J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Original Article

Volume 16, Number 2-3, March 2024, pages 81-93

The Association Between Lean-to-Fat Mass Ratio and Cardiometabolic Abnormalities: An Analytical Cross-Sectional Study

Figure 2. Lean-to-fat mass ratio (kg/kg) according to sex and age group (a). Lean-to-fat mass ratio (kg/kg) according to sex and age group, stratified by tertiles of the ratio are shown in (b) for women and (c) for men.

Figure 3. The proportion of cardiometabolic abnormalities according to lean-to-fat mass ratio tertiles by sex. Cardiometabolic abnormality was defined as a clustering of abnormalities that comprise hypertriglyceridemia, dysglycemia, altered blood pressure, low HDL-cholesterol, insulin resistance, and high C-reactive protein. The Chi-squared test for independence was performed for bivariate analysis between the number of cardiometabolic abnormalities and lean-to-fat mass ratio tertiles by sex (P < 0.001). HDL: high-density lipoprotein.

**Table 1.** Sample Characteristics According to Cardiometabolic Abnormalities Presence
Characteristics	Total (n = 959)	Cardiometabolic abnormalities	P^a
^aAnalysis was performed with the Chi-square test for independence. ^bAnalysis was performed with Fisher’s exact test. ^cMedian (interquartile ranges). ^dAnalysis was performed with the Mann-Whitney test. *The significative P value (P < 0.05). BMI: body mass index.
Sex				< 0.001*
Female	510 (53.18)	217 (42.55)	293 (57.45)
Male	449 (46.82)	253 (56.55)	196 (43.65)
Age				< 0.001*
30 to 44 years	421 (43.9)	259 (61.52)	162 (38.48)
45 to 59 years	395 (41.19)	161 (40.76)	234 (59.24)
60 or older	143 (14.91)	50 (34.97)	93 (65.03)
Migration status				< 0.001*
Rural	189 (19.71)	118 (62.43)	71 (37.57)
Migrant	574 (59.85)	274 (47.74)	300 (52.26)
Urban	196 (20.44)	78 (39.80)	118 (60.20)
Current smoker				0.300
No	851 (88.74)	412 (48.41)	439 (51.59)
Yes	108 (11.26)	58 (53.70)	50 (56.30)
Alcohol intake				0.034*
Low	874 (91.14)	419 (47.94)	455 (52.06)
High	85 (8.86)	51 (60.00)	34 (40.00)
Physical activity level				0.001*
Low	249 (25.96)	106 (42.57)	143 (57.43)
Moderate	282 (29.41)	126 (44.68)	156 (55.32)
High	428 (44.63)	238 (55.61)	190 (44.39)
Educational level				0.020*
None/incomplete primary	312 (32.53)	133 (42.63)	179 (57.57)
Complete primary	148 (15.43)	80 (54.05)	68 (45.95)
Secondary	499 (52.03)	257 (51.50)	242 (48.50)
Socioeconomic status				0.099
Low	329 (34.91)	176 (53.5)	153 (46.5)
Medium	324 (33.79)	156 (48.15)	168 (51.85)
High	306 (31.91)	138 (45.10)	168 (54.90)
Hypertensive medication				0.003*
No	923 (96.25)	461 (49.95)	462 (50.05)
Yes	36 (3.75)	9 (25.00)	27 (75.00)
Blood glucose medication				0.002^b
No	950 (99.06)	470 (49.47)	480 (50.53)
Yes	9 (0.94)	0 (0.00)	9 (100.00)
BMI categories				< 0.001*
Normal	393 (40.98)	253 (64.38)	140 (35.62)
Overweight	373 (38.89)	185 (49.60)	188 (50.40)
Obesity	193 (30.12)	32 (16.58)	161 (83.42)
Lean-to-fat mass ratio (tertiles)				< 0.001*
Lowest	322 (33.58)	84 (26.09)	238 (73.91)
Middle	325 (33.89)	164 (50.46)	161 (49.54)
Highest	312 (33.53)	222 (71.15)	90 (28.85)
Lean mass index (kg/m²)^c	17.00 (15.33 - 18.45)	16.83 (15.11 - 18.24)	17.1 (15.63 - 18.79)	0.002^d
Fat mass index (kg/m²)^c	8.55 (6.32 - 1.30)	7.40 (5.38 - 9.64)	9.82 (7.37 - 13.01)	< 0.001^d
Lean-to-fat mass ratio^c	1.86 (1.40 - 2.84)	2.26 (1.56 - 3.33)	1.59 (1.27 - 2.45)	< 0.001^d

