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AbstractObjectiveTo quantify the association of indices of central obesity, including waist circumference, hip circumference, thigh circumference, waist-to-hip ratio, waist-to-height ratio, waist-to-thigh ratio, body adiposity index, and A body shape index, with the risk of all cause mortality in the general population, and to clarify the shape of the dose-response relations.DesignSystematic review and meta-analysis.Data sourcesPubMed and Scopus from inception to July 2019, and the reference lists of all related articles and reviews.Eligibility criteria for selecting studiesProspective cohort studies reporting the risk estimates of all cause mortality across at least three categories of indices of central fatness. Studies that reported continuous estimation of the associations were also included.Data synthesisA random effects dose-response meta-analysis was conducted to assess linear trend estimations. A one stage linear mixed effects meta-analysis was used for estimating dose-response curves.ResultsOf 98 745 studies screened, 1950 full texts were fully reviewed for eligibility. The final analyses consisted of 72 prospective cohort studies with 2 528 297 participants. The summary hazard ratios were as follows: waist circumference (10 cm, 3.94 inch increase): 1.11 (95% confidence interval 1.08 to 1.13, I2=88%, n=50); hip circumference (10 cm, 3.94 inch increase): 0.90 (0.81 to 0.99, I2=95%, n=9); thigh circumference (5 cm, 1.97 inch increase): 0.82 (0.75 to 0.89, I2=54%, n=3); waist-to-hip ratio (0.1 unit increase): 1.20 (1.15 to 1.25, I2=90%, n=31); waist-to-height ratio (0.1 unit increase): 1.24 (1.12 to 1.36, I2=94%, n=11); waist-to-thigh ratio (0.1 unit increase): 1.21 (1.03 to 1.39, I2=97%, n=2); body adiposity index (10% increase): 1.17 (1.00 to 1.33, I2=75%, n=4); and A body shape index (0.005 unit increase): 1.15 (1.10 to 1.20, I2=87%, n=9). Positive associations persisted after accounting for body mass index. A nearly J shaped association was found between waist circumference and waist-to-height ratio and the risk of all cause mortality in men and women. A positive monotonic association was observed for waist-to-hip ratio and A body shape index. The association was U shaped for body adiposity index.ConclusionsIndices of central fatness including waist circumference, waist-to-hip ratio, waist-to-height ratio, waist-to-thigh ratio, body adiposity index, and A body shape index, independent of overall adiposity, were positively and significantly associated with a higher all cause mortality risk. Larger hip circumference and thigh circumference were associated with a lower risk. The results suggest that measures of central adiposity could be used with body mass index as a supplementary approach to determine the risk of premature death.

Background Insulin resistance, represented by increased triglyceride-glucose (TyG) index levels, shows interplay with visceral obesity and together promotes cardiovascular diseases and mortality. However, significant controversies exist regarding whether modified TyG indices, such as TyG-BMI, TyG-WC, and TyG-WHtR, outperform the TyG index in predicting cardiovascular outcomes. We aimed to explore whether there was a synergistic effect of a body shape index (ABSI), a better parameter reflecting visceral obesity, and the TyG index on cardiovascular mortality. Methods We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2001–2018 of 17,329 individuals. The associations of the TyG index and ABSI with cardiovascular mortality were investigated via Cox regression analysis and restricted cubic splines. Receiver operating characteristic (ROC) curve analysis was performed to compare the predictive value. Mediation analysis was used to explore the potential mediator. Results A total of 673 (3.9%) cardiovascular deaths occurred during a median follow-up of 8.92 years. Individuals with high TyG and high ABSI (TyG > 9.04 and ABSI > 0.085) were at the highest cardiovascular mortality risk both in individuals with (HR = 1.714, 95% CI 1.123–2.616) and without diabetes (HR = 1.402, 95% CI 1.003–1.960), suggesting a synergistic effect. Next, we multiplied these two indicators and established TyG-ABSI. It showed a J-shaped relationship and a positive linear relationship with cardiovascular mortality in individuals with and without diabetes, respectively. Arterial stiffness, represented by estimated pulse wave velocity, partially mediated the effect of TyG-ABSI on cardiovascular mortality, with a mediation proportion of 42.7%. The predictive value of TyG-ABSI was greater than that of the TyG index, TyG-BMI, TyG-WC, and TyG-WHtR (Harrell’s C-index: 0.710 vs 0.623 vs 0.539 vs 0.612 vs 0.622, all p  < 0.001). Conclusions The simultaneous assessment of the TyG index and ABSI revealed a synergistic effect on cardiovascular mortality. We recommended the use of TyG-ABSI instead of the TyG index and other modified TyG indices in cardiovascular risk assessment.

