Body shape index and mortality in hemodialysis patients

Predicting the 10-year incidence of dyslipidemia based on novel anthropometric indices, using data mining

BACKGROUND

The aim was to establish a 10-year dyslipidemia incidence model, investigating novel anthropometric indices using exploratory regression and data mining.

METHODS

This data mining study was conducted on people who were diagnosed with dyslipidemia in phase 2 (n = 1097) of the Mashhad Stroke and Heart Atherosclerotic Disorder (MASHAD) study, who were compared with healthy people in this phase (n = 679). The association of dyslipidemia with several novel anthropometric indices including Conicity Index (C-Index), Body Roundness Index (BRI), Visceral Adiposity Index (VAI), Lipid Accumulation Product (LAP), Abdominal Volume Index (AVI), Weight-Adjusted-Waist Index (WWI), A Body Shape Index (ABSI), Body Mass Index (BMI), Body Adiposity Index (BAI) and Body Surface Area (BSA) was evaluated. Logistic Regression (LR) and Decision Tree (DT) analysis were utilized to evaluate the association. The accuracy, sensitivity, and specificity of DT were assessed through the performance of a Receiver Operating Characteristic (ROC) curve using R software.

RESULTS

A total of 1776 subjects without dyslipidemia during phase 1 were followed up in phase 2 and enrolled into the current study. The AUC of models A and B were 0.69 and 0.63 among subjects with dyslipidemia, respectively. VAI has been identified as a significant predictor of dyslipidemias (OR: 2.81, (95% CI: 2.07, 3.81)) in all models. Moreover, the DT showed that VAI followed by BMI and LAP were the most critical variables in predicting dyslipidemia incidence.

CONCLUSIONS

Based on the results, model A had an acceptable performance for predicting 10 years of dyslipidemia incidence. Furthermore, the VAI, BMI, and LAP were the principal anthropometric factors for predicting dyslipidemia incidence by LR and DT models.

Sex Differences in the Association of Weight-Adjusted-Waist Index with Sarcopenic Obesity: A Cross-Sectional Study of Hemodialysis Patients

Objective: To explore the association between weight-adjusted-waist index (WWI) and sarcopenic obesity (SO) in patients with maintenance hemodialysis (MHD). Methods: A multicenter, cross-sectional study that included 3311 adult MHD patients was conducted in 20 hemodialysis (HD) centers from June 1, 2021, to August 30, 2021. Body composition was evaluated by body composition monitor based on bioimpedance spectroscopy. Hand grip strength was measured by CAMRY® dynamometer. WWI was calculated as waist circumference (cm) divided by the square root of body weight (kg). Multiple logistic regression models, spearman correlation analysis, and receiver-operating characteristic (ROC) analyses were conducted. Results: The median age of the study was 55 years, and 39.4% of patients were female. The prevalence of SO was 22.7% in the total population, and patients with SO had higher WWI. Higher WWI quartiles were independently associated with a higher risk of SO in men after adjusting for potential confounders, including age, dialysis vintage, body mass index, biochemical indicators, and various medical histories; the odds ratio (OR) of SO was highest in the fourth quartile of the WWI (OR: 4.08, 95% confidence interval: 2.65-6.27, P for trend <0.001). Age-adjusted WWI provided a better diagnostic power than WWI only for SO in men (area under the ROC curve: 0.72 vs. 0.68, P < 0.001). WWI was not associated with SO in female HD patients. Conclusion: WWI is independently associated with SO in male but not female MHD patients. This anthropometric index is simple to calculate, making it applicable in clinical practice.

Association of body indices and risk of mortality in patients with type 2 diabetes

INTRODUCTION

A body shape index (ABSI) is independently associated with mortality in general population, but studies on the predictability of ABSI in the risk of mortality in patients with type 2 diabetes (T2D) are limited. We aimed to examine the independent and joint association of ABSI, body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and body roundness index (BRI) with mortality in patients with T2D.

