Sex- and age-specific differences in associations of a body shape index with all-cause and cardiovascular death risks among US adults with diabetes

Background and aims Evidence regarding the effect of body shape index (ABSI) on mortality is scarce among individuals with diabetes mellitus (DM). Herein, we explored the relationships between ABSI and all-cause and cardiovascular death risks among US individuals with DM. Methods and results A total of 4657 US adults with DM were enrolled from the National Health and Nutrition Examination Survey (NHANES 2003–2014) who had baseline waist circumference, height, and weight data. ABSI was calculated as W C × w e i g h t − 2 / 3 × h e i g h t 5 / 6 and the survival information of patients was available from recruitment until 2015 utilizing the national death index. We employed Cox proportional hazards models to estimate the association of ABSI with survival. A total of 817 adults with DM died after a median follow-up period of 5.6 years, with an annual all-cause death rate per 1000 person-years of 30.0 [95% CI, 28.0–32.1]. Continuous ABSI z score was positively and significantly associated with all-cause mortality with adjustment for potential confounders (HR = 1.16, 95% CI: 1.06–1.28). ABSI tended to show a higher all-cause and CVD (cardiovascular disease) mortality among men (HR = 1.35, 95% CI: 1.19–1.53 and HR = 1.45, 95% CI: 1.12–1.87, respectively) and patients younger than 60 years (HR = 1.45, 95% CI: 1.16–1.80 and HR = 1.66, 95% CI: 1.09–2.53, respectively). Statistically significant interactions were found between the ABSI and both sex and age for total mortality. Conclusions Among US adults with DM from NHANES, ABSI exhibited a linear and positive relationship with total and CVD mortality risk, especially in men and younger patients.