Independent association between the visceral adiposity index and microalbuminuria in patients with newly diagnosed type 2 diabetes

Association of visceral adipose tissue with albuminuria and interaction between visceral adiposity and diabetes on albuminuria

AIMS

To explore the correlation between visceral adipose tissue and albuminuria, and whether there is interaction between visceral adipose tissue and diabetes on albuminuria.

METHODS

The study subjects were adult subjects (age ≥ 18 years) from the National Health and Nutrition Examination Surveys (NHANES) database of the USA in 2017-2018. Visceral fat area (VFA) was measured by dual-energy X-ray absorptiometry (DXA). Subjects were divided into three groups according to VFA: low (VFA 0-60cm2), medium (VFA 60-120 cm2) and high (VFA ≥ 120 cm2). Albuminuria was defined as urinary albumin-to-creatinine ratio (UACR) ≥ 30 mg/g. The statistical analysis software used is STATA 17.0.

RESULTS

Data pertaining to 2965 participants (2706 without albuminuria) were included in the analysis. High VFA is an independent risk factor for albuminuria (OR 1.367, 95% CI 1.023-1.827). In the low-VFA group, there is no significant association between diabetes and albuminuria (OR 1.415, 95% CI 0.145-13.849). In the medium-VFA group, diabetes is an independent risk factor for albuminuria (OR 2.217, 95% CI 1.095-4.488). In the high-VFA group, diabetes is also an independent risk factor for albuminuria (OR 5.150, 95% CI 3.150-8.421). There is an additive interaction between high VFA (VFA ≥ 120 cm2) and diabetes on the effect of albuminuria (RERI 3.757, 95% CI 0.927-6.587, p = 0.009), while no multiplication interaction (OR 1.881, 95% CI 0.997-1.023, p = 0.141).

CONCLUSIONS

High VFA may represent an independent risk factor for albuminuria. The amount of visceral fat may affect the effect of diabetes on albuminuria. The higher the visceral fat, the stronger the correlation between diabetes and albuminuria should be present. We suppose an additive interaction between VFA and diabetes on the effect of albuminuria.

The association of visceral adiposity index with the risk of kidney stone and kidney stone recurrence

AIM

Our aim in this study was primarily to assess the relationship between visceral adiposity index (VAI) and the risk of kidney stones and kidney stone recurrence in US adults.

METHODS

We used data from the National Health and Nutrition Examination Survey (NHANES) 2007-2014 for our analysis. VAI was calculated from waist circumference (WC), body mass index (BMI), triglycerides (TG), and high-density lipoprotein-cholesterol (HDL-C). Kidney stones and recurrence of kidney stones were obtained from questionnaire interview data. We used multivariate logistic regression analysis to explore the correlation between VAI and the risk of kidney stone and kidney stone recurrence. In addition, we performed subgroup analysis, interaction tests, and restricted cubic spline (RCS) analysis.

RESULTS

A total of 9886 participants were included in this study, with a prevalence of 9.24% for kidney stones and 2.97% for recurrence of kidney stones. The prevalence of kidney stones and kidney stone recurrence increased with higher quartiles of VAI. We observed a significantly positive correlation between VAI and the risk of kidney stone and kidney stone recurrence. Participants with the highest VAI quartiles had a 48% (OR: 1.48, 95%CI: 1.08-2.02) and 52% (OR: 1.52, 95%CI: 0.86-2.71) increased risk of kidney stones and kidney stone recurrence, respectively, compared to participants with the lowest VAI quartiles. Subgroup analysis and interaction tests demonstrated this positive association independent of different subgroup factors.

CONCLUSION

Visceral fat accumulation may be associated with an increased risk of kidney stones and kidney stone recurrence.

The association between visceral adiposity index and decreased renal function: A population-based study

Aims

We aimed to investigate the association of visceral adiposity index (VAI) with decreased renal function in US adults.

Design and methods

Cross-sectional data were analyzed for 35,018 adults in the National Health and Nutrition Examination Survey (NHANES) 2005–2018. VAI was determined using waist circumference, body mass index (BMI), triglycerides (TGs) and high-density lipoprotein-cholesterol. Albuminuria was defined as urinary albumin-to-creatinine ratio (ACR) >30 mg/g. A low estimated-glomerular filtration rate (eGFR) was defined as an eGFR lower than 60 ml/min/1.73 m2. Chronic kidney disease (CKD) was defined as either albuminuria or low-eGFR. A multivariable logistic regression analysis was utilized to explore the relationship of VAI with albuminuria, low-eGFR and CKD. Subgroup analysis and interaction tests were also conducted.

