Associations of body shape, visceral adiposity, and metabolic function indices with risk of major noncommunicable diseases: evidence from a nationwide population cohort

Comparative data evaluating the predictive performance of various obesity and metabolic indices for multiple noncommunicable diseases (NCDs) remain limited. We used the data sourced from the Health Evaluation and risk Reduction through nationwide Teamwork cohort (ChinaHEART), a national population-based study that enrolled 4,258,033 Chinese adults and followed them for more than 20 million person-years between November 2014 and December 2023. Fifteen obesity and metabolic indices were categorized into three groups: (1) body shape-related indices, including body mass index (BMI), body roundness index (BRI), waist-to-height ratio (WHtR), a body shape index (ABSI), weight-adjusted waist index (WWI), and conicity index (CI); (2) visceral fat-related indices, including lipid accumulation product (LAP) and Chinese visceral adiposity index (CVAI); and (3) metabolic function-related indices, including triglyceride-glucose index (TyG), TyG-BMI, TyG-BRI, TyG-WHtR, TyG-ABSI, TyG-WWI, and TyG-CI. The study outcomes comprised composite events of death or first hospitalization attributable to each of cardiovascular diseases (CVD), diabetes mellitus (DM), cancers, and chronic obstructive pulmonary disease (COPD) individually. Composite obesity and metabolic indices reflecting visceral adiposity accumulation and insulin resistance, respectively exhibited enhanced predictive accuracy for cardiovascular and diabetic risk, whereas their performance for cancer and COPD was comparatively limited. These findings support the paradigm that weight management strategies should be guided by risk assessments rather than relying solely on body weight or body shape. Furthermore, the development of diverse definitions for obesity measurement and management tailored to different population subgroups is warranted.