Evidence mapPaperPMID 42237293Full record

ArticleCardiovascular diabetology2026

Effects of adiposity, insulin resistance, and inflammation on cardiometabolic multimorbidity: insights from interaction analyses and metabolic phenotyping in the China health and retirement longitudinal study 2011-2018.

Lili You, Wenbo Zhao, Meiguang Zheng, Xiaosi Hong, Meng Ren, Wenpeng Li

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Article in Cardiovascular diabetology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

Authors and funding

6 authors.

Lili You *The Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Wenbo Zhao *The Department of Neurosurgery, Second Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China.
Meiguang Zheng *The Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Xiaosi HongThe Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Meng RenThe Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China. liwp7@mail.sysu.edu.cn.
Wenpeng LiThe Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China. renmeng@mail.sysu.edu.cn.

Funding

Guangdong Clinical Research Center for Metabolic Diseases 2020B1111170009Sun Yat-sen Pilot Scientific Research Fund SYSQH-II-2026-08
6 · The paper itself

Abstract

backgroundCardiometabolic multimorbidity (CMM) burdens aging populations. Obesity drives CMM via insulin resistance and inflammation, but their nonlinear and combined effects remain unclear. We elucidated how these factors contribute to CMM incidence.

methodsFrom CHARLS 2011 to 2018, 6,510 participants were enrolled. CMM was defined as ≥ 2 of diabetes, heart disease, and stroke. Cox regression, Kaplan-Meier, and Fine-Gray models were used. Restricted cubic splines (RCS) evaluated nonlinear relationships. Multiplicative and additive interactions were assessed, and mediation analysis with 1,000 bootstraps estimated indirect effects. K-means clustering based on eight standardized variables, including age, body mass index (BMI), waist circumference (WC), triglyceride-glucose (TyG), high-sensitivity C-reactive protein (hs-CRP), systolic blood pressure (SBP), high-density lipoprotein cholesterol (HDL-C), and fasting plasma glucose (FPG), identified metabolic phenotypes carried high CMM risk.

resultsOver 7 years, 212 (3.26%) developed CMM. RCS revealed a J-shaped association between WC and CMM. Optimal cut-offs were 60 years for age, 25.6 kg/m² for BMI, 90.6 cm for WC, 8.7 for the TyG index, 154.3 mg/dL for LDL-C, and 0.86 mg/L for hs-CRP. All six parameters independently predicted CMM. No significant additive interactions were found, but dual elevation markedly increased risk. The TyG index mediated 14.6% of the BMI effect and 10.0% of the WC effect on CMM. Clustering identified insulin-resistant and obese-insulin-resistant phenotypes.

conclusionOptimal cut-offs offer practical screening tools. Dual elevation markedly increases CMM risk and insulin resistance mediates adiposity effects. Clustering identified insulin-resistant and obese-insulin-resistant phenotypes, supporting phenotype-based prevention.

Indexed as

AdiposityCardiovascular DiseasesDiabetes MellitusInflammationInflammation MediatorsInsulin ResistanceMetabolic SyndromeObesityAgedAge FactorsBiomarkersBlood GlucoseCardiometabolic Risk FactorsChinaFemaleHumansBiomarkersBlood GlucoseInflammation MediatorsAdiposityCardiometabolic multimorbidity (CMM)Insulin resistanceK-means clusteringMetabolic phenotypes

Identifiers

PMID42237293
PMCPMC13459958

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.