Results

A total of 35,018 participants were enrolled with albuminuria, low-eGFR, and CKD prevalence rates of 5.18, 6.42, and 10.62%, respectively, which increased with the higher VAI tertiles. After full adjustment, a positive association of VAI with albuminuria (OR = 1.03, 95% CI: 1.00, 1.06) and CKD (OR = 1.04, 95% CI: 1.02, 1.06) was observed. Participants in the highest VAI tertile had a significantly 30% increased risk for albuminuria (OR = 1.30, 95% CI: 1.07, 1.58) and a 27% increased risk for CKD (OR = 1.27, 95% CI: 1.08, 1.49) compared with those in the lowest VAI tertile. No statistically significant association between VAI and low-eGFR was detected. Subgroup analysis and the interaction term indicated that there was no significant difference among different stratifications.

Conclusion

Visceral adiposity accumulation evaluating by VAI was associated with increased likelihood of the decline in renal function.

Associations between visceral adiposity index and incident nephropathy outcomes in diabetic patients: Insights from the ACCORD trial

AIMS

Visceral adiposity index (VAI) was a reliable marker for visceral adiposity accumulation and dysfunction. The association between VAI and nephropathy outcomes remains uncertain in patients with type 2 diabetes (T2DM). We aimed to evaluate the longitudinal relationships between VAI and incident nephropathy outcomes in T2DM patients.

MATERIALS AND METHODS

Ten thousand one hundred and thirty two participants with T2DM from the ACCORD trial were included in the present study. Cumulative average VAI based on VAI measurements at baseline and follow-up was used to represent long-term VAI status. The primary outcome was the incident composite nephropathy outcome defined as: (1) serum creatinine doubling or >20 ml/min decrease in eGFR; or (2) development of macro-albuminuria; or (3) renal failure or end stage kidney disease (dialysis) or serum creatinine >3.3 mg/dl.

RESULTS

During 26,168 person-years follow-up duration, 6094 (60.1%) participants developed the incident composite nephropathy outcome. When assessing cumulative average VAI as quartiles, compared with those in the 1-2 quartiles (<2.6), a significantly higher risk of incident composite nephropathy outcomes was observed among participants in the 3-4 quartiles (≥2.6, adjusted HR: 1.09, 95% CI: 1.01, 1.18). Moreover, the positive association was consistent in participants with or without single abnormal VAI components, including general obesity, abdominal obesity, elevated triglycerides, and low high-density lipoprotein cholesterol, or with different numbers of abnormal VAI components. Additionally, the positive association was stronger in participants with cumulative average systolic blood pressure <130 mmHg (vs. ≥130 mmHg; p-interaction < 0.001).

CONCLUSIONS

In T2DM patients, higher cumulative average VAI was associated with a higher risk of incident composite nephropathy outcomes.

CLINICAL TRIAL REGISTRATION

clinicaltrials.gov, identifier: NCT00000620.

Association Between Sleep Duration and Albuminuria in Patients with Type 2 Diabetes: A Cross-Sectional Study in Ningbo, China

PURPOSE

Type 2 diabetes mellitus (T2DM) can lead to microvascular complications including diabetic kidney disease. Albuminuria is an important marker to diagnose kidney injury in T2DM patients and healthy sleep duration is important for maintaining good health in patients with T2DM. However, the association between sleep duration and albuminuria in T2DM patients is unclear. Thus, this study aimed to investigate the association between sleep duration and albuminuria in patients with T2DM in Ningbo, China.

METHODS

A cross-sectional study was conducted at National Metabolic Management Centre (MMC) - Ningbo First Hospital from March 2018 to February 2021. Adult patients with T2DM were included in the study. The sleep duration (daytime and nocturnal) was self-reported. Albuminuria was defined as the presence of urinary albumin-creatinine ratio ≥30 mg/g. Logistic regression analyses were performed to identify the association.

RESULTS

There were 2688 T2DM patients in the study. In the unadjusted model (1), the odds of albuminuria increased with the daytime sleep duration (31-60 minutes: OR 1.36, 95% CI 1.09-1.71; ≥61 minutes: 1.73, 1.33-2.24). Similarly, after adjusting for age and sex (model 2), the odds of albuminuria increased with the daytime sleep duration (31-60 minutes: 1.34, 1.07-1.68; ≥61 minutes: 1.69, 1.30-2.20). After adjusting for age, sex, physical activity, smoking, alcohol drinking, overweight/obesity, hypertension, hyperuricaemia, duration of T2DM, glycated haemoglobin, angiotensin-converting enzyme inhibitors/angiotensin receptor blocker usage and nocturnal sleep duration (model 3), the odds of albuminuria increased with the daytime sleep duration (31-60 minutes: 1.33, 1.04-1.71; ≥61 minutes: 1.71, 1.29-2.26). However, no relationship was found between nocturnal sleep duration and albuminuria.

