Visceral adiposity index, premature mortality, and life expectancy in US adults

Abstract Importance Visceral adiposity index (VAI) vividly reflects body fat distribution through comprehensively integrating body mass index, sex, waist circumference, triglycerides, and high-density lipoprotein cholesterol. While VAI is an established predictor of various clinical outcomes, its re...

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Main Authors: Mei Xue, Xiaoqian Zhang, Kening Chen, Fangjieyi Zheng, Bochun Wang, Qiushi Lin, Zhixin Zhang, Xiaoqun Dong, Wenquan Niu
Format: Article
Language:English
Published: BMC 2025-04-01
Series:Lipids in Health and Disease
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Online Access:https://doi.org/10.1186/s12944-025-02560-3
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author Mei Xue
Xiaoqian Zhang
Kening Chen
Fangjieyi Zheng
Bochun Wang
Qiushi Lin
Zhixin Zhang
Xiaoqun Dong
Wenquan Niu
author_facet Mei Xue
Xiaoqian Zhang
Kening Chen
Fangjieyi Zheng
Bochun Wang
Qiushi Lin
Zhixin Zhang
Xiaoqun Dong
Wenquan Niu
author_sort Mei Xue
collection DOAJ
description Abstract Importance Visceral adiposity index (VAI) vividly reflects body fat distribution through comprehensively integrating body mass index, sex, waist circumference, triglycerides, and high-density lipoprotein cholesterol. While VAI is an established predictor of various clinical outcomes, its relationship with premature mortality and life expectancy remains unclear. Objective To explore the association between VAI and premature mortality or life expectancy in a nationally representative cohort of US adults. Methods This study included adults who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018, linked to the National Death Index through December 31, 2019. Data were analyzed from August to October, 2024. VAI was categorized into quartiles from the lowest Q1 to the highest Q4. Primary endpoints were premature mortality (death before 80 years of age) and life expectancy. Results A total of 43,672 participants (women: 22,164; men: 21,508) aged > 20 years were included. Over a median follow-up of 9.2 years (IQR: 4.9–13.8), 3,187 premature deaths were documented. Higher VAI quartiles were significantly associated with increased multi-adjusted premature mortality risk compared to Q1 (Q3 vs. Q1: hazard ratio [HR], 95% confidence interval [CI]: 1.30, 1.05 to 1.61; Q4 vs. Q1: 1.68, 1.34 to 2.11). This association was particularly pronounced in women (Q3 vs. Q1: 1.53, 1.01 to 2.30; Q4 vs. Q1: 2.36, 1.52 to 3.68), with significant linear trends (P < 0.001). Estimated life expectancy at age 40 years was 41.45 (95% CI: 41.24 to 41.66), 41.32 (41.11 to 41.53), 40.55 (40.35 to 40.75), and 39.26 (39.08 to 39.45) years in Q1, Q2, Q3, and Q4 of VAI, respectively. By sex, estimated life expectancy at age 40 in Q4 was reduced by 3.33 years in women and 1.24 years in men, compared to Q1. By race and ethnicity, it was shortened by 3.90 years in Black participants and 1.68 years in White participants in Q4 group, compared to Q1. Conclusions In this nationwide cohort study, higher VAI was significantly associated with an increased risk of premature mortality and reduced life expectancy at age 40 among US adults. These associations we heterogeneous by sex, race and ethnicity, more pronounced in women and Black participants.
