Association between Chinese visceral adiposity index and risk of stroke incidence in middle-aged and elderly Chinese population: evidence from a large national cohort study

Association between cardiometabolic index and the incidence of stroke: a prospective nationwide cohort study in China

Objectives

Cardiometabolic index (CMI), based on triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C) ratio and waist-to-height ratio (WHtR), has been recognized as a novel and practical marker for the assessment of cardiometabolic risk. However, the relationship between CMI and the incidence of stroke remains to be elucidated. This investigation aimed to explore the association between CMI and stroke incidence.

Methods

The investigation included 6,633 individuals aged over 45 years from the China Health and Retirement Longitudinal Study. Logistic regressions and restricted cubic spline regression were uitilized to determine the relationship between CMI and the incidence of stroke. Weighted quantile sum regression was used to offer a comprehensive explanation of the CMI by calculating the weights of triglyceride-glucose (TG), high-density lipoprotein cholesterol (HDL-C), weight, and height.

Results

During the 9-year follow-up, 827 (12%) incident stroke participants were identified. With CMI as a continuous variable, the OR (95% CI) for the risk of incident stroke was 1.09 (1.01-1.19) (p = 0.047) after adjusting for potential confounders, indicating a significant link between increased CMI and an elevated incidence of stroke. Additionally, when CMI was categorized into quartiles, compared to the first quartile, the incident stroke was significantly higher in the fourth quartile (OR 1.57, 95%CI 1.22-2.04, p <0.001). The association between CMI and stroke incidence was nonlinear (p overall=0.002, p non-linear = 0.006). TG emerged as the primary contributor when the weights were assigned to the constituent elements of the CMI (weight = 0.645).

Conclusions

The CMI was independently associated with stroke incidence in middle-aged and elderly Chinese populations. Long-term CMI monitoring is of great importance for early identification and prevention of stroke, with significant implications for clinical practice.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-024-01530-3.

Association between relative muscle strength and cardiometabolic multimorbidity in middle-aged and older Chinese adults

BACKGROUND

Relative muscle strength (RMS) serves as a valuable indicator of skeletal muscle function. As the body ages, skeletal muscle function declines gradually, leading to a range of adverse effects. Cardiometabolic multimorbidity (CMM) is a prevalent co-morbidity in middle-aged and elderly populations. However, there are few studies to investigate the association between RMS and CMM.

METHODS

This study adopted a cross-sectional design, including participants from the China Health and Retirement Longitudinal Study (CHARLS) of 2011. Appendicular skeletal muscle mass (ASM) was estimated using previously validated anthropometric equations. RMS was defined as the ratio of maximum hand grip strength (HGS) to ASM. CMM was characterized by the presence of at least two cardiometabolic disorders (cardiopathy, stroke, and diabetes), as assessed through self-reported physician diagnoses. The relationship between RMS and CMM was evaluated through multifactor logistic regression analysis.

RESULTS

A total of 9,200 participants with a mean age of 59.49 years were included in this study. Among them, 6,844 (74.4%) had no cardiometabolic disease (CMD), 2,052 (22.3%) had a single CMD, and 304 (3.3%) had cardiometabolic multimorbidity (CMM). Multifactor logistic regression was used to evaluate the relationship between them. In the initial model, there was a negative correlation between RMS and CMM. After adjusting for confounders, this association remained statistically significant. Specifically, for each additional unit increase in RMS, the risk of CMM was reduced by 40% (OR: 0.60, 95%CI: (0.45, 0.78)). Additionally, the highest RMS value group had a lower risk of CMM compared to the lowest value group (OR: 0.46, 95%CI: (0.31, 0.67)). As indicated by the restricted cubic spline plots, there was an L-shape correlation between RMS and CMM (P for nonlinear = 0.003).

CONCLUSION

The RMS, calculated based on HGS and ASM, was a potential indicator of CMM in middle-aged and elderly adults in China.

Association between the triglyceride glucose-Chinese visceral adiposity index and new-onset stroke risk: a national cohort study

BACKGROUND

Numerous studies have investigated the effect of an integrated index that combines the triglyceride‒glucose (TyG) index with various obesity indicators on stroke incidence. However, how to use the TyG index and the Chinese Visceral Adiposity Index (CVAI) for stroke prevention remains unclear. This study examined the associations between dynamic changes in the TyG-CVAI index and cumulative, baseline, and new-onset stroke risk.

METHODS

Data from 3,769 participants in the China Health and Retirement Longitudinal Study(CHARLS) were analyzed, concentrating on the baseline TyG-CVAI, TyG-CVAI in 2015, and the cumulative TyG-CVAI derived from these. The fluctuations of the TyG-CVAI index were grouped into three clusters using K-means clustering analysis. Logistic regression models were used to examine the relationship between the TyG-CVAI index and new-onset stroke risk. Restricted cubic splines (RCS) were employed to investigate potential nonlinear relationships while assessing the predictive capability by receiver operating characteristic curve.

RESULTS

During the follow-up period, 181 participants experienced stroke events. The stroke incidence rates in Clusters 1, 2, and 3 were 2.42%, 8.72%, and 4.37%, respectively. After adjustment for confounding factors, Cluster 2 with high and increasing TyG-CVAI index (OR = 3.16, 95% CI 1.94-5.22), the Q3 group with high cumulative TyG-CVAI index (OR = 2.53, 95% CI 1.60-4.02), and the Q3 group with high baseline TyG-CVAI index (OR = 2.49, 95% CI 1.57-3.95),which were all correlated with an elevated risk of new-onset stroke. The RCS analysis disclosed a U-shaped relationship between cumulative and baseline TyG-CVAI index and stroke risk.

CONCLUSION

The fluctuations in and baseline, and cumulative TyG-CVAI index are independently correlated with an increased risk of stroke. The TyG-CVAI index is anticipated to be a more efficient and significant indicator for evaluating early stroke.

