Abstract
Obesity impacts skeletal health. A Body Shape Index (ABSI), a novel obesity metric based on epidemiological data, offers advantages over traditional measures such as body mass index and waist circumference. This study investigates the association between ABSI and total bone mineral density (BMD) in American adults. Comprehensive data on ABSI and total BMD from 2011 to 2018 were sourced from the National Health and Nutrition Examination Survey. ABSI is calculated as waist circumference/(body mass index^(2/3) × height^0.5). The study employed multivariate linear regression and smoothing spline fitting to examine the association between ABSI and total BMD. Additionally, subgroup analyses and interaction tests were performed. In a multivariate regression analysis of 9952 adults aged 20 to 59, ABSI showed a significant negative association with total BMD. In the fully adjusted model (Model 3), each 1-unit increase in ABSI corresponded to a decrease of 3.797 units in total BMD (β = -3.797, 95% confidence interval [CI]: -4.665 to -2.929, P < .0001). When categorized into quartiles, the highest ABSI quartile had 0.044 lower total BMD compared to the lowest (β = -0.044, 95% CI: -0.054 to -0.034, P for trend < .0001). Significant interactions were found with gender, race, and hypertension status (P < .05). Men showed a stronger negative correlation (β = -5.909, 95% CI: -6.695 to -5.124) compared to women (β = -2.780, 95 % CI: -3.411 to -2.149), and the correlation was also more pronounced in non-hypertensive individuals (β = -4.551, 95% CI: -5.197 to -3.905) compared to those with hypertension (β = -2.863, 95% CI: -3.610 to -2.116). The research indicates a significant negative association between ABSI and total BMD in American adults between 20 and 59 years old.