{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T23:40:16Z","timestamp":1792626016498,"version":"4.5.0"},"reference-count":50,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["American Journal of Preventive Cardiology"],"published-print":{"date-parts":[[2026,8]]},"DOI":"10.1016\/j.ajpc.2026.101650","type":"journal-article","created":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T15:58:14Z","timestamp":1776959894000},"page":"101650","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"special_numbering":"C","title":["Body mass index, waist-to-height ratio, and the risks of early-onset heart failure in adults age under 45"],"prefix":"10.1016","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-7803-4357","authenticated-orcid":false,"given":"Zhiqi","family":"Yao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priya","family":"Umapathi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Goldenberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kavita","family":"Sharma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5138-9683","authenticated-orcid":false,"given":"Michael J.","family":"Blaha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.ajpc.2026.101650_bib0001","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.carpath.2011.11.007","article-title":"The pathophysiology of heart failure","volume":"21","author":"Kemp","year":"2012","journal-title":"Cardiovasc Pathol"},{"key":"10.1016\/j.ajpc.2026.101650_bib0002","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1002\/ejhf.2333","article-title":"2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"24","author":"Members","year":"2022","journal-title":"Eur J Heart Fail"},{"key":"10.1016\/j.ajpc.2026.101650_bib0003","doi-asserted-by":"crossref","first-page":"e11","DOI":"10.15420\/cfr.2023.05","article-title":"Global public health burden of heart failure: An updated review","volume":"9","author":"Shahim","year":"2023","journal-title":"Card Fail Rev"},{"key":"10.1016\/j.ajpc.2026.101650_bib0004","doi-asserted-by":"crossref","DOI":"10.21037\/amj.2020.03.03","article-title":"Global epidemiology and future trends of heart failure","volume":"5","author":"Lippi","year":"2020","journal-title":"AME Med J"},{"key":"10.1016\/j.ajpc.2026.101650_bib0005","doi-asserted-by":"crossref","first-page":"1306","DOI":"10.1002\/ejhf.1594","article-title":"Survival of patients with chronic heart failure in the community: a systematic review and meta-analysis","volume":"21","author":"Jones","year":"2019","journal-title":"Eur J Heart Fail"},{"key":"10.1016\/j.ajpc.2026.101650_bib0006","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.cardfail.2024.07.001","article-title":"HF STATS 2024: heart failure epidemiology and outcomes statistics an updated 2024 report from the Heart Failure Society of America","volume":"31","author":"Bozkurt","year":"2025","journal-title":"J Card Fail"},{"key":"10.1016\/j.ajpc.2026.101650_bib0007","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1093\/eurheartj\/ehac651","article-title":"Epidemiology of heart failure in young adults: a French nationwide cohort study","volume":"44","author":"Lecoeur","year":"2022","journal-title":"Eur Heart J"},{"key":"10.1016\/j.ajpc.2026.101650_bib0008","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1161\/CIRCULATIONAHA.116.025941","article-title":"Age-specific trends in incidence, mortality, and comorbidities of heart failure in Denmark, 1995 to 2012","volume":"135","author":"Christiansen","year":"2017","journal-title":"Circulation"},{"key":"10.1016\/j.ajpc.2026.101650_bib0009","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1093\/eurheartj\/eht278","article-title":"Heart failure in young adults: 20-year trends in hospitalization, aetiology, and case fatality in Sweden","volume":"35","author":"Barasa","year":"2014","journal-title":"Eur Heart J"},{"key":"10.1016\/j.ajpc.2026.101650_bib0010","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1093\/eurjpc\/zwac024","article-title":"Sex-specific temporal trends in the incidence and prevalence of cardiovascular disease in young adults: a population-based study using UK primary care data","volume":"29","author":"Okoth","year":"2022","journal-title":"Eur J Prev