The association between weight-adjusted waist circumference index and cardiovascular disease and mortality in patients with diabetes

Abstract

Cardiovascular disease (CVD) is a significant health concern, particularly among patients with diabetes. The weight-adjusted waist circumference index (WWI), a novel metric that accounts for central obesity, has shown potential in predicting obesity-related health risks. This study aimed to evaluate the association of WWI with CVD and mortality in patients with diabetes. Utilizing data from the National Health and Nutrition Examination Survey from 1999 to 2020, WWI was calculated by dividing waist circumference (WC) by the square root of body weight. Multivariate logistic regression, multivariate Cox regression and restricted cubic spline curves were used to assess the association between WWI and the prevalence of CVD and mortality in patients with diabetes, subgroup and sensitivity analyses were carried out to delve into the stability of the findings. The predictive performance of WWI was evaluated using the area under the receiver operating characteristic curve (ROC). This study included 8,005 individuals with diabetes. With the increase in WWI values, the risk of developing CVD and the likelihood of mortality progressively rise. The fully adjusted continuous model indicated a 28% higher chance of developing CVD and a 25% higher risk of all-cause mortality for each one-unit increase in WWI. When using the lowest quartile of WWI as the reference category, the highest quartile was linked to an increased risk of CVD (OR 1.66; 95% CI 1.10-2.50, p = 0.015) and all-cause mortality (HR 1.53, 95% CI 1.27-1.83, p < 0.001) among patients with diabetes. Subgroup and sensitivity analyses confirmed that these associations were consistent and stable in most different demographics. The ROC analysis indicated that WWI had a higher predictive capacity for CVD and all-cause mortality than WC, waist to hip ratio, and weight to height ratio. The WWI was significantly associated with the prevalence of CVD and all-cause mortality among patients with diabetes in the United States and may serve as a useful tool for identifying individuals at risk.

Keywords: Cardiovascular disease; Diabetes; Mortality; NHANES; Obesity; Weight-adjusted waist circumference index.

Figure 1

Flowchart of participants’ selection. WWI, weight-adjusted waist circumference index; CVD, cardiovascular disease.

Figure 2

The restricted cubic spline regression analyses for the association between weight-adjusted waist circumference index (WWI) and the risk of cardiovascular disease (CVD) and all-cause mortality. All covariates from model 2 were adjusted. (A) Non-linearity of WWI and CVD; (B) Non-linearity of WWI and all-cause mortality.

Figure 3

The weighted receiver operating characteristic curves (ROC) of weight-adjusted waist circumference index (WWI) for the risk of cardiovascular disease (CVD) and all-cause mortality. (A) ROC of WWI for CVD; (B) ROC of WWI for all-cause mortality.