This study aimed to investigate the association between sarcopenic obesity and 30-day mortality in critically ill patients with intra-abdominal sepsis. We analyzed 236 surgical ICU patients with sepsis due to intra-abdominal infection who underwent urgent surgical intervention. Sarcopenia, visceral obesity and sarcopenic obesity were analyzed by computed tomography scans using the third lumbar vertebrae skeletal muscle index and visceral adipose tissue area, using previously reported cutoff values. The cohort was divided into 4 groups: 52 were diagnosed with sarcopenic obesity, 62 with sarcopenia only, 58 with visceral obesity only, and 64 with no sarcopenia or visceral obesity. 57 (24.2%) patients died within 30days. The frequency of 30-day mortality differed significantly among the groups. Multivariate analysis showed that only sarcopenic obesity was associated with increased risk for 30-day mortality. Sarcopenic patients were older than non-sarcopenic patients. To address this limitation, subgroup analyses stratified by age showed that the risk of 30-day mortality increased significantly in sarcopenic patients, both in patients with age≤70years and in those with age >70years. Sarcopenic obesity is an independent risk factor for 30-day mortality in critically ill patients with intra-abdominal sepsis. •Sarcopenic obesity has attracted much attention.•We investigate the association between sarcopenic obesity and 30-day mortality in critically ill patients with intra-abdominal sepsis.•Sarcopenic obesity is an independent risk factor for 30-day mortality in critically ill patients with intra-abdominal sepsis.

Abdominal and general adiposity are independently associated with mortality, but there is no consensus on how best to assess abdominal adiposity. We compared the ability of alternative waist indices to complement body mass index (BMI) when assessing all-cause mortality. We used data from 352,985 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) and Cox proportional hazards models adjusted for other risk factors. During a mean follow-up of 16.1 years, 38,178 participants died. Combining in one model BMI and a strongly correlated waist index altered the association patterns with mortality, to a predominantly negative association for BMI and a stronger positive association for the waist index, while combining BMI with the uncorrelated A Body Shape Index (ABSI) preserved the association patterns. Sex-specific cohort-wide quartiles of waist indices correlated with BMI could not separate high-risk from low-risk individuals within underweight (BMI < 18.5 kg/m 2 ) or obese (BMI ≥ 30 kg/m 2 ) categories, while the highest quartile of ABSI separated 18–39% of the individuals within each BMI category, which had 22–55% higher risk of death. In conclusion, only a waist index independent of BMI by design, such as ABSI, complements BMI and enables efficient risk stratification, which could facilitate personalisation of screening, treatment and monitoring.

Background Metabolic Syndrome (MetS) significantly increases the risk of cardiovascular disease (CVD), with central obesity and insulin resistance as major contributors. The TyG-ABSI index is a newly proposed composite measure that combines the TyG index and ABSI, aiming to assess both insulin resistance and central obesity simultaneously. Previous studies have shown that TyG-ABSI has potential in predicting cardiovascular mortality, but its applicability in MetS populations remains unclear. This study aims to explore the association between TyG-ABSI and cardiovascular events in individuals with MetS and compare its predictive value with the traditional TyG index in this specific population. Methods Participants from the National Health and Nutrition Examination Survey (NHANES) between 2001 and 2018 were selected, with all data weighted for sample design, clustering, and stratification to ensure national representativeness. Associations between TyG-ABSI and other TyG indices with cardiovascular mortality and all-cause mortality were assessed using weighted Cox proportional hazards models; CVD prevalence was analyzed using weighted logistic regression models. Additional analyses included Kaplan–Meier survival curves and restricted cubic spline regression. Model performance was compared between TyG-ABSI, TyG, and its derived indices using ROC curves, NRI, IDI, and DCA. E-value, subgroup analyses, and competing risks models were conducted to assess robustness. Results This study analyzed data from 12,813 individuals with metabolic syndrome in the NHANES cohort to systematically compare the performance of TyG-ABSI and other TyG-related indices in assessing CVD and mortality. The results revealed significant associations between TyG-ABSI and CVD, cardiovascular mortality, and all-cause mortality. Specifically, for each 1-unit increase in TyG-ABSI, the risk of CVD increased by 28%, cardiovascular mortality by 25%, and all-cause mortality by 28%. These associations showed a dose–response relationship in stratified analyses based on tertiles, and TyG-ABSI outperformed the traditional TyG index in overall analysis. Compared to other TyG-related indices, TyG-ABSI demonstrated superior predictive performance in metrics such as the ROC curve, NRI, and DCA. Further analyses, including competing risks models, E-value estimation, and RCS modeling, confirmed the robustness of these associations. Subgroup analyses also supported the stability of TyG-ABSI, with limited interaction effects. Conclusion Our study highlights the value of TyG-ABSI in assessing cardiovascular disease and mortality risk in populations with MetS, providing new evidence for medical practice and public health interventions. Graphical abstract

