Association between abdominal obesity indices and falls among older community-dwellers in Guangzhou, China: a prospective cohort study

Abstract

Background: Central obesity was considered as a risk factor for falls among the older population. Waist circumference (WC), lipid accumulation product (LAP), visceral adiposity index (VAI), and the Chinese visceral adiposity index (CVAI) are considered as surrogate markers for abdominal fat deposition in increasing studies. Nevertheless, the longitudinal relationship between these indices and falls among the older population remains indistinct. This study aimed to explore the association between abdominal obesity indices and falls among older community-dwellers.

Methods: Our study included 3501 individuals aged ≥ 65 years from the Guangzhou Falls and Health Status Tracking Cohort at baseline in 2021 and then prospectively followed up in 2022. The outcome of interest was the occurrence of falls. The Kaplan-Meier curves and multivariable Cox regression analysis were used to explore the associations between abdominal obesity indices and falls. Moreover, the restricted cubic spline analysis (RCS) was conducted to test the non-linear relationships between abdominal obesity indices and hazards of falls incident.

Results: After a median follow-up period of 551 days, a total of 1022 participants experienced falls. The cumulative incidence rate of falls was observed to be higher among individuals with central obesity and those falling within the fourth quartile (Q4) of LAP, VAI, and CVAI. Participants with central obesity and those in Q4 of LAP, VAI, and CVAI were associated with higher risk of falls, with hazard ratios (HRs) of 1.422 (HR 95%CI: 1.255-1.611), 1.346 (1.176-1.541), 1.270 (1.108-1.457), 1.322 (1.154-1.514), respectively. Each 1-SD increment in WC, LAP, VAI, and CVAI was a significant increased risk of falls among participants. Subgroup analysis further revealed these results were basically stable and appeared to be significantly stronger among those females, aged 65-69 years, and with body mass index (BMI) ≥ 28 kg/m². Additionally, RCS curves showed an overall upward trend in the risk of falls as the abdominal indices increased.

Conclusions: Abdominal obesity indices, as WC, LAP, VAI, and CVAI were significantly associated with falls among older community-dwellers. Reduction of abdominal obesity indices might be suggested as the strategy of falls prevention.

Keywords: Abdominal obesity indices; Cohort study; Falls; Older population.

Fig. 1

Flowchart of study population

Fig. 2

Cumulative incidence of falls according to quartiles of abdominal obesity indices of participants. Note: a: WC: waist circumference, Center obesity: Yes: Male WC ≥ 90 cm, or female WC ≥ 85 cm; b: LAP: lipid accumulation product, Q1-Q3 (≤ 54.72), Q4 (>54.72); c: VAI: visceral adiposity index, Q1-Q3(≤ 2.70), Q4 (>2.70); d: CVAI: Chinese visceral adiposity index, Q1-Q3 (≤ 151.44), Q4 (>151.44)

Fig. 3

Associations between abdominal obesity indices and falls of participants in different subgroups. Note: HR: hazard ratio, 95%CI: 95% confidence interval, WC: waist circumference. LAP: lipid accumulation product, VAI: visceral adiposity index, CVAI: Chinese visceral adiposity index. Each subgroup was adjusted for gender, age, ethnic groups, marital status, education, cigarette smoking, alcohol drinking, physical exercise, hypertension, diabetes, coronary heart disease, and chronic obstructive pulmonary disease. Hazard ratios show the risk of falls among participants with central obesity or those in Q4 of LAP, VAI and CVAI, compared with those without central obesity and those in Q1-Q3

Fig. 4

Restricted cubic splines analysis of the relationship between abdominal obesity indices and the risk of falls among of participants Note: HR: hazard ratio, 95%CI: 95% confidence interval. a: WC: waist circumference, b: LAP: lipid accumulation product, c: VAI: visceral adiposity index, d: CVAI: Chinese visceral adiposity index. HR is adjusted as model 3: Adjusted for gender, age, ethnic groups, marital status, education, cigarette smoking, alcohol drinking, physical exercise, hypertension, diabetes, coronary heart disease, and chronic obstructive pulmonary disease