Association of Chinese visceral adiposity index with asymptomatic hyperuricemia incidence in type 2 diabetes: a cross-sectional study

Background

Previous research has shown a correlation between high visceral fat levels and hyperuricemia incidence. The Chinese Visceral Adiposity Index (CVAI) assessed visceral fat status in the Chinese population. Our study investigates the correlation between CVAI and asymptomatic hyperuricemia in type 2 diabetes patients.

Methods

This cross-sectional study analyzed 1,588 hospitalized type 2 diabetes patients to investigate the association between CVAI and hyperuricemia. CVAI was included in the logistic regression analysis as both a continuous and categorical variable, and restricted cubic splines were used to assess the dose-response relationship. Additionally, subgroup analyses were performed to investigate potential interactions among variables. The predictive capability of CVAI was assessed using the receiver operating characteristic (ROC) curve based on the basic model.

Results

The CVAI quartile group analysis revealed a higher prevalence of hyperuricemia with increasing CVAI levels. CVAI is significantly associated with hyperuricemia, as identified through multifactorial logistic regression analysis. After adjusting for all covariates, the odds ratios for CVAI in the second, third, and fourth quartiles were significantly higher than in the lowest quartile, with values of 2.688 (95% CI [1.301-5.554], p = 0.008), 2.752 (95% CI [1.320-5.739], p = 0.007), and 4.990 (95% CI [2.392-10.409], p < 0.001), respectively. No significant interactions were observed in the subgroup analysis. Incorporating CVAI into the basic model increased the ROC curve's area under the curve to 0.714.

Conclusion

This study found a positive correlation between CVAI and hyperuricemia incidence in type 2 diabetes patients. Consequently, CVAI may reliably indicate hyperuricemia in this patient population.

Association between Chinese visceral adiposity index and cardiovascular events risk in individuals with cardiovascular-kidney-metabolic syndrome stage 0-3: a nationwide cohort study

BACKGROUND

The population with cardiovascular-kidney-metabolic (CKM) syndrome has a higher risk of cardiovascular events. Chinese visceral adiposity index (CVAI), an index of both visceral obesity and surrogate insulin resistance, has been linked to cardiovascular events. However, the nature of this relationship remains unclear in individuals with CKM syndrome.

METHODS

All data came from the China Health and Retirement Longitudinal Study (CHARLS). The association between CVAI and cardiovascular events risk was explored using Cox regression models, restricted cubic spline (RCS) curves, and multiple sensitivity analyses. To compare the predictive abilities of various indices, receiver operating characteristic (ROC) analyses were employed.

RESULTS

7744 participants were in final analysis. During 9 year follow-up, 1679 cases of cardiovascular disease (CVD), 1,255 cases of heart disease, and 604 cases of stroke were recorded. Cox regression analyses revealed that per-SD (standard deviation) increase in CVAI, the risk of CVD, heart disease, and stroke increased by 22% (95% CI 1.13-1.32), 22% (95% CI 1.13-1.32), and 32% (95% CI 1.19-1.47). In participants at CKM stage 3 with CVD, a J-shaped curve was observed in the RCS analyses (P non-linearity = 0.036). Subgroup analysis revealed an interaction between age and each 10-unit increase in CVAI in CVD (P interaction = 0.0173) and stroke risk (P interaction = 0.028). The AUC (area under curve) value for CVAI was highest compared to other indicators (all DeLong Test P values < 0.05).

CONCLUSIONS

This research demonstrates a higher CVAI was linked to increased cardiovascular risk in individuals with CKM syndrome stage 0-3. Monitoring CVAI can help identify high-risk individuals early and improve the effectiveness of disease management.

Association between Chinese visceral adiposity index and risk of new-onset hypertension in middle-aged and older adults with prediabetes: evidence from a large national cohort study

Purpose

Chinese Visceral Adiposity Index (CVAI) has been found significantly associated with hypertension in general and type-2 diabetes adults. However, the predictive value of CVAI for the incidence of hypertension in adults with prediabetes is unclear. This study aimed to assess the predictive utility of the CVAI for the new onset of hypertension in middle-aged and older adult Chinese individuals with prediabetes.

Methods

A prospective cohort study was conducted involving participants aged 45 years and above with prediabetes from the 2011-2012 cohort of the China Health and Retirement Longitudinal Study (CHARLS). Logistic regression models were utilized to investigate the association between CVAI levels and the risk of new-onset hypertension.

Results

The study included 2,186 participants, among whom 444 (20.31%) developed hypertension. Significantly higher incidence rates of hypertension were observed in individuals belonging to the highest quartile group (Q4) compared to those in the lowest quartile group (Q1) of CVAI (29.41% vs. 14.69%, p < 0.001). Multivariate logistic regression analysis indicated that participants in Q4 had a 1.91-fold greater risk of hypertension development compared to those in Q1 (odds ratio (OR): 1.91, 95% confidence interval (CI): 1.49-2.45, p < 0.001). The area under the receiver operating characteristic (ROC) curve (AUC) demonstrated that CVAI exhibited superior performance in discriminating individuals at heightened risk of hypertension compared to other obesity-related indices (p < 0.001). A subgroup analysis revealed that age may modulate the relationship between CVAI and new-onset hypertension, with a more pronounced interaction observed among participants below 60 years of age (P for interaction: 0.026).

Conclusion

Elevated CVAI levels were significantly associated with an increased risk of developing hypertension. CVAI proves to be a reliable and effective tool for risk stratification in middle-aged and older adult Chinese individuals with prediabetes, underscoring its substantial implications for primary prevention of hypertension and public health strategies.

Assessment of six insulin resistance surrogate indexes for predicting stroke incidence in Chinese middle-aged and elderly populations with abnormal glucose metabolism: a nationwide prospective cohort study

BACKGROUND

Estimate glucose disposal rate (eGDR), Chinese visceral adiposity index (CVAI), triglyceride-glucose (TyG), TyG-body mass index (TyG-BMI), metabolic score for insulin resistance (METS-IR), and atherogenic index of plasma (AIP) are considered surrogate indexes of insulin resistance (IR). There is a lack of studies comparing the predictive values of different IR surrogate indexes for stroke risk among individuals with abnormal glucose metabolism. This study aimed to investigate the relationships between six IR surrogate indexes and stroke risk in individuals with abnormal glucose metabolism, evaluate their predictive abilities for stroke risk.