Low handgrip strength (HGS) and abdominal obesity (AO) have been reported to be linked to an increased all-cause mortality risk in older adults. However, the combined impact of AO with low HGS and/or HGS asymmetry on mortality risk remains unclear. Therefore, this study aimed to investigate the synergistic effects of AO and abnormal HGS on mortality risk among Chinese older adults. Baseline data of the China Health and Retirement Longitudinal Study in 2011, along with mortality outcomes obtained in 2018 were used for the analysis. Low HGS was identified as HGS <18 kg in women or <28 kg in men, while HGS asymmetry is defined as an HGS of either hand > 10% stronger than the other. AO was characterized by a waist circumference ≥90 cm in men and ≥85 cm in women. Logistic regression analysis was used to evaluate the relationship between AO, abnormal HGS and mortality risk. A total of 5186 subjects aged 60 years or older were enrolled, 50.6% of whom were male. The proportions of participants with only AO, only low HGS, only HGS asymmetry, low HGS with asymmetry, both AO and low HGS, both AO and asymmetric HGS, and AO with both low HGS and asymmetry were 20.0%, 6.1%, 16.6%, 8.3%, 3.2%, 13.4%, and 3.9%, respectively. Over the course of a 7-year follow-up interval, 970 of these individuals died, with 13.4%, 12.4%, 13.6%, 15.5%, 4.1%, 10.1% and 6.9% of deaths in the above groups, respectively. The adjusted logistic regression analysis model confirmed that only low HGS (OR = 1.897, 95%CI: 1.386-2.596, p<0.001), low HGS with asymmetry (OR = 1.680, 95%CI: 1.265-2.231, p<0.001), and AO combined with both low HGS and asymmetry (OR = 2.029, 95%CI: 1.381-2.981, p<0.001) were associated with a higher risk of mortality. Low HGS, with or without asymmetry, is associated with increased mortality risk in older Chinese adults without AO, and the combination of low HGS and HGS asymmetry further elevates mortality risk in those with AO.

Epidemiological studies assessing general and abdominal obesity measures or their combination for mortality prediction have shown inconsistent results. We aimed to systematically review the associations of body mass index (BMI), waist-to-hip ratio (WHR), waist circumference (WC) and waist-to-height ratio (WHtR) with all-cause mortality in prospective cohort studies. In this systematic review, which includes a meta-regression analysis, we analysed the associations with all-cause mortality of BMI, WHR, WC and WHtR in prospective cohort studies available in Medline, Embase, the Cochrane Database of Systematic Reviews and Esbiobase from inception through 7 May 2010. A total of 18 studies met the inclusion criteria, comprising 689 465 participants and 48 421 deaths during 5–24 years of follow-up. The studies were heterogeneous, mainly due to differences in categorization of anthropometric parameters (AP) and different approaches to statistical analysis. Both general and abdominal obesity measures were significantly associated with mortality. In analyses using categorical variables, BMI and WC showed predominantly U- or J-shaped associations with mortality, whereas WHR and WHtR demonstrated positive relationships with mortality. All measures showed similar risk patterns for upper quantiles in comparison to reference quantiles. The parameters of general and abdominal obesity each remained significantly associated with mortality when adjusted for the other. This evidence suggests that abdominal obesity measures such as WC or WHR, show information independent to measures of general obesity and should be used in clinical practice, in addition to BMI, to assess obesity-related mortality in adults.