RESEARCH DESIGN AND METHODS

The study included 11 872 patients (46.5% women) aged 30 years and older and who took part in diabetes care management program of a medical center in Taiwan. Body indices were evaluated by anthropometric measurements at baseline between 2001 and 2016, and their death status was followed up through 2021. Multivariate Cox regression models were used to assess the effect of body indices on mortality.

RESULTS

During a mean follow-up of 10.2 years, 560 cardiovascular disease (CVD) deaths and 3043 deaths were recorded. For ABSI, WC, WHR, WHtR and BRI, all-cause mortality rates were statistically significantly greater in Q4 versus Q2. For BMI and WHtR, all-cause mortality rates were also statistically significantly greater in Q1 versus Q2. The combination of BMI and ABSI exhibited a superiority in identifying risks of all-cause mortality and CVD mortality (HRs: 1.45 and 1.37, both p<0.01).

CONCLUSIONS

Combined use of ABSI and BMI can contribute to the significant explanation of the variation in death risk in comparison with the independent use of BMI or other indices.

Sex- and age-specific differences in associations of a body shape index with all-cause and cardiovascular death risks among US adults with diabetes

BACKGROUND AND AIMS

Evidence regarding the effect of body shape index (ABSI) on mortality is scarce among individuals with diabetes mellitus (DM). Herein, we explored the relationships between ABSI and all-cause and cardiovascular death risks among US individuals with DM.

METHODS AND RESULTS

A total of 4657 US adults with DM were enrolled from the National Health and Nutrition Examination Survey (NHANES 2003-2014) who had baseline waist circumference, height, and weight data. ABSI was calculated as [Formula: see text] and the survival information of patients was available from recruitment until 2015 utilizing the national death index. We employed Cox proportional hazards models to estimate the association of ABSI with survival. A total of 817 adults with DM died after a median follow-up period of 5.6 years, with an annual all-cause death rate per 1000 person-years of 30.0 [95% CI, 28.0-32.1]. Continuous ABSI z score was positively and significantly associated with all-cause mortality with adjustment for potential confounders (HR = 1.16, 95% CI: 1.06-1.28). ABSI tended to show a higher all-cause and CVD (cardiovascular disease) mortality among men (HR = 1.35, 95% CI: 1.19-1.53 and HR = 1.45, 95% CI: 1.12-1.87, respectively) and patients younger than 60 years (HR = 1.45, 95% CI: 1.16-1.80 and HR = 1.66, 95% CI: 1.09-2.53, respectively). Statistically significant interactions were found between the ABSI and both sex and age for total mortality.

CONCLUSIONS

Among US adults with DM from NHANES, ABSI exhibited a linear and positive relationship with total and CVD mortality risk, especially in men and younger patients.

Association between hypertension-mediated organ damage and obesity defined by novel anthropometric indices in community-dwelling elderly individuals

OBJECTIVE

Body mass index (BMI), the most common anthropometric index, has recently been challenged by two emerging parameters: a body shape index (ABSI) and body roundness index (BRI). The purpose of this study was to explore the associations of hypertension-mediated organ damage (HMOD) with conventional and novel anthropometric parameters.

METHODS

This is a multistage community-based observational and cross-sectional study. A total of 3077 elderly Chinese individuals (mean age 70.92 ± 5.84, 1329 (43%) men) from the communities in the northern area of Shanghai were enrolled from June 2014 to August 2019. Waist-to-hip ratio (WHR), ABSI and BRI were calculated with validated formulas. HMOD, including left ventricular hypertrophy (LVH), arterial stiffness (AS), lower limb atherosclerosis (LLA), and microalbuminuria (MAU), was assessed using standardized methods. Correlation and multivariable linear and logistic regression analyses were performed to detect the relations between HMOD and anthropometric indices.