METHODS

Data from the China Health and Retirement Longitudinal Study (CHARLS) were analysed in this study. Multivariate logistic regression models were applied to analyse the relationships of IR surrogate indexes with stroke risk. The dose-response relationships between IR surrogate indexes and stroke risk were explored using restricted cubic splines. The areas under the curve (AUCs) of IR surrogate indexes were calculated by receiver operating characteristic (ROC) analysis.

RESULTS

After adjusting for potential confounders, we observed that each standard deviation (SD) increase in eGDR was associated with a reduced risk of stroke, with an adjusted odds ratio (OR) of 0.746 [95% confidence interval (CI): 0.661-0.842]. In contrast, each SD increase in CVAI, TyG, TyG-BMI, METS-IR, and AIP were associated with an increased risk of stroke, with adjusted ORs (95% CIs) of 1.232 (1.106-1.373), 1.246 (1.050-1.479), 1.186 (1.022-1.376), 1.222 (1.069-1.396), and 1.193 (1.050-1.355), respectively. Dose-response analyses showed that eGDR, CVAI, TyG-BMI and METS-IR were linearly associated with stroke risk (Pnonlinear ≥ 0.05), whereas TyG and AIP were nonlinearly associated with stroke risk (Pnonlinear < 0.05). According to ROC analysis, The AUC of eGDR for predicting stroke risk in the overall population with abnormal glucose metabolism (AUC: 0.612, 95% CI: 0.584-0.640) was significantly higher than that of other indexes.

CONCLUSION

The six IR surrogate indexes were closely associated with high risk of stroke in individuals with abnormal glucose metabolism. The eGDR showed promising potential in predicting stroke risk in Chinese middle-aged and elderly populations with abnormal glucose metabolism.

Conicity index and sex differences in relation to carotid plaque instability in Chinese community residents: Conicity index and carotid plaque

OBJECTIVES

The conicity index (CI), an anthropometric parameter of visceral obesity, has exhibited a strong correlation with the incidence of atherosclerosis and cardiovascular events. This study aimed to explore the relationship between CI and carotid plaque instability, as well as the potential differences between sexes in this context.

METHODS

Our cross-sectional study included a total of 44,248 participants from the China Stroke High-risk Population Screening and Intervention Program (CSHPSIP), all of whom underwent carotid ultrasound for the evaluation of carotid plaque. Multivariate logistics regression analysis and restricted cubic spline (RCS) curves were employed to examine the association between CI and the prevalence of carotid plaques and unstable plaques. A subgroup analysis was conducted to account for potential confounding variables.

RESULTS

Patients belonging to the higher CI quartiles had a greater prevalence of carotid plaque and unstable carotid plaque. After adjusting for confounding factors, each standard deviation (SD) increase in CI was associated with an odds ratio (OR) of 1.06 (95% confidence interval: 1.03-1.08) for carotid plaque and 1.03 (95% confidence interval: 1.00-1.05) for unstable carotid plaque. The RCS analysis revealed an escalating trend in the prevalence of unstable carotid plaque with increasing CI values. However, this observed trend was not evident among female participants. Furthermore, subgroup analysis revealed a more pronounced correlation between CI and carotid plaque instability in individuals with a fasting blood glucose (FBG) of ≥ 7 mmol/L and an unhealthy lifestyle characterized by physical inactivity and current smoking.

CONCLUSIONS

Our findings demonstrated that CI was significantly associated with carotid plaque and recommend CI as a promising indicator for the initial screening of atherosclerotic plaques in the future.

Association of CVAI, LAP and SMI with risk of haematological toxicity after immunochemotherapy in patients with DLBCL: a retrospective study

Background

The occurrence of adverse events after immunochemotherapy in patients with diffuse large B-cell lymphoma (DLBCL) frequently affects the course of chemotherapy, leading to a further decline in quality of life and survival.

Objectives

The primary objective of this study was to investigate the association between Chinese visceral adiposity index (CVAI), lipid accumulation product (LAP) index and skeletal muscle mass index (SMI) at initial diagnosis and the risk of haematological toxicity following immunochemotherapy in patients with DLBCL.

Design

Retrospective, single-centre study.

Methods

CVAI, LAP and SMI were calculated by combining clinical data of the patients. This study included 213 patients, of whom 117 (55%) patients experienced grades 3-4 haematological toxicity after immunochemotherapy. Participants were divided into four groups (Q1, Q2, Q3, Q4) based on the quartiles of CVAI, LAP and SMI.

Results

In the fully adjusted model, the risk of grades 3-4 haematological toxicity in group with the highest CVAI and LAP was reduced by 75.1% (OR: 0.249, 95% CI: 0.102-0.606, p = 0.002) and by 77.3% (OR: 0.227, 95% CI: 0.095-0.542, p = 0.001) compared to the group with the lowest CVAI and LAP. For SMI, the risk of grades 3-4 haematological toxicities in the group with the highest SMI was reduced by 62.9% compared with the lowest SMI group in the unadjusted model. The multivariable-adjusted restricted cubic spline curves and subgroup interaction analyses further confirmed the robustness of these findings.

Conclusion

The results indicate that DLBCL patients with relatively high CVAI, LAP and SMI at initial diagnosis have a lower risk of severe haematological toxicity following chemotherapy. Therefore, CVAI, LAP and SMI at initial diagnosis are reliable and effective biomarkers for predicting severe haematological toxicity after immunochemotherapy in DLBCL patients.

Trial registration

This is a retrospective study, and no registration on ClinicalTrials.gov.

