Weight-Adjusted Waist Index Best Predictor of CVD in CKM Syndrome: Study
Researchers have found in a new study that weight-adjusted waist index (WWI) was the most effective obesity measure for predicting cardiovascular disease (CVD) in patients with cardiovascular-kidney-metabolic (CKM) syndrome. By standardizing waist circumference to body weight, WWI more accurately captures central adiposity and fat distribution, outperforming traditional indices such as BMI and waist circumference in CVD risk prediction. The study was published in BMC Public Health by Tianyu W. and colleagues.
In this prospective cohort study, data were obtained from the UK Biobank and consisted of 13,064 subjects with CKM stage 0–3 syndrome. Subjects were followed-up for a median of 15.4 years. Cox proportional-hazards regression analysis with multivariate adjustment was performed to explore associations of nine obesity indices: Warmling Reciprocity Index (WWI), Cardiometabolic Index (CMI), Waists to Heights Ratio index (WHtR), Conicity Index (CI), Relative Fat Mass (RFM), Visceral Adiposity Index (VAI), Body Mass Index (BMI), Waist Circumference (WC), and Lipid Accumulation Product (LAP). Non-linear associations were explored using Restricted Cubic Spline regression, and receiver operating characteristic curve analysis evaluated model discrimination.Both were performed for the predictor with the largest effect size.
Key Results
Of these 13,064 subjects, 55.2% were men, with 2,537 people (19.42%) developing CVD.
In multivariate analysis, WWI, CMI, WHtR, CI, RFM, VAI, and BMI were found to be significantly related to increasing risk of developing CVD in CKD stage 0 to 3.
WWI had the most prominent hazard relationship with incidence of CVD with an HR of 1.33 (95% CI, 1.06–1.59) when adjusted, and this was followed by CMI with an HR of 1.27 (95% CI, 1.08–1.51).
Non-linear threshold relationships were present in a variety of indices such as CMI (1.63), WHtR (0.49), VAI (0.65), and BMI (24.88) units.
ROC curve analysis indicated that WWI.
The correlation of WWI with CVD risk was most evident in subjects under 60 years of age and in those with diabetes mellitus, hypercholesterolemia, or metabolic syndrome.
The results suggest a potential role for WWI in early risk assessment in metabolically susceptible subjects in the CKM risk continuum.
Among patients with CKM syndrome in stages 0–3, WWI showed the largest and most meaningful association with the incidence of cardiovascular disease during WWI, outperforming established and emerging markers of obesity. Such results support the application of WWI not only as a better tool for estimating cardiovascular risk but also highlight the importance of a multifaceted assessment aid in CKM syndrome treatment.
Reference:
Wang, T., Zhang, L., Chen, P. et al. Weight-adjusted waist index outperforms other obesity indices for cardiovascular disease prediction in cardiovascular-kidney-metabolic syndrome: insights from UK biobank. BMC Public Health (2025). https://doi.org/10.1186/s12889-025-25830-2
