Association of anthropometric indices with the development of multimorbidity in middle-aged and older adults: A retrospective cohort study

Abstract

Background Previous studies have explored the relationship between body mass index (BMI) and multimorbidity. However, the relationship between other obesity indicators and their dynamic changes and multimorbidity has not been systematically estimated. Therefore, we aimed to investigate the association of BMI and other obesity indicators, including waist circumference (WC), waist-to-height ratio (WHtR), waist divided by height0.5 (WHT.5R), and body roundness index (BRI) and their changes and the risk of multimorbidity in middle-aged and older adults through a retrospective cohort study. Methods Data collected from annual health examination dataset in the Jinshui during 2017 and 2021. Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) to evaluate the effect of baseline and dynamic changes in the anthropometric indices on the risk of multimorbidity. Results A total of 75,028 individuals were included in the study, and 5,886 participants developed multimorbidity during the follow-up. Multivariate Cox regression analysis revealed a progressive increase in the risk of multimorbidity with increasing anthropometric indicators (BMI, WC, WHtR, WHT.5R, and BRI) (all P<0.001). Regardless of general obesity status at baseline, increased WC was associated with a high risk of multimorbidity. Compared to the subjects with baseline BMI<24 kg/m2 and WC<90 (men)/80 (women), the HRs (95% CI) of the baseline BMI<24 kg/m2 and WC≥90 (men)/80 (women) group and BMI≥24 kg/m2 and WC≥90 (men)/80 (women) group were 1.31 (1.08, 1.61) and 1.82 (1.68, 1.97), respectively. In addition, the dynamics of WC could reflect the risk of multimorbidity. When subjects with baseline WC<90 (men)/80 (women) progressed to WC≥90 (men)/80 (women) during follow-up, the risk of multimorbidity significantly increased (HR = 1.78; 95% CI, 1.64, 1.95), while the risk of multimorbidity tended to decrease when people with abnormal WC at baseline reversed to normal at follow-up (HR = 1.40; 95% CI, 1.26, 1.54) compared to those who still exhibited abnormal WC at follow-up (HR = 2.00; 95% CI, 1.82, 2.18). Conclusions Central obesity is an independent and alterable risk factor for the occurrence of multimorbidity in middle-aged and elderly populations. In addition to the clinical measurement of BMI, the measurement of the central obesity index WC may provide additional benefits for the identification of multimorbidity in the Chinese middle-aged and elderly populations.

Adiposity indicators exhibit depot‐ and sex‐specific associations with multimorbidity onset: A cohort study of the UK Biobank

“…Considering this evidence, abdominal obesity indices and body fat percentage indices may offer greater accuracy than BMI in identifying adiposity and, consequently, may provide more precise predictions regarding the onset of multimorbidity. Although waist circumference‐related abdominal obesity indices and hip circumference‐related indices exhibit different associations with chronic diseases, 22 the existing studies only examined the associations between waist circumference‐related indices and incident multimorbidity 23–25 . We did not find any studies examining the effects of hip circumference‐related indices on incident multimorbidity.…”

“…Abdominal obesity was found to elevate plasma triglycerides and low-density lipoprotein concentrations, thereby increasing the risk of hyperlipidaemia, insulin resistance and cardiovascular disease. 24 Although no studies have examined the effects of hip circumference-related indices on multimorbidity onset, previous studies have reported inverse associations between hip circumference, height and the risk of diabetes, 34,30 cardiovascular diseases, 35 and mortality. 36 A larger hip circumference indicates greater muscle and fat mass in the gluteofemoral region.…”

“…These inverse associations suggest the heterogeneity of obesity, wherein abdominal fat has a detrimental effect while hip fat appears to be protective. Abdominal obesity was found to elevate plasma triglycerides and low‐density lipoprotein concentrations, thereby increasing the risk of hyperlipidaemia, insulin resistance and cardiovascular disease 24 . Although no studies have examined the effects of hip circumference‐related indices on multimorbidity onset, previous studies have reported inverse associations between hip circumference, height and the risk of diabetes, 34,30 cardiovascular diseases, 35 and mortality 36 .…”

“…Although waist circumference-related abdominal obesity indices and hip circumference-related indices exhibit different associations with chronic diseases, 22 the existing studies only examined the associations between waist circumference-related indices and incident multimorbidity. [23][24][25] We did not find any studies examining the effects of hip circumference-related indices on incident multimorbidity. Furthermore, only one cross-sectional study examined the association between body fat percentage and the prevalence of multimorbidity 26 ; however, the causal associations could not be implied because of the study design.…”

Association of changes in waist circumference, waist-to-height ratio and weight-adjusted-waist index with multimorbidity among older Chinese adults: results from the Chinese longitudinal healthy longevity survey (CLHLS)

“…The few studies that have examined changes in obesity and multimorbidity have also shown inconsistent results. A study from China indicated that increasing WC was associated with a high risk of multimorbidity, regardless of general obesity status at baseline [ 25 ] while another study from Italy suggested that those who lost weight had a significantly increased risk of multimorbidity than other participants. In other words, the relationship between changes in obesity and multimorbidity remains controversial.…”