Association Study Of Body Shape With Risk Of Cardiometabolic Disorders In A Middle-aged And Elderly Chinese Population

BackgroundPrevious studies have shown that fat distribution is strongly associated with cardiometabolic disorders.Anthropometric measurements,such as body mass index（BMI）and waist-hip ratio（WHR）,as surrogates of adiposity,are associated with human health status and chronic diseases in epidemiological studies.However,most of these studies have focused on one single anthropometric measurement at a time and may not adequately capture differences in body shape among individuals who are similar in one anthropometric measurement but different in another.For example,subjects with similar BMI or WHR may have different comorbidities,which indicating the role of body shape in diseases.Therefore,our study aimed to explore the association of body shape with risk of cardiometabolic disorders in Chinese community population.MethodsA cross-sectional analysis was conducted in 6570 middle-aged and elderly participants who were enrolled from Jiading district,Shanghai,China,from August 2014 to May 2015.All participants completed standard questionnaire,anthropometry and biochemistry measurement.Non-alcoholic fatty liver disease（NAFLD）was defined by hepatic ultrasonography.Carotid intima media thickness（CIMT）were measured by a high-resolution B-mode tomographic ultrasound system.A bilateral CIMT average greater than0.8 mm was defined as subclinical atherosclerosis.Metrics of fat distribution that were strongly associated with insulin resistance were adopted to define body shape.The metrics were waist circumference（WC）,waist-to-thigh circumference ratio（WTR）,and neck-to-thigh circumference ratio（NTR）.We then further evaluated the associations of body shape with insulin resistance and cardiometabolic disorders.Results1.Association of body shape with insulin resistance and cardiometabolic disorders:We described human body shape by combining different degrees of WC,WTR,with NTR in middle-aged and elderly Chinese population and found that subjects with low thigh circumference and high neck circumference can independent of WC additionally increased the risk of cardiometabolic disorders.Stratified by WC,we compared IR and cardiometabolic disorders risk within these subgroups,and found that women with low WC,low thigh circumference,and high neck circumference（WC/WTR/NTR:Low/High/High）and with high WC,low thigh circumference,and high circumference（WC/WTR/NTR:High/High/High）were positively associated with cardiometabolic disorders,but not in men.The risk of having IR,diabetes,and hypertension in the WC/WTR/NTR:Low/High/High subgroup compared with WC/WTR/NTR:Low/Low/Low subgroup were 1.87（1.34-2.62）,1.74（1.23-2.47）,and 1.73（1.33-2.24）,respectively（all P<0.05）;while in the WC/WTR/NTR:High/High/High subgroup compared with WC/WTR/NTR:High/Low/Low subgroup,the risk were 2.22（1.61-3.05）,1.71（1.48-2.54）,and 1.49（1.08-2.05）,respectively（all P<0.05）.2.Association between mid-upper arm circumference（MUAC）and insulin resistance and non-alcoholic fatty liver disease:with the increase of MUAC level,BMI,WC,blood pressure,triacylglycerol,fasting insulin,homeostasis model assessment of insulin resistance（HOMA-IR）levels,low-density lipoprotein-cholesterol,alanine aminotransferase,γ-glutamyl transpeptidase,and aspartic transaminase levels were increased significantly（all P<0.01）,as well as the prevalence of NAFLD,hypertension,dyslipidemia,and insulin resistance（all P<0.01）.A fully adjusted multivariate logistic regression analysis revealed that with the increase of MUAC level,the risk of having NAFLD and insulin resistance were increased among women.However,there was no association between MUAC and NAFLD and insulin resistance in men.3.Associations of MUAC with risks of subclinical atherosclerosis and cardiometabolic disorders:We found that MUAC was significantly associated cardiometabolic disorders including obesity,hypertension,after fully adjusted for multiple confounding in women.As compared to quartile one of MUAC,quartile 2 to 4 of MUAC was significantly associated with an increased risk of subclinical atherosclerosis(OR=1.31,95%CI[1.09-1.58],1.33[1.10-1.62],and 1.45[1.16-1.80],respectively;P_{for trend}=0.005).Moreover,this association was more prominent in women with diabetes,and insulin resistance,but not in men.ConclusionsIn our study,we explored the associations of body shape with cardiometabolic disorders in middle-aged and elderly Chinese population.We described human body shape by combining different degrees of WC,WTR,with NTR.Women with low WC,low thigh circumference,and high neck circumference（WC/WTR/NTR:Low/High/High）and with high WC,low thigh circumference,and high circumference（WC/WTR/NTR:High/High/High）were positively associated with cardiometabolic disorders.Women with large MUAC was positively associated with insulin resistance,NAFLD,subclinical atherosclerosis,and cardiometabolic disorders in women.Moreover,women with diabetes and insulin resistance had higher risk of subclinical atherosclerosis than subject without these diseases.Our study provides new way for early detection and diagnosis of cardiometabolic disease,but need to validated in other population and prospective studies.