{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T06:08:11Z","timestamp":1791612491308,"version":"4.3.4"},"reference-count":51,"publisher":"Elsevier BV","issue":"2","license":[{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010318","name":"University of Manitoba","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010318","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","mayoclinicproceedings.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Mayo Clinic Proceedings"],"published-print":{"date-parts":[[2026,2]]},"DOI":"10.1016\/j.mayocp.2025.09.021","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T04:32:17Z","timestamp":1767069137000},"page":"259-269","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":8,"title":["Visceral Adiposity Index Is Associated With Cardiometabolic Multimorbidity and Improves Risk Prediction: The English Longitudinal Study of Ageing"],"prefix":"10.1016","volume":"101","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2625-0273","authenticated-orcid":false,"given":"Setor K.","family":"Kunutsor","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sae Young","family":"Jae","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jari A.","family":"Laukkanen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"23","key":"10.1016\/j.mayocp.2025.09.021_bib2","doi-asserted-by":"crossref","first-page":"2493","DOI":"10.1001\/jama.2012.5265","article-title":"Designing health care for the most common chronic condition\u2014multimorbidity","volume":"307","author":"Tinetti","year":"2012","journal-title":"JAMA"},{"issue":"1","key":"10.1016\/j.mayocp.2025.09.021_bib3","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1186\/s12916-021-02147-6","article-title":"Hospitalisation events in people with chronic kidney disease as a component of multimorbidity: parallel cohort studies in research and routine care settings","volume":"19","author":"Sullivan","year":"2021","journal-title":"BMC Med"},{"issue":"6","key":"10.1016\/j.mayocp.2025.09.021_bib4","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1097\/MNH.0000000000000270","article-title":"Multimorbidity in people with chronic kidney disease: implications for outcomes and treatment","volume":"25","author":"Fraser","year":"2016","journal-title":"Curr Opin Nephrol Hypertens"},{"issue":"3","key":"10.1016\/j.mayocp.2025.09.021_bib5","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-024476","article-title":"Multimorbidity of cardiometabolic diseases: prevalence and risk for mortality from one million Chinese adults in a longitudinal cohort study","volume":"9","author":"Zhang","year":"2019","journal-title":"BMJ Open"},{"issue":"suppl 1","key":"10.1016\/j.mayocp.2025.09.021_bib6","article-title":"Risk factors for cardiometabolic multimorbidity: an analysis of 4 million participants from May Measurement Month 2017-2019","volume":"45","author":"Janssen-Telders","year":"2024","journal-title":"Eur Heart J"},{"issue":"1","key":"10.1016\/j.mayocp.2025.09.021_bib7","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1186\/s12916-022-02427-9","article-title":"Costs of multimorbidity: a systematic review and meta-analyses","volume":"20","author":"Tran","year":"2022","journal-title":"BMC Med"},{"issue":"2","key":"10.1016\/j.mayocp.2025.09.021_bib8","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1515\/hmbci-2014-0047","article-title":"Visceral adiposopathy: a vascular perspective","volume":"21","author":"Farb","year":"2015","journal-title":"Horm Mol Biol Clin Investig"},{"issue":"1","key":"10.1016\/j.mayocp.2025.09.021_bib9","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1186\/s41043-024-00614-3","article-title":"Association between body shape index and coronary heart disease in individuals over 20 years old with obese","volume":"43","author":"He","year":"2024","journal-title":"J Health Popul