{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T14:08:25Z","timestamp":1787062105755,"version":"build-2736575974"},"reference-count":45,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2022,10,14]],"date-time":"2022-10-14T00:00:00Z","timestamp":1665705600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The National Key Research and Development Program \u201cResearch on prevention and control of major chronic non-communicable diseases\u201d of China","award":["Grant NO: 2017YFC1307705"],"award-info":[{"award-number":["Grant NO: 2017YFC1307705"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Previous studies have explored the relationship between body mass index (BMI) and multimorbidity. However, the relationship between other obesity indicators and their dynamic changes and multimorbidity has not been systematically estimated. Therefore, we aimed to investigate the association of BMI and other obesity indicators, including waist circumference (WC), waist-to-height ratio (WHtR), waist divided by height\n                      <jats:sup>0.5<\/jats:sup>\n                      (WHT.5R), and body roundness index (BRI) and their changes and the risk of multimorbidity in middle-aged and older adults through a retrospective cohort study.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data collected from annual health examination dataset in the Jinshui during 2017 and 2021. Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) to evaluate the effect of baseline and dynamic changes in the anthropometric indices on the risk of multimorbidity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 75,028 individuals were included in the study, and 5,886 participants developed multimorbidity during the follow-up. Multivariate Cox regression analysis revealed a progressive increase in the risk of multimorbidity with increasing anthropometric indicators (BMI, WC, WHtR, WHT.5R, and BRI) (all\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001). Regardless of general obesity status at baseline, increased WC was associated with a high risk of multimorbidity. Compared to the subjects with baseline BMI&lt;24 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      and WC&lt;90 (men)\/80 (women), the HRs (95% CI) of the baseline BMI&lt;24 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      and WC\u226590 (men)\/80 (women) group and BMI\u226524 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      and WC\u226590 (men)\/80 (women) group were 1.31 (1.08, 1.61) and 1.82 (1.68, 1.97), respectively. In addition, the dynamics of WC could reflect the risk of multimorbidity. When subjects with baseline WC&lt;90 (men)\/80 (women) progressed to WC\u226590 (men)\/80 (women) during follow-up, the risk of multimorbidity significantly increased (HR = 1.78; 95% CI, 1.64, 1.95), while the risk of multimorbidity tended to decrease when people with abnormal WC at baseline reversed to normal at follow-up (HR = 1.40; 95% CI, 1.26, 1.54) compared to those who still exhibited abnormal WC at follow-up (HR = 2.00; 95% CI, 1.82, 2.18).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Central obesity is an independent and alterable risk factor for the occurrence of multimorbidity in middle-aged and elderly populations. In addition to the clinical measurement of BMI, the measurement of the central obesity index WC may provide additional benefits for the identification of multimorbidity in the Chinese middle-aged and elderly populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0276216","type":"journal-article","created":{"date-parts":[[2022,10,14]],"date-time":"2022-10-14T13:47:45Z","timestamp":1665755265000},"page":"e0276216","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":16,"title":["Association of anthropometric indices with the development of multimorbidity in middle-aged and older adults: A retrospective cohort study"],"prefix":"10.1371","volume":"17","author":[{"given":"Shuoji","family":"Geng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuejiao","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhan","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaizhi","family":"Bai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2214-1440","authenticated-orcid":true,"given":"Songhe","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,10,14]]},"reference":[{"issue":"10131","key":"pone.0276216.ref001","doi-asserted-by":"crossref","first-page":"1637","DOI":"10.1016\/S0140-6736(18)30941-3","article-title":"Making more of multimorbidity: an emerging priority","volume":"391","author":"L. The","year":"2018","journal-title":"Lancet"},{"issue":"4","key":"pone.0276216.ref002","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/j.arr.2011.03.003","article-title":"Aging with multimorbidity: a systematic review of the literature","volume":"10","author":"A