess the most diagnostic factor for hyperuricemia, the receiver operating characteristic (ROC) curve analysis was employed. The area under the curve (AUC) was used to assess the diagnostic power of each parameter.

Results

The study included 24,763 participants, 3,528 of whom were diagnosed with hyperuricemia. Compared with the first quartile (Q1), the fourth quartile's (Q4) BRI, WWI, ABSI and CoI were linked to an increased risk of hyperuricemia (OR: 9.34, 95% CI: 7.73-11.28; OR: 4.67, 95% CI: 3.97-5.49; OR: 2.61, 95% CI: 2.26-3.02; OR: 7.34, 95% CI: 6.12-8.81, respectively). This relationship persisted after adjusting for confounding factors. Among the four novel obesity parameters, BRI had the largest AUC and was a good diagnostic index of hyperuricemia (AUC = 0.697 for male and AUC = 0.751 for female).

Conclusion

In the general population, larger obesity parameters are linked to a higher risk of hyperuricemia. BRI has high diagnostic value and can be used as a new index for the evaluation of hyperuricemia. This study provides a new basis for the prevention and monitoring of hyperuricemia.

Non-linear association between weight-adjusted-waist index and obstructive sleep apnea: a cross-sectional study from the NHANES (2005-2008 to 2015-2020)

Background

The principal objective of the present investigation is to undertake an in-depth exploration of the relationship that exists between the newly introduced weight-adjusted waist index (WWI), employed as a surrogate way for corpulence, and obstructive sleep apnea (OSA).

Methods

Analysis using cross-sectional data from 11,545 NHANES participants across 2005-2008 and 2015-2020. Obesity via WWI (waist circumference over sqrt of body weight). OSA via 3 NHANES QnA items: monthly excessive sleepiness, weekly wheezing/snoring/breathing stoppage, weekly snoring. Relationships between WWI and OSA probed with weighted multivariate logistic regression and smoothed curve fitting. Also did subgroup, interaction tests and threshold effect analysis. Excluded those with incomplete WWI, OSA or hypertension data as they might have different health profiles. We excluded participants with incomplete data on WWI, OSA, or hypertation-related items, as those with missing data might have different health profiles.

Results

The study, encompassing a cohort of 11,545 participants, revealed that 5,727 individuals were diagnosed with OSA. Upon conducting fully adjusted models, A positive relevance between WWI and OSA was established, with an odds ratio of 1.57 (95% CI: 1.44, 1.71), indicating a significant relationship. Notably, participants falling within the highest quartile of WWI exhibited a markedly heightened propensity for OSA, being 2.58 times more likely to suffer from it than those in the bottom quartile [OR: 2.58 (95% CI: 2.10, 3.17)]. Rigorous subgroup analyses and interaction tests further confirmed the robustness of this positive association across various subgroups, thereby affirming the consistency of the observed relationship. Additionally, a noteworthy non-linear association and saturation phenomenon were discerned between the WWI and OSA, demarcated by an inflection point at 11.70 cm/√kg.

Conclusion

Our research has clearly shown a significant positive correlation, along with a saturation effect, between WWI and OSA in the American population. However, the cross-sectional design limits causal inference, and the exclusion of certain participants may affect the generalizability of the findings. Future longitudinal studies are needed to explore causality and address potential biases associated with participant exclusion, ultimately improving the broader applicability of the results.

Association of the weight-adjusted waist index with mortality in osteoporotic patients

INTRODUCTION

The prevalence of osteoporosis (OP) is steadily rising, leading to a higher risk of mortality. This study assessed the impact of the Weight-Adjusted Waist Index (WWI) on osteoporosis-related mortality.

MATERIALS AND METHODS

Data from NHANES 2005-2010, 2013-2014, and 2017-2018 were analyzed to evaluate the relationship between WWI and mortality in osteoporotic patients using weighted proportional hazards model and Kaplan-Meier survival analysis. A subgroup analysis was performed to ensure the stability of the findings.

RESULTS

The study included 1324 participants. The findings indicated a positive correlation between WWI and OP (OR 1.65, 95% CI 1.45-1.89). Among patients with OP, WWI showed a positive association with all-cause mortality (HR 1.28, 95% CI 1.10-1.48). There was no observed correlation between varying WWI levels and mortality due to cardiovascular disease or cancer.

CONCLUSIONS

Maintaining a lower WWI is associated with a reduced risk of all-cause mortality among individuals with OP.

Relationship between weight-to-waist index and post-stroke depression

BACKGROUND

The weight-to-waist index (WWI) serves as an innovative metric specifically designed to assess central obesity. However, the relationship between WWI and the prevalence of post-stroke depression (PSD) remains inadequately explored in the literature.

AIM

To elucidate the relationship between WWI and PSD.

METHODS

Data from the National Health and Nutrition Examination Survey 2005 to 2018 were analyzed. Multivariable logistic regression models and propensity score matching were utilized to investigate the association between WWI and PSD, with adjustments for potential confounders. The restricted cubic spline statistical method was applied to explore non-linear associations.

RESULTS

Participants with elevated WWI values had a significantly greater risk of developing PSD. Specifically, individuals in the higher WWI range exhibited more than twice the likelihood of developing PSD compared to those with lower WWI values (odds ratio = 2.21, 95% confidence interval: 1.84-2.66, P < 0.0001). After propensity score matching, the risk of PSD remained significantly elevated (odds ratio = 1.43, 95%confidence interval: 1.09-1.88, P = 0.01). Tertile analysis revealed that participants in the highest WWI tertile faced a significantly higher risk of PSD compared to those in the lowest tertile. Restricted cubic spline analysis further revealed a non-linear association, with the risk of PSD plateauing at higher WWI values.

CONCLUSION

There is a significant association between elevated WWI and increased risk of PSD. Thus, regular depression screening should be implemented in stroke patients with elevated WWI to enhance patient outcomes.

Conditions for Nutritional Care of Elderly Individuals with Dementia and Their Caregivers: An Exploratory Study

Background/Objective: Although the context, personal conditions, and caregivers' abilities influence the nutrition of older people with dementia, adequate parameters are not always applied to identify these conditions. The aim of this study was to characterize the nutritional care needs of older people with dementia and their caregivers. Method: This descriptive exploratory study was conducted in Colombia. An intentional sample included 73 elderly individuals with dementia and 73 caregivers. This study described the participants' characteristics with the GCPC-UN-D survey. Their nutritional conditions include medical history, objective tests, and interviews. We used the Edinburgh Scale to evaluate elderly feeding behavior and the QUALID tool to evaluate their quality of life. This study measured caregiver competence using the CUIDAR tool. Results: Adults of 78.8 years on average, with low to middle socio-economic status, low education levels, and multiple comorbidities, have adverse well-being and support conditions, except for the spiritual component. These adults have visible nutritional issues including low muscle mass indices (47.9%), muscle mass levels (arm 61.6%; calf 58.9%), and vitamin D levels (50.7%), with high cholesterol levels (57.9%) and altered hematocrit and red blood cell counts (46.4%). These adults required supervision (41%) or help (23%) for their nutrition. Caregivers were predominantly women with an average age of 32.4 years, with moderate caregiving competences (70.43%), experienced high caregiver burden (83.6%), and had low orientation in nutritional management (30.1%). Conclusions: Elderly individuals with dementia had significant nutritional and feeding problems. Their caregivers lacked adequate conditions to ensure quality care. These dyads need a strategy to improve their healthcare experience.

Predictive model for sarcopenia in chronic kidney disease: a nomogram and machine learning approach using CHARLS data

Background

Sarcopenia frequently occurs as a complication among individuals with chronic kidney disease (CKD), contributing to poorer clinical outcomes. This research aimed to create and assess a predictive model for the risk of sarcopenia in CKD patients, utilizing data obtained from the China Health and Retirement Longitudinal Study (CHARLS).

