Frontiers in endocrinology · 2025
Association between A body shape index and bone mineral density in middle-aged and elderly adults: a retrospective analysis of NHANES 2005-2018.
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Wang Zhi-Zhuang, Ma Guo-Liang, Xu Bo, Chen Xin, Yang Bo-Wen, Qin Xiao-Kuan, Duan Wei-Li, Feng Min-Shan, Yin He, Sun Kai, Zhu Li-Guo
Аннотация
INTRODUCTION: Despite accumulating evidence on central obesity and osteoporosis, the role of a body shape index (ABSI), a nonlinear index quantifying body shape via body mass index (BMI), waist circumference (WC), and height, remains controversial and underexplored. Although recent meta-analyses suggest central obesity may modulate fracture risk bidirectionally, no research has comprehensively compared ABSI with traditional adiposity metrics, such as BMI, WC, and waist-to-height ratio (WHtR), to predict site-specific changes in bone mineral density (BMD) across anatomical regions.
METHODS: This study utilized National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2018, involving 12,421 participants. ABSI was computed using the formula: ABSI = WC/(BMI²/³ × Height¹/²). BMD was assessed at four sites-the total femur (TF), femoral neck (FN), trochanter (TR), and intertrochanter (IN) regions-via dual-energy X-ray absorptiometry (DXA). The association between ABSI and BMD was analyzed via multiple regression models and a generalized additive model (GAM). To compare ABSI's predictive efficacy with conventional adiposity indices, regression analyses juxtaposed ABSI against BMI, WC, and WHtR in assessing correlations with site-specific BMD.
RESULTS: After full covariate adjustment, a significant negative association was observed between ABSI and BMD in four femoral regions (P< 0.01). Smoothed curve fitting revealed a significant nonlinear relationship and threshold effect between ABSI and BMD among middle-aged and older individuals. Additionally, an inverted J-shaped curve was observed between ABSI and BMD in all four femoral regions. Meanwhile, ABSI showed significant negative associations with BMD across all femoral sites (β = -0.27 to -0.31, p-trend< 0.000001), whereas BMI, WC, and WHtR exhibited positive correlations (WHtR showing the strongest effect: β = 0.41-0.69). This highlights ABSI's ability to detect central adiposity-related bone loss obscured by conventional obesity metrics.
CONCLUSION: ABSI's robust inverse associations with femoral BMD (β = -0.27 to -0.31), persisting across nonlinear threshold analyses, establish it as a novel biomarker of central adiposity-related skeletal fragility. Unlike conventional indices reflecting mechanical loading benefits (BMI β = 0.008-0.012; WC β = 0.003-0.005; WHtR β = 0.41-0.69), ABSI specifically captures visceral fat-driven metabolic disorder-a critical pathway for osteoporosis risk stratification in normal-weight and obese populations.
METHODS: This study utilized National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2018, involving 12,421 participants. ABSI was computed using the formula: ABSI = WC/(BMI²/³ × Height¹/²). BMD was assessed at four sites-the total femur (TF), femoral neck (FN), trochanter (TR), and intertrochanter (IN) regions-via dual-energy X-ray absorptiometry (DXA). The association between ABSI and BMD was analyzed via multiple regression models and a generalized additive model (GAM). To compare ABSI's predictive efficacy with conventional adiposity indices, regression analyses juxtaposed ABSI against BMI, WC, and WHtR in assessing correlations with site-specific BMD.
RESULTS: After full covariate adjustment, a significant negative association was observed between ABSI and BMD in four femoral regions (P< 0.01). Smoothed curve fitting revealed a significant nonlinear relationship and threshold effect between ABSI and BMD among middle-aged and older individuals. Additionally, an inverted J-shaped curve was observed between ABSI and BMD in all four femoral regions. Meanwhile, ABSI showed significant negative associations with BMD across all femoral sites (β = -0.27 to -0.31, p-trend< 0.000001), whereas BMI, WC, and WHtR exhibited positive correlations (WHtR showing the strongest effect: β = 0.41-0.69). This highlights ABSI's ability to detect central adiposity-related bone loss obscured by conventional obesity metrics.
CONCLUSION: ABSI's robust inverse associations with femoral BMD (β = -0.27 to -0.31), persisting across nonlinear threshold analyses, establish it as a novel biomarker of central adiposity-related skeletal fragility. Unlike conventional indices reflecting mechanical loading benefits (BMI β = 0.008-0.012; WC β = 0.003-0.005; WHtR β = 0.41-0.69), ABSI specifically captures visceral fat-driven metabolic disorder-a critical pathway for osteoporosis risk stratification in normal-weight and obese populations.