RESULTS

In the total population, compared to those with ABSI, BRI and WHR in the lowest quartiles, participants with values in the highest quartiles exhibited a significantly higher risk of LVH, AS and MAU independent of BMI and other confounders (all P for trend <0.01). In females but not in males, compared to BMI, BRI and WHR had a greater area under the curve (AUC) for detecting HMOD. In the further stepwise logistic regression with all anthropometric indices put into models simultaneously, only BRI remained in the LVH (odds ratio [OR]: 1.42, 95% confidence interval [CI]: 1.30-1.55) and LLA (OR: 1.48, 95% CI: 1.23-1.77) models, and WHR remained in the AS (OR: 1.30, 95% CI: 1.18-1.43) and MAU (OR: 1.48, 95% CI: 1.28-1.72, all P < 0.01) models.

CONCLUSION

Compared to BMI, the novel anthropometric parameter BRI, together with the conventional parameter WHR, exhibits a closer relationship with HMOD in the elderly population, especially in females.

Association between new anthropometric parameters and arterial stiffness based on brachial-ankle pulse wave velocity

BACKGROUND

Obesity is an important risk factor of cardiovascular disease (CVD). Atherosclerosis can be considered an important signal of CVD. Primary physicians can reduce the risk of CVD by preventing and treating obesity. Therefore, finding a tool to diagnose the association of obesity with arteriosclerosis is important. The association between obesity parameters and arterial stiffness remains controversial. To our knowledge, no previous studies reported the relationships between multiple new anthropometric parameters (a body shape index [ABSI], body round index [BRI], and visceral adiposity index [VAI]) and brachial-ankle wave velocity (ba-PWV) as an indicator of CVD risk, especially in the Korean population.

OBJECTIVE

To investigate the relationships between arterial stiffness (assessed using ba-PWV) and anthropometric parameters estimated on the basis of body mass index (BMI), waist circumference (WC), ABSI, BRI, and VAI, and to identify the indicators of obesity that best represents CVD risk.

METHODS

A total of 2,647 adults (1,474 men and 1,173 women) were recruited for this cross-sectional study. The correlations between the anthropometric indexes (BMI, WC, ABSI, BRI, and VAI) and mean ba-PWV were analyzed. A multivariate linear regression analysis was performed to evaluate the association between each anthropometric and the presence of arterial stiffness.

RESULTS

We investigated the relationships between the obesity parameters and ba-PWV by adjusting the covariates (age, diabetes mellitus [DM], hypertension [HTN], and smoking status) related to the mean ba-PWV. In the multivariate regression analysis, ABSI (men: β =0.066, p<0.01; women: β =0.087, p<0.001) and VAI (men: β =0.067, p<0.01; women: β =0.136, p<0.001) were found to be significantly correlated with the mean ba-PWV in both men and women in Korea.

CONCLUSION

Among the new obesity indices, ABSI and VAI were found to be significantly associated with arterial stiffness, represented by the mean ba-PWV, in both men and women in Korea. These results suggest that ABSI and VAI may be convenient, highly cost-effective, and simple assessment tools for obesity and CVD risk in clinical practice.

ABSI is a poor predictor of insulin resistance in Chinese adults and elderly without diabetes

OBJECTIVE

Recently, a new obesity index (A Body Shape Index, ABSI) based on waist circumference (WC) was developed, and high ABSI corresponds to a more central concentration of body volume. It is well known that central obesity is closely linked with insulin resistance (IR). Therefore, our study aimed to examine the discriminatory power of ABSI for IR in Chinese adults and elderly without diabetes.

SUBJECTS AND METHODS

In 2007, a cross-sectional study was made. In this study, 570 individuals without diabetes were available for analysis (male: 56.1%, mean age: 62.3 ± 6.5 years). Insulin resistance was assessed by homeostasis model assessment (HOMA-IR). Areas under the receiver operating characteristic (ROC) curves were determined to identify variables/models that could predict insulin resistance.