Table 1. Sample Characteristics According to Cardiometabolic Abnormalities Presence

Characteristics

Total (n = 959)

Cardiometabolic abnormalities

P^a

No (n = 470), n (%)

Yes (n = 489), n (%)

^aAnalysis was performed with the Chi-square test for independence. ^bAnalysis was performed with Fisher’s exact test. ^cMedian (interquartile ranges). ^dAnalysis was performed with the Mann-Whitney test. *The significative P value (P < 0.05). BMI: body mass index.

Sex

< 0.001*

Female

510 (53.18)

217 (42.55)

293 (57.45)

Male

449 (46.82)

253 (56.55)

196 (43.65)

Age

< 0.001*

30 to 44 years

421 (43.9)

259 (61.52)

162 (38.48)

45 to 59 years

395 (41.19)

161 (40.76)

234 (59.24)

60 or older

143 (14.91)

50 (34.97)

93 (65.03)

Migration status

< 0.001*

Rural

189 (19.71)

118 (62.43)

71 (37.57)

Migrant

574 (59.85)

274 (47.74)

300 (52.26)

Urban

196 (20.44)

78 (39.80)

118 (60.20)

Current smoker

0.300

851 (88.74)

412 (48.41)

439 (51.59)

Yes

108 (11.26)

58 (53.70)

50 (56.30)

Alcohol intake

0.034*

Low

874 (91.14)

419 (47.94)

455 (52.06)

High

85 (8.86)

51 (60.00)

34 (40.00)

Physical activity level

0.001*

Low

249 (25.96)

106 (42.57)

143 (57.43)

Moderate

282 (29.41)

126 (44.68)

156 (55.32)

High

428 (44.63)

238 (55.61)

190 (44.39)

Educational level

0.020*

None/incomplete primary

312 (32.53)

133 (42.63)

179 (57.57)

Complete primary

148 (15.43)

80 (54.05)

68 (45.95)

Secondary

499 (52.03)

257 (51.50)

242 (48.50)

Socioeconomic status

0.099

Low

329 (34.91)

176 (53.5)

153 (46.5)

Medium

324 (33.79)

156 (48.15)

168 (51.85)

High

306 (31.91)

138 (45.10)

168 (54.90)

Hypertensive medication

0.003*

923 (96.25)

461 (49.95)

462 (50.05)

Yes

36 (3.75)

9 (25.00)

27 (75.00)

Blood glucose medication

0.002^b

950 (99.06)

470 (49.47)

480 (50.53)

Yes

9 (0.94)

0 (0.00)

9 (100.00)

BMI categories

< 0.001*

Normal

393 (40.98)

253 (64.38)

140 (35.62)

Overweight

373 (38.89)

185 (49.60)

188 (50.40)

Obesity

193 (30.12)

32 (16.58)

161 (83.42)

Lean-to-fat mass ratio (tertiles)

< 0.001*

Lowest

322 (33.58)

84 (26.09)

238 (73.91)

Middle

325 (33.89)

164 (50.46)

161 (49.54)

Highest

312 (33.53)

222 (71.15)

90 (28.85)

Lean mass index (kg/m²)^c

17.00 (15.33 - 18.45)

16.83 (15.11 - 18.24)

