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. 2024 Jun 12;23(1):62.
doi: 10.1186/s12937-024-00947-z.

Association of weight-adjusted waist index with all-cause mortality among non-Asian individuals: a national population-based cohort study

Ting Cao  1 , Ruijie Xie  2 , Jiusong Wang  2 , Meimei Xiao  2 , Haiyang Wu  3 , Xiaozhu Liu  4 , Songlin Xie  2 , Yanming Chen  2 , Mingjiang Liu  5   6 , Ya Zhang  7   8
Affiliations

Association of weight-adjusted waist index with all-cause mortality among non-Asian individuals: a national population-based cohort study

Ting Cao et al. Nutr J. .

Abstract

Introduction: The Weight-Adjusted Waist Index (WWI) is a new indicator of obesity that is associated with all-cause mortality in Asian populations. Our study aimed to investigate the linear and non-linear associations between WWI and all-cause mortality in non-Asian populations in the United States, and whether WWI was superior to traditional obesity indicators as a predictor of all-cause mortality.

Methods: We conducted a cohort study using data from the 2011-2018 National Health and Nutrition Examination Survey (NHANES), involving 18,592 participants. We utilized Cox proportional hazard models to assess the association between WWI, BMI, WC, and the risk of all-cause mortality, and performed subgroup analyses and interaction tests. We also employed a receiver operating characteristics (ROC) curve study to evaluate the effectiveness of WWI, BMI, and WC in predicting all-cause mortality.

Results: After adjusting for confounders, WWI, BMI, and WC were positively associated with all-cause mortality. The performance of WWI, BMI, and WC in predicting all-cause mortality yielded AUCs of 0.697, 0.524, and 0.562, respectively. The data also revealed a U-shaped relationship between WWI and all-cause mortality. Race and cancer modified the relationship between WWI and all-cause mortality, with the relationship being negatively correlated in African Americans and cancer patients.

Conclusions: In non-Asian populations in the United States, there is a U-shaped relationship between WWI and all-cause mortality, and WWI outperforms BMI and WC as a predictor of all-cause mortality. These findings may contribute to a better understanding and prediction of the relationship between obesity and mortality, and provide support for effective obesity management strategies.

Keywords: All-cause mortality; NHANES; Obesity; Weight-adjusted-waist.

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Conflict of interest statement

All authors declare that they have no competing financial interests.

Figures

Fig. 1
Fig. 1
Flow chart of participants selection. NHANES, National Health and Nutrition Examination Survey
Fig. 2
Fig. 2
The nonlinear associations between weight-adjusted waist index, body mass index, waist circumference and all-cause mortality. The solid red line represents the smooth curve fit between variables. Blue bands represent the 95% of confidence interval from the fit. (A) weight-adjusted waist index and all cause mortality; (B) body mass index and all cause mortality; (C) waist circumference and all cause mortality
Fig. 3
Fig. 3
Subgroup non-linear relationship between weight-adjusted waist index and all-cause mortality. (A) Stratified by gender; (B) Stratified by race; (C) Stratified by age; (D) Stratified by diabetes; (E) Stratified by stroke; (F) Stratified by coronary heart disease; (G) Stratified by cancer; (H) Stratified by renal failure; (I) Stratified by myocardial infarction; (J) Stratified by hypertension; (K) Stratified by liver diseases; (L) Stratified by body mass index
Fig. 4
Fig. 4
Receiver-operating characteristics (ROC) curves of weight-adjusted waist index, body mass index, and waist circumference for predicting all-cause mortality
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