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Life sciences · Journal article
BMC Cardiovascular Disorders · November 5, 2026
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This study aimed to comparatively evaluate the associations of body mass index (BMI) and central/visceral adiposity indicators with heart rate variability (HRV) as an early marker of cardiometabolic risk and autonomic dysfunction in overweight/obese individuals. This retrospective cross-sectional study included 200 overweight and obese females. Resting autonomic functions (SDNN, RMSSD, LF/HF) were evaluated using a Polar H10 sensor under spontaneous breathing. Body composition and visceral adiposity were assessed via bioelectrical impedance analysis and anthropometric indices, including waist-to-height ratio (WHtR) and A Body Shape Index (ABSI).Age-adjusted associations and sample-specific exploratory thresholds for depressed HRV were determined by linear regression and Receiver Operating Characteristic (ROC) curve analyses. Among the evaluated indices, the highest numerical negative correlation was observed between Visceral Fat Score and SDNN ( r =-0.453, p < 0.001) and RMSSD ( r =-0.397, p < 0.001). In age-adjusted regression models, a 1-unit increase in Visceral Fat Score showed an age-adjusted association with a decrease in SDNN of 0.899 ms ( p = 0.001). Both WHtR ( p = 0.016) and BMI ( p = 0.004) remained significantly associated with reduced SDNN in age-adjusted models, with comparable model performance and only marginal numerical differences in effect sizes. No significant age-adjusted association of ABSI with autonomic impairment was observed, however. ROC analysis established a Visceral Fat Score > 11.5 and WHtR > 0.745 as preliminary statistical cut-offs for identifying the low HRV group within this specific cohort. Regional fat distribution indices, specifically visceral adiposity and WHtR, demonstrate significant age-adjusted associations with early cardiac autonomic dysfunction, showing comparable model performance with only marginally higher numerical effect sizes relative to BMI. However, given the potential for residual confounding by unmeasured metabolic, menopausal, and lifestyle factors, these strictly sample-specific exploratory findings require prospective external validation before any clinical consideration. Not applicable.