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. 2025 May 17;24(1):181.
doi: 10.1186/s12944-025-02599-2.

Inverted L-shape association between a body shape index and peak expiratory flow among middle-aged and older adults: findings from the China Health and Retirement Longitudinal Study (CHARLS)

Guosong Jiang  1 , Licheng Feng  2 , Xiaoxiao Qu  3 , Jia Wang  4 , Yun Li  5
Affiliations

Inverted L-shape association between a body shape index and peak expiratory flow among middle-aged and older adults: findings from the China Health and Retirement Longitudinal Study (CHARLS)

Guosong Jiang et al. Lipids Health Dis. .

Abstract

Background: Peak expiratory flow (PEF) serves as a direct indicator of the functional status of the respiratory system. Higher body fat content, especially abdominal obesity, may relate to a deterioration in long-term respiratory function. The "A Body Shape Index" (ABSI) better assesses abdominal obesity, but its association with PEF is poorly understood.

Methods: The analysis demonstrated data from 14,386 middle-aged and older adults from the 2015 China Health and Retirement Longitudinal Study (CHARLS). ABSI, a sex-specific metric integrating waist circumference, weight, and height via allometric modeling derived from Chinese anthropometrics, was analyzed against PEF/PEF prediction using multivariable linear and spline regressions to characterize nonlinear associations. Threshold effects, subgroup, and sensitivity analyses ensured robustness.

Results: This research showed a negative relationship between ABSI and both PEF and PEF predictions. An inverted L-shaped curve in the spline analysis characterized the association between ABSI and PEF/PEF prediction across the sexes. The ABSI threshold was 0.0782 and 0.0691 in males and females, respectively.

Conclusions: Abdominal obesity negatively affects respiratory function, with ABSI thresholds varying by sex. Therefore, weight management should focus on a healthy ABSI to reduce abdominal obesity and safeguard respiratory health.

Keywords: A body shape index; Abdominal obesity; Peak expiratory flow; Respiratory function tests.

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Conflict of interest statement

Declarations. Ethical approval and consent to participate: Ethical approval was obtained from the Institutional Review Boards of Peking University (No. IRB00001052-11015) for the CHARLS, and all participants gave informed consent. Consent for publication: All authors have reviewed the final version of the manuscript and approve its submission for publication. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Participant inclusion flowchart (China health and retirement longitudinal study [CHARLS])
Fig. 2
Fig. 2
association between ABSI and PEF/PEF prediction. Curves indicate the association between ABSI and PEF/PEF predictions, adjusted for confounders. P < 0.001 for non-linearity in both sexes. Histograms show ABSI distribution. The width of each bar represents the bin range (group interval), and the height indicates the frequency of data within that bin range. TC: total cholesterol; TG: triglycerides; LDL: low-density lipoprotein. Adjusted for age, race, residence, educational status, marital status, sleep duration, smoking status, drinking status, hypertension, diabetes, heart diseases, stroke, dyslipidemias, kidney diseases, creatinine, glucose. TC, TG, LDL, Cystatin C. Only 0.91% ~ 99.86% of the data is displayed. ** Continuous variable: ABSI was scaled by a factor of 100
Fig. 3
Fig. 3
Subgroup analysis of the association between ABSI and PEF/PEF prediction in the entire population. TC: total cholesterol; TG: triglycerides; LDL: low-density lipoprotein; CI: confidence interval. Adjusted for race, residence, educational status, marital status, sleep duration, hypertension, diabetes, heart diseases, stroke, dyslipidemias, kidney diseases, creatinine, glucose, TC, TG, LDL, Cystatin C. ABSI was scaled by a factor of 100
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