Evaluation of the effects of central and general adiposity indicators on heart rate variability as an early marker of cardiometabolic risk

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Overweight and obesity (n=200). Intervention: Central and visceral adiposity indicators (Visceral Fat Score, Waist-to-Height Ratio, ABSI, Neck-to-Height Ratio) vs. Body mass index (BMI). Primary outcome: Resting heart rate variability time-domain parameter SDNN (ms) per 1-unit increase in Visceral Fat Score (age-adjusted linear regression) (Beta -0.899 ms (r = -0.453), p=0.001).

Q: What does this research mean for the field?

Visceral and central adiposity indicators are inversely associated with heart rate variability in overweight and obese women, showing comparable age-adjusted explanatory performance and only marginally larger effect sizes than BMI. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Servet Emir; Sema Basat

doi:10.1186/s12872-026-06899-y

November 5, 2026BMC Cardiovascular DisordersOpen Access

Evaluation of the effects of central and general adiposity indicators on heart rate variability as an early marker of cardiometabolic risk

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Why the study?

The comparative associations of BMI versus central and visceral adiposity indicators with heart rate variability as an early marker of cardiometabolic risk and autonomic dysfunction in overweight and obese individuals needed evaluation.

Do central and visceral adiposity indicators (Visceral Fat Score, waist-to-height ratio, neck-to-height ratio, and ABSI) have stronger associations with resting heart rate variability parameters (SDNN, RMSSD, LF/HF) compared to traditional BMI in overweight and obese females?

Key Points

To comparatively evaluate the associations of body mass index and central or visceral adiposity indicators with heart rate variability as an early marker of autonomic dysfunction and cardiometabolic risk.
Retrospective cross-sectional study including 200 overweight and obese females (mean age 42.9 ± 11.9 years).
Resting cardiac autonomic function (SDNN, RMSSD, LF/HF) was assessed using a Polar H10 sensor under spontaneous breathing.
Adiposity was evaluated using bioelectrical impedance (Visceral Fat Score) and anthropometrics (BMI, waist-to-height ratio, and A Body Shape Index) analyzed via age-adjusted linear regression and ROC curves.
Visceral Fat Score showed the highest unadjusted inverse correlation with SDNN (r = -0.453, p < 0.001) and RMSSD (r = -0.397, p < 0.001).
In age-adjusted regression models, each 1-unit increase in Visceral Fat Score was associated with a 0.899 ms decrease in SDNN (p = 0.001), while waist-to-height ratio (p = 0.016) and BMI (p = 0.004) also maintained significant inverse associations.
ROC analysis established exploratory cut-offs for predicting the lowest quartile of SDNN at a Visceral Fat Score > 11.5 (AUC = 0.726, p < 0.001) and waist-to-height ratio > 0.745 (AUC = 0.674, p < 0.001).

Study Design

Type

Cross-Sectional (n=200)

Multicenter

No

Structured PICO

Do central and visceral adiposity indicators (Visceral Fat Score, waist-to-height ratio, neck-to-height ratio, and ABSI) have stronger associations with resting heart rate variability parameters (SDNN, RMSSD, LF/HF) compared to traditional BMI in overweight and obese females?

P

Population

200 overweight and obese female outpatients (mean age 42.9 years, BMI ≥ 25 kg/m2) in normal sinus rhythm without major cardiac or thyroid disease, evaluated retrospectively at a single center.

E

Exposure

Assessment of central and visceral adiposity indicators via bioelectrical impedance analysis (Tanita-DC360: Visceral Fat Score, Fat Mass, Lean Mass) and anthropometric indices (waist-to-height ratio [WHtR], neck-to-height ratio, A Body Shape Index [ABSI]).

C

Comparator

Traditional general adiposity measurement via Body Mass Index (BMI).

