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. 2025 Jul 31;20(7):e0328796.
doi: 10.1371/journal.pone.0328796. eCollection 2025.

Independent association of weight-adjusted waist index with asthma in U.S. adolescents: Mediating roles of eosinophil percentage, total cholesterol, and HDL cholesterol

Lei He  1 , Yingxia Deng  1 , Xiaohua Liu  1 , Yao Wang  1 , Jing Tang  1
Affiliations

Independent association of weight-adjusted waist index with asthma in U.S. adolescents: Mediating roles of eosinophil percentage, total cholesterol, and HDL cholesterol

Lei He et al. PLoS One. .

Abstract

Background: Obesity is a risk factor for asthma in adolescents. "Although body mass index (BMI) is the most widely used metric for assessing obesity, it has several limitations. The weight-adjusted waist index (WWI) is a novel central obesity indicator and accurately reflects body composition. We aimed to explore the association of WWI with asthma in adolescents using NHANES 1999-2020 data.

Methods: WWI was calculated based on waist circumference (cm) divided by the square root of weight (kg). Current asthma status in adolescents was determined based on participants' self-reports. Multivariate logistic regression analysis, restricted cubic spline (RCS) analysis, mediation analysis, and stratified analysis were used to comprehensively explore this association.

Results: A total of 15,796 adolescents were included. In the fully adjusted model, WWI was positively associated with current asthma in adolescents (odds ratio 1.252, 95% confidence interval 1.125-1.392, p = 0.0001). Participants in the highest WWI quartile (Q4) showed a 54.5% higher prevalence of asthma compared to Q1 (p for trend = 0.0007).. RCS modeling indicated that the association was linear. Mediation analyses indicated that blood eosinophil percentage (EOS%), total cholesterol (TC), and high-density lipoprotein cholesterol (HDL-C) partially mediated this association by 9.89% (p < 0.0001), 7.47% (p = 0.048), and 8.24% (p = 0.044), respectively. This association was independent of BMI, and BMI also did not significantly interact with this association (p for interaction = 0.682).

Conclusions: WWI was linearly and positively associated with the prevalence of current asthma among U.S. adolescents, independently of BMI. EOS%, TC, and HDL-C partially mediated this association.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart of study population selection from NHANES 1999–2020.
Fig 2
Fig 2. RCS analysis of the association between WWI and odds of asthma in adolescents.
Fig 3
Fig 3. Schematic representation of the effect of WWI on adolescent asthma through mediating variables (EOS%, TC, and HDL-C).
Fig 4
Fig 4. Stratified analysis of the association between WWI and asthma according to selected covariates (Age, sex, race, PIR, family history of asthma, anti-asthma medication use, household smokers).
Fig 5
Fig 5. Stratified analysis of the association between WWI and asthma according to BMI in adolescents.
See this image and copyright information in PMC

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