Methods

Sarcopenia was diagnosed based on the Asian Working Group for Sarcopenia (AWGS 2019) criteria, including low muscle strength, reduced physical performance, and low muscle mass. The 2015 CHARLS data were split randomly into a training set (70%) and a testing set (30%). Forty-nine variables encompassing socio-demographic, behavioral, health status, and biochemical factors were analyzed. LASSO regression identified the most relevant predictors, and a logistic regression model was used to explore factors associated with sarcopenia. A nomogram was developed for risk prediction. Model accuracy was evaluated using calibration curves, while predictive performance was assessed through receiver operating characteristic (ROC) and decision curve analysis (DCA). Four machine learning algorithms were utilized, with the optimal model undergoing hyperparameter optimization to evaluate the significance of predictive factors.

Results

A total of 1,092 CKD patients were included, with 231 (21.2%) diagnosed with sarcopenia. Multivariate logistic regression revealed that age, waist circumference, LDL-C, HDL-C, triglycerides, and diastolic blood pressure are significant predictors. These factors were used to construct the nomogram. The predictive model achieved an AUC of 0.886 (95% CI: 0.858-0.912) in the training set and 0.859 (95% CI: 0.811-0.908) in the validation set. Calibration curves showed good agreement between predicted and actual outcomes. ROC and DCA analyses confirmed the model's strong predictive performance. The Gradient Boosting Machine (GBM) outperformed other machine learning models. Applying Bayesian optimization to the GBM achieved an AUC of 0.933 (95% CI: 0.913-0.953) on the training set and 0.932 (95% CI: 0.905-0.960) on the validation set. SHAP values identified age and waist circumference as the most influential factors.

Conclusion

The nomogram provides a reliable tool for predicting sarcopenia in CKD patients. The GBM model exhibits strong predictive accuracy, positioning it as a valuable tool for clinical risk assessment and management of sarcopenia in this population.

The relationship between VAI, LAP, and depression and the mediation role of sleep duration-evidence from NHANES 2005-2020

BACKGROUND

The relationship between obesity and mental health has attracted attention. However, large sample studies on the relationship between visceral fat obesity and depression are lacking. This study aimed to explore the relationship between visceral fat obesity and depression by using visceral adiposity index (VAI) and lipid accumulation product (LAP). Additionally, it sought to explore the potential mediating role of sleep duration in these associations.

METHODS

The data used in the current cross-sectional investigation are from the National Health and Nutrition Examination Survey (NHANES) spanning from 2005 to 2020, including 19,659 participants. Depression was measured using the nine-item Patient Health Questionnaire. Weighted multivariable regression analysis was used to evaluate the correlation of VAI and LAP with depression. The potential non-linear relationship was determined using smooth curve fitting and threshold effect analysis. Additionally, mediation analysis was performed to investigate the potential mediating role of sleep duration. The stability of the relationship was assessed through sensitivity analysis.

RESULTS

VAI and LAP were closely related to depression. In the fully adjusted model, VAI and LAP in the highest quartile increased the association of depression by 52% (OR = 1.52, 95% CI 1.20-1.92, P < 0.001) and 51% (OR = 1.51, 95% CI 1.19-1.91, P < 0.001), respectively, compared with the lowest quartile. Specific saturation effects for VAI, LAP, and depression were identified by smoothed curve fitting, with inflection points of 3.81 and 98.55, respectively. Additionally, mediation analysis revealed that 5.1% and 2.8% of the associations between VAI and LAP with depression were mediated through sleep duration. The results of the sensitivity analysis showed interactions between hypertension and cardiovascular disease in the associations of VAI, and depression (P < 0.05).

CONCLUSION

VAI and LAP are associated with depression in US adults. The associations between VAI and LAP with depression are non-linear, which may be mediated through sleep duration. The study highlights the potential of VAI and LAP as valuable tools for the prevention and management of depression.

Association between the weight-adjusted waist index and age-related macular degeneration in US adults aged≥40 years: the NHANES 2005-2008

Objective

The association between the weight-adjusted waist index (WWI) and age-related macular degeneration (AMD) in US adults aged 40 years and older is unknown. The goal of this study was to ascertain a possible association between the two.

Methods

Data were obtained from the National Health and Nutrition Examination Survey (NHANES) in the US from 2005 to 2008. The WWI was calculated by dividing waist circumference (WC) by the square root of body weight (kg). AMD was diagnosed based on distinctive features observed in the fundus, using a standard classification system. Weighted logistic regression analyses were conducted to investigate the association between the WWI and AMD. Spline smoothing and threshold effects were applied to explore non-linear correlations. Subgroup analyses were performed to identify underlying covariates affecting this relationship. In addition, receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive power of the WWI for AMD.

Results

A total of 5,132 participants were enrolled in this study. The results showed a significant positive association between the WWI and risk of AMD (OR = 1.76 (1.52, 2.04); p < 0.0001). When the WWI was categorized into tertiles, the highest group exhibited a stronger association compared to the lowest tertile (OR = 2.90 (2.18, 3.86); p < 0.0001) in model 1. The subgroup analyses and interaction tests indicated that the relationship between the WWI and AMD was stable across various populations. The spline smoothing and threshold effects showed a positive non-linear correlation between the WWI and AMD incidence. Furthermore, compared to body mass index (BMI), WC, and weight, the WWI showed better predictability for AMD, as shown by the ROC analysis.

Conclusion

There exists a positive non-linear association between the WWI and AMD in US adults aged 40 years and older. The WWI-related obesity management is necessary for the prevention and treatment of AMD.

Weight-Adjusted Waist Index May Predict Hypertension Plus Hyperuricemia

The weight-adjusted waist index (WWI) is a novel indicator that could estimate body fat and muscle mass. This study aimed to investigate the relationship between WWI and hypertension plus hyperuricemia (HTN-HUA). The data were obtained from the National Health and Nutrition Examination Survey (NHANES) database from 1999 to 2018. Logistic regression analyses were used to explore the association between WWI with HTN-HUA, hypertension (HTN) alone, and hyperuricemia (HUA) alone. Restricted cubic spline (RCS) analyses were employed to examine potential nonlinear associations. Receiver operating characteristic (ROC) curves were utilized to assess the predictive ability of WWI. A total of 16 294 participants were included, among whom 2280 (12%) were diagnosed with HTN-HUA, 5148 (28%) with HTN alone, and 1252 (9%) with HUA alone. WWI was significantly associated with HTN-HUA, HTN alone, and HUA alone after adjusting for potential confounders. Compared to the lowest quartiles of WWI, the odds ratios of the highest quartiles were 2.13 (95% confidence interval [CI]: 1.59-2.83) for HTN-HUA, 1.28 (95% CI: 1.08-1.5) for HTN alone, and 1.6 (95% CI: 1.18-2.16) for HUA alone. RCS analyses demonstrated a nonlinear association between WWI and HTN-HUA. The fully adjusted model, which included WWI, exhibited a moderate predictive ability for HTN-HUA (area under the curve [AUC]: 0.804, 95% CI 0.796-0.813). The association between WWI and HTN-HUA was more prominent among young individuals and those with normal weight. The study suggested that a significant and nonlinear association between WWI and HTN-HUA. WWI had the potential to facilitate the early detection of HTN-HUA.

