Body Shape Index and Cardiovascular Health: Life’s Essential 8 and Crucial 9

Peter D. Hart^{1, 2,}

¹Health Promotion Research, Havre, Montana, USA

²Kinesmetrics Lab, Tallahassee, Florida, USA

Cite this paper:
Peter D. Hart. Body Shape Index and Cardiovascular Health: Life’s Essential 8 and Crucial 9. American Journal of Cardiovascular Disease Research. 2024; 9(2):23-31. doi: 10.12691/ajcdr-9-2-3

Abstract

Background: Obesity has been a growing concern to public health and novel measures of body composition could aid prevention efforts. A body shape index (BSI) is a relatively new measure that adjusts waist circumference for height and weight and may be a good predictor of cardiovascular outcomes. The aim of this study was to examine the population-level association between BSI and cardiovascular health (CVH) in adults. Methods: The 2017-2020 (pre-pandemic) National Health and Nutrition Examination Survey (NHANES) was used. BSI (m^11/6/kg^2/3) was computed for adults 20+ years of age using measured height, weight, and waist circumference (WC). CVH was assessed using the American Heart Association (AHA) Life’s Essential 8 (LE8) metric along with an additional psychological health component that yields Life’s Crucial 9 (LC9). Multiple linear regression and multinomial logistic regression were used to regress different forms of CVH onto BSI quartiles while controlling for age, sex, race, and income. Results: Approximately 36.6% (95% CI: 33.6 – 39.7) of adults had high-risk BSI with rates increasing linearly with age (p < .001). Bivariate correlations showed BSI was indirectly associated with LE8 (r = -.294, p < .001) and LC9 (r = -.289, p < .001). Adults with high-risk BSI had lower mean LE8 (60.6 vs 68.2, p < .001) and mean LC9 (63.9 vs 70.8, p < .001) as compared to their low-risk counterparts. In the fully adjusted model predicting LE8, adults in BSI Q1 (b = 9.3, p < .001), Q2 (b = 3.6, p = .003), and Q3 (b = 2.1, p = .006) had greater LE8 than those in Q4 (p trend < .001). Similarly, the fully adjusted model predicting LC9 showed adults in BSI Q1 (b = 8.5, p < .001), Q2 (b = 3.4, p = .005), and Q3 (b = 1.9, p = .008) had greater LC9 than those in Q4 (p trend < .001). Finally, the fully adjusted multinomial logistic regression model showed adults in BSI Q2, Q3, and Q4 had 1.77, 1.81, and 2.13 (respectively, all ps < .05) times the odds of adults in BSI Q1 to have moderate CVH over high CVH. Furthermore, adults in BSI Q2, Q3, and Q4 had 3.57, 4.26, and 5.96 (respectively, all ps < .05) times the odds of adults in BSI Q1 to have low CVH over high CVH. Conclusion: This study has shown that a novel measure of body composition is predictive of cardiovascular risk in U.S. adults. Specifically, BSI was found to have an indirect relationship with both continuous (i.e., LE8 and LC9) and categorical (i.e., high, moderate, and low CVH) forms of CVH. BSI may be a useful metric to consider in addition to conventional measures when predicting cardiovascular risk in adults.

Keywords:
Body shape index (BSI) Cardiovascular health (CVH) Life’s essential 8 (LE8) MVPA Life’s crucial 9 (LC9) Population health

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References:

