Correlations between multiple obesity diagnostic criteria and fracture risk as well as cardiovascular diseases in patients with diabetes mellitus

OBJECTIVE: This study aimed to analyze the global disease burden of high body mass index (BMI) and to evaluate and compare the associations between three obesity diagnostic criteria-World Health Organization (WHO), European Association for the Study of Obesity (EASO), and American Obesity Association (AOU)-alongside the waist-to-height ratio (WHtR), with fracture risk and cardiovascular diseases (CVD) in a clinical population with diabetes mellitus. METHODS: Data on the high BMI burden in China and globally (1990-2021) were sourced from the Global Health Data Exchange (GHDx). A cross-sectional clinical study enrolled 17,949 diabetic participants from a single center in China. Obesity was diagnosed using WHO, EASO, and AOU criteria. Logistic regression models were employed to analyze the associations between WHtR (analyzed as both a continuous variable and by tertiles) and CVD, high-risk hip fracture (HRHF), and high-risk major osteoporotic fracture (HRMOF), with adjustments for multiple covariates including demographic, lifestyle, and metabolic factors. RESULTS: From 1990 to 2021, the age-standardized rate of high BMI in China increased by 146.22% (AAPC = 2.95%), exceeding the global increase of 70.89% (AAPC = 1.74%). In the clinical cohort, EASO criteria demonstrated significant associations with CVD. WHtR, as a continuous variable, was a significant risk factor for CVD and hip fracture (HF) across all models. When analyzed by tertiles, the highest WHtR tertile was associated with significantly increased risks of CVD (OR = 1.14, 95% CI: 1.04-1.25) and HF (OR = 1.83, 95% CI: 1.41-2.62) compared to the lowest tertile in fully adjusted models, showing a dose-response relationship. Restricted cubic spline models confirmed increases in risk with rising WHtR. CONCLUSION: The high BMI burden is rising markedly, especially in China. In this diabetic population, elevated WHtR was independently associated with higher risks of CVD and HF. Integrating WHtR into clinical practice could improve risk stratification for obesity-related comorbidities.