Weight-adjusted waist index shows superior detection of coronary artery disease than body mass index in NHANES 1999-2020

Coronary artery disease (CAD) is a leading cause of morbidity and mortality globally, highlighting the need for improved risk assessment tools. Traditional measures like body mass index (BMI) do not fully capture the risk associated with body fat distribution. The weight-adjusted waist index (WWI) has emerged as a potential anthropometric measure that may provide a more precise evaluation of central adiposity and its cardiovascular risks. We analyzed data from 49,240 participants in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2020. Participants were stratified into quartiles based on WWI: Q1 (WWI < 10.43), Q2 (10.43 ≤ WWI < 10.99), Q3 (10.99 ≤ WWI < 11.56), and Q4 (WWI ≥ 11.56). The primary outcome was self-reported coronary artery disease (CAD). Multivariate logistic regression, generalized additive models, and stratified analyses were conducted. The predictive performance of WWI versus body mass index (BMI) for CAD was assessed using receiver operating characteristic (ROC) curves, with differences in area under the curve (AUC) evaluated by DeLong's test. Multivariate logistic regression analysis showed a positive association between WWI and CAD prevalence, which persisted after adjusting for confounding variables. Higher WWI was associated with increased risk of CAD, with Group 4 showing the highest risk compared to Group 1 (OR 2.06, 95% CI 1.37-3.09, P < 0.001). This relationship was not observed between BMI and CAD risk. Subgroup analysis revealed that the association between WWI and CAD prevalence was more pronounced in participants aged ≤ 60 years (P for interaction < 0.001). ROC curve analysis demonstrated that WWI had superior predictive ability for CAD compared to BMI (AUC 0.694 vs. 0.547, De-long test P < 0.001). WWI demonstrated a stronger association with CAD prevalence compared to BMI in the US population, with this relationship particularly pronounced among younger adults. Longitudinal studies are needed to establish this relationship.

Longitudinal relationship between baseline Weight-Adjusted Waist Index and stroke risk over 8 years in Chinese adults aged 45 and older: a prospective cohort study

Background

This study explores the longitudinal relationship between the Weight-Adjusted Waist Index (WWI), an innovative obesity metric, and stroke incidence in aged 45 and older Chinese adults.

Methods

Data from 9,725 individuals aged 45 years and older were analyzed from the China Health and Retirement Longitudinal Study (2011-2020). Baseline characteristics were analyzed across different quartiles of the WWI. Stroke incidents were determined through self-reported doctor diagnoses. Multivariate logistic regression analyses and curve fitting assessed the WWI-stroke risk relationship, adjusting for various demographic, lifestyle, and health-related factors.

Results

Higher WWI quartiles were associated with older age and higher prevalence of stroke and adverse health conditions. In the fully adjusted model, participants in the highest WWI quartile had an odds ratio of 1.52 (95% CI: 1.19, 1.92) for stroke compared to the lowest quartile. Curve fitting revealed a linear relationship between WWI and stroke risk, consistent across various demographic and clinical subgroups.

Conclusion

Higher WWI is linked to an increased risk of stroke in aged 45 and older Chinese adults over an eight-year period. WWI may serve as an effective tool for predicting long-term stroke risk within this population. However, the study is limited by the reliance on self-reported stroke diagnoses and the presence of potential residual confounding factors.

Association of weight-adjusted-waist index with type 2 diabetes mellitus in Chinese urban adults: a cross-sectional study

Background

Recently, weight-adjusted-waist index (WWI), a new index for evaluating obesity, has been developed. This study aimed to examine the association between WWI and T2DM in Chinese urban adults.

Method

A total of 5,0978 eligible participants drawn from the prospective REACTION study (Cancer Risk Assessment in Chinese People with Diabetes) were included in this study. Participants were divided into 3 groups based on baseline WWI levels. Pearson correlation analysis and binary logistic regression analysis were conducted to explore the association of WWI with T2DM risk factors and with T2DM risk.

Results

The prevalence of obesity, central obesity and T2DM was 14.2%, 46.8% and 11.0% respectively, with a median age of 57 years. Logistic analysis showed that the WWI was significantly associated with the risk of T2DM. Compared to the lowest tertile of WWI (T1) serving as the reference group, the second tertile (T2) and the third tertile (T3) were associated with a 0.218-fold [1.218 (1.152, 1.288), P <0.001] and 0.286-fold [1.286 (1.212, 1.364), P <0.001] increase in the odds of developing T2DM respectively. After adjusting for all factors with the exception of the stratified variable, this association held true in age, sex, BMI, hypertension, and hyperlipidemia subgroup and was especially pronounced in those aged <60 years, BMI ≥24 kg/m2, and males, with interactions between WWI and age, sex, and BMI (P for interaction <0.05).

Conclusion

WWI was positively associated with T2DM in Chinese urban adults, especially in young and middle-aged males with BMI ≥24 kg/m2.

Sex-specific association of weight-adjusted waist index with mortality in stroke survivors: A national longitudinal cohort study

BACKGROUND AND AIMS

The weight-adjusted waist index (WWI) is a novel indicator of obesity, and its association with mortality in stroke patients remains unknown. We aimed to explore these associations through a national longitudinal cohort study.

METHODS AND RESULTS

We included stroke survivors from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 who were followed up until December 31, 2019. The study outcomes were all-cause and cardiovascular disease (CVD) mortality in stroke patients. A total of 1427 stroke patients were enrolled, and after a median follow-up duration of 83 months, 624 stroke patients died, including 251 from CVD. Kaplan‒Meier survival analyses indicated that WWI was significantly associated with the probability of survival over time in stroke patients (log-rank tests, both p < 0.0001). After adjusting for confounders, WWI was significantly and positively associated with all-cause and CVD mortality after stroke. Restricted cubic spline analysis revealed that WWI was linearly associated with all-cause mortality and nonlinearly associated with CVD mortality. Stratified analyses suggested that sex significantly influenced the effect of WWI on all-cause mortality in stroke patients. Additional body mass index (BMI) adjustments did not significantly change the results.

CONCLUSION

WWI was positively associated with all-cause and CVD mortality in stroke patients, independent of BMI. These effects were present only in men. These findings suggest that WWI is an independent prognostic factor in stroke patients and that maintaining appropriate WWI values can help improve the prognosis of stroke survivors.

Association between weight-adjusted-waist index and serum anti-aging protein α-Klotho in U.S. adults: Evidence from NHANES 2007-2016

BACKGROUND

As unhealthy diets have proliferated, there has been an increasing trend in the prevalence of obesity along with socioeconomic progress. WWI, mainly representing weight-independent central obesity, is a more accurate indicator of obesity than BMI and WC. Klotho is known to be one of the root causes of several age-related illnesses. There has never been any prior evidence associating WWI and serum α-Klotho levels.

METHODS

The current cross-sectional investigation used data from the National Health and Nutrition Examination Survey (NHANES) 2013-2016. The calculation of each participant's WWI involved dividing their waist circumference in centimeters by the square root of their weight in kilograms. Using multivariable linear regression models, the association between serum Klotho concentrations and WWI was analyzed. Smoothed curve fitting was utilized to investigate the nonlinear connection. In addition, interaction tests and other subgroup analyses were carried out.

RESULTS

With an average age of 57.57 ± 10.81 years, 13,172 participants were enrolled in this study, of whom 51.45 % were female. After full adjustment, each unit increase in WWI was significantly associated with a decrease in Klotho by 23.18 ng/ml [β(95%CI) = -23.18 (-31.34, -15.02)]. Moreover, we uncovered that WWI had a stronger negative correlation with Klotho than other obesity markers, such as WC, body mass index (BMI), and a body shape index (ABSI).

CONCLUSIONS

To sum up, weight-adjusted-waist index levels were negatively associated with serum Klotho protein concentration and showed a stronger correlation than other obesity markers. Our findings indicated that WWI may be a predictor of reduced Klotho levels, and that controlling obesity in accordance with WWI may help lower the Klotho levels.

