Abstract
BACKGROUND AND OBJECTIVE: A Body Shape Index (ABSI) serves as a potential indicator of fat distribution, offering a more reliable association with all-cause mortality compared to overall adiposity. The present cohort study aims to explore the relationship between ABSI and all-cause mortality in US adults with Type 2 Diabetes (T2D). METHODS: For this cohort study, we extracted information on 5,461 US adults with T2D from the National Health and Nutrition Examination Survey (NHANES) and the NHANES Linked Mortality File. Trends in ABSI from 1999 to 2018 were calculated and analyzed using partial Mann-Kendall tests. To assess the relationship between ABSI and all-cause mortality, as well as the robustness of the association results, we employed weighted restricted cubic splines (RCS), weighted Cox proportional hazards models, sensitivity analyses, and stratified analyses. Additionally, we conducted time-dependent receiver operating characteristic (ROC) curve analysis to evaluate ABSI's predictive capability for all-cause mortality over 3, 5, and 10 years. RESULTS: Among US adults with Type 2 Diabetes (T2D), the mean ABSI gradually increased from 0.08333 to 0.08444 between 1999 and 2018. Following a median follow-up period of 90 months, 1,355 deaths (24.8% of the participants) occurred due to all causes. A left J-shaped association was observed between ABSI and all-cause mortality, with a 39% increased risk among US adults with T2D who had an ABSI below 0.08105 after full adjustment. CONCLUSION: Our research has demonstrated a significant association between an elevated ABSI and the risk of all-cause mortality among US adults with T2D. These findings support the potential use of ABSI as a noninvasive tool to estimate mortality risk among US adults with T2D. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40200-025-01570-3.