17.1 (15.63 - 18.79)

0.002^d

Fat mass index (kg/m²)^c

8.55 (6.32 - 1.30)

7.40 (5.38 - 9.64)

9.82 (7.37 - 13.01)

< 0.001^d

Lean-to-fat mass ratio^c

1.86 (1.40 - 2.84)

2.26 (1.56 - 3.33)

1.59 (1.27 - 2.45)

< 0.001^d

**Table 2.** Crude and Adjusted Regression Analysis for the Association of the Lean-to-Fat Mass Ratio and Cardiometabolic Abnormalities, Stratified by Sex and Age
Lean-to-fat mass ratio	Female (n = 510)	Male (n = 449)
^aAdjusted by migration status, smoking, alcohol intake, physical activity level, educational level, and socioeconomic status. ^bAdjusted by the same covariables in model 1 plus overweight/obesity presence and abdominal obesity presence (men ≥ 90 cm, women ≥ 80 cm). ^cAdjusted by the same covariables in model 2 plus hypertension and blood glucose medication. *The significative P value (P < 0.05). PR: prevalence ratio; CI: confidence interval.
Crude model	Lowest	Reference			Reference
	Middle	0.58 (0.43 - 0.77)*	0.75 (0.61 - 0.92)*	0.62 (0.44 - 0.87)*	0.52 (0.36 - 0.76)*	0.77 (0.55 - 1.07)	1.02 (0.71 - 1.45)
	Highest	0.24 (0.15 - 0.38)*	0.64 (0.49 - 0.82)*	0.60 (0.39 - 0.89)*	0.22 (0.13 - 0.38)*	0.44 (0.25 - 0.76)*	0.59 (0.33 - 1.07)
Adjusted model 1^a	Lowest	Reference			Reference
	Middle	0.57 (0.42 - 0.78)*	0.74 (0.60 - 0.92)*	0.61 (0.41 - 0.88)*	0.50 (0.33 - 0.74)*	0.77 (0.54 - 1.08)	1.02 (0.73 - 1.42)
	Highest	0.22 (0.14 - 0.35)*	0.68 (0.50 - 0.92)*	0.55 (0.35 - 0.84)*	0.21 (0.11 - 0.37)*	0.44 (0.25 - 0.78)*	0.69 (0.35 - 1.33)
Adjusted model 2^b	Lowest	Reference			Reference
	Middle	0.58 (0.43 - 0.79)*	0.73 (0.57 - 0.92)*	0.49 (0.28 - 0.88)*	0.59 (0.32 - 1.12)	0.62 (0.33 - 1.19)	1.33 (0.69 - 2.54)
	Highest	0.13 (0.02 - 0.86)*	0.60 (0.35 - 1.03)	0.38 (0.17 - 0.84)*	0.25 (0.09 - 0.69)*	0.34 (0.14 - 0.82)*	0.92 (0.31 - 2.66)
Adjusted model 3^c	Lowest	Reference			Reference
	Middle	0.58 (0.42 - 0.80)*	0.73 (0.57 - 0.92)*	0.45 (0.25 - 0.82)*	0.60 (0.31 - 1.17)	0.62 (0.32 - 1.18)	1.41 (0.74 - 2.70)
	Highest	0.13 (0.02 - 0.87)*	0.60 (0.36 - 1.00)	0.36 (0.17 - 0.80)*	0.26 (0.09 - 0.72)*	0.33 (0.14 - 0.81)*	0.99 (0.33 - 3.00)

Table 2. Crude and Adjusted Regression Analysis for the Association of the Lean-to-Fat Mass Ratio and Cardiometabolic Abnormalities, Stratified by Sex and Age

Lean-to-fat mass ratio

Female (n = 510)

Male (n = 449)

30 - 44 years (n = 224)

45 - 59 years (n = 211)

60 or older (n = 75)

30 - 44 years (n = 197)

45 - 59 years (n = 184)

60 or older (n = 68)

PR (95% CI)

^aAdjusted by migration status, smoking, alcohol intake, physical activity level, educational level, and socioeconomic status. ^bAdjusted by the same covariables in model 1 plus overweight/obesity presence and abdominal obesity presence (men ≥ 90 cm, women ≥ 80 cm). ^cAdjusted by the same covariables in model 2 plus hypertension and blood glucose medication. *The significative P value (P < 0.05). PR: prevalence ratio; CI: confidence interval.