Evidence from NHANES 2011-2014: a correlation between the weight-adjusted-waist index and cognitive abilities in the United States

Background

Obesity exerts a significant detrimental impact on cognitive function. The weight-adjusted waist index (WWI) serves as a more precise indicator of visceral obesity that is independent of weight, in contrast to body mass index (BMI). Still, little research has been conducted on the interrelation between WWI and cognitive abilities. This investigation explored the link between WWI and older Americans' cognitive function.

Methods

Utilizing data from the 2011-2014 National Health and Nutrition Examination Cross-Sectional Survey, multiple linear regression analysis was used to assess the influence of WWI on cognitive abilities in those over 60. Three cognitive assessments were administered: the Animal Fluency Test (AFT), the Digit Symbol Substitution Test (DSST), and the Word Learning and Recall Module from the Coalition to Establish a Registry for Alzheimer's Disease (CERAD). We implemented threshold effects analysis and smoothed curve fitting to elucidate the nonlinear relationship. Additionally, we analyzed subgroups to check for variability.

Results

There were 2,762 participants, including1,504 (54.45%) females and 1,258 (45.55%) males. 53.77% of them had completed high school or above, and their average age was 69.05 ± 6.62. After controlling for confounding variables, the improved model predicted a negative connection between WWI and CERAD-Total, AFT, and DSST scores (all p < 0.05). Furthermore, we performed a smoothenable curve fitting between WWI and cognitive function scores, resulting in a nonlinear connection and a threshold saturation effect. We also executed subgroup analyses and interaction tests based on gender, race, educational background, marital status, diabetes, body mass index, alcohol consumption, hypertension, smoking habits, stroke, depression, and sleep quality to assess whether the relationship between WWI and cognitive function was affected by heterogeneity across different population segments. The subgroup analysis found no significant differences in cognitive performance associated with WWI across the various subgroups.

Conclusion

Higher WWI levels are associated with impaired cognitive function in Americans aged 60 and older.

Association between sarcopenia and weight-adjusted waist index in male patients with type 2 diabetes

BACKGROUND

The Weight-adjusted-waist index (WWI) has emerged as a predictive factor for a range of metabolic disorders. To date, the predictive value of the WWI in relation to sarcopenia in individuals with diabetics has not been extensively explored. This study aims to investigate the impact of the WWI on the prevalence of sarcopenia among patients with type 2 diabetes mellitus (T2DM).

METHOD

In this study, we enrolled 417 patients with T2DM from the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University between Dec. 2023 and Apr. 2024. The relationship between the WWI and the prevalence of sarcopenia in T2DM patients was evaluated using multivariate logistic regression, subgroup analysis, restricted cubic spline (RCS) analysis, and receiver operating characteristic (ROC) curve analysis.

RESULTS

Among the 417 patients with T2DM, 76 (18.22%) were identified as having sarcopenia. The prevalence of sarcopenia across the WWI quartile categories, from the first to the fourth quartile, was 8.65%, 8.57%, 20.19% and 8.65% respectively. Multivariate logistic regression analysis revealed that, after adjusting for covariates, a higher WWI was an independent risk factor for sarcopenia in male T2DM patients (OR = 1.836, 95% CI: 1.216-2.772, P = 0.004). This association was not observed in female patients. Subgroup analysis further revealed a stronger correlation between WWI and sarcopenia among male patients with higher HbA1c levels. In males, RCS regression demonstrated a non-linear positive correlation, with an inflection point at a WWI of 10.42 cm/√kg. Finally, the area under the ROC curve (AUC) for the WWI was 0.612.

CONCLUSIONS

WWI emerges as a robust and independent risk factor for sarcopenia in male patients with T2DM. WWI may serve as an accessible and cost-effective tool for identify sarcopenia in patients with diabetes.

Association between weight-adjusted waist index and cognitive impairment in Chinese older men: a 7-year longitudinal study

Background

Obesity, through mechanisms such as insulin resistance and systemic low-grade inflammation, can damage the central nervous system and impair cognitive function. Weight-adjusted waist index (WWI) is a novel measure of obesity that may offer more precise assessments of muscle and fat mass. This study aims to investigate the association between WWI and cognitive function in older Chinese men.

Methods

Data from the 2011-2018 China Longitudinal Health and Longevity Survey (CLHLS) were used in this study. WWI and cognitive function were examined in both linear and non-linear situations using Kaplan-Meier survival curves, multivariate Cox regression models, and restricted cubic spline (RCS) regression.

Results

This study included 1,392 older Chinese men aged 65 years and over for whom complete data were available. After controlling for all potential confounding variables, our analysis showed a statistically significant positive association between WWI and cognitive decline. Specifically, for every 1 cm/√kg increase in WWI, the risk of cognitive impairment increased by 17% (HR = 1.17, 95% CI: 1.02-1.35). Using 11.52 cm/√kg as the cutoff point for WWI, we found that High WWI was associated with a 44% increased risk of cognitive impairment compared with Low WWI (HR = 1.44, 95% CI: 1.07-1.96). RCS regression analysis confirmed a linear positive correlation between WWI and cognitive impairment.

Conclusion

Higher WWI is linked to worse cognitive performance in older Chinese men.

Association between weight-adjusted-waist index and long-term prognostic outcomes in cardiovascular disease patients: results from the NHANES 1999-2018 study

BACKGROUND

As cardiovascular disease (CVD) morbidity and mortality increase yearly, this study aimed to explore the potential of the weight-adjusted-waist index (WWI) and its relation to long-term mortality in patients with CVD.

METHODS

The diagnosis of CVD was based on standardized medical condition questionnaires that incorporated participants' self-reported physician diagnoses. WWI (cm/√kg) is a continuous variable and calculated as waist circumference (WC, cm) divided by square root of body weight (kg). For analysis purposes, the participants were divided into four groups based on the quartiles (Q1 - Q4) of the WWI. The study's primary outcome was all-cause mortality in patients with CVD, with cardiovascular mortality as the secondary outcome, and sample weights and complex survey designs were used to ensure reliable, accurate results.

RESULTS

The final analysis included 4,445 study participants. In the fully adjusted model, the highest quartile (WWI > 12.05 cm/√ kg) showed a higher all-cause mortality rate compared with the lowest quartile (WWI < 11.03 cm/√ kg) (HR = 1.37, 95% CI: 1.03, 1.82, P < 0.05). The risk of all-cause mortality increased with WWI and showed a linear association in patients with congestive heart failure, heart attack (P-overall < 0.05, P - nonlinear > 0.05); WWI was nonlinearly associated with the risk of all-cause mortality in patients with coronary heart disease and angina (P-overall < 0.05, P - nonlinear < 0.05). Survival curve analysis further showed that all cause and cardiovascular mortality were higher in the high WWI group (Q4) (P < 0.001). The time-dependent receiver operating characteristic (ROC) curve showed that WWI's area under the curves (AUC) for 5- and 10-year survival rates were 0.76 and 0.792 for all-cause mortality and 0.734 and 0.757 for CVD mortality. WWI's AUC were higher than those of body mass index (BMI) and WC (all P < 0.01).

CONCLUSION

Our findings indicate that a high WWI is positively associated with an increased risk of all-cause mortality. Additionally, the high AUC values for WWI strengthen its potential as a meaningful prognostic marker, underscoring its utility in clinical practice for assessing long-term survival risk in patients with CVD.

Correlation between weight-adjusted waist index and coronary heart disease: NHANES 1999-2020

Background

The weight adjusted waist index (WWI) represents a novel indicator for assessing central obesity. The objective of this study is to investigate the association between WWI and coronary heart disease (CHD).

Method

The data of 44,528 participants in total were gathered from NHANES database from 1999 to 2020. WWI is calculated as the waist circumference (WC, cm) divided by the square root of the body weight (kg), and CHD was determined based on participants' self-reports. The association between WWI and CHD was examined using multiple logistic regression analysis, restrictive cubic spline (RCS), receiver operating characteristic (ROC) curve, mediation analysis, subgroup and interaction analyses.