Nutr"},{"issue":"9","key":"10.1016\/j.mayocp.2025.09.021_bib10","doi-asserted-by":"crossref","first-page":"1702","DOI":"10.1016\/j.numecd.2023.05.016","article-title":"A Body Shape Index is positively associated with all-cause and cardiovascular disease mortality in the Chinese population with normal weight: a prospective cohort study","volume":"33","author":"Zhou","year":"2023","journal-title":"Nutr Metab Cardiovasc Dis"},{"issue":"19","key":"10.1016\/j.mayocp.2025.09.021_bib11","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.124.034768","article-title":"Body Roundness Index trajectories and the incidence of cardiovascular disease: evidence from the China Health and Retirement Longitudinal Study","volume":"13","author":"Yang","year":"2024","journal-title":"J Am Heart Assoc"},{"issue":"11","key":"10.1016\/j.mayocp.2025.09.021_bib12","doi-asserted-by":"crossref","first-page":"3008","DOI":"10.1017\/S1368980022001768","article-title":"A nonlinear association between body roundness index and all-cause mortality and cardiovascular mortality in general population","volume":"25","author":"Zhou","year":"2022","journal-title":"Public Health Nutr"},{"issue":"4","key":"10.1016\/j.mayocp.2025.09.021_bib13","doi-asserted-by":"crossref","first-page":"920","DOI":"10.2337\/dc09-1825","article-title":"Visceral Adiposity Index: a reliable indicator of visceral fat function associated with cardiometabolic risk","volume":"33","author":"Amato","year":"2010","journal-title":"Diabetes Care"},{"issue":"9","key":"10.1016\/j.mayocp.2025.09.021_bib14","doi-asserted-by":"crossref","first-page":"2204","DOI":"10.1016\/j.numecd.2022.05.020","article-title":"Association between the visceral adiposity index and risks of all-cause and cause-specific mortalities in a large cohort: findings from the UK biobank","volume":"32","author":"He","year":"2022","journal-title":"Nutr Metab Cardiovasc Dis"},{"issue":"2","key":"10.1016\/j.mayocp.2025.09.021_bib15","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1111\/dom.16074","article-title":"Relationship between trajectory of Chinese visceral adiposity index and risk of type 2 diabetes mellitus: evidence from the China-PAR project","volume":"27","author":"Fu","year":"2025","journal-title":"Diabetes Obes Metab"},{"key":"10.1016\/j.mayocp.2025.09.021_bib16","article-title":"Non-linear associations between visceral adiposity index and cardiovascular and cerebrovascular diseases: results from the NHANES (1999-2018)","volume":"9","author":"Zhang","year":"2022","journal-title":"Front Cardiovasc Med"},{"issue":"1","key":"10.1016\/j.mayocp.2025.09.021_bib17","first-page":"11","article-title":"Associations between Chinese visceral adiposity index and the risk of metabolic dysfunction-associated steatotic liver disease and liver fibrosis: a large cross-sectional study","volume":"50","author":"Liu","year":"2025","journal-title":"Iran J Med Sci"},{"issue":"14","key":"10.1016\/j.mayocp.2025.09.021_bib18","doi-asserted-by":"crossref","first-page":"2277","DOI":"10.3390\/nu16142277","article-title":"Association of visceral adiposity index and handgrip strength with cardiometabolic multimorbidity among middle-aged and older adults: findings from CHARLS 2011-2020","volume":"16","author":"Liu","year":"2024","journal-title":"Nutrients"},{"key":"10.1016\/j.mayocp.2025.09.021_bib19","doi-asserted-by":"crossref","DOI":"10.3389\/fendo.2024.1381949","article-title":"The association between Chinese visceral adiposity index and cardiometabolic multimorbidity among Chinese middle-aged and older adults: a national cohort study","volume":"15","author":"Ye","year":"2024","journal-title":"Front Endocrinol (Lausanne)"},{"key":"10.1016\/j.mayocp.2025.09.021_bib20","doi-asserted-by":"crossref","DOI":"10.3389\/fendo.2024.1302296","article-title":"Association of adiposity indicators with cardiometabolic multimorbidity risk in hypertensive patients: a large cross-sectional