Correlation between Chinese visceral adiposity index and serum uric acid levels in type 2 diabetes mellitus patients

Purpose

The Chinese Visceral Adiposity Index (CVAI), a measure of visceral adiposity dysfunction, is used to assess visceral fat (VFA) malfunction. This research was performed to evaluate the relationship between CVAI and serum uric acid levels in type 2 diabetes mellitus (T2DM) patients.

Methods

A total of 2268 patients with T2DM were enrolled in this study. We collected the general clinical information of patients, measured the basic anthropometric indicators, tested glycolipid metabolism and biochemical indicators, and measured the visceral and subcutaneous fat area with bioelectrical impedance technology. According to the quartiles of the CVAI, the T2DM patients were classified into four groups: group A (CVAI ≤ 94.43), group B (94.43

Results

Among quartiles of CVAI, as CVAI increased, the proportion of patients with HUA gradually increased. The correlation analysis showed that the majority of basal measures, glycolipid metabolism and biochemical indicators were positively correlated with CVAI. By comparison, the level of CVAI in the HUA group was significantly higher than non-HUA group. Meanwhile, through using the ROC curve, our study observed the more predictive value of CVAI than other obesity indicators for T2DM with HUA.

Conclusion

CVAI is a simple but effective indicator, which is significantly correlated with HUA in T2DM and can reflect the incidence of HUA in T2DM patients. As CVAI increased, the risk of HUA in T2DM patients increased. Therefore, we should pay more attention to the application of CVAI in T2DM.

Collapse

Key Words

• Chinese visceral adiposity index
• hyperuricemia
• obesity
• type 2 diabetes mellitus
• uric acid

Collapse

MESH Headings

• Humans
• Diabetes Mellitus, Type 2/blood
• Male
• Female
• Middle Aged
• Uric Acid/blood
• Intra-Abdominal Fat
• Adiposity
• Aged
• China/epidemiology
• Hyperuricemia/blood
• Adult
• Biomarkers/blood
• Obesity, Abdominal/blood
• East Asian People

Collapse

Grants Collapse

Affiliation(s)

Swailla Amina Araújo Intchasso Adotey
Qian Zhang
Mengxue Chen
Yang Jiao
Yin Zhang
Claudette Butoyi
Dong Wang
Ling Yang
Guoyue Yuan Department of Endocrinology and Metabolism, The Affiliated Hospital of Jiangsu University, Institute of Endocrine and Metabolic Diseases, Jiangsu University, Zhenjiang, China
Jue Jia Department of Endocrinology and Metabolism, The Affiliated Hospital of Jiangsu University, Institute of Endocrine and Metabolic Diseases, Jiangsu University, Zhenjiang, China

Collapse

The Association between Serum Lipid Profile Levels and Hypertension Grades: A Cross-Sectional Study at a Health Examination Center

INTRODUCTION

Hypertension and dyslipidemia are major cardiovascular risk factors that often coexist. Hyperlipidemia is a crucial modifiable risk factor in preventing cardiovascular disease.

AIM

We aimed to explore the relationship between lipid levels and the grading of hypertension in a community-based adult population.

METHODS

A total of 63,091 non-employed individuals were included in this study. Measurements included systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), fasting plasma glucose (FPG), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (STB), serum creatinine (SCr), blood urea nitrogen (BUN), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-c), and high-density lipoprotein cholesterol (HDL-c). Chi-square and t-tests were used to obtain basic population characteristics. Multivariate logistic regression was used to evaluate the association between the prevalence of hypertension and lipid profiles, as well as to identify influencing factors. A P-value < 0.05 was considered statistically significant. Statistical charts were utilized to analyze the relationship between lipid parameters and hypertension grades.

RESULTS

A total of 30,588 men and 32,503 women with an average age of 64.57 ± 12.5 years participated in this study. After adjusting STB and TC, every 1 mmol/L increase in TG and LDL-c was associated with a 6.0% and 6.5% increase in the prevalence of hypertension, respectively. Conversely, for every 1 mmol/L increase in HDL-c, the prevalence of hypertension decreased by 4.1%. Increases in TG and LDL-c levels were observed across all grades of hypertension, while very high HDL-c was significantly associated in grade III hypertension (1.54→1.66 mmol/L). Additionally, age, BMI, FPG, ALT, AST, SCr, and BUN significantly influenced the association between hypertension and lipid levels.

CONCLUSION

Hyperlipidemia and hypertension often coexist in health examination populations. Elevated levels of TG and LDL-C are associated with all grades of hypertension, while extremely high HDL-C level is linked to more severe hypertension.

Impact of Chinese visceral adiposity index on all-cause mortality risk in community-dwelling older adults: a prospective cohort study

BACKGROUNDS

Whether excess visceral fat tissue increases the risk of death in older individuals remains controversial.

AIMS

To investigate the association between the Chinese Visceral Adiposity Index (CVAI) and all-cause mortality risk in older Chinese individuals.

METHODS

This cohort study utilized data of individuals aged ≥ 65 years in 2014 to 2018 wave from the Chinese Longitudinal Healthy Longevity Survey database. Older individuals in the 2014 wave were included and followed up in 2018. CVAI was calculated based on age, body size, and blood lipid parameters, with higher values indicating increased visceral fat. Survival status was determined from official death certificates, local primary healthcare providers, or the family members of participants. Kaplan-Meier survival curve and log-rank test were employed to analyze cumulative mortality risk through CVAI tertiles (tertile 1: CVAI index < 97.34; tertile 2: 97.43 ≤ CVAI index < 132.21; and tertile 3: CVAI index ≥ 132.21). A Cox proportional hazards regression model was used to assess the relationship between the CVAI groups and all-cause mortality risk. Additionally, a sensitivity analysis was performed by excluding participants who died within the first year of follow-up. A subgroup analysis was performed based on age and sex, and a restricted cubic spline plot was created to analyze the dose-response relationship between CVAI and mortality risk.