Crude model

Lowest

Reference

Middle

0.58 (0.43 - 0.77)*

0.75 (0.61 - 0.92)*

0.62 (0.44 - 0.87)*

0.52 (0.36 - 0.76)*

0.77 (0.55 - 1.07)

1.02 (0.71 - 1.45)

Highest

0.24 (0.15 - 0.38)*

0.64 (0.49 - 0.82)*

0.60 (0.39 - 0.89)*

0.22 (0.13 - 0.38)*

0.44 (0.25 - 0.76)*

0.59 (0.33 - 1.07)

Adjusted model 1^a

Lowest

Reference

Middle

0.57 (0.42 - 0.78)*

0.74 (0.60 - 0.92)*

0.61 (0.41 - 0.88)*

0.50 (0.33 - 0.74)*

0.77 (0.54 - 1.08)

1.02 (0.73 - 1.42)

Highest

0.22 (0.14 - 0.35)*

0.68 (0.50 - 0.92)*

0.55 (0.35 - 0.84)*

0.21 (0.11 - 0.37)*

0.44 (0.25 - 0.78)*

0.69 (0.35 - 1.33)

Adjusted model 2^b

Lowest

Reference

Middle

0.58 (0.43 - 0.79)*

0.73 (0.57 - 0.92)*

0.49 (0.28 - 0.88)*

0.59 (0.32 - 1.12)

0.62 (0.33 - 1.19)

1.33 (0.69 - 2.54)

Highest

0.13 (0.02 - 0.86)*

0.60 (0.35 - 1.03)

0.38 (0.17 - 0.84)*

0.25 (0.09 - 0.69)*

0.34 (0.14 - 0.82)*

0.92 (0.31 - 2.66)

Adjusted model 3^c

Lowest

Reference

Middle

0.58 (0.42 - 0.80)*

0.73 (0.57 - 0.92)*

0.45 (0.25 - 0.82)*

0.60 (0.31 - 1.17)

0.62 (0.32 - 1.18)

1.41 (0.74 - 2.70)

Highest

0.13 (0.02 - 0.87)*

0.60 (0.36 - 1.00)

0.36 (0.17 - 0.80)*

0.26 (0.09 - 0.72)*

0.33 (0.14 - 0.81)*

0.99 (0.33 - 3.00)