Marengoni","year":"2011","journal-title":"Ageing Res Rev"},{"issue":"5","key":"pone.0276216.ref003","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1016\/j.mayocp.2015.02.006","article-title":"Health-enhancing multibehavior and medical multimorbidity","volume":"90","author":"PD Loprinzi","year":"2015","journal-title":"Mayo Clin Proc"},{"issue":"1","key":"pone.0276216.ref004","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1186\/s12955-017-0806-6","article-title":"Individual diseases or clustering of health conditions? Association between multiple chronic diseases and health-related quality of life in adults","volume":"15","author":"DA Gonzalez-Chica","year":"2017","journal-title":"Health Qual Life Outcomes"},{"key":"pone.0276216.ref005","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.archger.2016.07.008","article-title":"Multimorbidity and mortality in older adults: A systematic review and meta-analysis","volume":"67","author":"BP Nunes","year":"2016","journal-title":"Arch Gerontol Geriatr"},{"issue":"10","key":"pone.0276216.ref006","doi-asserted-by":"crossref","first-page":"2579","DOI":"10.1007\/s11136-016-1282-x","article-title":"Predictors of health-related quality of life in people with a complex chronic disease including multimorbidity: a longitudinal cohort study","volume":"25","author":"Z Tyack","year":"2016","journal-title":"Qual Life Res"},{"issue":"582","key":"pone.0276216.ref007","doi-asserted-by":"crossref","first-page":"e12","DOI":"10.3399\/bjgp11X548929","article-title":"Epidemiology and impact of multimorbidity in primary care: a retrospective cohort study","volume":"61","author":"C Salisbury","year":"2011","journal-title":"Br J Gen Pract"},{"issue":"19","key":"pone.0276216.ref008","doi-asserted-by":"crossref","first-page":"2149","DOI":"10.1016\/j.jacc.2018.03.022","article-title":"Multimorbidity in Older Adults With Cardiovascular Disease","volume":"71","author":"DE Forman","year":"2018","journal-title":"J Am Coll Cardiol"},{"issue":"10","key":"pone.0276216.ref009","doi-asserted-by":"crossref","first-page":"e456","DOI":"10.1016\/S2468-2667(18)30187-7","article-title":"Public health in China: achievements and future challenges","volume":"3","author":"H. The Lancet Public","year":"2018","journal-title":"Lancet Public Health"},{"issue":"8","key":"pone.0276216.ref010","doi-asserted-by":"crossref","first-page":"e024268","DOI":"10.1136\/bmjopen-2018-024268","article-title":"Prevalence and patterns of multimorbidity among the elderly in China: a cross-sectional study using national survey data","volume":"9","author":"R Zhang","year":"2019","journal-title":"BMJ Open"},{"issue":"6","key":"pone.0276216.ref011","doi-asserted-by":"crossref","first-page":"e277","DOI":"10.1016\/S2468-2667(17)30074-9","article-title":"Overweight, obesity, and risk of cardiometabolic multimorbidity: pooled analysis of individual-level data for 120 813 adults from 16 cohort studies from the USA and Europe","volume":"2","author":"M Kivimaki","year":"2017","journal-title":"Lancet Public Health"},{"issue":"11","key":"pone.0276216.ref012","doi-asserted-by":"crossref","first-page":"827","DOI":"10.7326\/M14-2525","article-title":"Normal-Weight Central Obesity: Implications for Total and Cardiovascular Mortality","volume":"163","author":"KR Sahakyan","year":"2015","journal-title":"Ann Intern Med"},{"issue":"10046","key":"pone.0276216.ref013","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1016\/S0140-6736(16)30175-1","article-title":"Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents","volume":"388","author":"Global BMIMC","year":"2016","journal-title":"Lancet"},{"key":"pone.0276216.ref014","doi-asserted-by":"crossref","first-page":"105737","DOI":"10.1016\/j.jsbmb.2020.105737","article-title":"Abdominal Obesity, Adipokines and Non-communicable Diseases","volume":"203","author":"D Dhawan","year":"2020","journal-title":"J Steroid Biochem Mol Biol"},{"issue":"1","key":"pone.0276216.ref015","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1186\/s12889-021-11421-4","article-title":"An assessment of anthropometric indices and its association with NCDs among the older adults of India: evidence from LASI Wave-1","volume":"21","author":"M Bramhankar","year":"2021","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0276216.ref016","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1038\/s41598-017-18854-1","article-title":"Body mass index, waist circumference, and waist-to-height ratio for prediction of multiple metabolic risk factors in Chinese elderly population","volume":"8","author":"Z Gu","year":"2018","journal-title":"Sci Rep"},{"issue":"3","key":"pone.0276216.ref017","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1111\/j.1467-789X.2011.00952.x","article-title":"Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis","volume":"13","author":"M