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spelling doaj-art-9a5abde7d4fe4a3ca8752c1765178d812025-08-20T02:28:11ZengBMCLipids in Health and Disease1476-511X2025-04-0124111910.1186/s12944-025-02560-3Visceral adiposity index, premature mortality, and life expectancy in US adultsMei Xue0Xiaoqian Zhang1Kening Chen2Fangjieyi Zheng3Bochun Wang4Qiushi Lin5Zhixin Zhang6Xiaoqun Dong7Wenquan Niu8Graduate School, Beijing University of Chinese MedicineGraduate School, Beijing University of Chinese MedicineInstitute of Clinical Medical Sciences, China-Japan Friendship HospitalCenter for Evidence-Based Medicine, Capital Institute of PediatricsNortheast Forestry UniversityDepartment of Radiology, College of Human Medicine, Precision Health Program, Michigan State UniversityInstitute of Clinical Medical Sciences, China-Japan Friendship HospitalDepartment of Radiology, College of Human Medicine, Precision Health Program, Michigan State UniversityCenter for Evidence-Based Medicine, Capital Institute of PediatricsAbstract Importance Visceral adiposity index (VAI) vividly reflects body fat distribution through comprehensively integrating body mass index, sex, waist circumference, triglycerides, and high-density lipoprotein cholesterol. While VAI is an established predictor of various clinical outcomes, its relationship with premature mortality and life expectancy remains unclear. Objective To explore the association between VAI and premature mortality or life expectancy in a nationally representative cohort of US adults. Methods This study included adults who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018, linked to the National Death Index through December 31, 2019. Data were analyzed from August to October, 2024. VAI was categorized into quartiles from the lowest Q1 to the highest Q4. Primary endpoints were premature mortality (death before 80 years of age) and life expectancy. Results A total of 43,672 participants (women: 22,164; men: 21,508) aged > 20 years were included. Over a median follow-up of 9.2 years (IQR: 4.9–13.8), 3,187 premature deaths were documented. Higher VAI quartiles were significantly associated with increased multi-adjusted premature mortality risk compared to Q1 (Q3 vs. Q1: hazard ratio [HR], 95% confidence interval [CI]: 1.30, 1.05 to 1.61; Q4 vs. Q1: 1.68, 1.34 to 2.11). This association was particularly pronounced in women (Q3 vs. Q1: 1.53, 1.01 to 2.30; Q4 vs. Q1: 2.36, 1.52 to 3.68), with significant linear trends (P < 0.001). Estimated life expectancy at age 40 years was 41.45 (95% CI: 41.24 to 41.66), 41.32 (41.11 to 41.53), 40.55 (40.35 to 40.75), and 39.26 (39.08 to 39.45) years in Q1, Q2, Q3, and Q4 of VAI, respectively. By sex, estimated life expectancy at age 40 in Q4 was reduced by 3.33 years in women and 1.24 years in men, compared to Q1. By race and ethnicity, it was shortened by 3.90 years in Black participants and 1.68 years in White participants in Q4 group, compared to Q1. Conclusions In this nationwide cohort study, higher VAI was significantly associated with an increased risk of premature mortality and reduced life expectancy at age 40 among US adults. These associations we heterogeneous by sex, race and ethnicity, more pronounced in women and Black participants.https://doi.org/10.1186/s12944-025-02560-3Visceral adiposity indexPremature mortalityLife expectancy
spellingShingle Mei Xue
Xiaoqian Zhang
Kening Chen
Fangjieyi Zheng
Bochun Wang
Qiushi Lin
Zhixin Zhang
Xiaoqun Dong
Wenquan Niu
Visceral adiposity index, premature mortality, and life expectancy in US adults
Lipids in Health and Disease
Visceral adiposity index
Premature mortality
Life expectancy
title Visceral adiposity index, premature mortality, and life expectancy in US adults
title_full Visceral adiposity index, premature mortality, and life expectancy in US adults
title_fullStr Visceral adiposity index, premature mortality, and life expectancy in US adults
title_full_unstemmed Visceral adiposity index, premature mortality, and life expectancy in US adults
title_short Visceral adiposity index, premature mortality, and life expectancy in US adults
title_sort visceral adiposity index premature mortality and life expectancy in us adults
topic Visceral adiposity index
Premature mortality
Life expectancy
url https://doi.org/10.1186/s12944-025-02560-3
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