RESULTS

ABSI was associated with IR, the cut-off points was 0.0785 m11/6kg-2/3 to identifying IR and the area under the ROC (AUC) curve was 0.618 (95%CI: 0.561-0.675), which was not better than body mass index BMI (AUC = 0.753; 95%CI: 0.706-0.801), WC (AUC = 0.749; 95%CI: 0.700-0.797), and fasting plasma glucose (FPG, AUC = 0.752; 95%CI: 0.705-0.799). Furthermore, combination with ABSI could improve the discriminatory power of other variables for IR. The AUC curve increased from 0.753 to 0.771for BMI, 0.749 to 0.754 for WC, 0.752 to 0.769 for FPG, respectively.

CONCLUSIONS

ABSI is associated with IR in the general Chinese adults and elderly without diabetes, but the discriminatory power for IR is poor. It is recommended that ABSI be used in combination with other variables.

Effectiveness of Z-score of log-transformed A Body Shape Index (LBSIZ) in predicting cardiovascular disease in Korea: the Korean Genome and Epidemiology Study

Body mass index (BMI) and waist circumference (WC) have limitations in stratifying cardio-metabolic risks. Another obesity measure, A Body Shape Index (ABSI), has been introduced but its applicability remains limited. To address this, the z-score of the log-transformed ABSI (LBSIZ) was recently developed. This study aimed to examine the ability of LBSIZ, compared to that of WC and BMI, to predict cardiovascular disease (CVD) risk. The study included 8,485 participants aged 40-69 years (mean age = 52.1) who were followed for 10 years and recruited from the Korean Genome and Epidemiology Study, a population-based cohort study. The area under the curve was 0.635 (95% confidence interval [CI]: 0.614-0.657) for LBSIZ, 0.604 (95%CI: 0.580-0.627) for WC, and 0.538 (95%CI: 0.514-0.562) for BMI. The AUC of the Framingham risk score (FRS) was 0.680 (95%CI: 0.659-0.701) in comparison. When we added LBSIZ to the model, the integrated AUC significantly improved from 0.680 to 0.692 (95%CI: 0.672-0.713; p value, 0.033), whereas there were no changes with BMI (AUC, 0.678; 95%CI: 0.656-0.699) or WC (AUC, 0.679; 95%CI: 0.658-0.701). In the multivariate Cox regression analysis, LBSIZ but not BMI or WC showed a significant hazard ratio of CVD event compared to 1st decile of each parameter. In the restricted cubic spline regression, BMI and WC showed an overall J-shaped relationship with CVD events whereas LBSIZ showed a linear relationship. LBSIZ is strongly associated with CVD risk and should predict CVD risk better than BMI and WC in the general population.

Effectiveness of A Body Shape Index (ABSI) in predicting chronic diseases and mortality: a systematic review and meta-analysis

Anthropometric measures are simple, inexpensive, noninvasive tools to assess the risk of morbidity and mortality. This systematic review assessed the performance of A Body Shape Index (ABSI) in predicting hypertension, cardiovascular disease, type 2 diabetes and all-cause mortality and compared the differential predictability between ABSI and two other common anthropometric measures - body mass index and waist circumference. A keyword and reference search were conducted in the PubMed and Web of Science for articles published until 1 November 2017. Thirty-eight studies were included in the review, including 24 retrospective cohort studies and 14 cross-sectional studies conducted in 15 countries. Meta-analysis found that a standard deviation increase in ABSI was associated with an increase in the odds of hypertension by 13% and type 2 diabetes by 35% and an increase in cardiovascular disease risk by 21% and all-cause mortality risk by 55%. ABSI outperformed body mass index and waist circumference in predicting all-cause mortality but underperformed in predicting chronic diseases. ABSI is highly clustered around the mean with a rather small variance, making it difficult to define a clinical cutoff for clinical practice. Future studies are warranted to assess ABSI's potential usefulness as an anthropometric measure in population-level health surveillance.

Body shape index: Sex-specific differences in predictive power for all-cause mortality in the Japanese population

Background

While body mass index (BMI) is the most widely used anthropometric measure, its association with all-cause mortality is generally J-shaped or U-shaped. A body shape index (ABSI) is a recently formulated anthropometric measure that shows linear relationship to all-cause mortality, especially in Caucasian cohorts. We aimed to address the relationship between ABSI and all-cause mortality in Asians and to assess the influence of sex difference and of chronic kidney disease (CKD) on this relationship.