Result

This was a cross-sectional investigation. A total of 44,528 participants were included [50.23% male; mean WWI 10.89 (0.01) cm/√kg]. The multivariate logistic regression analysis revealed that in three models, one-standard-deviation increment in WWI was associated with an increased probability of CHD occurrence by 2.39 (2.22,2.57),1.47 (1.32,1.65), and 1.15 (1.00,1.32) times, respectively. Additionally, RCS analysis indicated a linear relationship between WWI and CHD. and the ROC analysis results showed that the discriminatory power of WWI for CHD was superior to that of body mass index (BMI) and WC. Glycated hemoglobin (HbA1c) partially mediated the relationship between WWI and CHD. Subgroup and interaction analyses confirmed that age, systolic blood pressure, and diabetes status had a significant impact on the association between WWI and CHD (P for interaction <0.05).

Conclusion

The level of WWI has been demonstrated to be associated with an increased risk of CHD. Specifically, as WWI increases, the risk of CHD becomes higher. On this basis, it is hypothesized that WWI may potentially serve as an independent risk factor for CAD, thereby highlighting the substantial value of WWI in the identification and management of CHD.

Association between lipid accumulation product and chronic obstructive pulmonary disease: a cross-sectional study based on U.S. adults

Background

Lipid Accumulation Product (LAP), which is derived from measurements of waist circumference and triglyceride (TG) levels, serves as a comprehensive indicator of lipid accumulation. Emerging research indicates that lipid accumulation dysfunction might significantly contribute to the pathogenesis of Chronic Obstructive Pulmonary Disease (COPD). Nevertheless, the investigation into the association between LAP and COPD risk is still insufficient, particularly in population-based research. This research intends to examine the possible correlation between LAP and the likelihood of developing COPD.

Methods

This study, designed as a cross-sectional analysis, made use of data gathered from the National Health and Nutrition Examination Survey (NHANES) spanning the years 2017 to 2020, encompassing a total of 7,113 eligible participants. LAP, the exposure variable, was calculated using waist circumference and triglyceride concentration. COPD diagnosis was determined using participants' self-reported information. To explore the association between LAP and COPD, multivariate logistic regression models were applied, and smoothing curve fitting was employed to examine any potential nonlinear patterns. Further analysis included stratified subgroup evaluations to assess how variables such as sex, smoking habits, and alcohol intake might impact the relationship between LAP and COPD.

Results

The findings indicated a significant increase in COPD risk with each one-unit rise in ln LAP, as evidenced by an Odds Ratio (OR) of 1.16 [95% Confidence Interval (CI): 1.04-1.30, p < 0.01]. Furthermore, a quartile-based analysis revealed that individuals in the highest ln LAP category had a considerably higher likelihood of developing COPD compared to those in the lowest category, with an OR of 1.35 (95% CI: 1.04-1.75, P for trend <0.01). Furthermore, the smoothing curve fitting identified a nonlinear and positive association between ln LAP and COPD, suggesting a steeper increase in risk as ln LAP values rise. Subgroup analysis suggested that this association remained fairly consistent across various demographic groups.

Conclusion

This study found a significant link between higher LAP levels and an elevated risk of COPD, with the association displaying a nonlinear pattern. As a marker of lipid accumulation abnormalities, LAP may serve as a valuable tool for assessing COPD risk and could inform strategies for early identification and targeted clinical management.

Association between five novel anthropometric indices and erectile dysfunction in US adults from NHANES database

Erectile Dysfunction (ED) is the leading cause of sexual dysfunction affecting hundreds of millions of men worldwide, and has been described as an important public health problem. The association of five novel anthropometrics related to obesity, lipids and glucose with ED remains unclear. To investigate the association of lipid accumulation products index (LAP), triglyceride glucose index (TyG), waist triglyceride index (WTI), weight-adjusted-waist index (WWI) and a body shape index (ABSI) with ED. Cross-sectional data from the NHANES were used. Participants were adults aged 20-85 y from 2001 to 2004. The analysis of logistic regressions, smooth curve fitting, subgroup analyses and generalized addition model were performed to examine the relationship between five novel anthropometric indicators and the prevalence of ED. An overall 1413 adult men were included in the study. After adjusting for confounding factors, the results of multiple regression analysis showed, ED positively correlated with LAP(OR = 1.0031, P < 0.05), TyG(OR = 1.2981, P < 0.05), WTI(OR = 1.4220, P < 0.05), WWI(OR = 1.6043, P < 0.001), and ABSI(OR = 1.6211, P < 0.05). Smoothed curve fitting and subgroup analyses proved the stability of the relationship. This cross-sectional study showed a positive correlation between these five novel anthropometric indicators (LAP, TyG, WTI, WWI, ABSI) and ED. Further studies are needed to explore their association better and the underlying mechanisms.

Weight-adjusted waist index associated with bone mineral density in rheumatoid arthritis patients: a cross-sectional study

The research examined the association between weight-adjusted waist index (WWI) and bone mineral density (BMD) in individuals with rheumatoid arthritis, considering the impact of obesity on bone health. The association between WWI and BMD was examined utilizing weighted linear regression and smoothed curve fitting with data from NHANES 2005-2010, 2013-2014, and 2017-2018. Subgroup analysis verified the stability of the results. The study included a cohort of 983 rheumatoid arthritis patients. A significant negative correlation was found between WWI and BMD at the total femur, femoral neck, and lumbar spine (β = -0.03, 95% CI (-0.04, -0.02), p < 0.001; β = -0.02, 95% CI (-0.04, -0.01), p = 0.001; β = -0.04, 95% CI (-0.06, -0.02), p < 0.001). This negative association was not significantly influenced by factors like age, gender, race, education, PIR, diabetes, hypertension, sleep disorders, alcohol consumption, or smoking status (p > 0.05 for interaction). The findings indicate a negative correlation between WWI and BMD in the rheumatoid arthritis population. Key Points •A negative correlation was found between WWI and BMD at the total femur, femoral neck, and lumbar spine in the rheumatoid arthritis population.

Weight-Adjusted Waist Index (WWI)-A Promising Anthropometric Indicator of Depressive Symptoms in Hospitalized Older Patients

OBJECTIVES

The aim of this study was to evaluate which anthropometric index, either body mass index (BMI) or weight-adjusted waist index (WWI), is more accurately associated with the prevalence of the most common chronic diseases and components of geriatric assessment in hospitalized older adults.

METHODS

The study included a total of 2945 hospitalized older adults (median age 82 years). The associations between the presence of chronic diseases and Comprehensive Geriatric Assessment (CGA) results were compared with WWI and BMI values.

RESULTS

The WWI was significantly higher in both sex groups suffering from hypertension, diabetes, osteoarthritis, and depression. In women, the parameter was increased among individuals with previous myocardial infarction, who presented heart failure symptoms or had chronic kidney disease diagnosed, whereas in men, among those with pulmonary diseases and osteoporosis, WWI was related to many CGA parameters oftentimes where BMI proved to fail. There was a positive correlation of WWI with the presence of depressive symptoms assessed with the geriatric depression scale (GDS) but no significant correlation with BMI. In multiple logistic regression models, WWI was a stronger predictor of depression as compared to waist circumference or the waist-to-height ratio.

CONCLUSIONS

There is an association between a higher WWI and depression diagnosis as well as the presence of depressive symptoms according to the GDS in hospitalized older adults, both women and men. There is no such correlation between depression and BMI. Both high BMI and high WWI values seem to identify older patients with cardiometabolic diseases such as hypertension and diabetes. According to this study, WWI seems to be a promising indicator of depression risk and, similarly to BMI, a useful parameter for the assessment of cardiometabolic risk in older hospitalized adults.