CONCLUSION

Longer daytime sleep is found to be associated with albuminuria in patients with T2DM in Ningbo, China but no association is found between nocturnal sleep duration and albuminuria. The findings are exploratory, and there is a need for longitudinal studies on this topic.

Visceral adiposity index is closely associated with urinary albumin-creatinine ratio in the Chinese population with prediabetes

AIMS

Visceral obesity is a major health issue and is a risk factor for an atherogenic state. Visceral obesity has been reported to be a crucial link between albuminuria and cardiovascular diseases (CVD). This study attempted to explore the association between visceral obesity and albuminuria in prediabetic individuals.

METHODS

This cross-sectional study included 24871 prediabetic participants over 40 years of age from seven centres across China (REACTION study). The visceral adiposity index (VAI) was determined based on the measurements of anthropometric indices and lipid parameters. Increased albuminuria was defined as a urinary albumin-creatinine ratio (UACR) ≥30 mg/g, indicating kidney damage. Propensity score matching was used to reduce bias, and a multiple logistic regression model was performed to evaluate the association between visceral obesity and albuminuria in the population with prediabetes.

RESULTS

Participants with increased UACR exhibited increased VAI, age, blood pressure, triglycerides, poor glycaemic control, CVD events, and decreased estimated glomerular filtration rate (eGFR). Multiple logistic regression analysis demonstrated that VAI quartiles were positively associated with an increased risk of albuminuria (Q2: odds rate [OR]: 1.10, 95% confidence intervals [CI] 0.96-1.25; Q3: OR: 1.16, 95% CI 1.01-1.32; Q4: OR: 1.26, 95% CI 1.10-1.44, p for trend = 0.001). Stratified analysis revealed that the association of VAI level with increased albuminuria risk also occurred in people who were young, women, overweight or obese, with poor control of blood pressure, and eGFR ≥90 ml/min per 1.73 m² .

CONCLUSIONS

Visceral obesity assessed by VAI is significantly associated with increased UACR in a Chinese population with prediabetes.

Association between organ damage and visceral adiposity index in community-dwelling elderly Chinese population: the Northern Shanghai Study

BACKGROUND

The visceral adiposity index (VAI) is a newly developing indicator about visceral fat function and insulin resistance. This research aims to assess the association between organ damage and VAI in the community-dwelling elderly Chinese population.

METHODS

In total, 3363 elderly participants were recruited between June 2014 and August 2019. VAI was used to measure visceral adipose accumulation, and organ damage was measured with standardized methods, including arterial stiffness, lower extremity atherosclerosis, carotid hypertrophy, left ventricular hypertrophy, micro-albuminuria, and chronic kidney disease.

RESULTS

According to multivariable linear regression analysis, VAI was related to carotid-femoral pulse wave velocity (cf-PWV; β = 0.047, P = 0.024), urine albumin to creatinine ratio (UACR; β = 3.893, P = 0.008), estimated glomerular filtration rate (eGFR; β =  - 0.526, P = 0.003) and log_e(ankle-to-brachial index) (ABI; β = -0.003, P = 0.024). Using multivariable stepwise logistic regression model, higher VAI was found to be significantly related to cf-PWV > 10 m/s (OR 1.44, [95% CI 1.17-1.78]; P_{for trend} < 0.001), and chronic kidney disease (CKD; OR 1.54, [95% CI 1.09-2.20]; P_{for trend} = 0.015).

CONCLUSIONS

Since higher VAI is related to increased risk of arterial stiffness and CKD, it may serve as a useful index for the assessment of arteriosclerosis and CKD in elderly population.

TRIAL REGISTRATION

NSS, NCT02368938.

Association of adiposity with diabetes: A national research among Chinese adults

BACKGROUND

Adiposity is an established risk factor for diabetes. The different measurements of adiposity for predicting diabetes have been compared in recent studies in Western countries. However, similar researches among Chinese adults are limited.