**Table 3.** Crude and Adjusted Regression Analysis for the Association of the Lean Mass Index and Cardiometabolic Abnormalities, Stratified by Sex and Age
Lean mass index	Cardiometabolic abnormalities
^aAdjusted by migration status, smoking, alcohol intake, physical activity level, educational level, and socioeconomic status. ^bAdjusted by the same covariables in model 1 plus hypertension and blood glucose medication. *The significative P value (P < 0.05). PR: prevalence ratio; CI: confidence interval.
Crude Model	Lowest	Reference			Reference
	Middle	1.72 (0.94 - 3.16)	1.17 (0.88 - 1.55)	1.19 (0.82 - 1.74)	1.25 (0.67 - 2.33)	1.53 (0.98 - 2.37)	1.52 (0.92 - 2.49)
	Highest	3.68 (2.12 - 6.41)*	1.53 (1.21 - 1.93)*	1.4 (0.99 - 1.96)	2.35 (1.36 - 4.06)*	1.65 (1.07 - 2.5)*	1.97 (1.29 - 3.00)*
Adjusted Model 1^a	Lowest	Reference			Reference
	Middle	1.88 (1.04 - 3.40)*	1.10 (0.81 - 1.50)	1.18 (0.79 - 1.76)	1.22 (0.65 - 2.30)	1.48 (0.95 - 2.31)	1.45 (0.88 - 2.38)
	Highest	4.03 (2.36 - 6.90)*	1.43 (1.08 - 1.88)*	1.51 (1.05 - 2.15)*	2.22 (1.27 - 3.86)*	1.48 (0.95 - 2.29)	1.81 (1.14 - 2.86)*
Adjusted Model 2^b	Lowest	Reference			Reference
	Middle	1.84 (1.01 - 3.35)*	1.08 (0.80 - 1.47)	1.18 (0.79 - 1.75)	1.19 (0.63 - 2.25)	1.48 (0.95 - 2.31)	1.51 (0.89 - 2.53)
	Highest	4.05 (2.36 - 6.94)*	1.43 (1.09 - 1.87)*	1.56 (1.10 - 2.24)*	2.17 (1.24 - 3.80)*	1.46 (0.93 - 2.28)	1.80 (1.15 - 2.83)*

Table 3. Crude and Adjusted Regression Analysis for the Association of the Lean Mass Index and Cardiometabolic Abnormalities, Stratified by Sex and Age

Lean mass index

Cardiometabolic abnormalities

Female (n = 510)

Male (n = 449)

30 - 44 years (n = 224)

45 - 59 years (n = 211)

60 or older (n = 75)

30 - 44 years (n = 197)

45 - 59 years (n = 184)

60 or older (n = 68)

PR (95% CI)

Crude Model

Lowest

Reference

Middle

1.72 (0.94 - 3.16)

1.17 (0.88 - 1.55)

1.19 (0.82 - 1.74)

1.25 (0.67 - 2.33)

1.53 (0.98 - 2.37)

1.52 (0.92 - 2.49)

Highest

3.68 (2.12 - 6.41)*

1.53 (1.21 - 1.93)*

1.4 (0.99 - 1.96)

2.35 (1.36 - 4.06)*

1.65 (1.07 - 2.5)*

1.97 (1.29 - 3.00)*

Adjusted Model 1^a

Lowest

Reference

Middle

1.88 (1.04 - 3.40)*

1.10 (0.81 - 1.50)

1.18 (0.79 - 1.76)

1.22 (0.65 - 2.30)

1.48 (0.95 - 2.31)

1.45 (0.88 - 2.38)

Highest

4.03 (2.36 - 6.90)*

1.43 (1.08 - 1.88)*

1.51 (1.05 - 2.15)*

2.22 (1.27 - 3.86)*

1.48 (0.95 - 2.29)

1.81 (1.14 - 2.86)*

Adjusted Model 2^b

Lowest

Reference

Middle

1.84 (1.01 - 3.35)*

1.08 (0.80 - 1.47)

1.18 (0.79 - 1.75)

1.19 (0.63 - 2.25)

1.48 (0.95 - 2.31)

1.51 (0.89 - 2.53)

Highest

4.05 (2.36 - 6.94)*

1.43 (1.09 - 1.87)*

1.56 (1.10 - 2.24)*

2.17 (1.24 - 3.80)*

1.46 (0.93 - 2.28)

