Anthropometric indices WWI and ABSI significantly increased all-cause mortality by up to 62% and 43% respectively in CKM stages 1–2, while in CKM stages 3–4 ABSI (HR 1.41) and WWI (HR 1.35) were linked to increased cardiovascular mortality risk despite an obesity paradox for BMI and WC.
Observational (n=28,911)
Yes
Do higher anthropometric indices predict mortality and advanced disease stage in adults with cardiovascular-kidney-metabolic syndrome?
Central adiposity measures, particularly ABSI and WWI, demonstrate stronger associations with advanced CKM stage and mortality than general adiposity measures like BMI.
Effect estimate: HR 1.62 for all-cause mortality with WWI Q4 in CKM stages 1–2; HR 1.43 for all-cause mortality with ABSI Q4 in CKM stages 1–2; HR 1.41 for cardiovascular mortality with ABSI Q4 in CKM stages 3–4; HR 1.35 for cardiovascular mortality with WWI Q4 in CKM stages 3–4
p-value: p=<0.05 for reported hazard ratios
Background: Cardiovascular–kidney–metabolic (CKM) syndrome embodies the interconnection between cardiovascular, renal, and metabolic disorders. Anthropometric indices reflect distinct aspects of obesity and may aid in stratifying the severity of CKM syndrome and predicting mortality. Thus, this study aimed to assess and compare the relationships between multiple obesity-related measures and advanced CKM stages, as well as the risk of mortality. Methods: Data included in this analysis were from the National Health and Nutrition Examination Survey (NHANES). Participants were categorized into quartiles (Q1–Q4) based on each anthropometric index. We estimated the associations with all-cause, cardiovascular, and non-cardiovascular mortality outcomes using Cox proportional hazards models, and evaluated the odds of an advanced CKM stage (stages 3/4) using logistic regression. Possible non-linear exposure–outcome patterns were further investigated through restricted cubic spline modelling. Then, to compare the predictive performance of the indices, we calculated the area under the receiver operating characteristic curve (AUC). Results: We included 28,911 adults from the NHANES (1999–2018) (median age (interquartile range (IQR)) 55.0 (40.0–67.0) years, 52.5% male), comprising 21,789 in CKM stages 1–2 and 7122 in stages 3–4. The anthropometric indices varied significantly across CKM stages (p < 0.001), with body mass index, waist circumference, Weight-adjusted Waist Index (WWI), and relative fat mass increasing with disease severity. In stages 1–2, the highest quartile (Q4) of A Body Shape Index (ABSI), WWI, waist-to-height ratio (WHtR), and Conicity Index (C-index) was associated with higher all-cause and cardiovascular mortalities, often following U-shaped or J-shaped non-linear patterns. In stages 3–4, predictive strength diminished, with only the ABSI and WWI showing consistent associations with mortality. For CKM progression, the ABSI (AUC = 0.73), WWI (AUC = 0.70), and C-index (AUC = 0.69) demonstrated the best discrimination. Conclusions: This study shows that several anthropometric indices, particularly the ABSI, WWI, WHtR, and C-index, are strongly associated with advanced CKM stage and increased mortality risk. These associations were stronger for central adiposity measures than for general adiposity, suggesting the potential relevance of central fat distribution and supporting the possible role of anthropometric indices in early risk stratification and targeted intervention in CKM syndrome.
Zhong et al. (Wed,) conducted a observational in Adults with cardiovascular-kidney-metabolic syndrome from stages 1 to 4 based on NHANES data (n=28,911). Anthropometric indices including BMI, WC, WWI, ABSI, WHtR, C-index and others vs. Lowest quartile (Q1) of respective anthropometric indices was evaluated on All-cause, cardiovascular, and non-cardiovascular mortality risk associated with highest quartile (Q4) vs lowest quartile (Q1) of anthropometric indices in CKM stages 1–2 and 3–4 (HR 1.62 for all-cause mortality with WWI Q4 in CKM stages 1–2; HR 1.43 for all-cause mortality with ABSI Q4 in CKM stages 1–2; HR 1.41 for cardiovascular mortality with ABSI Q4 in CKM stages 3–4; HR 1.35 for cardiovascular mortality with WWI Q4 in CKM stages 3–4, p=<0.05 for reported hazard ratios). Anthropometric indices WWI and ABSI significantly increased all-cause mortality by up to 62% and 43% respectively in CKM stages 1–2, while in CKM stages 3–4 ABSI (HR 1.41) and WWI (HR 1.35) were linked to increased cardiovascular mortality risk despite an obesity paradox for BMI and WC.