Ashwell","year":"2012","journal-title":"Obes Rev"},{"issue":"11","key":"pone.0276216.ref018","doi-asserted-by":"crossref","first-page":"1470","DOI":"10.1111\/sms.12780","article-title":"Scaling waist girth for differences in body size reveals a new improved index associated with cardiometabolic risk","volume":"27","author":"AM Nevill","year":"2017","journal-title":"Scand J Med Sci Sports"},{"issue":"11","key":"pone.0276216.ref019","doi-asserted-by":"crossref","first-page":"2264","DOI":"10.1002\/oby.20408","article-title":"Relationships between body roundness with body fat and visceral adipose tissue emerging from a new geometrical model","volume":"21","author":"DM Thomas","year":"2013","journal-title":"Obesity (Silver Spring)"},{"key":"pone.0276216.ref020","doi-asserted-by":"crossref","first-page":"801582","DOI":"10.3389\/fnut.2022.801582","article-title":"Body Roundness Index and Waist-Hip Ratio Result in Better Cardiovascular Disease Risk Stratification: Results From a Large Chinese Cross-Sectional Study","volume":"9","author":"Y Li","year":"2022","journal-title":"Front Nutr"},{"issue":"3","key":"pone.0276216.ref021","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1093\/ajcn\/nqab412","article-title":"Associations of longitudinal trajectories in body roundness index with mortality and cardiovascular outcomes: a cohort study","volume":"115","author":"M Wu","year":"2022","journal-title":"Am J Clin Nutr"},{"issue":"1","key":"pone.0276216.ref022","first-page":"83","article-title":"Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults\u2014study on optimal cut-off points of body mass index and waist circumference in Chinese adults","volume":"15","author":"Cooperative Meta-Analysis Group of the Working Group on Obesity in C","year":"2002","journal-title":"Biomed Environ Sci"},{"issue":"9","key":"pone.0276216.ref023","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1001\/jama.2013.168118","article-title":"Prevalence and control of diabetes in Chinese adults","volume":"310","author":"Y Xu","year":"2013","journal-title":"JAMA"},{"issue":"7","key":"pone.0276216.ref024","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1016\/j.mayocp.2018.02.012","article-title":"Patterns of Multimorbidity in Middle-Aged and Older Adults: An Analysis of the UK Biobank Data","volume":"93","author":"DT Zemedikun","year":"2018","journal-title":"Mayo Clin Proc"},{"issue":"10","key":"pone.0276216.ref025","doi-asserted-by":"crossref","first-page":"1974","DOI":"10.1093\/gerona\/glz185","article-title":"Prevalence and Patterns of Multimorbidity in a Nationally Representative Sample of Older Chinese: Results From the China Health and Retirement Longitudinal Study","volume":"75","author":"SS Yao","year":"2020","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"pone.0276216.ref026","doi-asserted-by":"crossref","first-page":"m127","DOI":"10.1136\/bmj.m127","article-title":"Algorithm based smartphone apps to assess risk of skin cancer in adults: systematic review of diagnostic accuracy studies","volume":"368","author":"K Freeman","year":"2020","journal-title":"BMJ"},{"issue":"10","key":"pone.0276216.ref027","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1017\/S0007114517002859","article-title":"Prediction of a new body shape index and body adiposity estimator for development of type 2 diabetes mellitus: The Rural Chinese Cohort Study","volume":"118","author":"C Han","year":"2017","journal-title":"Br J Nutr"},{"issue":"10","key":"pone.0276216.ref028","doi-asserted-by":"crossref","first-page":"2232","DOI":"10.1002\/oby.21612","article-title":"Body mass index and all-cause mortality among older adults","volume":"24","author":"FW Cheng","year":"2016","journal-title":"Obesity (Silver Spring)"},{"key":"pone.0276216.ref029","first-page":"17683","article-title":"The relationship between multimorbidity, obesity and functional impairment in older adults","author":"DH Lynch","year":"2022","journal-title":"J Am Geriatr Soc"},{"issue":"2","key":"pone.0276216.ref030","doi-asserted-by":"crossref","first-page":"e89","DOI":"10.1093\/gerona\/glab116","article-title":"Multimorbidity Accumulation Among Middle-Aged Americans: Differences by Race\/Ethnicity and Body Mass Index","volume":"77","author":"A Botoseneanu","year":"2022","journal-title":"J Gerontol A Biol Sci Med Sci"},{"issue":"5","key":"pone.0276216.ref031","doi-asserted-by":"crossref","first-page":"e036664","DOI":"10.1136\/bmjopen-2019-036664","article-title":"Association between obesity-related anthropometric indices and multimorbidity among older adults in Shandong, China: a cross-sectional study","volume":"10","author":"J Zhang","year":"2020","journal-title":"BMJ Open"},{"issue":"1","key":"pone.0276216.ref032","doi-asserted-by":"crossref","first-page":"e12947","DOI":"10.1111\/obr.12947","article-title":"Optimum