METHODS

Data were collected from a national survey conducted during September 2014 and May 2015 Among Chinese adults aged 40 years and older across 30 China's provinces. Multilevel model analysis was performed to examine the impacts of different obesity indices [body mass index (BMI), waist circumference (WC), lipid accumulation product index (LAP), visceral adiposity index (VAI), and body adiposity index (BAI)] on the risk of diabetes.

RESULTS

A total of 162 880 participants were included in this study. Of them, 54.47% were female. With an increase in BMI, WC, LAP, VAI, and BAI, the prevalence of diabetes significantly grew (P < 0.001). The multilevel model analysis showed that WC has the strongest impact on diabetes prevalence, while BAI was the weakest. For one SD increment in BMI, WC, LAP, VAI, and BAI, the prevalence of diabetes increased by 27.0% (Odds Ratio (OR) = 1.270, 95% Confidence interval (CI) = 1.251-1.289), 37.4% (OR = 1.374, 95% CI = 1.346-1.401), 28.1% (OR = 1.281, 95% CI = 1.266-1.297), 22.0% (OR = 1.220, 95% CI = 1.204-1.236), and 17.4% (OR = 1.174, 95% CI = 1.151-1.192), respectively.

CONCLUSION

Obesity indicators of BMI, WC, LAP, VAI, and BAI have significant positive relationships with the risk of diabetes. WC has the strongest impact on diabetes, while BAI has the weakest.

Chinese visceral adiposity index: A reliable indicator of visceral fat function associated with risk of type 2 diabetes

BACKGROUND

The evidence of the association between Chinese visceral adiposity index (CVAI) and risk of type 2 diabetes mellitus (T2DM) is limited. We explored the association of CVAI with T2DM and directly compared with the predictive power of CVAI with other visceral obesity indices (visceral adiposity index, waist to height ratio, waist circumference and body mass index) based on a large prospective study.

METHODS

We conducted a population-based study of 12 237 Chinese participants. Cox proportional-hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between CVAI and T2DM.

RESULTS

During follow-up (median: 6.01 years), the incidence of T2DM was 3.29, 7.34, 12.37 and 23.72 per 1000 person-years for quartiles 1, 2, 3 and 4 of CVAI, respectively. The risk of T2DM was increased with quartiles 2, 3 and 4 vs quartile 1 of CVAI (HR 2.12 [95% CI 1.50-3.00], 2.94 [2.10-4.13] and 5.01 [3.57-7.04], P_trend  < 0.001). Per-SD increase in CVAI was associated with a 72% increased risk of T2DM (HR 1.72 [95% CI 1.56-1.88]). Sensitivity analyses did not alter the association. The area under receiver operating characteristic curve was significantly higher for CVAI than other visceral obesity indices (all P <.001). Similar results were observed in stratified analyses by sex.

CONCLUSIONS

Our findings show a positive association between CVAI and risk of T2DM. CVAI has the best performance in predicting incident T2DM, so the index might be a reliable and applicable indicator identifying people at high risk of T2DM.

Association Between Neck Circumference and Microalbuminuria in Community Residents

OBJECTIVE

Neck circumference (NC) represents the subcutaneous fat deposition in the neck and is an effective indicator for evaluating metabolic disorders, such as metabolic syndrome, subclinical atherosclerosis, and non-alcoholic fatty liver disease. Microalbuminuria (MAU) is regarded as a potential sign of systemic endothelial dysfunction and microvascular abnormalities. The aim of this study was to elucidate the association of NC with urine albumin-to-creatinine ratio (UACR) and MAU.

METHODS

A total of 1882 Shanghai community residents were enrolled (816 men and 1066 women), with age ranging from 40 to 80 years. Anthropometric parameters, including NC, and biochemical indices were measured. MAU was determined if 30 mg/g ≤ UACR < 300 mg/g. An elevated NC was defined as NC ≥ 38.5 cm for men and NC ≥ 34.5 cm for women.

RESULTS

Individuals with an elevated NC had significantly higher prevalence of MAU and UACR values than those with normal NC in both men and women (all P < 0.05). The logistic regression analysis showed that there were significant and positive associations between elevated NC and the increasing risk of MAU after adjusting for lipid profile and glycemic indices (P = 0.007 for men and P = 0.009 for women). After further adjusting for blood pressure, elevated NC caused an 69.3% additional risk of MAU in men (P = 0.037) and the positive correlation in women disappeared (P = 0.131).

CONCLUSION

There was an independent and positive association between elevated NC and the risk of MAU in men in the Chinese community population.

CHINESE CLINICAL TRIAL REGISTRY WWWCHICTRORGCN REGISTRATION NUMBER

ChiCTR1900024011.