1.80 (1.15 - 2.83)*

**Table 4.** Crude and Adjusted Regression Analysis for the Association of the Fat Mass Index and Cardiometabolic Abnormalities, Stratified by Sex and Age
Fat mass index	Cardiometabolic abnormalities
^aAdjusted by migration status, smoking, alcohol intake, physical activity level, educational level, and socioeconomic status. ^bAdjusted by the same covariables in model 1 plus hypertension and blood glucose medication. *The significative P value (P < 0.05). PR: prevalence ratio; CI: confidence interval.
Crude model	Lowest	Reference			Reference
	Middle	2.19 (1.30 - 3.70)*	1.14 (0.85 - 1.52)	0.82 (0.49 - 1.35)	2.16 (1.15 - 4.05)*	1.27 (0.76 - 2.13)	1.68 (1.00 - 2.82)
	Highest	3.71 (2.29 - 6.03)*	1.55 (1.21 - 1.97)*	1.47 (1.07 - 2.02)*	4.47 (2.57 - 7.78)*	1.83 (1.15 - 2.90)*	1.56 (0.92 - 2.64)
Adjusted model 1^a	Lowest	Reference			Reference
	Middle	2.33 (1.40 - 3.89)*	1.06 (0.76 - 1.47)	0.79 (0.48 - 1.29)	2.17 (1.09 - 4.30)*	1.20 (0.70 - 2.08)	1.49 (0.88 - 2.54)
	Highest	3.92 (2.42 - 6.35)*	1.43 (1.08 - 1.91)*	1.50 (1.04 - 2.18)*	4.85 (2.53 - 9.28)*	1.64 (1.00 - 2.69)	1.39 (0.80 - 2.41)
Adjusted model 2^b	Lowest	Reference			Reference
	Middle	2.30 (1.38 - 3.85)*	1.05 (0.77 - 1.45)	0.76 (0.46 - 1.25)	2.15 (1.09 - 4.26)*	1.18 (0.68 - 2.06)	1.54 (0.91 - 2.64)
	Highest	3.94 (2.43 - 6.40)*	1.44 (1.09 - 1.91)*	1.56 (1.07 - 2.28)*	4.76 (2.48 - 9.14)*	1.64 (0.98 - 2.72)	1.40 (0.82 - 2.42)

Table 4. Crude and Adjusted Regression Analysis for the Association of the Fat Mass Index and Cardiometabolic Abnormalities, Stratified by Sex and Age

Fat mass index

Cardiometabolic abnormalities

Female (n = 510)

Male (n = 449)

30 - 44 years (n = 224)

45 - 59 years (n = 211)

60 or older (n = 75)

30 - 44 years (n = 197)

45 - 59 years (n = 184)

60 or older (n = 68)

PR (95% CI)

Crude model

Lowest

Reference

Middle

2.19 (1.30 - 3.70)*

1.14 (0.85 - 1.52)

0.82 (0.49 - 1.35)

2.16 (1.15 - 4.05)*

1.27 (0.76 - 2.13)

1.68 (1.00 - 2.82)

Highest

3.71 (2.29 - 6.03)*

1.55 (1.21 - 1.97)*

1.47 (1.07 - 2.02)*

4.47 (2.57 - 7.78)*

1.83 (1.15 - 2.90)*

1.56 (0.92 - 2.64)

Adjusted model 1^a

Lowest

Reference

Middle

2.33 (1.40 - 3.89)*

1.06 (0.76 - 1.47)

0.79 (0.48 - 1.29)

2.17 (1.09 - 4.30)*

1.20 (0.70 - 2.08)

1.49 (0.88 - 2.54)

Highest

3.92 (2.42 - 6.35)*

1.43 (1.08 - 1.91)*

1.50 (1.04 - 2.18)*

4.85 (2.53 - 9.28)*

1.64 (1.00 - 2.69)

1.39 (0.80 - 2.41)

Adjusted model 2^b

Lowest

Reference

Middle

2.30 (1.38 - 3.85)*

1.05 (0.77 - 1.45)

0.76 (0.46 - 1.25)

2.15 (1.09 - 4.26)*

1.18 (0.68 - 2.06)

1.54 (0.91 - 2.64)

Highest

3.94 (2.43 - 6.40)*

1.44 (1.09 - 1.91)*

1.56 (1.07 - 2.28)*

4.76 (2.48 - 9.14)*

1.64 (0.98 - 2.72)

1.40 (0.82 - 2.42)