Cardiol"},{"key":"10.1016\/j.ajpc.2026.101650_bib0011","first-page":"606","article-title":"Forecasting the impact of heart failure in the United States","volume":"6","author":"Heidenreich","year":"2013","journal-title":"Circ: Heart Fail"},{"key":"10.1016\/j.ajpc.2026.101650_bib0012","doi-asserted-by":"crossref","first-page":"1412","DOI":"10.1016\/j.cardfail.2023.07.006","article-title":"Heart failure epidemiology and outcomes statistics: a report of the Heart Failure Society of America","volume":"29","author":"Bozkurt","year":"2023","journal-title":"J Card Fail"},{"key":"10.1016\/j.ajpc.2026.101650_bib0013","doi-asserted-by":"crossref","first-page":"62","DOI":"10.3390\/jcm5070062","article-title":"Heart failure: diagnosis, management and utilization","volume":"5","author":"Inamdar","year":"2016","journal-title":"J Clin Med"},{"key":"10.1016\/j.ajpc.2026.101650_bib0014","doi-asserted-by":"crossref","first-page":"1845","DOI":"10.1016\/j.jacc.2013.05.072","article-title":"Clinical characteristics and outcomes of young and very young adults with heart failure: the CHARM programme (Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity)","volume":"62","author":"Wong","year":"2013","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.ajpc.2026.101650_bib0015","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1001\/jamacardio.2024.0615","article-title":"Reversals in the decline of heart failure mortality in the US, 1999 to 2021","volume":"9","author":"Sayed","year":"2024","journal-title":"JAMA Cardiol"},{"key":"10.1016\/j.ajpc.2026.101650_bib0016","first-page":"1472","article-title":"Heart failure in young adults is associated with high mortality: a contemporary population-level analysis","volume":"33","author":"Wong","year":"2017","journal-title":"Can J Cardiol"},{"key":"10.1016\/j.ajpc.2026.101650_bib0017","doi-asserted-by":"crossref","first-page":"M9","DOI":"10.1093\/eurheartj\/suz216","article-title":"Monitoring functional capacity in heart failure","volume":"21","author":"Piepoli","year":"2019","journal-title":"Eur Heart J Suppl"},{"key":"10.1016\/j.ajpc.2026.101650_bib0018","doi-asserted-by":"crossref","first-page":"1624","DOI":"10.1177\/2047487317727337","article-title":"The prognostic value of exercise testing: exercise capacity, hemodynamic response, and cardio-metabolic risk factors","volume":"24","author":"Zafrir","year":"2017","journal-title":"Eur J Prev Cardiol"},{"key":"10.1016\/j.ajpc.2026.101650_bib0019","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1136\/heartjnl-2020-317833","article-title":"Association of heart failure and its comorbidities with loss of life expectancy","volume":"107","author":"Drozd","year":"2021","journal-title":"Heart"},{"key":"10.1016\/j.ajpc.2026.101650_bib0020","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1093\/eurheartj\/ehac730","article-title":"Increasing incidence of heart failure among young adults: how can we stop it?","volume":"44","author":"Schaufelberger","year":"2023","journal-title":"Eur Heart J"},{"key":"10.1016\/j.ajpc.2026.101650_bib0021","first-page":"1926","article-title":"Body weight in adolescence and long-term risk of early heart failure in adulthood among men in Sweden","volume":"38","author":"Rosengren","year":"2017","journal-title":"Eur Heart J"},{"key":"10.1016\/j.ajpc.2026.101650_bib0022","doi-asserted-by":"crossref","first-page":"1841","DOI":"10.1002\/ehf2.14641","article-title":"Obesity: the perfect storm for heart failure","volume":"11","author":"Lembo","year":"2024","journal-title":"ESC Heart Fail"},{"key":"10.1016\/j.ajpc.2026.101650_bib0023","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1056\/NEJMoa0807265","article-title":"Racial differences in incident heart failure among young adults","volume":"360","author":"Bibbins-Domingo","year":"2009","journal-title":"N Engl J Med"},{"key":"10.1016\/j.ajpc.2026.101650_bib0024","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1007\/s13679-024-00580-1","article-title":"Strengths and limitations of BMI in the diagnosis of obesity: what is the path forward?","volume":"13","author":"Sweatt","year":"2024","journal-title":"Curr Obes Rep"},{"key":"10.1016\/j.ajpc.2026.101650_bib0025","doi-asserted-by":"crossref","DOI":"10.1016\/S2213-8587(24)00316-4","article-title":"Definition and diagnostic criteria of clinical