Background The effect of baseline hypertension status on the BMI–mortality association is still unclear. We aimed to explore the relationships of body mass index (BMI) and waist circumference (WC) with all-cause mortality among older hypertensive and normotensive Chinese individuals. Methods This retrospective cohort study was conducted in Xinzheng, Henan Province, Central China. The data came from the residents’ electronic health records of the Xinzheng Hospital Information System. A total of 77,295 participants (41,357 hypertensive participants and 35,938 normotensive participants) aged ≥ 60 years were included from January 2011 to November 2019. Cox proportional hazard regression model was used to examine the relationships. Results During a mean follow-up of 5.3 years, 10,755 deaths were identified (6,377 in hypertensive participants and 4,378 in normotensive participants). In adjusted models, compared with a BMI of 18.5–24 kg/m2, the hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) of BMI < 18.5, 24–28 and ≥ 28 kg/m2 for mortality in hypertensive participants were 1.074 (0.927–1.244), 0.881 (0.834–0.931) and 0.856 (0.790–0.929), respectively, and 1.444 (1.267–1.646), 0.884 (0.822–0.949) and 0.912 (0.792–1.051), respectively, in normotensive participants. Compared with normal waist circumference, the adjusted HRs and 95% CIs of central obesity for mortality were 0.880 (0.832–0.931) in hypertensive participants and 0.918 (0.846–0.996) in normotensive participants. A sensitivity analysis showed similar associations for both hypertensive and normotensive participants. Conclusion Low BMI and WC were associated with a higher risk of all-cause mortality regardless of hypertension status in older Chinese individuals. The lowest risk of death associated with BMI was in the overweight group in normotensive participants and in the obesity group in hypertensive participants.

Background. It remains controversial whether body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), or triglyceride glucose (TyG) index has a stronger association with diabetes. The aims of the study were to compare the magnitude of associations of four indicators with diabetes risk. Methods. Data collected from annual health examination dataset in the Xinzheng during 2011 and 2019. A total of 41,242 participants aged ≥ 45 years were included in this study. Cox proportional hazard regression models were used to examine associations between the four indicators and diabetes risk. Results. After 205,770 person-years of follow up, diabetes developed in 2,472 subjects. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of diabetes (highest vs reference group) were 1.92 (1.71–2.16) for BMI, 1.99 (1.78–2.23) for WC, 1.65 (1.47–1.86) for WHtR, and 1.66 (1.47–1.87) for TyG, respectively. In addition, the risk of diabetes increased with baseline BMI (HR: 1.30; 95% CI: 1.25, 1.35) and TyG (HR: 1.25; 95% CI: 1.20, 1.30), but the lowest HR was 0.78 (95% CI 0.65–0.92) when WC was approximately 72 cm, and 0.85 (95% CI 0.72–0.99) when WHtR was approximately 0.47 in women. In joint analyses, the highest risk was observed in participants with a high BMI combined with a high WC (HR: 2.26; 95% CI: 1.98, 2.58). Conclusions. In middle-aged and elderly Chinese population, BMI and WC were more strongly associated with diabetes than WHtR or TyG, especially the combined effect of BMI and WC.

Background Previous studies have explored the relationship between body mass index (BMI) and multimorbidity. However, the relationship between other obesity indicators and their dynamic changes and multimorbidity has not been systematically estimated. Therefore, we aimed to investigate the association of BMI and other obesity indicators, including waist circumference (WC), waist-to-height ratio (WHtR), waist divided by height0.5 (WHT.5R), and body roundness index (BRI) and their changes and the risk of multimorbidity in middle-aged and older adults through a retrospective cohort study. Methods Data collected from annual health examination dataset in the Jinshui during 2017 and 2021. Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) to evaluate the effect of baseline and dynamic changes in the anthropometric indices on the risk of multimorbidity. Results A total of 75,028 individuals were included in the study, and 5,886 participants developed multimorbidity during the follow-up. Multivariate Cox regression analysis revealed a progressive increase in the risk of multimorbidity with increasing anthropometric indicators (BMI, WC, WHtR, WHT.5R, and BRI) (all P<0.001). Regardless of general obesity status at baseline, increased WC was associated with a high risk of multimorbidity. Compared to the subjects with baseline BMI<24 kg/m2 and WC<90 (men)/80 (women), the HRs (95% CI) of the baseline BMI<24 kg/m2 and WC≥90 (men)/80 (women) group and BMI≥24 kg/m2 and WC≥90 (men)/80 (women) group were 1.31 (1.08, 1.61) and 1.82 (1.68, 1.97), respectively. In addition, the dynamics of WC could reflect the risk of multimorbidity. When subjects with baseline WC<90 (men)/80 (women) progressed to WC≥90 (men)/80 (women) during follow-up, the risk of multimorbidity significantly increased (HR = 1.78; 95% CI, 1.64, 1.95), while the risk of multimorbidity tended to decrease when people with abnormal WC at baseline reversed to normal at follow-up (HR = 1.40; 95% CI, 1.26, 1.54) compared to those who still exhibited abnormal WC at follow-up (HR = 2.00; 95% CI, 1.82, 2.18). Conclusions Central obesity is an independent and alterable risk factor for the occurrence of multimorbidity in middle-aged and elderly populations. In addition to the clinical measurement of BMI, the measurement of the central obesity index WC may provide additional benefits for the identification of multimorbidity in the Chinese middle-aged and elderly populations.

