Endocrinology and Metabolism

Original Articles

Association between the Chinese Visceral Adiposity Index and Multimorbidity in Middle-Aged and Older Chinese Adults: A Prospective Cohort Study: Weihao Shao, Zuolin Lu, Xiaoxia Wei, Yutong Long, Enying Gong, Yueqing Wang, Yunyuan Kong, Yue Zhang, Ruitai Shao; Received July 1, 2025 Accepted October 20, 2025 Published online January 22, 2026; DOI: https://doi.org/10.3803/EnM.2025.2525 [Epub ahead of print]

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Abstract PDF Supplementary Material PubReader ePub: Background
The association between visceral adiposity and multimorbidity in Chinese middle-aged and older adults remains underexplored. This study used data from the China Health and Retirement Longitudinal Study (CHARLS) to examine the relationship between visceral adiposity, measured by the Chinese visceral adiposity index (CVAI), and multimorbidity.
Methods
This prospective cohort study analyzed data from 6,410 participants who were multimorbidity-free in the 2015 CHARLS wave, with follow-up assessments in 2018 and 2020. CVAI was calculated using age, body mass index, waist circumference, triglycerides, and high-density lipoprotein cholesterol. Latent class analysis (LCA) identified multimorbidity patterns, defined as the presence of ≥2 chronic conditions based on self-reported physician diagnoses. Cox regression and restricted cubic spline (RCS) analyses assessed the impact of CVAI on multimorbidity risk.
Results
Over a median 5.0-year follow-up (interquartile range [IQR], 3.0 to 5.0), 2,809 participants (43.8%) developed multimorbidity. Each IQR increase in CVAI significantly elevated the risk of multimorbidity (hazard ratio [HR], 1.20; 95% confidence interval [CI], 1.16 to 1.24). Higher risks were observed in the second (HR, 1.16; 95% CI, 1.04 to 1.30), third (HR, 1.28; 95% CI, 1.14 to 1.43), and fourth (HR, 1.76; 95% CI, 1.58 to 1.96) quartiles compared with the first. The RCS analysis demonstrated a dose–response relationship (P_nonlinearity=0.109). LCA identified four multimorbidity clusters. CVAI increments were significantly associated with the cardio- metabolic cluster (HR, 1.51; 95% CI, 1.42 to 1.62) and the arthritis–renal cluster (HR, 1.29; 95% CI, 1.21 to 1.39).
Conclusion
Elevated CVAI is a strong risk factor for incident multimorbidity among middle-aged and older Chinese adults, emphasizing its importance in the development of distinct disease clusters.

Prevalence and Characteristics of Metabolically Obese but Normal Weight and Metabolically Healthy but Obese in Middle-aged Koreans: the Chungju Metabolic Disease Cohort (CMC) Study.: Seung Hwan Lee, Hee Sung Ha, Young Jun Park, Jin Hee Lee, Hyeon Woo Yim, Kun Ho Yoon, Moo Il Kang, Won Chul Lee, Ho Young Son, Yong Moon Park, Hyuk Sang Kwon; Endocrinol Metab. 2011;26(2):133-141. Published online June 1, 2011; DOI: https://doi.org/10.3803/EnM.2011.26.2.133

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2 Crossref

BACKGROUND
We attempted to determine the prevalence and characteristics of metabolically obese but normal weight (MONW) and metabolically healthy but obese (MHO) individuals in a large cohort of middle-aged Koreans. METHODS: 8,987 non-diabetic subjects were selected from the Chungju Metabolic disease Cohort Study performed in 2003-2006. MONW was defined as a body mass index (BMI) > or = 18.5 and < 23 kg/m2 with a homeostasis model assessment of insulin resistance (HOMA-IR) in the highest quartile. MHO was defined as BMI > or = 25 kg/m2 with HOMA-IR in the lowest quartile. RESULTS: The mean age of the subjects was 62.3 +/- 10.5 years (men 40.4%). The age-adjusted prevalence of MONW and MHO were 4.3% (5.3% men, 3.7% women) and 5.6% (3.6% men, 7.0% women), respectively. 14.2% of men and 12.9% of women were classified as MONW among the normal weight population, whereas 10.7% of men and 14.5% of women were classified as MHO among the obese subjects. The prevalence of prediabetes was significantly higher in the MONW group than in the MHO group (34.7 vs. 12.5%, P < 0.0001 in men; 23.1 vs. 8.8%, P < 0.0001 in women). The MONW group evidenced an equivalent risk of coronary heart disease (CHD) relative to the MHO group (10.77 +/- 0.68 vs. 10.22 +/- 0.90% in men; 7.02 +/- 0.34 vs. 7.26 +/- 0.26% in women, means +/- standard error [SE]). CONCLUSION: The subjects in the MONW group are characterized by a high risk of diabetes and CHD, despite their normal weights. Their substantial prevalence in the population emphasizes the importance of identifying subjects in the MONW group, and warrants more intensive risk management.

Citations

Citations to this article as recorded by

Obesity, metabolic health, and mortality in adults: a nationwide population-based study in Korea
Hae Kyung Yang, Kyungdo Han, Hyuk-Sang Kwon, Yong-Moon Park, Jae-Hyoung Cho, Kun-Ho Yoon, Moo-Il Kang, Bong-Yun Cha, Seung-Hwan Lee
Scientific Reports.2016;[Epub] CrossRef
The Definition of Metabolically Healthy Obesity
Hae Kyung Yang, Seung-Hwan Lee
The Journal of Korean Diabetes.2014; 15(1): 17. CrossRef

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