[1]	Martin SS, Aday AW, Almarzooq ZI, et al. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association [published correction appears in Circulation. 2024 May 7; 149(19): e1164.
[2]	U.S. Department of Health & Human Services. Leading Causes of Death. National Center for Health Statistics. Updated October 25, 2024. Accessed November 1, 2024: https:// www.cdc.gov/ nchs/fastats/ leading-causes-of-death.htm.
[3]	Kronish IM, Carson AP, Davidson KW, Muntner P, Safford MM. Depressive symptoms and cardiovascular health by the American Heart Association's definition in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. PLoS One. 2012; 7(12): e52771.
[4]	Hart P. Contribution of physical activity to the life’s simple 7 metric in older rural adults. American Journal of Cardiovascular Disease Research. 2017; 5(1): 1-4.
[5]	Lloyd-Jones DM, Allen NB, Anderson CAM, et al. Life's Essential 8: Updating and Enhancing the American Heart Association's Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association. Circulation. 2022; 146(5): e18-e43.
[6]	Gaffey AE, Rollman BL, Burg MM. Strengthening the Pillars of Cardiovascular Health: Psychological Health is a Crucial Component. Circulation. 2024; 149(9): 641-643.
[7]	Krakauer NY, Krakauer JC. A new body shape index predicts mortality hazard independently of body mass index. PLoS One. 2012; 7(7): e39504.
[8]	Hoermann R, Fui MNT, Krakauer JC, Krakauer NY, Grossmann M. A body shape index (ABSI) reflects body composition changes in response to testosterone treatment in obese men. Int J Obes (Lond). 2019; 43(11): 2210-2216.
[9]	Lee H, Chung HS, Kim YJ, et al. Association between body shape index and risk of mortality in the United States. Sci Rep. 2022; 12(1): 11254. Published 2022 Jul 4.
[10]	Akinbami LJ, Chen TC, Davy O, Ogden CL, Fink S, Clark J, et al. National Health and Nutrition Examination Survey, 2017–March 2020 prepandemic file: Sample design, estimation, and analytic guidelines. National Center for Health Statistics. Vital Health Stat 2(190). 2022.
[11]	Hart PD. Sleep Quality Predicts Body Shape Index While Adjusting for Physical Activity. American Journal of Public Health Research. 2024; 12(3): 40-47. https:// pubs.sciepub.com/ ajphr/12/3/1.
[12]	Gomez-Peralta F, Abreu C, Cruz-Bravo M, et al. Relationship between "a body shape index (ABSI)" and body composition in obese patients with type 2 diabetes. Diabetol Metab Syndr. 2018; 10: 21. Published 2018 Mar 20.
[13]	Lloyd-Jones DM, Ning H, Labarthe D, et al. Status of Cardiovascular Health in US Adults and Children Using the American Heart Association's New "Life's Essential 8" Metrics: Prevalence Estimates From the National Health and Nutrition Examination Survey (NHANES), 2013 Through 2018 [published correction appears in Circulation. 2022 Nov 15; 146(20): e298.
[14]	Ge J, Peng W, Lu J. Predictive Value of Life's Crucial 9 for Cardiovascular and All-Cause Mortality: A Prospective Cohort Study From the NHANES 2007 to 2018. J Am Heart Assoc. 2024; 13(20): e036669.
[15]	U.S. Department of Health & Human Services. Healthy Eating Index SAS Code. National Institutes of Health. National Cancer Institute. Updated August 19, 2024. Accessed October 15, 2024: https://epi.grants.cancer.gov/hei/sas-code.html
[16]	Wang Z, Huang B, Ding Y, Cao F, Li F, Li PF. Association between life's essential 8 and metabolic dysfunction-associated steatotic liver disease among US adults. Arch Public Health. 2024; 82(1): 101. Published 2024 Jul 5.
[17]	SAS Institute Inc. 2016. SAS/STAT® 14.2 User’s Guide. Cary, NC: SAS Institute Inc.
[18]	Feng X, Zhu J, Hua Z, Yao S, Tong H. Comparison of obesity indicators for predicting cardiovascular risk factors and multimorbidity among the Chinese population based on ROC analysis. Sci Rep. 2024; 14(1): 20942. Published 2024 Sep 9.
[19]	Dong L, Wang Y, Xu J, et al. Association of multiple anthropometric indices with in 944,760 elderly Chinese people. Epidemiol Health. 2023; 45: e2023046.
[20]	Zhao G, Zhou Z. Correlation between obesity-related indices and hypertension. Am J Transl Res. 2024; 16(8): 3842-3850. Published 2024 Aug 15.
[21]	Yang HI, Cho W, Ahn KY, et al. A new anthropometric index to predict percent body fat in young adults. Public Health Nutr. 2020; 23(9): 1507-1514.
[22]	Kajikawa M, Maruhashi T, Kishimoto S, et al. A Body Shape Index as a Simple Anthropometric Marker of Abdominal Obesity and Risk of Cardiovascular Events. J Clin Endocrinol Metab. Published online April 25, 2024.
[23]	He H, Chen Y, Liao Y, Hu L, Qin H, Yang R. Association between body shape index and coronary heart disease in individuals over 20 years old with obese. J Health Popul Nutr. 2024; 43(1): 123. Published 2024 Aug 16.
[24]	Michalsen VL, Wild SH, Kvaløy K, Svartberg J, Melhus M, Broderstad AR. Obesity measures, metabolic health and their association with 15-year all-cause and cardiovascular mortality in the SAMINOR 1 Survey: a population-based cohort study. BMC Cardiovasc Disord. 2021; 21(1): 510. Published 2021 Oct 21.
[25]	Brenner PS, DeLamater J. Lies, Damned Lies, and Survey Self-Reports? Identity as a Cause of Measurement Bias. Soc Psychol Q. 2016; 79(4): 333-354.
[26]	Hart PD. Bivariate and multivariate associations between physical activity and body measure variables in US adults, 2017-2020 pre-pandemic. J Phys Act Res. 2022; 7(2): 98-105.