Table 3_Ranges, temporal trend, and determinants of novel obesity indices in middle-aged and older Chinese population: insights from a nationally representative and longitudinal study.xlsx

BackgroundTraditional obesity assessment using body mass index (BMI) fails to adequately capture fat distribution, particularly central obesity, which is closely linked to metabolic dysfunction and obesity-related complications. Alternative obesity indices that better reflecting fat distribution and body composition have shown promise, yet large-scale population-based data remain limited. This study evaluates the ranges, temporal trends, and associated factors of novel obesity indexes in a nationally representative cohort of middle-aged and older Chinese adults.
MethodsUsing data from the China Health and Retirement Longitudinal Study (CHARLS), we analyzed 17,708 adults in 2011 and followed 5,078 participants over 5 years nationally. Six obesity indexes: waist-to-height ratio (WHtR), lipid accumulation product (LAP), visceral adiposity index (VAI), body shape index (ABSI), Chinese visceral adiposity index (CVAI), and weight-adjusted waist index (WWI), were evaluated for ranges, temporal trends, and associated factors using logistic regression and generalized estimating equations (GEE). Associated factors included demographic, socioeconomic, lifestyle, and medical variables.
ResultsThe national ranges were as follows: VAI (−1.805 to 6.615), ABSI (0.071 to 0.095), WHtR (0.462 to 0.622), CVAI (48.993 to 147.057), WWI (10.264 to 12.144), and LAP (−3.158 to 80.818). Significant associated factors were grouped into demographic (age, sex, urban/rural residence), medical (diabetes, and hypertension), and lifestyle factors (smoking, and drinking), with varying impacts across indexes. Over the five-year period, WHtR, CVAI, and LAP increased significantly (β = 0.00489, β = 4.51607, β = 6.37441; all p < 0.001), while ABSI decreased (β = −0.00048, p < 0.001). Interaction effects showed that diabetic participants experienced reductions in VAI, WHtR, CVAI, and LAP, indication a time-dependent change. In contrast, chronic kidney disease (CKD) and hypertension had stable effects on obesity indices, with no significant changes over time.
ConclusionThis study provides nationally representative baseline ranges, temporal changes and influencing factors of novel obesity indexes among middle-aged and older Chinese adults. These findings underscore the potential of these obesity indices to guide clinical interventions aimed at controlling and preventing obesity-related health issues.

背景 传统的体质量指数（body mass index, BMI）肥胖评估方法无法充分反映脂肪分布特征，尤其是与代谢功能紊乱及肥胖相关并发症密切相关的中心性肥胖。虽已有能够更精准反映脂肪分布与身体构成的新型肥胖指数展现出应用前景，但基于人群的大规模相关数据仍较为匮乏。本研究针对具有全国代表性的中国中老年人群队列，系统评估新型肥胖指数的参考范围、时间变化趋势及其关联影响因素。
方法 本研究利用中国健康与养老追踪调查（China Health and Retirement Longitudinal Study, CHARLS）的数据，对2011年纳入的17708名成年人进行基线分析，并对5078名参与者开展了为期5年的全国性随访。本研究共纳入6种新型肥胖指数：腰高比（waist-to-height ratio, WHtR）、脂质蓄积指数（lipid accumulation product, LAP）、内脏脂肪指数（visceral adiposity index, VAI）、身体形态指数（body shape index, ABSI）、中国内脏脂肪指数（Chinese visceral adiposity index, CVAI）及体重调整腰围指数（weight-adjusted waist index, WWI），采用logistic回归与广义估计方程（generalized estimating equations, GEE），对上述指数的参考范围、时间变化趋势及关联影响因素进行分析。关联影响因素涵盖人口学、社会经济、生活方式及临床医疗相关变量。
结果 本次研究得出的全国参考范围如下：内脏脂肪指数（-1.805~6.615）、身体形态指数（0.071~0.095）、腰高比（0.462~0.622）、中国内脏脂肪指数（48.993~147.057）、体重调整腰围指数（10.264~12.144）及脂质蓄积指数（-3.158~80.818）。显著的关联影响因素可分为三类：人口学因素（年龄、性别、城乡居住地）、临床医疗因素（糖尿病、高血压）及生活方式因素（吸烟、饮酒），且不同肥胖指数的影响因素存在差异。在5年随访期间，腰高比、中国内脏脂肪指数及脂质蓄积指数均显著升高（β=0.00489、β=4.51607、β=6.37441；所有p<0.001），而身体形态指数则显著降低（β=-0.00048，p<0.001）。交互效应分析显示，糖尿病参与者的内脏脂肪指数、腰高比、中国内脏脂肪指数及脂质蓄积指数均出现下降，提示存在时间依赖性变化。与之相反，慢性肾脏病（chronic kidney disease, CKD）与高血压对肥胖指数的影响较为稳定，未随时间出现显著变化。
结论 本研究明确了具有全国代表性的中国中老年人群新型肥胖指数的基线参考范围、时间变化趋势及影响因素。本研究结果凸显了此类新型肥胖指数在指导临床干预以防控肥胖相关健康问题方面的应用潜力。