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Background <p>The association between relative fat mass (RFM), a sex-specific adiposity index derived from waist circumference and height, and incident cardiovascular diseases (CVDs) remains underexplored in Chinese populations. This study aimed to evaluate the predictive value of RFM for CVD risk in Chinese adults, addressing a gap in evidence for Asian cohorts with unique adiposity patterns.</p> Methods <p>We analyzed 7,027 adults aged≥45 years without baseline CVD from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2020). RFM was calculated using validated sex-specific equations. Cox regression models assessed RFM-CVD associations, with comprehensive subgroup analyses conducted to evaluate effect modification. The incremental predictive value of RFM beyond conventional Framingham risk factors was evaluated using area under the curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). </p> Results <p>Over a median 9-year follow-up, 24.6% participants developed CVDs. Each 1-unit RFM increase conferred a 3% higher CVD risk (adjusted HR=1.03, 95% CI: 1.02-1.05). Participants in the highest RFM quartile had 46% greater CVD risk versus the lowest quartile (adjusted HR=1.46, 95% CI: 1.05-2.03; <i>P</i>-trend=0.004). Sex-stratified analyses revealed consistent associations in both genders, though stronger effects were observed in males. Subgroup analyses confirmed robust associations across age groups and those without comorbidities. RFM significantly improved CVD prediction when added to Framingham risk factors (AUC 0.640 vs. 0.634; NRI=0.140, IDI=0.004; <i>P</i>&lt;0.001).</p> Conclusions <p>Higher RFM independently predicts incident CVDs in Chinese adults and enhances conventional risk stratification. RFM represents a practical anthropometric index for CVD prevention in clinical and public health settings, particularly valuable for resource-limited environments.</p>

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Relative fat mass and cardiovascular risk in Chinese adults: a nationwide prospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月13日

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  • Fang Wang,
  • Xingliang Li,
  • Long Wang,
  • Jingang Zheng

摘要

Background

The association between relative fat mass (RFM), a sex-specific adiposity index derived from waist circumference and height, and incident cardiovascular diseases (CVDs) remains underexplored in Chinese populations. This study aimed to evaluate the predictive value of RFM for CVD risk in Chinese adults, addressing a gap in evidence for Asian cohorts with unique adiposity patterns.

Methods

We analyzed 7,027 adults aged≥45 years without baseline CVD from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2020). RFM was calculated using validated sex-specific equations. Cox regression models assessed RFM-CVD associations, with comprehensive subgroup analyses conducted to evaluate effect modification. The incremental predictive value of RFM beyond conventional Framingham risk factors was evaluated using area under the curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI).

Results

Over a median 9-year follow-up, 24.6% participants developed CVDs. Each 1-unit RFM increase conferred a 3% higher CVD risk (adjusted HR=1.03, 95% CI: 1.02-1.05). Participants in the highest RFM quartile had 46% greater CVD risk versus the lowest quartile (adjusted HR=1.46, 95% CI: 1.05-2.03; P-trend=0.004). Sex-stratified analyses revealed consistent associations in both genders, though stronger effects were observed in males. Subgroup analyses confirmed robust associations across age groups and those without comorbidities. RFM significantly improved CVD prediction when added to Framingham risk factors (AUC 0.640 vs. 0.634; NRI=0.140, IDI=0.004; P<0.001).

Conclusions

Higher RFM independently predicts incident CVDs in Chinese adults and enhances conventional risk stratification. RFM represents a practical anthropometric index for CVD prevention in clinical and public health settings, particularly valuable for resource-limited environments.