Obesity Distribution Indices and Cardio-Cerebrovascular Metabolic Multi-morbidity: Insights from a National Longitudinal Cohort Study

Objective This study examines the associations between body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), visceral adiposity index (VAI), and Chinese visceral adiposity index (CVAI) with the risk of cardiovascular, cerebrovascular, and metabolic multimorbidity, collectively referred to as cardio-cerebrovascular-metabolic multimorbidity (CCMM). Methods We analyzed data from 6,472 individuals aged 45 and older from the CHARLS cohort. Logistic regression was used to evaluate the impact of obesity indices on CCMM, while restricted cubic spline analysis examined dose-response relationships. Subgroup analyses accounted for age, sex, baseline cardio-cerebrovascular-metabolic disease count, and hypertension status. Receiver operating characteristic (ROC) curves assessed predictive efficacy, with the net reclassification index (NRI) and integrated discriminant improvement (IDI) measuring incremental predictive value. Additionally, logistic regression was applied to investigate the influence of obesity indices on the three most prevalent CCMM patterns. Results CVAI showed the strongest association with CCMM compared to BMI, WC, WHtR, and VAI. All obesity indices displayed a nonlinear relationship with CCMM risk. Among them, CVAI had the highest AUC value and contributed the most significant incremental risk when added to the fully adjusted model. Overall, the analysis indicated that obesity indices primarily impact metabolic disease patterns within multimorbidity. Conclusions BMI, WC, WHtR, VAI, and CVAI independently predict CCMM, with CVAI emerging as the strongest predictor, especially in middle-aged individuals and those without pre-existing cardio-cerebrovascular-metabolic conditions. Additionally, these obesity indices significantly influence multi-morbidity patterns, particularly those linked to metabolic diseases.