RESULTS

A total of 1414 individuals were included, and the mean age of the participants was 84.6 (standard deviation: 10.9) years, of which 46.4% were women and 32.8% were died during a median follow-up time of 36.4 months. In the multivariable adjusted Cox regression model, we observed a significantly lower risk of mortality in the CVAI tertile 2 and 3 groups than in the tertile 1 group. The hazard ratios (HR) of the tertile 2 and 3 groups were 0.68 (95% CI, approximately 0.52-0.89) and 0.63 (95% CI, approximately 0.48-0.82), respectively. Subgroup analysis revealed that the protective effect of higher CVAI levels on mortality was more pronounced in participants aged 65-79 years and in women.

CONCLUSION

Our study established a linear relationship between CVAI and mortality risk among community-dwelling older adults, with higher CVAI levels associated with a lower risk of all-cause mortality. These findings highlight the potential importance of visceral adiposity in predicting mortality risk in community-dwelling older adults.

Neck circumference, waist-to-height ratio, Chinese visceral adiposity index and incident heart failure

BACKGROUND

The indicators of abdominal obesity have shown to be associated with a high risk of cardiovascular diseases (CVDs), even adjusted for body mass index (BMI). We aimed to investigate the association between neck circumference, waist-to-height ratio (WHtR), Chinese visceral adiposity index (CVAI) and incident heart failure (HF) in Chinese adults.

METHODS

The current study included 86,546 participants from two independent cohorts: the Kailuan I study established in 2006 and the Kailuan study II established in 2008. Participants aged 18-80 years who were free of CVDs or cancer were recruited at baseline. The values of neck circumference, WHtR and CVAI were available in 2014. The trajectory analysis was conducted using repeated measures of WHtR and CVAI in the 2008, 2010, 2012 and 2014 surveys. The incident HF cases were identified via reviewing medical records by cardiologists.

RESULTS

During a mean follow-up of 5.62 years, 724 incident HF cases were documented. The highest quartiles of neck circumference, WHtR and CVAI respectively, were significantly associated with a high risk of HF compared to the lowest quartiles of adiposity measures (neck circumference: HR:1.30, 95%CI: 1.03-1.65; WHtR: HR:1.49, 95%CI: 1.16-1.92; and CVAI: HR:1.98, 95%CI: 1.48-2.65). The combination of adiposity measures with BMI or metabolic abnormalities jointly predicted incident HF. Presence of hypertension and diabetes appeared to be the major mediators, accounting for ∼ 8.11-24.7% of the associations between three indicators of abdominal obesity and HF risk.

CONCLUSION

The new indices of abdominal adiposity could help to identify those who were at a high risk of HF, especially in the presence of high BMI or metabolic abnormalities.

The interaction between triglyceride-glucose index and visceral adiposity in cardiovascular disease risk: findings from a nationwide Chinese cohort

BACKGROUND

Globally, cardiovascular disease (CVD) constitutes the primary cause of death, with insulin resistance (IR), measured by the triglyceride-glucose (TyG) index, and visceral obesity, reflected by the Chinese Visceral Adiposity Index (CVAI), as key contributors. However, the relationship between the TyG index and CVAI regarding CVD risk remains insufficiently understood. This research investigates the interactive impact of the TyG index and CVAI on the risk of cardiovascular disease.

METHODS

We analyzed data from 8,358 participants from the China Health and Retirement Longitudinal Study (CHARLS) over a 9-year follow-up period. Participants were classified into four groups based on median TyG index (8.59) and CVAI values (101.26), and baseline characteristics were summarized. Missing data were addressed using multiple imputation by chained equations (MICE). Cox proportional hazards models assessed associations between TyG index, CVAI, CVD, coronary heart disease (CHD), and stroke risks, with Kaplan-Meier analysis used for cumulative hazard. Interaction effects were evaluated using both multiplicative and additive measures. Subgroup analyses by age, gender, and clinical conditions were conducted to explore interaction effects across different populations. Sensitivity analyses re-tested models, excluding the covariates BMI and diabetes, using tertiles for classification, and re-evaluating imputed data.

RESULTS

Over the 9-year follow-up, 1,240 participants (14.8%) developed CVD, including 896 cases of CHD and 475 strokes. Kaplan-Meier curves indicated that participants with low TyG index but high CVAI had the highest cumulative hazard of CVD. Cox regression showed that this group had the highest CVD risk (HR = 1.87, 95% CI: 1.57-2.24), followed by those with both high TyG index and high CVAI (HR = 1.75, 95% CI: 1.49-2.06). Interaction analysis revealed a negative interaction effect between high TyG and high CVAI on CVD and CHD risks, with no significant effect on stroke. Subgroup and sensitivity analyses further confirmed these findings, showing consistent results across demographic groups and under various analytical conditions.

CONCLUSION

This study suggests that the interaction between IR (TyG index) and visceral fat accumulation (CVAI) plays a complex role in CVD risk, with a potential antagonistic effect observed between high TyG and high CVAI on CVD events. These findings highlight the importance of considering both IR and visceral adiposity in CVD risk assessments to improve the identification of high-risk individuals.

Insulin resistance and sarcopenia: a prognostic longitudinal link to stroke risk in middle-aged and elderly Chinese population

BACKGROUND

Stroke is the leading cause of death in middle-aged and elderly people in China. Insulin resistance (IR) and sarcopenia are both closely associated with metabolic diseases. However, the relationship between these two indicators and stroke has not been fully investigated. The aim of this study was to investigate the relationship between IR and sarcopenia and the risk of new-onset stroke.

METHODS

Using longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018, Cox proportional hazards models were used to determine the association between IR surrogate indicators and sarcopenia status with stroke incidence.

RESULTS

In the present study, during a median 7 years of follow-up, we included 7009 middle-aged and elderly residents, of whom 515 presented with stroke incidence. After adjustment for potential confounders, both baseline IR surrogates and sarcopenia independently predicted stroke risk. In addition, co-morbidities had a higher risk of stroke than other groups. The positive association between TyG-WC and sarcopenia on stroke risk was particularly significant [HR (95% CI): 2.03 (1.52, 2.70)]. In subgroups of different ages and sexes, the combination of IR and sarcopenia is associated with the highest risk of stroke.