Weight-adjusted waist index predicts metabolic syndrome in Caucasian patients with obesity

Introduction

Background and aims: the usefulness of the weight-adjusted waist index (WWI) among persons with metabolic syndrome (MS) has not been previously evaluated. The objective of this study was to evaluate the ability of WWI to predict MS in a Caucasian population with obesity. Methods: we conducted a cross sectional study in 2162 Caucasian patients with obesity. Anthropometric data (weight, height, body mass index [BMI], waist circumference, [WWI]), bioimpedanciometer parameters (total fat mass [FM], skeletal muscle mass [SMM] and skeletal muscle mass index [SMMi]), blood pressure, presence of MS and biochemical parameters were recorded and compared by tertiles of WWI. Results: a total of 1,176 subjects had MS (54.4 %) and 986 did not show MS (45.6 %). Compared with the lowest WWI category Q1 (< 11.24 cm/√kg), the prevalence of MS increased in the logistic regression model adjusted by sex and age in the Q3 group (OR = 2.53, 95 % CI = 1.71-3.23; p = 0.001). In addition, the prevalence of MS was higher in the Q3 group than in Q2 (OR = 1.65, 95 % CI = 1.25-2.17; p = 0.005). Finally, the prevalence of MS in Q2 was higher than in the Q1 group (OR = 1.21, 95 % CI = 1.06-3.11; p = 0.01). The area under the curve (AUC) to assess the ability of WWI to identify MS showed values of 0.811 (0.687-0.871; p = 0.001). The cut-off point according to the Youden index was 11.59, with sensitivity and specificity of 70 % and 93.4 %, respectively. Conclusion: we described a good accuracy of WWI to identify MS an independent association between WWI in Caucasian patients with obesity.

The association between weight-adjusted-waist index and psoriasis: A cross-sectional study based on NHANES 2009 to 2014

Weight-adjusted-waist index (WWI) is an anthropometric indicator of central obesity, which is calculated by dividing the waist circumference (WC) by the squared weight. The purpose of this study was to investigate the association between WWI and psoriasis in adults. Multivariate logistic regression and smoothing curve fitting were used to investigate the relationship between WWI and psoriasis based on data from the National Health and Nutrition Examination Survey (NHANES) 2009 to 2014. Subgroup analysis and interaction tests were employed to examine the population-level stability of this connection. There was a positive association between WWI and psoriasis in 15,932 participants > 20 years of age. In the fully adjusted model, each 1-unit increase in WWI was associated with a 14% increase in the risk of developing psoriasis [1.14 (1.01, 1.32)]. Participants in the highest quartile of WWI had a 38% higher risk of developing psoriasis than those in the lowest quartile [1.38 (1.01, 1.94)]. This positive association was more pronounced in males. WWI is positively associated with psoriasis in US adults. Our findings imply that WWI has the potential to improve psoriasis prevention in the general population.

U-shaped Association Between Weight-Adjusted-Waist Index and Arterial Stiffness Among Adult Hypertensive Patients: A Population-Based Study in the United States

The weight-adjusted-waist index (WWI) is an innovative measure of obesity that appears to surpass body mass index (BMI) in assessing lean body mass and fat mass. This study aimed to evaluate the relationship between WWI and AS in hypertensive adults in the United States. The study included 9753 adults diagnosed with hypertension from the National Health and Nutrition Examination Survey (NHANES), which spanned the years 2007-2016. WWI was calculated by dividing waist circumference (in cm) by the square root of body weight (in kg), and arterial stiffness (represented by estimated pulse wave velocity [ePWV]) was analyzed as the outcome. Weighted multiple linear regression and smooth curve fitting were used to test for linear and nonlinear associations. Threshold effects were determined using a two-part linear regression model. Additionally, subgroup analyses and interaction tests were conducted to gain a more in-depth understanding of the observed associations. The mean WWI of the participants was 11.32 ± 0.76. After multivariable adjustment, WWI showed a significant nonlinear association with ePWV, with a U-shaped association observed between the two. Specifically, WWI below the threshold of 10.23 was negatively associated with arterial stiffness (β = -0.39, 95% CI: -0.54 to -0.25), while WWI above the threshold of 10.23 was positively associated with arterial stiffness (β = 0.04, 95% CI: 0.01-0.07). To conclude, the present findings imply that maintaining WWI within an optimal range could reduce AS in hypertensive individuals and potentially decrease cardiovascular risk. However, this observation needs to be confirmed in large clinical trials.

Weight-Adjusted Waist Index: an anthropometric measure for frailty in older adults

PURPOSE

Current measures of frailty often rely on subjective assessments or complex scoring systems. This study aims to investigate the utility of a novel anthropometric measure, the Weight-Adjusted Waist Index (WWI), as a simple and objective predictive marker for frailty in older adults.

METHODS

This cross-sectional study included 847 patients aged 65 years and older. Comprehensive geriatric assessments and anthropometric measurements were conducted. Frailty was diagnosed using the Clinical Frailty Scale (CFS). The association between WWI and frailty was analyzed using multivariate logistic regression analysis.

RESULTS

The mean age of the participants was 74.9 ± 6 years, with 56.3% (n = 477) being women and 14.8% (n = 125) classified as frail. The frail group had a significantly higher WWI than the non-frail group (p < 0.001). In multivariate logistic regression analysis, WWI remained significantly associated with frailty, even after adjusting for other potential confounding factors (OR = 2.51, 95% CI 1.77-3.57, p < 0.001). The predictive ability of WWI for frailty was measured by the area under the receiver operating characteristic (ROC) curve, which was 0.705 (95% CI 0.67-0.73; p < 0.001). The optimal WWI threshold for predicting frailty was identified as > 12.

CONCLUSION

The Weight-Adjusted Waist Index shows significant potential as a simple and objective predictive marker for frailty in older adults.

Association of weight-adjusted waist index (WWI) and a body shape index (ABSI) with serum neurofilament light chain levels in a national study of U.S. adults

OBJECTIVE

This study explored how the weight-adjusted waist index (WWI) and a body shape index (ABSI) are related to serum neurofilament light chain (sNfL) levels among U.S. adults. We aimed to evaluate sNfL, which plays key roles in neuronal injury in neurological diseases, given its understudied connection to obesity.

METHODS

We used cross-sectional data from the 2013-2014 National Health and Nutrition Examination Survey (NHANES) of people with complete information on the weight-adjusted waist index (WWI), a body shape index (ABSI), and serum neurofilament light chain (sNfL). Multiple linear regression analysis allowed us to investigate the separate connections among the WWI, ABSI, and sNfL. Moreover, interaction testing and subgroup analysis were performed to improve the general validity of our results. To assess any nonlinear correlations, we also performed threshold effect analysis and smoothed curve fitting.

RESULTS

WWI and ABSI were positively linked with sNfL (WWI: β = 0.05, 95% CI 0.01-0.09; ABSI: β = 1.65, 95% CI 3.53-13.72). There was no clear reliance on this association according to subgroup analysis and interaction tests. Smoothed curve fitting and saturation effects also demonstrated nonlinear associations between WWI and ABSI and sNfL, with inflection points of 10.38 and 0.38, respectively.

CONCLUSION

In the adult American population, while the WWI and ABSI are linearly positively correlated with serum neurofilament light protein (sNfL), the effect size is greater for the ABSI. This correlation provides fresh evidence connecting obesity to neurological conditions, deepening our comprehension of the extensive health impacts associated with obesity. Level of Evidence Level I, experimental studies.

