TY - JOUR
T1 - The limb-to-waist ratio
T2 - resolving the divergence between mortality and cardiovascular risk
AU - Zuo, Shenghao
AU - Guo, Tongshuai
AU - Ren, Hui
AU - Cao, Hang
AU - Yang, Yanjie
AU - Wang, Ruiyu
AU - Liu, Chenyang
AU - Zhuo, Yan
AU - Xia, Tian
AU - Yuan, Xiao
AU - Chang, Mingke
AU - Hu, Guilin
AU - Sun, Yue
AU - Zhang, Xi
AU - Du, Mingfei
AU - Jia, Hao
AU - Man, Ziyue
AU - Zhang, Teng
AU - Mu, Jianjun
AU - Zuo, Mei
N1 - Publisher Copyright:
Copyright © The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
PY - 2026
Y1 - 2026
N2 - Aim: We aimed to resolve the paradoxical associations of limb circumference—inverse with mortality but positive with cardiovascular risk factors (CVRFs)—by systematically comparing the predictive value of the ratio of combined arm and thigh circumference (ATC) to waist circumference (WC) against that of the sum of ATC for mortality and key CVRFs. Methods: Our analysis utilized data from 17,276 U.S. participants in the 1999-2006 NHANES (National Health and Nutrition Examination Survey). We utilized Cox proportional hazards, generalized linear, and restricted cubic spline models, with comprehensive adjustment for confounders including adiposity. The outcomes assessed were all-cause and cardiovascular mortality, hypertension, diabetes, and resting tachycardia. Results: During median 18.04-year follow-up (3,927 deaths, 1,047 cardiovascular deaths), the highest versus lowest ATC/WC quartile showed consistently protective associations: all-cause mortality (hazard ratio (HR) = 0.47, 95% confidence interval (95%CI): 0.38-0.57), cardiovascular mortality (HR = 0.32, 0.21-0.49), hypertension (OR = 0.49, 0.41-0.59), diabetes (odds ratio (OR) = 0.26, 0.18-0.37), and resting tachycardia (OR = 0.28, 0.19-0.39; all P < 0.001). Conversely, ATC exhibited adiposity-dependent paradoxical associations: protective for mortality but harmful for CVRFs when unadjusted for adiposity. After adiposity adjustment, ATC's harmful CVRFs associations were attenuated or reversed, while mortality benefits persisted. ATC/WC demonstrated superior linearity in dose-response relationships compared to ATC. Conclusion: The ATC/WC ratio consistently demonstrates protective associations with both mortality and CVRFs. The waist standardization approach clarifies the relationship between limb measurements, cardiovascular health, and mortality by adjusting for central adiposity-related confounding that limits the utility of absolute rather than relative peripheral limb measurements.
AB - Aim: We aimed to resolve the paradoxical associations of limb circumference—inverse with mortality but positive with cardiovascular risk factors (CVRFs)—by systematically comparing the predictive value of the ratio of combined arm and thigh circumference (ATC) to waist circumference (WC) against that of the sum of ATC for mortality and key CVRFs. Methods: Our analysis utilized data from 17,276 U.S. participants in the 1999-2006 NHANES (National Health and Nutrition Examination Survey). We utilized Cox proportional hazards, generalized linear, and restricted cubic spline models, with comprehensive adjustment for confounders including adiposity. The outcomes assessed were all-cause and cardiovascular mortality, hypertension, diabetes, and resting tachycardia. Results: During median 18.04-year follow-up (3,927 deaths, 1,047 cardiovascular deaths), the highest versus lowest ATC/WC quartile showed consistently protective associations: all-cause mortality (hazard ratio (HR) = 0.47, 95% confidence interval (95%CI): 0.38-0.57), cardiovascular mortality (HR = 0.32, 0.21-0.49), hypertension (OR = 0.49, 0.41-0.59), diabetes (odds ratio (OR) = 0.26, 0.18-0.37), and resting tachycardia (OR = 0.28, 0.19-0.39; all P < 0.001). Conversely, ATC exhibited adiposity-dependent paradoxical associations: protective for mortality but harmful for CVRFs when unadjusted for adiposity. After adiposity adjustment, ATC's harmful CVRFs associations were attenuated or reversed, while mortality benefits persisted. ATC/WC demonstrated superior linearity in dose-response relationships compared to ATC. Conclusion: The ATC/WC ratio consistently demonstrates protective associations with both mortality and CVRFs. The waist standardization approach clarifies the relationship between limb measurements, cardiovascular health, and mortality by adjusting for central adiposity-related confounding that limits the utility of absolute rather than relative peripheral limb measurements.
KW - Arm circumference
KW - body composition
KW - cardiovascular risk factors
KW - mortality
KW - thigh circumference
KW - waist circumference
UR - https://www.scopus.com/pages/publications/105043643844
U2 - 10.20517/2574-1209.2025.147
DO - 10.20517/2574-1209.2025.147
M3 - 文章
AN - SCOPUS:105043643844
SN - 2574-1209
VL - 10
JO - Vessel Plus
JF - Vessel Plus
M1 - 19
ER -
可持续发展目标 3 良好健康与福祉