CONCLUSIONS

We found that IR and sarcopenia synergistically increase the incidence of stroke in older adults. This finding provides new perspectives for stroke detection and intervention and highlights the importance of early detection and management of IR and sarcopenia in older adults.

Deep pelvis and low visceral fat mass as risk factors for neurogenic bladder after rectal cancer surgery

BACKGROUND

Postoperative neurogenic bladder (PONB) frequently occurs as a complication after rectal cancer surgery. This study aimed to analyze risk factors for developing PONB after rectal cancer surgery, particularly the association between pelvic anatomy and visceral fat mass.

METHODS

We included 138 patients who underwent rectal resection for lower rectal cancer in our department between 2017 and 2021. PONB was defined as the need for urethral catheter reinsertion or oral medication administration for urinary retention after catheter removal with severe NB that required treatment for ≥ 60 days. We obtained visceral fat area (VFA) at the umbilical level based on a CT scan and measured five pelvic dimensions.

RESULTS

Of the 138 patients, 19 developed PONB, with 16 being severe cases. PONB more frequently occurs in patients with a height of < 158 cm, age ≥ 70 years, surgery lasting ≥ 8 h, intraoperative bleeding volume ≥ 150 mL, lateral lymph node dissection, and narrower pelvis. It was more prevalent in cases with low VFA. Conversely, gender, body mass index (BMI), and medical history showed no significant correlations. Multivariate analysis revealed older age, prolonged surgery, and low VFA as independent risk factors for PONB. Independent risk factors for severe PONB included low VFA, older age, prolonged surgery, and deep pelvis.

CONCLUSION

Lower VFA, older age, and prolonged surgery are independent risk factors for developing PONB. Additionally, a deep pelvis is an independent risk factor for severe PONB. Delicate surgical techniques should consider the risk of nerve injury in cases with low VFA and deep pelvis.

The Chinese visceral adiposity index: a novel indicator more closely related to cardiovascular disease than other abdominal obesity indices among postmenopausal women

BACKGROUND

Several abdominal obesity indices including waist circumference (WC), waist-hip ratio (WHR), visceral adiposity index (VAI), lipid accumulation product (LAP), and Chinese visceral adiposity index (CVAI) were considered effective and useful predictive markers for cardiovascular disease (CVD) in general populations or diabetic populations. However, studies investigating the associations between these indices among postmenopausal women are limited. Our study aimed to investigate the associations of the five indices with incident CVD and compare the predictive performance of CVAI with other abdominal obesity indices among postmenopausal women.

METHODS

A total of 1252 postmenopausal women without CVD at baseline were analyzed in our investigation based on a 10-year follow-up prospective cohort study. Link of each abdominal obesity index with CVD were assessed by the Cox regression analysis and the Kaplan-Meier curve. The receiver operating characteristic (ROC) curves were drawn to compare the predictive ability for CVD.

RESULTS

During the median follow-up of 120.53 months, 121 participants newly developed CVD. Compared to quartile 1 of LAP and CVAI, quartile 4 had increased risk to develop CVD after fully adjusted among postmenopausal women. When WC, VAI and CVAI considered as continuous variables, significant increased hazard ratios (HRs) for developing CVD were observed. The areas under the curve (AUC) of CVAI (0.632) was greatly higher than other indices (WC: 0.580, WHR: 0.538, LAP: 0.573, VAI: 0.540 respectively).

CONCLUSIONS

This study suggested that the abdominal obesity indices were associated with the risk of CVD excluded WHR and highlighted that CVAI might be the most valuable abdominal obesity indicator for identifying the high risk of CVD in Chinese postmenopausal women.

The association of changes in the Chinese visceral adiposity index and cardiometabolic diseases: a cohort study

OBJECTIVE

The relationship between changes in Chinese visceral adiposity index (CVAI) and cardiometabolic diseases (CMD) in middle-aged and elderly individuals remains unclear. This study aimed to explore whether changes in the CVAI were associated with CMD incidence.

METHODS

This study included 3,243 individuals aged over 45 years from the China Health and Retirement Longitudinal Study. The exposures were changes in the CVAI and cumulative CVAI from 2012 to 2015. Changes in the CVAI were classified using K-means clustering analysis, and the cumulative CVAI was calculated as follows: (CVAI2012 + CVAI2015)/2 × time (2015-2012). Multivariable logistic regression models were used to assess the relationship between different CVAI change classes and CMD incidence. Restricted cubic splines regression was used to assess the dose-response relationship between cumulative CVAI and CMD incidence. To investigate the relationship between combined exposure to each component of CAVI and CMD incidence, a weighted quantile sum regression analysis was employed.

RESULTS

During the 5 years of follow-up, 776 (24%) incident CMD cases were identified. Changes in CVAI and cumulative CVAI were independently and positively associated with CMD. After adjusting for potential confounders, compared with Class 1, the adjusted ORs (95% CIs) for incident CMD were 1.18 (0.90-1.57) for Class 2, 1.40 (1.03-1.92) for Class 3, and 1.56 (1.04-2.34) for Class 4. When cumulative CVAI was categorized into quartiles, compared with Q1, the adjusted ORs (95% CIs) for incident CMD were 1.30 (1.00-1.70) for Q2, 1.34 (1.01-1.79) for Q3, and 1.63 (1.15-2.31) for Q4. In addition, cumulative CVAI in the overall population exhibited a linear association with CMD (Poverall = 0.012, Pnon-linearity = 0.287), diabetes (Poverall = 0.022, Pnon-linearity = 0.188), and stroke (Poverall = 0.002, Pnon-linearity = 0.978), but showed no significant association with heart disease (Poverall = 0.619, Pnon-linearity = 0.442).

CONCLUSION

Participants with higher baseline CVAI level and a change of elevating CVAI level may suffer an increased incidence of CMD. Furthermore, our findings elucidate the underlying mechanisms of the CVAI by highlighting TG as the primary contributor to the observed associations. Long-term CVAI monitoring is of significant importance for early identification and prevention of CMD, with significant implications for clinical practice.