Aim To explore the associations of body mass index (BMI) and mortality among people with normal fasting glucose (NFG), impaired fasting glucose (IFG), and type 2 diabetes mellitus (T2DM) in an elderly Chinese population.  Methods A retrospective cohort study was conducted that included 59,874 elderly people who were aged 60 and older at baseline. Data for the study came from a health check-up program in China between 2011 and 2019. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using multivariable Cox proportional hazard models of BMI categories by glycemic status. Results During the median of 5.96 years of follow-up, 7928 participants died (6457/49057 with NFG, 712/5898 with IFG and 759/4919 with T2DM). In adjusted Cox models, risk of mortality showed a decreasing trend with BMI < 18.5 kg/m2, 24 ≤ BMI < 28 kg/m2, and BMI ≥ 28 kg/m2 compared to 18.5 ≤ BMI < 24 kg/m2: HR (95% CI): 1.33 (1.18 to 1.49), 0.88 (0.83 to 0.93), and 0.90 (0.82 to 0.98), respectively, for NFG; 0.89 (0.55 to 1.46), 0.84 (0.71 to 0.99), and 0.88 (0.70 to 1.11), respectively, for IFG; and 1.42 (0.88 to 2.29), 0.75 (0.64 to 0.89), and 0.76 (0.62 to 0.93), respectively, for T2DM. There were curvilinear-shaped associations between BMI and mortality in the NFG and T2DM groups (P overall < 0.001 and P overall < 0.001, respectively; P nonlinearity < 0.001 and P nonlinearity = 0.027, respectively) and no significantly association between BMI and all-cause mortality was observed in the IFG group (P overall = 0.170). Conclusion High BMI compared to normal BMI was associated with decreased mortality, especially in the old populations with NFG and T2DM. Future studies are needed to explain the obesity paradox in elderly patients with T2DM.

ObjectivesThe body roundness index (BRI) is a novel anthropometric index that is a better indicator for predicting fat distribution than the body mass index (BMI). The longitudinal study can repeatedly collect measured results for the variables to be studied and then consider the potential effects of intraindividual changes in measurement. However, few population-based, longitudinal studies of BRI have been conducted, especially among the Chinese population. The study aimed to investigate the association of BRI and its longitudinal trajectories with all-cause and cardiovascular mortality.MethodsA total of 71,166 participants with four times BRI measurements between January 2010 and December 2019 were included in this longitudinal study, with a median follow-up was 7.93 years, and 11,538 deaths were recorded, of which 5,892 deaths were due to cardiovascular disease (CVD). A latent class growth mixture modeling (LCGMM) was used to identify BRI trajectories. Cox proportional hazard models were used to estimate associations between BRI trajectories and the risk of all-cause and cardiovascular mortality.ResultsIn the restricted cubic spline regression models, a U-shaped relationship between BRI and all-cause and cardiovascular mortality was observed. Three BRI longitudinal trajectories of low-stable (mean BRI = 2.59), moderate-stable (mean BRI = 3.30), and high-stable (mean BRI = 3.65) were identified by LCGMM. After being adjusted for potential confounders, the HRs for all-cause mortality were 1.18 (1.13–1.24) for the moderate-stable group and 1.74 (1.66–1.82) for the high-stable group compared to the low-stable group. The HRs for cardiovascular mortality were 1.12 (1.05–1.18) for the moderate-stable group and 1.64 (1.53–1.75) for the high-stable group compared to the low-stable group.ConclusionA nonlinear association of BRI with all-cause and cardiovascular mortality was observed, and participants in the higher BRI longitudinal trajectory group were significantly associated with an increased risk of all-cause and cardiovascular mortality.