waist circumference-height indices for evaluating adult adiposity: An analytic review","volume":"21","author":"P Hwaung","year":"2020","journal-title":"Obes Rev"},{"issue":"9","key":"pone.0276216.ref033","doi-asserted-by":"crossref","first-page":"e0183934","DOI":"10.1371\/journal.pone.0183934","article-title":"Prevalence of overweight, obesity, abdominal obesity and obesity-related risk factors in southern China","volume":"12","author":"L Hu","year":"2017","journal-title":"PLoS One"},{"issue":"6","key":"pone.0276216.ref034","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1017\/S136898001700338X","article-title":"Predicting cardiometabolic disturbances from waist-to-height ratio: findings from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline","volume":"21","author":"M Castanheira","year":"2018","journal-title":"Public Health Nutr"},{"issue":"11","key":"pone.0276216.ref035","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.1038\/ijo.2011.268","article-title":"Body mass index versus waist circumference as predictors of mortality in Canadian adults","volume":"36","author":"AE Staiano","year":"2012","journal-title":"Int J Obes (Lond)"},{"key":"pone.0276216.ref036","doi-asserted-by":"crossref","first-page":"1745","DOI":"10.3389\/fimmu.2017.01745","article-title":"Aging, Obesity, and Inflammatory Age-Related Diseases","volume":"8","author":"D Frasca","year":"2017","journal-title":"Front Immunol"},{"issue":"4","key":"pone.0276216.ref037","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1161\/HYPERTENSIONAHA.108.110320","article-title":"Visceral obesity: the link among inflammation, hypertension, and cardiovascular disease","volume":"53","author":"P Mathieu","year":"2009","journal-title":"Hypertension"},{"issue":"3","key":"pone.0276216.ref038","doi-asserted-by":"crossref","first-page":"463","DOI":"10.5114\/aoms.2015.52350","article-title":"Central obesity, type 2 diabetes and insulin: exploring a pathway full of thorns","volume":"11","author":"GS Papaetis","year":"2015","journal-title":"Arch Med Sci"},{"issue":"3","key":"pone.0276216.ref039","doi-asserted-by":"crossref","first-page":"R63","DOI":"10.1530\/JOE-14-0368","article-title":"Obesity-related hypertension: possible pathophysiological mechanisms","volume":"223","author":"I Vaneckova","year":"2014","journal-title":"J Endocrinol"},{"issue":"9","key":"pone.0276216.ref040","doi-asserted-by":"crossref","first-page":"3340","DOI":"10.1210\/JC.2014-4479","article-title":"Abdominal Fat Distribution and Cardiovascular Risk in Men and Women With Different Levels of Glucose Tolerance","volume":"100","author":"SH Scheuer","year":"2015","journal-title":"J Clin Endocrinol Metab"},{"key":"pone.0276216.ref041","doi-asserted-by":"crossref","first-page":"16008","DOI":"10.1038\/nrdp.2016.8","article-title":"Kidney stones","volume":"2","author":"SR Khan","year":"2016","journal-title":"Nat Rev Dis Primers"},{"issue":"1","key":"pone.0276216.ref042","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1038\/s41467-018-08159-w","article-title":"Central body fatness is a stronger predictor of cancer risk than overall body size","volume":"10","author":"AM Barberio","year":"2019","journal-title":"Nat Commun"},{"issue":"1","key":"pone.0276216.ref043","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.jand.2017.08.024","article-title":"Diet Quality as Assessed by the Healthy Eating Index, Alternate Healthy Eating Index, Dietary Approaches to Stop Hypertension Score, and Health Outcomes: An Updated Systematic Review and Meta-Analysis of Cohort Studies","volume":"118","author":"L Schwingshackl","year":"2018","journal-title":"J Acad Nutr Diet"},{"key":"pone.0276216.ref044","doi-asserted-by":"crossref","first-page":"106816","DOI":"10.1016\/j.ypmed.2021.106816","article-title":"Multimorbidity and obesity in older adults from six low- and middle-income countries","volume":"153","author":"E Romano","year":"2021","journal-title":"Prev Med"},{"issue":"1","key":"pone.0276216.ref045","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1186\/s12916-019-1339-0","article-title":"Physical activity, multimorbidity, and life expectancy: a UK Biobank longitudinal study","volume":"17","author":"YV Chudasama","year":"2019","journal-title":"BMC Med"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0276216","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,14]],"date-time":"2022-10-14T13:48:49Z","timestamp":1665755329000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0276216"}},"subtitle":[],"editor":[{"given":"Alvaro","family":"Reischak-Oliveira","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,10,14]]},"references-count":45,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,10,14]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0276216","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,14]]}}}