O

Outcome

Resting heart rate variability (HRV) parameters in time-domain (SDNN, RMSSD) and frequency-domain (LF/HF ratio) evaluated via a 5-minute supine recording using a Polar H10 sensor under spontaneous breathing.surrogate

Main Result

Effect estimate: Beta -0.899 ms (r = -0.453)

p-value: p=0.001

Limitations

Single-center, retrospective, cross-sectional design precludes causal inference
No recorded information on standard pre-measurement preparations for BIA and HRV (e.g., caffeine/alcohol restriction, fasting, hydration)
Included only female patients due to low male sample size, limiting generalizability to men
Potential residual confounding from unmeasured metabolic biomarkers (fasting glucose, HbA1c, HOMA-IR, lipids), habitual physical activity, and menopausal status
Visceral fat was assessed via bioelectrical impedance analysis (BIA) rather than gold-standard MRI or CT imaging
Exploratory ROC cut-off thresholds lack external validation and prospective outcome data
Single-center, retrospective, and cross-sectional design prevents establishing a definitive causal relationship between adiposity indices and HRV.
Lack of recorded information regarding standard pre-measurement preparations for BIA and HRV (such as caffeine or alcohol restrictions, fasting, or optimal hydration).
Exclusion of male patients due to low numbers, limiting generalizability to the male population.
Potential for residual confounding by unmeasured habitual physical activity levels, menopausal status, and comprehensive biochemical metabolic profiles (e.g., insulin resistance and glycemic status).

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Implication

Visceral adiposity and waist-to-height ratio are significantly associated with reduced heart rate variability in overweight and obese women, demonstrating comparable model performance to traditional BMI while A Body Shape Index (ABSI) failed to show an age-adjusted association.

Abstract

This study aimed to comparatively evaluate the associations of body mass index (BMI) and central/visceral adiposity indicators with heart rate variability (HRV) as an early marker of cardiometabolic risk and autonomic dysfunction in overweight/obese individuals. This retrospective cross-sectional study included 200 overweight and obese females. Resting autonomic functions (SDNN, RMSSD, LF/HF) were evaluated using a Polar H10 sensor under spontaneous breathing. Body composition and visceral adiposity were assessed via bioelectrical impedance analysis and anthropometric indices, including waist-to-height ratio (WHtR) and A Body Shape Index (ABSI).Age-adjusted associations and sample-specific exploratory thresholds for depressed HRV were determined by linear regression and Receiver Operating Characteristic (ROC) curve analyses. Among the evaluated indices, the highest numerical negative correlation was observed between Visceral Fat Score and SDNN ( r =-0.453, p < 0.001) and RMSSD ( r =-0.397, p < 0.001). In age-adjusted regression models, a 1-unit increase in Visceral Fat Score showed an age-adjusted association with a decrease in SDNN of 0.899 ms ( p = 0.001). Both WHtR ( p = 0.016) and BMI ( p = 0.004) remained significantly associated with reduced SDNN in age-adjusted models, with comparable model performance and only marginal numerical differences in effect sizes. No significant age-adjusted association of ABSI with autonomic impairment was observed, however. ROC analysis established a Visceral Fat Score > 11.5 and WHtR > 0.745 as preliminary statistical cut-offs for identifying the low HRV group within this specific cohort. Regional fat distribution indices, specifically visceral adiposity and WHtR, demonstrate significant age-adjusted associations with early cardiac autonomic dysfunction, showing comparable model performance with only marginally higher numerical effect sizes relative to BMI. However, given the potential for residual confounding by unmeasured metabolic, menopausal, and lifestyle factors, these strictly sample-specific exploratory findings require prospective external validation before any clinical consideration. Not applicable.

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Cite This Study

Emir et al. (2026) conducted a cross-sectional in Overweight and obesity (n=200). Central and visceral adiposity indicators (Visceral Fat Score, Waist-to-Height Ratio, ABSI, Neck-to-Height Ratio) vs. Body mass index (BMI) was evaluated on Resting heart rate variability time-domain parameter SDNN (ms) per 1-unit increase in Visceral Fat Score (age-adjusted linear regression) (Beta -0.899 ms (r = -0.453), p=0.001).

synapsesocial.com/papers/6aee6bc771a7594806220bc0 https://doi.org/10.1186/s12872-026-06899-y

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Evaluation of the effects of central and general adiposity indicators on heart rate variability as an early marker of cardiometabolic risk

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Evaluation of the effects of central and general adiposity indicators on heart rate variability as an early marker of cardiometabolic risk

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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