study","volume":"15","author":"Dong","year":"2024","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"1","key":"10.1016\/j.mayocp.2025.09.021_bib21","doi-asserted-by":"crossref","DOI":"10.1002\/dmrr.3764","article-title":"Assessment of six surrogate insulin resistance indexes for predicting cardiometabolic multimorbidity incidence in Chinese middle-aged and older populations: insights from the China health and retirement longitudinal study","volume":"40","author":"Xiao","year":"2024","journal-title":"Diabetes Metab Res Rev"},{"issue":"4","key":"10.1016\/j.mayocp.2025.09.021_bib22","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"61","author":"von Elm","year":"2008","journal-title":"J Clin Epidemiol"},{"issue":"6","key":"10.1016\/j.mayocp.2025.09.021_bib23","doi-asserted-by":"crossref","first-page":"1640","DOI":"10.1093\/ije\/dys168","article-title":"Cohort profile: the English Longitudinal Study of Ageing","volume":"42","author":"Steptoe","year":"2013","journal-title":"Int J Epidemiol"},{"issue":"11","key":"10.1016\/j.mayocp.2025.09.021_bib24","doi-asserted-by":"crossref","DOI":"10.1016\/j.numecd.2025.104167","article-title":"A paradoxical association between A Body Shape Index and cardiometabolic multimorbidity: findings from the English Longitudinal Study of Ageing","volume":"35","author":"Kunutsor","year":"2025","journal-title":"Nutr Metab Cardiovasc Dis"},{"issue":"6","key":"10.1016\/j.mayocp.2025.09.021_bib25","doi-asserted-by":"crossref","DOI":"10.1002\/dmrr.3669","article-title":"Association of sleep quality, its change and sleep duration with the risk of type 2 diabetes mellitus: findings from the English Longitudinal Study of Ageing","volume":"39","author":"Song","year":"2023","journal-title":"Diabetes Metab Res Rev"},{"key":"10.1016\/j.mayocp.2025.09.021_bib26","article-title":"Systemic inflammation, lifestyle behaviours and dementia: a 10-year follow-up investigation","volume":"38","author":"Hillari","year":"2024","journal-title":"Brain Behav Immun Health"},{"key":"10.1016\/j.mayocp.2025.09.021_bib27","article-title":"Association between weight-adjusted waist index and cardiometabolic multimorbidity in older adults: findings from the English Longitudinal Study of Ageing","author":"Kunutsor","year":"2025","journal-title":"Geroscience"},{"issue":"7","key":"10.1016\/j.mayocp.2025.09.021_bib28","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1111\/j.1464-5491.2009.02755.x","article-title":"Undiagnosed diabetes\u2014data from the English Longitudinal Study of Ageing","volume":"26","author":"Pierce","year":"2009","journal-title":"Diabet Med"},{"issue":"3","key":"10.1016\/j.mayocp.2025.09.021_bib29","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/j.jamda.2021.07.011","article-title":"Sex differences in the associations of handgrip strength and asymmetry with multimorbidity: evidence from the English Longitudinal Study of Ageing","volume":"23","author":"Liu","year":"2022","journal-title":"J Am Med Dir Assoc"},{"key":"10.1016\/j.mayocp.2025.09.021_bib30","series-title":"Regression Modeling Strategies: With Applications to Linear Models, Logistic Regression, and Survival Analysis","author":"Harrell","year":"2001"},{"issue":"5","key":"10.1016\/j.mayocp.2025.09.021_bib31","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1002\/sim.4780080504","article-title":"Flexible regression models with cubic splines","volume":"8","author":"Durrleman","year":"1989","journal-title":"Stat Med"},{"issue":"20","key":"10.1016\/j.mayocp.2025.09.021_bib32","doi-asserted-by":"crossref","first-page":"3735","DOI":"10.1002\/sim.2848","article-title":"Comparing smoothing techniques in Cox models for exposure-response relationships","volume":"26","author":"Govindarajulu","year":"2007","journal-title":"Stat Med"},{"issue":"6","key":"10.1016\/j.mayocp.2025.09.021_bib33","doi-asserted-by":"crossref","first-page":"e265","DOI":"10.1016\/S2666-7568(23)00054-5","article-title":"Cardiometabolic