obesity","author":"Rubino","year":"2025","journal-title":"Lancet Diabetes Endocrinol"},{"key":"10.1016\/j.ajpc.2026.101650_bib0026","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1016\/j.eprac.2025.07.017","article-title":"American Association of Clinical Endocrinology Consensus Statement: algorithm for the evaluation and treatment of adults with obesity\/adiposity-based chronic disease \u20132025 update","volume":"31","author":"Nadolsky","year":"2025","journal-title":"Endocr Pract"},{"key":"10.1016\/j.ajpc.2026.101650_bib0027","series-title":"Evidence review for accuracy of anthropometric measures in assessing health risks associated with overweight and obesity in adults: weight management suite","year":"2022"},{"key":"10.1016\/j.ajpc.2026.101650_bib0028","unstructured":"Health E-stats December 2020 prevalence of underweight among adults aged 20 and over: united States, 1960\u20131962 through 2017\u20132018. 2020."},{"key":"10.1016\/j.ajpc.2026.101650_bib0029","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1056\/NEJMsr1809937","article-title":"The All of us research Program investigators. The \u201call of us\u201d research program","volume":"381","year":"2019","journal-title":"N Engl J Med"},{"key":"10.1016\/j.ajpc.2026.101650_bib0030","series-title":"Eating disorders and obesity, second edition: a comprehensive handbook","author":"Fairburn","year":"2013"},{"key":"10.1016\/j.ajpc.2026.101650_bib0031","first-page":"1926","article-title":"Body weight in adolescence and long-term risk of early heart failure in adulthood among men in Sweden","volume":"38","author":"Rosengren","year":"2017","journal-title":"Eur Heart J"},{"key":"10.1016\/j.ajpc.2026.101650_bib0032","doi-asserted-by":"crossref","first-page":"e540","DOI":"10.1016\/j.orcp.2013.12.005","article-title":"Mechanisms of heart failure in obesity","volume":"8","author":"Ebong","year":"2014","journal-title":"Obes Res Clin Pr"},{"key":"10.1016\/j.ajpc.2026.101650_bib0033","doi-asserted-by":"crossref","first-page":"378","DOI":"10.3390\/ijms16010378","article-title":"Oxidative stress in obesity: a critical component in Human diseases","volume":"16","author":"Marsegla","year":"2015","journal-title":"Int J Mol Sci"},{"key":"10.1016\/j.ajpc.2026.101650_bib0034","doi-asserted-by":"crossref","first-page":"3117","DOI":"10.3390\/ijms12053117","article-title":"Inflammation, oxidative stress, and obesity","volume":"12","author":"Fern\u00e1ndez-S\u00e1nchez","year":"2011","journal-title":"Int J Mol Sci"},{"key":"10.1016\/j.ajpc.2026.101650_bib0035","doi-asserted-by":"crossref","first-page":"1911","DOI":"10.1089\/ars.2010.3739","article-title":"Oxidative stress as pathogenesis of cardiovascular risk associated with metabolic syndrome","volume":"15","author":"Otani","year":"2011","journal-title":"Antioxid Redox Signal"},{"key":"10.1016\/j.ajpc.2026.101650_bib0036","article-title":"Epicardial adipose tissue and outcome in heart failure with mid-range and preserved ejection fraction","volume":"15","author":"van Woerden","year":"2022","journal-title":"Circ: Heart Fail"},{"key":"10.1016\/j.ajpc.2026.101650_bib0037","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1001\/archinte.1933.00160060085007","article-title":"Adiposity of the heart: a clinical and pathologic study of one hundred and thirty-six obese patients","volume":"52","author":"Smith","year":"1933","journal-title":"Arch Intern Med"},{"key":"10.1016\/j.ajpc.2026.101650_bib0038","doi-asserted-by":"crossref","first-page":"3434","DOI":"10.1093\/cvr\/cvac120","article-title":"Obesity and heart failure with preserved ejection fraction: new insights and pathophysiological targets","volume":"118","author":"Borlaug","year":"2023","journal-title":"Cardiovasc Res"},{"key":"10.1016\/j.ajpc.2026.101650_bib0039","doi-asserted-by":"crossref","first-page":"1868","DOI":"10.1056\/NEJMcp1511175","article-title":"Heart failure with preserved ejection fraction","volume":"375","author":"Redfield","year":"2016","journal-title":"N Engl J Med"},{"key":"10.1016\/j.ajpc.2026.101650_bib0040","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1054\/jcaf.2003.4","article-title":"Body mass and survival in patients with chronic heart failure without cachexia: the importance of