Association between Weight-Adjusted Waist Index and Depression in NAFLD: the modulating roles of sex and BMI

BACKGROUND

The Weight-Adjusted Waist Index (WWI) is a novel indicator of obesity that accurately reflects body composition. However, the association between WWI and depression in patients with non-alcoholic fatty liver disease (NAFLD) remains unclear. This study aims to explore this relationship through a nationally representative cross-sectional analysis.

METHODS

This study included adult participants diagnosed with NAFLD from NHANES 2017-2020. WWI was calculated as the waist circumference (cm) divided by the square root of body weight (kg). NAFLD diagnosis relied on vibration-controlled transient elastography (VCTE) with a controlled attenuation parameter (CAP) exceeding 248 dB/m to indicate hepatic steatosis. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), with scores ≥ 10 indicating the presence of major depression.

RESULTS

After adjusting for all covariates, a significant positive association was found between WWI and depression in NAFLD (OR = 1.725, 95% CI: 1.442-2.063, p < 0.00001), with a dose-response relationship indicated by restricted cubic spline analysis. The association was stronger in men and lean/normal weight NAFLD patients. Adjusting further for BMI did not alter these findings (OR = 1.643, 95% CI: 1.357-1.989, p < 0.00001). BMI's association with depression was negated after adjusting for WWI.

CONCLUSIONS

WWI had a positive association with depression in NAFLD, independent of BMI. This association was more pronounced in men and lean/normal weight NAFLD. These findings suggest that WWI may be a novel indicator of depression in NAFLD and potentially valuable in depression prevention.

Weight-adjusted waist index and cardiovascular disease: a population-based study in Ravansar, Iran

BACKGROUND

The weight-adjusted-waist index (WWI) is a relatively new index to obesity. This study aimed to explore the reationship between WWI and cardiovascular disease (CVD).

METHODS

This cross-sectional study included 8,899 participants aged 35 to 65 from the Ravansar non-communicable diseases (RaNCD) cohort study in Ravansar, Iran. The WWI was calculated by dividing waist circumference (WC) by the square root of weight. The receiver operating characteristic (ROC) curve was utilized to assess the predictive performance of WWI in relation to CVD. The study applied multiple logistic regression to assess the association between WWI and CVD.

RESULTS

Participants had an average age of 47.52 ± 8.29 years, with 45.30% being men and 41.13% residing in rural areas. The prevalence of CVD was found to be 17.36%. A positive correlation between WWI and CVD was obseved, with individuals in the highest WWI quartile having a 36% (OR = 1.36, 95%CI: 1.11, 1.78) greater odds of CVD compared to those in the lowest quartile (OR = 1.03, 95%CI: 0.79, 1.33) (ptrend = 0.010). Subgroup analyses indicated stronger links between WWI and CVD among participants over 50, males, urban residents, those of high socioeconomic status (SES), and passive smokers (p < 0.001). The ROC analysis revealed that WWI is a greater ability in predicting CVD (AUC: 0.64, 95%CI: 0.61, 0.64) compared to body mass index (BMI) (AUC: 0.60, 95%CI: 0.58, 0.61) and WC (AUC: 0.61, 95%CI: 0.59, 0.62).

CONCLUSION

The increase in WWI elevates the odds of CVD, making the management of WWI crucial for CVD prevention.

Association Between the Weight-Adjusted Waist Index and OSA Risk: Insights from the NHANES 2017-2020 and Mendelian Randomization Analyses

Background

Obesity is a significant risk factor for obstructive sleep apnea (OSA). The weight-adjusted-waist index (WWI) reflects weight-independent centripetal obesity. Our study aims to evaluate the relationship between WWI and OSA.

Methods

The data used in the current cross-sectional investigation are from the National Health and Nutrition Examination Survey (NHANES), which was carried out between 2017 and 2020. We utilized weighted multivariable-adjusted logistic regression to evaluate the relationship between WWI and the risk of OSA. In addition, we applied various analytical methods, including subgroup analysis, smoothing curve fitting, threshold effect analysis and the receiver operating characteristic (ROC) curve. To further explore the relationship, we conducted a MR study using genome-wide association study (GWAS) summary statistics. We performed the main inverse variance weighting (IVW) method along with other supplementary MR methods. In addition, a meta-analysis was conducted to provide an overall evaluation.

Results

WWI was positively related to OSA with the full adjustment [odds ratio (OR)=1.14, 95% confidence interval (95% CI): 1.06-1.23, P<0.001]. After converting WWI to a categorical variable by quartiles (Q1-Q4), compared to Q1 the highest WWI quartile was linked to an obviously increased likelihood of OSA (OR=1.26, 95% CI: 1.06-1.50. P=0.01). Subgroup analysis revealed the stability of the independent positive relationship between WWI and OSA. Smoothing curve fitting identified a saturation effect of WWI and OSA, with an inflection point of 11.62. In addition, WWI had the strongest prediction for OSA (AUC=0.745). Sensitivity analysis was performed to verify the significantly positive connection between WWI and stricter OSA (OR=1.18, 95% CI: 1.05-1.32, P=0.005). MR meta-analysis further supported our results (OR=2.11, 95% CI: 1.94-2.30, P<0.001). Sensitivity analysis confirmed the robustness and reliability of these findings.

Conclusion

WWI was significantly associated with the risk of OSA, suggesting that WWI could potentially serve as a predictor for OSA.

Relationship between weight-adjusted waist index (WWI) and osteoarthritis: a cross-sectional study using NHANES data

This study aims to evaluate the association between the Weight-Adjusted Waist Index (WWI) and osteoarthritis (OA) utilizing cross-sectional data from the 2005-2014 National Health and Nutrition Examination Survey (NHANES). The study analyzed data from 12,696 participants across the 2005-2014 NHANES cycles to examine differences in demographic, socioeconomic, lifestyle, and health-related variables across WWI quartiles. Multivariable logistic regression models were employed to assess the relationship between WWI and the risk of OA. Receiver Operating Characteristic (ROC) curve analysis was conducted to evaluate and compare the predictive ability of WWI, BMI, waist circumference, and weight in identifying OA risk. Scatter plots were generated to visualize the association between WWI and OA, with linear regression lines illustrating trends and statistical significance. Restricted cubic spline (RCS) analysis was used to further explore the nonlinear relationship between WWI and OA risk. Forest plots were used to display the impact of WWI on OA risk across subgroups such as gender, age, and race, showing that individuals with higher WWI generally exhibit a significantly increased risk of OA. After adjusting for multiple covariates, the findings indicated a significant association between higher WWI and an increased risk of OA. Subgroup analyses, including gender, age, and race, further reinforced the consistent association between WWI and OA risk. In the U.S. adult population, an elevated WWI is significantly associated with an increased risk of OA, suggesting that WWI could serve as a potential indicator for assessing OA risk.

Correlation between weight-adjusted-waist index and hypertension in the US population: based on data from NHANES 2005-2018

Objectives

This study aimed to investigate the association between the weight-adjusted waist index (WWI) and the prevalence of hypertension in U.S. adults.

Methods

Data were sourced from the National Health and Nutrition Examination Survey (NHANES) spanning 2005-2018. In our cross-sectional study, we focused on the non-institutional U.S. population over the age of 18 from various communities in the United States. WWI is derived by dividing waist circumference by the square root of body weight. The definition of hypertension was based on self-reported history of hypertension, antihypertensive drug use, and blood pressure measurements. Participants without complete information on WWI and hypertension were excluded. The independent relationship and consistency between WWI and hypertension were assessed through weighted multivariate regression. The Pearson correlation test was used to detect the association between WWI and BMI. Subgroup analyses were used to verify the stability of the relationship between WWI and the prevalence of hypertension, and interaction tests were also conducted by gender, age, smoking, and triglycerides.