Association between abdominal obesity indices and falls among older community-dwellers in Guangzhou, China: a prospective cohort study

BACKGROUND

Central obesity was considered as a risk factor for falls among the older population. Waist circumference (WC), lipid accumulation product (LAP), visceral adiposity index (VAI), and the Chinese visceral adiposity index (CVAI) are considered as surrogate markers for abdominal fat deposition in increasing studies. Nevertheless, the longitudinal relationship between these indices and falls among the older population remains indistinct. This study aimed to explore the association between abdominal obesity indices and falls among older community-dwellers.

METHODS

Our study included 3501 individuals aged ≥ 65 years from the Guangzhou Falls and Health Status Tracking Cohort at baseline in 2021 and then prospectively followed up in 2022. The outcome of interest was the occurrence of falls. The Kaplan-Meier curves and multivariable Cox regression analysis were used to explore the associations between abdominal obesity indices and falls. Moreover, the restricted cubic spline analysis (RCS) was conducted to test the non-linear relationships between abdominal obesity indices and hazards of falls incident.

RESULTS

After a median follow-up period of 551 days, a total of 1022 participants experienced falls. The cumulative incidence rate of falls was observed to be higher among individuals with central obesity and those falling within the fourth quartile (Q4) of LAP, VAI, and CVAI. Participants with central obesity and those in Q4 of LAP, VAI, and CVAI were associated with higher risk of falls, with hazard ratios (HRs) of 1.422 (HR 95%CI: 1.255-1.611), 1.346 (1.176-1.541), 1.270 (1.108-1.457), 1.322 (1.154-1.514), respectively. Each 1-SD increment in WC, LAP, VAI, and CVAI was a significant increased risk of falls among participants. Subgroup analysis further revealed these results were basically stable and appeared to be significantly stronger among those females, aged 65-69 years, and with body mass index (BMI) ≥ 28 kg/m2. Additionally, RCS curves showed an overall upward trend in the risk of falls as the abdominal indices increased.

CONCLUSIONS

Abdominal obesity indices, as WC, LAP, VAI, and CVAI were significantly associated with falls among older community-dwellers. Reduction of abdominal obesity indices might be suggested as the strategy of falls prevention.

Relationship between weight-adjusted-waist index and blood pressure as well as incident hypertension among middle-aged and elderly Chinese: A longitudinal study

BACKGROUND AND AIM

The Weight-Adjusted Waist Index (WWI) is a novel obesity metric linked to metabolic disorders. Its relationship with blood pressure and hypertension prevalence in middle-aged and elderly Chinese is unclear. This study examined the association between WWI, blood pressure, and hypertension incidence.

METHODS AND RESULTS

This cross-sectional study included 9298 participants from the China Health and Retirement Longitudinal Study, with 4120 non-hypertensive individuals enrolled in the cohort study. In the cross-sectional analysis, WWI was positively associated with systolic blood pressure (SBP) (Beta 0.88, 95% CI: 0.57-1.21, p < 0.001), showing stronger correlations than waist circumference (WC) (Beta 0.20, 95% CI: 0.16-0.23, p < 0.001) and body mass index (BMI) (Beta 0.63, 95% CI: 0.52-0.74, p < 0.001). WWI also showed a positive association with diastolic blood pressure (DBP) (Beta 0.51, 95% CI: 0.32-0.69, p < 0.001), stronger than those with WC (Beta 0.13, 95% CI: 0.11-0.15, p < 0.001) and BMI (Beta 0.43, 95% CI: 0.37-0.50, p < 0.001). In the longitudinal cohort study, there were 1325 (32%) incident cases of hypertension by the end of follow-up. WWI was positively associated with incident hypertension (OR 1.11, 95% CI: 1.04-1.18, p = 0.001), with a stronger predictive value than WC (OR 1.02, 95% CI: 1.01-1.03, p < 0.001) and BMI (OR 1.04, 95% CI: 1.02-1.06, p < 0.001).

CONCLUSION

Elevated WWI may serve as an independent risk factor for incident hypertension in the middle-aged and elderly Chinese population.

J-shaped relationship between Chinese visceral adiposity index and hyperuricemia: a cross-sectional study

BACKGROUND

Recent years have seen the emergence of numerous novel indicators for visceral obesity. This study investigates the potential correlation between the Chinese visceral adiposity index (CVAI) and hyperuricemia (HUA).

METHODS

This research, derived from a 2011 cross-sectional analysis in Dalian, China, employed restricted cubic spline (RCS) plots to identify inflection points. Subsequently, one-way and multifactorial logistic regression models were utilized, with HUA as the outcome variable. Additionally, subgroup analyses and interaction tests were conducted. Eventually, receiver operating characteristic (ROC) curves were calculated to assess the effectiveness of CVAI and other body composition indices in predicting HUA.

RESULTS

The study included 10,061 individuals, with a HUA prevalence of 14.25%. Significant relationships with HUA were observed for CVAI. RCS analysis revealed a J-shaped relationship between CVAI and HUA. Compared to those in the low CVAI category, HUA was notably associated with individuals in the high CVAI category in multifactorial logistic regression (OR = 2.661, 95% CI: 2.323, 3.047). Subgroup analyses demonstrated stronger relationships in women, participants without hypertension, and participants without diabetes. Additional modeling via ROC curves suggested that the CVAI may offer effective predictive value for HUA.

CONCLUSION

This study confirmed that an elevated CVAI elevates the risk of HUA in middle-aged and elderly populations in the Dalian community. The findings advance obesity prevention strategies that mitigate HUA risk and support healthcare initiatives for China's aging population.

Associations between Chinese visceral adiposity index and risks of all-cause and cause-specific mortality: A population-based cohort study

AIM

To determine the associations between the Chinese visceral adiposity index (CVAI) and the risks of all-cause and cause-specific mortality.

