Anthropometric indices and mortality in postmenopausal women: NHANES 1999-2018 evidence

Limited research has focused on how anthropometric measures relate to mortality risk, specifically among postmenopausal women. Our study aimed to explore the association between anthropometric indices and risks of all-cause and cardiovascular mortality in American postmenopausal women.

Data from the NHANES cycles 1999-2018 were extracted. Firstly, weighted multivariable Cox proportional hazards models and restricted cubic splines (RCS) were used to detect the association between six body indicators, including body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), a body shape index (ABSI), body roundness index (BRI), and weight-adjusted waist index (WWI), and all-cause and CVD mortality risk in postmenopausal women. Furthermore, the predictive power of different anthropometric indices for mortality was assessed by time-dependent receiver operator characteristic (ROC) curves. Subgroup and sensitivity analyses were further employed to evaluate the consistency and robustness of the findings.

During an average follow-up of 10.04 years, 2522 deaths were reported from any cause, and 783 participants died of CVD in total. A fully adjusted multivariate Cox regression model indicated a significant positive association between WWI and ABSI and all-cause and CVD mortality in postmenopausal Americans. The RCS revealed a significant nonlinear relationship between BRI and WC and all-cause mortality, whereas the relationships between WWI and ABSI and CVD/all-cause mortality were positively linear. For all-cause mortality prediction, WWI outperformed other anthropometric parameters, with an AUC of 0.616 (95% CI 0.594-0.637) for 5 year, 0.624 (95% CI 0.608-0.640) for 10-year, and 0.641 (95% CI 0.624-0.658) for 15-year. Consistently, WWI showed the highest AUC of 0.642 (95% CI 0.605-0.679), 0.656 (95% CI 0.631-0.681)and 0.675 (95% CI 0.651-0.699) when predicting 5-year, 10-year and 15-year CVD mortality, respectively. Subgroup and sensitivity analyses confirmed the stability and robustness of our findings.

Higher ABSI and WWI values were linearly associated with increased all-cause and CVD mortality in postmenopausal women in the U.S. WWI and ABSI anthropometric indicators may be useful tools to detect CVD and all-cause mortality risks and to support early intervention strategies for individuals after menopause in clinical practice.