Weight adjusted waist index is a superior obesity index for predicting arterial stiffness in type 2 diabetes mellitus

Abstract

Obesity is a key risk factor for arterial stiffness (AS) and a strong predictor of cardiovascular diseases (CVD). In patients with type 2 diabetes mellitus (T2DM), the risk of AS is further exacerbated due to metabolic dysregulation and chronic inflammation, especially when both conditions coexist. Traditional obesity indices such as Body Mass Index (BMI) and Waist Circumference (WC) have limitations in assessing fat distribution and metabolic risk. New indices like Weight-adjusted Waist Index (WWI), A Body Shape Index (ABSI), and Body Roundness Index (BRI) have been proposed as supplementary or alternative measures. However, the association between WWI and AS in patients with T2DM has not been sufficiently studied. This study aims to evaluate the association between WWI and AS in T2DM patients and compare the diagnostic performance of WWI with traditional obesity indices (BMI, WC) and other new indices (ABSI, BRI) in predicting AS. 1406 patients with type 2 diabetes mellitus (T2DM) were included in this cross-sectional study. Obesity indices were calculated using anthropometric parameters. Brachial-ankle pulse wave velocity (BaPWV) was measured to determine AS. Multivariate logistic regression analysis was used to assess the correlation between the five obesity indices and AS. Smoothed curve fitting was used to test the linear correlations. The diagnostic accuracy of each obesity index was evaluated using receiver operating characteristic (ROC) analyses. Additional subgroup analyses and tests for interaction were conducted. The average BaPWV was 1611.98 (318.81) cm/s. Multivariate logistic analysis indicated a strong correlation between WWI and AS, with each standard deviation increase in WWI resulting in a 48.59 cm/s rise in BaPWV (95% CI 31.66-65.52) and a 44% higher risk of AS (OR = 1.44, 95% CI 1.21-1.70). ROC analysis indicated that WWI identified AS more accurately than the other obesity indices, with an area under the curve (AUC) of 0.659. The AUC for WC, BMI, ABSI, and BRI were 0.538, 0.519, 0.626, and 0.599, respectively. Further examination of subgroups showed that the correlation between WWI and AS remained consistent and positive. The results of this study show that there is a significant positive correlation between WWI and BaPWV in patients with T2DM. Additionally, compared to other obesity indices, WWI is associated with a higher risk of AS. It may be a potentially simple and effective tool for assessing AS in clinical practice.

Keywords: Arterial stiffness; Brachial-ankle pulse wave velocity; Obesity; Type 2 diabetes mellitus; Visceral fat; Weight-adjusted-waist index.

Fig. 1

Dose–response relationship between five obesity indices and growth of BaPWV. (a) BMI, (b) WC, (c) WWI, (d) BRI, (e) ABSI. Each plot was adjusted for age, sex, smoking, drinking, physical activity, SBP, DBP, antihypertensive, hypoglycemic, hypolipidemic medications use, duration of diabetics, HbA1c, FPG, 2hPG, TG, HDL-C, TC, LDL-C, ABI, ALT, AST, CR, eGFR.

Fig. 2

Receiver operating characteristic analysis of five obesity indices for predicting AS. AS, arterial stiffness; BMI, body mass index; WC, waist circumference; WWI, weight-adjusted waist index; ABSII, a body shape index; BRI, body round index; ROC, Receiver-operating-characteristic; AUC, Area under the curve.