Results

Among the 37,299 participants included, the hypertension prevalence was 33.9%. After adjusting for confounding variables, WWI demonstrated a significant association with hypertension. Individuals in the top quarter of WWI had a 2.27fold higher chance of hypertension prevalence compared with the bottom quarter (OR = 2.27, 95% CI 1.97-2.61; P < 0.0001). Subgroup analysis highlighted that this association was particularly pronounced in males aged ≤60 years.

Conclusion

The findings underscore a robust correlation between elevated WWI and a heightened risk of hypertension, especially in males aged ≤60 years.

Association between the weight-adjusted-waist index and Familial hypercholesterolemia: a cross-sectional study

OBJECTIVE

The weight-adjusted-waist index (WWI) is a novel obesity measurement indicator, and this study aims to determine the relationship between WWI and Familial hypercholesterolemia (FH).

METHODS

Using data from the National Health and Nutrition Examination Survey (NHANES) from 2017 to March 2020, cross-sectional data from 3698 participants were analyzed. The study examined the correlation between WWI and FH using multivariate logistic regression and smooth curve fitting, and conducted subgroup analysis and interaction tests.

RESULTS

The study sample consisted of 3698 subjects for whom the overall probable prevalence of FH was 5.43% and increased with WWI tertile (quantile 1: 4.00%; quantile 2: 4.94%; quantile 3: 7.34%); individuals with the highest WWI tertile were significantly more likely to have FH than those with the lowest tertile (OR = 4.60,95% CI: 2.00-10.60). Subgroup analysis and interaction tests showed significant significance between WWI and personal history of early Atherosclerotic cardiovascular disease (ASCVD), family history of early ASCVD and probable prevalence of FH (p < 0.05).

CONCLUSION

This study demonstrates a nonlinear positive correlation between WWI and FH. This may provide new ideas for the prevention and treatment of FH in the future.

Association of weight-adjusted waist index with all-cause and cause-specific mortality among cancer survivors: a cohort study of the NHANES 1999-2018

Background

Obesity is becoming more widely acknowledged as a chronic illness that raises the risk of oncogenesis. This inquiry aimed to look into the correlation between cancer patient mortality and obesity, as measured by the weight-adjusted waist index (WWI).

Methods

We used continuous data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018 as the benchmark, with a follow-up validity period of December 31, 2019. First, we assessed the correlation between WWI and the all-cause and cause-specific execution of cancer sufferers using multivariable Cox proportional hazards models. Second, a smoothed curve fit was utilized to examine the relationship between WWI and both cause-specific and all-cause mortality in cancer patients. Lastly, we analyzed the relationship between WWI and both cause-specific and all-cause mortality in cancer patients, to find out if this link held across the population subgroup evaluation and impact analyses were used as well during the last step.

Results

With a median follow-up of 87.8 months, 1,547 (34.7%) of the 4,463 cancer patients had deceased. Among them, 508 (11.4%) succumbed to cancer, while 322 (7.2%) passed away due to cardiovascular disease. Multivariate Cox proportional hazards model of mortality among cancer patients revealed an all-cause mortality hazard ratio [HR=1.13; 95% CI (1.04, 1.23)] and cardiovascular mortality [HR=1.39; 95% CI (1.16, 1.67)]. Furthermore, for each unit increase in WWI, all-cause mortality was significantly higher in male cancer survivors than in female cancer survivors.

Conclusions

Our study reveals substantial correlations between WWI and all-cause and cardiovascular mortality in US cancer survivors, helping to identify cancer survivors at higher risk of death and thus potentially guiding targeted interventions.

Weight-adjusted waist index as a practical predictor for diabetes, cardiovascular disease, and non-accidental mortality risk

BACKGROUND AND AIM

Identifying a more suitable marker among various measures of adiposity, demonstrating strong associations and predictive ability for clinical use, remains a topic of debate. Weight-adjusted waist index (WWI) has been proposed as a novel index of adiposity, yet its exploration is limited, especially in Chinese populations. This study seeks to examine the associations between body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHTR), weight-adjusted waist index (WWI), waist circumference divided by body mass to the power of 0.333 (WC/M0.333), visceral adiposity index (VAI), lipid accumulation product (LAP), and the incidence of diabetes, cardiovascular disease, and non-accidental mortality in Chinese populations. Furthermore, our goal is to compare the respective predictive values of these measures for these health outcomes.

METHODS AND RESULTS

This prospective cohort study included 21,750 subjects with a 9-year follow-up period. Cox proportional hazard models were used to investigate the relationship between eight anthropometric indexes and the incidence of diabetes, cardiovascular disease, and non-accidental mortality. The predictive value of these eight indexes was compared using the area under the curve metric. Significant positive associations were found between WWI and the risk of diabetes. Using the first quartile (Q1) of WWI as the reference group, hazard ratios with 95% confidence intervals for the risk of diabetes were 1.58 (0.98-2.55) for Q2, 2.18 (1.34-3.35) for Q3, and 2.27 (1.41-3.67) for Q4. Significant associations were observed with the highest quartile of WWI for the risk of cardiovascular disease [Q2: HR 1.45 (95% CI 1.06-1.98); Q3: 1.33 (0.97-1.83); Q4: 1.55 (1.13-2.14)] and risk of non-accidental mortality [Q2: 0.94 (0.80-1.11); Q3: 1.24 (1.04-1.48); Q4: 1.44 (1.16-1.79)]. Receiver operating characteristic analysis revealed that WWI exhibited superior discrimination and accuracy in predicting cardiovascular disease and non-accidental mortality compared to other adiposity indexes (BMI, WC, WHR, WHTR, WC/M0.333, VAI, and LAP).

CONCLUSION

WWI exhibited the most robust and consistent association with the incidence of cardiovascular disease and non-accidental mortality. Given its simplicity and widespread use, WWI emerges as a novel and practical predictor of diabetes, cardiovascular disease, and non-accidental mortality among the eight adiposity indexes investigated in this study.

Weight-adjusted waist index is an independent predictor of all-cause and cause-specific mortality in patients with asthma

BACKGROUND

There is a close relationship between obesity and the occurrence of asthma.The weight-adjusted waist index (WWI) is a relatively novel anthropometric parameter that reflects obesity.

OBJECTIVE

We aimed to explore the association between WWI and mortality in the asthma population.

METHODS

We included adult with asthma from NHANES 1999-2018. WWI = Waist circumference (cm)/square root of body weight (kg). Current asthma was determined by the participant's responses in standardized questionnaires. All-cause, cardiovascular disease (CVD), cancer, and respiratory disease mortality information was obtained by prospectively matching these data to the National Death Index. Multivariate-adjusted Cox proportional hazards regression analyses, Kaplan Meier survival analyses, restricted cubic spline (RCS) analyses, stratified analyses, and sensitivity analyses were used to clarify these associations.

RESULTS

A total of 101,316 participants were included in the study, and 3223 were diagnosed with asthma.WWI was independently and positively associated with all-cause and all factor-specific mortality in asthma. In fully adjusted models, each unit increase in WWI was associated with 43 % (hazard ratio [HR] and 95 % confidence interval [CI] = 1.43 [1.25,1.64], p < 0.0001), 58 % (1.58 [1.25, 1.99], p < 0.001), 50 % (1.50 [1.19, 1.90], p < 0.001), and 79 % (1.79 [1.34, 2.39], p < 0.0001) increased all-cause, CVD, cancer, and respiratory disease mortality, respectively. RCS analyses showed largely linear associations between WWI and all mortality risks. Stratified analyses indicated that these associations were influenced by multiple factors, and that age was consistently the effect modifier across all associations.

CONCLUSIONS

WWI is an independent predictor of all-cause, CVD, cancer, and respiratory-related mortality in the adult asthma population. These findings highlight that WWI may have novel prognostic value as a simple and easily accessible obesity parameter in asthma patients.