MATERIALS AND METHODS

A total of 3 916 214 Chinese adults were enrolled in a nationwide population cohort covering all 31 provinces of mainland China. The CVAI was calculated based on age, body mass index, waist circumference, and triglyceride and high-density lipoprotein cholesterol concentrations. We used a Cox proportional hazards regression model to determine the hazard ratios and 95% confidence intervals (CIs) for risk of mortality associated with different CVAI levels.

RESULTS

The median follow-up duration was 3.8 years. A total of 86 158 deaths (34 867 cardiovascular disease [CVD] deaths, 29 884 cancer deaths, and 21 407 deaths due to other causes) were identified. In general, after adjusting for potential confounding factors, a U-shaped relationship between CVAI and all-cause mortality was observed by restricted cubic spline (RCS). Compared with participants in CVAI quartile 1, those in CVAI quartile 4 had a 23.0% (95% CI 20.0%-25.0%) lower risk of cancer death, but a 23.0% (95% CI 19.0-27.0) higher risk of CVD death. In subgroup analysis, a J-shaped and inverted U-shaped relationship for all-cause mortality and cancer mortality was observed in the group aged < 60 years.

CONCLUSIONS

The CVAI, an accessible indicator reflecting visceral obesity among Chinese adults, has predictive value for all-cause, CVD, and cancer mortality risks. Moreover, the CVAI carries significance in the field of health economics and secondary prevention. In the future, it could be used for early screening purposes.

The association between Chinese visceral adiposity index and cardiometabolic multimorbidity among Chinese middle-aged and older adults: a national cohort study

Objective

This study aimed to explore the association between the Chinese visceral adiposity index (CVAI) and cardiometabolic multimorbidity in middle-aged and older Chinese adults.

Methods

The data used in this study were obtained from a national cohort, the China Health and Retirement Longitudinal Study (CHARLS, 2011-2018 wave). The CVAI was measured using previously validated biomarker estimation formulas, which included sex, age, body mass index, waist circumference, triglycerides, and high-density lipoprotein cholesterol. The presence of two or more of these cardiometabolic diseases (diabetes, heart disease, and stroke) is considered as cardiometabolic multimorbidity. We used Cox proportional hazard regression models to examine the association between CVAI and cardiometabolic multimorbidity, adjusting for a set of covariates. Hazard ratios (HRs) and 95% confidence intervals (CIs) were used to show the strength of the associations. We also conducted a subgroup analysis between age and sex, as well as two sensitivity analyses. Receiver operator characteristic curves (ROC) were used to test the predictive capabilities and cutoff value of the CVAI for cardiometabolic multimorbidity.

Results

A total of 9028 participants were included in the final analysis, with a mean age of 59.3 years (standard deviation: 9.3) and women accounting for 53.7% of the sample population. In the fully-adjusted model, compared with participants in the Q1 of CVAI, the Q3 (HR = 2.203, 95% CI = 1.039 - 3.774) and Q4 of CVAI (HR = 3.547, 95% CI = 2.100 - 5.992) were associated with an increased risk of cardiometabolic multimorbidity. There was no evidence of an interaction between the CVAI quartiles and sex or age in association with cardiometabolic multimorbidity (P >0.05). The results of both sensitivity analyses suggested that the association between CVAI and cardiometabolic multimorbidity was robust. In addition, the area under ROC and ideal cutoff value for CVAI prediction of cardiometabolic multimorbidity were 0.685 (95% CI = 0.649-0.722) and 121.388.

Conclusion

The CVAI is a valid biomarker with good predictive capability for cardiometabolic multimorbidity and can be used by primary healthcare organizations in the future for early warning, prevention, and intervention with regard to cardiometabolic multimorbidity.

Association of adiposity indicators with cardiometabolic multimorbidity risk in hypertensive patients: a large cross-sectional study

Background

Cardiometabolic multimorbidity (CMM) has emerged as a prominent public health concern. Hypertensive patients are prone to develop comorbidities. Moreover, the accumulation of visceral adipose tissue is the main cause for the development of cardiometabolic diseases. The cardiometabolic index (CMI), lipid accumulation product (LAP), visceral adiposity index (VAI), and Chinese visceral adiposity index (CVAI) not only assess adipose tissue mass but also reflect adipose tissue dysfunction. So far, no study has been reported to evaluate the association of CMI, LAP, VAI, and CVAI with CMM risk in hypertensive patients. Therefore, this study aimed to assess the association between these adiposity indicators and the risk of CMM among Chinese hypertensive patients.

Methods

In this cross-sectional study, a total of 229,287 hypertensive patients aged 35 years and older were included from the National Basic Public Health Service Project. All participants underwent a face-to-face questionnaire survey, physical examination, and the collection of fasting venous blood samples. Multivariable logistic regression models were performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Receiver operating characteristic curve was utilized to evaluate the identification ability for CMM.

Results

After adjusting for confounders, each 1-standard deviation increase in CMI, LAP, VAI, and CVAI was associated with a 14%, 8%, 12%, and 54% increased risk of CMM, respectively. When comparing the highest quartile of these indicators with the lowest quartile, individuals in the highest quartile of CMM, LAP, VAI, and CVAI had a 1.39-fold (95% CI 1.30, 1.48), 1.28-fold (95% CI 1.19, 1.37), 1.37-fold (95% CI 1.29, 1.46), and 2.56-fold (95% CI 2.34, 2.79) increased risk of CMM after adjusting for potential confounders. Notably, a nonlinear association was observed for CMI, LAP, and VAI with the risk of CMM (all P nonlinearity < 0.001). CVAI exhibited the highest area under the receiver operating characteristic curve (AUC) among all the included adiposity indices in this analysis.

Conclusion

This study indicated the significant positive association of CMI, LAP, VAI, and CVAI with the risk of CMM in hypertensive patients. Among these indicators, CVAI demonstrated the most robust performance in predicting CMM risk and may serve as a valuable tool for identifying CMM risk in Chinese hypertensive patients.