A Body Shape Index (ABSI) had been derived from a study of the United States National Health and Nutrition Examination Survey (NHANES) 1999-2004 mortality data to quantify the risk associated with abdominal obesity (as indicated by a wide waist relative to height and body mass index). A national survey with longer follow-up, the British Health and Lifestyle Survey (HALS), provides another opportunity to assess the predictive power for mortality of ABSI. HALS also includes repeat observations, allowing estimation of the implications of changes in ABSI. We evaluate ABSI z score relative to population normals as a predictor of all-cause mortality over 24 years of follow-up to HALS. We found that ABSI is a strong indicator of mortality hazard in this population, with death rates increasing by a factor of 1.13 (95% confidence interval, 1.09-1.16) per standard deviation increase in ABSI and a hazard ratio of 1.61 (1.40-1.86) for those with ABSI in the top 20% of the population compared to those with ABSI in the bottom 20%. Using the NHANES normals to compute ABSI z scores gave similar results to using z scores derived specifically from the HALS sample. ABSI outperformed as a predictor of mortality hazard other measures of abdominal obesity such as waist circumference, waist to height ratio, and waist to hip ratio. Moreover, it was a consistent predictor of mortality hazard over at least 20 years of follow-up. Change in ABSI between two HALS examinations 7 years apart also predicted mortality hazard: individuals with a given initial ABSI who had rising ABSI were at greater risk than those with falling ABSI. ABSI is a readily computed dynamic indicator of health whose correlation with lifestyle and with other risk factors and health outcomes warrants further investigation.

Kidney Stone Disease (KSD) is a prevalent urological condition, while abdominal obesity is on the rise globally. The conicity index, measuring body fat distribution, is crucial but under-researched in its relation to KSD and all-cause mortality. This study, using data from 59,842 participants in the NHANES (2007–2018), calculated the conicity index from waist circumference, height, and weight. Logistic regression and Cox models revealed a significant positive correlation: each 0.1 unit increase in the conicity index was linked to a 23% rise in KSD odds (OR: 1.23, 95% CI: 1.14, 1.35) and higher predictive ability compared to traditional measures (AUC = 0.619). In KSD patients, this increase corresponded to a 44% higher risk of all-cause mortality (HR: 1.44, 95% CI: 1.14, 1.82), and in non-KSD patients, a 53% increase (HR: 1.53, 95% CI: 1.37, 1.70). Serum albumin and Red Cell Distribution Width (RDW) partially mediated these relationships. Addressing central obesity could significantly lower the risks of KSD and mortality.

Background Sarcopenic obesity is a condition where loss of muscle mass occurs alongside fat gain, and it is considered a risk factor for mortality. However, the use of various definitions for this condition has led to conflicting results. Aim To investigate whether the coexistence of low muscle mass and abdominal obesity, defined using two simple measures employed in clinical practice, is a risk factor for mortality in individuals aged 50 or older. Methods A longitudinal study with a 14-year follow-up was conducted involving 5,440 participants of the English Longitudinal Study of Ageing . Abdominal obesity and low muscle mass were respectively defined based on high waist circumference and low skeletal muscle mass index (SMMI) determined by an equation. The sample was divided into four groups: non-low muscle mass/non-abdominal obesity (NLMM/NAO), non-low muscle mass/abdominal obesity (NLMM/AO), low muscle mass/non-abdominal obesity (LMM/NAO), and low muscle mass/abdominal obesity (LMM/AO). Cox regression models were used to estimate the mortality risk as a function of muscle mass and abdominal obesity status. Results LMM/AO increased the risk of death by 83% (HR:1.83; 95%CI: 1.35–2.66) compared to those in the NLMM/NAO group. AO alone was not associated with a greater risk of mortality (HR:1.09; 95%CI: 0.93–1.27), whereas LMM alone increased the risk by 40% (HR:1.40; 95%CI:1.18–1.66). Conclusions Identifying LMM/AO in individuals aged 50 or older can be crucial for predicting the risk of mortality. Simple and easily applicable measures can serve as a proxy for sarcopenic obesity and aid in implementing the necessary interventions.