multimorbidity, lifestyle behaviours, and cognitive function: a multicohort study","volume":"4","author":"Jin","year":"2023","journal-title":"Lancet Healthy Longev"},{"issue":"8","key":"10.1016\/j.mayocp.2025.09.021_bib34","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1007\/s10654-011-9606-1","article-title":"Selection of confounding variables should not be based on observed associations with exposure","volume":"26","author":"Groenwold","year":"2011","journal-title":"Eur J Epidemiol"},{"issue":"3","key":"10.1016\/j.mayocp.2025.09.021_bib35","doi-asserted-by":"crossref","first-page":"837","DOI":"10.2307\/2531595","article-title":"Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach","volume":"44","author":"DeLong","year":"1988","journal-title":"Biometrics"},{"issue":"7","key":"10.1016\/j.mayocp.2025.09.021_bib36","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1161\/CIRCULATIONAHA.106.672402","article-title":"Use and misuse of the receiver operating characteristic curve in risk prediction","volume":"115","author":"Cook","year":"2007","journal-title":"Circulation"},{"issue":"5","key":"10.1016\/j.mayocp.2025.09.021_bib37","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.1016\/j.numecd.2023.12.024","article-title":"Visceral adiposity associated with incidence and development trajectory of cardiometabolic diseases: a prospective cohort study","volume":"34","author":"He","year":"2024","journal-title":"Nutr Metab Cardiovasc Dis"},{"issue":"7","key":"10.1016\/j.mayocp.2025.09.021_bib38","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1161\/CIRCRESAHA.121.318093","article-title":"Obesity, adipose tissue and vascular dysfunction","volume":"128","author":"Koenen","year":"2021","journal-title":"Circ Res"},{"issue":"21","key":"10.1016\/j.mayocp.2025.09.021_bib39","doi-asserted-by":"crossref","first-page":"e984","DOI":"10.1161\/CIR.0000000000000973","article-title":"Obesity and cardiovascular disease: a Scientific Statement from the American Heart Association","volume":"143","author":"Powell-Wiley","year":"2021","journal-title":"Circulation"},{"issue":"2","key":"10.1016\/j.mayocp.2025.09.021_bib40","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1038\/nri2921","article-title":"Adipokines in inflammation and metabolic disease","volume":"11","author":"Ouchi","year":"2011","journal-title":"Nat Rev Immunol"},{"issue":"11","key":"10.1016\/j.mayocp.2025.09.021_bib41","doi-asserted-by":"crossref","first-page":"1477","DOI":"10.1161\/CIRCRESAHA.120.316101","article-title":"obesity phenotypes, diabetes, and cardiovascular diseases","volume":"126","author":"Piche","year":"2020","journal-title":"Circ Res"},{"issue":"11","key":"10.1016\/j.mayocp.2025.09.021_bib42","doi-asserted-by":"crossref","first-page":"1150","DOI":"10.1001\/2012.jama.11132","article-title":"Dysfunctional adiposity and the risk of prediabetes and type 2 diabetes in obese adults","volume":"308","author":"Neeland","year":"2012","journal-title":"JAMA"},{"issue":"6","key":"10.1016\/j.mayocp.2025.09.021_bib43","doi-asserted-by":"crossref","first-page":"2595","DOI":"10.1210\/jc.2004-0372","article-title":"Obesity, metabolic syndrome, and cardiovascular disease","volume":"89","author":"Grundy","year":"2004","journal-title":"J Clin Endocrinol Metab"},{"issue":"14","key":"10.1016\/j.mayocp.2025.09.021_bib44","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1016\/j.jacc.2025.02.016","article-title":"Cardiac troponins and cardiovascular disease risk prediction: an individual-participant-data meta-analysis","volume":"85","author":"Shah","year":"2025","journal-title":"J Am Coll Cardiol"},{"issue":"1","key":"10.1016\/j.mayocp.2025.09.021_bib45","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1093\/eurjpc\/zwac176","article-title":"Including measures of chronic kidney disease to improve cardiovascular