obesity","volume":"9","author":"Davos","year":"2003","journal-title":"J Card Fail"},{"key":"10.1016\/j.ajpc.2026.101650_bib0041","doi-asserted-by":"crossref","first-page":"442","DOI":"10.3390\/nu8070442","article-title":"Nutritional deficiency in patients with heart failure","volume":"8","author":"Sciatti","year":"2016","journal-title":"Nutrients"},{"key":"10.1016\/j.ajpc.2026.101650_bib0042","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1007\/s13167-021-00251-4","article-title":"Caution, \u201cnormal\u201d BMI: health risks associated with potentially masked individual underweight-EPMA position Paper 2021","volume":"12","author":"Golubnitschaja","year":"2021","journal-title":"EPMA J"},{"key":"10.1016\/j.ajpc.2026.101650_bib0043","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1002\/jcsm.13417","article-title":"Association between underweight and risk of heart failure in diabetes patients","volume":"15","author":"Yoo","year":"2024","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"10.1016\/j.ajpc.2026.101650_bib0044","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-020-75667-5","article-title":"Waist-height ratio and waist are the best estimators of visceral fat in type 1 diabetes","volume":"10","author":"Parente","year":"2020","journal-title":"Sci Rep"},{"key":"10.1016\/j.ajpc.2026.101650_bib0045","doi-asserted-by":"crossref","first-page":"403","DOI":"10.2147\/DMSO.S34220","article-title":"Predicting cardiometabolic risk: waist-to-height ratio or BMI. a meta-analysis","volume":"6","author":"Savva","year":"2013","journal-title":"Diabetes Metab Syndr Obes"},{"key":"10.1016\/j.ajpc.2026.101650_bib0046","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1093\/oxfordjournals.aje.a008733","article-title":"How useful is body mass index for comparison of body fatness across age, sex, and ethnic groups?","volume":"143","author":"Gallagher","year":"1996","journal-title":"Am J Epidemiol"},{"key":"10.1016\/j.ajpc.2026.101650_bib0047","first-page":"e895","article-title":"2022 AHA\/ACC\/HFSA Guideline for the management of heart failure: a report of the American College of Cardiology\/American Heart Association Joint Committee on clinical practice guidelines","volume":"145","author":"Heidenreich","year":"2022","journal-title":"Circulation"},{"key":"10.1016\/j.ajpc.2026.101650_bib0048","doi-asserted-by":"crossref","first-page":"2388","DOI":"10.1016\/j.jacc.2019.02.057","article-title":"10-Year risk equations for incident heart failure in the general population","volume":"73","author":"Khan","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.ajpc.2026.101650_bib0049","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1161\/CIRCHEARTFAILURE.111.964841","article-title":"Prediction of incident heart failure in general practice: the ARIC study","volume":"5","author":"A garwal","year":"2012","journal-title":"Circ Heart Fail"},{"key":"10.1016\/j.ajpc.2026.101650_bib0050","doi-asserted-by":"crossref","DOI":"10.1016\/j.jacc.2025.05.008","article-title":"2025 ACC scientific statement on the management of obesity in adults with heart failure: a report of the American College of Cardiology","author":"Kittleson","year":"2025","journal-title":"J Am Coll Cardiol"}],"container-title":["American Journal of Preventive Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2666667726002254?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2666667726002254?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T23:09:13Z","timestamp":1792624153000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S2666667726002254"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":50,"alternative-id":["S2666667726002254"],"URL":"https:\/\/doi.org\/10.1016\/j.ajpc.2026.101650","relation":{},"ISSN":["2666-6677"],"issn-type":[{"value":"2666-6677","type":"print"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Body mass index, waist-to-height ratio, and the risks of early-onset heart failure in adults age under 45","name":"articletitle","label":"Article Title"},{"value":"American Journal of Preventive Cardiology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.ajpc.2026.101650","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 The Author(s). Published by Elsevier B.V.","name":"copyright","label":"Copyright"}],"article-number":"101650"}}