Methods

This was a longitudinal cohort study assessing the association of ABSI, BMI, waist circumference (WC), and waist-to-height ratio (WHtR) with all-cause mortality in a Japanese nationwide Specific Health Checkup database. The study enrolled 160,625 participants followed-up between 2008 and 2012. We calculated the all-cause mortality risk associated with a 1-standard deviation increase (+1SD) in ABSI, BMI, WC, or WHtR in cohorts stratified by sex and the presence of CKD.

Results

During the 4-year follow up, 1.3% of participants died. In men, ABSI (+1SD) significantly increased the risk for all-cause mortality after adjusting for other known risk factors including CKD; hazard ratio (HR) and 95% confidence intervals (CI) of non-CKD cohort, 1.30 (1.18 to 1.43), p<0.01; HR and 95%CI of CKD cohort, 1.16 (1.01 to 1.34), p = 0.04. In women, ABSI (+1SD) did not show significant association with all-cause mortality, especially in the CKD cohort; HR and 95% CI of non-CKD cohort, 1.07 (0.99 to 1.17), p = 0.09; HR and 95%CI of CKD cohort, 0.98 (0.84 to 1.14), p = 0.78. Conversely, BMI (+1SD) was associated with significantly lower risk in men, although minimal association was found in women. WC and WHtR showed little association with all-cause mortality. On stratification per ABSI quartiles, mortality risk increased linearly and significantly with ABSI in men, but not in women with CKD. Both BMI and WC showed significant but U-shaped association with mortality in the non-CKD cohort and in men with CKD. WHtR also showed significant U-shaped association with mortality in men.

Conclusions

In the Japanese population, ABSI showed significant and linear correlation with mortality risk in men but not in women, especially in the presence of CKD.

Feasibility of body roundness index for identifying a clustering of cardiometabolic abnormalities compared to BMI, waist circumference and other anthropometric indices: the China Health and Nutrition Survey, 2008 to 2009

The body mass index (BMI) and waist circumference (WC) are commonly used anthropometric measures for predicting cardiovascular diseases risk factors, but it is uncertain which specific measure might be the most appropriate predictor of a cluster of cardiometabolic abnormalities (CMA) in Chinese adults. A body shape index (ABSI) and body roundness index (BRI) have been recently developed as alternative anthropometric indices that may better reflect health status. The main aims of this study were to investigate the predictive capacity of ABSI and BRI in identifying various CMA compared to BMI, WC, waist-to-hip ratio (WHpR), and waist-to-height ratio (WHtR), and to determine whether there exists a best single predictor of all CMA.We used data from the 2009 wave of the China Health and Nutrition Survey, and the final analysis included 8126 adults aged 18 to 85 years with available fasting blood samples and anthropometric measurements. Receiver-operating characteristic (ROC) analyses were conducted to assess the best anthropometric indices to predict the risk of hypertension, diabetes, dyslipidemia, hyperuricemia, and metabolic syndrome (MetS). Logistic regression models were fit to evaluate the OR of each CMA according to anthropometric indices.In women, the ROC analysis showed that BRI and WHtR had the best predictive capability in identifying all of CMA (area under the curves [AUCs] ranged from 0.658 to 0.721). In men, BRI and WHtR were better predictor of hypertension, diabetes, and at least 1 CMA (AUC: 0.668, 0.708, and 0.698, respectively), whereas BMI and WC were more sensitive predictor of dyslipidemia, hyperuricemia, and MetS. Furthermore, the ABSI showed the lowest AUCs for each CMA. According to the multivariate logistic regression analysis, BRI and WHtR were superior in discriminating hyperuricemia and at least 1 CMA while BMI performed better in predicting hypertension, diabetes, and MetS in women. In men, WC and BRI were the 2 best predictor of all CMA except MetS, and the ABSI was the worst.Our results showed the novel index BRI could be used as a single suitable anthropometric measure in simultaneously identifying a cluster of CMA compared to BMI and WHtR, especially in Chinese women, whereas the ABSI showed the weakest discriminative power.