risk prediction by SCORE2 and SCORE2-OP","volume":"30","author":"Matsushita","year":"2023","journal-title":"Eur J Prev Cardiol"},{"key":"10.1016\/j.mayocp.2025.09.021_bib46","doi-asserted-by":"crossref","first-page":"785","DOI":"10.2147\/CLEP.S410971","article-title":"Agreement between self-reported information and health register data on chronic diseases in the oldest old","volume":"15","author":"Halonen","year":"2023","journal-title":"Clin Epidemiol"},{"issue":"1","key":"10.1016\/j.mayocp.2025.09.021_bib47","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1111\/j.1532-5415.2004.52021.x","article-title":"Agreement between self-report of disease diagnoses and medical record validation in disabled older women: factors that modify agreement","volume":"52","author":"Simpson","year":"2004","journal-title":"J Am Geriatr Soc"},{"issue":"5","key":"10.1016\/j.mayocp.2025.09.021_bib48","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1016\/j.mayocp.2019.12.030","article-title":"Prognostic relevance of cardiorespiratory fitness as assessed by submaximal exercise testing for all-cause mortality: a UK Biobank prospective study","volume":"95","author":"Laukkanen","year":"2020","journal-title":"Mayo Clin Proc"},{"key":"10.1016\/j.mayocp.2025.09.021_bib49","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.ejim.2023.05.007","article-title":"Contribution of low skeletal muscle mass in predicting cardiovascular events: a prospective cohort study","volume":"114","author":"Xu","year":"2023","journal-title":"Eur J Intern Med"},{"issue":"1-3","key":"10.1016\/j.mayocp.2025.09.021_bib50","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1080\/14779072.2024.2328644","article-title":"Physical activity, exercise and adverse cardiovascular outcomes in individuals with pre-existing cardiovascular disease: a narrative review","volume":"22","author":"Kunutsor","year":"2024","journal-title":"Expert Rev Cardiovasc Ther"},{"issue":"9","key":"10.1016\/j.mayocp.2025.09.021_bib51","doi-asserted-by":"crossref","first-page":"1631","DOI":"10.1016\/j.mayocp.2022.02.028","article-title":"Association of self-reported walking pace with type 2 diabetes incidence in the UK Biobank prospective cohort study","volume":"97","author":"Boonpor","year":"2022","journal-title":"Mayo Clin Proc"},{"issue":"1","key":"10.1016\/j.mayocp.2025.09.021_bib52","doi-asserted-by":"crossref","DOI":"10.1080\/14017431.2025.2550279","article-title":"Sleep duration and quality, physical activity and cardiometabolic multimorbidity: findings from the English Longitudinal Study of Ageing","volume":"59","author":"Kunutsor","year":"2025","journal-title":"Scand Cardiovasc J"}],"container-title":["Mayo Clinic Proceedings"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0025619625005725?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0025619625005725?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T08:53:13Z","timestamp":1780908793000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0025619625005725"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":51,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["S0025619625005725"],"URL":"https:\/\/doi.org\/10.1016\/j.mayocp.2025.09.021","relation":{},"ISSN":["0025-6196"],"issn-type":[{"value":"0025-6196","type":"print"}],"subject":[],"published":{"date-parts":[[2026,2]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Visceral Adiposity Index Is Associated With Cardiometabolic Multimorbidity and Improves Risk Prediction: The English Longitudinal Study of Ageing","name":"articletitle","label":"Article Title"},{"value":"Mayo Clinic Proceedings","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.mayocp.2025.09.021","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 The Authors. Published by Elsevier Inc on behalf of Mayo Foundation for Medical Education and Research.","name":"copyright","label":"Copyright"}]}}