Head-to-head comparison of visceral adiposity indices (A Body Shape Index and Visceral Adiposity Index) with traditional anthropometrics: a community-based strategy for cardiovascular risk prediction in urban China.

WHtR demonstrated the greatest discriminative power for CVD high-risk status among all individual adiposity indices examined.

• WHtR achieved AUC=0.826 (95% CI 0.819 to 0.832)
• This outperformed BMI, WC, ABSI, and VAI as individual predictors
• The primary outcome was CVD high-risk status defined by Chinese guidelines
• Study included 38,427 adults aged 35-79 years recruited via stratified sampling in urban and rural communities in Nanjing, China from 2020 to 2023

Among the study participants, 23.3% were classified as high risk for cardiovascular disease.

• 8,905 out of 38,427 participants were classified as CVD high risk
• Participants were aged 35-79 years
• Recruitment used stratified sampling across urban and rural communities in Nanjing, China
• Exclusion criteria included age <35 or >79 years, pregnancy, severe illness, or cognitive impairment

A PCA-derived composite obesity index (COI) achieved discriminative performance second only to WHtR among all indices tested.

• COI achieved AUC=0.822
• COI was derived from principal component analysis (PCA) of traditional anthropometric indices
• COI also mitigated severe multicollinearity observed among traditional indices
• Traditional indices showed variance inflation factor >40, indicating severe multicollinearity

ABSI showed a clear risk gradient for CVD high-risk status, with the highest ABSI category showing a 38.5% detection rate.

• ABSI ≥0.085 was associated with a 38.5% detection rate in the high-risk group
• ABSI demonstrated a clear risk gradient across categories
• ABSI is described as a novel adiposity index compared to traditional anthropometrics
• ABSI was found to enhance stratification in specific subgroups rather than serving as a primary screening tool

VAI showed a modest but statistically significant association with CVD high-risk status.

• VAI had OR=1.026, p=0.001
• The effect was described as 'modest but statistically significant'
• VAI was noted to enhance stratification in specific subgroups
• VAI is a novel adiposity index compared to traditional anthropometrics (BMI, WC, WHtR)

Combined models incorporating COI, ABSI, and VAI achieved comparable AUC to the best individual index with improved parsimony.

• COI+ABSI+VAI combined model achieved AUC=0.825
• This was comparable to WHtR alone (AUC=0.826)
• The combined model had AIC=174,010.34, reflecting improved parsimony
• Combined models were described as achieving 'comparable AUC with improved parsimony'

Age, hypertension, and dyslipidaemia were identified as key covariates in CVD risk prediction models.

• ORs for these covariates ranged from 1.15 to 3.88
• All were statistically significant at p<0.001
• These were identified as key covariates alongside adiposity indices
• The study used a community-based cross-sectional design

Severe multicollinearity among traditional anthropometric indices was identified as a methodological concern in CVD risk modeling.

• Variance inflation factor (VIF) exceeded 40 among traditional indices (BMI, WC, WHtR)
• VIF >40 indicates severe multicollinearity
• This multicollinearity was mitigated by using the PCA-derived composite obesity index (COI)
• Principal component analysis was evaluated as a secondary objective for creating composite indices