Zhongguo quanke yixue (May 2023)
Predictive Value of Cardiometabolic Index for Metabolically Obese Phenotype in Normal Weight Population
Abstract
Background Cardiometabolic index (CMI) is a simple index to measure blood lipid, which is closely related to diabetes and stroke. Metabolically obese normal weight (MONW) individuals have higher risks of morbidity and mortality of diabetes and cardiovascular and cerebrovascular diseases. Correctly identifying individuals with MONW phenotype is essential for the prevention and control of metabolism-related diseases. However, there are few studies on the predictive value of CMI for MONW phenotype. Objective To investigate the association between CMI and MONW phenotype, and to evaluate the predictive value of CMI for MONW phenotype. Methods The multistage stratified cluster sampling method was used to select permanent residents aged ≥18 years as subjects from Nanjing. The investigation time was from January 1, 2017 to June 30, 2018. The basic data of subjects were collected and multivariate robust Poisson regression model was used to evaluate the RR value with 95%CI of CMI for MONW phenotype. The receiver operating characteristic (ROC) curve was used to evaluate the predictive ability of CMI, waist-to-height ratio (WHtR) , triglyceride/ high-density lipoprotein cholesterol (TG/HDL-C) ratio, waist circumference (WC) and body mass index (BMI) for MONW phenotype. DeLong test was used to compare the area under the ROC curve (AUC) of the above-mentioned five indicators, and to further explore the value of CMI in predicting MONW phenotype in different gender and age groups. Results A total of 30 408 people were included, including 13 213 males and 17 195 females, 23 691 cases of MHNW and 6 717 cases of MONW. There was statistically significant difference in age, education, occupation, current smoking, alcohol consumption, physical activity, duration of static behavior, high red meat intake, disease history, medication history, height, waist circumference (WC) , body mass index (BMI) , total cholesterol (TC) , triglyceride (TG) , high density lipoprotein cholesterol (HDL-C) , low density lipoprotein cholesterol (LDL-C) , systolic blood pressure (SBP) , diastolic blood pressure (DBP) , fasting blood glucose (FPG) , TG/HDL-C, waist-height ratio (WHtR) and CMI (P<0.05) . There was statistically significant difference in age, education, occupation, current smoking, alcohol consumption, duration of static behavior, high red meat intake, history of disease, medication, height, WC, BMI, TC, TG, HDL-C, LDL-C, SBP, DBP, FPG, TG/HDL-C, WHtR, and CMI of male MHNW and NONW phenotypes (P<0.05) . There was statistically significant difference in age, education, occupation, current smoking, alcohol consumption, physical activity, duration of static behavior, history of disease, medication, height, WC, BMI, TC, TG, HDL-C, LDL-C, SBP, DBP, FPG, TG/HDL-C, WHtR, and CMI of the female MHNW and NOWN phenotype subjects (P<0.05) . The number of Q1 to Q4 groups was 7 739, 7 940, 7 904, 6 825, and the CMI range was ≤0.253, 0.254 to 0.382, 0.383 to 0.539, and ≥0.540, respectively. Male subjects in Q1 to Q4 were 2 697, 3 410, 3 661, 3 445, and the CMI range was ≤0.281, 0.282 to 0.407, 0.408 to 0.569, and ≥0.570, respectively. 5 042, 4 530, 4 243 and 3 380 female subjects in Q1 to Q4 group were studied, and the CMI ranges were ≤0.235, 0.236-0.361, 0.362-0.516 and ≥0.517, respectively. After adjusting for confounding factors, the CMI quartile grouping was the factor affecting metabolic phenotype in all subjects, male subjects, and female subjects (P<0.05) . Multivariate robust Poisson regression model analysis showed that the risk of MONW phenotype in the general population, male and female increased by 68%, 55% and 81% with each additional SD of CMI. In male subjects, CMI predicted MONW phenotype better than WHtR (Z=18.97, P<0.001) , TG/HDL-C (Z=12.53, P<0.001) , WC (Z=23.85, P<0.001) and BMI (Z=24.13, P<0.001) . The predictive power of CMI for MONW phenotype in female subjects was higher than that of WHtR (Z=27.38, P<0.001) , TG/HDL-C (Z=15.27, P<0.001) , WC (Z=30.83, P<0.001) and BMI (Z=30.84, P<0.001) . The AUC value of CMI predicted MONW phenotype in female subjects was higher than that in male subjects (Z=-6.10, P<0.001) , and the difference was statistically significant. In male subjects, the AUC predicted by CMI from 18 to 34 years old was 0.835〔95%CI (0.818, 0.852) 〕, higher than that of 35 to 44 years old (Z=1.55, P=0.04) , 45 to 54 years old (Z=6.92, P<0.001) , 55 to 64 years old (Z=4.95, P<0.001) , ≥65 years old (Z=7.92, P<0.001) ; In female subjects, the AUC predicted by CMI from 18 to 34 years old was 0.832〔95%CI (0.817, 0.847) 〕, which was higher than that of 35 to 44 years old (Z=1.95, P=0.03) , 45 to 54 years old (Z=2.56, P=0.02) , 55 to 64 years old (Z=3.79, P<0.001) , ≥65 years old (Z=5.71, P<0.001) . Conclusion CMI was positively associated with the risk of the MONW phenotype, which has strong predictive power and can be used as an effective tool to identify MONW phenotype in the general population, especially in 18-34 years-old people.
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