Predictive power of a body shape index for development of diabetes, hypertension, and dyslipidemia in Japanese adults: a retrospective cohort study

BACKGROUND/OBJECTIVES

Recently, a body shape index (ABSI) was reported to predict all-cause mortality independently of body mass index (BMI) in Americans. This study aimed to evaluate whether ABSI is applicable to Japanese adults as a predictor for development of diabetes, hypertension, and dyslipidemia.

SUBJECTS/METHODS

We evaluated the predictive power of ABSI in a retrospective cohort study using annual health examination data from Chiba City Hall in Japan, for the period 2008 to 2012. Subjects included 37,581 without diabetes, 23,090 without hypertension, and 20,776 without dyslipidemia at baseline who were monitored for disease incidence for 4 years. We examined the associations of standardized ABSI, BMI, and waist circumference (WC) at baseline with disease incidence by logistic regression analyses. Furthermore, we conducted a case-matched study using the propensity score matching method.

RESULTS

Elevated BMI, WC, and ABSI increased the risks of diabetes and dyslipidemia [BMI-diabetes: odds ratio (OR) = 1.26, 95% confidence interval (95%CI) = 1.20-1.32; BMI-dyslipidemia: OR = 1.15, 95%CI = 1.12-1.19; WC-diabetes: OR = 1.24, 95%CI = 1.18-1.31; WC-dyslipidemia: OR = 1.15, 95%CI = 1.11-1.19; ABSI-diabetes: OR = 1.06, 95%CI = 1.01-1.11; ABSI-dyslipidemia: OR = 1.04, 95%CI = 1.01-1.07]. Elevated BMI and WC, but not higher ABSI, also increased the risk of hypertension [BMI: OR = 1.32, 95%CI = 1.27-1.37; WC: OR = 1.22, 95%CI = 1.18-1.26; ABSI: OR = 1.00, 95%CI = 0.97-1.02]. Areas under the curve (AUCs) in regression models with ABSI were significantly smaller than in models with BMI or WC for all three diseases. In case-matched subgroups, the power of ABSI was weaker than that of BMI and WC for predicting the incidence of diabetes, hypertension, and dyslipidemia.

CONCLUSIONS

Compared with BMI or WC, ABSI was not a better predictor of diabetes, hypertension, and dyslipidemia in Japanese adults.

CVD-predictive performances of "a body shape index" versus simple anthropometric measures: Tehran lipid and glucose study

PURPOSE

To examine whether a body shape index (ABSI) calculated by using waist circumference (WC) adjusted for height and weight could improve the predictive performances for cardiovascular disease (CVD) of the Framingham's general CVD algorithm and to compare its predictive performances with other anthropometric measures.

METHODS

We analyzed data on a 10-year population-based follow-up of 8,248 (4,471 women) individuals aged ≥30 years, free of CVD at baseline. CVD risk was estimated for a 1 SD increment in ABSI, body mass index (BMI), waist-to-hip ratio (WHpR) and waist-to-height ratio (WHtR), by incorporating them, one at a time, into multivariate accelerated failure time models.

RESULTS

ABSI was associated with multivariate-adjusted increased risk of incident CVD among both men (1.26, 95% CI 1.09-1.46) and women (1.17, 1.03-1.32). Among men, for a one-SD increment, ABSI conferred a greater increase in the hazard of CVD [1.26 (1.09-1.46)] than did BMI [1.06 (0.94-1.20)], WC [1.15(1.03-1.28)], WHpR [1.02 (1.01-1.03)] and WHtR [1.16 (1.02-1.31)], and the corresponding figures among women were 1.17 (1.03-1.32), 1.02 (0.90-1.16), 1.11 (0.98-1.27), 1.03 (1.01-1.05) and 1.14 (0.99-1.03), respectively. ABSI as well as other anthropometric measures failed to add to the predictive ability of the Framingham general CVD algorithm either.

CONCLUSIONS

Although ABSI could not improve the predictability of the Framingham algorithm, it provides more information than other traditional anthropometric measures in settings where information on traditional CVD risk factors are not available, and it can be used as a practical criterion to predict adiposity-related health risks in clinical assessments.

Intensive weight loss combining flexible dialysis with a personalized, ad libitum, coach-assisted diet program. A "pilot" case series

Obesity is a growing problem on dialysis. The best approach to weight loss has not been established. The risks of malnutrition may offset the advantages of weight loss. Personalized hemodialysis schedules, with an incremental approach, are gaining interest; to date, no studies have explored its potential in allowing weight loss. This case series reports on combining flexible, incremental hemodialysis, and intensive weight loss.

SETTING

a small Dialysis Unit, following incremental personalized schedules (2-6 sessions/week, depending on residual function), tailored to an equivalent renal clearance >12 mL/min. Four obese and two overweigh patients (5 male, 1 female; age: 40-63 years; body mass index [BMI] 31.1 kg/m(2)) were enrolled in a coach-assisted weight loss program, with an "ad libitum" approach (3-6 foods/day chosen on the basis of their glycemic index and glycemic load). The diet consists of 8 weeks of rapid weight loss followed by 8-12 weeks of maintenance; both phases can be repeated. This study measures weight loss, side effects, and patients' opinions. Over 12-30 months, all patients lost weight (median -10.3 kg [5.7-20], median ΔBMI-3.2). Serum albumin (pre-diet 3.78; post-diet 3.83 g/dL), hemoglobin (pre-diet 11; post-diet 11.2 g/dL), and acid-base balance (HCO(3) pre-diet: 23.3; post-diet: 23.4 mmol/L) remained stable, with decreasing needs for erythropoietin and citrate or bicarbonate supplements. Calcium-phosphate-parathyroid hormone (PTH) balance improved (PTH-pre 576; post 286 pg/mL). Three out of 4 hypertensive patients discontinued, 1 decreased antihypertensives. None experienced severe side effects. Patient satisfaction was high (9 on a 0-10 analog scale). Personalized, incremental hemodialysis schedules allow patient enrollment in intensive personalized weight loss programs, with promising results.

Dynamic association of mortality hazard with body shape

Background

A Body Shape Index (ABSI) had been derived from a study of the United States National Health and Nutrition Examination Survey (NHANES) 1999–2004 mortality data to quantify the risk associated with abdominal obesity (as indicated by a wide waist relative to height and body mass index). A national survey with longer follow-up, the British Health and Lifestyle Survey (HALS), provides another opportunity to assess the predictive power for mortality of ABSI. HALS also includes repeat observations, allowing estimation of the implications of changes in ABSI.

Methods and Findings

We evaluate ABSI z score relative to population normals as a predictor of all-cause mortality over 24 years of follow-up to HALS. We found that ABSI is a strong indicator of mortality hazard in this population, with death rates increasing by a factor of 1.13 (95% confidence interval, 1.09–1.16) per standard deviation increase in ABSI and a hazard ratio of 1.61 (1.40–1.86) for those with ABSI in the top 20% of the population compared to those with ABSI in the bottom 20%. Using the NHANES normals to compute ABSI z scores gave similar results to using z scores derived specifically from the HALS sample. ABSI outperformed as a predictor of mortality hazard other measures of abdominal obesity such as waist circumference, waist to height ratio, and waist to hip ratio. Moreover, it was a consistent predictor of mortality hazard over at least 20 years of follow-up. Change in ABSI between two HALS examinations 7 years apart also predicted mortality hazard: individuals with a given initial ABSI who had rising ABSI were at greater risk than those with falling ABSI.

Conclusions

ABSI is a readily computed dynamic indicator of health whose correlation with lifestyle and with other risk factors and health outcomes warrants further investigation.